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With insults, harassment, or even threats of violence against them and their families, at least 190 top public health officials have resigned, retired, or been fired in the last year, a Johns Hopkins researcher reported Wednesday.

Most were victims of opposition to health guidelines or mandates issued during the pandemic.

"A year into the pandemic, I'm still experiencing rather regular harassment," said Sara Cody, MD, public health director in Santa Clara, California, where some of the first coronavirus cases in the U.S. were diagnosed. "People [are] coming to protest at my home, [there are] letters written in the paper, [and they are sending] emails that are way outside the norm of what we could consider normal discourse and differences of opinion."

She's needed a round-the-clock protective detail for almost a year "because of concerns about my safety and the safety of my family." This was not something she expected in the field of public health, where "we're usually the behind-the-scenes people."

Cody was one of a dozen public health officials who spoke at a devoted to "workplace pressures, health risks and personal threats" such officials have faced.

"In the last year, amid the global pandemic, public health workers have experienced more direct attacks than at any time in the previous century," said webcast moderator Joshua Sharfstein, MD, the Bloomberg school's vice dean for public health practice and community engagement. It's taken the form of "harassment online, harassment in person, threats of violence, even violence itself."

The speakers talked about how their under-resourced county and state public health infrastructures not only left them without the weapons to manage the pandemic in their communities, but also enabled a sense of public distrust when they tried to relate what the science said they must do to save lives.

Health Official Exodus

Beth Resnick, DrPH, the Bloomberg school's assistant director for practice and training, said her team had documented the departures of 190 public health officials in the last 11 months based only on public reports in the media. And there were probably many more, she said.

She showed a map of the country covered with red dots, each one representing a case of harassment or a threat to a public health official from March 2020 to January 2021. And those were just the instances publicly reported in the media, likely not "the full scope of what public health officials are experiencing," she said.

What's more, she said, many of those targeted have been women and minorities.

"Some of the rhetoric and vitriol that's been out there has made it difficult to get a clear and clean message out to folks," said Greg Holzman, MD, medical officer for the Montana Department of Public Health and Human Services. "Science got meshed into politics and we got comments about flip-flopping, and that you're changing your viewpoints ... [when] it's a matter of using the science that we have at the time and making an informed decision."

Holzman added that many health officers have quit or whole health departments have resigned.

Jennifer Bacani McKenney, MD, health officer of the Wilson County Health Department in Kansas, noted the harassment has not just come from the public, but from her supervisors.

Her county commissioners, who act as the county Board of Health, "told me that I focused too much on health and science, and not enough on the economics of the town. At one point, they told me they were going to open up the applications for my position, because they didn't agree with what I was saying."

The pandemic has prompted many governmental jurisdictions to try to roll back authorities that have enabled public health officials to protect their communities, said Paulani Mui, MPH, assistant director of the Bloomberg School's office of public health and training.

"As of December, at least 24 states have filed bills that would limit governmental public health powers at both the state and local levels, including limits on quarantines, contact tracing, vaccine requirements, and emergency executive powers," she said. "And while some of those bills failed, others are under consideration."

If they succeed, Mui said, "health departments could lose legal authority that is essential for the protection of communities from disease and illness."

One webcast slide carried a quote from Tim Lawther, former health officer of Sauk County, Wisconsin, who felt last October.

"The political gamesmanship has empowered some county supervisors to demand retraction of evidence-based public health guidance," Lawther said. "It has encouraged and rewarded political allies to rail against science and data-driven measures to protect our neighbors. It has emboldened others to think it is appropriate to treat public health professionals with disrespect and disdain when they are just trying to do their jobs."

In Michigan, where Democratic Gov. Gretchen Whitmer's life was threatened, chief state deputy health director Joneigh S. Khaldun, MD, said she, too, felt unsafe. "I've certainly had people say some very unkind things to me and send me letters that were pretty scary and made me think I had to get law enforcement involved." They weren't just directed toward her, but to her family and her children as well.

Across her state, public health leaders "are choosing at this time to step down, and I think it's unfortunate. We're losing a lot of leaders and a lot of public health expertise."

Khaldun worries whether the way so many health officials have been treated during the pandemic will dissuade members of the next generation from seeking public health careers.

Calls to Action

The speakers described five steps that would help health officials get through the current pandemic, as well as prepare for the next one:

• Speak out by endorsing a policy against harassment or threats against public health officials.
• Report threats. Congress should require state and local monitoring and reporting to the CDC of threats and harassment against public health workers who perform their official duties. This includes threats related to race, religion, sexual orientation, or gender.
• Use the law to deter and protect. State and local prosecutors and law enforcement leaders should utilize existing statutes and support new laws to protect public health officials from threats and harassment.
• Do not lose ground. Defend existing statutes that allow health officials to enforce rules, including routine vaccination policies for children who attend public school and requirements that children exposed to measles must quarantine.
• Rebuild the nation's public health infrastructure, which has faced personnel shortages and has relied on a fragmented data system.

"The Biden administration has proposed funding for 100,000 new public health workers to aid in the COVID-19 response," said Marcus Plescia, MD, chief medical officer for the Association of State and Territorial Health Officials (ASTHO).

But the federal government also has to expand scholarships and loan repayment systems to fund, recruit, and retain a diverse public health workforce, Plescia said.

The webcast was a collaboration between the Bloomberg School, ASTHO, the National Association of County and City Health Officials, and the Big Cities Health Coalition.

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