Small, incremental change

August is National Immunization Awareness Month. In this issue, I wanted to write about the importance of getting the appropriate vaccinations especially since the school year is starting or has started for so many of us. Childhood vaccinations have saved lives for years and eradicated diseases that used to kill or greatly harm us.

Then the U.S. HHS director threw a monkey wrench into immunization recommendations. He also shared and continues to share inaccurate and dangerous information about other health issues. As a result of these actions, we saw several key CDC personnel resign. These are people considered experts in their field. These are people with incredible knowledge borne of years of scholarship, study, and practice. These are people who question and scrutinize the work of others as well as themselves ensuring scientific rigor and adherence to incredibly high academic and professional standards. These are people you want to consult with regarding health policy. Health, science and health care should not be political.

Yet…….they are.

These recent actions gave me pause. I can no longer say I am shocked by anything this administration does, particularly regarding health care, but I can continue to be disappointed. I worry about the health of my family, friends and community. I do care about health care, science, the truth, and communicating so people are able to make informed decisions about their health based on science.

It is becoming more and more difficult to do that given the propaganda coming from those we should be able to trust to share the truth. I find myself stymied. How can I make sure people know they can trust me? That I adhere to the same academic and professional rigor and standards as those they trust or should trust? That I do truly care and can help?

In developing this issue of my newsletter, instead of focusing exclusively on vaccinations, I’ve found myself reading the content of several other newsletters as well as posts from those in my network to get some perspective and additional insights about the state of public health nationwide.

Recently, I had the pleasure of speaking with several people at the Ontario County Health Department about my book, Fake News, Witch Hunts & Conspiracy Theories, an Infodemiologist’s Guide to the Truth (get your copy wherever you get books but I will like you better if you purchase it from my bookstore – The Beekeeper’s Bookshop).

One of the questions they asked me is how do I communicate the truth with people when the narrative from on high is untrue and negative? This is a question I hear often.

Since the recent CDC shakeup, I find myself asking that same question. How do I communicate the truth with people when the narrative from our “leaders” is negative and untrue? I could go one step further and note that the narrative is also incredibly dangerous and will have lasting negative impacts on us all.

First, let me share what I said in response to the question from the members of the public health book club.

Keep doing what you are doing.

In Jess Steier’s wonderful newsletter (I recommend that you subscribe and follow her on social media via unbiasedsciencepod), she references a quote from the television show Parks and Recreation in which Leslie Knope (Amy Poehler) states why public service is so important. It comes down to small, incremental change. As Dr. Steier notes:

“Not grand victories. Not immediate transformation. Just showing up, day after day, doing the work even when it feels hopeless. Especially when it feels hopeless.”

She also noted that, sadly, most people in the U.S. have no idea what the heck is happening. That could be for a number of reasons. They don’t think it impacts them. They don’t have access to quality news sources. They don’t know how to read and understand science and health (hey, not everyone is a nerd like me and my peers). They have other worries – like the price of eggs – and don’t have the bandwidth (literally and figuratively). They have to take care of their own mental health. They don’t care. There are likely other reasons and there is likely some combination of the above. Whatever the reason, we have a job to do to make sure people are safe and healthy.

Not knowing what is going on doesn’t make anyone a bad person. Heck, I don’t follow all news. There are some areas in which I could give a rip. I do follow science and health because it’s my background and also my passion, such as it is. I care about communicating these heady topics so that people have the information they need to make data-driven decisions that are best for themselves and their families. Those decisions are often not easy to make. Couple that with where people are choosing to get their information and you have a disinformation soup that is not palatable.

What does it mean to keep doing what you are doing? Our county health departments often work with bare-bones staff. Those staff are passionate about the work they do. They aren’t in this business because they hope to make millions of dollars. They do it because the work they do has an impact on their communities. And communities are important to us all – or should be. We do not live in isolation. The decisions that I make as an individual have an impact on those around me – my husband, my sister, my brother, my mother, my friends, my neighbors, you get the point.

Trust is also an important factor. A study published in November 2023 by the Institute for Public Relations noted that people have “some” trust in families (75%), people like me (72%) and friends (69%). We look to those we know to get information. While we are certainly right to be worried that directives coming from the HHS director are dangerous, we should work to make sure we maintain our community connections and contacts. People are going to look to those of us right next door to get information. Are we sharing it in a way that is accurate? That is not inflammatory? That does not speak down and smack of elitism? Are we honest, accurate, transparent, and authentic?

We better be.

Keep reaching out to your community with accurate information. Keep speaking and interacting with people by meeting them where they are. Keep listening and hearing. Respond with kindness, compassion and empathy. Remember why people may not know. Remember that just because they do not know does not mean they are dumb or stupid or uneducated or whatever label you’d like to give them. I can assure you they have labels for you also but I hope that you work to make sure those labels are trustworthy, authentic, caring, etc.

Importantly, remember that you don’t know everything. I often say that I am well aware of what I know. I am more aware of what I do not know. Know the difference and check your ego. Don’t be afraid to ask questions and be ready to accept the answers.

Keep learning and getting the best information you can. Keep listening to the chatter so that you may respond appropriately. Don’t respond to everything but choose your battles wisely. Ask yourself, “to what end?” Is this battle worth fighting or will it just fizzle out without my input?

I want to end this issue with two warnings, so to speak. The first is an open letter from several key figures in public health titled America, Wake Up. View it here:

https://techingitapart.substack.com/cp/172286710 The second is the content of former Director of the National Center for Immunization and Respiratory Diseases at the CDC, Dr. Demetre Daskalakis’ resignation letter. It is long but it is impactful and sums up very well what so many of us working in the public health and health care fields are feeling right now. Thank you to Dr. Steier for sharing it via her newsletter. Additionally, several professionals and experts have also shared it. Below:

Dear Dr. Houry,

I am writing to formally resign from my position as Director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), effective August 28, 2025, close of business.   I am happy to stay on for two weeks to provide transition, if requested.

This decision has not come easily, as I deeply value the work that the CDC does in safeguarding public health and am proud of my contributions to that critical mission. However, after much contemplation and reflection on recent developments and perspectives brought to light by Secretary Robert F. Kennedy Jr., I find that the views he and his staff have shared challenge my ability to continue in my current role at the agency and in the service of the health of the American people. Enough is enough.

While I hold immense respect for the institution and my colleagues, I believe that it is imperative to align my professional responsibilities to my system of ethics and my understanding of the science of infectious disease, immunology, and my promise to serve the American people.  This step is necessary to ensure that I can contribute effectively in a capacity that allows me to remain true to my principles.

I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.  The recent change in the adult and children’s immunization schedule threaten the lives of the youngest Americans and pregnant people.   The data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership.  This lack of meaningful engagement was further compounded by a “frequently asked questions” document written to support the Secretary’s directive that was circulated by HHS without input from CDC subject matter experts and that cited studies that did not support the conclusions that were attributed to these authors.  Having worked in local and national public health for years, I have never experienced such radical non-transparency, nor have I seen such unskilled manipulation of data to achieve a political end rather than the good of the American people.

It is untenable to serve in an organization that is not afforded the opportunity to discuss decisions of scientific and public health importance released under the moniker of CDC.  The lack of communication by HHS and other CDC political leadership that culminates in social media posts announcing major policy changes without prior notice demonstrate a disregard of normal communication channels and common sense.  Having to retrofit analyses and policy actions to match inadequately thought-out announcements in poorly scripted videos or page long X posts should not be how organizations responsible for the health of people should function.  Some examples include the announcement of the change in the COVID-19 recommendations for children and pregnant people, the firing of scientists from ACIP by X post and an op-ed rather than direct communication with these valuable experts, the announcement of new ACIP members by X before onboarding and vetting have completed, and the release of term of reference for an ACIP workgroup that ignored all feedback from career staff at CDC.

The recent term of reference for the COVID vaccine work group created by this ACIP puts people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy to a director hamstrung and sidelined by an authoritarian leader.   Their desire to please a political base will result in death and disability of vulnerable children and adults.  Their base should be the people they serve not a political voting bloc.

I have always been first to challenge scientific and public health dogma in my career and was excited by the opportunity to do so again.  I was optimistic that there would be an opportunity to brief the Secretary about key topics such as measles, avian influenza, and the highly coordinated approach to the respiratory virus season.  Such briefings would allow exchange of ideas and a shared path to support the vision of “Making America Healthy Again.”  We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary.  I am not sure who the Secretary is listening to, but it is quite certainly not to us.  Unvetted and conflicted outside organizations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources.  At a hearing, Secretary Kennedy said that Americans should not take medical advice from him.  To the contrary, an appropriately briefed and inquisitive Secretary should be a source of health information for the people he serves. As it stands now, I must agree with him, that he should not be considered a source of accurate information.

The intentional eroding of trust in low-risk vaccines favoring natural infection and unproven remedies will bring us to a pre-vaccine era where only the strong will survive and many if not all will suffer.  I believe in nutrition and exercise.  I believe in making our food supply healthier, and I also believe in using vaccines to prevent death and disability.  Eugenics plays prominently in the rhetoric being generated and is derivative of a legacy that good medicine and science should continue to shun.

The recent shooting at CDC is not why I am resigning.  My grandfather, who I am named after, stood up to fascist forces in Greece and lost his life doing so.  I am resigning to make him and his legacy proud.   I am resigning because of the cowardice of a leader that cannot admit that HIS and his minions’ words over decades created an environment where violence like this can occur.  I reject his and his colleagues’ thoughts and prayers, and advise they direct those to people that they have not actively harmed.

For decades, I have been a trusted voice for the LGBTQ community when it comes to critical health topics.  I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision.

Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world. The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest.

I want to express my heartfelt gratitude for the opportunities for growth, learning, and collaboration that I have been afforded during my time at the CDC. It has been a privilege to work alongside such dedicated professionals who are committed to improving the health and well-being of communities across the nation even when under attack from within both physically and psychologically.

Thank you once again for the support and guidance I have received from you and previous CDC leadership throughout my tenure. I wish the CDC continued success in its vital mission and that HHS reverse its dangerous course to dismantle public health as a practice and as an institution.  If they continue the current path, they risk our personal well-being and the security of the United States.

Sincerely,

Demetre C. Daskalakis MD MPH (he/his/him) 

Amen.

Stay vigilant. Stay honest. Stay authentic. Stay.