On Wednesday, California, Oregon and Washington announced a new collaborative alliance that officials say “will help safeguard scientific expertise by ensuring that public health policies in California, Oregon, and Washington are informed by trusted scientists, clinicians, and other public health leaders.” For starters, the alliance will work toward immunization guidelines “informed by respected national medical organizations.” Then, on Thursday, Hawaii announced that it’s also joining the alliance.
Nine former CDC directors used language including “alarming,” “a raging fire” and “hurting badly” to describe the state of things at the CDC.
Immunization guidelines would normally be issued by the Centers for Disease Control and Prevention, but in a shockingly short period of time, Health and Human Services Secretary Robert F. Kennedy Jr. has devastated its critical public health functions. In a New York Times op-ed this week, nine former CDC directors used language including “alarming,” “a raging fire” and “hurting badly” to describe the state of things at the CDC.
They decried the developments at the CDC that include Kennedy’s firing thousands of federal health workers and well-qualified leaders (among them the CDC director, Susan Monarez), dismantling key public health programs, promoting unproven treatments, failing to encourage vaccination during a major measles outbreak, promoting flawed science and inaccurate health statements to disparage vaccines, canceling investments in medical research and supporting legislation that will lead to the loss of health coverage for millions of Americans.
Kennedy also replaced seasoned experts on federal health advisory committees, including members of the Advisory Committee on Immunization Practices, with people whose relevant qualifications seem to be that they share his views.
In a contentious hearing before the Senate Finance Committee on Thursday during which Kennedy was grilled by Republicans and Democrats for his management of HHS, he insisted his actions were geared toward making the CDC “trustworthy.” However, Sen. Ron Wyden of Oregon, the ranking Democrat on the committee, said, “Every single day, there’s been an action that endangers the health and wellness of American families.” He said, “Robert Kennedy has elevated conspiracy theorists, crackpots and grifters to make life-or-death decisions about the health care of the American people.”
In their New York Times op-ed, the former CDC directors exhorted the nation to rally to protect the health of every American. Forming the West Coast Health Alliance appears to be how the four states mentioned are rallying on behalf of the American people. While the details have yet to emerge, its intent is clear: restore science, in whatever way and at whatever scale we can.
It’s surreal that medical professionals and the American public can no longer depend on the CDC. For decades, the CDC has led public health campaigns, defined priority areas for boosting national health, issued recommendations for preventive measures that guided clinicians and communities and defined what insurers will cover. Relying on the leadership of this agency has long been embedded in the practice of health care and public health. Before Kennedy helped crumble it, the CDC’s bedrock was made up of qualified, credible scientists leading rigorous processes, working under an unwavering mission to preserve the safety and the health of the nation.
Unfortunately, Florida is following the CDC’s lead, abandoning school vaccination mandates that have protected the public from diseases such as measles and whooping cough. Even in normal times, doctors’ offices and emergency rooms face challenges meeting the October-to-March surges in RSV, influenza and Covid. Now relying on the CDC — or the empty hull that carries its name — will put our patients at a disadvantage.
No one wakes up and decides to recreate the functions of the CDC to make a statement
To quote the supercomputer in the 1980s apocalyptic movie “War Games,” “The only winning move is not to play.”
And so my state of Oregon, along with Washington, California and Hawaii, wisely decided to step away from a dysfunctional enterprise and establish its own evidence-based health alliance.
No one wakes up and decides to re-create the functions of the CDC to make a statement. This will be a monumental task for states that are fighting a million battles to preserve the health of their residents. The slashing of Medicaid funding alone is a catastrophe that is already requiring an outpouring of ingenuity from states’ public health agencies. But the establishment of this alliance is a functional necessity. The practice of medicine in ordinary times is tenable because we have working guidelines for preventing illness and treating patients for common conditions. This involves prevention of harmful infectious diseases through immunization, yes, but also preventing violence, opioid overdose, heart disease, lead poisoning and the myriad other health threats we face. We have relied on the CDC for the topical and methodologic expertise that allowed it to synthesize vast amounts of evidence into national recommendations. Maybe it will again one day. Until then, our reaction to science’s being dismantled in plain sight must be to use creative solutions to build it back up. There is a role for our medical societies to advocate for scientifically grounded practices for the populations they represent. There is a role for private philanthropy’s stepping in to keep research funded. There is a role for insurance companies to look for solid evidence from reliable sources to guide their coverage decisions so costs do not skyrocket for individuals as health care providers continue to try to provide routine care. And there is a huge role for our states’ leaders and their health agencies, which are chronically overburdened and underfunded but staffed by those who believe in the fundamental charge of public health: to protect and improve the health of the entire population. In a devastating time for public health, at least these four states are showing us that some parts of government are still investing in keeping us all alive and well.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
