Poor public health policies in some states are creating key pockets of susceptibility with the potential to fuel outbreaks across state lines. Abandoning mask use risks breakthrough infection among the vaccinated and mass infection among the unvaccinated, as we are now seeing with the surge in cases and deaths driven in part by the spread of COVID-19’s more transmissible Delta variant. Los Angeles County was wise to once again mandate universal mask wearing in response to the spike in infections there. Other jurisdictions where cases are mounting should follow suit. This is why we need to be deeply concerned by emerging policies and practices that are sidelining public health evidence and authority. We recommend three actions to counteract these dangerous trends:
1. Fully support public health messengers. Leaders at the National Institutes of Health and the Centers for Disease Control and Prevention, state and local health departments, and responsible elected officials have paid a heavy price for speaking forthrightly about pandemic control. While front-line medical providers are appropriately lauded, public health protectors have been derided, threatened (sometimes along with their families, sometimes by armed protestors), and fired or forced to resign.
When seasoned experts are forced out of office, we lose the benefit of their invaluable experience. Organizational transitions are always disruptive, but particularly at a time of crisis. Potential successors may be reluctant to fill leadership roles that are sure to subject them or their families to personal attacks.
2. Don’t join the anti-science chorus. Over the course of the past four years, the CDC — long considered a global beacon in the world of disease control — was sorely tested by interference from the White House and others. This is not new. Fatal earlier examples included the White House’s pressure on the CDC during the AIDS epidemic related to explicit public educational material, needle exchange and condom availability.
Now, as then, administrative overreach has cost countless lives. In the case of COVID-19, state and federal elected leaders have spurned the substantial public health science expertise of their own health departments or other organizations. Elected officials at every level of government have also attacked the science itself, fueling the rejection of vaccination and mask use, fomenting skepticism about the CDC and encouraging segments of the public to embrace untested treatments.
More worrisome are moves by policymakers to prevent sound public health action. In New York state, the governor’s temporary emergency powers were repealed. In Florida, new policies not only have invalidated local COVID-19 restrictions but limited future governors’ powers to impose statewide orders. Ohio's Legislature also has sharply checked executive control over emergency orders. In Texas, the governor has issued orders to block cities from issuing more stringent masking requirements. Unlike Los Angeles County, where a mask mandate has been reinstated, Austin, Dallas and Houston can no longer protect their citizens with the arsenal that Los Angeles County is using.
3. Encourage vaccination, but not through early abandonment of social distancing and masking. Vaccination has been the single most important tool in bringing the pandemic under control, yet all but nine states and the District of Columbia have legislation passed or pending that would effectively prohibit mandatory vaccination under various or all circumstances. In Kansas, legislation is pending that, as part of a COVID-19 “bill of rights,” would prohibit physicians and nurses from promoting vaccination. Pending legislation in Arizona would make it a felony to incentivize vaccination.
Requiring a mask likely does not undermine vaccination motivation, while early abandonment of social distancing and masking clearly does. But those who are unmotivated to be vaccinated due to scientific skepticism, political affiliation or discomfort with the health-care system now feel that they can abandon masks with impunity in light of current policies allowing the unvaccinated to be unmasked indoors and in crowds. According to data from the Kaiser Family Foundation, vaccination rates plateaued as more localities opened up and lifted restrictions. The threat from pockets of vulnerability becomes more urgent as viral variants become more transmissible and, as new data out of Israel and Scotland underscore, reduce the efficacy of current vaccines.
A dramatic decline in the rate of infection for vaccinated individuals masks a stark fact: Infection rates among the unvaccinated remain as high as in January, when the epidemic was peaking, and are rising dramatically in some communities with large swaths of unvaccinated people. Fourteen states still have fewer than 40 percent of the eligible population fully vaccinated, and 18 states have fewer than 50 percent even partially vaccinated. As of June 11, only seven major cities had provided initial vaccines to 70 percent or more of their residents, and disparities by race and ethnicity continue to persist.
The miraculous efficacy of the vaccines, along with the proven capability of masking and social distancing to dramatically limit the spread of COVID-19, give us a genuine opportunity to defeat the pandemic in this country. But if we cannot find ways to bridge the political gap in approaches to COVID-19 and support our domestic and global public health authorities by adhering to the best scientific advice, we are in for a long-haul pandemic of enormous consequence.
Cheryl G. Healton is the dean and professor of public health policy and management at the New York University School of Global Public Health. Amy Lauren Fairchild is the dean of the College of Public Health and professor of health services management and policy at The Ohio State University.
Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
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