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Healthcare executives debated this topic at the Healthcare In Politics salon
One of the most disturbing, and saddest, things to watch since the start of the pandemic has been the politicization of the response. There's a lack of trust that people now have in America's public health institutions, on both sides of the aisle, and that has only served to keep the pandemic raging.
This topic came up during the Healthcare in Politics event last week, hosted by Vator and HP, in which panels of experts, policy makers and lawmakers who were on hand to discuss topics related to healthcare policy and decision making.
During the second panel of the salon, moderated by Archana Dubey, Global Medical Director at HP and Bambi Francisco Roizen, Founder & CEO at Vator, Dubey mentioned the lack of trust that people have in healthcare agencies and the issues that has caused.
"That has a fallout effect on opening up schools, or opening up other organizations, governmental organizations, or even private institutes, because we don't have clear and concise guidelines with a scientific base. It's more reactionary," she said.
"The response of our agencies in supporting healthcare providers, the first responders, was, to put it diplomatically, suboptimal. And the fact that each one of these folks were put at risk also makes the teachers and the nurses and other folks coming back to school a little bit more nerve wracking."
In addition, she noted, we haven't utilized data to guide policy.
"We need to have a very trustworthy source that talks about, ‘hey, it is okay, kids can actually go back to school, and here's why they can go back to school. This is a scientific approach. And these are the guidelines that we will do.’ But CDC put out some guidelines about opening up schools and then took it back and then it gave them again, so people are not really trusting that policy."
Duncan Davidson, Partner at Bullpen Capital, called it "a very profound point."
"If you think about this, we all want to follow the science, but science is given to us through institutions. And we're in a period of time where we don't trust institutions to start with. I don't want to put Trump in the center of this, he makes himself the center of everything, but when he stood in front of this panel on the task force, he's already living in a hyper political environment and that just made everything more hyper political. So, it sort of amplified the noise,” he said.
Davidson also put the onus on the media, which he said has also been making people afraid.
“If you survey people, ‘what percent of people have COVID in the country?’ they say it's like 30 percent. Really, 100 million people have COVID? It’s stupidly so out of whack because they've been scared by all the amplification and that means institutions can't do the job, not that they were doing a good job anyway, but this compounds the problem.”
Rajiv Bhatia, Physician at Palo Alto VA, agreed, noting that in prior pandemics we’ve followed the established literature on science, something he says has not been happening this time around.
“There is an established literature on the science you generate and use when you have a pandemic. There's a game plan for science, like there's a game plan for everything else. The whole country has been off the game plan and I really hold CDC responsible for that, irrespective of Trump,” he said.
There are three groups of studies: those of transmissions, those of severity, and surveillance studies to ease the disease burden. During the H1N1 pandemic, we followed those studies so we knew who was giving it to who, which settings were how much but this time “the science that's come out of CDC has been atrocious.”
“I'm trying to figure out why in the world would CDC not do the right science? Why in the world would it not clarify things? So, there’s fear. Fear has driven the response, the political response, more than actual science. So, if you don't do the science, then anybody can say anything, and confusion can reign and with the uncertainty there will be more fear,” said Bhatia.
“How much of this is deliberate? There's a deep animosity, and I'm sitting here as a relatively neutral person, but there's a deep animosity between the institution and Trump. How much are they simply going to say, ‘well, you know what? He owns it. So, no matter how bad it gets, he's going to own it.'”
The other problem he identified is the lack of organizational leadership.
“What's happening inside the CDC with all these studies is that there are EIS officers who are green, they're sitting around tables making study proposals for what they're going to do. The science is not being directed. It's not being orchestrated by anyone. So, there's that level of chaos. They have to get approval for everything to do studies and so it's being politically controlled by the high management of CDC. You have to diagnose what happened here. Is it organizational? Is it purely political?,” he said.
“The other dimension is that this is power for public health, power that they’ve wanted for a long time. There is a tension between those people in public health that are for paternalistic, top down solutions, versus people-oriented solutions and obviously one side is winning right now. People who work in public health are institutionalists, they have loyalty to institutions over loyalty to anything. So, there's a lot that has to be exposed about this.”
Dubey then brought up what the potential solutions are to this problem.
“You just described that the CDC is full of cancer, like it has a disease and we need to fix it because it's dysfunctional. But we need to have trusted bodies that guide us during this time of crisis. How do we rebuild that trust? How do we bring that back to our institutions? I think that's a critical question,” she said.
All of this causes a domino effect, she noted, since politics influences policy which influences trust which influences what they do, like if they wear masks or they socially distance.
“We need to figure out how we make that dysfunction go away. Do we reboot CDC? Do we abandon it or defund it and go in and create a new one? Do we learn from the private sector? A lot of companies have had a turnaround. They have pivoted, and they have actually made themselves better.”
Bhatia’s answer: exposure and transparency.
“Show us the evidence, let the people have the evidence. Let us start to start to push in that direction. There are good people in CDC, they're better people and better angels but they need to be held to account and people need to be questioned and need to say, ‘look, these guys may be the experts, but we can't let them make conclusionary statements.’”
Phil Kerpen, President at American Commitment, also blamed a leadership problem at the CDC, with Director Robert Redfield unable to get the agency under his control.
“It's not just that you’ve got a lot of people at CDC that dislike President Trump. They also dislike Dr. Redfield. So, we've got a CDC director who doesn't have control of his own agency. And we frequently have seen the director saying one thing while you've got the opposite posted on the website. How can anyone from an outside perspective make sense of that? Which is the message of the agency? Is it what they're posting on their website and the positions that they're taking, or is it what their director is saying on TV, which is often in conflict? As well as the fact that both of them then change regularly, sometimes even swapping positions. It's very difficult to have institutional credibility when you have contradictory statements coming out of an institution, even simultaneously from the leadership and the rank and file,” he said.
“To a certain extent you could say, ‘well, the scientific process is going to have disagreement, there's going to be information, they're going to change as they learn more, but that's not, by and large, what we're talking about here. We’re talking about really the political appointee at the top of an agency that has been unable to get control of that agency for whatever reason and that's been the fundamental problem with CDC.”
We need to rebuild confidence and trust in institutions and government, so that they can manage this in a way people can rely on, said Emily Barson, Executive Director at United States of Care.
“I served in the Obama administration at HHS as the liaison with state, local, and tribal governments and that was through H1N1 and Zika and Ebola, and maybe it was more normal then but the independence of CDC has certainly been an issue. At the individual level it becomes a political badge of honor to follow or not follow public health guidance and that just leaves all of us without a trusted source of information and being able to follow those guidelines.”
Countries that were able to open up schools and other facilities were in countries were people trust their system, said Dubey.
“They actually surveyed people in South Korea and they were able to open their economy and their schools because people trusted and followed what the government actually asked them to do during the time of pandemic. Scientifically valid information is shared with people, and they had masking, they had testing, they had distancing. That's not just one country; New Zealand and several other countries were able to do that because there's trust, and they downloaded their contact tracing and that doesn't have that has not happened in the US,” she said.
Barson responded by bringing up what Davidson had said about the overestimation of how many people have COVID, but also mentioned the flip side that.
“There’s a numbing to the numbers of deaths or the fact that 7 million people have been affected and over 200,000 people have died from this, that we're still learning about and, let alone the impacts that will be ongoing for many of those millions of people,” she said.
Francisco then brought it back to the back the distrust that people have to the media.
“The one I would look at the one institution, I would look at that is really distributing and creating this division that would be the media. And so, they’re doing a huge disservice by not being very favorable or being biased or being impartial when they report the news. They have significant power and I think they're abusing that.”
(Image source: theoec.org)
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