S1E44 / Science & Public Health Under Attack / Gary Kasparov, Lori Freeman, Theresa Anselmo

We have already seen what lack of leadership at the highest levels of government has impacted this pandemic, but at least at the local level, at that community level where we need it most, to be losing that is really, really concerning.

Hi, you're listening to Epidemic, the podcast about social and public health impacts of the coronavirus. I'm your host, Dr. Celine Gounder. At the start of the pandemic, Ohio got a lot of credit for taking decisive action to stop spread of the virus.

All bars in the state and all restaurants will close at 9 o'clock tonight. How long this order will be in effect, we don't frankly know.

It was one of the first states to close its schools back in March, cancel major events. The state even took the dramatic step of delaying its presidential primary. Public health experts applauded these moves. They said the lockdowns and social distancing measures saved lives. And the person behind many of these recommendations was Dr. Amy Acton, the director of the Ohio Public Health Department. Please know, everyone, this, this is the real thing. This is not a drill. This is the once-in-a-lifetime pandemic, and everything each of us does matters. But these decisions were also unpopular. Democrats in the state sued over the delayed primary. Republican lawmakers tried to strip Dr. Acton of her authority to declare a public health emergency. And then there were the protests. Open Ohio now! The line doesn't get paid till we get paid! O-H-I-O, we need access back to them! Protesters were upset about the lockdown's impact on the economy. They saw public health measures as a violation of their rights as Americans. During a protest at the Ohio State Capitol, some held anti-Semitic signs, something many say was directed at Dr. Acton personally because she's Jewish. Other protesters went to Dr. Acton's home. Some openly carried guns.

This week, Dr. Acton told me that she feels it is time for her to step down., as our Director of Health.

In June, Dr. Acton resigned her position as Ohio's Director of Public Health.

I will always believe and know that many, many lives have been saved because of the advice that I received from her and from the great work that she did.

In August, she left the state government altogether. Governor DeWine has been trying to fill the job ever since. His latest pick turned down the job in September. Why? She cited the harassment Dr. Acton received. At this recording, Governor DeWine has not appointed a new director of public health. Dr. Acton's departure is not unique.

Well, I can't speak specifically for Amy, but I can tell you after speaking with many local health officers and others that have experienced these sorts of threats and intimidation tactics that it's a very hard time for public health.

This is Lori Freeman. She's the CEO of the National Association of County and City Health Officials.

Some of these folks are simply saying enough is enough. I can't take anymore. I'm feeling risk to not only myself, but my family. And they're either making the choice to get out of the positions themselves by resigning or retiring early, or in some cases they're being fired. Fired for standing their ground to, to keep their communities safe and healthy.

Across the country, dozens of public health leaders and staffers have quit, retired, or been fired during the pandemic. We'll see why these healthcare workers are being targeted, how some politicians aren't helping, and why the loss of these public health officials may be permanent if changes aren't made. Even before Dr. Amy Acton resigned, Laurie had noticed that many of her members were facing similar pushback.

I think the biggest red flag to me was when 3 of my board members either resigned, took early retirement, or were fired.

Besides resignations and firings, Laurie also noticed a jump in retirements.

Local health officials care very much about the jobs that they do, the work they do in their community, and During a pandemic, they understand the importance of their role. So retirement during pandemic is unusual, but we are guessing around 35, it could be up to 40 by now.

Is that a lot? Is that a little bit?

It's a lot because these are coming in a short period of time since about March, April timeframes. You're only talking about a few months for that to happen.

Turnover is not uncommon in state government, especially when there's a new administration. But that wasn't the case here. So why were all these public health officials leaving?

We have heard everything from physical threats to themselves. There have been death threats.

It's gotten so bad that Teresa Anselmo, the executive director of the Colorado Association of Local Public Health Officials, has a folder dedicated to threats her members receive.

Yes, I have an— I do have an email folder called Threats.

In May, Theresa polled the 53 members of the organization about any threats they may have received.

80% of people responded that they themselves or their staff or their property had been threatened in some way, shape, or form.

Email and social media threats are the most common, but Theresa says it's not infrequent for these threats to spill into the real world.

And they're telling me that the protesters at the city council meetings talking about mask wearing are following them home or that they feel like they are being stalked. They find vehicles parked on ridges outside of their homes and they don't know who they belong to and they become very worried that they and their families are going to be harmed. And, and I will tell you that, you know, when you do drive through some of these communities and their gun racks are on the back of their truck, You do have to kind of worry if that is one of the individuals that's following you home out on a dark country road.

Theresa says many agencies no longer let their employees work alone in the office. They're afraid public health workers could be attacked. These threats have totally upended the lives of public health officials.

So a number of them don't go to the grocery store anymore. They send somebody else. They have curtailed their own physical activity because they don't want to confront folks that are upset with them.

Theresa says public health officials are supposed to report these threats to the police and the Colorado Bureau of Investigation. Many of the threats aren't deemed credible, she says, but that's hardly reassuring.

It's kind of like waiting for something to happen before they can do anything about it, which is a very uncomfortable position to be in for these directors.

And of course, politics drives a lot of the outrage. Remember that survey Teresa did of local health officials in Colorado? The one that found that 80% said they'd received threats or had property vandalized?

The follow-up question that we asked that also received an 80% positive response was whether they had had any political pressure applied up to and including the threat of being fired or the removal of funding from their agency.

We'll look at the politics of this situation after the break.

Public health is one of the few agencies locally that you can guarantee is apolitical. They just care about protecting the health of the community.

Lori Freeman says that public health leaders are there to advise elected officials about the latest science and disease control measures when there are emergencies like a pandemic. But the way the United States has responded to the pandemic has made it difficult for science to stand apart from politics.

These measures and these tactics by health officers are, are seen as political and an attempt to limit people's rights.

Elected officials are getting pressure from opponents of public health measures like mask mandates and business closures.

But when the pressure is high and people are anxious about their jobs, their economic situation, themselves, their families, the scapegoat becomes public health.

And it makes it very, very difficult then for public health directors to be that neutral advisor, the bringer of evidence and best practice into what needs to be done to address the public health issue because ultimately they either have the potential to get fired or their funding could be revoked, which would just devastate these communities because then they would be without public health leadership at all.

And this has led some to a false choice that somehow the public's health and safety is incompatible with reopening the economy.

All of us that work in public health know You cannot have a healthy economy if you don't have a healthy public. You can't have employees going to work. You can't have people producing goods. You don't have consumers purchasing goods if they're all sick or worse, dying.

Not to mention mental health, stress, substance use, housing and food insecurity. These are all public health concerns that are affected by people's economic stability.

So it really is not a true war between public health and a good economy. We can do both safely in order to stop this pandemic.

Where do you think the blame-the-messenger psychology comes from?

Well, my own personal feeling is that it comes from the top. I mean, we see this happening just at the highest levels of our government.

And as much as I respect you, Dr. Fauci, I don't think you're the end-all. I don't think you're the one person that gets to make a decision.

We can listen to President Trump taking on his CDC director, calling him confused and mistaken on two issues central to stopping the spread of the virus: masks and vaccines.

Let's start with this. So it sort of is curious. A man works for us, with us very closely, Dr. Fauci, and Dr. Birx, also highly thought of. And yet they're highly thought of, but nobody likes me.

Trump is following the footsteps of world dictators trying to control the information. But in America, it's virtually impossible because there's so many open channels and sources that help American public to know the truth.

This is former world chess champion Garry Kasparov. He's also chairman of the Human Rights Foundation and the Renew Democracy Initiative.

It's also a classical rule of any dictator. They want total control but zero responsibility.

Garry grew up in the Soviet Union. He eventually founded his own political party opposed to Russian President Vladimir Putin. But the threat of assassination for his political organizing forced him to leave Russia in 2013. Now he lives in the United States. So why are we talking to a former chess grandmaster about public health officials? Well, Garry knows a thing or two about how authoritarian governments approach science. Living in the Soviet Union and later Putin's Russia, Garry saw how the scientific approach to understanding the world was not compatible with authoritarian rule.

Instead of selling you a concept, a theory, one truth, it did something else: attacking the truth as a concept altogether. But science as a concept also is under suspicion because scientific truth stays no matter who is in power and no matter what party says today or tomorrow.

We're seeing similar behavior here in the United States. In September, Politico reported that Trump political appointees had been meddling with the CDC's weekly reports about the pandemic. The news organization said the interference was an attempt to intimidate the report's authors and bend the CDC's messaging to match Trump's rosy version of events. Both of these appointees have since left their positions. Dr. Tony Fauci told The Atlantic that he too has received threatening emails.

The person who was trying to influence the CDC and even me with emails is gone. I never listened to the person. Just don't bother me. Get out of here. I mean, that's the way it was.

And the attacks continue. The same week this episode was released, President Trump attacked FDA safety guidelines for an eventual COVID vaccine. He later threatened to withhold Medicare funds from hospitals that did not comply with his administration's plan to funnel COVID stats away from the CDC and to the Department of Health and Human Services. Gary thinks something as big as the pandemic is difficult to control with disinformation like this. People will eventually see those around them getting sick.

Now we could see that it's not working as effectively because it's more and more difficult for Trump to deny the reality. And obviously COVID-19 caused tremendous damage. But the fact is that he's trying, desperately trying to control it and to claim victory based not on real numbers, but on the numbers that he invents, I mean, demonstrates that intent is there. He is failing, but we should not be mistaken about his intents.

And that's why the administration has attacked public health officials like Dr. Tony Fauci. Garry says this is also part of the authoritarian playbook.

It's very simple. President, dictator, head of Communist Party, mafia boss, you name it. Cannot be wrong, period. If something goes wrong, you have to find a person to blame. That's it. And in America today, Dr. Fauci is the most natural target. If pandemics cannot be controlled, you have to find the person who is responsible for it, because Donald Trump cannot be criticized. And it's quite frightening that in America, we are having It's this direction where the country leader is excluded from criticism and he always finds others to blame for his own misdeeds and failures.

This level of control may suit someone like Trump in the short term, but it's bad for scientific innovation in the long run.

The science world will suffer as well as every other walk of life. Because science is about freedom. And I think America's unprecedented success in the 20th century was very much due to an ability of American scientists to experiment. Scientists who are frightened, scientists who are lying because they are afraid for their life or their life, for the lives of their loved ones, these scientists cannot be productive and creative. And that's why Eventually, dictatorships are paying a very high price for their brazen attempts to control science as they control every other walk of life.

The United States is not China or Russia. Gary says there's a lot about American democracy and its press freedoms that make this kind of authoritarian control difficult. But it shouldn't be taken for granted.

I think people should recognize that even America is not immune, let's use this medical term, it's not immune against the virus of dictatorship. It's all about us today being engaged and actively participating in democratic process. And looking at 2016, we should remember that It was not about 70,000 or so votes that decided the elections in 3 battleground states, but it's about 100 million people who didn't vote at all.

We've paid a lot of attention to the federal government's response to the pandemic, but public health is something that, by and large, happens at the local level. And during a pandemic, these are thankless jobs.

If I could sum it up in one word, it would be exhausting.

Theresa Anselmo again.

They have been responding to COVID before the first case was confirmed, and how they have become villainized and how this has become such a politicized issue, it has been quite detrimental to the public health field here in the state of Colorado.

Theresa says they're trying to help these public health workers cope with the stress.

We have a text group that we often send each other inspirational messages or quotes or say, "I'm having a really tough day today," and then everybody rallies behind that person and helps support them through that tough time that they're having. It's been really, actually, wonderful to see this group of public health directors come together and support each other. And how supported they report they feel because of this opportunity to talk together.

Lori Freeman says her organization has been doing advocacy to reach elected officials to make sure they understand the importance of public health. She says they're also pushing to add health officials to the list of government workers whose personal information is not available to the public. But many public health officials have quit, retired, or been fired. These protections didn't come in time. And these vacancies are on top of health departments that have already lost upwards of 20% of their staff to budget cuts over the last decade.

This is when we needed public health and the infrastructure to be its strongest, and it's perhaps its weakest at this point. So It is no wonder why we're struggling with this response.

So the question is, who's going to replace these public health workers?

You have to wonder how many people want that job right now. It's a very difficult job. There's enough stress and strain to go around the whole health department. They see what these health officials go through at every level of staff. So it is going to be It's going to be challenging to fill these positions.

The pandemic has exposed flaws in many of our institutions, and public health is no exception.

We have a $3.6+ trillion healthcare budget, and 3% of that goes towards public health and prevention activities. So our priorities are, are messed up. We have to reprioritize prevention and public health and reinvest in that infrastructure and fill those cracks and rebuild that workforce so that we can get out of this and so that we're ready for the next time. COVID-19 is not the only thing that's going to ever impact this country, and who knows what's right behind it.

Epidemic is brought to you by Just Human Productions. We're funded in part by listeners like you. We're powered and distributed by Simplecast. Today's episode was produced by Zach Dyer and me. Our music is by the Blue Dot Sessions. Our interns are Annabelle Chen and Brian Chen. If you enjoy the show, please tell a friend about it today. Today. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. You can learn more about this podcast, how to engage with us on social media, and how to support the podcast at epidemic.fm. That's epidemic.fm. Just Human Productions is a 501(c)(3) nonprofit organization, so your donations to support our podcasts are tax deductible. Go to epidemic.fm to make a donation. We release Epidemic every Friday, but producing a podcast costs money. We've got to pay our staff, so please make a donation to help us keep this going. And check out our sister podcast, American Diagnosis. You can find it wherever you listen to podcasts or at americandiagnosis.fm. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. In season 1, we covered youth and mental health. In season 2, the opioid overdose crisis. And in season 3, gun violence in America. I'm Dr. Celine Gounder. Thanks for listening to Epidemic.