THE COMING DISASTER
The war on Public Health is weakening and endangering our country
By Jonathan Fielding, Peter Katona, and Seth Freeman
Public health saved us even before the American colonies had won their independence from England and become the United States, when George Washington ordered that all soldiers in the Continental Army be immunized against smallpox. That mandate was a major contributor to the success of the American Revolution.
Over the succeeding decades public health in the U.S. achieved significant victories, virtually eliminating polio with the polio vaccines of the 1950s and early 1960s, reducing measles and other childhood diseases to nearly zero, finding effective prevention and treatments for almost half of known cancers under President Richard Nixon’s War on Cancer, and successfully combating HIV/AIDS in the 1980s and 1990s, among many other notable wins. The United States also saved millions of lives abroad through innovative programs like USAID and George W. Bush’s President’s Emergency Plan for AIDS Relief (PEPFAR).
As Ronald Reagan’s surgeon general, C. Everett Koop, famously pointed out, "healthcare is vital to all of us some of the time, but public health is vital to all of us all of the time." He – and most of our country’s leaders throughout our history – appreciated that prevention and public health interventions ultimately keep more people healthy and safe than medical care, practiced one person at a time, can accomplish.
Until now. Suddenly, we are living in a different world in which, instead of a War on Cancer, we have, literally, a War on Public Health.
Since January, the Trump administration has cancelled hundreds of millions of dollars of research grants and contracts aimed at better understanding and effective treatment for many cancers. It has suspended or delayed payments for other projects related to cancer and various diseases worth an additional hundreds of millions of dollars. These actions will inevitably lead to more pain, suffering, and deaths, weakening our country and ultimately costing the American taxpayers far more in treatments, lost work, and waste than the research which this administration scuttled.
The Centers for Disease Control and Prevention (CDC), the cornerstone of American public health, has been shredded, with its leader fired for refusing to agree in advance to support unproven or disproven remedies, and with other scientists (1,300 of them) fired in a disorganized, middle-of-the-night purge. Half of those fired were later reinstated, but the Center’s data office, global health outreach, injury prevention, and other vital services were shuttered. In total, since the beginning of the year, one in three CDC employees has been let go. The agency has constantly been under attack from misinformed critics with a partisan agenda. Anti-CDC rhetoric led to a deranged person shooting up one of its buildings and killing a police officer. Loyalty to the Trump administration’s political agenda has been prioritized over expertise.
Ideological purity as a litmus test for investigators and educators has never previously been a part of science in the United States. Still, it has shown up in other countries, most famously in the Soviet Union of the 1930s, when Communist Party boss Josef Stalin anointed the rogue scientist Trofim Lysenko as the high priest of Russian science. Lysenko denounced Mendelian genetics, Darwin’s understanding of evolution, and other great scientific accomplishments as “bourgeois pseudoscience,” a characterization that was philosophically pleasing to Stalin. The Lysenko approach substituted conviction for evidence-based science, creating the basic playbook that Robert F. Kennedy, Jr, and his adherents follow today. The result in Lysenko’s time was a devastating famine, initially killing around 6 to 8 million people and then killing another 2 million in a second famine.
Two authors of this article are physicians, an infectious disease specialist and a pediatrician, who began their careers in public health when it was still recognized as the primary mechanism for protecting the health and safety of the American people.
Peter worked as a “disease detective” for the CDC’s Epidemic Intelligence Service (EIS). Over the last decades, when an epidemic was suspected, teams of EIS officers would be dispatched to the site to investigate. Peter was assigned to outbreaks in Mississippi, Michigan, Georgia, and Kuwait, and worked on African Hemorrhagic Fever viruses like Ebola. But this month, the Trump administration and RFK, Jr, fired the entire EIS division of the CDC, along with others, in their middle-of-the-night bloodletting, then, in typical flailing-around fashion, rehired some of them.
Jonathan served as Massachusetts Commissioner of Public Health from 1975 to 1979 and for 16 years as Public Health Director and Health Officer for Los Angeles County. During his tenure, in 2009, a decade before the COVID-19 pandemic began, the world faced another pandemic. It was caused by a virus labeled H1N1 and colloquially called the “swine flu” because it resembled the flu viruses that circulate in pigs. The virus was discovered when a 10-year-old boy in San Diego was diagnosed with the disease, followed by a 9-year-old girl in a nearby county. Neither child had had contact with pigs. H1N1 was similar to the virus that had caused the “Spanish Flu” of 1918, which killed over 50 million people around the world.
The Los Angeles County Department of Health rolled into action – setting up 60 public sites for dispensing the H1N1 vaccine, developing novel reporting and tracking systems to monitor the disease, and generating county-wide messaging about the best protective practices and vaccine availability. Ultimately, 141 deaths were attributed to confirmed swine flu in Los Angeles and about 10,000 deaths across the country. But the disease and death burden of this pandemic would have been far greater if not for these powerful, science-based public health countermeasures.
In contrast, today, vaccine policy, the country’s first line of defense against contagious disease and epidemics, is in complete chaos, with every member and their staff of the Advisory Committee on Immunization Practices (ACIP) fired. A variety of groups with different viewpoints, competing interests, and ultimately widely divergent recommendations have turned the vaccine conversation into an ineffective cacophony, resulting in fewer adults getting vaccinated and fewer parents getting their children vaccinated against measles, mumps, rubella, chickenpox, the flu, and the latest variants of the coronavirus. Once we had George Washington’s wise immunization mandate. Now, in states like Idaho, we have laws making mandates illegal.
While the domestic war on public health is cruel and economically foolish, the Trump administration’s withdrawal of support for essential immunization and other aid to third-world countries is a global disaster. U.S. programs have saved hundreds of millions of lives and, in the process, won friends for our country, strengthening American diplomacy over many decades. Recently, in another thoughtless, unkind, and expensive move, the administration stopped the distribution of medications stored in warehouses around the world, allowing them to go to waste for no good reason.
As people who have experienced population-focused health initiatives at their best, personally witnessing their capacity to save and improve lives, we are heartbroken and outraged by the current administration’s War on Public Health and the stupidity and cruelty of its unconscionable attacks on average Americans. This harmful assault will only stop when people across the country grasp its dangers and act to reinstall bright, knowledgeable, caring people in our Public Health leadership. Hopefully, when this finally happens, it will not be too late.
Jonathan Fielding, MD, MPH, MA, MBA, is a Distinguished Professor of Health Policy and Management and of Pediatrics in the Schools of Public Health and Medicine at UCLA. He served as Massachusetts Commissioner of Public Health and, for 16 years, as Public Health Director and Health Officer for Los Angeles County. The UCLA Fielding School of Public Health is named for Jonathan and his wife, Karin.
Peter Katona, MD, a PCIP member, has been a clinical professor of medicine at the UCLA David Geffen School of Medicine in Infectious Diseases, and an adjunct professor of Public Health at the UCLA Fielding School of Public Health in Epidemiology. He helped design UCLA’s campus COVID policy.
Seth Freeman, MPH, a PCIP member, is an Emmy-winning writer/producer for television, a playwright, and a journalist, who writes about technology, education, policy, and public health.
The views and opinions expressed here are those of the author(s) and do not necessarily reflect the official policy or position of the Pacific Council.
