Intended for healthcare professionals


Covid 19: NEJM and former CDC director launch stinging attacks on US response

BMJ 2020; 371 doi: (Published 08 October 2020) Cite this as: BMJ 2020;371:m3925

Linked Opinion

Politics and public health in America—taking a stand for what is right

  1. Janice Hopkins Tanne
  1. New York, USA

The US is “dying in a leadership vacuum,” in responding to the covid-19 pandemic, the New England Journal of Medicine has said in an editorial.

“Our leaders have failed. They have taken a crisis and turned it into a tragedy,” the NEJM editors said. US leaders are “dangerously incompetent,” have undercut trust in science and in government,” and should be voted out,1 the journal said.

The intervention came as a former director of the Centers for Disease Control and Prevention (CDC) suggested the current CDC director should update staff in writing about the agency’s failings, apologise, and resign.23

The US leads the world in the death rate from covid-19, which is far higher than larger countries and those with less sophisticated technology and health services, the editors said.

“We have failed at almost every step,” they wrote, describing problems with supplies of personal protective equipment, delays in testing, and failure to employ quarantine, isolation, and social distancing appropriately and quickly. Government inaction has led to business losses and unemployment.

Earlier, William Foege, former director of the CDC and a leader in smallpox eradication, criticised the US response and the failure of the CDC. He sent a letter to Robert Redfield, the current CDC director, asking him to write to CDC employees describing the White House’s failure to put the CDC in charge of the covid-19 pandemic and then resign. A letter, he wrote, would be on the record.

Foege called the US response to the pandemic “a slaughter and not just a political dispute” that had turned the CDC’s reputation from “gold to tarnished brass.”

Foege is emeritus presidential distinguished professor of international health at Emory University. He was director of the Carter Center’s Task Force for Child Survival and senior medical advisor to the Bill and Melinda Gates Foundation. President Barack Obama awarded him the Presidential Medal of Freedom, the nation’s highest civilian honour, in 2012. His private letter, written on 23 September, was published by USA Today on 7 October.

Redfield, a virologist with expertise in HIV/AIDS and a clinician, served in the US Army’s medical corps. He co-founded the University of Maryland’s Institute of Human Virology and was chief of infectious diseases at the university’s medical school.

Foege wrote, “You don’t want to be seen, in the future, as forsaking your role as servant to the public in order to become a servant to a corrupt president. You could send a letter to all CDC employees (a letter leaves a record and avoids the chance of making a mistake with a speech) laying out the facts. The White House will, of course, respond with fury. But you will have right on your side. Like Martin Luther, you can say, ‘Here I stand, I cannot do otherwise.’”

Among the truths that need to be faced, Foege said, are that, despite White House spin attempts, the failure of the US public health system is because of “the incompetence and illogic of the White House programme.”

The White House failed to put the CDC in charge of the pandemic, violating rules of public health so that “people and the media go to the academic community for truth, rather than to CDC,” Foege’s letter says. Unlike former responses to health crises, there has been no federal plan, “resulting in 50 states developing their own plans, often in competition.”

The need to form coalitions to fight the pandemic “has been ignored as the president thrives instead on creating divisions, and the need for global cooperation has been squandered by an ‘America first’ policy. The best decisions are based on the best science while the best results are based on the best management. The White House has rejected both science and good management,” Foege wrote.

Foege, the CDC, Redfield, and the White House have not publicly commented on the letter.