University of Wisconsin-Madison Journalist in Residence Cassandra Willyard joined UW public health experts Lillie Williamson and Malia Jones on Oct. 21 for a discussion on reconciling public health policy with a cultural ethos in the United States that values individual freedoms.
With public health policy debates concerning the COVID-19 pandemic in the not so distant past, federal funding cuts to research and healthcare training remind public health experts that public health and safety battles continue.
Balancing public health and personal freedom
Many Americans view health as a personal matter — in the face of the fact that public health issues have the potential to impact everyone, said Malia Jones, Assistant Professor of Community and Environmental Sociology. Jones said expert influence is constrained by current federal policies that align with personal responsibility, like removing COVID-19 vaccine recommendations for pregnant women and children, which could cause insurers to drop coverage for vaccinating individuals in this group that want it.
“In this country, our value system is really strongly oriented towards whose responsibility is health; it is each person's individual responsibility to make healthy choices… getting individual people to think beyond that is very challenging,” Jones said.
As an example, Willyard brought up the case of an elementary school janitor in South Carolina with tuberculosis who unwittingly exposed others in the community to the disease and then, when instructed to quarantine by public health officials, refused and continued working until he was detained in a medical lockdown facility.
“This just blew my mind because I… didn’t even know this could happen,” Willyard said.
The 1944 Public Service Health Act and 1976 National Emergencies Act give the federal executive broad powers to limit the spread of infectious disease from other countries and across the country, but smaller outbreaks and general public health policies are up to state governance.
“The Tenth Amendment gives states the powers that are not reserved for the federal government, and… that [has been] widely understood as the power to do things to protect their citizens,” Jones said.
Public health experts are challenged with researching and communicating best practices for population health. It is up to public health officials to support research and balance public health policies with personal freedoms.
“Public health is a big space… I would not say there is consensus on much of anything in terms of health experts,” Jones said. “I think in principle, the idea is that individual freedoms end where someone else's safety begins, right?”
Although the Centers for Disease Control and Prevention collect data and make health and safety recommendations, it is up to states to implement them. While billions of dollars in federal public health and research budgets are being scaled back, Willyard pointed out state-level health agencies as an alternative: currently, California, Oregon and Washington have formed a “health alliance” to advise residents “as Trump destroys [the] CDC’s credibility,” a California government website stated.
Jones’ research indicates that rural Wisconsinites place greater trust in local health officials than federal ones, which could be leveraged in public health emergencies through localized recommendations.
However, different recommendations in different states could cause problems when some policies are more scientifically driven than others. Moreover, state programs would be limited by their tax revenue as federal support recedes. New York and California generate the highest tax revenue per capita while Alabama and Tennessee generate the least. In all cases, public health measures depend on funding expert research.
Centuries of American health mandates
Health mandates date back to the U.S. Revolutionary War and have frequently been contentious. Smallpox was a significant threat to the newly formed U.S. military, and General George Washington mandated inoculation by May 1776. Similar to debates over the COVID-19 vaccine, some military leaders resisted Washington’s prescription.
Health and Human Services Secretary Robert F. Kennedy Jr. is currently questioning the efficacy and safety of COVID-19 vaccines that leverage RNA technology and has terminated 22 mRNA vaccine investments. Critics argue speculation about vaccine safety is contrary to scientific evidence and will jeopardize future pandemic-readiness. Interestingly, the Department of Defense continues to fund mRNA research, citing risks for global outbreak and military personnel.
The Nobel Prize-winning research that made the COVID-19 vaccine possible was first published in 2005. Williamson, an assistant professor of Communication Science, noted that the COVID-19 vaccine was developed from a large base of evidence, but said that evidence should have been communicated more clearly to Americans during vaccine mandates: “We think about a recommendation but not about explaining or communicating how that recommendation was arrived [at].”
Jones said new vaccines are always met with public resistance. Subjects in her Wisconsin public health research commonly declined COVID-19 vaccines for their children despite accepting long-used and mandated measles and mumps vaccines.
How can public health experts build trust?
A disconnect of communication and trust between health and research institutions and the general public could explain the hesitancy around new vaccines. Williamson, whose work focuses on the way racial health inequities are impacted by racial experiences and health communication, says bridging gaps between institutions and the general public depends on understanding trust and mistrust.
“I think that's one of the things we saw in [the COVID pandemic]: a lot of communities were like, ‘you've never cared about my health before, but now you're in front of me and you expect me to think that you have my best interests at heart,’” Williamson said.
Williamson said the publish or perish incentive structure in academia undermines public health experts’ ability to engage the public and earn trust. There is a strong correlation between publishing and research grant awards. Current budget reductions could exacerbate this problem as research grants become harder to obtain, limiting experts’ ability to educate the public on current and future health threats.
“It might take me two years working with a community before… I can publish a paper, but the paper is what gets valued, not that I was committed to collaborating with communities,” she said.
