Stop attacking public health officials, experts plead

Stressed woman at computer
Stressed woman at computer

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In a commentary published yesterday in JAMA, experts from Stanford and Johns Hopkins universities implored the public and elected official to stop the recent wave of attacks on US public health officers amid the COVID-19 pandemic.

Across the United States, public health officers have been subjected to armed people protesting on their front lawns, vandalism, harassing phone calls and social media posts, threats of violence or death, and doxing (the publication of private information to help others target the officer for harassment). Even some White House officials and members of Congress have joined in the fray, criticizing leading public health officials such as Anthony Fauci, MD, and Deborah Birx, MD.

As a result, at least 27 public health officers in 13 states have resigned or been fired since the pandemic started.

Name-calling, threats, abuse

Attacks at the state and local levels have gotten even more personal, including one leveled against Ohio Department of Health Director Amy Acton, who is Jewish, by State Rep. Nino Vitale, who called her "an unelected Globalist Health Director," an anti-Semitic slur that recalls the conspiracy theory that a Jewish secret faction controls the world.

In Wisconsin, elected judges harshly rejected an expansion of state health official Andrea Palm's stay-at-home orders, alleging "tyranny" by "an unelected official" using "controlling, subjective judgment."

The abuse is similar to that resulting from the growing resistance to childhood vaccinations since the 2015 measles outbreak, the authors said. After the outbreak focused attention on vaccine policy, anti-vaccination groups began attacking health officials and lawmakers in person and online, threatening them with death or physically attacking them.

"Some of the same groups, joined by other individuals frustrated with public health officials, are now actively resisting efforts to require masks, reinstitute business closures, and prepare for COVID-19 vaccination, jeopardizing the eventual acceptance of vaccines," the experts wrote.

They partially attribute the extraordinary hostility to omission bias, which produces a preference for risks tied to doing nothing, such as allowing the virus to spread unchecked, over those associated with affirmative acts such as public health orders. It could also be due to distance bias and optimism bias, in which people believe that coronavirus won't affect them, or to confirmation bias, in which some people dismiss evidence that does not confirm their preexisting beliefs.

"It reflects misunderstanding of the pandemic, biases in human risk perception, and a general decline in public civility," they wrote. "Some of these causes resist easy fixes, but elected officials and health officials can take certain actions to help address the problem."

'We have to acknowledge the pain'

Michael Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, has been criticized before as public health advisor for different elected officials over his 45-year career, but he said that it pales in comparison to the vitriol he's gotten in response to some of his comments during the COVID-19 pandemic.

For example, while Osterholm has supported wearing face coverings as a way to lessen the risk of coronavirus infection, he also has cautioned people about their effectiveness to avoid instilling a false sense of security. As a result, he's been skewered by both anti- and pro-maskers.

"Being heavily criticized by either side of an issue isn't unusual, but the kinds of comments and threats that have been made have been remarkable," he said, describing efforts to defund CIDRAP or have him fired, as well as threats he's received that he had to turn over to law enforcement.

He attributes the hostility to a ravaged economy, uncertainty, stress, and a sharply divided nation. "This pandemic is tough on people," he said. "People are losing their jobs. We have to acknowledge the pain."

Once, he said, scientific information was worth its weight in gold. "Today, I'm not sure if you wouldn't have to pay someone to take it."

Transparency, communication, visibility

The commentary authors urged elected leaders to protect health officials from harassment, assault, and violence by investigating credible threats, providing security, and prosecuting people who illegally target them. "Without protection and support, the already scarce supply of qualified individuals willing to serve in health officer roles will decline further," they said.

Now that the initial stages of the pandemic, when rapid decisions were needed, are over, health officials can engage the public in community reflection and input—particularly in school reopening discussions—so that the people know that officials understand their values.

The authors recommend that officials invite trusted public representatives such as nurses, paramedics, and leaders of essential workers and ethnic communities when they announce new public health measures likely to meet opposition.

Lastly, the authors said, health officials should increase their public visibility beyond emergencies to foster familiarity and trust, as well as transparently communicate the evidence behind their decisions.

"Harassment of public health officials must stop; instead, all efforts and attacks should be directed against the virus," they wrote. "Success will require overcoming the inaction and division that have allowed it to spread."

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