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JOSHUA SHARFSTEIN:
Welcome to season two
of Public Health
on Call, a podcast
from the Johns Hopkins Bloomberg
School of Public Health.
I'm Joshua Sharfstein, vice
dean for Public Health Practice
and Community Engagement, and a
former secretary of Maryland's
Health Department.
Our goal is to bring scientific
evidence and experience
to the public health
news of the day
through informative interviews
with scientists, community
leaders, policy experts, public
health officials, clinicians
and more.
If you have ideas or
questions for us to cover,
please email us at
publichealthquestion@jhu.edu--
that's
publichealthquestion@jhu.edu--
for future podcast episodes.
Today, I speak to California
State Senator Dr. Richard
Pan about threats to
public health officials
in the era of COVID-19.
Let's listen.
So Dr. Pan, thank you so
much for joining me today.
When I read yet another
story about health officers
who are being attacked online or
fired or being forced to quit,
and I think there are now
dozens across the country
in the middle of the
pandemic, I really
wanted to talk about this
with someone on the podcast,
and I couldn't think of
anyone better than you.
Could you start just
by introducing yourself
to our audience?
RICHARD PAN: Sure
thing, Dr. Sharfstein.
And really, I want to thank you
for having me on your podcast.
I'm Dr. Richard Pan.
I am a state senator who
represents the Sacramento area,
and I chair the health committee
for the states and California.
I'm a pediatrician.
I, in fact, trained
out in the east coast,
came out to be a faculty
member at UC Davis,
actually to teach social
determinants of health.
Ran the residency program, so
was involved in the community,
and was there for 12 years.
And then because
I got frustrated
during the Great Recession, ran
for the state assembly and won.
And so I've been in the state
legislature for 10 years
and worked on a variety
of different issues,
including trying to
strengthen our public health
infrastructure and vaccinations,
as well as, of course,
expanding access to health care.
But because of my work
around public health,
I've certainly run into
some of the experiences
and have witnessed
many of the experiences
that public health
officers are facing now.
JOSHUA SHARFSTEIN: So let's talk
about that a little bit more.
What do you think is going
on with all these attacks
on public health officials?
RICHARD PAN:
Unfortunately, we are
in a era where we are
divided, it's hyperpartisan,
but also there's been erosion
of trust in our institutions.
And public health is actually
a collective activity.
A lot of public health depends
on people working together.
But we all still are
in a situation where
there is tremendous division.
So as public health
leaders are trying
to combat this COVID
outbreak, this pandemic,
they are asking
people to do things
to try to slow
this pandemic down,
and yet we have other
people out there basically
opposing every effort
to stop this disease.
And they are given a
platform and a megaphone
by social media, but
unfortunately also
by some political
leaders, as well.
And that's making it very hard
for public health leaders, who
are brought on for their
expertise and knowledge,
to then have to go up against
politics and the tribalism
that some people
adopted in terms
of how they view how they
should act in their communities.
JOSHUA SHARFSTEIN: One
of the hardest things
for public health
officials to appreciate
is, you know, why,
if you disagree,
don't you just go
through the process
to express your disagreement?
Why the hurtful comments online?
Why the protests
on my front lawn?
Why the doxxing, you
know, all these things
that are happening?
That usually doesn't
happen when it's just
a question of a water permit or
something else that the health
department's doing, or
a stop smoking campaign.
Why does it cross the line?
And you have such
a unique experience
because you see the politics
and you're a pediatrician,
and have this background
in public health.
You know, what would you
say to health officials who
are wondering that?
RICHARD PAN: So
unfortunately, what's happened
is that many people who oppose
public health measures also
oppose government, they
oppose big corporations,
and that's how they view it.
And they feel like the
way to get their way
is to essentially
bully and intimidate.
And social media has
given them the tools
to both organize and also
incite this type of behavior.
And this is a huge challenge,
certainly, for public health.
So by the way, this did
not begin with COVID.
JOSHUA SHARFSTEIN: Yeah.
RICHARD PAN: So I found it
fascinating that Anthony Fauci,
who has spent his
career fighting
infectious diseases,
HIV and now COVID,
is talking about his surprise
that not only himself,
but his family are being
threatened with death threats,
and they have to
have protection.
But by the way,
those of us who've
been advocating for
vaccination pre-COVID,
we've already experienced this.
JOSHUA SHARFSTEIN:
Yeah, so I want to talk
to you a little bit about that.
I mean, some of
these attacks must
be giving you a little bit
of a feeling of deja vu.
RICHARD PAN: It has.
So I will point out that, just
last year, I authored a bill
to have public health oversight
over medical exemptions
for vaccinations.
The opponents, not having
science on their side,
engaged in very
violent rhetoric.
They had rallies with
pictures of my bloodied face
at the front of the rally.
They wore t-shirts
with that image.
They mailed bricks
to legislators.
Of course, people
got death threats.
And in the end, what happened
was that I was assaulted
on the street by an
anti-vaccine activist--
extremist, actually--
who had actually
been harassing me in my
community for many years,
and finally decided to
assault me on the street.
And then another one
actually threw blood
from the public gallery
onto the Senate floor
while we were in session.
And just to keep in
mind, that has never
happened before in the
history of California
that someone has
actually thrown something
from the public
gallery onto the floor
during a session of
the California State
Senate, or the state
assembly, for that matter.
So the fact that they
felt justified in engaging
in this kind of
violence basically shows
that this is part of
their strategy, right?
And what we then
saw with COVID is
that you have people
carrying weapons
in front of the houses of public
health officials as an effort
to bully and intimidate
them, calling out
their addresses during
meetings so that people
could go and harass not only
themselves, but their families.
It's about bullying
and intimidation,
it's not about
expressing a position.
JOSHUA SHARFSTEIN: Yeah.
What was that like for you, to
have that terrible experience?
RICHARD PAN: Well, actually,
unfortunately, I've
had this experience since
I started doing legislation
to try to improve
vaccination rates.
So when I did SB-277 to
abolish nonmedical exemptions,
my staff and I
got death threats,
including other legislators.
Some had to close their district
offices, they were so worried.
JOSHUA SHARFSTEIN: That was
after the measles outbreak,
is that right?
RICHARD PAN: Yes.
That's the 2015
measles outbreak.
Some of my colleagues,
they closed their offices
because they were so
concerned about the safety
of their staff.
Even after the passage
of that particular law,
I've continually received
death threats and harassment,
particularly over social media.
We know they organize
over social media,
as well, particularly Facebook,
in these closed Facebook
groups.
And by the way, we see this
not just around vaccines,
but around other conspiracy
theories, as well.
But then you think about
families and other doctors,
as well-- and I really want to
recognize Todd Wolynn, who's
organized a volunteer effort
to help defend pediatricians
like Nicole Baldwin.
So this is not just limited
to people like myself.
I'm an elected official.
There's a certain bit of
that that goes with that.
But they are attacking
doctors, they're
attacking even
parents of children
who have died or suffered from
vaccine-preventable disease
with harassment and threats.
JOSHUA SHARFSTEIN:
So it's really
kind of the emergence of this
very aggressive and sometimes
violent and illegal
kind of tactic.
RICHARD PAN: And
unfortunately, these tactics
work because people are
less likely to say something
because they're afraid of this.
I understand some doctors
have talked about,
if they have employers or
people they work with, they tell
them please don't,
because if we don't
want to attract the attention.
Interesting enough-- now,
this isn't related vaccines,
but even the
Facebook spokesperson
was afraid to say something
about who they were
because they were
afraid they'd be
attacked by the QAnon
people, the QAnon groups
on their own platform.
So even the platform people are
so afraid of their own platform
and being harassed.
And so we see this activity
going on against physicians,
against parents, and then now,
unfortunately, with COVID,
against public health leaders.
JOSHUA SHARFSTEIN: Is the
connection just the tactic,
or is it some of the same
people and organizations
that mobilize against these
different public health
measures?
RICHARD PAN: Well, it
does seem like there's
a merging of these things.
So for example,
we have identified
that many of the leaders
of the rallies that
oppose public health
measures against COVID,
whether it's at the
state capital or locally,
were led by the very
same people who also
opposed the vaccination bill.
It's the same people, but
they've also teamed up
with other extremists--
you know, white supremacists,
other Second Amendment
extremists-- to basically go
out and bully and intimidate.
So they try to find the home
addresses of public health
officers to go and attack them
at home, and their families,
not just in public spaces.
So certainly
everyone has a right
to petition the government, and
we need to protect that right,
but when you're trying to
sway people through bullying
and intimidation instead
of through facts,
that becomes a danger to
all of us during a pandemic.
JOSHUA SHARFSTEIN: Absolutely.
And what have you been able
to do as a Californian state
senator?
Have you thought about
different protections
that could be put into
place, either to protect
the work of legislators or
to protect the work of health
officials, recognizing
that we're not talking
about shutting off dissent
or not giving people a chance
to express their views,
but really focusing
on the violence
and the harassment?
RICHARD PAN: So I think
one of the challenges
is that social media
companies are essentially
immune to any liability for this
type of violent rhetoric, which
unfortunately translate--
it's not just online,
it translates into real world.
OK?
I think sometimes people go,
you know, it's just the trolls.
They're just, you know,
sticks and stones don't break.
But the problem is that the
sticks and stones actually
sometimes become real.
They're real life.
And when I talk about
people like Nicole Baldwin,
she wasn't just
harassed in her home.
She actually had to have the
police at her practice, right?
We've had numerous examples
where, essentially,
this online harassment
then translates
into real world threats.
And we need to do
more about that.
Ideally, our social
media companies
should step up and
do that on their own.
They're private platforms.
They have the
ability to do this.
But unfortunately,
some of them--
I think some are
taking some steps.
I think Facebook,
in particular, has
been particularly
slow in trying to stop
this kind of harassment.
In fact, CNN did an article
where they presented harassment
to parents--
not just doctors, parents,
as well as doctors.
Facebook said they'd
investigate it.
They recognized that this
violates community standards.
Nine months later,
they did nothing.
Nothing.
So that's a problem.
And we need to set new norms
of behavior about social media
and this type of
bullying and harassment
because it's having
real world consequences.
I would also mention that,
unfortunately, this has also
led to people who are elected
and political leaders, some
of them deciding to pander or
cater to these groups, as well,
and not support public
health officers.
They're worried about
them politically.
And you know, recently, you
had a QAnon candidate win
essentially a primary.
They'll probably
end up in Congress.
You know, a conspiracy theorist.
We have the
anti-vaccine groups have
been active in trying to
do campaigns, as well,
engage in political activity.
And at some point, we
also need to think about,
as a community, how we push
back against that, because we
are talking about people's
lives being in danger.
We have over 160,000
Americans dead,
and yet, at the same time, we
have public health officials
who are in the frontlines
trying to slow this disease,
and they're not
getting enough support
from some of their
elected officials
and they're not getting enough
support from social media
companies that continue to
platform bullying and hate
and intimidation.
And unfortunately, some of them,
rightfully, I can understand,
said I've had enough, I'm
not doing this anymore.
And we don't have
enough public health
experts in our country to
have this continue to happen.
JOSHUA SHARFSTEIN: So
higher expectations
for social media companies,
perhaps more protection
for public health
officials if they need it?
RICHARD PAN: Well, I'd say
both more protection, but also
more support, right?
I think the medical
community has
been standing up and
saying, you know,
we need to support our
public health officials.
For example, down
in San Diego County,
a public health official
was being attacked.
In fact, her home address was
read out at a board meeting.
And the San Diego
Medical Society
waged a social media campaign
to express their support
for the public health officer.
But we also need to
have elected officials.
Unfortunately, in Orange
County, the board of supervisors
did not back up Dr. Quick.
You can disagree with your
public health officer,
but you need to support your
public servants and say,
you know what, they're
trying to do the best job.
It's not acceptable for
people to attack them
at the board of
supervisors meetings.
You're chairing that board
of supervisors meeting.
There is acceptable and
unacceptable behavior.
You can certainly criticize.
That's fine.
But threats and
doxxing and bullying
should not be acceptable.
We need to see elected leaders
standing up and saying,
you know what, we can have
differences of opinion,
but that crosses the line.
JOSHUA SHARFSTEIN: What's
at stake here, do you think?
RICHARD PAN: The stake is our
health and our lives, right?
I mean, we have over 160,000
Americans dead of COVID-19,
and it's not stopping.
Right?
We had the largest outbreak of
measles last year since 1992.
All right?
We have outbreaks of
pertussis and other diseases
when it comes to vaccines.
We want to talk
about climate change
and other types of things,
environmental effects.
This is a real world
threat to our health
when our public health leaders
are not being supported.
And they are basically being
subject to very personal
attacks, particularly women.
I would point out it's
very misogynistic.
Particularly the women
are under personal attack,
not only themselves, but
their families, as well.
That is not part of the job.
That should not be
part of the job.
Note that, historically,
it is challenging
to be a public health
leader during a pandemic,
and that we certainly can
point to historical things
where they've also been
harassed and attacked.
But I think that what
we're seeing now,
especially with the
amplification by social media,
is really not just
problematic, it's dangerous.
In fact, the World
Health Organization,
which unfortunately,
again, we've
politicized our relationship
with the World Health
Organization, said that
the infodemic is just
as serious as the virus itself.
So we have two viruses.
We have the virus, the
actual virus that's
infecting people and killing
people and hospitalizing people
and causing long-term
damage, and then we
have the infodemic, the virus
of disinformation online,
which unfortunately
is discouraging people
in the United States, in
particular, from taking
the steps they need to do,
undermining the trust they have
in the experts, undermining our
ability to contain this virus.
JOSHUA SHARFSTEIN:
Thank you for everything
that you're doing to keep
focus on science and evidence,
to defend public health
officers, their ability
to at least do their job
without harassment and violence,
and for your work on vaccines.
RICHARD PAN: Well, thank you
very much, Dr. Sharfstein.
Really appreciate this
opportunity to talk to you.
JOSHUA SHARFSTEIN:
Public Health on Call
is produced by Joshua
Sharfstein, Lindsay Smith
Rogers, Stephanie Desmon,
and Lymari Morales.
Audio production by Spencer
Greer, Niall Owen McCusker,
Cian Oates and Matthew Martin,
with support from Chip Hickey.
Distribution by Nick Moran.
Thank you for listening.
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