by: Carlos C. (Kent) Campbell, MD, MPH., and Richard C. Collins, PhD.

During the 1960-70’s, the Centers for Disease Control (CDC) developed into the preeminent public health agency in the United States and the world.  Whenever a state health department or a foreign health ministry had an infectious disease problem on which they wanted assistance, they called on CDC.  Inherent in the CDC ethos was institutional leadership that emphasized sound scientific principals and preparedness as practiced in a team environment made up of capable individuals. Throughout our CDC careers, we had the good fortune to experience and learn about real leadership in public health defined across a spectrum of infectious diseases and chronic health conditions.

Regrettably, the leadership and competence of CDC has been eroded during the past decade, largely attributable to the strong political control imposed on the organization by the highest level of national government.  Its leaders and core missions have been chosen more on political considerations instead of scientific competence and national and global health threats. Budget and personnel levels have been reduced.  Areas of scientific inquiry and mission preparedness have been narrowed, especially internationally, leaving America unable to respond adequately to pandemic threats.  Many of the best scientists and physicians have moved on.

The novel COVID-19 virus has exploited our weaknesses in public health preparedness and leadership. The concentration of illnesses and deaths has not had parallels for a century. The virus is highly transmissible, such that the spread of the infection out-strips what the principle public health control strategy of social isolation and sanitation can effectively halt.

In stark contrast to the leadership examples experienced personally at CDC and more recently during my work at the University of Arizona Medical Center and with the Bill and Malinda Gates Foundation, the United States has now experienced the antithesis in virtually every important leadership attribute. To be clear, the Trump administration did not create the COVID-19 pandemic, but their deficits have made it measurably worse, including the numbers of infections and fatalities.  Many of these situations have stemmed from President Trump’s personal attributes.

Inattention and pervasive unwillingness to accept proven scientific expertise even in critical situations. As COVID-19 spread globally in January and February, the president continually and publicly downplayed the threat as late as mid-March. Consequently, the nation’s health systems lost the chance to contain its spread and had to deal with the surge of cases in urban areas. The U.S. now leads the world in COVID-19 cases and deaths. [1]

Virtually no adherence to the truth or consistency.  The President fabricates when the truth would serve the nation better.  The result has been the erosion of public trust that effective leadership requires. Americans will follow their leaders through perilous times provided they been honest about the conditions, like we followed FDR out of the Great Depression.

Demands absolute loyalty from staff ahead of competence and independent contributions based on their expertise. The result has been an erosion of competency and critical skills in his administration. People who refuse to repeat Trump’s party line are demoted, fired, or leave. The results have been devastating on institutions like CDC that Americans rely on for protection from catastrophic diseases.

Nationalistic isolationist philosophy that is dysfunctional in an interconnected world.  He displays little empathy and compassion for others. The result of his go-it-alone approach has been the loss of allies necessary to combat mutual threats like COVID-19.

Impulsive decision making and refusal to accept responsibility for his mistakes, instead passing the blame to others. In 2018, his administration did away with the office of global health security early warning system established during the Ebola disease crisis. Now Trump blames WHO.

Leadership in public health programs, when it is effective, is always a group activity; it is not about who is out in front or who gets the most attention. COVID-19 is a complex disease requiring the best minds working in a team approach with multiple fields of expertise encompassing medicine, virology, genomics, biology, ecology, anthropology and human behavior as wells as logistics and financial management. They must be supported by competent and consistent leadership at the top.