Leana Wen: ‘Public health is now under attack in a way that it has not been before’

Leana Wen, 38, is a physician, a CNN medical analyst, a contributing columnist at The Washington Post, and a former Baltimore health commissioner. Her latest book, “Lifelines: A Doctor’s Journey in the Fight for Public Health,” was released in July.

Q: You write movingly in your book about your family relying on the social safety net, about difficult things you saw as a child - and how those influences shaped your path.

A: We came to the U.S. with $40. My parents were both professionals in China who had difficulty finding employment here. They worked multiple jobs, but we still really struggled. There were times when we could not make rent and were dependent on the good graces of people that we met, and sometimes we depended on shelters. We went through substantial periods of being dependent on some type of government service, whether food stamps, WIC, Medicaid, children’s health insurance. And I had an acute awareness as a child of what happens when people go without access to health care. I also had an acute awareness that people’s lives were not valued the same.

Q: Do you remember when that understanding hit you?

A: I saw a neighbor’s child die in front of me as a child. And watching someone die from an illness that I knew was preventable - because I had asthma - left an imprint on me. And he died not because of lack of medical care, but because his family - his grandmother - was too afraid for what would happen to their family, that they could be deported, if they called for help. And so that’s what motivated me to go into medicine. I felt very strongly about caring for the most vulnerable, who otherwise would have nowhere else to go for their care.

But I had no idea how to actually become a doctor. I thought it was such an unbelievable aspiration that I was too afraid to even tell people that that’s what I wanted to do. In college, if anyone asked me - professors or classmates - I said, “I want to be a lab tech.” Because I was afraid that people would laugh at me if I said I wanted to be a doctor. That they would say, “Who are you to even think that you could do that?” Even after I took my MCATs and had good grades, I talked to the career counselor in this very large state university system. I think they wanted to set my expectations, so they said, “There are people like you who have similar test scores who applied to 40 medical schools and didn’t get into any of them.” But when I recounted this to one of my mentors, Raymond Garcia - I am so thankful to have incredible mentors - he said, “In that case, you have to apply to 41.” And that’s what I did.

Q: As you reflected on your journey in writing your book, what would you say is the most difficult thing that you’ve had to confront?

A: Facing my stuttering and acknowledging that I am a person who stutters was probably the most difficult. I spent so much of my time and energy thinking about it and worrying about it. I mean, everything that I decided to do, from even deciding what courses I would be taking or whether I spoke up in a small-group discussion - everything - was centered around: Would I show that I stutter, would I show my disfluency? As a covert stutterer, I felt the pressure to substitute words that I think I might not get out the first time.

When I finally addressed my stuttering - I was almost through with medical school by the time that I finally sought therapy for speech - one of the exercises was making sure that we say what we want to say and not substitute words. I realized how much extra capacity I had in my brain! Because I was always thinking two sentences ahead. And trying to figure out what word might I stumble on and what word do I need to replace it with. And when I stopped having to do that, I thought, Oh my goodness. My mind is free to do so much else.

Q: How has deciding to share these personal stories shaped the way you think about your role as a doctor, as a public health leader?

A: I come back a lot to a quote by Congressman Elijah Cummings about pain, passion and purpose, that you channel your pain into your passion that is your purpose. And, actually, it was really helpful for me to put into words sources of deep pain and realize that each of these things, in some way, was the source of my drive and why I’m doing what I’m doing.

Q: You’ve said that responding to covid has been sort of a life calling for you. I want to ask your thoughts on vaccine hesitancy, and whether that stems, in part, from a failure in how things were handled?

A: Yeah. It’s the height of American exceptionalism that we are where we are. I have family in other parts of the world where health-care workers and vulnerable elderly people are begging to get the vaccine. And here, we’re sitting on stockpiles and begging people to take the vaccine.

I think how we got here is complicated, right? I agree with the surgeon general in issuing the advisory about misinformation and disinformation - certainly that plays a big role here. There are individuals out there who are knowingly spreading misinformation. There are others who are clicking and then, unfortunately, sharing misinformation that’s leading to question that and the efficacy of vaccines. That misinformation is taking away people’s freedom to make decisions for themselves and their families.

And I think the Biden administration needs to take some responsibility here, also, for their miscalculation and misjudgment in being so uneasy about vaccine verification and relying on the honor code. Come on. Did they really think that the honor system was going to work during a pandemic when many people behaved so dishonorably? The honor system did not work. And, of course, the unvaccinated are now running around living their lives as if they are vaccinated. And that’s led to the surge that we are now seeing. We lost the powerful incentive to increase vaccines in that really important window.

Q: You said recently that to actually end the pandemic, we need to “make getting vaccinated the easy choice.” What specifically would you suggest?

A: I think there are three things that we can do now that would make a big difference. The first thing is to reset based on the knowledge that the delta variant is a lot more contagious and that we are now seeing major surges. This is a very different circumstance to when the CDC first issued their guidance. So I think the CDC needs to say that indoor mask mandates are needed in all areas where unvaccinated and vaccinated people are mixing, with two exceptions: One is if the community has a very high vaccination rate. And two is if there is proof of vaccination. Vaccinated people do not need to be wearing masks around other vaccinated people. They can be around other people without restrictions. That, in itself, would be a powerful statement about the effectiveness of the vaccines and help to incentivize vaccinations.

The second thing is the Biden administration really needs to get behind a vaccine verification system. There are many private enterprises, including concert venues, gyms, workplaces, universities, that want to create safe environments where people can be unmasked, but that only works if they are vaccinated.

And then third, I think that the federal government needs to move in the direction of vaccine mandates. Another way to reframe this is, everybody needs to do a health screen. So everybody needs to go for twice-weekly testing. But you can opt out of it if you have a vaccine.

Q: And do you think that would be effective?

A: Yes. In fact, we have proof from France. When (President Emmanuel) Macron said that tests were going to be required to enter essentially any aspect of public social life - restaurants, bars, trains - the vaccine appointments went through the roof.

Q: Do you think verification and mandates could work in the U.S. with our notions of freedom, individual liberty?

A: So I think we need to reframe freedom here, right? I don’t agree with the statement that some people have been putting out about vaccines, that this is just about personal choice. You can say that maybe eating unhealthy food is your personal choice. But in this case, nobody should have the right to carry an infectious disease that is able to endanger others and potentially kill them. I mean, I’ve got two little kids. I’m very upset thinking about how there are other people who are choosing not to be vaccinated. And as a result, they are choosing to endanger our children. I’m sure they’re not trying to do this intentionally, but that is the end result.

I hope that people see that by not being vaccinated, they’re actually impeding societal progress too. They’re making it harder for kids to get back in school. They’re making it harder for the economy to come back. And why are we allowed to make that kind of personal choice when we do not allow people to make the personal choice to go drunk driving?

Q: The U.S. is sitting on stockpiles of vaccines while other countries have negligible numbers of people vaccinated. As a public health leader, what responsibility do you feel toward sharing vaccines with people around the world? What part should the U.S. play in global public health?

A: It’s a really important question. And I don’t have an easy answer here. Of course, from a humanitarian perspective, it’s essential that we share the vaccine with the rest of the world. It’s unconscionable for us to have a lifesaving remedy that so many people want in other parts of the world. From a selfish perspective as well, there’s a need to vaccinate the world. I heard the quote that said: If we don’t share the vaccine, the virus will share the world. I mean, this is a global virus, a global pandemic, that will only get worse with new emerging variants if we do not control the pandemic. So there is a self-interest reason, also.

It should not just be allocating the supplies that we have. It should be boosting supplies elsewhere. The U.S. should be doing a lot more when it comes to increasing manufacturing capabilities abroad. And I think, coming into the next several months, we’re going to face a lot more of these ethical challenges. Because, for example, what about booster shots? If it turns out that immunity does wane, and that, for some people, for most people, the immunity is not going to fall off a cliff. They’re not going to go from 99 percent immune to severe infection to zero, but might go from 99 percent to 80 percent. What are the ethics involved, then, of boosting them from 80 percent to 99 percent vs. giving it to our counterparts around the world? So I think there are going to be challenges moving forward.

Q: You’ve expressed a lot of frustration with the different messages the CDC has shared. If you had been leading the CDC, or were leading it now, what would you do differently?

A: Well, I first want to say that it’s much easier for those of us on the outside to be criticizing. So when I speak out about some aspect of CDC guidance, it’s never meant to point fingers and say, “Aha, you did this wrong.” Rather, it’s about how this can be changed, what needs to be done.

Understandably, the Biden administration saw what happened during the Trump administration, where scientists were silenced, and data were manipulated for partisan aims and said: We don’t want to do that. But they have swung the pendulum too far to the other side. Following the science means you don’t manipulate scientific data, and your decisions are based on science. But public health is not just about science and knowing the right data. It’s about values. It’s understanding how to communicate those data to stakeholders. It’s getting the buy-in of others around you, and effective communication that earns people’s trust is essential to achieving your outcomes. And so the CDC is great at the science. They have been impeccable about the getting the data. But the interpretation of the data into policy cannot just involve the CDC. And, in fact, it needs to involve many stakeholders, both within the federal government and with local and state health departments, businesses, unions and so forth. If those entities were consulted around the guidance for fully vaccinated people, we wouldn’t be in the situation that we’re in now. Because any of them would have pointed out that the honor system would not have worked.

Q: How much do you worry about hesitancy, not just around the vaccine, but mistrust of science and mistrust of public health even?

A: I worry about this a lot. You’ve seen what happened in Tennessee with the vaccine director being fired for trying to promote covid vaccines to adolescents. And even more disturbing, I think is that now, Tennessee health officials are being prohibited from promoting vaccines to children. Not just covid vaccines, but all other childhood immunizations. I mean, public health is now under attack in a way that it has not been before.

As a clinician, I talk to my patients all the time about vaccines. And I actually think that for us, as clinicians who also work in public health, drawing on those conversations is really important because that’s where change happens. I would say that for the people I’m seeing who are still unvaccinated, and there are a fair number of them, they are not anti-vaxxers. These are not people who are spreading disinformation online, who are going to anti-vaxxing rallies. I mean, these are individuals who have specific questions about the covid vaccine. The main reason is that they believe that they have more to fear from the vaccine than they do from the virus.

Q: And what do you tell those patients?

A: I address whatever concerns they have, right? If I just started telling this patient, who has a very specific concern, all the benefits of vaccine, she’s only going to tune out and think that I am not really understanding - and I would not be able to earn her trust. And when I talk to other physicians about this as well, it’s the same. We talk to our patients. We address their concerns. We approach them with empathy and compassion and not with judgment. And I think that that’s the same lens that we bring to our public health work. Recognizing that the message is really important, but the messenger is too.

To many of my patients, I am the most credible messenger. But to some of them I’m not. And I need to recognize that in order to make a difference in their decision. And we also need to be enlisting other people in their lives as well. And that, I think, is a call to action for everyone that, no matter who you are, there is somebody out there for whom you are the most trusted messenger. So we have to meet an obligation to be that trusted messenger in someone else’s life.