On Wednesday, the Biden administration appealed a federal judge’s decision to disallow the Centers for Disease Control and Prevention’s (CDC) mandates for mask use on airlines and other modes of transportation. While there is substantial disagreement among experts about the utility of mask use as a public health measure at the population level, there is little dispute that the CDC must have some public health authority.
As a former local deputy health officer during the 1990s, we used our local public health authority sparingly. Even during the heyday of debates on maintaining commercial sex establishments during the beginning of the AIDS crisis, public health officials were reluctant to issue business closure orders due to the concern that such orders might be appealed by a business and stayed by a local judge. Exceeding one’s authority was always a cause for hesitancy in using it. Because of that, we often turned to community-level education, dialogue with business or community leaders and persuasion. We invited businesses to convene local groups to address health issues together and often had business owners co-chair working groups on controversial topics.
Now is not the time to undermine further the role and authority of the CDC. If anything, our public health institutions must be strengthened with increased resources and increased authority. In exchange for that strengthening, we should expect increased transparency in decision making, leadership with exceptional qualifications and experience in the practice of public health and community-level participation in the policymaking process.
There are clear scenarios where public health authority, the authority to quarantine, isolate, vaccinate or even require testing or treatment of recalcitrant individuals is necessary and ethical. During the early response to the COVID-19 pandemic, quarantine of those exposed and isolation of those infected was a useful strategy to slow transmission and “flatten” the curve of hospitalizations, thus, temporarily maintaining hospital capacity. The control of vaccine-preventable diseases has saved millions of lives of children and adults and that has primarily been achieved through vaccination mandates for school entry. In rare circumstances, diagnostic testing or treatment may be imposed on a pregnant woman to identify and cure the developing fetus of an infection.
If we do not agree with the policy of a governmental agency, it is wrong-headed to respond by decreasing the authority of that agency. While many may think a judicial action to stay a policy provides correction, it places too much control in the hands of one politically appointed individual like a federal district judge. The Biden administration’s appeal to that judge’s decision is critical and timely.
We have witnessed far too much politicization of the greatest public health tragedy in our lifetime. In respect to the nearly 1 million recorded lives lost, the millions of families affected and tens of millions with longer-term health and social consequences from COVID-19, we must preserve what works in our institutions, not undermine them.
Jeffrey D. Klausner, MD, MPH is a professor of Medicine and Public Health at the Keck School of Medicine of the University of Southern California. He is a former U.S. Centers for Disease Control medical officer and a former San Francisco deputy health officer. Twitter: @DrKlausner.