There is always a political element to public health decisions or, more broadly, public policy decisions that draw on science. Such decisions involve not only scientific data but also debates about how to allocate resources—and resources are always limited—and how to balance different values. But real problems arise when the decisions are not based on a shared factual foundation, or when the science used to describe and assess the situation is politicized. Such politicization of the science around vaccines, for example, can lead to decisions that directly increase the rates and harms of diseases, with potentially deadly consequences.
The handling of the COVID-19 pandemic in the United States was politicized relatively early, which made responding to the pandemic challenging. Politicization was not, of course, the only issue. The tricky nature of the infection, which can be transmitted before or without symptoms, public health messaging failures or errors, and previous underfunding of public health infrastructure all contributed to the United States’ failed response—resulting in the United States having a disproportionately high rate of both COVID-19 cases and deaths compared to other countries. But politicization had a role. For example, there is evidence that the Trump administration, concerned about the political impacts of the pandemic, put pressure on the Centers for Disease Control and Prevention (CDC) to change not only the guidance it provided but also the scientific reports used by public health officials and other policymakers to make decisions. There is, again, an appropriate role for politics in making decisions in a pandemic situation. But manipulating the scientific evidence on which decisions are made can undermine the ability of politicians of all orientations to make decisions that match values.
Traditionally, vaccines have not been a partisan issue. In the 1960s and 1970s, all states—with a variety of political views—adopted school immunization requirements for a variety of diseases. In the early 2000s, both left-leaning California and right-leaning Texas offered very easy-to-get exemptions from those school mandates. At the other extreme, left-leaning New York used a relatively hard-to-get religious exemption, and West Virginia never offered a non-medical exemption, while Mississippi’s religious exemption was struck down by its Supreme Court in 1979 and never revived.
In 1986, President Ronald Reagan signed a bill to protect the vaccine supply by creating a no-fault program that provided limited liability protections to vaccine manufacturers—though with reservations. The bill was supported by other members of his administration (though opposed by civil servants in the Department of Justice) after being drafted by a Democrat chair of a congressional committee.
In the past few years, struggles around vaccine mandates have become politicized. In many states—including Maine, California, Colorado, Connecticut, and New York—votes on laws regarding school vaccine mandates were along party lines. School vaccine mandates are not just about science; they involve a discussion of values and address views about the balance of parental rights with public health. But the discussion in legislatures often drew on conflicting views of the science. More often than not, opponents of bills aiming to change mandates (not all from one party) echoed or repeated misleading claims made by the anti-vaccine movement. For example, speaking about a bill that would have required doctors to give parents seeking to vaccinate the CDC’s excipient list, Republican Senator Bob Hall from Texas expressed inaccurate statements about vaccines ingredients, for example alleging vaccines contain “fetal parts” and expressing concerns about aluminum in vaccines. The first comment refers, inaccurately, to the fact that a small number of vaccines use viruses grown on cells descended—at long remove—from fetal cells deriving from abortions performed in the 1960s. The remoteness convinces even the most of pro-life commenters that using these vaccines to prevent harm is morally permissible and does not create complicity with abortions. But that is not how anti-vaccine groups present it, including to supporting legislators. As to aluminum, many vaccines contain tiny amounts of aluminum salts to help the vaccine work better—but extensive data supports the experts’ consensus that these tiny amounts of aluminum salts, far smaller than what we are exposed to through food, are not a danger.