CLINICAL MATTERS

As I write this column, it is becoming increasingly clear that former US President Donald Trump will win a second term of office. This is not entirely unexpected due to the economic issues that are preoccupying most American voters. It is disappointing how vicious the rhetoric has become, and I remain hopeful that the US can move beyond partisanship and heal the deep wounds of their nation.

One aspect of the elections that does worry me is the anti-science stance that some of President Trump’s allies have taken. There are known anti-vaxxers in his orbit that have figured prominently in his campaign. These people have done a lot of harm by promoting debunked conspiracy theories and attacking safe and effective public health interventions. Scientifically proven policies such as vaccine mandates for the most debilitating and contagious infectious diseases like polio and measles are allegedly going to be reviewed and potentially rolled back. If this does happen, it could cause a public health disaster and potentially endanger millions of lives not just in the United States but throughout the world.

The Centers for Disease Control and Prevention along with the US National Institutes of Health are two of the most respected scientific health institutions in the world. We saw how, during the first President Trump term, these institutions were attacked, vilified, and prevented from doing their job properly. Dr. Anthony Fauci, one of the most admired and accomplished physician-scientists in the world, was marginalized, undermined and publicly harassed for being nonpartisan and disagreeing with unscientific proposals during the Covid-19 pandemic. 

As a result, the US had the highest confirmed number of Covid-19 deaths out of any nation in the world. More than 1.2 million Americans died of Covid-19. This occurred despite the US having the biggest pandemic stockpile on the planet, the most advanced detection technologies, and the largest pool of vaccines to choose from. Vaccine uptake was suboptimal, people refused to wear masks, and misinformation was rampant. Some fringe doctors pushed ivermectin which ultimately was shown to be useless and, in fact, proved harmful for some patients. 

Some doctors that I trained with during residency in Wisconsin and who were on the front line in the US told me all sorts of horror stories as their hospitals were deluged with severe Covid-19 cases. One colleague who became an anesthesiologist described how he had to somehow share a ventilator among four patients by splitting the output four ways because they were no more ventilators available. President Trump, when he got Covid-19, had access to the best treatments and recovered quickly. When he revealed that he had gotten vaccinated against Covid-19 and received a booster in 2021, the crowd he was speaking to booed him.

In contrast, the Philippine government followed a science-based policy. Numerous physicians and public health experts directly advised the Department of Health and the Interagency Taskforce for Emerging Infectious Diseases (IATF-EID). President Rodrigo Duterte regularly invited experts to Malacanang Palace to directly give input to him during the pandemic. He sometimes overturned policies that the IATF-EID had already decided on after he heard our views. Finally, Filipinos protected each other by following mask mandates and receiving their vaccines, resulting in a relatively low number of deaths (an estimated 66,000) from Covid-19.

A recent CDC report reviewing the impact of vaccines in children in the US from 1994 to 2023 estimates that routine childhood vaccinations prevented approximately 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths, resulting in direct savings of $540 billion and societal savings of $2.7 trillion. Jeopardizing vaccine programs by appointing conspiracy theorists with no medical training to oversee healthcare institutions will result in dire consequences for generations to come. Presumably, not all of the people in President Trump’s administration are anti-vaxxers and we hope they will put the health of their nation first over political considerations.

To be fair, there were many scientific breakthroughs during the first term of President Trump. The development of mRNA vaccines for Covid-19 was funded in part by the US government. Important international programs such as the Presidential Emergency Plan for AIDS Relief which has saved millions of lives in Africa and the rest of the world continued to receive support. In addition, support for healthcare such as the Affordable Care Act (colloquially known as Obamacare after it was passed during President Barack Obama’s term) which is healthcare insurance for the poorest citizens continued despite some partisan efforts to overturn it. I believe there are enough patriotic Americans in government who see beyond politics and will do the right thing. The unique political structure of the United States also somewhat limits the impact of the Federal Government, which the President heads, on individual state policies. For instance, if vaccine mandates are rolled back by the Federal Government, State Governors can make their own vaccine mandates to mitigate the effect within their territory. The opposite was seen during the Biden administration when some states such as Florida enacted their own laws to prevent Covid-19 vaccine mandates. How this will all play out remains to be seen. 

I sincerely hope that despite the terrible rhetoric that has been deployed in the US election season, the government institutions of the US remain steadfast in pursuing their mandates and remain non-partisan in doing their jobs. I believe most people in government are professionals who understand their duties under the law. The leadership of the US in science and medicine has always been one of its brightest shining lights. This is why people from all over the world come to the US to train from the best teachers and at the most advanced institutions. I hope that this is not undermined by partisan political considerations, and that the US continues to believe in the importance of public health.