rewrite this title After Fauci Senate hearing, experts worry about ‘chilling effect’ on public health

For almost three hours on Wednesday morning, Dr. Anthony Fauci sat before the Senate Committee on Homeland Security and Governmental Affairs and declined to answer questions about the origins of the COVID-19 pandemic.

Instead, he invoked his Fifth Amendment right more than a hundred times — which later led Sen. Rand Paul, R-Ky., to say he would push to hold Fauci in contempt of Congress next week.

These moves have once again foregrounded Paul’s unproven claims that the SARS-Cov-2 virus came from a lab leak and that Fauci covered it up — a charge the scientist has vociferously denied. But the renewed attacks on Fauci, once the nation’s leading infectious disease expert, have caused Democrats, health workers and researchers to worry that these events may further erode public health staffing and infrastructure in the U.S.

“These firings and these cuts — they’re creating a chilling effect, honestly,” Andy Kim, D-N.J., said at the hearing, while also thanking Fauci and decrying what he called the demonization of public servants. “A chilling effect for the next generation of people who might consider stepping up to serve our nation, to be the next generation of researchers who now are wondering whether or not this is the right thing for them to do at a time when they see some of their colleagues, or those that they looked up to, being attacked.”

Other public health professionals agree that what played out on Capitol Hill earlier this week is part of a larger corrosion of the field to which they’ve dedicated their lives, endangering its future and undermining health outcomes in the U.S.

“I thought that we were healing as a country around COVID-19,” says epidemiologist Katelyn Jetelina. “I think what yesterday did was open some really deep wounds.”

Health freedom

During the pandemic, there was a surge in people asserting their right to reject various medical treatments and public health interventions. It’s a movement that’s often called health freedom.

“People were rejecting things like schools demanding that children be vaccinated for COVID before they return to school,” says Nicole Huberfeld, a professor of health law at Boston University. But those claims, she says, were not based on empirical evidence. “Rather, they were rooted in often religious or moral objections to vaccination.”

There were other pandemic policies that became increasingly unpopular — masking, social distancing, and school and work closures. People may have accepted these restrictions initially, but “that moment wasn’t long-lived in part because there was fairly swift pushback from the top during the first Trump administration,” says Huberfeld.

She says interest in ‘health freedom’ sloped downward during Biden’s presidency but it has spiked again during the second Trump administration. “I think it’s because people take their signals from the leaders that speak to them,” she says. And at this week’s hearing, Huberfeld says Republican lawmakers may have been speaking as much to members of their base as they were to Fauci.

But in her view, such attacks on the man who once helped lead the federal COVID-19 response, combined with a hollowing out of agencies like the U.S. Department of Health and Human Services, add up to a broader assault on the people and programs that keep Americans healthy.

“I think these hearings play into a larger picture,” says Huberfeld, “which is that the field of public health has been devalued significantly by leadership right now. And that devaluing will make it much harder to do the work of public health and it will make it so that the public doesn’t trust public health professionals.”

Dr. Georges Benjamin, the head of the American Public Health Association, says the consequences of that erosion are already apparent. “We are less healthy,” he says. “We’ve seen it every day, right? This inability to respond effectively to hantavirus, measles, cyclospora.”

The results can quickly become dire — especially, states Huberfeld, now that this scenario is compounded by recent sweeping cuts and changes to health care. “I do think there will be more illness and injury, which leads to preventable death,” she says.

Problems in the pipeline

Benjamin argues that public health professionals need to be able to provide educated and evidence-based information to lawmakers and other officials. But he worries that this week’s hearing and the political challenges that Fauci continues to face are likely to be intimidating.

“If you’re going to be threatened by members of Congress, you’re going to be a lot less willing to be frank and speak truth to power and give people the information that they desperately need to make decisions,” he says. “We can’t be tainted by a fear that if we say something, they’ll do something to destroy our careers and maybe put our lives at risk.”

Jetelina, who’s also an adjunct professor at the Yale School of Public Health, is concerned about the public health pipeline more broadly. She’s witnessed enrollment numbers drop and she’s had conversations with her students about their concerns about what a future in the profession might look like.

“We’re just scientists,” she says. “We are never supposed to be on TV and getting croissants thrown at us and death threats. It’s a whole new level of risk, and with risk comes really real calculations that people need to make.”

Jetelina believes that the current environment is forcing individuals to make difficult decisions about what to do professionally, especially in light of what happened to Fauci this week. “If you see someone like this — a public servant for the past 50 years — be just completely vilified,” she says, “it makes me wonder about the next emergency. Like, do I want to raise my hand and put my neck out there?”

In terms of how to move past this moment of mistrust and antagonism, Jetelina argues that the next step is to develop systems where health professionals and the public are engaging in conversation, “where we actually listen to the questions, concerns and confusion around health topics on the ground and then integrate that not only into communications but into operations,” she says. “People are demanding a far more participatory approach.”

And she wants to see something akin to a 9/11 Commission for COVID-19 to figure out “what we got wrong, what we got right and how are you going to fix it for the future.”

There’s no time to waste, says Benjamin, since questioning the legitimacy of science “makes us less healthy as a nation,” more vulnerable to current pathogens and future pandemics, and interferes with the essential objective of the field — treating and healing communities.