Future public health emergencies will be deadlier

As Philadelphia’s former health commissioner, I know that, sooner or later, we will face another grave public health emergency.

Besides the COVID-19 pandemic, my nearly three years as the head of Philly’s health department included the mpox outbreak, the arrival of multiple displaced populations with urgent medical needs, and a measles outbreak. We saw wildfires in Canada that led to the worst air pollution the city has seen in decades, and a spill of chemical contaminants into our water supply.

We needed to keep city residents safe and informed about those flare-ups while maintaining our day-to-day work to protect the public’s health, like tackling the city’s high rates of smoking, chronic disease, overdose deaths, and maternal mortality.

Whether it is a new pandemic, a toxic threat to our drinking water, or a crisis we cannot yet imagine, recent experience teaches us that we will continue to face public health emergencies. But in the face of Robert F. Kennedy Jr.’s reckless and uninformed approach to the protection of American lives, future emergencies will be far more harmful and deadly than in the past.

The Centers for Disease Control and Prevention normally serves as a resource during public health crises, its deep bench of experts offering recommendations and vetted research that inform real-time decisions by local public health leaders.

With the CDC’s leadership and expertise gutted, and their decades of experience lost, we cannot count on those resources to be available. This loss will take years, if not decades, to rebuild.

Even worse, the forced departure of thousands of dedicated, veteran scientists and the substitution of social media influencers and appointees chosen for their loyalty to President Donald Trump in place of nonpartisan leaders picked for their expertise means that we may be unable to count on the reliability of information and guidance the CDC provides.

Kennedy is now planning unnecessary reviews of routine, lifesaving childhood vaccinations that already have decades of established scientific evidence supporting their safety and efficacy. Vaccines against diseases like polio, diphtheria, and measles that once killed thousands of children each year will now be re-reviewed by the same U.S. Department of Health and Human Services administration that brought us an apparently AI-generated report on children’s health, including references to studies that don’t exist.

The vast majority of Americans support childhood vaccinations. But many parents now fear Kennedy’s HHS may make politically motivated decisions that could put lifesaving vaccines out of reach.

I’m already hearing from patients who can’t figure out how to get their fall flu and COVID-19 shots. People who want these shots to protect themselves and their families are confused, frustrated, and angry. Tens of thousands of Americans die each year from the flu, including more than 200 children this year. But Kennedy has fired all the highly qualified members of the Advisory Committee on Immunization Practices and appointed a group of people whose primary qualifications seem to be their willingness to support anything he suggests.

Having our nation’s vaccine approvals guided by an unqualified HHS director who relies on conspiracy theories and right-wing social media influencers will further undermine vaccine confidence, even for those who believe strongly in vaccines.

The CDC also funds local health departments across the country, providing more than half of their funding. That money allows local agencies to hire staff to respond to day-to-day public health needs like keeping our food safe to eat and our air safe to breathe, controlling rat and mosquito populations, preventing chronic conditions like heart disease and cancer that cause 70% of deaths in this country, and much more.

The funding also supports emergency preparedness teams that respond to the wide range of urgent and emergent situations that come up again and again. Whether it’s a hepatitis outbreak from food at a grocery store, a fungal outbreak at a local nursing home, or a war that suddenly drives thousands of people to seek refuge in our city, these dedicated staff members are there, working nights and weekends to keep us all safe.

Slashing CDC funding puts Philadelphia, along with cities and counties across the country, at high risk. Without the people, the research, and the funding to do the critical public health work that usually occurs behind the scenes, we will absolutely see deaths rise and disease increase.

We can’t prevent every public health emergency. But we can and must use existing, evidence-based tools like vaccination, data systems to track acute and chronic disease, and tobacco control programs to maintain the gains in health and life expectancy. Despite Kennedy’s claim that he will “Make America Healthy Again,” he has proposed decimating programs that save tens of thousands of lives every year.

Mixing politics with public health is dangerous. Public health leaders must hear different points of view on a problem, which means they must create an atmosphere in which people who disagree feel safe expressing their opinions and the reasons behind them, without fear of political reprisal. I am an experienced physician with degrees in medicine, public health, and anthropology, and that breadth of training and knowledge has helped me in my work, but I am not an expert in, for example, tropical disease, toxicology, or the experience of being a Black person living in Philadelphia.

A high-functioning public health team includes multiple types of expertise, providing a range of perspectives. Suppressing dissent and insisting on hiring only compliant people means we will make mistakes that could be prevented and fail to imagine potential solutions to critical public health problems.

After firing Susan Monarez, Kennedy has appointed a new CDC director, Jim O’Neill, who does not have a degree in medicine or public health, who championed quack cures for COVID like ivermectin (a medicine used to treat parasitic worms), and whose principal qualification seems to be his willingness to agree to anything Kennedy demands.

If confirmed, O’Neill would be the person in charge during a potential outbreak of highly pathogenic avian flu, dengue, or even polio. That prospect should frighten us all, but it should also motivate us to speak out for our communities, our families, and our country.

There is no other option: Kennedy must resign, and Congress must insist that the people who run HHS and the CDC possess the scientific qualifications and experience to do those jobs. Then, we will need our elected representatives and everyone who cares about the future of our country to insist that our public health institutions be rebuilt by rehiring the experienced staff we have lost, when possible, and by recruiting new, highly qualified staff where it is not.

That can’t happen with Kennedy or another unqualified leader at the helm — no one qualified would agree to accept a job in the current HHS. But none of us wants our health to rely on people whose only qualification for a job is their willingness to do what they are told, regardless of the outcome. The health of all Americans is on the line.

Cheryl Bettigole is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, where she is also professor of clinical family medicine and community health and director of Public Health Integration for the Center for Public Health.