Backlash jeopardizes public health powers, leaders
Tisha Coleman has lived in close-knit Linn County, Kansas, for 42 years and never felt so alone.
As the public health administrator, she’s struggled every day of the coronavirus pandemic to keep her rural county along the Missouri border safe. In return, she’s been harassed, sued, vilified — and called a “sheep.”
The months of fighting over masks and quarantines were already wearing her down. Then she got COVID-19, likely from her husband, who refused to require masks at the family hardware store. Her mother got it, too, and died Sunday.
Across the U. S., state and local public health officials have found themselves at the center of a political storm.
Threats proliferate
Some have become the target of far-right activists, conservative groups and anti-vaccination extremists, who have coalesced around common goals — fighting mask orders, quarantines and contact tracing with protests, threats and personal attacks. Public health powers are being undermined in the courts. Lawmakers in at least 24 states also have crafted legislation to weaken long-held public health powers.
Amid this pushback, at least 181 state and local public health leaders in 38 states have resigned, retired or been fired since April 1, according to an ongoing investigation by The Associated Press and KHN. According to experts, this is the largest exodus of public health leaders in American history.
Departures mount
One in 8 Americans — 40 million people — lives in a community that has lost its local public health department leader during the pandemic. Top public health officials in 20 states have left state-level departments,
and an untold number of lower-level staffers has also departed.
Many of the leaders exited due to political blowback or pandemic pressure. Some left to take higherprofile positions or due to health concerns. Others were fired for poor performance. Dozens retired.
“We don’t have a long line of people outside of the door who want those jobs,” said Dr. Gianfranco Pezzino, health officer in Shawnee County, Kansas, who had decided to retire from his job at the end of the year. “It’s a huge loss that will be felt probably for generations to come.”
But Pezzino could not even make it to Dec. 31. On Monday, after county commissioners loosened restrictions, he immediately stepped down.
The departures are a further erosion of the nation’s already fragile public health infrastructure ahead of the largest vaccination campaign in U.S. history. AP and KHN previously reported that per capita spending for state public health departments had dropped by 16%, and for local health departments by 18%, since 2010. At least 38,000 state and local public health jobs have disappeared since the 2008 recession.
Since the pandemic began, the public health workforce in Kansas has been hit hard — 17 of the state’s 100 health departments have lost leaders since the end of March.
Democratic Gov. Laura Kelly issued a mask mandate in July, but the state legislature allowed counties to opt out. A recent Centers for Disease Control and Prevention report showed the
24 Kansas counties that had upheld the mandate saw a 6% decrease in COVID-19, while the 81 counties that opted out entirely saw a 100% increase.
Coleman pushed for Linn County to uphold the rule, but commissioners wrote that masks are “not necessary to protect the public health and safety of the county.”
Coleman was disappointed but not surprised. “At least I know I’ve done everything I can to attempt to protect the people,” she said.
Political pushback
In Idaho, hundreds of protesters, some armed, swarmed health district offices and health board members’ homes in Boise on Dec. 8, screaming and blaring air horns. They included members of the antivaccination group Health Freedom Idaho. The antivaccine movement has linked up with political extremists on the right, experts said, and taken on a larger anti- science role, pushing back against other public health measures.
Now, opponents are turning to state legislatures and even the Supreme Court to strip public officials of the legal power they’ve held for decades to stop foodborne illnesses and infectious diseases by closing businesses and quarantining individuals, among other measures.
Lawmakers in Missouri, Louisiana, Ohio, Virginia and at least 20 other states have crafted bills to limit public health powers. In some states, the efforts have failed; in others, legislative leaders have embraced them enthusiastically.