Where is the Republican plan for public health reform?

Few figures have been as relentlessly reviled by the Republican Party as Anthony Fauci. In 2021, a group of House Republicans introduced legislation called the Fire Fauci Act to eliminate the top health official’s salary. More recently, when director of the National Institute of Allergy and Infectious Diseases announced his plan to retire, House Republicans vowed to continue investigating Fauci after he leaves government service, although it is unclear what form that will take.

And then there’s Florida Gov. Ron DeSantis, perhaps Fauci’s most vocal GOP opponent, selling T-shirts and drinks emblazoned with slogans like “Don’t Fauci My Florida” and flip-flops that read, “Fauci can kick sand.” DeSantis said a characteristically blunt send-off to the public health officer, saying: “somebody needs to grab that little elf and throw him across the Potomac.”

As DeSantis’ koozie slogan suggests, many of these objections are so much against what might be called Fauciism as for Fauci himself. These Republicans, and the voters they’re trying to reach, object not only to the man, but to the bureaucratic spirit of public health that he represents.

We need not endorse DeSantis’ harsh remarks found fault with the way American public health is being conducted over the past two years and change, from failed testing to divisive school closings to confusing and conflicting masking recommendations to wavering vaccine approvals.

At best, the nation’s public health apparatus has communicated its guidance poorly and slowly, relying on euphemisms and distortions born of a sense that the public cannot be trusted with plain, direct language. At worst, it acts imperiously, pushing highly politicized policies supported by scant evidence, while claiming the authority of science and refusing to acknowledge the significant human and economic costs of its pandemic response policies.

There is also cause for concern that public health has not learned any lessons from COVID: Many of the same mistakes are being carried out again in response to monkeypox.

All of this means that America’s public health agencies represent a legitimate target for both criticism and reform. While the Republican Party has provided much of the former, it has produced almost no plan for the latter. Republicans have spent the past two years criticizing Public Health for its failings, but have no clear plan to reform the agencies. With few exceptions, they are stuck at the level of school insults and catchphrases.

Not that the dysfunction of the public health agency has gone undiagnosed. In your book Uncontrolled distributionformer director of the Food and Drug Administration (FDA) in the Trump administration Scott Gottlieb paints a damning portrait of the bureaucratic mistakes made by the Centers for Disease Control and Prevention (CDC) not only during the COVID-19 pandemic, but in the years preceding it.

It has been widely reported, for example, that the agency botched the testing kit release during COVID, releasing a faulty, contaminated test when COVID first spread.

But what’s less well known is that the agency also struggled with test kits during the Zika outbreak years earlier. As a government accountability office reported all the way back in 2017, the agency’s process for authorizing diagnostic tests was plagued by poor communication and manufacturing challenges. Both The CDC and FDA did not follow “some of their guidelines in communicating with users of diagnostic tests, including providing clear information that would allow users to more easily compare the performance of different tests,” the GAO report concluded.

Gottlieb also recounts how the CDC resisted early calls for widespread testing during COVID, in part because it would have meant relying on private labs, giving up its watchdog status in the process. Gottlieb also documented how the agency promoted arbitrary physical distancing rules that had little basis in science in 2021, even though those rules contributed to school closures.

So the agency has both simple bureaucratic process problems and deeper-rooted internal cultural problems that concerned critics could address through reform.

Most Republicans, however, offered nothing but ridicule and sloganeering to develop their criticisms. One exception is Sen. Mitt Romney (R–Utah) plan to create a separate agency for public health data aimed at faster response during outbreaks. This may have some benefits on the fringes, but it is unlikely to amount to the extensive cultural reform that the public health bureaucracy needs.

If anything, the CDC seems more likely to reform itself than most of its loudest GOP critics seem likely to reform the agency: officials recently announced an internal overhaul focused on faster data analysis and clearer public communications , although the agency has yet to detail its reform plan.

Unfortunately, bureaucratic inertia is a powerful force, and CDC’s centralized processes and gatekeeper mentality will not be corrected by more capable communications. At its heart, the agency problem, since ReasonRon Bailey recently argued that it has strayed from its core mission of combating infectious diseases, becoming a broader “public health” agency dealing with social problems such as obesity and gun violence, when what is needed , is a narrower and more discrete focus on viral pathogens. The Centers for Disease Control and Prevention should focus on, well, diseases.

For now, critics will have to hope that the CDC’s internal reforms will make some productive progress, because there is scant evidence that political critics of public health have any plans to address the problems they so incessantly complain about.

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