As the COVID-19 public health emergency winds down, there has been an increased focus on the federal response to the pandemic.
There is finger-pointing at public health officials, the Centers for Disease Control and Prevention and departments of health for problematic and confusing communication. There is a backlash against COVID-19 public health control efforts and vaccines. In some circumstances, this backlash has triggered investigations and reactive legislation.
But we need to recognize that what we are experiencing is not merely a reaction against public health and medical experts, but rather an expansion of denialism — the rejection of facts — with potentially very harmful consequences.
Denialism represents a shift in the common practice of disputing notions that we may not agree with to the outright rejection of facts in an antagonistic way. Notable examples of denialism include the idea that climate change is a hoax, that human immunodeficiency virus (HIV) is not the cause of acquired immune deficiency syndrome (AIDS), smoking does not cause cancer, that guns are not a leading cause of death for children, and that the 2020 election was rigged. This escalating rejection of truth poses special challenges to public health and healthcare.
Denialism related to the pandemic is now taking hold with a belief that some states fought COVID-19 by having a laissez-faire approach — a fact that is wrong. Even in states in which schools and businesses reopened before others and there were less strict COVID-control measures, billions of dollars were spent to control COVID-19 spread and impact. Mitigation measures took place across the country during the pandemic that included stay at home or safer at home orders, mask distribution, testing and contact tracing programs, vulnerable population protection strategies, efforts to protect students and large-scale vaccination efforts. More than $4 trillion was allocated to the pandemic response by the federal government. Irrespective of whether they had more or less stringent COVID control strategies, we cannot deny that billions of dollars went to each and every state to support pandemic response efforts.
Denialism has similarly ignored and discredited the impact of public health in combating COVID-19. Ample evidence shows the effectiveness of face masks, improved ventilation and testing and contact tracing in controlling COVID-19. The importance of infection control measures to protect individuals who are medically vulnerable or are older is clear as well.
Nevertheless, ignoring mainstream expert opinion, legislation has been enacted in many states to curb public health activities. In more than 20 states, laws have been recently passed that now limit the activities of state and local health departments.
Denialism has trampled over the established belief that businesses and communities best know their employee or resident characteristics, social networks and health care availability in implementing infection control measures. Businesses and communities may have people who are especially vulnerable medically — either by age or underlying medical conditions. Yet, in many states, businesses and communities are now prohibited from implementing CDC or medical expert recommendations. More than 15 states have passed laws banning the implementation of recognized mitigation measures including mask use, COVID screening, or COVID vaccination requirements — even in high-risk settings.
There is no denying that vaccines and vaccination prevent illness and save lives. In the U.S., the importance of vaccines goes back to the 1700s when there was mandatory vaccination of the Continental Army against smallpox. Most states in the country provide exemptions from vaccination based on religious or personal preference. But we are now seeing an increasing objection to vaccines based upon false claims that vaccines are not effective or cause illnesses when they indeed have excellent efficacy and safety profiles. Unfortunately, these claims are supported by non-mainstream physicians that misrepresent scientifically accepted facts.
There is now a catchphrase that public health and vaccine choice is about personal freedom. But this call for personal freedom denies the ability of all individuals to venture into public safety, as a high proportion of the population needs to be vaccinated leading to herd immunity to prevent disease outbreaks. The recent outbreak of measles in children in Ohio which had a 40 percent hospitalization rate, is an example of the consequences of under vaccination. The legislative impact of the anti-vaccine movement is expanding at a level of great concern to the medical community. Anti-vaccine legislation is being proposed in many states across the U.S.
Throughout the pandemic, and now, you have heard experts say, “talk to your health care provider if you have questions about COVID-19 or vaccines.” But denialism has also undermined long-standing confidence in health care providers, leading to COVID-19 control recommendations being ignored. In some states, legislation has been introduced that will also allow practitioners protection against making public statements about infection control, even if their statements are viewed as incorrect by the mainstream medical community.
To keep people healthy those in public health and healthcare must now wrestle with communication issues that transcend addressing misinformation. Experts have identified five major characteristics of denialism: claims of conspiracies, the use of fake experts, the selective use of medical literature, the creation of impossible expectations of what experts can deliver and the presentation of logical fallacies. Understanding these components provides the framework for addressing denialism.
Studies have also examined how to best address denialism with effective approaches focusing on the continued delivery of facts and reinforcement of who are legitimate experts in the field. It is also imperative that we identify receptive minds in the legislative process to prevent false facts from undermining health care and public health.
Medicine and public health are based on a foundation of science and accepted facts. But when consensus medical expert opinion is replaced with legislative actions not based on accepted scientific facts, there is no denying that the consequences will be real and unfortunate for all of us.
Scott A. Rivkees, M.D. is a professor of practice at the Brown School of Public Health. He is the former state surgeon general and secretary of health of Florida.