As we approach the fifth anniversary of the COVID-19 pandemic declaration, we find ourselves in a perilous moment. The principal agencies responsible for protecting the health of the American people are now led by Robert F. Kennedy Jr., who openly and consistently disregards scientific evidence. As secretary of Health and Human Services, he oversees flagship institutions such as the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration. All were central to the nation’s COVID-19 response and will be central to how we respond to current and future health threats.
These agencies are being stripped of funding and experienced, world-leading experts. Essential online public health data have disappeared, public communications from these agencies — central to informing the actions of local and state officials — have been stopped, and new rules have been set, including the elimination of data on gender and demographics. These actions undermine the quality of research, education, and communication on key issues from heart disease to HIV. Kennedy has also been the loudest voice in a dangerously uninformed chorus of vaccine skeptics, ignoring overwhelming evidence and sowing distrust in these lifesaving tools.
Five years since the worst pandemic in a century began spreading across the globe, we find ourselves in a world where trust in science and public health is diminished, and where the loudest voices are powered by ideology, not evidence. How did we get here, and how do we do better moving forward?
The United States did not do as well in communicating about COVID as many experts anticipated, me included. While bad-faith actors exploited every misstep and error of public health officials throughout the pandemic, we in public health must understand and take responsibility for our errors. Only through that process can we begin to rebuild trust in public health — to both counter misleading information unsupported by evidence and to help Americans live healthier lives.
So what’s the most common error that public health leaders made during the pandemic? Treating science as settled knowledge, rather than an open, transparent, and dynamic process in which we are continuously refining the questions and the answers that lead to evidence-based actions. Many of the successes in our pandemic response, like Operation Warp Speed, which gave the world life-saving vaccines, came from effectively and respectfully pursuing the scientific process. On the other hand, many of the missteps came when health officials failed to follow the scientific process, which requires an updating of our understanding and recommendations as new evidence and data are generated.
Following the scientific process means being dynamic. Recommendations for 6-foot distancing made some sense in February 2020, but not by April or May, when we knew that COVID was spread through the air, in aerosols that could travel dozens of feet in a closed room, making distancing less important and better ventilation key to reducing indoor spread. Routine use of ventilators for patients experiencing respiratory failure made sense in March 2020, but no longer by September, when there was much better evidence of their benefits and harms.
Even the pandemic’s most controversial policy — vaccine mandates — was reasonable in April 2021, when health experts believed that vaccination would prevent most infections and transmission, but certainly did not make sense by April 2023, when we knew that vaccinations had only a modest impact on transmission. And possibly the most egregious example of our inability to update our recommendations based on changing evidence was the failure to open schools in the fall of 2020.
The new leadership in the nation’s public health agencies now has an opportunity to learn from what worked and didn’t during the pandemic response. From the new leadership, I will be looking for three key strategies to better manage current and future outbreaks.
The first is transparency. Public health officials must openly acknowledge uncertainty and explain the rationale behind their decisions in real time. For example, early COVID messaging such as “flatten the curve” was often misinterpreted as a goal unto itself because its broader purpose — buying time to expand testing and treatment — wasn’t communicated clearly.
“Flatten the curve” guidance initially helped prevent hospitals from being completely overwhelmed. Bans on large gatherings, shelter-in-place orders, and similar measures helped prevent up to 35 million COVID cases in the United States by the end of April 2020. However, the lack of a clear, long-term national plan to ramp up testing and transparent communication about what we were learning about the virus during this time meant people lost trust in the original recommendation and its purpose. As situations evolve, explaining the reasoning behind decisions is essential so the public understands and stays engaged.
Second, adaptation to new evidence is essential. For example, in the summer of 2020, it was not clear if states were ready to open schools safely. By the end of September, after schools in states like Florida and Rhode Island opened, evidence started accumulating that even with modest mitigation measures such as testing, opening schools did not lead to meaningfully higher transmission rates. Thus, by September’s end, it was clear that schools could open safely across the country. Despite this clarity of evidence, many states and communities kept schools closed, including most schools in Massachusetts, leading to many parents struggling to balance work and child care, significant learning losses — and further distrust in public health recommendations.
Third, following the scientific process is what helps save lives. Let’s remember that over the past century, the world has witnessed a near doubling of life expectancy, with death rates falling for every age group. The primary driver of all these gains isn’t ideology, it is a commitment to the scientific process, which is driven by a commitment to rigorously test what works, and transparently share how scientists arrive at evidence so others can investigate and confirm or improve results. This collective problem-solving is the bedrock of modern medicine. It was critical to getting vaccines and treatments that helped bring the COVID pandemic to an end.
As we now face a new set of public health threats, and under new leadership, let’s take these lessons forward. Transparency, adapting recommendations in light of new evidence, and following the scientific process is how to advance health and quality of life, in public health emergencies and every day.
Dr. Ashish K. Jha is dean of Brown University School of Public Health and a contributing Globe Opinion writer.