(excerpted from a lecture given at the Drexel College of Medicine’s Clinical Research and Organization program)
The response to the Covid-19 pandemic has become so highly emotional and political for many people in the U.S. that even our most basic approach to public health is being challenged. In fact, the current environment has compelled me to feel the need to choose my words carefully. But it is not out a concern for political correctness.
Let me be clear. I think we should wear masks, practice physical distancing, avoid large gatherings and wash our hands often. As an aside, I don’t like the phrase social distancing and use physical distancing. Our political disputes are all too frequently creating social distancing among us – and not in healthy ways.
Anyway, I think we should wear masks, practice physical distancing, avoid large gatherings and wash our hands often To me, it is just common sense. You cannot negotiate with a virus. And Covid-19 is not like the flu because we have no vaccines and almost nothing to treat the disease itself.
Sadly, these last few words ordinarily would not be anything special or extraordinary. But in this climate, these words could be construed as politically provocative.
So when contemplating this lecture, I was irritated/astonished/disconcerted/dismayed – call it what you may — to even realize that maybe I have to choose my words carefully if I wanted to create some teachable moments.
Fortunately, I had a conversation with a very close friend, who wondered why Anthony Fauci, the NIH Director of the Institute of Allergy and Infectious Diseases, has been so measured in the way he presents his thoughts and prescriptions.
Isn’t it obvious that we need to wear masks, wash our hands, avoid large crowds, and practice physical distancing?
After putting aside my own exasperation with the truth of my friend’s words. – I realized that public health officials are trained to deal with public health –and that means all of the public – not just those who agree with us.
And those in public health understand that we will not berate our way into convincing people to put on masks, wash their hands, avoid large crowds or practice physical distancing as satisfying as yelling and insulting may feel.
That strategy has not gotten us far with the anti-vaccine crowd and it is not getting us anywhere now.
But who could have predicted that such a simple measure as wearing a mask would provoke such outrage in some people? We don’t often see this when other medical treatments often require more complicated, lengthy and painful things of people.
So the times speak to a need to talk in ways that continue discussions, not end them or create winners and losers or the need to score meaningless rhetorical points. We need a mixture of persistence, patience and good will.
The pandemic has shown us that our products and therapies will not always be well-received by everyone. Even if the stakes are life and death or serious illness.
The situation is more than a little frustrating but it calls for more exploration, not resignation….
SCIENCE STILL MATTERS
But as the federal government talks about a warp speed program for a vaccine, the manufacturers and policymakers will have a harder time in trying to take shortcuts on the science.
Science still matters in product development.
Because the public needs to have confidence that a vaccine or treatment will work. We’ve already run into confusion and angst over the unfounded assertions that prompted the off-label use of chloroquine and hydroxychloroquine.
And also remember, that the rest of the world is dealing with Covid-19. It will be difficult to indefinitely sustain a problematic product or course of action when the rest of the world is watching and reacting. Not only on a scientific basis, but also on decisions on how to share the vaccine when one is developed. And in yet other ways. For example the EU is limiting U.S. citizens entry into member countries because of the Covid rates in the U.S.
Despite all of this, we will get through Covid-19. But the danger – my concern- my fear — is that we will no longer feel the proper urgency to save lives to do it – at least in the short-term….
VACCINE SKEPTICS & RACIAL INEQUALITY
The nation as a whole is starting to accept that there has been systemic racism in the U.S. and that there have been health consequences that stem from these inequalities. People of color seem to have higher infection rates possibly because they are ones providing essential services and have not been able to stay at home. And do not have access to the same kinds of services as others.
People of color also have a sad history with organized medicine that goes beyond the horrors inflicted on the Tuskegee Airmen and being routinely denied medical treatment due to the color of their skins.
But there’s more to this that also goes to the prosperity of a community and how retailers feel about serving those communities.
A few years ago, I had to change doctors because the one I was seeing had retired. My new doctor learned that I taught at Drexel and so she asked me what I thought we needed to do about healthcare. I suspect she expected me to say something about the Affordable Care Act or something about changing regulations on research.
What I did tell her was this: If I could do only one thing, I would ensure that every community had access to fresh produce.
Initially, she was startled at my answer, but then understood quite clearly what I meant. Good health starts with good nutrition which means easy access to nutritious foods. And Covid-19 is particularly dangerous to those who already have health problems. It is not a big leap to go from poor nutrition to to poor health….
NEW PRODUCTS EVEN FOR DENIERS
The virus also attacks those with respiratory problems – which could prompt new products to treat those types of conditions in the new world of Covid-19. So public health and population health are not divorced from our world of clinical trials – they help inform our next development moves.
And if a significant portion of the population are in denial about the virus or refuse to listen to medical advice, then the biomedical product companies can be expected to develop or at least examine the market for products that meet the health needs of that population. It is a cold hard truth that if enough people make poor decisions on a health issue or simply have bad luck, medical product makers will try to meet the need.
We do similar things now in dealing with opiate addiction and cigarette smoking.
Not to be too harsh, but this is what may go for compassion in a free market system…
We don’t see people often argue about getting a treatment for a specific disease or do any number of unpleasant things in getting treatment for cancer or even wear a mask when asked to in a hospital.
But we see people reject treatments as well… as not worth the cost of quality of life for the remaining time they have or out of concern of bankrupting their families or out of religious conviction or for any number of reasons too numerous to list.
The outcry – if there is one – is usually confined to family and friends. Sometimes, however, such decisions do become incredibly public and political, most notably when the issues involve reproductive rights or the right to die.
But it is the collective nature of a pandemic’s effects that make the difference.
Our actions or inactions directly affect everyone else in the pandemic era. So the public health response and biomedical product develop process have the potential to be turned into political battles.
And so they have this year.
And in this election year, we are confronted with two distinct political choices on how to confront public health issues. The outcome will affect the choices we make in biomedical R&D.