We should all be dismayed at the prospect of science being manipulated or ignored in policy, says Joe Ross
If we have learned anything over the course of the covid-19 pandemic in 2020, it is that politicians are increasingly emboldened to interject and seemingly overrule scientists in their guidance and interpretation of information for the public. This is taking place so frequently in the United States that it is no longer unusual. Just this past month, the Centers for Disease Control and Prevention (CDC) released its revised guidelines on SARS-CoV-2 testing to exclude people who do not have symptoms of covid-19—even if they have been recently exposed to the virus—only later reversing this questionable recommendation after it was revealed that the guidance had been influenced by political appointees of the Trump Administration. The Food and Drug Administration (FDA) made its decision to issue an emergency use authorization of blood plasma as treatment for covid-19, a decision reported to have been made under pressure from the Trump Administration, on the eve of the Republication Party’s National Convention, and further complicated by President Trump’s and the FDA’s Commissioner’s exaggerations of the therapy’s anticipated benefits at the press conference announcing the decision.
While these are only a few prominent examples, it is the even more common, less publicized, routine day-to-day decisions and statements that pose an ever-greater threat to public health and trust. Promoting theories that the evidence demonstrating the effectiveness of masks to reduce airborne viral spread is unclear. Reviewing and rewriting CDC weekly scientific reports to ensure optimistic messaging. Contradicting public health officials by suggesting that children cannot spread the virus, or that if children are infected, they do not become ill. Or advocating for unproven clinical treatments for covid-19, on the basis of theory or non-credible evidence, and diminishing efforts to subject these treatments to rigorous evaluation.
Efforts to undermine experts and expertise in the United States and the world over are not new and have been taking place for decades. On Twitter, climate scientists expressed both empathy and frustration as they watched epidemiologists and virologists, physicians and clinical trialists ignored, questioned, undermined, and “mansplained” (for lack of a better term) since the beginning of the pandemic, mirroring their experiences since the 1970s. Not only do many citizens, with Wikipedia and Google at their fingertips, believe themselves to be equal experts with physicians and epidemiologists, but politicians seemingly believe they can simply ignore advice from scientists that do not align with their political world views.
Our world is now confronting the reality of having politicians overrule and ignore countless warnings and recommendations from climate scientists. In the US, our pandemic summer has been made ever more difficult by widespread forest fires raging along the West Coast, a record number of hurricanes arriving out of the Caribbean and travelling up and into the Gulf States or along the East Coast, along with excessive heat waves throughout the country. These hazards invariably lead to public injuries and deaths, as well as property and environmental damage. Must we now be prepared for a reality of having politicians ignore and overrule the science and public health recommendations pertaining to the covid-19 pandemic?
No scientist is so naïve to think that politics plays no role in policy. But every scientist should be dismayed at the prospect of science being manipulated or ignored in policy. The consequences to public health and trust are too immediate. Already, the overt politicization of the vaccine development and testing process, with a not so subtle expected market approval just ahead of the U.S. Presidential election in November, has led to public distrust. Recent polls show that 62% of Americans are worried that the FDA will rush to approve vaccines without assuring safety and effectiveness due to political pressure, while only half say they would definitely or probably get a vaccine if it were available today. What good is an effective and safe vaccine if no one trusts in the integrity of the process?
We must take steps to restore scientific independence and integrity in public health. The evidence used to guide policy decisions must be transparently disclosed and available for public and scientific scrutiny. This includes the public health and epidemiological research supporting CDC advisories and guidance, as well as the clinical research supporting FDA decisions on emergency use authorization, as well as agency approval, of drugs, medical devices, diagnostic tests and vaccines used to manage and treat covid-19. Advisory committees composed of independent scientists should be convened to review more prominent decisions. And agency career staff making these decisions—and there are innumerable individuals in government who are remarkable servants to the public, devoting their careers to the service of others—should promote public accountability by ensuring their Center or Office leadership is associated with any decision. Finally, clear timeframes should be issued for revisiting decisions, as well as revisiting or requiring additional evidence, given the speed with which our understanding of covid-19 is advancing.
No matter the decision being made, if the public perceives that politicians have pressured scientists and government officials, then public health and trust is lost. If scientists are ignored or publicly contradicted, we are even worse off. In this pandemic, public health needs to be science-based and guided by scientists, not by politicians.
Joseph S. Ross, Professor of Medicine and Public Health, Yale University, U.S. Outreach and Research Editor, The BMJ.
Competing Interests: In the past 36 months, Dr. Ross received research support through Yale University from the Laura and John Arnold Foundation for the Collaboration for Research Integrity and Transparency (CRIT) at Yale, from Medtronic, Inc. and the Food and Drug Administration (FDA) to develop methods for postmarket surveillance of medical devices (U01FD004585) and from the Centers of Medicare and Medicaid Services (CMS) to develop and maintain performance measures that are used for public reporting (HHSM-500-2013-13018I); Dr. Ross currently receives research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from the Medical Device Innovation Consortium as part of the National Evaluation System for Health Technology (NEST), from the Food and Drug Administration for the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation (CERSI) program (U01FD005938); from the Agency for Healthcare Research and Quality (R01HS022882), from the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) (R01HS025164, R01HL144644), and from the Laura and John Arnold Foundation to establish the Good Pharma Scorecard at Bioethics International.