There have long been people who don’t follow the recommendations of public health agencies, including those who want school vaccine exemptions. Wanting everyone to have freedom of medical choice isn’t a right-wing political stance; it is a call for personal liberty that goes all the way back to the antebellum and Civil War days. It’s entwined in health care debates ranging from vaccine exemptions to transgender medical care to abortion rights and medically assisted suicide. Balancing the foundational American value of personal liberty with other competing values is complicated and messy, and sometimes excruciatingly tragic.
In the case of vaccinations, Americans have largely been able to fold the choices of abstainers into our herd, still protecting the masses by the collective actions of the majority. But as the erosion of public trust grows larger, the herd is getting smaller. Cases of measles across the United States suggest the herd is breaking down.
There are many sensible, not-science-denying, moderate or slightly-right-of-center American parents like me who see immense value in having a national public health authority, and yet no longer trust it. We question whether health agencies are nonpartisan, value-neutral, science-driven and financially independent of Big Pharma.
While the spark of this distrust was glowing before 2020, the Covid-19 pandemic threw gasoline on the fire.
In March 2020, I settled into pandemic life by trying my hand at baking more bread and drawing chalk rainbows on my sidewalk to encourage my neighbors to stay #SafeAtHome for two weeks to flatten the curve. But as weeks gave way to months, mandates from public health agencies started to collide with other concerns and values. Out here in West Texas, personal autonomy quickly won the day. Within a few months, we were attending in-person birthday parties again and resumed worship at our churches, much to the derision of huge swaths of our country.
Even though my community quickly prioritized normalcy, we still felt the sting of the mitigation policies. As was the case elsewhere in the country, our small businesses were crushed, older people experienced inhumane social isolation and died alone in nursing homes and children struggled through online school.
By late spring 2020, we’d discovered one of Covid’s few mercies: Children weren’t commonly succumbing to the disease. I started publicly calling for them to return to school in person that summer. Outside of my local community, where most people seemed to agree with me, the backlash was swift and cruel. Like many other dissenters, I was accused of denying science and lacking concern for humanity. From my view, it seemed as if our public health agencies and the people who unquestionably followed their every edict showed little concern for children’s best interests.
Prolonged school closures and other mitigation measures happened everywhere. But in areas like mine, people bristled at restrictions and advice that seemed to defy common sense. Authorities I’d trusted to tell me when to vaccinate my children for measles and polio also said a cheap cloth mask from Old Navy could help protect them from microscopic pathogens. It made no sense, yet expressing doubts about “following the science” was treated as sacrilegious. Many of us stopped paying attention to public health authorities. Others grew more emboldened to resist the government’s mandates, even if it cost them their jobs and good standing.
It wasn’t just about personal liberty. But valuing personal freedom helped us to see how curtailing liberties in service of disease eradication alone could do long-term harm to children, older adults, and lonely and lower-income people.
It was a pandemic, and information evolved over time. Mistakes were unavoidable. Now, it’s much more common to hear public health experts say that they think schools were closed too long. But where was the humility at the time? Why hasn’t there been a large-scale federal effort to study how well masks worked, or whether closing schools would be the right choice to make next time? In conservative communities like mine, there’s little trust that the same Covid playbook wouldn’t be used again, in spite of the costs.
Humility and respect: This is what the new leaders of our public health agencies must demonstrate to the American people to restore public trust. Although some want to see heads roll, that’s not the case for everyone. Some of us would settle for a robust Covid commission to assess what went wrong.
There are other steps that could be taken. The research and policymaking departments of our public health agencies could be separated. The people making the policy decisions shouldn’t be the ones directing the research, and vice versa. Experts or not, we’re all fallible humans who don’t know what we don’t know.
It would also help if our public health agencies became more dispassionate in their advice. During the pandemic, I paid closer attention to the advice of agencies in Europe. They didn’t seem as embroiled in American-style culture wars, and the advice they issued was often less ideological, emphasizing their citizens’ right and responsibility to make an informed choice rather than bludgeoning them into submission. American leaders wanted children to resume their normal lives only if they were vaccinated, but some European countries focused only on vaccinating children in high-risk households or those who had major underlying medical issues (and some countries seemed to take seriously potential risks). This approach took into account children’s lower likelihood for bad outcomes from the virus.
President Trump has never been a leader to exemplify humility and respect, and people who despise him may be quick to dismiss all of his appointees as just like him. But he’s elevated some experts who could rebuild public trust, given their appeal to many skeptics for their willingness to bear personal consequences to defend the right to dissent, such as Dr. Jay Bhattacharya, the new leader of the National Institutes of Health, and Dr. Marty Makary, the new commissioner of the Food and Drug Administration. During the pandemic, many Americans came to see “the scientific establishment as essentially an authoritarian power sitting over them, rather than as a force for good,” Dr. Bhattacharya told The Wall Street Journal in December. Acknowledging that is a good first step.