WASHINGTON — Even without a presidential winner, one thing is already certain: The 2020 election results were a disaster for public health.
Results from Tuesday and early Wednesday underscore just how many Americans agree with a president who has called the nation’s top scientists “idiots,” openly mocked mask-wearing, and has insisted states must be “liberated” from lockdowns. No matter who wins the presidency, more than 67 million Americans already seem to have sided with Trump on public health. In preliminary exit polls, just 14% of Republican voters surveyed said the coronavirus pandemic was the deciding factor in who they voted for, despite the fact that the virus has killed more than 233,000 Americans and is spreading unabated across the nation.
That leaves public health officials to grapple with hard, existential questions: How can they forge new relationships with this huge swath of the country as the pandemic continues to unfold? Where does the public health field go from here?
“Even if Trump does not win, much of the population will have voted for him, so that still seems like a big wake-up call!” said Heidi Tworek, an associate professor at the University of British Columbia, who has studied the successes of various countries in getting their populations to comply with Covid-19 mitigation measures.
“We’re going to have to do some serious soul searching,” said Georges Benjamin, the executive director of the American Public Health Association, who insisted that public health officials don’t deserve the blame for the political backlash to their message, but can “play a big role in making sure that we come up with ways to deal with this in the future.”
Public health measures and guidance are not ideological in nature; nor is the response to them a monolith. But polling shows that Democrats, broadly, tend to favor a more robust public health response to the pandemic while Republicans have tended to oppose such measures.
Scientists, epidemiologists, and public health experts who spoke with STAT were divided about the future of public health. Most insisted there were straightforward, albeit challenging, ways to win over the people who have, until now, disavowed public health measures and who seemed to have voted against a more stringent public health response on Tuesday.
But at least one expert said the cause was hopeless.
“If there was a way to fix it, we would have done it,” said Holden Thorp, the editor-in-chief of Science and its family of other journals. “Science was on the ballot and this means that a significant portion of America doesn’t want science. … Science is now something for a subset of America.”
For Lindsey Leininger, a public health educator and clinical professor at Dartmouth College, winning more people over to the side of science is an existential imperative. Failing is “simply unacceptable.” For her, the first step is simple: acknowledging the problem.
“We have a huge gaping hole in our cultural intelligence and I think that that is really important for us to recognize and embrace,” she said. “We need to know that this is a blind spot, and we need to partner with people who believe in the science and have credibility in conservative circles.”
Others suggested that strikingly simple tactics — like listening to skeptics thoughtfully, like asking them to help brainstorm solutions — would also make major inroads.
“The approach often used is, ‘We just need to tell people who have those beliefs that they’re wrong.’ Maybe not that directly, but in other ways. Maybe what we need to do is invest in listening to their concerns, and understanding their perspectives, before we start giving them our messages,” said Glen Nowak, a longtime communicator at the Centers for Disease Control and Prevention who now heads the University of Georgia’s Center for Health and Risk Communication.
APHA’s Benjamin said similar. “Take it seriously. … Sit down and talk to folks and say: Hey, we want to stop the spread of this disease, what are your ideas?”
Krutika Kuppalli, a physician and professor at the Medical University of South Carolina, suggested doing in-person community outreach to make reluctant communities “feel empowered.”
Gregg Gonsalves, an assistant professor at Yale School of Public Health, added a caveat: target that engagement to those who seem willing to listen.
“You give people the benefit of the doubt as long as you can,” he said. “You see where you can engage … you don’t waste your time on the trolls or the ones who see public health as a punching bag for a larger political debate.”
There are reasons for hope for public health. Officials, for example, successfully helped quell the West Africa Ebola outbreak partially through door-to-door outreach. Taiwan, which publicly struggled to contain the 2003 SARS outbreak when its citizens resisted public health measures like quarantines, is now considered one of the best countries in terms of its response to the Covid-19 pandemic.
“Our fate really is in our hands … it is wholly possible to reform your system,” said the University of British Columbia’s Tworek, who studied the Taiwan example. “It’s an extraordinary difficult challenge, but that doesn’t mean that we should be nihilistic, give up, and do nothing.”
But knocking on doors and taking the time to make outreach to reluctant Americans could be harder if the public health workforce continues to dwindle — as several predicted it might after Tuesday’s election.
“We’ve been working on this pandemic for 10 months. … We are already exhausted, we are already overwhelmed, you are asking us to put our lives on the line,” said the Medical University of South Carolina’s Kuppalli, who noted she has colleagues who are already putting application packets together to work overseas.
“We could have what we call a brain drain in the United States,” she added.
As of August, at least 49 state and local public health officials around the country have left their post, according to an investigation by Kaiser Health News and the Associated Press. And that count does not include infectious disease doctors working in hospitals or academics working in universities.
Yale’s Gonsalves, insists, however that many people are not “cutting and running.”
“This is what we were made for. This is a pandemic, this is our challenge, this is our calling, this is our mission,” said Gonsalves. “We do what we do: Doctors don’t give up on patients and we don’t give up on the public health.”
“If scientists shut up, there’s no countervailing weight to the crackpot theories and charlatanism,” he added.