Ruinous effects of politicizing public health agencies, such as the CDC

During a congressional hearing on Wednesday, March 30, House Democrats and Republicans slammed each other for political interference in Covid-19 politics. They are both right, but for totally different reasons. Public health has been hijacked by politics, and it has happened throughout the Covid-19 pandemic, under the Trump and Biden administrations. At times, the Trump administration has blatantly ignored science, even going so far as to undermine public health officials. The Biden administration did not sabotage public health measures. Yet it has allowed politics to trump public health in pernicious ways.

In order to renew public confidence in public health, it is essential that agencies such as the Centers for Disease Control and Prevention (CDC) be as independent and apolitical as possible.

Coinciding with the drop in Omicron cases, the White House announced last month that the CDC would relax federal guidelines on mask wearing. Additionally, virtually every state (including those led by Democratic governors) has lifted hidden mandates. Are these examples of “following the science”? Or, are public health officials and political leaders simply putting the pandemic in the rearview mirror, despite a possible Omicron BA.2 wave?

What is clear is that there is enormous political pressure to return to normality, after two years of Covid-19 rules. Moving forward — the Democratic Party’s talking point suggests “mitigating pandemic exhaustion” — is an understandable human need. But that doesn’t mean it’s based on science. And this is not the first example of political behavior disguised as scientific orientation.

When delivering statements about masking and vaccine effectiveness against coronavirus transmission, the CDC has repeatedly used the phrase “follow the science.” Yet the agency has repeatedly changed course on masks and shifted focus on vaccine effectiveness. The end result has been a confusing message that’s not necessarily rooted in science. As a result, this contributed to public mistrust.

Experts said some of the resistance to masks, social distancing measures and vaccines stemmed from confusing public messages issued by public health officials throughout the pandemic.

The problem is exacerbated when multiple government agencies are involved in messaging and they contradict each other. An illustrative example of miscommunication, lack of coordination and politicization was the first recall deployment in the fall of 2021. In August 2021, President Biden declared that the administration would begin offering mass recalls on September 20 , pending Food and Drug Administration (FDA) and CDC clearance. A few weeks later, the FDA and CDC tried to rein in the White House, saying there wasn’t enough data yet to make a general recommendation on boosters. And then, at the end of September 2021, the two government agencies themselves issued conflicting recommendations on boosters, which caused confusion. First, a panel of FDA advisers has recommended booster shots for people over 65, at high risk of complications from Covid-19, or employed in industries that put this at risk of serious teachers of Covid-19. Subsequently, about a week later, another panel, the Advisory Committee on Immunization Practices (ACIP) — which is part of and advises the CDC — said that people employed in professions likely to expose them to a increased risk of severe Covid-19, should not to get reminders. A day later, CDC Director Walensky canceled the ACIP.

This is just one instance in which the FDA, CDC (and ACIP within the CDC), and the White House clearly did not communicate or coordinate optimally, and apparently had different interpretations to “follow the science”.

To be fair, the CDC has faced a loud and influential anti-science movement, which makes messaging all the more difficult. Bizarrely, for example, in right-wing political circles, ivermectin has become increasingly popular as an antidote to Covid-19. The drug has been embroiled in a Covid-19 culture war that pits unproven treatments, such as ivermectin, against proven measures, such as vaccines.

Additionally, many have questioned efforts to mitigate the spread of Covid-19 as well as vaccination mandates, saying such public health measures infringe on individual rights. This has been a driving force behind the limitation of public health powers by state and local authorities. And, in the extreme, an anti-science mob has accused the global public health movement of being fascist, comparing vaccination mandates to wearing yellow Stars of David, for example.

But, clearly the communication and messaging issues didn’t help matters, and they started almost as soon as the pandemic hit.

At the start of the pandemic, public health officials said masks were not necessary for anyone not showing symptoms. In fact, they discouraged people from buying them.

The CDC then changed course in early April 2020, saying new research showed asymptomatic carriers to be common spreaders of the virus, although some experts say evidence for appropriate mask use had already been shown.

A year later, CDC Director Walensky said that “vaccinated people do not carry the virus.” May 13e 2021, people were told they no longer needed to wear masks indoors or outdoors if they had been vaccinated. At the time, many scientists criticized the comments, saying it was too early to know for sure what effect vaccines might have on transmission. And, it turns out that vaccinated individuals infected with the Delta variant have been shown to be able to transmit the virus as easily as those who are not vaccinated.

Walensky quickly announced a reversal of guidelines on masking in vaccinated people. The new orientation reflected a strategic retreat. Walensky said even vaccinated people should wear masks indoors in communities where there is significant viral spread.

But that wasn’t the only mask mistake the CDC director made. Last month, Walensky called the mask “the scarlet letter of this pandemic.” It was a weird reference for something that doesn’t evoke shame. Moreover, it was an extremely poor analogy. In Hawthorne’s famous book, at the beginning, the scarlet letter that Hester Prynne carried was a punitive emblem; a symbol of shame for a sin committed. Of course, masks are not that. Then the letter evolved over time to become a source of rejuvenation for Prynne. Masks aren’t that either.

Along with poor messaging and unfortunately chosen metaphors, the CDC also hid key data the agency collected on hospitalizations stratified by age, sex, race, and vaccination status. Likewise, the CDC has not released comprehensive data on the effectiveness of boosters. To illustrate, two months ago when the CDC released the data on the effectiveness of boosters in adults under 65, it omitted the numbers for the 18-49 age group. This kind of information could help national and local health authorities better target their efforts to contain the virus. Nevertheless, the CDC has been reluctant to release this data for fear that it will be “misinterpreted”.

Sincerity, based on nuanced and detailed analysis, builds trust. For example, it would be better to openly acknowledge the limitations of vaccines – they are far better at preventing hospitalization than reducing transmission – than to gloss over the issue. Worse still, the concealment or selective selection of data leads to a breach of trust, which the anti-science mob is seizing on as it attacks the medical establishment.

CDC could do its part by being as neutral an arbiter as possible while improving messaging. In turn, this would reduce the mistrust that exists.

It is important not to allow scientific issues to become captive to partisan politics on either side of the aisle, as this will have negative implications for future public health policy. Public health authorities must be consistent, truthful and transparent, and not change mid-stream due to political pressure. Otherwise, public trust in government decision-makers erodes over time.

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