We need an independent public health agency
As the Trump administration seizes and buries the Centers for Disease Control’s public health data and tries to isolate and undermine Dr. Anthony Fauci, we are now seeing a dangerous battle between political expediency and sound science.
But it is not altogether new. And there are institutional solutions in sight.
Other key public health institutions have already been eroded. In 2007 three former Surgeons General, having worked in Democratic and Republican administrations, testified
The eclipse of rigorous science has only gotten worse since then. The Federal Government established a national pandemic response team “after the Ebola epidemic of 2014 to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic.” Yet the White House disbanded the Task Force in 2018, such “that no senior administration official is now focused solely on global health security.”
Subsequently, other White House staffers justified the cut as a “reorganization,” a matter of “streamlining” to remove “bloat.” Under the law now existing, this decimation of readiness and expertise is the prerogative of the White House.
Eventually, on Jan. 29, 2020 — only after there were already over 7,000 coronavirus confirmed cases in China, and nearly 60 million Chinese people were under lockdown — president Trump empaneled a coronavirus task force. Political-appointee HHS Secretary Alex Azar initially led this ad hoc group, before politician Vice President Pence took over. (The president’s son-in-law reportedly had his shadow task force as well.)
Like the original pandemic task force, most senior Federal officials on the task force, including the Secretary of HHS and the Surgeon General, serve at the president’s pleasure. In theory, this political control allows the elected-President to ensure that they do their job in the way that the electorate expects.
In contrast, technically, the President cannot directly fire Anthony Fauci, a career civil servant. But in practice, President Trump could cause intermediaries to fire him, leaving Fauci to spend years tied up in appeals (as is Rick Bright, who President Trump dismissed from the Biomedical Advanced Research Developmental Authority). But frankly, there is no need to fire Dr. Fauci, when he can be sidelined, silenced, and impugned instead.
America needs a stable and independent public health institution with its voice and real expertise to speak truth to power. We have such a model for the economy in the Federal Reserve Board. If presidents could dump money into the U.S. economy whenever they wanted a political boost, it might well overheat, creating a crash in future years. Instead, the Federal Reserve governors serve for fourteen-year terms to focus on economic fundamentals, rather than the changing winds of politics.
Yet, as 17.8 million Americans are out of work due to the pandemic, it is clear that fiscal stimulus is not enough to prevent economic catastrophe. Other countries like Australia, Canada, and the European Union are heading back to work because they had an early and consistent response to the pandemic.
In June, the Supreme Court decided a case involving the Consumer Financial Protection Bureau, an independent agency that Congress established in the wake of the 2008 financial crisis. The law says the director could only be fired for “inefficiency, neglect of duty or malfeasance in office.” The Supreme Court says that this political insulation violates the Constitutional separation of powers.
Still, the decision reinforced the validity of other independent agencies, with multiple commissioners. Accordingly, Congress could create such a system that could reinvigorate and protect the Office of the Surgeon General, the United States Public Health Service, the CDC, and the National Institutes of Health. In addition to protection from political firings, the agency needs an independent source of funding as well.
The country deserves stable institutions it can trust. President Trump can continue tweeting, but he should not be allowed to put our public health and our economy in jeopardy through reckless behavior, lacking a basis in scientific evidence. Congress must act.
Christopher Robertson, J.D., Ph.D., is the author of Exposed: “Why Our Health Insurance is Incomplete and What Can be Done About It.” He is the N. Neal Pike Scholar and Professor of Law at Boston University. Richard Carmona, M.D., MPH, was the 17th Surgeon General of The United States and a distinguished professor at the University of Arizona.