Public health has been through an extraordinary period over the past two years. Between December 31, 2019, and today, millions of people died, economies slowed, and unemployment reached record levels in many countries, all stemming from a pandemic that had been unknown two years ago. In the United States, COVID-19 was the third leading cause of death in 2020 and resulted in a downturn in life expectancy unprecedented since World War II.
I was the executive director of the Utah Department of Health from 2005 to 2011, appointed by Governor Jon Huntsman. During my tenure, we also experienced a “pandemic” of a “novel virus,” the H1N1 variant, in 2009 and 2010, which the Centers for Disease Control and Prevention estimated killed 151 700 to 575 400 people worldwide. Utah was among the first states affected, but it had relatively low mortality because of a prompt and effective response (I believe we succeeded in immunizing approximately 70% of our state’s population). Looking back on this time, it seems almost trivial compared with the current, protracted COVID-19 pandemic. I can assure you, though, that it was a very serious threat at the time, and tragic for those who died, many of whom were younger than those who die from the typical viral flu. But because it was relatively short-lived, we did not experience the resistance to public health efforts to combat the infection.
Now is a very different time. We have a stubborn germ that changes—“mutates”—into different variants. This has required our public health response to also adapt to these changes, which unfortunately has been interpreted by some to be “flip-flopping” when they update recommended safety practices. Fortunately, we have safe and effective vaccines to prevent COVID, which has undoubtedly saved millions of lives worldwide. But it is apparent that among our fellow citizens there are serious philosophical differences, including deeply held beliefs by a minority of the population related to the role of government in regulating our lives. These views have been vigorously expressed in the media—some political, some personal—and to some extent have hindered our efforts of mitigate the consequences of this infection. Notwithstanding this facet of our society that values freedom of expression, our collective public health efforts have overall been successful: we have been able to make the vaccine available to the 85% of the population that wants its protection. Thus, the noisy political debate does not reflect this acceptance of public health policies by a significant majority of Americans.
I am a primary care physician who has had the unexpected opportunity to also work in developing public health policy and administering public health programs—at the national and state levels—for many years. As a Republican, I hold dear certain principles that include limited government in most aspects of our lives, prudence in spending taxpayers’ dollars, assurance of a strong national defense, and promotion of free enterprise. I also think there is an important and essential role for government in ensuring the health and well-being of all of our citizens, and this requires providing public education about safe health practices, information about risks to our heath, and the resources to fight a pandemic—for example, support for proven efforts, such as vaccines, and personnel who are so essential at such times.
I call upon everyone to respect each other, to not demonize the detractors of public health, and—for those who are resistant to government recommendations—to recognize the benefits to all that will result from containment over time. And I call upon my colleagues in public health to demonstrate some humility, to acknowledge that broad-scale lockdowns of entire communities, school closures, and mandates have not proven as effective as hoped, and have been very costly, both economically and on our emotional health. The world’s slow exit from COVID-19 will be a time for reflection and careful reconsideration of what really works and what hasn’t, and for learning from the many other voices that have emerged in the past five years.
8. Years Ago
A Pincer Movement Between the Courts and Public Health
2013 was not kind to efforts to use the law to protect public health. In July the Appellate Division of the New York Supreme Court affirmed a lower-court ruling enjoining New York City’s innovative ban on the sale of large sugary sodas. A few months earlier, the Food and Drug Administration . . . announced that it would not appeal a federal appeals court ruling striking down regulations requiring graphic warning labels on cigarette packages. . . . [T]hese decisions are emblematic of a worrisome development. . . . [A]dversaries of public health laws have won several high-profile court challenges . . . [that] have helped to shift legal doctrine in ways that present new dangers for public health . . . [and] are also likely to strengthen public health’s opponents. . . . Along with an ideological climate suspicious of government’s ability to solve problems, powerful political and economic interests have supported the development of these troubling doctrines. . . . [P]ublic health laws will be most secure in court only if and when the public believes that laws can provide effective and appropriate solutions to health problems they care about.
From AJPH, March 2014, pp 392–396, passim
17. Years Ago
Public Health and the Diminishing Legacy of Jacobson v. Massachusetts
One hundred years ago, the US Supreme Court handed down a 7-2 decision in the case of Jacobson v. Massachusetts that upheld the right of states to enact compulsory vaccination laws. In asserting that there are “manifold restraints to which every person is necessarily subject for the common good,” the Court took a firm position on one of the most challenging constitutional dimensions of public health. . . . Nevertheless, it is not clear whether a case that emerged from the legal and social environment of the 19th century remains relevant for the 21st century. . . . Jacobson came at a pivotal moment when both the mission and the methods of public health were shifting. As the most terrifying contagions in the 19th century . . . receded from view, public health lost much of the urgency that had provided the warrant for use of coercive measures. . . . [T]he trend in public health practice during the 20th century was in the opposite direction. . . . Coercion became figurative and metaphorical and was expressed through advertisements that characterized the failure to follow expert hygienic advice as morally culpable or criminal behavior.
From AJPH, April 2005, pp. 571–573, passim
Biography
