Missouri’s war on public health shows extent of national rift

Reviewed by Emily Henderson, B.Sc.Feb 8 2022

Republican Missouri state Sen. Mike Moon believes that covid-19 vaccinations, especially among children, should cease until the long-term effects are known. He points to the research of sources of covid misinformation like America's Frontline Doctors and Dr. Robert Malone, a guest on Joe Rogan's podcast. He himself is not vaccinated.

So, on Feb. 1, he and other senators tanked the nomination of Donald Kauerauf to become the state's next health director. Kauerauf had held the office in an interim capacity since September and professed on the record that he was anti-abortion and anti-mandate for masks and vaccinations, all while being nominated by a Republican governor who is also anti-mandate. But it wasn't enough for Moon.

"Missourians don't want to be ruled with an iron fist," Moon said.

The heartland state's kerfuffle is one more example of political pushback to public health leadership. A KHN and Associated Press investigation last year found that at least 1 in 5 Americans lived in places that had lost their top local public health official amid a wave of threats to the profession and chronic stress that led to firings, resignations, and retirements since the pandemic began. Such blows endanger the public health system's ability to respond to other issues in the future, public health officials said.

In Florida, the nominee for that state's surgeon general declined five times to definitively acknowledge in a hearing that covid vaccines work. And the state health department recently placed a local public health official on administrative leave for encouraging vaccinations among his staff.

Montana passed a law banning employers — including in health care settings — from requiring vaccinations for covid, the flu, or anything else.

A Tennessee legislator threatened the existence of the state medical board for warning that doctors could jeopardize their licenses if they spread covid misinformation.

Serving at the pleasure of elected leaders is becoming "twisted and grotesque" amid extreme politicization, said Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health. Governmental public health leaders are being chosen based on their political ideology rather than their scientific and leadership abilities, he added.

"This is public health dying," he said. "A dark age of politics has begun that is choking science."

Over half of states have rolled back public health powers during the pandemic, which experts say permanently weakens states' abilities to protect their constituents' health.

"Both the fundamental legal authorities of public health, as well as the people who are practicing, are being threatened in ways we've never seen before," said Dr. Georges Benjamin, executive director of the American Public Health Association. He warned that even more legislative rollbacks would take place this year across the country, as well as court rulings limiting public health authorities.

This stripping of public health powers doesn't just mean that unpopular covid restrictions will end, he said. These curbs often cripple public health's ability to fight other scourges.

In Missouri, state legislators passed a law last summer limiting public health powers. A judicial ruling in November further chipped away at local health officials' authority to issue covid restrictions, saying they were "based on the unfettered opinion of an unelected official." Missouri Attorney General Eric Schmitt — who is also running for Senate — is suing schools to eliminate mask mandates and in December created an email tip box where parents can send concerns, photos, and videos that involve mask wearing by students.

Kelley Vollmar, executive director of the health department in Jefferson County, in eastern Missouri, said these actions have severely weakened her public health powers. The state legislation, for example, requires her to get orders confirmed by the county board of health. But the orders must be reconfirmed after 30 days, and Vollmar has to spend $2,000 advertising them in her local paper.

"You cannot rule by committee," Benjamin said. "That's like telling the chief of police that they can't make an arrest."

The November judicial ruling stripped Vollmar and other public health officials in the state of the ability to issue any orders involving infectious diseases. Those must now come from elected officials above them. That affects public health tools like contact tracing, isolation, and quarantine — not just for covid, but also for the other 134 communicable diseases she's tasked with protecting the public from.

"The things they are stripping powers of are things normally happening in the background," she said.

Vollmar has seen a sharp increase in requests for vaccine exemptions for measles and other preventable infectious diseases — and fears what could come next.

It doesn't help that Missouri has underfunded public health for years — a 2020 KHN and AP investigation found public health spending per person was $50 a year in Missouri — one of the bottom 10 states in the nation.

That is part of a right-wing strategy, said Democratic state Sen. John Rizzo, minority floor leader. "They actively go and break government, and then run their next campaign about how government is broken," he said.

All the while, the vaccination rate against covid in Missouri hovers around 55%, with outliers like Pulaski County in the Ozarks below 21%. But those who opposed Kauerauf took his statements that he wanted to increase vaccination levels as a sign that he may be pro-mandate, despite his protestations otherwise.

Kauerauf declined to comment for this article.

Republican Gov. Mike Parson was outraged that his nominee had been blocked. "I’ve been a conservative Republican my entire life and contrary to what some Senators believe, tarnishing a man’s character by feeding misinformation, repeating lies, and disgracing 35 years of public health experience is not what it means to be conservative," he tweeted.

Finding a state health department leader to tackle all these issues now may be nearly impossible, said former Kansas City health department head Dr. Rex Archer, who left his Missouri-based post last summer after 23 years. He'd advise anyone who asked about the job not to buy a house in the state or move their family.

"What qualified candidate would want to risk coming here and then not get confirmed because the party in power won't even support their governor's nomination?" he said.

Moon's not worried. He believes the state will find an anti-abortion, anti-mandate candidate whose positions he can stomach. "We don't want someone coming in who has been part of a state that had strict processes and procedures for this virus, bringing them with them," he told KHN, citing Kauerauf's prior public health experience in Illinois.

And he said he received roughly 1,000 emails encouraging his move to block the nomination, as well as support from dozens of protesters, including some from the Concerned Women for America of Missouri, which opposed Kauerauf's appointment.

That's terrifying to Vollmar, who said that means Moon doesn't want a public health director — he wants a politician.

"Our greatest chance for a better public health system in Missouri lies in the hands of the silent majority of our population that support science-based decisions," she said. "I pray they find their voice before it is too late."