Former U.S. Surgeon General Richard Carmona is concerned about the future of public health

There were more than 2,000 confirmed cases of measles in the United States as of last week. That’s according to numbers from the Centers for Disease Control and Prevention and is only a couple hundred cases away from the total from all of last year.

That is part of the context in which former U.S. Surgeon General Richard Carmona says he’s concerned. Carmona served in the George W. Bush administration and is affiliated with the College of Public Health at the University of Arizona.

Carmona recently said we are living in one of the most consequential inflection points in modern history, and The Show asked what he means by that through the lens of public health.

Full conversation

DR. RICHARD CARMONA: Well, as I viewed the state of our nation and the world, and the challenges before us, many of them self-imposed, politically driven, that's where my thoughts started. And I actually reflected back and I thought, what are what are periods in history where we've struggled as a nation? And I thought back at the Civil War where we were divided, North and South, and where a single leader stepped up and united us, Abraham Lincoln.

And then I fast forward to today, once again, we're a disunited states, mostly tribal in our camps, fueled by mis- and disinformation. And I thought, you know, this is a plague in sorts. And, you know, that's what I was referring to, and then the subtext within that is: what's happened to public health? And so, as we have struggled with maintaining our democracy and have eliminated what I consider to have been essential public health, global public health programs that put the world at risk and put our nation at risk. Because after the Second World War, we had the United Nations, we got NATO, we got the World Health Organization, we got the World Bank. All of those organizations created global stability and improved public health.

So now, we start seeing some of these programs unraveling, and we see more instability, and we see disease spreading, we see mass migration of people, that all have public health implications.

MARK BRODIE: Well, so you mentioned the World Health Organization, and that of course is an entity from which President Trump has withdrawn the United States. What kind of practical implications do you see that action having — both for us and for other countries around the world?

DR. RICHARD CARMONA: Well, the ramifications are significant. The World Health Organization came to be after the Second World War. It was one of those things that the United States helped to put together to be able to create global health and global stability because without global health, you have global instability.

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And so, now, we are less ready to be able to identify any emerging threats in infectious disease around the world, especially in those countries that don't have the ability to stop the spread. We had teams that would go in there, a U.S. public health service deployed all over the world to do those things, our epidemiological intelligence service. We provided intellectual property to our allies, and then in some cases even adversaries, because we recognized if we cannot stop the spread of disease ... it will affect all of us. And we we've seen that happen.

MARK BRODIE: So, when you look at some of the public health challenges that we're dealing with sort of globally right now, you think of things like Ebola, you think of closer to home maybe the measles. Are these diseases that you think — or might these outbreaks be different had different decisions been made by American leadership?

DR. RICHARD CARMONA: Most definitely. Well, starting right at home, the mis- and disinformation about vaccines. You know, up until uh recently, young doctors and nurses going through medical training had never seen a case of measles because it's a vaccinable disease. But yet, when we have leaders at the highest level preaching ideology and misinformation and disinformation that has the public pause and not sure if they should vaccinate their children or vaccinate the adults for disease, you see what happens, disease spreads.

So, um it is very, very significant now that especially at quite frankly at HHS [Health & Human Services], where the good scientists that are still there, the good practitioners that are still there, struggle to be able to drive policy by the best science when ideology is substituting and mis- and disinformation is dividing the public who don't know who to believe anymore. There are ... significant consequences from that, both in health and cost of care.

MARK BRODIE: How much of all of this do you draw back to COVID and sort of the distrust that some folks had for public health officials? I mean, is there something else either before or after that you think had a a similar kind of impact on what's going on right now?

DR. RICHARD CARMONA: Let's put in perspective. COVID was the first pandemic in a century, 100 years. The institutional memory was lost. Unless you read books on the history of public health, most people didn't know how to deal with a pandemic, and you know, a rapidly spreading infection like that. So, there were some missteps. There were plenty of health professionals who didn't get to speak publicly because politicians spoke publicly, and often they gave out poor information that was more driven by ideology.

On the other hand, there were some of our senior scientists who were castigated because they told the truth about what needed to be done. Now, you can argue in retrospect, did we really need to have everybody put a mask on? Did we really need to have people stay home? Those are reasonable things that in an after-action report, we should think through and say, "You know what? We may have overreacted, but the reason was we hadn't done this for 100 years."

And so, the key message that and information that I look at, retrospectively, people reacted very forcefully to prevent the spread of infection with masks. So, many argued that the mask doesn't do anything. Well, in fact, the mask does prevent spread of infection. On the other hand, if you have a healthy population, is it important that they were masked? Is it important that they stay home? Is it important that we shut down businesses? No. We probably overreacted.

But I think it's because of the complicating factor that there wasn't the institutional memory on how to best deal with this, and then the mis- and disinformation where ... people are telling telling you to take certain drugs that were had no validity in dealing with a virus, swaying you not to get vaccines because they didn't work. All of that created the divisiveness which ultimately had people, many people, revert to their tribes, either left or right of center, and that didn't help the nation.

MARK BRODIE: What is your level of optimism that if another pandemic should come our way, that we will heed those lessons and and do better as you suggest that we could have?

DR. RICHARD CARMONA: Unfortunately, I think it depends on who is in office at the time at the highest levels, and who are the scientific and health leaders who will be given the opportunity and authority to speak to the American public. So, I'm cautiously optimistic that when and if this happens again, we come together as Americans.

MARK BRODIE: I wonder if you think that there is a way for public health to, I don't want to say work around, but maybe work independently from government at this point. Like, if leadership is not doing the things that someone thinks they ought to be doing in the realm of public health, is it possible for, you know, experts and doctors and other folks in in the public health world to still operate sort of independently from that?

DR. RICHARD CARMONA: Well ... I think it's a good question, and it's what what we actually did. The information that was being provided by many elected and appointed officials was not correct. So, rather than get into a battle, we traded our credibility and basically addressed the public to provide good scientific information. So, we've already done that. But isn't it a shame in a democracy that we have to figure out covert ways to be able to get information to the public that is scientifically valid?

MARK BRODIE: All right. We'll have to leave it there. That is Dr. Richard Carmona, former U.S. surgeon general. Dr. Carmona, thank you so much. I really appreciate it.

DR. RICHARD CARMONA: Thank you. Appreciate the opportunity.