Public health leaders, including state commissioners and directors, and frontline health workers experienced threats to their well-being and safety during the COVID-19 pandemic, which led to up to 30% to step down, retire, or leave the field, according to a recent study in Public Health in Practice.
The study, conducted by researchers at the University of Delaware, was based on surveys given to staff at state and local health departments in 23 states in fall 2020 and summer 2021. Researchers said more than half of local health directors reported harassment of themselves or their staff from March 2020 to January 2021, and one-third of public health leaders retired, resigned, or were fired because of the threats.
Kris Ehresmann, MPH, former director of the Minnesota Department of Health, said her experience during the pandemic included daily hate mail and threats to her personal safety. The harassment began shortly after the pandemic started in spring 2020 and ramped up when vaccines were introduced statewide in early 2021. Eventually, the threats pushed her to retire early in 2022, a move she had been contemplating.
I just decided I don't want to die early from stress.
"I just decided I don't want to die early from stress," Ehresmann told CIDRAP News. "I had no idea people you didn’t know could be so hateful on something. It was just so surprising to me that something like wearing a mask could elicit this response."
Ehresmann was the public face of Minnesota’s response to the pandemic, along with Health Commissioner Jan Malcolm. Ehresmann said being women in those roles may have played in a role in the level of vitriol they experienced.
"The level of evil character ascribed to us, calling us Nazis, for example, was so surprising," she said.
Threats contributed to staffing shortages
Ehresmann was not alone. Nineteen months after the pandemic began, the New York Times reported that more than 500 top health officials across the country had left their jobs, partly because of abuse and threats.
In the present study, the authors suggest that the pandemic taught communities a hard lesson: Public health officials need police and sheriff departments to provide more protection. Ehresmann said she had protection offered to her by state patrols, but she never had a personal detail.
Jeff Duchin, MD, health officer for Seattle and King County, Washington, said he had people come to his house to threaten him during the height of the pandemic. "I had good support from the King County Sheriff," Duchin said, adding that threats against him have decreased markedly but that he still has support from the sheriff’s office.
Duchin said while the threats were gratuitous for him at times, he saw frontline health workers also threatened. "Frontline workers took a lot of abuse," he said. "And it's created a wave of early retirements and staffing shortages."
Workplace violence may lead to worker loss
Julie Ward, RN, PhD, is a professor and researcher at Vanderbilt University. She has published work on threats to public health and medical officials during the pandemic, including research on departures in the first year of the pandemic and its relationship to on-the-job violence.
"When we framed our work as looking at the threats as workplace violence—that was the real lightbulb moment," Ward said. She said her work also highlighted the future danger to public health caused by pandemic-era threats; like all health fields, public health recruits people inspired to serve a community, and if people don't feel safe doing so, there will be a lack of future leaders.
"If they don’t feel safe at work, it can't be sustained and effective," Ward said. "Knowing what we know now, we have to protect workers so we are not losing public health leadership during a crisis."
In the new Public Health in Practice study, the authors say that while public health officials are now more visible than ever, they also have less power in the states in which they work.
"At least 25 states passed legislation that limited public health authorities in an emergency, which could limit the ability of public health agencies and professionals to enact important, evidence-based interventions," the authors wrote.
In a press release on the study, author Jennifer Horney, PhD, said, "The COVID-19 pandemic also marked the first time dozens of state legislators introduced new laws to take away public health powers. It was very shortsighted because vaccination powers are pivotal in preventing deadly disease outbreaks."
Politics become dangerous
The pandemic brought with it threats from political actors, the authors explained, something Peter Hotez, MD, dean of the National School of Tropical Medicine at Baylor College of Medicine and codirector of the Texas Children’s Hospital Center for Vaccine Development, experienced on a national scale.
The vaccine researcher has long dealt with critics—and even threats—for authoring, Vaccines Did Not Cause Rachel's Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad, a defense of vaccines woven through his story of raising a daughter with autism.
This became very high-profile and more dangerous than earlier criticism.
That book, published in 2018, brought Hotez threats from nongovernmental groups he characterized as "unpleasant" but relatively contained.
"The big game changer during the pandemic was that the anti-vaccine movement got adopted by a major political party," Hotez said. As Hotez became a regular on cable news defending COVID-19 vaccines, he saw Republican senators, governors, and President Trump’s former chief strategist Steve Bannon name-check him as an enemy of the state.
"This became very high-profile and more dangerous than earlier criticism," Hotez said. "Suddenly the Proud Boys were at anti-vaccine rallies."
In his new book published this fall, The Deadly Rise of Anti-science: A Scientist's Warning, Hotez describes how threats against him haven't ended now that the pandemic is over. In fact, as the 2024 presidential race begins to heat up, Hotez sees the threats ramping up again.
Hotez dedicated his latest book to the Houston Police Department and the Texas Children's security staff.
