I knew things had changed at the Centers for Disease Control and Prevention in early 2018 when my routine request to interview a CDC scientist was held up for days on end. I’d been interviewing researchers there for decades and had never before hit a delay that meant missing my deadline. When I asked what was going on, I was told, off-the-record, that media requests were now being routed from the CDC press office in Atlanta up to the bosses at the Department of Health and Human Services (HHS) in Washington, D.C., for approval.
Yikes, I thought, that’s insane. And this was well before the COVID-19 pandemic, lockdowns and mask debates made the nuts-and-bolts field of epidemiology a politically incendiary topic.
Still, I never imagined the level of Big Brothering would extend to the CDC’s most essential tool for communicating science: its world-class weekly bulletin known as the MMWR—for Morbidity and Mortality Weekly Report. (It was the MMWR that first reported in 1981 a spike in cases of opportunistic infections in gay men—the first glimmer of HIV/AIDS in the United States.) On Friday night, Politico revealed that even the MMWR is being routed to political overseers at HHS to soften science and health recommendations that might contradict the president’s often dishonest and sometimes dangerous messaging about the pandemic, among other CDC matters.
Such interference is “unprecedented,” says Tom Frieden, the infectious disease specialist who served as CDC director from June 2009 through January 2017. While politics and public health inevitably intersect, Frieden says, “I can tell you that in my eight years, no political appointee ever read the MMWR before it was published or before the media got it.”
According to reporting by Politico and the Washington Post, which have obtained leaked e-mails, political operatives at HHS have attempted to add caveats to the findings of CDC scientists and tried to slow down the release of politically inconvenient data, including a negative report on hydroxychloroquine—the malaria drug wrongly touted by the president as a COVID-19 therapy—and data on children spreading the virus.
Who are these political overseers, filtering and twisting federal science? Back in April, the Trump administration appointed Michael Caputo to be assistant secretary for public affairs at HHS. Caputo has no training in science or medicine. (Neither, for that matter, does his boss, HHS Secretary Alex Azar, a lawyer who was a pharmaceutical industry lobbyist and executive.) Unlike Azar’s appointment, Caputo’s did not require Senate approval.
What were Caputo’s qualifications to manage communications for an 80,000-employee federal department and to direct the nation’s health messaging during a pandemic? His anodyne official HHS bio describes his 17 years as president of his own PR firm. It doesn’t mention his association with convicted felons Roger Stone, who served as Caputo’s mentor, and Paul Manafort, with whom he worked on Trump’s 2016 campaign. Nor does it mention his earlier work helping to burnish the image of Vladimir Putin—a project he admitted to his hometown paper, the Buffalo News, that “I’m not proud of.” The same 2016 article noted that Caputo then owed U.S. government more than $100,000 in back taxes and quotes him as follows: “If I were to run for office, my skeletons would come dancing out of the closet in a can-can.”
Caputo was doing some fast tap dancing this week after he let loose with bizarre remarks on Facebook Live and Twitter over the weekend. He accused the CDC of harboring an anti-Trump “resistance unit,” warned of violence by armed left-wing hit squads after the election and encouraged Trump supporters to prepare by buying bullets now: “If you carry guns, buy ammunition, ladies and gentlemen, because it’s going to be hard to get.” Both his Facebook and Twitter accounts have since been deleted.
With #CAPUTOMUSTRESIGN trending on Twitter, Caputo apologized to HHS staff on Tuesday for his remarks about an internal cabal. On Wednesday, the department announced he was taking a 60-day medical leave of absence.
Also departing was the scientist Caputo had hired to challenge and edit MMWR reports and CDC statements that might contradict White House positions. Paul Alexander has worked under contract as a part-time assistant professor of health research methodologies at McMaster’s University in Canada.
E-mails leaked to Politico show that Alexander had attempted to muzzle public statements by Anthony Fauci, the government’s leading infectious disease expert, and downplay the risks of kids and college students spreading COVID-19 and the need to test young people for the infection. In one leaked e-mail. Alexander writes with exaggerated certainty: “There is no data, none, zero, across the entire world, that shows children especially young children, spread this virus to other children, or to adults or to their teachers.”
In July, the Washington Post reported that Alexander scolded the CDC for warning about the coronavirus’ risk to pregnant women, writing in an e-mail that the warning would “frighten women … as if the President and his administration can’t fix this and it’s getting worse.”
It’s clear that political minders such as Caputo and Alexander have succeeded to some degree in tilting federal health policies and statements. The emergency use authorization of hydroxychloroquine for severe COVID-19 back in March by the Food and Drug Administration, is one example. The FDA reversed itself in May when evidence showed the drug likely caused more harm than good.
Frieden points to other examples. “What is unprecedented—and deeply disturbing— is things on the CDC website being written by people who aren’t public health experts, he says. “I think that is analogous to someone vandalizing a national monument and scrawling graffiti on it.”
He cites three examples: omitting a mention that choir singing represents a significant risk in the reopening of houses of worship. “The White House asked for that,” Frieden says. Second, a statement on the CDC website about the importance of kids going back to school that reads more like a position paper than a public health analysis.
Third, “and most egregious,” he adds, is the suggestion that people who have been in contact with someone who tested positive for the coronavirus do not need to be tested if they have no symptoms. “This clearly was the writing of people in Washington who don’t understand public health,” Frieden says. Better information, urging that all contacts be tested, appears elsewhere on the CDC site.*
Even if November’s election should bring an end to efforts to run federal science and health policy through a political distortion field, the reputational damage may be done. Will reporters like me be able to look at the MMWR in the same way as before? More importantly, will the American public be able to trust federal assessments of coronavirus treatments and vaccines?
An NBC/SurveyMonkey poll out on Tuesday shows declining trust in the promised vaccine: only 39 percent of poll respondents said they would get it, down from 44 percent in August.
As Richard Besser, who was acting CDC director in 2009, writes in Scientific American, “we now see the undermining of the public’s trust of our key institutions at the very moment we should be shoring up that trust.”
*Update: On September 18, the CDC "clarified" the recommendation, saying that people who were in close contact with someone infected with the coronavirus should be tested for the virus, whether they have symptoms or not.