By most accounts, the “Make America Healthy Again” agenda is backfiring. Measles is back with a vengeance, health insurance premiums are skyrocketing, and as Stat reported this week, American food safety could be on the verge of a breakdown. Meanwhile, the agencies that protect public health, like the Centers for Disease Control and Prevention, are being gutted of funding and experiencing mass layoffs. Against this backdrop, messaging at the federal level has taken a sometimes anti-scientific tone, such as implying Tylenol or vaccines can cause autism.
In response to this, many states are abandoning federal leadership and forging their own path. Less than a week after an advisory committee at the CDC changed a recommendation on when infants should receive the hepatitis B vaccine, California announced it was launching the Public Health Network Innovation Exchange. The regional alliance, state officials said, would be led by former CDC health officials. In a media release, the state elaborated that PHNIX would serve as a counterpoint to Robert F. Kennedy Jr. and the Trump administration’s anti-science public health policies. It would focus on “innovation,” “developing advanced technology,” and “funding frameworks” for public health preparedness and response.
“Dramatic and unfounded changes in federal policy, funding, and scientific practice have created uncertainty and instability in public health and health care,” Dr. Erica Pan, director at California Department of Public Health, said in a statement.
Other states are also going somewhat rogue in the wake of the Trump administration’s dismantling of public health care and the CDC. As previously reported for Salon, doctors across the country are losing faith in the CDC as the “voice of reason” in public health. In September, California, Oregon and Washington formed a West Coast Health Alliance to provide unified health information, of which the latest initiative builds upon. In the Northeast, seven states, including New York, Pennsylvania and New Jersey, came together to form the Northeast Public Health Collaborative to make its own vaccine recommendations.
More recently, Illinois Gov. JB Pritzker signed legislation to expand an executive order empowering the state’s Department of Public Health to offer transparent and science-based vaccine guidelines through its own Immunization Advisory Committee. The formation of so-called micro health alliances marks a new and uncharted chapter in public health, leaving open-ended questions about what this means for the future of public health.
“The trend of these multi-state public health alliances that are mostly framed in opposition to the federal government, in combination with declining resources, staffing and support for public health from the federal government itself, indicate the future of public health in the U.S. looks more fractured and challenging than ever,” Josh Michaud, the associate director of global health and public health policy at KFF, told Salon.
When asked if there’s anything to be gained by forming these micro-alliances, Michaud said states can “benefit from coordination of public health recommendations, regulations, information and practices,” especially when they feel that the federal government is no longer a trustworthy source of information and effective partner. He gave an example: states can guarantee that vaccine recommendations across states are in alignment.
“The future of public health in the U.S. looks more fractured and challenging than ever.”
“In the event of a public health emergency, having these connections already forged can speed detection, improve data-sharing and response, and can allow states to share resources and know-how without having to count solely on federal support,” Michaud said, adding that they can also be a display of “political unity” for public health issues. It can also be symbolic and a way for states to “publicly push back against federal guidance that they feel is no longer rooted in the best science and evidence.”
The U.S. briefly saw this during the COVID-19 pandemic under the first Trump administration when Western states formed a coalition to share supplies in response to hoarding at the federal level. Notably, Republican states also took similar actions to oppose pandemic policies led by the Biden administration. But under Trump’s second term, micro-health alliances have so far only included Democratic-led states. Michaud said this fracturing of public health will make “a unified response to a national public health emergency more challenging.”
“And it will leave the public more confused than ever because they will likely have multiple voices to look to for guidance and support who may offer conflicting messages and advice,” he said.
Indeed, while the formation of these alliances seems to be almost a short-term solution, they speak to a larger trend in public health in America: politicization.
“Having some states be at odds with the federal government can introduce delays and challenges when it comes time for coordinated and timely responses to national public health issues or a major emergency,” Michaud said. “It risks further politicizing and undermining public health to have multiple actors providing different, often conflicting messages.”
Start your day with essential news from Salon.
Sign up for our free morning newsletter, Crash Course.
Abby Tighe, executive director for the National Public Health Coalition, who was previously terminated in February, agreed that if the U.S. continues on this path of regional health alliances, it will end up with a “fragmented” public health system.
“That, frankly, leaves a lot of people out,” Tighe said. “And some of our most vulnerable populations out.”
Tighe said this is what concerns her the most. That’s not to say there is no need for them, though.
“The federal government is no longer offering that kind of reliable structure for public health,” Tighe said. “But what this means is that the states that have the money or the political will to go into these agreements within the region, it means that those are the only people who get access to quality public health.”
Epidemiologists can move to areas that can hire them and pay their salary to do the work they care about, Tighe said, but then those regions are only going to focus on the people that they serve.
Both Tighe and Michaud warned that there are limits on what these alliances can do as well, which raises bigger questions around public health agencies in the United States.
“There are limits to state powers when it comes to public health, so alliances can’t replace the role of the federal government,” Michaud said. “In addition, each state is very much independent of other states when it comes to deciding policy and must work within its own political and regulatory set of rules, so true coordination across states can only go so far as well.”
We need your help to stay independent
Indeed, Tighe emphasized that the CDC, for example, is not a “regulatory body,” but it makes recommendations. However, in the chaos of public health being politicized, it’s become a scapegoat for policies that some don’t like. She gave an example with COVID-19.
“CDC at no point put out a vaccine mandate that is something that policymakers decided to do,” Tighe said, adding that this lack of understanding about the CDC’s role ends up framing it as a “political pawn,” which ultimately “degrades science.”
As people reimagine U.S. public health in the future, especially beyond the Trump administration, Tighe said the country might benefit from a system that is “insulated from partisanship.”
“I deeply believe that public health is political and we rely on policymakers to prioritize it, but it is not partisan,” Tighe said. “I think if you talk to people about what public health does, and what the importance of it is, and even health care is a piece of this as well, it’s not partisan to want to live in a safe place, to not want your family members to die of a disease, and to want safe and healthy and clean food.”
As far as how much these micro-alliances will take on, it remains unknown.
“I think these alliances are still mostly in pilot stages,” Michaud said. “Certainly there could be more ‘real-world impact’ to come, and how much responsibility these alliances take on may depend partially on future actions, or inaction, from the federal government.”
Read more
about public health
