Muzzling the MMWR–When Incompetence and Malevolence Join Forces

Dan Diamond has an explosive scoop that makes my blood boil–the Trump Administration is directing political operatives to influence and control messages put out by the CDC’s Morbidity and Mortality Weekly Report (MMWR), the usually obscure source of breaking health information for many decades. Instead of leaving public health discovery and communication to civil servant professionals, political operatives who are loyalists of the President and who have no health or public health expertise like Michael Caputo have been seeking since April, 2020 to turn the CDC into just another tool for the stoking of the President’s ego and his re-election bid.

Both my undergraduate and Ph.D. degrees are from the UNC School of Public Health, and we learned about MMWR as being the “just the facts” first report source for outbreaks and widespread health risks. To provide context, the Obama Administration sought a synopsis of what MMWR reports would be the day before they were released, and that was initially denied! What the Trump Administration has been doing is beyond the pale. This is “Dear Leader” level co-opting of every tool of government for the personal aggrandizement of the President, and people have and will die because of it.

An important note about MMWR and public health surveillance during a novel disease outbreak–things are always clearer in retrospect, and there will be errors, mistakes and rabbit trails that turn out to be unproductive. Being able to trust MMWR to play it straight with what is known each week is of vital importance to the health of the American people. It is unclear if anything that emanates from the Trump Administration can be trusted to do anything other than advance the interests of the President as he understands them.

A quick historical example. Here is the MMWR on June 5, 1981, that concluded this way (emphasis mine):

All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis. Although the role of CMV infection in the pathogenesis of pneumocystosis remains unknown, the possibility of P. carinii infection must be carefully considered in a differential diagnosis for previously healthy homosexual males with dyspnea and pneumonia.

This June 5, 1981 piece is remarkably prescient–it is the first note of what would become known as HIV/AIDS, which is a virus that makes people susceptible to opportunistic infections of all types because they become immuno-compromised.

This report–dispassionate and clinical in noting that the first 5 cases of of Pneumocystis Carinii pneumonia occurred among gay men–lead to the stigma that came with it being labelled as the “gay disease” when in fact we now know that body fluids of numerous types can lead to transmission and heterosexuals are also at risk. Similarly, there was a great deal of energy put into the fact that all of the first 5 cases repored “huffing” inhaled drugs, leading to investigation of drug impurities that could plausibly cause pneumonia. Eventually more data won out and we came to understand how the disease was spread and how folks were at risk and how that risk could be minimized. Now we have treatments that have rendered HIV/AIDS a chronic disease instead of a death sentence, but that outcome was built brick by brick on public health findings and reports that stuck to what facts were known at the time.

The indepedence of MMWR has been bipartisan as can be seen by looking at these 25 key MMWR reports on HIV/AIDS from 1981-2001 (Reagan x2, GHW Bush x1, Clinton x2) and here is a 30 year look back (adding W Bush x2, Obama to the span of Presidents who allowed the CDC to do its thing and report via MMWR in an unvarnished manner). Ronald Reagan is often criticized, and I think rightfully so, for not talking about AIDS while he was in office, thus missing a bully pulpit opportunity to comfort and provide leadership in the fight against the disease and reduce its stigma. However, he didn’t manipulate what MMWR put out, even if he choose not to be vocal about it.

None of this is normal. President Trump is not a normal politician, there is nothing sacred in his mind, expect for himself. All of our institutions and norms are in jeopardy so long as he remains in office. Next June will be the 40th Anniversary of HIV/AIDS. One wonders what the state of the trusted MMWR will be then if Donald Trump is still the President.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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