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The New Polio Challenge

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In the mid-1950s, Americans anxiously waited for the first vaccine to stop a highly infectious disease that left thousands of children paralyzed.

There is irony in living in an information-rich age that still allows bubbles of completely looney falsehoods. By nature, humans are fantasists and often uncritical thinkers. If vaccine resistance has taken many of us by surprise, it is perhaps because we thought we understood the power of widely available and credible medical advice. But ask members of our species about material causes for a particular result, and some will manage to weave together alternate narratives that convert a rare exception into the rule. Add in some conspiracy thinking and suddenly routine protocols for dealing with fast-spreading diseases can be reimagined as partisan ploys designed to destroy personal freedom.

In 1900 one of ten American children died before their first birthday.

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Too many Americans have forgotten hard truths that recent generations understood. In the span of our grandparent’s lives one of ten American children never made it to their first birthday. The causes have faded from our discourse because of vastly improved treatments, especially vaccines. In the not-so-distant past children died from measles, tuberculosis, diphtheria, scarlet fever, and whooping cough.

The eradication of polio is an especially telling case. Many were permanently disabled by polio. The stories of Americans as diverse as Franklin Roosevelt and  Senator Mitch McConnell include accounts of hardship created by this cruel form of viral sabotage.  Polio was so common in after World War II it was not unusual to keep children from any swimming pool.

In the mid-1950s, Americans anxiously lined up their children for the first vaccine against the highly infectious disease that left thousands of children paralyzed. As medical historian David Oshinsky noted,

If you had to pick a moment as the high point of respect for scientific discovery, it would have been then, After World War II, you had antibiotics rolling off the production line for the first time. People believed infectious disease was [being] conquered. And then this amazing vaccine is announced. People couldn’t get it fast enough.

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By early 1960, polio in the U.S. had been all but eliminated.  The CDC reports that three doses are up to 99% effective. In 1954 I was one of the eight-year-old “polio pioneers” that got the vaccine, but also had some side effects. I was still far better off with the new treatment than the prospect of paralysis.

But this is not 1954. The COVID pandemic of 2000 soon turned into an unforeseen experiment in how to manage the rapid transmission of a another virus, while fighting off scores of misleading social media messages. As it has turned out, and in spite of advances in immunology, helpful medical advice would have to compete with the lightning-dissemination of misinformation, frequently springing from fantasies that a Hollywood screenwriter would have thought too outrageous. Perhaps eight to ten percent of the population want unrealistic guarantees of perfect safety, with anything less understood as a dire sign of malfeasance. Their skepticism has been fed by individuals like Robert F. Kennedy Jr., who is likely to become the secretary of health and human services in spite of having no medical background. Against all evidence, he believes that it is “a mythology” that the vaccines mostly eradicated polio. He would make the drugs optional: the reverse of a perfect response, since a weakened strain in vaccinated individuals can more easily take hold in the unimmunized population.

Overlay this resistance to newer fantasies that political treatments are surreptitious tools of dominance, and suddenly medical staffs have been forced to also deal with the disabling ignorance of parents. Again, COVID is a cautionary story. Thousands went from hospital ICUs to their graves with the belief that the SARS-CoV-2 virus was a governmental plot. As this new administration will find out, willful Ignorance can be life-threatening. It is appropriate to worry about kids today who may face the same fate of children a generation ago.

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Fit For Service?

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Donald Trump was elected to be the next president by a plurality of the nation’s voters, who apparently wanted lower food prices even more than they wanted competence.

Those working in a governmental capacity need to be “fit for service,” meaning capable of representing the interests of the public they have sworn to serve. Taxpayers have a right to expect that they will be treated fairly by those officials who will be paid from public funds. Does this prohibit the election of a felon also convicted of sexual harassment? Apparently not. This particular felon was elected to be the next president by a plurality of the nation’s voters who probably wanted lower food prices even more than they wanted competence. His immediate task is to select department and agency heads that can administer the vast number of workers and tasks that have evolved over the years. The Department of Defense, for example, has almost three million employees. The Department of Transportation is smaller, but oversees 11 agencies, covering vital areas including aviation, highways and railroads. No corner of American life is neglected for oversight of a federal agency.

The federal establishment is so vast, and because this is politics, it seems improbable that any president could consistently make appointments of people who are fully versed in the needs of stakeholders they are meant to serve.  This is because every president taps friends and supporters for plum agency and overseas positions. Luckily, there are also real experts with career-long work already in staff support positions.

It is also useful to think counterintuitively for a moment. Most administrative agencies are actually needed by the businesses and groups they regulate. They serve in part to reassure  citizens that important governmental functions are monitored. As political scientist Murray Edelman pointed out years ago in The Symbolic Uses of Politics, agencies like the FAA or the department of Agriculture have useful symbiotic relationships to the businesses they ostensibly regulate. The perception may be that the agencies serve all Americans. The reality is that they often foster policies favored by special interests, sometimes at the expense of the larger public. Laws passed in Congress and enforced by the agencies are often written by interest groups themselves. Writing in the 1960s, Edelman’s point was that organizations need the legitimacy of an apparent watchdog who can share in the blame if a key function goes off the rails. Businesses are anxious to win government certifications. FDA approval of a prescription drug, or FAA certification of an airplane can act as a buffer for complaints from citizens or public interest groups.

It is also true that agency heads come disproportionately from the enterprises they would regulate. For that reason, many fit the characterization of being potential wolves guarding a henhouse. Will Elon Musk, a co-chair of an invention called the Department of Governmental Efficiency, be a fair arbiter of how many staffers remain at the National Highway Traffic Safety Administration? The agency sets standards for auto safety, including Musk’s Tesla vehicles. And how will NPR, Amtrak and the Corporation for Public Broadcasting—all quasi-public enterprises–fare against the world’s richest man and the and billionaires lined up behind Trump?

The question of fitness for office promotes reasonable queries about those selected to lead various major departments and agencies. The problem is complex, with some  disturbing results.

The final cabinet is still evolving. But had Matt Gaetz continued as Donald Trump’s pick for attorney general, he would have carried a legacy of open legal challenges arising from charges of statutory rape, using illegal drugs, and accepting gifts prohibited by congressional rules. The idea of Gaetz as the nation’s face of law enforcement left many Americans aghast.

And the list goes on and on. Pat Bondi as the present Department of Justice nominee has also been a lobbyist for private prison companies sued by the Justice Department for polluting. Dr. Mehmet Oz as the nominated head of the Centers for Medicare and Medicaid has been accused of promoting dubious medical products on his TV shows. And Pete Hegseth, who has an impressive record as a soldier, still comes to the position of Secretary of Defense as a Fox News host, along with allegations of a sexual assault and a clear record of alcohol abuse. He has the usual MAGA list of aggressive opinions: that Muslim Americans represent “an existential threat;” that the military could be used against other Americans in places like Seattle, that Mexico might be a legitimate target for unleashing American firepower, and so on. Even Trump allies wonder if Hegseth is up to leading one of the most consequential federal departments.

We can wonder if gross incompetence posed by some of Trump’s nominees is greater than the external threats that he loves to promote. In this bewildering new government, even very supportive NATO allies Canada and Denmark are potential adversaries. There is shame in misusing American “leadership” in this way, and we will pay a price. Attacking our friends has all the grace of shouting insults to neighbors across the backyard fence. More crucially, it gives our enemies openings they can exploit.