Stephanie Zaza, MD, MPH, FACPM is the President of the American College of Preventive Medicine, a professional medical association of physicians dedicated to prevention and preparedness. She is a 25-year veteran of the US Public Health Service at the Centers for Disease Control and Prevention, where she participated in federal responses to the 2009 H1N1 influenza pandemic and the 2013 MERS coronavirus threat.
Back in March I was pressed by a reporter to declare that CDC was being politicized. The clear intent was to engage me in taking sides regarding politics versus science. It was a difficult situation in which to find myself. On the one hand, I am no longer a federal scientist and can speak freely. On the other hand, many of the organizational members I represent are employed in Federal agencies; what I say on behalf of them has consequences.
During that interview I spoke cautiously and expressed my support for and belief in the effectiveness of the established structures for pandemic response throughout the Federal government I knew to be in place, especially at CDC. Of course, I was concerned about how the COVID-19 response was being handled. But I feared the subtleties of public health politicization would be lost on a reporter who hoped only for a quote from a former CDC medical officer expressing criticism of her former agency or the current administration.
Politics and “politicization” are not new to public health under this administration or during this pandemic. One definition of politicization is, “the action of causing an activity or event to become political in character.” Public health is inherently political in character. It deals with the body politic. Policy is an important tool for population health improvement, but the science behind public health policy often challenges strongly held economic or religious philosophies. It has always been a function of public health to find solutions that balance numerous considerations – driven by science but adapting to the economic and social mores of the time.
If I have any criticism of CDC it is that it has, for many years, tried to navigate this inherent politicization through subtle forms of self-censorship. Because CDC’s budget is provided solely by Congress, it has had to walk a careful line to not risk its utter destruction. Gun violence, sexual health education, abortion, environmental health, vaccines. These are just a few of the topics for which we need additional research but also have more than enough solid science to support clear policies. But CDC has always been extremely cautious in whether and how it addresses these highly politicized issues to protect its overall mission and budget. This long, slow, historical self-censorship changed how CDC viewed its responsibilities and reinforced the idea among public health scientists that public health is apolitical.
I struggled to articulate these subtleties back in March – that public health is inherently political and politicized, that CDC has long been treading these waters but with dangerous consequences, and that I nevertheless remained confident in CDC’s ability to rapidly and effectively respond to COVID-19. At the time, I perceived the real danger to be that the political rhetoric threatened to destroy the public’s confidence in CDC’s ability to respond. Ultimately, that fear has come to pass, enfeebling both the response and our long-term confidence in public health.
In retrospect, I realize that the real question was not whether CDC was becoming politicized, but whether it was being corrupted by those politics. If asked in March whether CDC or any other Federal agency was at risk of having its decision-making and recommendations distorted or misused by politics, I would likely still have been optimistic that those agencies would be protected by long-standing and stringent safeguards. Although not perfect, these safeguards have stood the test of time and are rigorously enforced, reviewed, and updated. A few of those safeguards are:
- Federal executive branch employees, including in public health agencies, are strictly limited in their partisan political activity and protected from partisan coercion by the Hatch Act.
- Procurement laws require open competition for scientific grants and contracts to prevent favoritism or biased research findings.
- Onerous annual financial disclosure requirements prevent decision-making from being corrupted by personal financial gain.
- Strict ethics rules regarding who can serve on advisory committees aim to prevent individual interests from swaying recommendations.
- Protection of personally identifiable information and vulnerable research subjects seeks to balance the speed of progress with the protection of individuals to prevent repetition of past atrocities.
- Strict rules of evidence have been established to prevent corporate financial interests from driving regulatory approvals.
Over the past six months, the Administration has violated, ignored, or questioned the purpose of these and other safeguards. It has used political rhetoric that mis-represents data and disparages public health officials. The failure to mount an effective public health response to COVID-19 is only one of the tragic consequences. The loss of the public’s confidence in science, health recommendations, and medical product safety – decades in the making – will be destroyed. Public health is not being politicized. It is being corrupted. It is time to speak out.