History Repeats Itself: Pandemic, Politics, and Public Health

More than three months since the beginning of coronavirus lockdowns and stay-at-home orders, President Donald Trump tweeted for the first time a photograph of himself wearing a mask. After months of mixed messaging from the federal government, the act of wearing a mask has become politicized. Anti-mask propaganda is widely circulated on social media sites, with trending hashtags like #maskscauseillness and #nomasksneeded. Despite a large body of scientific research confirming the efficacy of face masks in reducing the transmission of respiratory viruses (MacIntyre et al, 2009; Milton et al, 2013; Liang et al, 2020; Leung et al, 2020) and prominent public health organizations like the CDC and WHO recommending their use, masks have evolved into a political painpoint, with proponents shouting common sense and opponents viewing mask mandates as attacks on individual freedom. How did we get to this point? 

While many have decried the politicization of science and public health, medical responses to diseases have always been heavily intertwined with the political climate. From the earliest cases of yellow fever in 1793, a political debate emerged on the most effective treatments: mercury and bloodletting, suggested by Dr. Benjamin Rush from the Democratic-Republican Party, vs. milder treatments such as quinine-rich cinchona bark, favored by Alexander Hamilton from the Federalist Party. Public opinion on this matter was largely determined by the media outlet people received their news from, but these conflicting arguments in the political spotlight prevented much of the progress in finding an effective solution. 

In another example, the polio eradication movement of the 1930s gained much of its momentum from President Franklin Delano Roosevelt’s own experience with the disease. Polio outbreaks in the U.S. at the time afflicted more than 35,000 people each year, and the March of Dimes campaign, headed by FDR himself, raised around $66.4M USD to support research and awareness (Goldberg, 2012). In contrast, around that same time, the American Cancer Society, American Heart Association, the National Association for Mental Health, and the Arthritis Foundation raised a total of $37.3M USD, even though the combined prevalence of these chronic illnesses was more than 900 times that of polio (Oshinsky, 2005). 

In short, we cannot avoid the politicization of public health. The political climate shapes which the public health focuses are deemed important and how proposed policies and programs are implemented. The biggest health agencies are federal entities whose actions are privy to the attitudes of the dominant political party. But why does there seem to be a huge gulf between public health advocates and political leaders, as seen in today’s news with Trump and Dr. Anthony Fauci? 

The conflicts that we see today can be largely attributed to fundamental philosophical differences between the roles of political actors and public health champions. Public health officials are trained to focus on prevention of death and illness and achieving quantifiable improvements in health and quality of life, but are often less likely to focus on the social or economic consequences of planned interventions. Their proposals are usually geared for the long-term and require the diffusion of responsibility among a myriad of stakeholders. Public health scientists fear that politics will trump science, and their voices will be suppressed in the political process. Politicians, on the other hand, often have to consider a more holistic view and make decisions where economic and ideological factors are valued over scientific considerations (Hunter, 2016). They are more likely to focus on short-term and visible outcomes and less likely to focus on population health based on the priority of their voters and their future electability (Brown, 2010). Additionally, many elected officials have limited training in the scientific or public health fields, making the language and evidence of public health proposals inaccessible. So, what needs to be changed?

Lucky for us, history has given us many model examples. Many of our top public health achievements have occurred through the work of public health officials openly engaging the political system at local and federal levels. For instance, second-hand tobacco smoke exposure has been tackled at the federal level with the ban of smoking on commercial airplanes and in federally owned buildings, while local governments have passed laws prohibiting smoking in public facilities and workplaces. Public funding programs for vaccinations like the federal Vaccines for Children program as well as local school requirements for vaccines have virtually eliminated once-common childhood diseases like measles and chickenpox (CDC, 1999). 

In order to ameliorate the fractured relationship between public health and politics in the face of COVID-19, public health officials can be cognizant of nonscientific factors that can influence political decisions and frame policies that capitalize on shifting political dynamics. Politicians are elected to improve the lives of their constituents and should be aware that a poorly handled public health crisis reflects on their leadership and can increase public mistrust decades down the line. Elected officials can recognize science and acknowledge its importance in decisions, even if it’s not the only element they consider. They can proactively engage public health officials in problem-solving the issues politicians are focused on as well instead of waiting for proposals to be brought to them. Creating this open discourse can ultimately empower communities and lead to the creation of more sustainable health programs.  The political system can be a powerful vehicle to affect lasting and population-level change, and the health of the population is similarly important and correlated to the economic viability of a nation. 

Disjointed recommendations and conflicting messaging from public health agencies and the federal and local governments chip away at public trust. In the case of masks, these opposing opinions have made it extremely difficult to establish a coherent plan to tackle COVID-19 and have led people to other sources for information, such as social media. The lack of clear messaging about this pandemic has led people to believe that COVID-19 is a hoax, openly  disregarding the guidelines that can keep others safe. When lives are at risk, it is beyond important to consider how arguments at the top only lead to more loss for those they supposedly serve. 

Works Cited:

Brown, L. D. (2010). The Political Face of Public Health. Public Health Reviews, 32(1), 155–173. https://doi.org/10.1007/BF03391596

Centers for Disease Control and Prevention (CDC). (1999). Impact of vaccines universally recommended for children—United States, 1990-1998. MMWR. Morbidity and Mortality Weekly Report, 48(12), 243–248.

Goldberg, D. S. (2012). Against the Very Idea of the Politicization of Public Health Policy. American Journal of Public Health, 102(1), 44–49. https://doi.org/10.2105/AJPH.2011.300325

Hunter, E. L. (2016). Politics and Public Health—Engaging the Third Rail. Journal of Public Health Management and Practice, 22(5), 436–441. https://doi.org/10.1097/PHH.0000000000000446

Leung, N. H. L., Chu, D. K. W., Shiu, E. Y. C., Chan, K.-H., McDevitt, J. J., Hau, B. J. P., Yen, H.-L., Li, Y., Ip, D. K. M., Peiris, J. S. M., Seto, W.-H., Leung, G. M., Milton, D. K., & Cowling, B. J. (2020). Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine, 26(5), 676–680. https://doi.org/10.1038/s41591-020-0843-2

Liang, M., Gao, L., Cheng, C., Zhou, Q., Uy, J. P., Heiner, K., & Sun, C. (2020). Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Medicine and Infectious Disease. https://doi.org/10.1016/j.tmaid.2020.101751

MacIntyre, C. R., Cauchemez, S., Dwyer, D. E., Seale, H., Cheung, P., Browne, G., Fasher, M., Wood, J., Gao, Z., Booy, R., & Ferguson, N. (2009). Face Mask Use and Control of Respiratory Virus Transmission in Households. Emerging Infectious Diseases, 15(2), 233–241. https://doi.org/10.3201/eid1502.081167

Milton, D. K., Fabian, M. P., Cowling, B. J., Grantham, M. L., & McDevitt, J. J. (2013). Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks. PLoS Pathogens, 9(3). https://doi.org/10.1371/journal.ppat.1003205

Oshinsky D. M. (2005) Polio: An American Story. New York: Oxford University Press.