Jay Bhattacharya a Disaster for NIH

I first got interested in health policy because of Ronald Reagan, but not in the way you might think.

Growing up in the San Francisco Bay Area with a mom who worked at the United Way, I was well aware of the HIV/AIDS epidemic. I knew people who were HIV positive. So when HBO released the film adaptation of And the Band Played On, I was riveted. Enraged. Filled with righteous indignation.

To be honest, it hasn’t really worn off.

Randy Shilts wrote in his prologue to And the Band Played On (which I reread amid the COVID-19 pandemic) the following:

“The bitter truth was that AIDS did not just happen to America – it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health. This failure of the system leaves a legacy of unnecessary suffering that will haunt the Western world for decades to come…. The story of these first five years of AIDS in America is a drama of national failure, played out against a backdrop of needless death. People died while Reagan administration officials ignored pleas from government scientists and did not allocate adequate funding for AIDS research until the epidemic had already spread throughout the country… People died while public health authorities and the political leaders who guided them refused to take the tough measures necessary to curb the epidemic’s spread, opting for political expediency over the public health.”

So was also the case for the COVID-19 pandemic, which was unleashed upon the world at a time in which the United States’ public health bureaucracy was hotly politicized, chronically underfunded, and constrained by anti-science forces at the head of the Trump Administration.

And rather than learning from the mistakes of this pandemic, the most dangerous among them are being rewarded with high-level posts from which to spew anti-scientific drivel, which can come with real life-or-death consequences.

I’m not talking about R.F.K. Jr… this time. Right now, I’m talking about Jay Bhattacharya, who according to Dan Diamond of The Washington Post is likely poised to be the new head of the National Institute of Health (NIH), having been listed by RFK Jr. as a top contender for the position, which falls under the broader umbrella of HHS.

It has admittedly been an interesting experience to watch the nominations unfold, having written a doctoral dissertation on the problems that arise when agencies are headed by people who oppose the agencies’ core missions, and when Congress and others are ill-equipped or disinclined to hold those agencies accountable. You know, hypothetically.

So, who is Jay Bhattacharya? Needless to say, he has been a critic of the NIH while being celebrated by noted public health opponent, Florida Governor Ron DeSantis. His other cheerleaders include Peter Thiel, Elon Musk, and Joe Rogan – you know the voices of reason in public health.

His opposition within the public health community is not about partisanship, but rather the anti-science stances that he embraced over the course of the deadly pandemic, and which have been widely perceived among experts as having prioritized the business community over health outcomes. While I joined with experts in public health and medicine through the organization Brief-19 to disseminate evidence-based analyses of the public health and policy implications of what we were learning from day to day about the pandemic, Bhattacharya downplayed the threat of the virus, instead emphasizing less government control and more reliance on individual choices to self-protect.

Rugged individualism and self-reliance. Now where have we heard that before?

To be sure, I have had many quibbles with Ayn Rand and her followers over the years. Some of it is political. Some of it isn’t.

The reality is that rugged self-reliance just simply doesn’t work in the public health setting. Public health can and indeed must be rather paternalistic, because by definition it’s focused not on individual health, but collective health outcomes and system performance. Choosing not to get vaccinated is bad for you, but it’s really bad for your community. Choosing not to mask or socially distance during a pandemic undercuts not only your and your family’s safety, but it compromises scientifically-grounded public interventions aimed at flattening the curve. This requires that we care not just about “me me me,” but to think more broadly. That isn‘t always easy for Americans. But given that we know that the next pandemic isn’t a matter of “if” but rather “when,” it’s vital that our institutions of public health be staffed with grown-ups who believe in science and understand that effective public health interventions should be prioritized over individual convenience. And they absolutely need to be staffed with people who know better than to elevate pseudoscience and grifters – whether in hedge funds, on podcasts, or widely discredited academics relying on a degree to lend credence to anti-scientific and/or anti-democratic theories.

Indeed, a prominent supporter of Bhattacharya was his Stanford colleague Scott Atlas, who went against the scientific community in encouraging lower-risk people to become infected with COVID-19 as a means to promote herd immunity, and who urged the reopening of schools even as we knew that there would be risks of increased transmission in those settings. And Bhattacharya contributed to The Great Barrington Declaration, which urged that younger Americans return to work and build immunity against the COVID virus.

All of this was in the interest of creating a false dichotomy between helping the economy and promoting public health. But the reality is that while people of both parties want a robust business sector, containing a deadly virus is an important precursor. What is the value of having a business open if would-be patrons are sick or dying? What is the value of forcing a business open if staff immediately become exposed and sick?

Investments in public health pay off. We see this in the insurance setting, which is where most of my own research and teaching are situated. Of course, covering people costs money. But what is the result? People are able to access needed care. They are able to manage chronic and acute medical conditions. They are able to not only survive but thrive. And in light of that, they can be productive in the American economy, while health care providers are relieved of the economic burdens of uncompensated care.

These are not burdens. They are investments.

America just emerged – far from unscathed – from a major, deadly pandemic the likes of which we had not seen since the 1918 Spanish flu. And we deserve public health leaders who learned the right lessons from it. Instead, Bhattacharya’s impulse amid the COVID pandemic was to see the core problem as the stifling of dissent (which is to say, prioritizing public health expertise over the legitimization of quackery).

These are not the only reasons why Bhattacharya would be a problematic selection to head NIH. While he boasts impressive academic credentials, he has never before overseen a large bureaucratic organization, while the National Institute of Health has nearly 20,000 staff. To be sure, RFK Jr. and others within Trump’s orbit see it as an advantage to lack government experience, largely because of a deeper distrust of the government apparatus and hostility to government interventions (even those which could honestly be termed “pro-life”). But governmental and managerial competence is vital, and when this is put on the back burner in the domain of public health, there are life-or-death consequences.

Bhattacharya has ideas for how the NIH should operate, and it doesn’t look good, essentially coming down to its decentralization as well as deprioritizing the expertise of long-serving bureaucrats. This disregard for agency expertise fits well within the Trump Administration’s broader opinions on the administrative state (or what’s left of it after Loper Bright), seeking to clamp down on civil servants who are perceived as being politically disloyal. Prof. Don Moynihan has written extensively on these issues in Schedule F positions, and you should read it.

If we are lucky, as with the first Administration, the degree of incompetence will exceed the high degrees of malevolence, thus stymying the most dangerous policy proposals that have been floated. But we should not have to root for public health incompetence when our lives – not to mention our research funding on a broad array of public health and health policy subjects – depend on the strength of this agency.

Jay Bhattacharya would deeply damage our efforts to study public health problems facing the country and the world and would signal even further entrenchment of conspiratorial perspectives and political expediency where we most need to follow the science. Tom Nichols wrote a book called The Death of Expertise: The Campaign Against Established Knowledge and Why it Matters. As with my own work on bureaucratic noncompliance amid misaligned agency objectives, I fear that this will be all too relevant in the coming months and years.