San Francisco Chronicle - (Sunday)
Politicization of pandemic hinders hope for solutions
Dr. Robert Wachter knew from the start that the U.S. pandemic response would be influenced by politics. The country already was steeped in bitter division, and disaster almost always brews controversy.
But he never expected the political interference to be so expansive, so intrusive, as to shake his faith in some of the country’s oldest and most trusted public health institutions. About the Centers for Disease Control and Prevention and the Food and Drug Administration, he said, “We no longer look to these previously trusted authorities for guidance.
“This feels like the most overly politicized health issue in my lifetime,” said
Wachter, chairman of the department of medicine at UCSF. “And it’s been wildly destructive.”
The COVID19 pandemic has been politicized in the United States almost since the first cases were reported in January. But the rhetoric has spiked in the past week or so in a way that is alarming many public health experts, who say they are feeling compelled to push back against what they perceive as an attempt to use the pandemic response as a political tool in the November election.
There’s more at stake than mask politics now, they say. Even the reelection campaign for President Trump, who once refused to condone face coverings in public, now sells masks printed with “Trump 2020.”
Public health experts say that everything from vaccine development to how COVID19 deaths are calculated has become campaign material. And they fear that charged language and rampant spread of misinformation could be disastrous for the country’s ability to claw out of the pandemic.
“What we’re seeing is a consistent attack on truth or science, the likes of which I’ve never seen before,” said Dr. Eric Topol, executive vice president of Scripps Research in La Jolla (San Diego County) who repeatedly has called out bad science during the pandemic on Twitter and other media platforms.
“It’s bad enough to have a pandemic. We don’t need to add further fog and diminish the strong efforts in terms of advances in science,” he said. “It’s just sickening.”
Over the past two weeks, public health experts say they’ve been appalled by statements made by leaders at the CDC and the FDA that seem to contradict known science and in some cases are baldly wrong. The head of the FDA, at a news briefing with President Trump, promoted convalescent plasma as a COVID19 therapy that could cut deaths by 35%, which was not true based on studies. He later apologized on Twitter for misstating the data.
A few days later, the CDC quietly changed its coronavirus testing policy to advise that people without symptoms not be tested, even if they believed they’d been exposed to the virus. The switch brought immediate blowback from public health officials who said they would refuse to follow the new guidance.
The National Institutes of Health so far seems untouched by politics, public health observers said. But Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, lately has been missing from public updates on the pandemic. And Dr. Scott Atlas, a policy fellow with Stanford’s conservative Hoover Institution who has no background in infectious disease or epidemiology, has become a trusted Trump adviser. Atlas already has drawn scorn from some public health authorities for his aggressive push to reopen the economy. In the meantime, the FDA has hinted that it expects to offer emergency approval to the first coronavirus vaccine by the end of October or early November, leading some public health experts to assume that it’s timed to the election. The CDC issued guidelines to states last week to plan for a widescale immunization effort as early as Nov. 1, according to documents obtained by the New York Times.
The FDA and the CDC have since stated that they are not being influenced by politics and they continue to make decisions guided by science. The White House said in a statement that its pandemic response is based on saving lives and protecting the economy, and that decisions are unrelated to the upcoming election.
“The rapid research, development, trials, and eventual distribution of a COVID19 vaccine is emblematic of President Trump’s highest priority: the health and safety of the American people — it has nothing to do with politics,” Sarah Matthews, White House deputy press secretary, said in an email.
On Friday, manufacturers of the main vaccine candidates said they would pledge to not seek federal approval until they felt confident their products were ready for the public, according to a Wall Street Journal report.
But many public health experts said they remain deeply skeptical of, and troubled by, the federal actions.
Topol, as well as other longtime public health and infectious disease experts, said he is stunned by the sidelining of traditional authorities on health and medicine. The CDC, for decades a global powerhouse in public health, has been silent for much of the U.S. pandemic, and at times seems harnessed as a tool for spreading questionable information, said experts who have long valued the agency.
“The latest recommendation to not test people who have been exposed to COVID is a direct hit at the health of the public, and contrary to not just the guidance of public health professionals but what anybody with common sense would expect,” said Dr. Steven Goodman, a Stanford epidemiologist. “At this point now, we have a complete abdication and corruption of the health protection role of the CDC. It can no longer really be viewed as a public health agency.”
Wachter said that many of his colleagues at UCSF and other health care and academic institutions have accepted that they can’t rely on the CDC or the FDA for guidance in responding to the pandemic.
“We no longer look to these previously trusted authorities for guidance,” he said. “We are making essentially independent decisions based on our reading of the literature and our experts. At UCSF, we’re lucky enough to have worldclass people to do that.”
Politics already have had disastrous effects on the pandemic response, many public health experts say. Face coverings became symbolic of party lines, and therefore many people refused to wear them, or were confused as to whom to trust regarding their efficacy. Early in the U.S. response, conservative states declined to shut down bars or clubs while liberal enclaves issued restrictive shelterinplace orders.
The result has been one of the worst pandemic responses in the world, many public health experts say. The United States has more cases and deaths than any other country. It makes up just 4% of the world population but more than 20% of all COVID19 deaths — about 190,000 in the U.S. as of Saturday.
Experts worry that the pace of politicization has picked up in recent weeks in the leadup to the election and threatens the way out of the pandemic: vaccination.
The speed of vaccine development has been impressive, infectious disease experts said, and several candidates already are in phase three trials, the last stage before going to FDA for approval. But they probably are still many months from having all the data needed to prove they’re safe and effective.
Fauci and other federal officials have said it’s possible they may have enough information by the end of October to allow emergency distribution of at least one vaccine. But many public health experts remain concerned. It can take months to determine if there are safety problems with a new drug product, they say, and they question whether enough people will have received the vaccine by then to prove that it prevents infection.
They also worry that if a vaccine is rushed to the public, people won’t trust it, especially after enduring many months of political back and forth around nearly every other aspect of the pandemic response. Even if one or more vaccines proves to be extremely effective, that doesn’t mean people will take it.
“What’s at stake now is the vaccine, which is the main exit strategy for this pandemic in the United States,” Topol said. “That’s going to be put in jeopardy. Even with all this great science.”
The excessive commingling of politics and pandemic has affected all levels of the response, several public health experts said. It has interfered with the ability to have rational conversations around when schools should reopen or how to safely scale back shelterinplace restrictions.
There’s room for debate on those topics, Goodman said. But when people can’t agree on basic science or data, more nuanced dialogues become impossible.
“There is a reasonable discussion that can be had,” he said, “but not in the current poisoned environment and not divorced from facts.”