September 12, 2020 Liz Borkowski, MPH 1Comment

The Trump administration’s attacks on the science and scientists we need to control COVID-19’s toll have been so frequent that it’s easy to become numb to them. When the pandemic first struck, many of us took comfort in knowing that the experienced and committed career staff at CDC had been doing their work with limited apparent interference during the first years of the Trump administration. I quickly realized that the White House would pressure the agency over its guidance, but I still held out hope that we could rely on the agency-generated evidence and analysis that informs the guidelines. And then this morning I read a report from POLITICO’s Dan Diamond that Trump administration officials are interfering with CDC’s Morbidity and Mortality Weekly Reports.

In public health, MMWR is one of the most valued and trustworthy resources for information on disease spread and health outcomes. But now whenever I read it I’ll be wondering whether political appointees interfered with the reports of public health findings.

Guideline concerns are now an unfortunate norm

Public confidence in CDC’s COVID-19 guidance has been compromised at least since early March, when the agency downgraded its guidance for healthcare workers to allow for the use of surgical masks rather than the more protective N95 masks it had previously recommended—a move that Reveal later reported was driven by a lobbying campaign aimed at reducing hospitals’ liability. Politics also interfered with CDC reopening guidelines.

It was alarming, but not altogether surprising, to learn last month that CDC had quietly altered its coronavirus testing guidelines to exclude those without COVID-19 symptoms—a dangerous move given that we know infected people can spread the virus without showing symptoms. The August 24 version of the guidelines states that those who have been in close contact with an infected individual “do not necessarily need a test” if they do not have symptoms. CNN reported that a federal health official close to the process said the change resulted from pressure in the upper ranks of the Trump administration, and that the White House coronavirus task force discussed them while task force member Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases) was undergoing surgery. Former Trump administration FDA head Scott Gottlieb disagrees with the change, and suggests it might have been motivated by businesses’ desire for people to return to work before they can show a negative test result.

Interfering with scientific reports

Diamond’s story about MMWR interference opens with these grim paragraphs:

The health department’s politically appointed communications aides have demanded the right to review and seek changes to the Centers for Disease Control and Prevention’s weekly scientific reports charting the progress of the coronavirus pandemic, in what officials characterized as an attempt to intimidate the reports’ authors and water down their communications to health professionals.

In some cases, emails from communications aides to CDC Director Robert Redfield and other senior officials openly complained that the agency’s reports would undermine President Donald Trump’s optimistic messages about the outbreak, according to emails reviewed by POLITICO and three people familiar with the situation.

Diamond explains that in April, appointee Michael Caputo—” a former Trump campaign official with no medical or scientific background”—took over as assistant secretary of public affairs for the Department of Health and Human Services, and efforts began to align publications with Trump’s statements or halt them altogether. Caputo’s team delayed by a month the release of a report stating that the potential benefits of hydroxychloroquine (the anti-malaria drug that Trump was promoting as a COVID-19 treatment) do not outweigh its risks. Diamond writes:

Caputo and his team have attempted to add caveats to the CDC’s findings, including an effort to retroactively change agency reports that they said wrongly inflated the risks of Covid-19 and should have made clear that Americans sickened by the virus may have been infected because of their own behavior, according to the individuals familiar with the situation and emails reviewed by POLITICO.

Appointee Paul Alexander, who serves as a senior advisor to Caputo and was recently in the news for his attempts to shape what Anthony Fauci says to media outlets, has demanded an immediate halt to MMWR reports until the process is modified to allow him to review and make line edits prior to each issue’s publication, Diamond reports. Alexander has called on CDC Director Robert Redfield to modify two published reports that he claims overstate the risks of coronavirus to children and harm Trump’s push to get children back in classrooms.

The jaw-dropping rationale for all of this interference is that the authors of these reports are undermining the Trump administration. This would be laughable if it didn’t have such awful implications. MMWR articles are written in measured, precise language and are careful not to draw conclusions beyond what the analyzed data indicate. The Trump appointees’ objection appears to be that they are accurately reflecting reality, which makes it harder for the president and his allies to lie and claim that the situation is rosier than it is.

Letting a political appointee review and line edit each issue of MMWR prior to its publication would decimate what has been a sterling reputation. It’s not clear how many of the attempts by Caputo’s team to add caveats to articles have succeeded, but Diamond’s article makes clear that the pressure is intense:

CDC officials have fought the efforts to retroactively change reports but have increasingly allowed Caputo and his team to review them before publication, according to the three individuals with knowledge of the situation. … The battles over delaying or modifying the reports have weighed on CDC officials and been a distraction in the middle of the pandemic response, said three individuals familiar with the situation. “Dr. Redfield has pushed back on this,” said one individual. “These are scientifically driven articles. He’s worked to shake some of them loose.”

I’m grateful to all of the scientists at CDC who are resisting this pressure, but it must be hard for them to continue doing their work as usual once they know that a political appointee will be reading all their articles and objecting to accurate statements that don’t accord with the administration’s falsely rosy picture. Even if Caputo, Alexander, and other members of their team don’t succeed in winning many changes to the final versions of the articles, self-censorship is a very real threat.

MMWR has been publishing crucial information about COVID, including reports on disparities in COVID-19 incidence; multisystem inflammatory syndrome in children; the disease’s spread among healthcare workers, meat and poultry processing workers, pregnant women, people in homeless shelters, and people in correctional and detention facilities; and cases associated with specific occurrences where spread was well or poorly controlled, such as a Washington choir practice, a Maryland nursing home, Rhode Island child care facilities, and overnight camps in Georgia and Maine. It provides timely information about how the disease manifests, how it spreads, and what kinds of actions can help control it.

Restoring scientific integrity

If we’re going to address COVID-19 and other public health threats effectively, we must be able to trust federal agencies’ publications, including MMWR. One important step toward enabling such trust is passing the Scientific Integrity Act, which states that federal employees or contractors involved with scientific activities may not “suppress, alter, interfere with, or otherwise impede the timely release and communication of, scientific or technical findings.” Representative Paul Tonko (D-New York) and Senator Brian Schatz (D-Hawaii) introduced the bill in 2019; the House Committee on Science, Space, and Technology passed it on a bipartisan basis; and the House passed it as part of the HEROES Act (which the Senate has failed to consider for nearly four months now). Of course, political appointees who respect science are also essential.

A recent KFF tracking poll found declining public trust in CDC, and that poll happened before this latest revelation. If we want local governments, healthcare providers, and individuals to follow public health guidance on measures from masks to vaccines, we must restore that trust.

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