Over six months have passed since the World Health Organization declared the novel coronavirus disease a pandemic, and COVID-19 is still wreaking havoc. In the United States, communities of color face higher disease incidence and mortality, social distancing and mask wearing have become a flashpoint, and national leadership receives top-tier medical care while frontline essential workers are inadequately supplied with personal protective equipment. Against a morbid backdrop of almost eight million cases of and 215,000 deaths from COVID-19, a dangerously inadequate response thus far from the Trump administration has compelled Govs. Gretchen Whitmer of Michigan and Andrew Cuomo of New York to enjoin Congress to investigate the office’s “politicization of government functions that have impeded the country’s response to the COVID-19 pandemic.”
This phenomenon, which effectively amounts to the politicization of science, is not new, nor is it the only reason behind people’s resistance to public health measures such as wearing masks — even despite the gravity of the pandemic. However, a comprehensive evaluation of the politics of COVID-19 reveals a new unsettling reality about the current state of our scientific institutions. As Dr. Tom Frieden, the former director of the Centers for Disease Control and Prevention, told the HPR, “Although the CDC has certainly made mistakes, as has every institution in the pandemic, they have been interfered with and criticized by their own branch of government in a way that is absolutely unprecedented.” The fallout of this interference has been a massive decline in the public’s trust in these cornerstones of society.
In the very long term, the right leadership dynamics, improved crisis management, and institutional memory will allow these scientific bodies to regain public trust. In the present, however, the politicization of the science surrounding COVID-19 has crippled our response to the pandemic and will continue to do so if we continue along this path. It is necessary to fundamentally reckon with this dangerous reality and invest in the necessary systemic shifts to turn around this pandemic and build a better relationship between science and society for tomorrow.
Science and Politics: Failures of COVID-19
“From day one, this has been more political than any other pandemic that I’ve been involved with,” said Dr. Angela Rasmussen, virologist at Columbia University, in an interview with the HPR. “There certainly has been general public misunderstanding in the past — there was during Ebola [in 2014], for example — but here, political leaders are contributing to concerns and misinformation. Every part of this process has been incredibly complicated by politics, even for things probably accepted without too much argument by the public in general.”
Many aspects of this pandemic may be unprecedented, but it certainly isn’t the first rodeo for governmental bodies and scientific institutions more broadly when it comes to navigating the intersection of science, public trust, and politics. In 1976, the failures of a swine flu vaccination campaign was followed by strong and unfair attacks against the CDC during an outbreak of Legionnaires’ Disease in Philadelphia; after the CDC deciphered the mystery of this entirely novel organism, however, there was a massive renewal of confidence in the agency. In 2002, the Bush administration’s management of anthrax attacks was heavily criticized before midterm elections; some even accused the administration of leveraging the attacks as political capital to garner support for the Iraq War. In 2009, the Obama administration was chastised upon reports that Wall Street was receiving priority access to swine flu vaccines. And in 2014, the Obama administration was similarly attacked for not doing enough to keep Ebola out of the country.
Juliette Kayyem, the Belfer senior lecturer in international security at the Harvard Kennedy School and former assistant secretary at the Department of Homeland Security, told the HPR that science in times of crisis has always been accompanied by politics, largely out of necessity. For her, politics come into play to implement science-driven measures, simply because “[d]emocracy demands attention to resources. We need to make resource allocation decisions, which is a political decision, but if we base it in science then people get it.”
However, this relationship has been perverted by the decision-making and tone set by President Donald J. Trump, who has been the primary source of misinformation in English-language media over the course of the pandemic and has “reduce[d] science to something that is not evidence-based, reducing evidence to someone’s opinion,” according to Rasmussen.
Trump’s “overwhelming dishonesty” over the course of the pandemic merits a scathing indictment for the supposed leader of the free world. From February interviews with The Washington Post’s Bob Woodward, Trump acknowledged the seriousness of the COVID-19 virus and how it could spread through the air, and yet he completely lied as he downplayed the threat to the public — in the words of H. Holden Thorp, editor-in-chief of the Science family of journals, “demoraliz[ing] the scientific community and cost[ing] countless lives in the United States.”
The recent superspreader Rose Garden event and the lack of mask-wearing by attendees, as well as Trump’s general opposition to masks even while infected with the virus, completely undermine the CDC’s public health directives. Pushing hydroxychloroquine without solid scientific evidence, downplaying the risk of sending children back to school, and allowing son-in-law Jared Kushner to run an unqualified, unsuccessful “task force” to procure vital medical equipment for healthcare professionals were all further examples of directly sidelining science for political gain with dangerous implications for the health of the country.
The most concerning form of politicization, however, emerges from Trump’s deliberate interference with scientific institutions by blocking and undermining the execution of their mandates. Trump rushed an emergency-use authorization of convalescent plasma, jeopardizing the future success of vital randomized clinical trials and blatantly pressuring both the National Institutes of Health and Food and Drug Administration. The White House blocked the approval of the FDA’s stricter guidelines for approving a vaccine for COVID-19 and the CDC’s order mandating masks on public transportation. Trump contradicted current CDC Director Dr. Robert Redfield’s Congressional testimony that most Americans would not be vaccinated until the summer of 2021 and that masks were “at least as important as a vaccine to control the virus’s spread.” And in a classic Tweet, he proclaimed his disdain for the “deep state” at the FDA because of their lack of quick approval of therapeutics and vaccines and feuded with Dr. Anthony Fauci over misappropriation of the National Institute of Allergy and Infectious Disease director’s public health guidance for a campaign advertisement.
Stanford radiologist Dr. Scott Atlas, Department of Health and Human Services spokesperson Michael R. Caputo, and medical advisor to Caputo Dr. Paul Alexander have all been proxies for Trump in undermining these hallowed institutions. From countering career agency scientists’ guidance on masks to seeking to modify the Morbidity and Mortality Weekly Reports upon which numerous researchers have depended for understanding the epidemiology of disease for decades, this politicization of science has crippled an effective response to the pandemic both in public messaging and scientific resources. These political appointees similarly pushed the modification of COVID-19 testing guidelines by circumventing the CDC’s rigorous scientific review process, countering commonly held scientific wisdom in stating it was unnecessary to test people with confirmed exposures to COVID-19 but without any symptoms. After investigative journalism uncovered this interference and sufficient pressure mounted, the CDC eventually reversed these guidelines.
In another confusing series of events, the CDC finally acknowledged aerosol transmission in its online guidance, removed the post days later because of a supposed error, and recently republished it months after much of the scientific community had been emphasizing this phenomenon — and Trump’s admission to Woodward. While the politics behind how this transpired are currently less clear than the testing debacle, the implications are obvious: public confidence in our scientific institutions is plummeting and will continue to do so when an aura of political interference lingers behind all such decision-making and communication.
Restoring Confidence
In order to counterbalance much of the misinformation disseminated from the federal government, an army of scientists and professionals have risen to the gargantuan challenge of communicating amidst a pandemic — spending countless hours with Twitter explainer threads, print and TV interviews, speaking engagements, and more — on top of their regular research and work. “A lot of us have been spending much more time debunking and addressing false information from all these levels of government rather than spending time actually responding to contagion,” explained Dr. Syra Madad, senior director of the System-wide Special Pathogens Program at New York City Health + Hospitals, in a conversation with the HPR.
In an ideal world, a safe and effective vaccine will be available in the coming months, and widespread vaccination can herald an era of recovery. However, no vaccine is a panacea, nor will one be available by some predetermined date. As Madad says, “[i]t’s not about the date, it’s about the data,” and clinical trials must meet certain benchmarks before making any such availability decisions. And in anticipation of potentially positive data, it is important to act now to mitigate the damage of the politicization of scientific institutions — not only for the rollout of this potential vaccine, but also for the security and credibility of agencies such as the CDC and FDA.
Major questions surround leadership and communication. Appointees and career scientists alike at the CDC have received heavy fire for their seeming lack of resistance to interference; however, Frieden stresses the importance of remembering that the challenge lies in the fact that the CDC is “part of the administration, so whatever they say has to be cleared.” This authority has sidelined scientific authorities in favor of political figures, and yet, especially in light of the long string of debacles in public health messaging, “the CDC cannot regain trust unless it communicates subject matter from the experts.”
“We know how to do this,” Dr. Carl Bergstrom, theoretical and evolutionary biologist at the University of Washington, told the HPR. He, like Frieden, Rasmussen, and Madad, has been instrumental in communicating science especially over Twitter over the course of the pandemic. “The CDC Field Epidemiology Manual for the Epidemic Intelligence Service has everything we need about communications — to be clear about what we know and don’t know, having scientists and not politicians speak, and more.”
While there have been hints of internal frustration at not following such basic, time-tested public health protocols, there has been little meaningful change to re-implement it. On a recent flight, CDC Director Redfield was overheard blasting Atlas, who has the ear of Trump, for perpetuating falsehoods about COVID-19; however, Redfield’s “private” criticism has translated into virtually no concrete action to counter any political interference. Bergstrom denounced this inaction, calling for Redfield’s resignation because “he hasn’t been able to keep White House interference out. He makes these half gestures but is not willing to actually do or say something about someone who has been denounced by his own colleagues from Stanford for his falsehoods.” Bergstrom is far from alone in this criticism, with Madad seconding the importance of leadership and former CDC Director Dr. William Foege urging Redfield in a private letter to stand up to the administration, even at the risk of losing his job.
Frieden believes that “[a]fter the election — whatever the outcome — maybe there will be more opportunity for dispassionate views of science,” as the politicization of Ebola intensified in October of 2014 during the midterm elections. He also sees an opportunity for structural fixes to catalyze the rebuilding trust: “If you can make the MMWR [Morbidity and Mortality Weekly Report] a national statistical product [under the National Center for Health Statistics], it’s against the law to see or meddle with the data. You can’t prevent meddling, but you can make it illegal— and it’s currently not illegal.”
Amidst the uncertainty of the robustness of vaccine data review, various other entities have stepped in to help bolster public confidence. This is a crucial task especially as recent polling indicates that over 80% of Americans worry about the safety of a vaccine if approved too quickly — perhaps not an entirely unfounded claim, despite reassurance from many including NIH Director Dr. Francis Collins, given Trump’s outlandish statements and the poorly named Operation Warp Speed. The response to assuage such doubt has included New York’s own clinical advisory task force and a pledge from the nine major vaccine-developing pharmaceutical companies to only submit vaccines with demonstrated safety and efficacy for approval.
Meanwhile, Madad emphasizes the importance of increasing community engagement with local leaders ahead of potential vaccination campaigns, particularly drawing on recent experience with the 2019 New York measles outbreak. While working with local at-risk populations before outbreaks and vaccination appointments is a component of the CDC’s “Vaccinate with Confidence” distribution strategy, there seems to have been little progress on this front thus far. “This [COVID-19] is going to be with us in the long run, and it’s not binary,” she explains. “Vaccine availability doesn’t mean no non-pharmaceutical interventions [i.e. masks, social distancing], and we need to educate the public how to do things safely. ”
Instead, there seems to be a substantial investment in a different kind of communication — a $300 million campaign to “soothe” feelings and “drive down concern” about COVID-19 through a series of public service announcements, rather than truly funding tangible, life-saving initiatives.
Defeating the Next Pandemic Before It Begins
This question of resource allocation, whether for PPE, testing supplies, or just pure funding, speaks to the bigger picture of the state of science in this country, especially as immediate concerns of rising case counts and mortality in younger people loom. Although we are currently witnessing sharp increases in COVID-19 case counts, there are deeper questions about what and how we learn from the debacle of this pandemic.
“Tony Fauci can’t live forever,” notes Rasmussen. “We need more strong evidence-based recommendations to the general public with the support of political leadership that allows and enables them to do their jobs. We need to invest in more scientific research and pandemic preparedness and response capabilities — we need to have a plan. The problem here? There was no plan.”
In the long run, there is a clear need for a great investment not only in foundational scientific research but also science education, both within and outside of government. “You can’t have public health without the public, and it’s really difficult to talk about an mRNA vaccine when you have to find ways to explain the central dogma in an accessible way,” she adds. Even for the most highly educated in upper echelons of government, “there are scientific literacy issues across the board. People are uncomfortable talking about it, then scientists are sometimes bad at communicating — it’s really difficult.”
Naomi Oresekes, history of science professor at Harvard University, told the HPR that she sees this unfamiliarity with science as a dangerous but combattable through the “deadilization” of science. “The exploitation of uncertainty in science is a very nefarious intellectual strategy, but it’s effective because people are disinclined to act anyway, and science has struggled in many domains to combat that.”
For Rasmussen, education is just the beginning, with a resurgence of and increase in interdisciplinary initiatives serving as the ideal vehicle for integrating science, politics and society in a healthy way, accompanied by adequate communication. “This needs public outreach that gets people ready for this the same way we do for earthquakes, volcanoes, hurricanes, or nuclear bombs. We need to be thinking much bigger and much more accessibly — it’s not a new office; it’s a new effort.”
“No one needs to be convinced anymore that this [expanded global approach] is necessary,” adds Kayyem. “This allows for a seismic shift in how we think about global security. And if you think about the pressing challenges of our era — [terror] radicalization, climate, pandemic, and cyber — there are no borders.”
The Road Ahead
In his final interview with Bob Woodward on July 21, Trump proclaimed, “The virus has nothing to do with me. It’s not my fault.” Months later, it could not be clearer that the virus does have everything to do with Trump — even if there are a host of factors that have exacerbated the pandemic.
But the story is far from over. The steps we take as we progress further into election season and the colder months of the end of the year will largely dictate the nature of 2021 and the security, health, and stability of our nation for the foreseeable future. Life as we know it has fundamentally changed because of this pandemic. But working toward a more sustainable, integrated scientific ecosystem in the world of politics as we weather this storm is integral to recovery. Only then can we begin to honor the unwavering service of frontline workers and thousands of lives lost, prevent as many future infections and casualties as possible, and learn from the catastrophe that has been 2020 to build toward a more secure future.
Image by United Nations COVID-19 Response is licensed under the Unsplash License.
