Physician Brendan Phibbs, who wrote “The Other Side of Time: A Combat Surgeon in World War II,” said, “It is a merciful God that doesn’t let us see the future.”
But we all have dreams for that future, and so we went into public health knowing it was not a great approach to riches, and we also knew it was not likely we would ever be thanked. People don’t thank us for something they did not know they were destined to encounter. So we must be secure in the knowledge that what we are doing has a beneficial impact. It became clear when smallpox disappeared with the strategic use of vaccine. It became clear that measles transmission was stopped in this country because of a deliberate strategy using vaccines, plus surveillance and all of the tools of public health. The majority of the increase in longevity in this country through the 20th century was due to public health, the stealth ingredient of health improvement.
But our view of the future did not include a vision that people would hunt us down with some of the most powerful guns developed for use in war. And we ask, “Why?”
During the Covid-19 crisis, public health practices were overturned. The usual approach was for a federal recommendation to states, counties, cities, and tribes that could be modified to fit local situations. The federal plans typically included getting vaccines and expertise to the field as needed. At the request of states, federal employees would be assigned to the states with supervision coming from the state. Public health people did not worry about the lack of federal authority to enter the state to help. These were people of quality, serving the public good and they could be trusted. The relationship between CDC and the states was so close that a phone call would usually lead to an invitation from the state. I worked on both sides of that agreement, in the state of Colorado and at CDC. It worked.
With Covid, the Trump White House gave a different message. The president told the states to develop their own plans and compete for resources. Chaos was the result.
In May 2020, when we thought the public health damage had reached its limits, the president withdrew from the World Health Organization, a decision so thoughtless that no one had a ready response.
The National Academy of Medicine developed a plan for vaccine distribution when supplies were limited. I was in my 80s but could isolate at home, so a healthy 30-year-old who was required to interface with the public could have been higher on the priority list under the NAM framework. That would have been the right move. Instead, the White House decided everyone 65 and over was a priority, making logical distribution more difficult. Their idea of sound practice was to hire a Stanford professor with no public health experience, Scott Atlas, who promoted the idea of letting low risk individuals get Covid to provide herd immunity.
We thought public health was on a path toward healing when suddenly, in his second term, President Trump acquired the peculiar expertise of health secretary Robert F. Kennedy Jr. He promotes raw milk, which can transmit pathogens; promotes the rotting of children’s teeth; and despite exhaustive testing that has shown vaccines don’t cause autism, clings to that belief for reasons that defy understanding.
One would think Kennedy’s track record of nonsense would win no followers, yet there are people willing to accept drivel from those in positions of authority. Kennedy would be less hazardous if he decided to do cardiac surgery. Then he would kill people only one at a time rather than his current ability to kill by the thousands. Why is it that killing a single person is seen as murder but killing masses is excused if you are a politician?
Despite this environment, those working in public health must continue to keep the objectives of their profession in mind: prevent premature death, reduce unnecessary suffering, and improve the quality of life for everyone.
We need to define the challenges faced. We have always been challenged by nature with organisms, droughts, malnutrition, and climate change. We have also been challenged by human foibles with addictions to alcohol, tobacco, violence, and power discrepancies. Now we have special challenges because of those who hold power but have no concept of public health responsibilities.
But we can face these new challenges with our traditional threefold approach.
First, try to get the science right. Thomas Henry Huxley, the famous 19th century biologist, described science as “common sense at its best.” Science is not the same as truth, but it is our best avenue to seek the truth.
Second, add art to create “creative common sense at its best.”
And third, add the moral compass that Roger Bacon called for 800 years ago. The pope asked for a summary of science, and Bacon warned him that science has no inherent moral compass. Therefore, it needs scientists with a moral compass. When that is done, we have the ability to strive for “moral common sense at its best.”
We will live through this drought of values, principles, and facts and again apply our talents to improving global health and happiness. Do not back down.
In the meantime, be clear. Kennedy’s words can be as lethal as the smallpox virus. Americans deserve better.
William Foege, M.D., served as director of the Centers for Disease Control and Prevention, founder of the Task Force for Global Health, and executive director of the Carter Center and was instrumental in the eradication of smallpox.
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