Even as Federal Support Wavers and Misinformation Spreads
Line at Morrisania Hospital in the Bronx in 1947 for the smallpox vaccine. AP/Shutterstock
By Irwin Redlener, MD
In 1947, when New York City faced a dire threat of a lethal smallpox outbreak, an emergency plan to vaccinate all New Yorkers was organized and implemented by Health Commissioner Israel Weinstein and Mayor William O’Dwyer. When the mayor explained the threat at a press conference, with the health commissioner by his side, New Yorkers responded. Within two weeks, some 5 million New Yorkers received the shot and by 4 weeks, more than 6.3 million were protected. And that was sufficient to stop the impending deadly outbreak in its tracks. And there were only two smallpox fatalities in New York.
What would happen today if we faced a major public health crisis?
It is highly unlikely that such a program as New York City implemented in 1947, with strong city leadership and overwhelming support by the public, could happen today, no matter what the threat. Here’s why:
First, there has been a dramatic rise in the number of anti-vaccine and anti-science conspiracists in the U.S.
Second, the new Secretary of the U.S. Department of Health and Human Services, Robert F. Kennedy, Jr., has been one of the world’s most influential anti-vaccine evangelists, who furthermore wants to “pause infectious disease research” for eight years.
Third, extremely problematic messaging from federal public health officials during the COVID-19 pandemic created a crisis of confidence in key agencies like the Centers for Disease Control and Prevention (CDC), and in the Administrations of Donald Trump and Joe Biden.
In the case of the Trump team during his first term, a steady stream of misinformation about vaccines, disease prevention strategies and bogus treatments were literally mocked by infectious disease and public health experts once disdain of science was adopted by the MAGA movement, that was the beginning of highly partisan politization of how to manage a dangerous, deadly outbreak.
When Biden’s Administration succeeded Trump’s, other problems arose. The most important of these was poor, inconsistent, and rapidly changing advice from the CDC and other officials. People lost confidence in public health messaging because of constantly evolving messages and the degree to which pure politics and ideology contaminated critical health debates.
All that said cities and states must find ways to sustain public health programs that protect the public’s health, even as federal support is diminished and information becomes increasingly unreliable.
What can cities and states do to develop and support a robust public health agenda?
It’s important to recognize that coherent, science-based policies and well-informed leadership coming from the federal government in public health are highly unlikely for the foreseeable future. Not only am I worried about the wholesale erosion of American innovation and global leadership on public health initiatives, I am deeply concerned that massive cuts in NIH funded research will undermine medical breakthroughs across all aspects of human health.
So, what can city leaders do?
Creating an atmosphere of public trust around public health policies can be done even in the absence of trust in federal policies. The goals for effective public health programs must always ensure honesty, credibility and accessibility.
Here’s some specific suggestions:
Select a respected, highly credentialled individual to run the health department. I believe he or she should be a physician with excellent communication skills who is also comfortable interacting with press and social media influencers.
The commissioner and other high-level officials should never attempt to obscure, underplay or overplay information in a crisis.
Uncertainty is a concept that, in spite of what many officials might believe, can be appropriately conveyed to the public. “We don’t know yet. Here’s why and what we expect” can be an appropriate and honest answer.
Create a diverse panel of expert advisors to the commissioner who reflect the community’s demographics, but also possess documented expertise in medical and public health sciences. This panel should meet regularly and discuss on-going challenges, as well as receive reports from the commissioner.
The department of health should maintain a robust, very accessible online resource, updated frequently, in language understandable to the lay public. And these resources should be available in languages consistent with languages spoken in the community.
If possible, the website should have an interactive section where the public could ask questions and receive answers. Alternatively, based on queries received from the public, each posting could have a well thought out FAQ section.
Senior health department staff should meet on a regular basis with people in neighborhoods across the city.
The health commissioner should hold regular press briefings, standing with the mayor, during crises or impending crises.
Assuming that resources to support local public health needs, including staffing, mayors should be prepared to seek alternate sources of funding from the state, relevant foundations and corporations.
City collaboration with state health departments and other city health departments across the U.S. should be encouraged.
Conclusion
Unfortunately, we need to understand that the usual relations with and support from federal agencies and the federal government in general are changing rapidly. This means that state and local health departments will have to step up in new ways. Innovative strategies to replace federal support may yield interesting and effective new ways to safeguard the health of communities.
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