When Is Silence No Longer an Option?

Hi community,

Something different for a short midweek post—something that’s been weighing on my mind, and likely on yours too.

Photo by Kristina Flour on Unsplash

Last week, I wrote an Opinion Letter in The New York Times to shed light on the human cost of reckless federal funding freezes and indiscriminate cuts across the nonprofit, science, academic, and health sectors. These actions don’t just harm vital programs and the people who rely on them—they inflict deep and lasting damage on the dedicated professionals who make these programs possible: teachers, nurses, nonprofit leaders, community health providers, social workers, researchers, public health professionals, disaster relief workers, and many more. Abrupt cuts don’t just disrupt services; they inflict moral injury on some of the most selfless individuals in our society—the very backbone of our communities.

Colleagues and friends have asked why I wrote this letter. My answer? For me, silence was no longer an option.

In a recent JAMA viewpoint article, Dr. Steven Woolf reflects on the shockwaves sent through the scientific, medical, and public health communities by the administration’s early executive actions. In response, some institutions will remain silent to appear nonpartisan, while others will attempt to find bipartisan solutions on issues like opioid addiction and chronic disease. Some programs are avoiding controversy by removing sensitive language or reframing initiatives in ways that align with political realities—strategies that, in some cases, may be necessary and even effective.

But Woolf poses a critical question:

“Is there a bridge too far—a point where it is no longer appropriate for medicine and public health to accede? How do we know where to draw the line, and when it is time to resist?”

I’ve been thinking about this a lot lately, as I’m sure many of you have as well. When must I stand my ground and vocally oppose policies or misinformation that threaten community health? This is not a question I take lightly. I deeply respect diverse viewpoints and value partnership. I also recognize that speaking up—especially in today’s climate—can come at great personal and professional risk. But as a physician, I also have a moral and ethical duty to speak out when policies jeopardize the well-being of my patients and communities.

To condone policies that I believe will compromise health—or to remain silent and look away—is to be complicit in putting our community’s health at risk. Policymakers may ignore our voice and expertise, but that does not excuse us from the duty to warn against actions and policies with the potential to harm.

Speaking up can be confident without being combative—rooted in respect, nuance, and an openness to diverse perspectives. Advocacy is most effective when tailored to the right audience, delivered with tact, and grounded in shared values, no matter how small. The goal isn’t just to highlight problems but to find meaningful solutions.

So, where is the line?

For me, it’s when the most vulnerable—such as children, who cannot advocate for themselves—are put at risk. When those with little agency to defend themselves are harmed, such as the millions of children and families facing the real possibility of losing comprehensive healthcare coverage, that is where I draw the line.

And, as Dr. Woolf emphasizes, science must be the guiding principle—not blind allegiance to the term, but a commitment to rigorous, peer-reviewed, evidence-based research. When the evidence clearly shows that a policy threatens public health—such as the disruption of vaccination services and the intentional, unfounded erosion of vaccine confidence from health leaders—that is where I draw the line.

The line may be different for each of us, but when it is crossed, silence is not an option.

---

Below is my letter to The New York Times.

"Sweeping federal funding freezes and indiscriminate cuts that affect schools, community health clinics, research centers, nonprofits and other public service organizations have grave consequences — not just for those they serve but also for the dedicated individuals within them.

Beyond job loss and uncertainty, these actions inflict moral injury by stripping people of their ability to serve their communities and leaving them feeling anxious, exhausted and helpless.

As a community health researcher and a nonprofit leader, I have seen this distress firsthand. As a pediatrician, I've experienced the same moral injury, sometimes unable to provide the care that my patients and families need because of factors outside my control.

For many, this work is often more than just a job; it is a calling they've pursued, often at great personal cost. When that calling is unjustly taken away, burnout, cynicism and despair follow.

To address this problem, our nation's leaders must recognize and acknowledge how brash and chaotic actions can affect those at the front lines — some of the most altruistic and dedicated individuals in our communities, who are critical to the fabric of our society.

Necessary reforms, such as reducing redundancies and inefficiencies in federal programs and contracts, must be thoughtful and targeted, ensuring that these individuals and their vital work are valued and protected.

While funding can be restored and organizations rebuilt, the distress suffered by people who serve our communities may take generations to heal."

---

The challenges facing nonprofit, public health, science, healthcare, and academic organizations are greater than ever. Where do you draw the line? When is it necessary to speak out, and when is it best to step away? I’d love to hear your thoughts.

---

Community Immunity is a newsletter dedicated to vaccines, policy, and public health, offering clear science and meaningful conversations for health professionals, science communicators, policymakers, and anyone who wants to stay informed. This newsletter is free for everyone, and I want it to be a conversation, not just a broadcast. I’d love to hear your feedback, questions, and topic suggestions—let me know what’s on your mind! And if you find this valuable, please help spread the word!