Hi all. You may have noticed I haven’t posted much in a while.
That’s not because there has been nothing to post. I’ve just been SO busy with work that I’ve been struggling to find the time. Since January 5 I’ve been to Atlanta, Tucson, Oceanside (near San Diego) and Calistoga (in the Napa Valley) for work meetings—with a bonus side quest to sleep on the floor in the Dallas airport during a snowstorm. My team and I at Facente Consulting have developed and disseminated two major surveys for a project in 7 different languages. We promoted a website we created and launched a social media campaign about last year’s project on medications for addiction treatment in California. We’ve extracted data from hundreds of published studies about Human T-Lymphotropic Virus 1 (HTLV-1) for the World Health Organization. I’ve given 4 presentations, facilitated 16 meetings, and conducted 21 qualitative interviews. I’ve talked to three different reporters who reached out about various topics. Plus I’m now almost halfway through the public health program planning class I teach to about 40 grad students at UC Berkeley each spring semester, to help make sure the next generation of public health professionals has the skills they need to plan effective interventions in partnership with the communities most neglected and harmed by our current health systems and societal structures.
I’m not saying this to brag—I’m trying to convey that even as the funding and support for public health has been yanked away or made increasingly uncertain, the need for public health has only increased. The people I work with every day have done their best to keep their heads down, stay focused on what matters (the people they’re trying to serve), and figure out how to persevere. Whether the government wants to acknowledge it or not, the public needs us and the work we do. We do this because we care, and we’re going to keep showing up as long as we can.
But it’s incredibly difficult to keep showing up amidst a constant onslaught of terrible news, and daily reminders that the people in power don’t care about our health, and are just fine if all the gains we’ve made in public health in the last few decades are erased, destroyed, and denigrated. Sometimes just getting through the day and then going to bed early after a tall glass of wine and 45 minutes of trashy TV is the best I can muster.
I promise you that the reason I haven’t been posting is NOT because nothing important has been happening. In fact, the intensity of the dystopian public health news has been part of the problem. It’s overwhelming. For example:
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The chair of the country’s Advisory Committee on Immunization Practices (ACIP) said that yes, he had some “concerns” that “some children might die of measles or become paralyzed with polio as a result of a choice not to vaccinate” but explained that these vaccines should be optional because “I am also saddened when people die of alcoholic diseases.” (In case you were wondering, this is a terrible comparison and these situations are not at all the same.) By the way, he also said “I don’t like established science,” going on to claim “science is what I observe.” (I can’t even…no.)
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The CDC announced that they were giving $1.6 million to some Danish researchers to experiment on babies in Guinea-Bissau in Africa by randomly denying some of them the hepatitis B vaccine at birth, despite 1 in 5 people in that country having hepatitis B. Guinea-Bissau has decided that starting next year they’ll begin implementing the birth dose of hepatitis B vaccine that just become optional again in the US, to try to better protect babies there. So our government thought “Well, this is a great opportunity to do a natural experiment. Let’s enroll 14,000 babies in this other country and randomize half of them to get the vaccine and half of them to not, and see who fares better!” Appropriately, there was so much outrage about this—including an official statement from the WHO about how unethical this was—that after about 2 months of back-and-forth chaos the government of Guinea-Bissau put a stop to the study.
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Vinay Prasad, the head of FDA’s Center for Biologics Evaluation and Research (aka our country’s top vaccine regulator), continued his controversial reign by sending a memo claiming that the FDA had concluded 10 children had died from the COVID-19 vaccine even though that was false. He also single-handedly overrode staff scientists at FDA by refusing to even review Moderna’s application for an mRNA flu vaccine in the US, even though they had followed the agreement already made by Moderna and FDA for seeking approval. (What this means for you: you’ll continue to only have access to our mediocre flu vaccines in the near future, instead of a considerably more effective mRNA vaccine.) But then after doing all this damage he apparently got fired (again!) so that was a glimmer of good news in the darkness.
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The Trump administration announced they were cutting $2 billion of funding for mental health and substance use services in the US and mailed out grant termination letters to more than 2,000 addiction and mental health programs around the country, only to reverse themselves one day later because there was so much outrage, including from Congress. (Imagine that! Our Congressional representatives do have power when they choose to use it!)
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HHS also announced they were cutting $600 million in CDC grants to four blue states—Minnesota, Colorado, Illinois, and California—that support local health departments and the vast majority of HIV prevention services in those states. The attorneys general in those states immediately sued over what was seen as an illegal, politically-motivated move, and a federal judge granted a temporary restraining order to prevent cuts while the case is being heard, but meanwhile the termination letters still went out to 66 public health agencies.
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The US officially withdrew from the WHO, then proposed replacing most of the WHO functions with something that will cost us much more than our WHO participation did. (Never mind public health, what a great business move!) This prompted California, New York, Illinois, and New York City to join the WHO themselves via the Global Outbreak Alert & Response Network (states and cities can’t be full members of WHO).
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The Trump administration announced a new rule (or more precisely, an expansion of what’s known as the “Mexico City policy,” which Trump reinstated a year ago) that no federal dollars can be spent on any organization that does anything to “promote DEI” or acknowledge that trans people exist—even if our tax dollars aren’t used for those purposes. A recent analysis by KFF estimates that nearly $40 billion of US foreign aid in 160 countries could be withdrawn over this new rule, on top of the damage that’s already been wreaked by this country on foreign health systems in the last year.
Oh, and perhaps you’ve heard that our country has an increasing number of massive measles outbreaks? This includes outbreaks in multiple ICE facilities, including our largest one two days ago, known as [Concentration] Camp East Montana. Did you know that ICE has a Health Service Corps? Their mission used to be to “Provide the best healthcare delivery system possible, to deliver high-quality healthcare to those in ICE custody.” Now, per their website, they are the entity within ICE responsible for “assessing aliens’ fitness for travel as they prepare for deportation.” Think about that. Measles is the world’s most infectious known pathogen. People with measles are supposed to be immediately isolated to prevent it from spreading like wildfire. But our government is warehousing people and then forcibly relocating them to other countries while they are potentially infectious with a deadly pathogen. (Yes, they are now isolating people who are known to be infected, but the damage has already been done.)
So you can see, it’s a tough time to work in public health. It’s a tough time to be a member of the public, honestly, because all our health will suffer because of these decisions being made by our government, whether or not we’re personally feeling the pain yet. I, for one, am taking a vacation starting tomorrow. I’m burning out, and if I don’t take some time away to recharge then I won’t be able to help anyone else.
Week after next I’ll be back, refreshed and striving to post more often, including deeper dives on most of the things I just touched upon above. I believe communication is power, especially under a regime that is working hard to suppress our free speech and clog our communication channels with distractions and disinformation. So I’ll be back to it soon.
In the meantime, take care of yourselves, and each other. ❤️