Sectarianism and the public’s health | The Healthiest Goldfish

A recent Kaiser Family Foundation analysis found that Americans who have not been vaccinated are now three times likelier to lean Republican than to lean Democrat. The persistence of vaccine hesitancy has kept vaccine uptake from being as widespread as it might be, helping prolong the pandemic. Its intersection with political partisanship suggests the role sectarianism plays in this. Vaccine hesitancy is, in many ways, a phenomenon of mutual incomprehension. The hesitant, for a range of reasons, are not able to see why so many would find the vaccines safe enough to take. And the vaccinated, particularly those in the public health establishment, cannot see why anyone would refuse an effective vaccine in the midst of a deadly pandemic. This divide mirrors other divides in the US; most notably, as the new analysis reflects, the red versus blue divide that has long characterized our politics.

The story of vaccine hesitancy, then, is, in large part, a story of sectarianism. I would argue that a key reason why the issue of vaccine hesitancy remains so intractable is because we have failed to fully reckon with the degree to which hesitancy is shaped by the larger story of division in this country. Certainly, we have acknowledged division, bemoaned it, but in terms of actually addressing it, we have done little. When it comes to vaccine hesitancy, much of our effort has been directed towards simply making the case for greater education about vaccines and for more expansive mandates. In doing so, we sidestep the central issue, one which is core not just to vaccine hesitancy but to how we collectively engage with the forces that shape health.       

Given this challenge, it seems helpful to take a step back and look at the role of sectarianism in our thinking and behavior around issues that matter for health, and at how we can address sectarianism towards shaping a better engagement with these issues.

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Covid-19 Profits and Profiteering | The Turning Point

Since March 2020, forty million Americans filed for unemployment payments. Meanwhile, 40 new billionaires took their places on the world’s richest lists, with many new fortunes created by the pandemic. Culture war grifters have made new fortunes selling alternatives to vaccines. Foreign swindlers have taken advantage of the huge transfer of wealth from federal programs to US households. While the era of the Covid-19 pandemic has been about human lives, it has also turned out to be a real workout for capitalism.

Executives and the biochemists with stakes in the companies that developed vaccines have made incredible profits, as have those running the contract research organizations that directed the clinical trials, and those directing the glass manufacturing businesses that make vials for the vaccines. Riches have come to those who led companies that made gowns and face masks, gloves and hand sanitizers, and those who produced diagnostic tests, digital x-ray analysis systems, and pulmonary products like oximeters. Those who created software for scheduling appointments at mass vaccination sites did as well as antibody treatment manufacturers and home delivery services.

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The challenge of slow-burning threats. | The Healthiest Goldfish

A few weeks ago, the 2021 United Nations Climate Change Conference, known as COP26, was held in Glasgow, Scotland. The meeting reflected a global effort to address climate change. Climate change is a unique challenge, in that it poses an existential threat, yet its effects have accrued so gradually over time that, until recently, it has been difficult to rally support for addressing the problem. In considering climate change, I have found myself thinking about other slow-burning threats, and how we often fall short in addressing them. For example, on May 15, 2017, TIME magazine ran the following cover story:

Source: TIME Magazine Web site. https://time.com/magazine/us/4766607/may-15th-2017-vol-189-no-18-u-s/. Accessed October 8, 2021.

The TIME cover story reflects one of the most perplexing realities of the COVID-19 pandemic: we saw it coming. We did not know specifically that a pandemic would strike in 2019. But we were long aware of the likelihood that such a contagion would emerge, and we knew it would probably happen relatively soon. Yet when COVID-19 did come, it looked very much like it caught the world unawares. Our response was a chaos of good ideas and bad ideas, good implementation and bad implementation. Many of these shortcomings can, of course, be ascribed to poor—or, at best, inconsistent—leadership. US leadership, in particular, was in the midst of immense disruption and transition when the pandemic struck, with the unprecedented figure of Donald Trump in the White House and a presidential election like no other culminating in November of 2020. It was perhaps unavoidable that these circumstances would shape the coherence of our pandemic response. Indeed, there is a temptation to lay all our failings during COVID at the feet of the unique political moment in which it unfolded. This temptation may be particularly acute for those of us in public health, who have an interest, human beings that we are, in not always facing our shortcomings as squarely as we might.

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Should We Mandate Vaccines for All? | The Turning Point

The triumph of the Covid-19 pandemic has been the development of safe, effective vaccines in mere months.  Vaccines are costly and slow to develop, and yet we had two, from Pfizer/BioNTech and Moderna, available within about eight months of the arrival of Covid-19 in the US, each with more than 90% efficacy. That is a remarkable technical achievement and represents the culmination of years of investment in the development of mRNA as a viable vaccine delivery platform. The rollout of vaccines at the beginning of 2021 was met with deserved enthusiasm, and predictions of a “summer of freedom” when sufficient numbers of people would be vaccinated to have essentially curtailed the spread of the Covid-19 pandemic.

And yet, once vaccines were made widely available, uptake was far slower than had been generally anticipated in the euphoria. While a substantial proportion of Americans rushed to get vaccines—and we were among that group—the number of people willing to get vaccinated soon stalled, with more than a third of Americans hesitating or downright refusing. This, reasonably enough, occasioned its fair share of public consternation and discussion about how best to increase the proportion of Americans vaccinated.  

This conversation inevitably turned to mandating vaccines for adults, recognizing that that would create the conditions for a more rapid return to “normal” functioning. Many workplaces did indeed mandate vaccination, leaning on their prerogative to create safe workplaces. This was initially a phenomenon of private workplaces, but soon extended to public sector employers such as fire departments and schoolteachers. The question then of course extended to whether we can, or should, mandate vaccines for all adults.

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Public health and tradition | The Healthiest Goldfish

As we prepare for Thanksgiving this week, I have been reflecting on the importance of tradition, and how we can weave together the past with the future. Public health is, by nature, forward-looking. We aspire to a progressive vision of the future, one that supports health through a radical reimagining of the status quo. This calls on us to envision new ways of structuring our world, with an eye towards optimizing it for health. Our pursuit of this vision leads us to explore novel approaches to supporting health, to innovate, and to embrace new ways of thinking about, and living in, the world. The most high-profile recent example of this is the emergence of mRNA vaccines, which have done so much to help address the COVID-19 pandemic. And it is worth recalling that public health tools and interventions we now take for granted—like hand-washing, public sanitation, and designing urban spaces with an eye toward health—were once new, radical even. Their success speaks to the importance of a public health that is moving ever-forward, eyes fixed on the possibilities of the future. I have written previously on why we need to keep evolving as a field, to continually hone our focus on what matters most for health. This emphasis on progress supported by collective forward momentum is close to the bone of public health, part of our field’s DNA, and rightly so.

Having established that this vision of progress matters, we can then ask—is it all that matters? Is a relentless focus on the future both necessary and sufficient for getting us to a healthier world? It strikes me that such a focus is not, in fact, enough. For public health to be most effective, it should balance a focus on the future with a respect for—and willingness to learn from—what has served us well in the past. We should pay special attention to what has been handed down to us through the generations—namely, tradition. A focus on tradition also aligns with the themes of the Thanksgiving season, as we pause to reflect, with gratitude, on all we have. This reflection can inform an appreciation of the best of our traditions and how tradition has helped shape a healthier world. Some thoughts on why tradition matters, and how thoughtful engagement with tradition can help us create a better future.

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Mismanaging Messages | The Turning Point

There was never going to be flawless public communication around Covid-19, a new illness that raised an array of novel scientific and sociological issues. Even with this lens, communication about the pandemic has been particularly fraught. The Trump presidency was characterized by repeated lies, and more recently the Biden presidency has demonstrated premature optimism, offering first a “freedom summer” when we were to be largely over Covid-19, only to see the delta wave sweep the nation, and in the fall of 2021, sweeping and premature scientific statements about booster vaccines.

In August, President Biden announced that a Covid-19 vaccine booster should be administered to all Americans already vaccinated. “Just remember as a simple rule, eight months after your second shot, get a booster shot,” Biden said, promising a booster roll-out in a month. Federal health agencies then weighed in, and their opinions had to be shoehorned into the basic shape Biden had offered so as not to contradict his original statement. Yet a month later, when the vaccine was to be available “to all,” only one type of booster had been approved, and only for the elderly, persons with workplace exposure to Covid-19, nursing home residents and immunocompromised people who had received that type of vaccine originally.

The confusion about whether boosters should be taken, and by whom, reflects what happens when policy makers jump to too simple conclusions from still unsettled science. When Biden made his announcement no one really knew the connection between antibody responses (which the booster promised to increase) and duration of human protection. Whether boosters would actually protect against infection, or re-infection, was simply not clear. This then complicated our thinking around boosters, why we may need boosters to begin with. Was the aim of a booster to reduce ongoing viral spread by curbing, at least temporarily, milder infections? After all, the initial vaccinations were continuing to limit the worst effects of Covid-19 in the United States. Would a booster, urgently delivered, save lives? And should we have been focusing on additional vaccinations for Americans before the elderly and health workers in many low-income countries could receive a single dose?

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A populist public health | The Healthiest Goldfish

Ever since roughly 2015, much has been written about populism. The catalyst for this was three political events, all occurring within months of each other. First, there was the rise of Donald Trump and Bernie Sanders in the presidential primaries of 2015—2016. Each in his own way seemed to speak—one from the political left and one from the political right—to the concerns of working-class Americans who felt marginalized by globalization and what they perceived as the misrule of social and economic elites. Sanders addressed this by calling for an ambitious program of redistributive economic policies to level a playing field which had long been uneven. Trump’s argument, too, was partially economic, embracing protectionist trade policies and hostility to NAFTA. He was also—rhetorically, at least (his policies in office would prove another matter) more sympathetic to the existing welfare state than many Republican candidates of the past. But his populism was tinged with racist and xenophobic overtones, which both fueled his political ascent and arguably poisoned the well of our public discourse in ways from which we have not yet recovered. Largely because of Trump, much of the discourse around populism was primed to view the phenomenon as, on the whole, a negative influence—crude, anti-intellectual, and even racist. This view was seemingly confirmed in the months before the presidential election, when voters in the UK chose to leave the European Union. This move was seen by many as motivated by reaction to high levels of immigration and by hostility towards the bureaucratic elite running the EU. Widespread fear of the potential economic and political ramifications of the Brexit vote meant that it, too, would do no favors for populism’s reputation, at least among those not part of the demographic which had already proven receptive to a populist message. Then there was the rise in populist far-right parties throughout Europe, reflected in the figure below. This, too, has cast populism in a negative light, and helped it become, for many, synonymous with far-right politics in general.

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False Confidence and Our Covid-19 Failings | The Turning Point

In 2009, President Obama declared a national emergency eleven days after the first case of swine flu was reported. Because recovery from the devastating Great Recession was the priority of the day, President Obama never shut down cities or business or schools. Republican governors and Congress fell in line quickly behind the Obama administration’s health decisions, perhaps because the most vulnerable to infection were children and those under 30 years old.  Funding decisions faced little opposition. Biologically, we got lucky. Swine flu turned out to be far less lethal than Covid-19. Although vaccines arrived late, after most infections had happened, fewer than 15,000 Americans died even as at least 60 million Americans were infected.

We had been lucky before. While in 2003 SARS resulted in the quarantine of thousands in Toronto, its effect was barely felt in the US. Other outbreaks like Ebola have barely touched our shores.

This good fortune perhaps left us with a false sense of confidence about our ability to weather pandemics. That false sense of confidence may have been disastrous in the context of Covid-19.

The Trump administration waited 53 days after the first case of Covid-19 was detected in the US to declare a national emergency. During those weeks, the president himself declared the virus “is going to disappear” like “a miracle.” The administration’s public health arm at the CDC was scared and silenced. The threat was dismissed.

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