Public health leaders report widespread harassment, threats after COVID-19

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Public health leaders report widespread harassment, threats after COVID-19

Interviews with over 100 leaders point to strategies that may reduce backlash

Backlash against public health officials, including intimidation and threats of physical harm, has been widespread in the years since the start of the COVID-19 pandemic and they face ongoing risk in a divisive nation, according to a new study.

"The backlash we're studying is different than people disagreeing about wearing masks or getting a COVID vaccine," said lead author Marian Moser Jones, associate professor of health services management and policy in The Ohio State University College of Public Health. "This is true hostility. Threats of violence. Undermining these people in ways that harm their ability to do their jobs."

Of 109 leaders interviewed for the study, 76% were threatened or harassed, a category of backlash the researchers deemed "extraordinary."

Among the experiences shared by public health leaders:

• The FBI arrest of a person making ongoing credible death threats. "That was the first time I felt scared because in his house he had over 100 guns…"
• A public health official described a persistent "scary," "obsessed" male "stalker" who sent a picture of someone strangling a child the same age as her child.
• "The worst day was [when] I came home from work one day. … I came home and on my front door I found a note taped. And when I opened it up, it was a threat to kill my dog. And it had a picture of my dog in my backyard."

About half experienced "undermining" backlash, which made it hard for them to work - things like overwhelming their offices with data requests, repeatedly demanding revisions to pandemic guidelines and publicly disparaging their qualifications. The research appears in the American Journal of Public Health.

The research team interviewed leaders from 18 geographically and politically diverse states. Participants were from suburban and rural areas and included local and state leaders.

Many of them have retired early or left the field, Moser Jones said.

"Politicians expect this kind of thing when they go into the field. But before this, most public health officials hadn't been in the spotlight and they hadn't been targets. It's been hard on the profession," Moser Jones said.

The good news? The research team identified some successful strategies officials used, approaches that could inform future fraught moments in public health leadership.

Particularly in smaller areas, officials often had deep ties to the community and knew the people making threats and creating other challenges, Moser Jones said. Sometimes, they had success bringing upset community members or small business owners to the table for conversations or calling opponents and talking it through.

"They'd say things like, 'Listen, you're threatening my kids,' and it would sometimes turn the temperature down," Moser Jones said.

"Anecdotally, promoting civil discourse seemed to cut down on the backlash. It didn't stop it entirely, but it helped prevent officials from being fired or forced out."

Amy Fairchild, senior author of the study and a professor at the University of Minnesota School of Public Health, said some health officials who weathered backlash involved local businesses in decision making.

"They understood that they needed to explain not only the science but acknowledge the painful tradeoffs at stake and explain the rationales behind these tough decisions," she said.

The researchers, whose work with public health leaders is ongoing, have identified some potential policy approaches as well, including:

• Criminalizing doxing, the act of publicly revealing private or personally identifiable information about someone online without their permission. (In many cases, officials' addresses or phone numbers were shared online to encourage organized backlash.)
• Requiring boards of health members to have backgrounds related to the field. (In some communities, people with little or no connection to public health are calling the shots.)

Outside of policy approaches, Moser Jones said health officials may build bridges outside a pandemic by building relationships with different groups in the community who have different values and viewpoints.

"Bringing people who have disagreed about the pandemic together around issues that matter to them, such as the ongoing opioid crisis, can be powerful," she said.

"Another take-away is there is a lot of work to do to deal with the vicious polarization in this country. For public health officials, it may be working harder to explain why they're relevant, and all the work they do to keep people healthy - from keeping food safe, to helping moms and babies, to offering people help quitting smoking."

The project received funding from the Commonwealth Fund, the Mellon Foundation and the National Science Foundation.

Study co-authors from NYU include Shevya Awasthi, Faith Daniel, Cheryl Healton, Julie Holm, José Plascencia Jimenez, José Pagán and Mahathi Vojjala. Study co-authors from Syracuse University include Ashley Marie Bursie, Anne N. M. Getz Eidelhoch, Tori-Ann Haywood, Sierra Jade Kaplan, Winston Junior Scott and Kelsey Anne Wilber.

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