In the fall of 2020, even as scientists raced to develop Covid-19 vaccines, Americans’ trust in these lifesaving shots plummeted. Many became more skeptical because of the behavior of U.S. leaders. Our recent study, published in the Journal of Health Politics, Policy and Law, tracks how the Trump administration applied public pressure on the FDA during the 2020 election season, sparking a crisis of vaccine confidence.
On Aug. 23, 2020, for example, then-FDA Commissioner Stephen Hahn stood beside President Trump to announce the emergency authorization of convalescent plasma for Covid-19 treatment — and wildly overstated the efficacy of the intervention. That marked the first time in FDA history that a president personally participated in announcing a treatment authorization.
Trump followed this event by accusing the FDA on two different occasions of deliberately delaying vaccine approvals until after the election and criticizing the agency’s safety guidelines as a “political move.”
Trump’s attacks on the FDA coincided with spikes in vaccine hesitancy. Willingness to “definitely” get a Covid-19 vaccine plummeted from 42% in May 2020 to 21% in September 2020. Gallup recorded a 10-percentage point increase in vaccine hesitancy from August to September 2020. That month, Kamala Harris, then running for vice president, raised concerns about the Trump administration rushing a vaccine out for political reasons. Vaccine hesitancy spiked across multiple groups, but particularly affected were Democrats, Black and Asian Americans, and highly educated individuals. Asian Americans saw their vaccine hesitancy increase by roughly 30 percentage points. Black Americans saw a 21-percentage point rise in vaccine hesitancy and remained skeptical beyond the initial crisis.
The repercussions extended beyond individual attitudes. By September 2020, several states announced they would establish their own independent vaccine review panels. Most had Democratic governors, who suggested that they did not trust the federal government under Trump. The National Medical Association, representing Black physicians, created a separate task force to vet FDA decisions — an unprecedented vote of no confidence in the agency’s independence from political influence.
We now find ourselves facing a similar challenge — this time, with concerns about political interference (or even the perception of it) extending beyond Covid-19 to other areas of public health and scientific governance. Within the past week, the FDA withdrew draft guidance aimed at improving diversity in clinical trials, following a directive to dismantle diversity, equity, and inclusion policies across federal agencies. Such actions undermine the credibility of public health institutions and signal a regression in efforts to address well-described disparities in health care access and outcomes. Public communications from agencies like the NIH and FDA now require review and approval by presidential appointees, causing delays in disseminating critical health information and resulting in an increased risk of political interference. Additionally, the administration has halted ongoing research reviews and new grant funding, further disrupting public health activities.
When political leaders subordinate scientific institutions to electoral interests, they do not just undermine immediate public health efforts. They also inflict lasting damage on institutional credibility, leading to reduced confidence in the organizations and the work they do. Experimental research shows that when scientific approval guidelines are weakened, Americans lose trust in vaccines and other products. To prevent further deterioration of public trust, it is imperative to uphold the independence of key scientific institutions and ensure that public health decisions are guided by evidence rather than political considerations.
In the wake of the first Trump administration’s disastrous public health response to the Covid pandemic, efforts have been made to protect scientific institutions from political interference. In 2022, the Government Accountability Office (GAO) set out to fortify agencies under the Department of Health and Human Services against political interference. Agency employees had reported a lack of avenues to report issues, a fear of retribution for reporting political interferences, and an estimation that higher-ups were already aware of the issues at hand. The GAO accordingly made seven recommendations on how the CDC, FDA, NIH, and HHS should focus on defining political interference, creating specific procedures on reporting and training for employees.
The Biden administration also tried to fortify the power of these institutions, including the establishment of a Scientific Integrity Council and Scientific Integrity Official within the National Institutes of Health. But these are not protected actions, and Trump could eliminate them at any time.
Ensuring that scientific integrity is preserved will not be easy, but there are still avenues available. Senate confirmation hearings for health agency leaders starting this week must include a rigorous review of nominees’ commitment to scientific integrity, ensuring that leadership reflects a strong, nonpartisan dedication to evidence-based policymaking. Members of Congress should refer to the challenges and consequences of political interference in Trump’s past administration and ask appointees what their plans are to mitigate undue influence from the executive branch to ensure that public trust is not eroded in these institutions.
Strengthening whistleblower protections and creating independent oversight mechanisms to safeguard agencies’ operations is more critical than ever. Whistleblower protections must be bolstered through policy reforms within agencies to empower employees to report political interference without fear of retaliation. There should be very clearly depicted avenues to report political interference across agencies, and the definition of political interference should be well-agreed upon and included consistently across agency trainings.
Whistleblowing should furthermore be responded to within a definably appropriate window of time, as in recent history the FDA has been slow to respond to whistleblower complaints. In response to the GAO report, the HHS established an updated scientific integrity policy that refers reports via the avenue of the agency’s scientific integrity officer. Others should follow this lead. But given the recent effort of the Trump Administration to fire officials such as HHS inspector general Christi Grimm and the broader threat to the independence of the Office of Inspectors General (OIG), early signals are that the current Trump administration will try to eliminate such protections.
Thus, more drastic and immediate solutions are required to ensure the freedom of scientific agencies from political interference and the authority of internal oversight bodies. Congress should enact emergency legislation that explicitly prevents the dismissal of inspectors general without bipartisan congressional approval and mandates a formal investigation into any proposed removal.
Additionally, it should establish an independent commission with subpoena power to oversee broad actions taken by agencies with obvious political motivations, such as the current block on NIH grant activity. Congress should immediately impose a moratorium on such assaults on the public trust and launch comprehensive investigations into their origins and impacts. These steps are not only critical to safeguarding the integrity of federal agencies but also to sending a clear signal that even temporary politicization of science and health policy can have enduring and detrimental effects on public welfare.
Regarding the FDA, Congress should create an oversight panel with statutory independence from agency leadership. This panel would conduct binding reviews of disputes involving potential political interference in regulatory decisions, evaluate senior officials’ justifications for overriding staff decisions to ensure they align with established scientific standards, and finally, provide transparent, publicly accessible reports on findings, offering a mechanism for sustained accountability.
The politicization of public health institutions not only undermines immediate efforts to protect public health but inflicts lasting damage on public trust. There is an urgent need to implement safeguards that protect the FDA, CDC, and other agencies from political interference. The recent rollback of policies like clinical trial diversity guidelines and increased restrictions on agency communications highlight the growing need for legislative safeguards. Without robust protections, these agencies risk further politicization, threatening their abilities to effectively accomplish their essential public health missions.
Anushka Bhaskar is a research assistant at the Program on Regulation, Therapeutics, and Law at Harvard Medical School. Aaron Kesselheim is a professor of medicine at Harvard Medical School and the director of the Program on Regulation, Therapeutics, and Law within the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital. Daniel Carpenter is Allie S. Freed professor of government and chair of the Harvard University Department of Government, as well as author of “Reputation and Power: Organizational Image and Pharmaceutical Regulation at the FDA.”