From medical editors: a call to the global infectious diseases and clinical microbiology community.
Description:The views expressed by the authors are their own and do not necessarily reflect those of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) or Elsevier. Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope. Robert F. Kennedy, Senior Political decisions in the United States of America influence every person on the planet. In the healthcare sphere alone, the first week of President Trump’s return to government has had massive reverberations. The effects of executive orders include: - The withdrawal of the USA from the World Health Organization (WHO), comprising 194 member states and of which it was a founding member. This will position the USA along Lichtenstein as the only members of the United Nations not part of the WHO. - An unprecedented and vaguely worded “pause” on all external communications from the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA), hampering the ability of these agencies to mount responses to and share alerts on emerging infectious and other health threats, during a period of heightened anxiety regarding human cases and pandemic potential of H5N1. - A 90-day stop-work order and freeze on disbursements of foreign aid, funding that is critical to fighting emerging threats (like Marburg virus in Tanzania), neglected tropical diseases and, via the President’s Emergency Plan for AIDS Relief (PEPFAR), HIV. - The interruption of NIH study sections, effectively disrupting the awarding of biomedical research grants to move evidence-based medicine forward. - A “pause” on all federal grants and loans. - A memo to all employees of Health and Human Services (HHS) and other agencies threatening “adverse consequences” if they do not report within 10 days on colleagues who may have tried to protect government programs aimed at diversity, equity, and inclusion. The Trump executive order to eliminate diversity, equity, and inclusion efforts in government programs will deprioritize research that addresses the social determinants of infectious diseases. As specialist clinicians and scientists, we know that infectious diseases cannot be controlled, prevented or treated optimally without attention to their socio-economic contexts. In the meantime, the Republican-controlled Senate appears poised to confirm as HHS Secretary Robert F. Kennedy, Jr., an anti-vaccine activist who has also questioned germ theory and whether HIV is the cause of AIDS. Mr. Kennedy has long been in the employ of anti-vaccination interest groups, taking in over $10 million this past year alone from them [1]. While he has recently promised to stop collecting fees on some of his vaccine lawsuits involving the U.S. government, he will continue to benefit financially by reportedly collecting referral fees for legal cases not involving the U.S. government: last year he reportedly received over $850,000 from the law firm that sued Merck over the human papillomavirus vaccine [1]. Investment in infectious diseases research is already suffering, but this is merely the beginning. When he was running to become president in 2023, Kennedy declared that “We’re going to give infectious diseases [research] a break for eight years [2].” Even if they say or do nothing going forward, US-based medical journals and their editors may well find themselves in the crosshairs. Mr. Kennedy promised in 2023 that if he were president, he would “order the Justice Department to investigate the editors and publishers of medical journals for ‘lying to the public’” on the safety and efficacy of approved vaccines [3]. These words should be taken seriously. Investigations of journal editors and publishers have been a highly effective means of stifling both free speech and rational scientific inquiry in recent past [4]. Concerned doctors and scientists have raised their voices against Mr. Kennedy’s nomination and these new orders, including 77 Nobel Prize winners who wrote a letter of opposition to the nomination [5]. Over 23,000 doctors have signed another letter opposing it, posted online by the Committee to Protect Health Care [6]. Mr. Kennedy’s spokesperson dismissed the signed statement as “just another grift” that would “bilk donors” to advocacy groups [7]. White is black and day is night. You did not see what you saw; you did not hear what you heard. Our colleagues in the United States have been courageous under uncertainty and significant duress. As physicians and editors, we call on the global infectious disease and clinical microbiology community to amplify their ripples. Letters are a good place to start, but their impact and reach are uncertain in a world whose media are increasingly controlled by profit-driven players bearing ideologies that bend with political winds. We ask for both individual and coordinated resistance. As individuals, we can learn from recent history. The lessons collected by the historian Timothy Snyder become sadly hyper-relevant now: do not obey in advance, defend institutions, stand out, believe in truth, listen for dangerous words…and be as courageous as you can [8]. As a collective in a globalized age, we can organize across borders, speak loudly, and in one voice. We can use open-source and open-protocol digital media to avoid supporting the very groups that are assailing science and evidence-based medicine. We must be available to and engage with general-interest and science journalists, whose work has never been more critical, to correct the falsehoods and provide accurate, conflict-free medical information to an increasingly confused public. Political decisions in a powerful nation influence every person on the planet. And yet personal decisions everywhere, if well coordinated, can too. Medicine—and infections—are more globalized than ever. Let us work together now to keep what we have built across borders.
