Now what for public health?
We need to be ready for a new world
The U.S. election this week sent shock waves through the field of public health—not just domestically, but internationally as well.
For many in public health, like me, the prospect of national leadership by individuals with an established track record of ignoring the evidence is deeply disconcerting. This has led to anxiety (and even feelings of loss and sadness). So much is unknown about the future of this field—from policies like routine vaccinations, to the impact of falsehoods moving mainstream, to the resources available to hold up an “invisible shield” for the public’s health.
What is becoming increasingly clear is that we are entering a new world. As we put one foot in front of another, we must remember there’s a difference between what we can and can’t change, and sometimes, there’s a difference between what is easy and what is needed.
This will be a different world
While we in public health are all too familiar with the cycle of panic and neglect, this terrain is different. The leadership choices are categorically unreliable for scientific narrative.
RFK Jr. will have more influence with his cast of characters, who have a history of opposing evidence-based public health practice. For example, RFK Jr. founded Children’s Health Defense, a well-oiled machine responsible for 1 in 4 low-credibility Tweets during the pandemic, leading to a large profit. His influence also led to a Samoa outbreak of measles that caused more than 80 deaths, mostly among children.
Similarly, the Washington Post reported that Joseph Ladapo—the Florida Surgeon General—is on the shortlist for the Secretary of Health and Human Services. Although a doctor, he has a well-documented history of falsehoods about Covid-19 vaccines and went against the standard of practice guidelines for a measles outbreak at a Florida school.
Leadership matters. Ineffective or dangerous health policy decisions can be driven by mixing reasonable ideas with falsehoods and/or not accurately identifying what is causing us to be unhealthy and “fixing” that. For example, RFK Jr. said his first move would be removing fluoride from water—this is not grounded in scientific evidence, and reflects a fundamental misunderstanding between a hazard (that something could potentially cause harm) and a risk (the probability of something happening).
Importantly, all of this unfolds after 5 years of public health being through the wringer. And, in an already shifting landscape: general amnesia of vaccine-preventable diseases, loss of trust in institutions, and a changing information landscape fueled by social media. This has led to policies like the following:
Last month, 6 counties in Idaho outright banned the availability of Covid-19 vaccines.
Texas doesn’t allow public health departments to educate about Covid-19 vaccines.
Missouri has removed the ability for public health departments to report data to WHO (and thus, CDC).
How we navigate this new world will matter
We will all overcome this together, and we will do so through thoughtful and clear communication.
For individuals, this will mean consuming information with a healthy skepticism. For trusted messengers, like physicians, faith-based communities, and businesses, your jobs are more critical than ever. For institutions, this means we need your courage to protect those who are speaking truth. For public health leaders, it’s time to be proactive.
How we navigate this changing landscape will matter if we want to ensure that public health is still guided by values that are important to all of us. This does not mean surrendering our mission but rather finding balance.
For public health (and all of us), this means:
Building bridges instead of manning the barricades by finding common ground, which requires active engagement and humility. (It always helps me focus on one fact: No one wants to die. Then I move from there.)
Recognizing what you say matters. That is, if you want people to hear you. Through literally the words we use, the framing, and the approach.
Communicate with empathy, as anger and shame will only drive people further away.
Listening (not simply hearing) so we can respond better to the needs on the ground. Americans need their questions answered, not to be told what to believe.
Making strategic choices about which battles to fight, at what time, and at what level of government. Political capital is as scarce as financial resources—and needs to be allocated carefully.
I think our biggest challenge will be fighting for the truth.
In this new world, there is a good chance that falsehoods and rumors will be broadcast from the most powerful office in the nation. This will drive even more confusion, anxiety, and questions that will have a direct, negative impact on Americans who genuinely have questions and are interested in making evidence-based health decisions.
We need to elevate reliable narrators to provide a counterweight. Unfortunately, voices that provide unbiased, evidence-based information are increasingly vulnerable, have limited capacity, and are in a fragmented world. Some Good Samaritans are holding up the front lines of science communication, but only with band-aids, hope, and very limited funding (if at all).
Bottom line
We are entering an uncertain and unfamiliar public health world. We must adapt effectively while keeping true to our mission—to protect the public’s health—as our North Star.
One thing is for certain: The entire YLE team will keep showing up. We will continue sharing accurate, honest, and reliable public health information regardless of politics. And we will still be here to empower you all to make evidence-based decisions to keep yourselves and your loved ones healthy. That won’t change.
Love, YLE
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Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE reaches more than 280,000 people in over 132 countries and has a team of 11 whose main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:
Please don't panic folks. We are witnessing a shift towards transparency and rigor from our agencies of public health. I understand why this readership is freaking out. This is an echo chamber. The real voices of clarity do not pay for a subscription here so you haven't heard from them and you don't seek them out. You are only listening to voices like Katelyn's who echo CDC PSA's and their data as if it cannot be questioned.
I am a physician and an engineer. I left my practice in 2021 to work for RFK Jr's Children's Health Defense as the Senior Science Editor for The Defender, our on-line publication. I have since left, but I still stand behind every single article I have written and edited for that organization. I have been leaving comments on this substack for two years. Katelyn has never responded to any of my questions and critiques.
Isn't that odd? One would think that she would be able to dismantle everything I share here in this public forum for the greater good.
Let me explain why there is such a growing "antivax" movement championed by Bobby and highly published physicians like Joe Ladapo. It has very little to do with so-called misinformation spreaders. It has to do with the public finally being informed about some difficult truths. The public is a lot smarter than you think.
1) Vaccine manufacturers cannot be sued if their products is found, even in an isolated case, to have caused harm. There is no other product like that. Obviously, there is much less incentive to do the proper safety testing if there are no consequences. The public knows this.
2) Nobody can deny that there has been an explosion of childhood diseases concomitant with the expansion of the CDC's childhood immunization schedule following the National Childhood Vaccine Injury Act of 1986. OF COURSE correlation doesn't equal causation. But if there was some causation, this is EXACTLY what we would be seeing. The public knows this.
3) The CDC could easily dispel all suspicion by doing a large retrospective study examining the health of vaccinated and unvaccinated children with regard to chronic disease rates. They have the data. They have not done the study and they refuse to release the data. Why?? There is no reasonable answer to this question except for the obvious: They don't want to know the answer. The public knows this too.
4) During the Covid pandemic, the mRNA shots were authorized after an initial observational period of only six weeks on average. Note that the median observational period was two months. Mathematically, that means that half of the 40,000 participants were observed for less than four weeks at most. There is NO WAY to make any claim about long term safety yet the CDC simply states that these shots have been rigorously tested for safety. That is a lie. The public knows this.
5) I have never met a single person, scientist or otherwise, who has read RFK Jr.'s "The Real Anthony Fauci", who could debunk any of his claims. That book was released at the height of the pandemic and excoriates the record of the pandemic czar, yet no defamation lawsuit was ever filed. Why is that? Obviously it is because everything is true and the receipts are there for all to see. The public is well aware of this.
6) RFK Jr.'s message is finally getting out, and he is making sense. Why on earth would anyone be against having vaccines tested by the same standards we use for medicines? Instead of pointing out the obvious, that that is an excellent idea for public health, the media runs hit piece after hit piece on this man. For every person who reads those character attacks and smiles a knowing smile, there are two more that see this as a desperate attempt to squelch some difficult truths.
7) Every other commercial on legacy media is for some sort of pharmaceutical product. It's a joke. These companies don't pay hundreds of millions of dollars to run ads to sell more product. They are buying good media coverage. People are seeing this too.
8) The idea that the pharmaceutical industry is out to improve public health is ridiculous. These are for profit companies and their executives' first priority is to the shareholders. They don't make the most money curing diseases. That eliminates demand for their product. They aren't trying to kill everybody. That also decreases demand. Whether you are willing to consider it or not, the most profit is made when the public suffers from a chronic disease epidemic. That is what we have. Our Covid mortality rates were among the highest of any country despite access to the shots and our overpriced health care system. This is staring us in right in the face.
I have no animosity towards those who disagree with me. I am just calling it as I see it. This is the way the public is starting to see it too. Every effort to discredit the movement towards a healthy America with pejoratives like "antiscience" and "antivax" is going to backfire more and more. The public is waking up. Relax and give people like Kennedy and Ladapo a chance. Let's see what happens. We all want our kids to grow up healthy and happy.
Madhava Setty, MD
Thank you for all you do. You will be a beacon in the darkness coming.