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  • Writer's pictureThe San Juan Daily Star

When public health loses the public



Sam Whitney/The New York Times

By Pamela Paul


“Put on your masks!”


My son and I were cycling during the pandemic when a passerby furiously screamed that in our direction. I shouted back something too long about updated recommendations on masking outdoors and was left yelling into the wind, my kid giving me the “Calm down, Mom” look.


We all had our uncalm moments during the pandemic. What rankled me during this one was that the science was on my side. Yet here was someone in my community operating within a completely different framework.


In his new book, “Within Reason: A Liberal Public Health for an Illiberal Time,” Sandro Galea, the dean of the Boston University School of Public Health, looks to his own field to explain the animating forces behind some of those disputes.


Despite remarkable successes, Galea argues, public health succumbed to a disturbing strain of illiberalism during the pandemic. This not only worsened the impact of the pandemic, it also destabilized public health institutions in ways that will serve us poorly when the next crisis comes.


Any pandemic finger pointing has to begin with Donald Trump, whose fecklessness in the face of crisis pinballed between falsehoods and crackpot science before settling into outright denialism.


Much harder for non-Trumpers is to recognize that many on the left, including those in the progressive field of public health, reacted with ideological intransigence. If Gov. Ron DeSantis of Florida said masks off, blue states encouraged mask wearing, even while students competed in sports or sat in preschool classrooms. Last summer, Francis Collins, the former head of the National Institutes of Health, admitted that the “public health mindset” had been too narrowly focused, which he now calls a mistake. “You attach a zero value to whether this actually totally disrupts people’s lives, ruins the economy, and has many kids kept out of school in a way that they never quite recovered,” he said.


Galea’s point is not to relitigate COVID’s sore points but to ask: If Americans have come to distrust public health advice, what role may public health officials have played in fostering that distrust?


During the pandemic, states, municipalities, school districts, businesses — sometimes using guidance from public health organizations and sometimes ignoring it — often relied on what felt right as opposed to empirical data. American health experts advocated almost universal child vaccination; meanwhile, in Europe, experts cautioned against vaccinating young children, who were at low risk for serious illness, without more long-term data. “Were we pushing to vaccinate children for their sake or for ours?” Galea asks. “Were we doing it to support health or to make a political point?”


Scientists should have made more nuanced risk assessments and revisited them regularly. They should have taken into account the consequences and the disproportionate impact of strict lockdowns on lower-income workers and at-risk youth. This zero-sum mode of thinking — neglecting to take into account one’s own biases, succumbing to groupthink, operating according to the expectations of one’s “side,” discouraging good-faith debate — persisted even as the pandemic eased.


“We need to have the courage to act in the way that overcomes fear, building on what the data shows us,” Galea told me, “even though there are activist voices that have captured the public conversation.”


Some pandemic mistakes were inevitable, especially when data was scarce. But others betrayed an ideological intransigence. The obvious example was long-term school closures, mostly in blue states, which we now know caused significant delays in learning, especially among the most vulnerable populations with the fewest resources. In many places during the pandemic, to suggest that kids might suffer learning loss or social and emotional consequences was tantamount to wishing death upon teachers. Forbidding socializing among young children denied them the development of social skills, yet to advocate otherwise could get you kicked out of a parent group chat.


If those were merely mistakes of the past, lessons learned, it would be easy to move on. Unfortunately, this tendency to view “core issues in Manichaean terms, with certain positions seen as on the side of good and others on the side of evil, with little gray area between,” as Galea puts it, has continued to inform public health post-pandemic. To politicize public health, cave to public sentiment and social media pressure and prioritize influence over the pursuit of truth, Galea says, puts all of us at risk.


It also undermines public faith in science, one of the few institutions that had maintained a high level of trust into the Trump era. According to the Pew Research Center, the percentage of Americans who believe science has a mostly positive effect on society dropped to 57% in 2023, from 67% in 2016. Those who say they have a great deal of confidence in scientists dropped to 23%, from 39% in 2020. And these declines took place among both Republicans and Democrats.


A contagion doesn’t care about political parties or Twitter sinkholes. Public health must transcend an us-vs.-them mindset to promote the common good across the political spectrum. Galea makes a powerful case that to carry the worst illiberal outcomes from the pandemic into the next crisis would be a devastating mistake.

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