By Porter Anderson, Editor-in-Chief | @Porter_Anderson
Public Health and Politics: ‘Messy and Complicated’Public health, Dr. Leana Wen writes in her new book, “should not be political, and certainly never partisan, but politics are inseparable from policy decisions.”
Today (July 27), with the release of Wen’s book Lifelines: A Doctor’s Journey in the Fight for Public Health (Macmillan’s Metropolitan Books), the intensity of that political reality is undeniable. “Public health needs to balance diverging interests,” she writes. “It’s messy and complicated, but the stakes are too high for us to get it wrong.”
And as it turns out, the book was originally conceived before any of us had seen just how messy and complicated—and global—the political dynamics around public health could become.
“I had actually submitted the book prior to the pandemic,” Wen tells Publishing Perspectives in an interview. “It was done. It was to be published. It was accepted. In February 2020.”
Wen’s ability to smile at her own struggles is one of her most charismatic features. She chuckles as she recalls, “My publisher said—and rightfully so, although I was not initially receptive to her comments—she said, ‘We need to wait and see how this plays out. And then you need to restructure the book around COVID and give it another go.’
“You know”—another chuckle—”when you’re an author, and you think you’re done? You’re not thrilled to hear this,” Wen says. “But of course waiting was the right thing to do.”
Wen—the former health commissioner for Baltimore—couldn’t know just how deeply politicized health care was about to get with the arrival of SARS-C0V-2. Last Thursday (July 22) found the New Yorker’s Susan Glasser writing, “If there’s one thing we’ve all learned by now in the pandemic, it’s that public health and politics are one and the same: there is no way to separate them. Biden came into office pledging to follow the science, to vaccinate the country and lead the recovery. But he could not vaccinate the country against Fox News.”
And nothing could better demonstrate the ironic role of that political edge than the release of this book which will find many of its sales in its political dynamic but also resonates with the generous, intimate humanity Wen brings to her story of hardship in China and her family’s flight to the States.
As Wen writes in Lifelines, “When I started writing this book, I thought the biggest challenge would be to illustrate the crucial impact of public health on our everyday lives. Tragically, COVID-19 made that task easier, while also inflicting on this country a public health crisis of unimaginable scale.”
And in our interview, she says, “I had had a goal, you see, to deliver the book before I delivered the baby.”
‘Not How It’s Worked Out at All’
“For a variety of reasons, we thought the baby was going to be early,” Wen says, “although she was due in March. So I gave myself a deadline of early to mid-February to finish the book because I felt like, ‘I’m not going to have time to work on this once the baby comes, so let me give it to my editor,'” Riva Hocherman. “She’d work on it while I was on maternity leave, and then I’d come back and we’d finalize it and be ready to go. That’s really not how it’s worked out at all.”
Wen is one of the sizable squadron of public health leaders whose faces and commentary have become familiar in daily print and digital news coverage of the pandemic.
She’s a columnist for the Washington Post, and is known to CNN’s audiences both domestic and international as one of the news network’s most ubiquitous and forthright commentators. Wen doesn’t hesitate to express her disappointment, for example, in how Joe Biden recently described the advantages of vaccination in a town hall appearance or her concern about mixed and confusing messaging from the Centers for Disease Control and Prevention (CDC).
She’s an emergency room doctor who says she learned from her patients that policy impacts health. A nonresident senior fellow at Brookings, she’s also a professor in public health at George Washington University, where she speaks with extraordinary second-language precision, now a hallmark for CNN viewers of her painstaking assessments of the pandemic’s progress and the government’s handling of it.
‘Living ‘in Constant Fear’
What may make Wen’s book a good candidate for international translation rights into many languages and territories—all of world publishing having felt the pathogen’s disruption, after all–is that Lifelines is not just about the public health phenomenon and addressing it.
Lifelines is also a memoir of a unique presence in this dark experience of a contemporary contagion, “so warmly and yet so crisply told,” as Andy Slavitt, the former senior advisor to the Biden White House COVID-19 response team, has put it in praising the outcome.
During the spring’s nightmarish groundswell of violence against Asian citizens in many parts of the world, Wen spoke movingly of the fear she’d experienced amid brash attacks on people of Asian backgrounds by assailants who had decided that all Asians were responsible for the Wuhan origination of COVID-19, what Donald Trump dangerously kept calling “the China virus” and “Kung Flu.”
Leana Wen was born in Shanghai and moved at age 7 in 1990 to the United States from China.
Her father was repeatedly jailed and abused by the Communists as a dissident. “He lives in constant fear,” Wen’s mother told her. “We all do.”
Her mother’s educational diligence in China had won her a chance to study at Utah State University–the ticket out of China. The family started its American life with $40 and quarters in Utah State graduate housing. “My mother showed me how the kitchen and bathrooms were actually inside the apartment and that they were our own,” she writes of her girlhood arrival in the States.
‘Do What You’re Best At’
Today a commanding voice in public health, a wife and mother of two, Wen has an interesting perspective on factors weighing into her experience with the pandemic.
“Since COVID first came in,” she says, “I’ve pivoted, all my work to addressing it, as many of us have in public health. One of my mentors is Sen. Barbara Mikulski (D-Maryland), who says, ‘Do what you’re best at and what you’re needed for.’
“As we say in public health, we’re living through the pandemic, too.”name
“But I’ve also experienced COVID in a deeply personal way. We all have. We all have experiences. As we say in public health, we’re living through the pandemic, too. And raising children, and seeing the impact of isolation on our kids out of school–and trying to figure out how to be working parents during this.”
Wen became a subject in the Johnson & Johnson vaccine trials, only to find that she’d been in the placebo arm of the testing, thus not initially vaccinated. “I never intended for that to become particularly monumental” she says wryly. On a CNN Town Hall with Anderson Cooper, she’d seen citizens saying that they wanted to participate in trials to do their part to help end the epidemic. “I thought that was really inspiring. And I didn’t want to look back and think I didn’t do everything I could. That seemed a pretty small thing I could be working on.”
Her motivation goes back all the way to that childhood of poverty and family. For a time living in Los Angeles–with three other families in a duplex–she was aware of a family “who’d fled from Mexico only to lose their young son, Tony, in an asthma attack that did not have to be fatal.” This would prove to be a signal memory for her. Policy impacting personal health.
‘Not Just About Science’
Today, she says, “Public health hinges on public trust.”
Despite what she sees as a major positive change from the Trump administration “which ignored science,” she says, “I do think that with the Biden administration, the pendulum has swung too far in the opposite direction” in listening “only to one scientific institution, the CDC.
“Change is the bedrock of good public health policy, and so much of medicine exists in the gray zone where there’s a lot of nuance to be navigated.”Leana Wen
“Public health is not just about science,” she says. “It’s about balance. It’s about winning over hearts and minds. It’s about embracing the fact that change is the bedrock of good public health policy, and that so much of medicine exists in the gray zone where there’s a lot of nuance to be navigated that hasn’t been communicated well at all by the CDC.”
Her concern has been with announcements from the CDC that reached the public as too black-and-white, leaving the public perplexed to find that initial CDC guidance of “if you’re vaccinated, you’re protected” now is having to be moderated. Breakthrough infections under the force of B.1.617.2, the “delta” variant, mean that vaccinated people need to consider wearing masks in indoor settings whenever everyone’s vaccination status isn’t known.
Today, in fact, CDC’s director, Dr. Rochelle Walensky, is announcing revised mask guidance, calling for unvaccinated people to utilize “universal masking” protection until they’re fully vaccinated. For those who are fully vaccinated, wearing masks indoors is being urgently advised. “The highest spread of cases and severe outcomes,” Walensky says, “is happening in places with low vaccination rates and among unvaccinated people. This moment, and most importantly the associated illness, suffering, and death, could have been avoided with higher vaccination coverage in this country.”
But Wen has become a dogged advocate for seeing CDC implement reportage on breakthrough infections. She makes the point that the United States doesn’t have an accurate count of how many breakthrough infections are occurring, in what circumstances, with what intensity, and in which vaccinated citizens. This makes parsing the need for boosters much harder, of course, among other things.
And Wen also has become an articulate champion of credentialing the vaccinated because so much of what civic leaders and businesses are grappling with comes down to there being no way to verify the vaccination status of American consumers or students or colleagues or others in pubic indoor settings. Unlike France’s pass sanitaire or Italy’s “green pass,” US citizens have only their CDC vaccination card and no custom established yet of being expected to show it at checkpoints.
What’s more, some are confused to have heard “now you’re immune,” only to be told to mask up again. “Vaccines are not 100-percent,” Wen says. “That doesn’t mean you shouldn’t take them. We wear seatbelts. They don’t 100-percent protect you from dying in an automobile accident, no we wear them.”
The political and public health are, as Glasser puts it, now one in the same. And the job, as Wen puts it, is messy.
She points to a recent comment from Dr. Anthony Fauci, who said that if there had been as much disinformation about the polio and smallpox vaccines as there is today about the COVID vaccines, we’d likely still have polio and smallpox plaguing populations in the United States and around the world.
“We need to be talking to two very different groups of people now,” she says. “One is a group that really wants to do the right thing. They are vaccinated. They want to protect the unvaccinated among us, including young children. They want to do the right thing for their family and they need to understand the data and the numbers–they can appreciate the nuance. We need to be honest with people and help them navigate this complicated time when there’s no clear right or wrong answer.”
The other group is not the anti-vaxxers, who likely are unmovable, she says, but a group that’s on the fence. “We need to be answering questions that are addressing people’s concerns, but I think we also need to say at this point that getting vaccinated or remaining unvaccinated is like choosing to drive drunk.
“If you want to be intoxicated, you can do that. You can stay home. You can’t drive, but you can be intoxicated. But if you want to engage in the public, you need to get vaccinated. If you want to go to the movie theater, if you want to go to any public setting, really, you have to be vaccinated.”
The COVID-19 vaccines are, in Wen’s interpretation, one of the “lifelines” we’re being thrown by public health. And whether we grab that lifeline or don’t, our decisions affect so many people.
More from us on the coronavirus COVID-19 pandemic and its impact on international book publishing is here.