E44: Science & Public Health Under Attack

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“Public health is one of the few agencies locally that you can guarantee is apolitical. They just care about protecting the health of the community. … But these measures and these tactics by health officers are seen as political and an attempt to limit people’s rights.” —Lori Freeman, CEO of the National Association of County and City Health Officials

Public health experts have faced strong backlash for supporting decisions to close businesses and to enforce lockdowns and social distancing measures. How have public health officials balanced these opposing pressures? On today’s episode of EPIDEMIC, we hear from Lori Freeman (CEO of the National Association of County and City Health Officials) and Theresa Anselmo (executive director of the Colorado Association of Local Public Health Officials), about how public health officials have been affected by this backlash. Then, we speak with Garry Kasparov (chairman of the Human Rights Foundation and the Renew Democracy Initiative) about his first-hand experiences with the fallout from his opposition of the Russian government, and what parallels he sees in present-day America. This podcast was created by Just Human Productions. We’re powered and distributed by Simplecast. We’re supported, in part, by listeners like you.

Lori Freeman: We have already seen what lack of leadership at the highest levels of government has impacted this pandemic but at least at the local level, at that community level, where we need it most, to be losing that is really, really concerning.

Celine Gounder: Hi, you’re listening to Epidemic, the podcast about the social and public health impacts of the coronavirus. I’m your host, Dr. Celine Gounder.

Celine Gounder: At the start of the pandemic, Ohio got a lot of credit for taking decisive action to stop spread of the virus. 

DeWine: All bars in the state and all restaurants, uh, will close at 9 tonight. How long this order will be in effect, um, we don’t frankly know.

Celine Gounder: It was one of the first states to close its schools back in March… cancel major events. The state even took the dramatic step of delaying its presidential primary. Public health experts applauded these moves. They said the lockdowns and social distancing measures saved lives. And the person behind many of these recommendations was Dr. Amy Acton — the Director of the Ohio Public Health Department.  

“Please know everyone, this, this is the real thing, This is not a drill. This is the once in a lifetime pandemic” https://www.youtube.com/watch?v=GXjLgBM7Uto   

Celine Gounder: But these decisions were also unpopular. Democrats in the state sued over the delayed primary. Republican lawmakers tried to strip Dr. Acton of her authority to declare a public health emergency. And then there were the protests. 

 Audio of protests at Ohio statehouse:

https://www.youtube.com/watch?v=HO-CMmsUqIQ Chants 

https://www.youtube.com/watch?v=9lFq5rwbULQ “Amy Acton’s Got to Go”

Celine Gounder: Protesters were upset about the lockdown’s impact on the economy. They saw public health measures as a violation of their rights as Americans. During a protest at the Ohio state capitol, some held anti-semtic signs, something many say was directed at Dr. Acton personally, because she’s Jewish. Other protesters went to Dr. Acton’s home. Some openly carried guns.

Gov. DeWine: This week Dr. Acton told me she feels it is time for her to step down, um, as our director of health… 

Celine Gounder: In June, Dr. Acton resigned her position as Ohio’s Director of Public Health. 

Gov. DeWine: … I will always believe and know that many, many lives were saved because of the advice I received from her and the great work that she did. https://www.youtube.com/watch?v=JOyIcz_soRU

Celine Gounder: In August, she left the state government altogether. Gov. DeWine has been trying to fill the job ever since. His latest pick turned down the job in September. Why? She cited the harassment Dr. Acton received. At this recording, Gov. DeWine has not appointed a new Director of Public Health. 

Dr. Acton’s departure is not unique. 

Lori Freeman: Well, I can’t speak specifically for Amy, but I can tell you, after speaking with many local health officers and others that have experienced these, um sorts of threats and intimidation tactics, that, um, it’s a very hard time for public health.

Celine Gounder: This is Lori Freeman. She’s the CEO of the National Association of County and City Health Officials. 

Lori Freeman: Some of these folks are simple as saying enough is enough. I can’t take it anymore. Um, I’m feeling risk to not only myself, but my family. And they’re either making the choice to get out of the positions themselves by resigning or retiring early or in some cases they’re being fired for standing your ground to keep their communities safe and healthy.  

Celine Gounder: Across the country, dozens of public health leaders and staffers have quit, retired, or been fired during the pandemic. We’ll see why these healthcare workers are being targeted, how some politicians aren’t helping, and why the loss of these public health officials may be permanent if changes aren’t made. 

Celine Gounder: Even before Dr. Amy Acton resigned, Lori had noticed that many of her members were facing similar pushback. 

Lori Freeman: I think the biggest red flag to me was when three of my board members either resigned, took early retirement, or were fired. 

Celine Gounder: Besides resignations and firings, Lori also noticed a jump in retirements. 

Lori Freeman: Local health officials care very much about the jobs that they do, the work they do in their community and during a pandemic, they, they understand their, the importance of their role. So retirement during pandemic is unusual. But we’re guessing around 35, it could be up to 40 by now.

Celine Gounder: Is that a lot? Is that a little bit?

Lori Freeman: It’s a, it’s a lot. Um, because these are coming in a short period of time since about March, April timeframe. We’re only talking about a few months for that to happen.

Celine Gounder: Turnover is not uncommon in state government, especially when there’s a new administration. But that wasn’t the case here. So why were all these public health officials leaving?

Lori Freeman:  We have heard everything from physical threats to themselves. There’ve been death threats. 

Celine Gounder: It’s gotten so bad that Theresa Anselmo, the executive director of the Colorado Association of Local Public Health Officials, has a folder dedicated to threats her members receive. 

Theresa Anselmo: Yes, I have. I do have an email folder called “threats”.

Celine Gounder: In May, Theresa polled the 53 members of the organization about any threats they may have received. 

Theresa Anselmo: 80% of people responded that they themselves, or their staff or their property had been threatened in some way, shape or form. 

Celine Gounder: Email and social media threats are the most common, but Theresa says it’s not infrequent for these threats to spill into the real world.

Theresa Anselmo: And they’re telling me that, that the protestors at the time city council meetings talking about mask wearing are following them home or that they feel like they are being stalked. Uh, they find vehicles parked on ridges outside of their homes and they don’t know who they belong to and they become very worried that they are going to, they and their families are going to be harmed. And, and I will tell you that, um, you know, when you do drive through some of these communities and their gun racks are on the back of their truck, you do have to kind of worry if that is one of the individuals that’s following you home out on a dark country road.

Celine Gounder: Theresa says many agencies no longer let their employees work alone in the office. They’re afraid public health workers could be attacked. These threats have totally upended the lives of public health officials.

Theresa Anselmo: So a number of them don’t go to the grocery store anymore. They send somebody else. They have curtailed their own physical activity because they don’t want to confront folks that are upset with them. 

Celine Gounder: Theresa says public health officials are supposed to report these threats to the police and the Colorado Bureau of Investigation. Many of the threats aren’t deemed credible, she says. But that’s hardly reassuring.

Theresa Anselmo: It’s kind of like waiting for something to happen before they can do anything about it, which is a very uncomfortable position to be in for these directors. 

Celine Gounder: And of course politics drive a lot of the outrage. Remember that survey Theresa did of local health officials in Colorado? The one that found that 80% said they’d received threats or had property vandalized? 

Theresa Freeman: The followup question that we asked that also received an 80% positive response was whether they had had any political pressure applied up to and including the threat of being fired or the removal of funding from their agency. 

Celine Gounder: We’ll look at the politics of this situation, after the break. 

Hi, everyone, Dr. Celine Gounder here asking for a quick favor before we get back to the show. We’re conducting a listener survey to learn more about who you are and what topics you’d like to hear more about. Please go to epidemic.fm and click the big yellow button that says Listener Survey. It’s quick and confidential. And you can even enter for a chance to win an Amazon gift card. So, head over to epidemic.fm, and click the yellow button for our survey. It’s a big help, thanks! 

OK, back to the show.

Lori Freeman: Public health is one of the few agencies locally that you can guarantee is apolitical. They just care about protecting the health of the community.

Celine Gounder: Lori Freeman says that public health leaders are there to advise elected officials about the latest science and disease control measures when there are emergencies like a pandemic. But the way the United States has responded to the pandemic has made it difficult for science to stand apart from politics.

Lori Freeman: These measures and these tactics by health officers are, are seen as political and an attempt to limit people’s rights.

Celine Gounder Elected officials are getting pressure from opponents of public health measures, like mask mandates and business closures. 

Lori Freeman: But when the pressure is high and people are anxious about their jobs, their economic situation, um, their selves, their families, um, the scapegoat becomes public health. 

Theresa Anselmo: And it makes it very, very difficult then for public health directors to be that neutral adviser, the bringer of evidence, and best practice into what needs to be done to address the public health issue, because ultimately they either have the potential to get fired or their funding could be revoked, which would just devastate these communities because then they would be without public health leadership at all. 

Celine Gounder: And this has led some to a false choice: That somehow the public’s health and safety, is incompatible with re-opening the economy. 

Theresa Anselmo: All of us that work in public health know you cannot have a healthy economy if you don’t have a healthy public. Um, you can’t have employees going to work. You can’t have people producing goods. You don’t have consumers purchasing goods if they’re all sick or worse, dying.

Celine Gounder: Not to mention mental health, stress, substance use, housing and food insecurity. These are all public health concerns that are affected by people’s economic stability. 

Lori Freeman: So it really is not a true war between public health and a good economy. We can do both safely in order to stop, this, this pandemic. 

Celine Gounder: Where do you think the blame the messenger psychology comes from?

Lori Freeman: Um, well my own personal feeling is that it comes from the top. I mean, we see this happening just at the highest levels of our government.

Sen. Rand Paul: And as much as I respect you, Dr. Fauci, I don’t think you’re the end all. I don’t think you’re the one person that gets to make the decisions 

Trump, GOP audio criticizing Fauci, masks etc. 

Trump calls Redfield confused: https://www.cnn.com/videos/politics/2020/09/16/donald-trump-robert-redfield-coronavirus-vaccine-cdc-masks-sot-vpx-ebof.cnn 

Caputo on CBS News: https://www.youtube.com/watch?v=IoVjuFosCrE&t=77s

Garry Kasparov: Trump is following the footsteps of world dictators trying to control the, the information. [00:22:30] Uh, but in America it’s virtually impossible because there’s so many open channels and sources that help American public to know the truth. 

Celine Gounder: This is former World Chess Champion Garry Kasparov. He’s also chairman of the Human Rights Foundation and the Renew Democracy Initiative. 

Garry Kasparov: It’s also a classical rule of any dictator they want total control, but zero responsibility.

Celine Gounder: Garry grew up in the Soviet Union. He eventually founded his own political party opposed to Russian President Vladimir Putin. But the threat of assassination for his political organizing forced him to leave Russia in 2013. Now he lives in the United States. So why are we talking to a former Chess Grandmaster about public health officials? Well, Garry knows a thing or two about how authoritarian governments approach science. Living in the Soviet Union and later Putin’s Russia, Garry saw how the scientific approach to understanding the world was not compatible with authoritarian rule.

Garry Kasparov: Instead of selling you a concept, a theory, one truth,  it did something else attacking the truth as a concept, uh, altogether. But science as a concept is under suspicion because scientific truths stay no matter who is in power and no [00:11:30] matter what party says today or tomorrow.

Celine Gounder: We’re seeing similar behavior here in the United States. In September, POLITICO reported that Trump political appointees had been meddling with the CDC’s weekly reports about the pandemic. The news organization said the interference was an attempt to intimidate the report’s authors and bend the CDC’s messaging to match Trump’s rosey version of events. Both of those appointees have since left their positions. Dr. Tony Fauci told The Atlantic that he, too, has received threatening emails.

Tony Fauci: The person who is trying to influence the CDC and even me with email is gone. I never listen to the person. Just don’t bother me here. I mean, that’s the way it was. 

Celine Gounder: And the attacks continue. The same week this episode was released, President Trump attacked FDA safety guidelines for an eventual COVID vaccine. He later threatened to withhold Medicare funds from hospitals that did not comply with his administration’s plan to funnel COVID stats away from the CDC and to the Department of Health and Human Services. Garry thinks something as big as the pandemic is difficult to control with disinformation like this. People will eventually see those around them getting sick.

Garry Kasparov: Now we could see that it’s, it’s not working as effectively because it’s more and more difficult for Trump to deny the reality. Obviously COVID-19 caused tremendous damage. But the fact is that he’s trying, desperately trying to control it and to claim victory, uh, based, not on, on real now, but only numbers that he invents. I mean, demonstrates that intent is there. He’s failing, but we should not be mistaken about his  intents. 

Celine Gounder: And that’s why the administration has attacked public health officials, like Dr. Tony Fauci. Garry says this is also part of the authoritarian playbook. 

Garry Kasparov: It’s very simple, president, dictator, head of Congress party, mafia, boss– you name it–cannot be wrong, period. If something goes wrong, you have to find person to blame. That’s it. And, uh, uh, in, in America today, Dr. Fauci is a most natural target. If, pandemics cannot be controlled,um, you have to find the person who is responsible for it because Donald Trump, cannot be criticized and it’s, uh, it’s quite frightening that in America we are heading, having, um this direction where the, uh, country leader is excluded from criticism uh, and, uh, he always finds, uh, others to blame for his own misdeeds and failures.

Celine Gounder: This level of control may suit someone like Trump in the short term, but it’s bad for scientific innovation in the long run. 

Garry Kasparov: The science will, will suffer as well as every other walk of life because science is about freedom, and I think America’s unprecedented success in the 20th century was very much due to, to an ability of American scientists to, uh, uh, to experiment. Scientists who are frightened scientist or lying because they’re afraid for their life or their life for the life of their loved ones. These scientists can not, uh, be productive and creative, and that’s why, uh,eventually dictatorships are paying a very high price for their brazen attempts to control science as they control every other walk of life.

Celine Gounder: The United States is not China or Russia. Garry says there’s a lot about American democracy and its press freedoms that make this kind of authoritarian control difficult. But it shouldn’t be taken for granted. 

Garry Kasparov: [00:17:49I think people should recognize that even America is not immune. Let’s use this medical term. It’s not immune against the virus of dictatorship. It’s all about us today being engaged and, and actively, uh, participating in, in democratic process. And uh,looking at 2016. We, we, we, we should remember that, uh, it was not about 70 or so thousand votes that decided to do the elections in three battleground States, but it’s about hundred million people who didn’t vote at all. 

Celine Gounder: We’ve paid a lot of attention to the federal government’s response to the pandemic. But public health is something that by and large happens at the local level. And during a pandemic… these are thankless jobs.

Theresa Anselmo: If I could sum it up in one word, it would be exhausting. 

Celine Gounder: Theresa Anselmo again.

Theresa Anselmo: They have been responding to COVID before the first case was confirmed in Colorado. So since and how they have become villainized and how this has become such a politicized issue. It’s been quite detrimental to the public health field here in the state of Colorado.

Celine Gounder: Theresa says they’re trying to help these public health workers cope with the stress. 

Theresa Anselmo: We have a text group that we often send each other inspirational messages or quotes or say I’m having a really tough day today. And then everybody rallies behind that person and helps support them through that tough time that they’re having. It’s been really, actually wonderful to see this group of public health directors come together and support each other and how supported they report they feel because of this opportunity to talk together. 

Celine Gounder: Lori Freeman says her organization has been doing advocacy to reach elected officials to make sure they understand the importance of public health. She says they’re also pushing to add health officials to the list of government workers whose personal information is not available to the public. But many public health officials have quit, retired, or been fired. These protections didn’t come in time. And these vacancies are on top of health departments that have already lost upwards of 20% of their staff to budget cuts over the last decade.

Lori Freeman: This is when we needed public health in the infrastructure to be its strongest. And it’s perhaps its weakest at this point. So, it is no wonder why we’re struggling with this response.

Celine Gounder: So the question is, who’s going to replace these public health workers?

Lori Freeman: You have to wonder how many people want that job right now. It’s a very difficult job. There’s enough stress and strain to go around the whole health department.They see what these health officials go through at every level of staff. Um, so it is going to be challenging to fill these positions.

Celine Gounder: The pandemic has exposed flaws in many of our institutions…and public health is no exception.

Lori Freeman: We have a $3.6 plus trillion dollar health care budget, and 3% of that goes towards public health and prevention activities. So our priorities are… are messed up. [laughs] We have to reprioritize prevention in public health and reinvest in that infrastructure and fill those cracks and, and rebuild that workforce so that we can get out of this and so that we’re ready for the next time. COVID-19, it’s not the only thing that’s going to ever impact this country knows what’s right behind it.

“Epidemic” is brought to you by Just Human Productions. We’re funded in part by listeners like you. We’re powered and distributed by Simplecast. 

Today’s episode was produced by Zach Dyer and me. Our music is by the Blue Dot Sessions. Our interns are Annabel Chen and Bryan Chen.

Additional audio in this episode from the AFP, The Columbus Dispatch.

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And check out our sister podcast “American Diagnosis.” You can find it wherever you listen to podcasts or at americandiagnosis.fm. On “American Diagnosis,” we cover some of the biggest public health challenges affecting the nation today. In Season 1, we covered youth and mental health; in season 2, the opioid overdose crisis; and in season 3, gun violence in America.

I’m Dr. Celine Gounder. Thanks for listening to “Epidemic.”

Guests
Gary Kasparov Gary Kasparov
Lori Freeman Lori Freeman
Theresa Anselmo Theresa Anselmo
Host
Dr. Celine Gounder Dr. Celine Gounder