On Oct. 21, Dan Yorke felt the need to weigh in on the comments and performance of Dr. Alexander-Scott, a physician and public health practitioner. As someone familiar with public health, I took issue with some of the misconceptions presented in the article about her role and responsibility as a public servant.
First, she works in the administration, not for the governor. Hence, the governor can’t just fire her (as noted by Mr. Yorke).
Second, she is responsible for the health of the people in the state, not the public image of her “boss.”
Third, she is not “flexing her muscles.” Dr. Alexander-Scott followed the principles of her field, not as a physician in charge of a patient, but as a public health practitioner responsible for the health of a population. Precisely, she followed the domain of “community dimensions of practice skills,” which delineates that “defending public health policies and programs” is a core competency for the profession.
The improving data the governor presented (and noted by Mr. Yorke) may have been better had we waited for vaccines to be widely available before re-opening and retaken some precautions when the Delta variant arrived. It is also worth noting that much of this success is because of the work of Dr. Alexander-Scott’s team.
Additionally, the field of public health constantly tests the balance of personal liberty and the common good. For example: quarantining. Historically, Rhode Island kept many ships from coming ashore until they were safe to land. Or the famous story of “Typhoid Mary,” which universities often use to illustrate the ethical difficulties of maintaining such balance. The source of the disagreement between the governor and the director of the Rhode Island Department of Health were vaccination mandates, a standard policy in many settings. On this issue, public health has reached a balance where nobody is forcibly vaccinated, but unvaccinated individuals are not allowed to put others at risk by being in places where many don’t have a say on who can be around them.
I don’t know if Mr. Yorke understands that public health is a separate, multidisciplinary field from medicine. “Her” projections and decisions about policy are not Dr. Alexander-Scott’s alone. She works with a team of dedicated epidemiologists, doctors, and policy experts who use their expertise to make their best approximations and decide on responses to multiple possible scenarios. And that’s one of the conundrums about this field; we will never know what could have been. Still, we can always try to estimate and put forth the “precautionary principle.”
This piece was particularly saddening given the recent attacks on public health officials due to political and economic interests.
In conclusion, Dr, Alexander-Scott did her job, followed the requirements of her profession, and acted ethically defending the health of Rhode Islanders.
Damian Lima, MPH
Lima works as adjunct faculty in the public health master’s program at Simmons University. He is also the director of Business Development at Maebright LLC.