We don’t have to choose between saving lives and saving jobs, between public health and the economy. Science can help us find the policies and interventions that will do both. And we have that scientific capacity right here in Atlanta. CDC is the world’s preeminent disease control agency, but we have to make sure that it is adequately supported and allowed to provide the science and the leadership that this country now needs.
Twenty-five years ago, I (Mark) was working at CDC to use the power of science to establish research on gun violence prevention. But the NRA did not think that the research would protect the rights of law-abiding gun owners or support its goal of selling more guns. So it tried to shut down this research. By using scare tactics and making science and research the enemy, the organization was able to cut off federal funding of gun research for 20 years.
As a country, we paid a heavy price. During that time, mass shootings increased substantially, and more than 600,000 lives were lost to gun violence in the U.S. In 2019, Congress passed and the President signed a bipartisan bill to restart this research using science to identify interventions that both reduce gun violence and protect gun rights.
Now, in the midst of the coronavirus pandemic, some people are drawing a similar false dichotomy, saying we must choose between the economy and public health. They distrust science and don’t want to support it because they see it as only serving public health goals and undermining efforts to restore the economy. Frequent policy changes around the use of masks, risk factors, and other emerging evidence have also led people to distrust science. Science is imperfect and evolving. But, science is not biased toward public health. And it can help us effectively reduce both the health burden and the economic burden on our country.
Our global battle against coronavirus will continue until all people everywhere are protected. The first way that science can help is by allowing us to test and refine an evidence-based approach to public health problems. It works to answer four basic questions:
1) What is the problem? For example, how many people have been infected? How many have been tested and what have been the results? How many became sick? How many have been hospitalized? How many recovered? How did they recover? Do we have enough tests to get a complete picture of what is happening and where, and how the results are changing over time? How does it spread? How is the picture changing over time?
2) What are the causes? How does this virus behave? What factors increase or decrease an individual's risk for severe illness? Why are some groups affected more than others?
3) What works to prevent and treat infections?
4) How do you deliver, scale up and spread those interventions that prevent and mitigate the illness? How do we distribute treatments and vaccines equitably?
Second, we need to combine the social sciences — like economics, political science and psychology — with the biological sciences to help us understand how best to protect the public's health and restore the economy. Given how much still remains unknown about this new virus, these are not things that we can figure out in our heads. The only way to find out is to do the experiments and track the results closely. This is the way science works.
Third, science allows recommendations to be objective and credible. Sharing the evidence and being transparent about our methods can also generate trust in our results, especially if we have new findings that result in changes to recommendations.
Fourth, science allows for efficiency and continuous improvement. There is much to be gained by sharing knowledge about what works so that we can continue to build upon it. For example, if the question is how to collect and process viral tests, it will be more efficient to answer the question once and use it 50 times than to have 50 states all try to answer the question and each use it once. Scientific knowledge can be integrated, translated, and shared. Scientific guidance can be used by government at all levels as well as the private sector and civil society.
We are fortunate that our government has a world-class scientific institution that draws over 15,000 of the top minds in science from all over the world here to Atlanta. The Centers for Disease Control and Prevention (CDC) employs more than 21,000 people across all 50 states and more than 50 countries. They are epidemiologists, statisticians, laboratorians, physicians, nurses, anthropologists, writers, psychologists, economists and policy analysts, representing all stages of knowledge management: generation, integration, dissemination and application.
The evidence that CDC uses to develop its recommendations does not just serve healthcare professionals and institutions. Science does not serve just Red states or Blue states. All businesses need evidence-based guidance on when to reopen and how to move forward, and they can benefit from CDC’s unbiased guidance. The benefit of this function being held within government is that these functions do not directly generate profits, so the work can be performed using objective and high-quality universal standards the public can trust. CDC can also help with the coordinated mobilization and allocation of resources. Strengthening our capacity in healthcare and public health will strengthen our capacity to put evidence-based, science-driven programs and policies into action.
CDC has not always shined during this pandemic. It did not perform well in quickly developing a test for infection and, like any institution, it has misspoken at times and made some mistakes. But our global community needs science more now than ever before. We need to know the truth. Politics has and will continue to play a role in determining public health policies. But we need to know what the science says so we can decide what policies to support and understand the importance of following CDC guidelines. CDC needs to be transparent with its evidence and information. CDC should be asked to report daily on the who, what, where, why, when and how people are becoming infected. We all have a role to play by asking to see and understand the evidence behind recommendations for closing or reopening parts of the economy.
CDC’s importance does not begin and end with the coronavirus. Its ongoing work of tracking and helping to control many more epidemics, including obesity, heart disease, and all sorts of interpersonal violence and suicide — remain essential for our country and the world. Even more now than ever, mental health needs attention.
Many countries around the world need to help strengthen their ability to prevent, detect, and treat new emerging viral diseases and they look to CDC for guidance and leadership. It is very much in our interest to prevent diseases there to protect our citizens here.
When we fail to use science, we all suffer. Let’s take a lesson from history and strengthen and sustain CDC and our public health science capacities. In fact, that’s the only way we will win.
Dr. Mark L. Rosenberg is an epidemiologist, infectious disease physician and psychiatrist. He is president emeritus of the Task Force for Global Health and a former assistant surgeon general. Julie Rosenberg is deputy director of the Global Health Delivery Project at Harvard. She is Mark Rosenberg’s daughter.
