By Joseph Marine at Brownstone dot org.

A few months ago, I was one of several candidates under consideration for Director of the Centers for Disease Control and Prevention (CDC). While I did not make the final cut, I was honored to be considered for such an important position. The administration has nominated a highly qualified team to lead the CDC and I wish them well. The experience gave me the opportunity to reflect on what reforms I would like to see at the CDC as it faces a pivot point in the history of medicine and public health. Here are six themes that I see as most important and urgent.

1. Develop a new ethical framework for public health practice. Too often during the pandemic, policies were justified by the intended effects with little attention paid to the means used to reach those ends. The Hippocratic Oath and its modern derivatives have served as that ethical framework for medical practice for over 2,000 years and they have made the health professions (until recently) one of the most trusted institutions in our society. Public health practice needs its own version and should adopt many of its principles, including:

Respect for individual rights: The US just celebrated the 250 Anniversary of the adoption of the Declaration of Independence. America is the "Land of the Free and Home of the Brave." Public health practice in the US must be consistent with our legal framework, traditions, and Constitution, including the Bill of Rights.

Subsidiarity: Problems are solved best by those closest to the problem. This idea has already been espoused by the CDC in its new priorities statement. The US is a vast and diverse country with over 50 state and territorial jurisdictions, each with its own constitution and separate police powers. A "one-size-fits-all" public health policy dictated by Washington or Atlanta will rarely be successful. While some public health leaders lamented lack of uniformity in the Covid pandemic response, federalism served us well and allowed states with less restrictive pandemic policies to lead the country away from the worst of other states' policies. The current US measles outbreaks have also demonstrated that local public health officials with local knowledge are better able to gain the trust of communities affected by outbreaks to bring them under control.

Non-maleficence: Avoiding harm is a basic Hippocratic principle in medicine which was largely ignored during the pandemic. Former NIH Director Francis Collins has belatedly acknowledged that US pandemic leaders paid little or no attention to the massive collateral damage caused by policies focused exclusively on preventing every possible Covid infection. "First, do no harm" is a dictum which should apply to public health practice as well as medicine.

Consideration of expertise of others: Public health is also public policy, not just science. A public health program must include expertise in economics, childhood development, psychology, and other fields which are not part of formal public health training. Dr. Fauci famously disclaimed responsibility for understanding the economic and social consequences of pandemic policies as being outside his field of concern. This attitude is not acceptable in medicine or surgery, where practitioners are expected to fully understand the consequences of the treatments that they recommend. It should not be acceptable in public health practice.

Use of least restrictive means to accomplish public health goals. This is already an acknowledged principle of public health policy, but it was ignored during the pandemic in favor of a misguided "precautionary principle" and "swiss cheese-layered protection" approach that promoted maximalist policies in almost all circumstances. Restraint needs to be reapplied.

Rejecting fear-based messaging. We recognize that manipulating patients through fear is unethical in the practice of medicine. It should be also in the practice of public health. Fear brings out the worst in h...