The first week of President Donald Trump’s second term dealt several body blows to public health. Among a flurry of executive orders signed on his first day in office is one that withdraws the U.S. from the World Health Organization (WHO)—a move experts say will make the U.S. and other countries around the world less safe from infectious diseases and other threats to health, according to Time.
Another executive order signed that day is aimed at “restoring freedom of speech and ending federal censorship” of US citizens. It alleges, in part, that “Under the guise of combatting ‘misinformation,’ ‘disinformation,’ and ‘malinformation,’ the Federal Government infringed on the constitutionally protected speech rights of American citizens across the United States in a manner that advanced the Government’s preferred narrative about significant matters of public debate.”
Many of the federal efforts President Trump decries were taken in an attempt to stem a flood of falsehoods about COVID-19, vaccine safety, and other public health measures. A Supreme Court ruling last year affirmed that the U.S. government can contact social media companies to express concern about mis- and disinformation on their platforms. Trump’s order sweeps this aside. As a result, false claims and deceptive statements will be able to spread freely on the internet and social media without comment from federal agencies.
Day Two Brought More Surprises
On Tuesday, January 21, the Trump administration halted external communications by staff of the Department of Health and Human Services (HHS) and its agencies, including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The pause is expected to last until Feb. 1, if not longer.
In a memo sent by Acting HHS Secretary Dorothy A. Fink entitled “Immediate Pause on Issuing Documents and Public Communications” department leaders were told to “Refrain from sending any document intended for publication to the Office of the Federal Register until it has been reviewed and approved by a Presidential appointee.” [Emphasis added]
Acting Secretary Fink went on to specify additional forms of proscribed communication, including:
“Refrain from publicly issuing any document (e.g., regulation, guidance, notice, grant announcement) or communication (e.g., social media, websites, press releases and communication using listservs) until it has been reviewed and approved by a Presidential appointee.”
“Refrain from participating in any public speaking engagement until the event and material have been reviewed and approved by a Presidential appointee.”
“Coordinate with Presidential appointees prior to issuing official correspondence to public officials (e.g., members of Congress, governors) or containing interpretation or statements of Department regulations or policy.”
The Acting Secretary’s memo included the assurance that ”Nothing in this guidance is intended to limit an employee’s personal correspondence with members of Congress or other third parties, including an employee’s whistleblower protected communications.” However, its central message was clear to HHS’ 80,000-plus employees.
Since then, official communications from HHS to the public, the states and even members of Congress have stopped. Although the Department stated that exceptions will be made for communications affecting “critical health, safety, environmental, financial or nation security functions.” these will also be subject to review. It’s unlikely that any Presidential appointee will approve an urgent HHS communication without the President’s consent.
But Wait, There’s More…
The same day the HHS memo was issued, NPR reported that a search of the Department’s main website revealed that recent government posts about abortion have been scrubbed. A Biden administration website, “ReproductiveRights.gov,” launched shortly after the Supreme Court overturned Roe v. Wade, is now a broken link.
A Department of Homeland Security (DHS) representative announced that Acting Secretary Benjamine Huffman has ended guidelines that previously limited Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) enforcement actions near or even in “sensitive areas” such as hospitals. Katherine Peeler, a pediatrician at Harvard Medical School said, “No one should have to hesitate to seek life-saving treatment because they fear detention, deportation, or being torn from their families.”
Additional executive orders that day targeted the healthcare marketplace established by the Affordable Care Act (also known as “Obamacare”). These could affect the enrollment process and medical insurance coverage for an estimated 24 million people. Millions could lose affordable coverage, according to Newsweek.
The sudden suspension of job-related travel by HHS employees, NIH study sections and others sparked mass confusion in the research community and panicked many participants in NIH-sponsored clinical trials of treatments for cancer and other serious diseases.
In response to administration’s communication ban, the CDC canceled an upcoming monthly call with “lab leaders, pathologists and laboratory scientists across the country, including at large health systems and hospitals — that had been intended to share updates about health threats such as Bird Flu and testing changes” according to the Washington Post. One lab leader remarked, “Viruses don’t care who the CDC director or HHS secretary is, or what spin newly appointed political leadership want to put on their agencies’ efforts.”
On Friday, January 24, President Trump terminated Dr. Anthony Fauci’s government security. Although Dr. Fauci served our nation with distinction for more than 4 decades, advised 7 presidents and received the Presidential Medal of Freedom from President George W Bush, he was the target of death threats during the COVID-19 pandemic. Now retired, he is still vilified by many of the President’s most ardent supporters. According to The New York Times, Trump explained his decision this way: “When you work for government, at some point your security detail comes off and, you know, you can’t have them forever.”
On Saturday the President floated the idea of eliminating FEMA. He also threatened to withold disaster relief from California.
What’s Next?
For now, the only health communications Americans receive will come from non-governmental sources, including professional societies, non-governmental organizations, advocacy groups, businesses, fellow citizens, anti-vaxxers, conspiracy theorists foreign agents and bots posing as Americans to spread disinformation. It will be up to us to figure out what to believe.
More executive orders could follow. Meanwhile, action shifts to the Senate, where the President’s nominee to lead HHS, prominent vaccine skeptic Robert F. Kennedy Jr., is scheduled to testify before the Finance Committee on Jan. 29. Recently, NPR reported that Mr. Kennedy intends to continue collecting fees from a law firm suing Merck over claims that it failed to properly warn consumers about risks from Gardasil, an HPV vaccine that is highly effective at preventing cervical cancer.
Once a vote on Mr. Kennedy’s nomination is held, the Senate will consider nominees for top HHS leadership posts, including the directors of the NIH, CDC, FDA, and the U.S. Surgeon General. However, if these recent actions are any guide, their views, as well as the views of countless medical and public health experts around the country will matter little compared to those of the President.