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Reader Opinions
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Editor's Note: The recent Congressional hearing featuring Dr. Anthony Fauci, ensuing subcommittee contempt vote against him, revelation of his personal journal and text messages, and guilty plea by his former aid Dr. David Morens has thrust Dr. Fauci and the COVID pandemic back to the forefront. The media is full of opinions (many of which you'll find in this month's What We're Reading towards the back of this publication) but it occurred to the EpiMonitor that we should ask the public health community what they felt about these new revelations. We asked for comments on a series of questions including but not limited to:
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How do these revelations change faith in public health in the USA and
the world in general? Despite the fact that all of this occurred during prime vacation season we were able to reach several of our regular contributors for comment. We encourage other readers who may be interested in being heard to forward their comments to us at info@epimonitor.net for publication in an upcoming issue. A Covid-19 Retro-perspective
Victor
J. Schoenbach, PhD Let me begin by recognizing and offering condolences for the over one million Americans who have died from Covid-19; the many more million victims globally; the many times that number who survived following severe illness, often still experiencing persistent symptoms and/or disability; the families and communities still suffering from the harms to their members; and the probably hundreds of millions of Americans (and billions globally) whose lives were upended by the closures, mandates, and control measures, often instituted on the basis of incomplete information. Given the heterogeneity of people and their situations, these harms were certainly not universal. But the collective trauma from the pandemic has fueled resentment in many, undermined trust and confidence in many institutions, exacerbated conflicts, and thereby created fodder for toxic media. My perspective attempts to be mindful of this context. The public release of the entries from Dr. Anthony Fauci’s diary by Sen. Rand Paul and his July 29, 2026 committee hearing in which Dr. Fauci pleaded the Fifth Amendment in response to every question seek to leverage Covid-19 trauma for political advantage. Releasing the diary entries certainly garnered media coverage for Sen. Paul’s hearings. The overall episode and many similar ones, though, puts in stark relief the contrast between (1) our species’ remarkable progress in understanding and navigating molecular and microbiological mechanisms and processes, and (2) our much less refined approaches to working collectively. On the molecular/microbiological side, in just over a year from the appearance of the first cases of Covid-19, the scientific community had identified the virus (SARS-Cov2), developed laboratory assays and clinical tests, gained some understanding of transmission mechanisms and the virus’s persistence in the environment, and developed two vaccines that provided some, although incomplete, protection against serious disease. There were nevertheless huge negative impacts on public health, from the infections and also from the control measures. But almost certainly the impacts would have been much more catastrophic had this virus appeared and spread fifty years ago. By contrast, the contentiousness that has characterized so much of our collective societal responses to the pandemic has hampered scientific understanding; public understanding, trust, and harmony; and mitigation of negative impacts. Life is enormously complex, and relatively few of us have the luxury of being able to avoid simplification in order to feel confident and effective. So many of us turn to faith, tribal connections, and narrow objectives to guide us in our lives. But simple explanations and solutions rarely lead to enduring and broad improvements. Dr. Fauci and other scientists who worked with Covid-19 devoted themselves to protecting public health and should be appreciated for that, even if they may have made mistakes. Punishing them, even threatening them, will not make us a safer society, nor aid our collective understanding - quite the contrary. In the end, the publication of Dr. Fauci’s diaries and the July 29th hearing by Sen. Rand Paul’s committee will in my opinion only modestly reinforce the views, pro- and con-, that are already entrenched. Perhaps some day we can determine with high confidence whether SARS-CoV2 came from a natural spillover or a lab leak, though the cooperative interactions among Western and Chinese scientists needed to resolve the question seem unlikely to occur - and because of actions taken in Wuhan in December 2019 / January 2020 definitive evidence may no longer exist. Ultimately it does not really matter for the future whether Covid-19 arose from a lab leak or a natural spillover. Since either scenario could lead to a future pandemic, we need to be prepared for both and work toward lowering the probability of either. But we surely need to reverse the erosion of trust in our public health system and institutions and rebuild their capabilities. We surely need to reduce our toxic media and political interactions. We need to find ways to broaden awareness, so that both competition and cooperation lead to a more harmonious society in the United States and across the world. Perhaps epidemiology can provide insights into breadth of awareness? The Fauci hearing: Deflecting attention from Republican failures and discrediting public health
For EpiMonitor What was the Fauci hearing about? Surely not understanding what happened during the COVID-19 pandemic. Were that the goal, we would have had a good-faith, no-fault inquiry, as aviation and patient safety have taught us. Rather, I argue, it was about deflecting attention from the failures of Republican leaders and discrediting public health. We see this in the questions that were, and should have been, asked. The origins of SARS-CoV-2 Whether SARS-CoV-2 was man-made or a lab leak is the wrong question. Initial signals that it could have been either were thoroughly investigated. Years later, both the virology and the epidemiology show these to be extremely unlikely. Rather than covering anything up, Dr. Fauci’s diaries show him and other scientists doing their job: working to understand the implications of fragmentary incomplete information as it became available and adjusting policy recommendations as appropriate. Uncertainty always exists when a new pathogen emerges, whatever the origin. The questions we should ask are how to more rapidly detect a new outbreak and characterize the risk – for example, how the virus is transmitted – to guide policy. Global surveillance networks are essential to this effort. However, as the current Ebola outbreak demonstrates, President Trump’s cuts to US AID and CDC have undercut the infrastructure that sustains them. Public health scientists have been concerned for decades about man-made pathogens and lab leaks and remain so regardless of the origins of SARS-CoV-2. Presidents Bush, Obama, and Biden established and maintained biosecurity programs in the White House and throughout the government; President Trump abolished them (twice). Trump’s break with the WHO will only make this more difficult. Public health interventions Whether masks, lockdowns, etc. “work” is also the wrong question. Many careful studies have shown that various public health restrictions – non-pharmaceutical interventions (NPIs) – can make a difference. A comprehensive review by the British Royal Society concludes that “there is clear evidence from studies conducted during the pandemic that stringent implementation of packages of NPIs was effective in some countries in reducing transmission of SARS-CoV-2.” In the U.S., almost 300 thousand deaths could have been avoided before vaccines were available had all states experienced the excess mortality rates of the best-performing states. This reflects earlier relaxation and weaker implementation of NPIs and related behaviors. The right question is how to deploy combinations of NPIs in particular settings to better balance the epidemiological benefits with the social and economic costs. For instance, how many infections in students and the community can we allow to maintain in-person schooling? Can policies such as mandatory masking and vaccination limit transmission enough to justify re-opening schools? What the hearing didn’t cover From early January 2020, Dr. Fauci was aware through contacts with the China CDC how dangerous the situation was. He took the warning seriously enough to initiate work on a vaccine only days after Chinese scientists published SARS-CoV-2’s viral sequence on Jan. 10. President Trump, meanwhile, consumed with his impeachment, did not get a briefing on COVID-19 until late January, after escalating warnings from WHO. An earlier response could have stockpiled PPE and ventilators to alleviate shortages later. Long before vaccines available, Robert F. Kennedy, Jr. and others began spreading misinformation about mRNA vaccine efficacy and safety. We now know that these vaccines are both safe and highly effective across age groups and in diverse populations. Across billions of administered doses, serious adverse events have been rare, well characterized, and consistently outweighed by the substantial protection conferred against severe disease, hospitalization, and death. Yet, more than 250 thousand American deaths could have been avoided, disproportionately in states with Republican governors and legislatures, between March and November 2021. The question to ask is how political leaders’ and social media’s Covid denialism and vaccine opposition undercut trust in public health limited vaccine uptake and contributed to the avoidable deaths. The impact of the hearing The public release of Dr. Fauci’s diaries and the hearing have had two serious effects. First, it deflected public attention away from President Trump’s and other Republican leaders’ misinformed statements, actions and policies about NPIs and vaccines. Many legitimate questions deserve attention and public debate, such as how to balance the epidemiological benefits of these interventions with the social and economic harms. Grilling Dr. Fauci about settled matters (that he has addressed in previous testimony and were not within his authority) does not advance this discussion. Second, pulling isolated statements from diaries intended to be private does not provide any insights in public health policies. Neither does forcing him to “take the fifth” on issues about which has previously testified. Together with the misdirection, though, doing so undermines trust in public health.
Editor's Note: In our first article this month the author offered these comments: "None of this means epidemiologists should become crusaders or abandon rigor. The world has enough people making grand claims with fragile evidence. But we can communicate more clearly without sacrificing honesty." "Epidemiologists help shape not only scientific understanding, but political will, regulatory action, and public perception. We should choose our words carefully. But we should also occasionally choose them bravely." The EpiMonitor is interested in printing pieces about how the public health community can help bridge the divide between the "sides" in this and other public health issues. Articles that outline concrete solutions or advance innovative approaches are always welcomed as are pieces about the Fauci hearing, journals, text messages, and Morens guilty plea. Please forward your submissions to info@epimonitor.net |
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