





































 V38 N1 / 2023 

©2023 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     12

The Walter C. Alvarez Award is named in honor of Walter C. 

Alvarez, MD, a pioneer in the field of medical communication. 

The award is presented to either a member or nonmember of 

the American Medical Writers Association (AMWA) to honor 

excellence in communicating health care developments and 

concepts to the public. The Alvarez Award is presented during 

AMWA’s Medical Writing & Communication Conference.

Hello everyone, it’s a pleasure to be with all of you. And as 

I start, I want to first of all acknowledge the people who’ve 

made this AMWA conference possible and the annual con-

ference chair, Dr Kimberly Korwek. I’d also like to thank the 

AMWA executive director, Susan Krug, and all of you at the 

American Medical Writers Association.

 All of you at AMWA have also been on the frontlines in 

this confusing and frightening time. We are working with 

incomplete information, interpreting new science, helping 

people with news that they need to use in their daily lives 

to navigate huge uncertainty and protect themselves and 

their families, and to understand changing policy impli-

cations that often are changing by the minute. All of you 

are on the frontlines, not just with COVID, but also with 

all other aspects of health and wellness. Your work is so 

important, and I want to thank you for what you are doing 

every day.

 I’m also delighted to join virtually another award 

winner, my colleague, Dr Peter Hotez, who as you know, is 

being honored for his exceptional work in medical commu-

nication and is a superb clinician and researcher, and who, 

along with his colleagues, has developed a COVID-19 vac-

cine. So, what great company we are all in.

 Well, in my presentation today, I would like to talk about 

communicating public health in times of conflict and con-

troversy, and my discussion is going to be in 2 parts. First, 

I want to talk about what we have learned from COVID-19, 

touching on the role of journalists, medical writers, and 

communicators, and then I want to discuss what we can do 

moving forward. And for each of these 2 categories, I want 

to give 3 lessons and move from less controversial to more 

controversial. And I look forward to engaging with all of you 

during this event and going forward as well.

 So, first category of what we have learned from COVID, 

3 things. The first—and again going from the more obvious, 

less controversial to perhaps more controversial—the first is 

that there are many neglected issues that have been bared 

for everyone to see. Not a surprise to any of us who work in 

health, but I think these may be some issues that much of 

the American public may not have had as much awareness 

of—for example, health disparities. Disparities did not start 

with COVID, but COVID certainly amplified them.

 We saw this early on in terms of who has the ability—the 

privilege of social distancing, and who does not. We also 

saw this in the way that vaccine distribution first occurred, 

and when something was in extremely short supply like 

COVID vaccines, it was those who were able to get their 

smartphones and have all their friends and family start find-

ing vaccine appointments who were able to get them first. 

Now, we also see those disparities don’t go away on their 

own, and we’re now seeing many of these same disparities 

playing out in monkeypox. We’re seeing the same dispari-

ties playing out in virtually every other health issue that we 

can think of. But that, I think, is a neglected issue that more 

people are seeing now more than ever.

2022 Walter C. Alvarez Award Address
Emerging Issues Following COVID-19: Public Health Communication
Leana Wen, MD, MSc, FAAEM / George Washington University, Washington, DC

CONFERENCE

http://www.amwajournal.org


AMWAJournal.org     13Emerging Issues Following COVID-19: Public Health Communication

 Similarly, with the concept of social determinants of 

health. Now again, all of us working in health and in health 

care know that you can’t separate someone’s health outcomes 

from the housing that they have access to, from the food that 

they have access to, or from working conditions, but I think 

those issues also really played out during COVID in a way that 

shed awareness for the first time for many individuals.

 One more issue, too, is that this country is really lacking 

in public health infrastructure, and one could even argue 

that we don’t have any kind of functional public health 

infrastructure. It was mentioned that I ran Baltimore’s 

health department. And I saw for myself every day how 

it was all about robbing Peter to pay Paul, that already—

those of you who have a public health system for local and 

state health departments across the country know what I’m 

talking about here—people are already wearing multiple 

hats. The same people working on school health are also 

being pulled to staff shelters for individuals experiencing 

homelessness in the winter. And then you have something 

like COVID come along, and those same people are being 

moved from school health to now working on setting up 

vaccine clinics or setting up testing. And then now there’s 

monkeypox, or now there’s the reemergence of polio, and 

now these people are being pulled off these other crucial 

priorities to emerging issues, too. And I think this has been 

another issue bared for everyone to see, that there is no face 

of public health.

 Now, by definition, public health works when we are 

invisible. But the problem when we’re invisible is that 

public health becomes the first thing on the chopping block 

when it comes to budget time, and as a result, we’re seeing 

the consequences of neglecting public health throughout. 

Well, I just hope that we have learned from all of this that 

the cost of doing nothing isn’t nothing. Just something that 

my former mentor, the late Congressman Elijah Cummings, 

used to say, “the cost of doing nothing isn’t nothing.” Now, 

when we neglect public health, there are severe conse-

quences, some of which we have seen during COVID.

 The second lesson that I believe we’ve learned from 

COVID is that public health depends on public trust, and 

when that’s eroded it’s very difficult to get back. When I look 

back at the very beginning of the pandemic—I think in ret-

rospect with 20/20 hindsight—things could have been done 

differently. And actually, probably the top thing that I wish 

that I and others had done a better job of communicating 

early on and throughout is that change is to be expected. 

Actually, change is the bedrock of sound public health 

policy when you’re in the middle of an ever-changing  

situation like a new virus and a new pandemic.

 Now, when you look at many of the arguments against 

vaccines or various COVID protocols, it’s that public health 

officials are accused of being flip-flopping, but it’s not 

flip-flopping when circumstances change. In the beginning, 

as you all remember, we didn’t know that COVID was air-

borne. We were really worried about surfaces, and we were 

advising people to wipe down groceries. There were no rec-

ommendations for masking early on because we just didn’t 

know about transmission, and then we recommended masks. 

But then, it looks like flip flopping even though it was that the 

science evolved, and also that circumstances changed.

 Similarly, when vaccines first came about, we believed 

that in addition to preventing severe illness, they also pre-

vented infection. Well, that changed with evolving time, with 

the arrival of the Omicron subvariants that the vaccines were 

less protective against infection during Omicron spread. And 

so, there is less a case for mandates than there were before, 

and so recommendations have to change with those growing 

circumstances with those changing circumstances in mind.

 And that’s actually something that in clinical medicine 

is really apparent because, in clinical medicine, you would 

absolutely expect that if you’re treating a patient with cancer, 

as an example, and there’s a new chemotherapy regimen 

that comes out, you would absolutely expect that your clini-

cian is going to be offering that new regimen. You want your 

doctor to stay up to date with the science. And also, changing 

circumstances matter too. Using the same analogy, if some-

one’s body is responding one way to one treatment and not 

responding as well as it should maybe to another, you would 

expect those recommendations to evolve.

 Well, that should really be the case when it comes to 

public health policy as well. And again, looking back, one 

thing that I wish we had done a better job of is to communi-

cate that change is the bedrock of good public health policy. 

And I think by communicating the change, communicating 

not just what changed but why, over and over again, I think 

that is going to be crucial to reestablishing trust.

 The third lesson that I believe that we’ve learned from 

COVID is that public health has become very polarized. 

Now, my great concern prior to COVID was that people 

were not thinking about public health. Now, we had to 

make the case for why public health matters to public safety, 

or why it matters to education, and why it matters to the 

economy. But it was a fairly neutral topic—it just wasn’t 

something that people really thought about. And a major 

concern, having run a local health department, was that 

public health was always underfunded.

 Well, I have a different concern now, and I think it’s an 

even more significant concern. Let me take you back to a 

http://www.amwajournal.org


AMWAJournal.org     14Emerging Issues Following COVID-19: Public Health Communication

focus group that I had the opportunity to participate in for 

the Bulwark, and we did a podcast based on this. But the 

focus group was looking at the various mitigation measures, 

and they were interviewing Republicans, Democrats, and 

Independents, and what really came through in the focus 

groups was that masks and vaccines means something other 

than what they are, which are public health measures that 

help to reduce virus transmission.

 For one group, and you can guess which group, but for 

the group that’s anti- these measures, they see masks and 

vaccines as being about control, about government con-

trol over individuals. This was a fight for individual liberty, 

versus for the other group that very much wanted masks 

and vaccines—one would argue perhaps even want mask 

mandates and vaccine mandates still. For the other group, it 

was almost a reaction to that first group, and masks and vac-

cines equaled caring for others and equaled not being part 

of that antimask, antivaccine “Republican” group.

 And so, I bring this up because I really worry about this. 

I mean, public health has always been hard because it’s 

about balancing individual liberty versus what’s best for 

all and protecting the most vulnerable. It’s not clear where 

that pendulum is going to be, someone is always going to 

be accusing you no matter what policy you set of having the 

balance wrong. You’re either weighing more toward indi-

vidual liberty or more toward doing something that protects 

all but at the cost of individual liberty, and that’s not an easy 

balance to strike.

 I mean, even thinking about something as basic as 

whether somebody with multidrug-resistant tuberculosis 

should be required to quarantine or be required to isolate 

for the duration of their illness. I mean, even something like 

that that I think for most of us in public health would be 

pretty easy to say, “yes, that person should be in isolation.” 

But enforcing that, especially against that person’s will, 

that’s still a matter of saying what’s best for people—for all 

people, is going to outweigh individual liberty. So that bal-

ance has always been hard to strike.

 But I would say now that balance is many times harder 

to strike because we are now seeing a substantial backlash 

against public health in a way that we have not before. We 

have more than half of states passing laws and legislatures 

passing laws that restrict public health authorities in some 

way. That’s not just going to affect COVID, but many other 

issues down the line. For example, if there is a bill that pre-

vents local health authorities from issuing mask mandates 

in the future, a patient with multidrug-resistant tuberculo-

sis, or somebody with measles, which is a most contagious 

illness—things like that will also be affected as well.

 We know that routine childhood immunizations are 

falling, and that’s something that’s also very concerning. 

We’re seeing that immunizations that previously were just 

accepted as something that children should do, was an opt-

out. Now a lot of parents are beginning to question whether 

certain immunizations should go forward or not.

 And I have this very significant concern that the back-

lash against COVID restrictions, because of how politicized 

COVID has become, is now bleeding into these other things, 

and there are really significant consequences here. We’re 

talking about infectious diseases, but we’re also talking 

about other aspects of public health. Again, if public trust 

is eroded, it’s very difficult to get back. And I’m very con-

cerned that we’re going to lose trust from the public for the 

next virus that could be a pandemic, or we could even lose 

trust from the public for other routine public health matters 

that previously were not questioned.

 Now, it’s unfortunate that many public health officials  

and experts during COVID have been attacked for our 

views. Dr Hotez is certainly one who’s come, unfortunately, 

under attack. I have had similar experiences, and I would 

just say that from my standpoint, I think there is a reflex—

sometimes blame, if you will—of saying, “well, it’s one side. 

It’s the antimaskers or the antivaxxers who are attacking us 

for our views.” But I actually think that these attacks come 

from all sides.

 And again, this backlash I really fear is going to hurt 

what public health is able to do in the future. And so, here’s 

the controversial statement that I’m going to state and leave 

us on before we move to the second part of this conver-

sation. And the controversial statement that I have is that 

the more we keep focusing on COVID, the more it’s going 

to bleed into and have consequences on other aspects of 

public health.

 And I actually believe that when restoring trust in public 

health, we have to recognize that good health is not just the 

absence of COVID, and we have to recognize that, like it or 

not, COVID has been inserted in the middle of culture wars. 

And that if we are going to have any chance of depoliticizing 

public health and bringing public health back to this non-

partisan state that it should be in, I believe that we need to 

put the focus away from COVID and more on other health 

issues that also very much impact health and well-being but 

are not subject to that same polarization as unfortunately, 

COVID-19 has been.

 I now want to move to the second part of this discus-

sion, which is “What can we do moving forward as medi-

cal communicators, as journalists, and as people who are 

public-facing?” And here, I have 3 recommendations, and 

http://www.amwajournal.org


AMWAJournal.org     15Emerging Issues Following COVID-19: Public Health Communication

they’re going to move again from more obvious and less 

controversial to perhaps a bit more controversial. So, 3 

things on how we can propel the conversation forward.

 The first is that we need to be transparent and intellec-

tually honest with the public. Let me explain to you what 

I mean here by giving you an example of something that 

happened at a conference several months ago. I went to a 

conference that was a lay audi-

ence conference, was talking 

about COVID, and at that time 

just doing an explainer on boost-

ers, vaccines, and immunity. 

And at the end of the conference, 

3 people came up to me and 

almost whispered a question, 

and it was said to me as well, 

basically, “I didn’t want to raise 

this issue in this forum in front of 

everyone, but I want to ask you 

about natural immunity—is that 

a thing?”

 Of course, it is a thing. I mean, it is true that there is such 

a thing as “natural immunity,” also referred to as immu-

nity after recovering from COVID or from other infections. 

I think what’s happened, and the reason why these very 

well-educated individuals who are very much pro-vaccine 

were afraid to ask the question, was that they feared a back-

lash. They feared a public response of other people in that 

audience accusing them of being antivax for asking the 

question about whether natural immunity exists.

 But you know what? It does exist, and I think if we are not 

honest about it with individuals. Because look, I understand 

all the reasons at the beginning of the pandemic—I think 

especially right after vaccines first came out—I think there 

was this fear that if you talked about immunity after recover-

ing, that people are not going to want to get vaccinated. But 

the thing is, you can say 2 things are true are once.

 It is true that you have some level of immune protec-

tion after getting infected. It is also true that you could get 

even better, more robust, and more lasting protection if, in 

addition to recovery from infection, you also got vaccinated. 

And, in fact, we have many studies now showing that this 

hybrid immunity conveys probably the most durable, the 

most consistent, and the strongest level of response.

 But acknowledging natural immunity isn’t being anti-

vax, and actually, not acknowledging it makes people think 

that you’re hiding something from them and that you’re 

not being intellectually honest. And so, I think part of this 

is what we can do, I believe, as medical communicators are 

really being honest even when that topic is nuanced and 

difficult.

 Now, we talked a little bit about masks earlier. I think 

that one of the reasons why the World Health Organization 

and the Centers for Disease Control and Prevention were 

not recommending masks early in the pandemic, very early 

in the pandemic, was that there was a very limited number 

of masks, especially N95 and 

new prevalent masks. And I 

think that we should have been 

honest and said masks could be 

helpful. We’re not sure because 

at that point in the pandemic—

we’re talking March of 2020—we 

didn’t know exactly how help-

ful they were, but we could have 

said, “They probably are helpful, 

but right now we need to save 

them for health care workers.” I 

think that that type of intellec-

tual honesty would have also 

avoided some of the accusations against flip-flopping later.

 Similarly, with monkeypox vaccines, I think we should 

have been honest to say that they need to be rationed when 

there’s a limited supply and a lot more people interested in 

getting the vaccines than the supply initially was for. I know 

that rationing is a bad word, but it’s also the truth that at 

that time rationing had to occur.

 I think sometimes in communication in general, there is a 

need to try to simplify for our audience—and look, I’m  

not saying that this is easy at all. But I also think that our  

audience deserves the truth from us, and the truth is that  

science isn’t always clear-cut, and that medicine exists in the 

area of gray.

 Two things—or multiple things—can be true at once. For 

example, mitigation measures can and do reduce the spread 

of the virus, but they all come at a cost. Telling people, for 

example, to not gather with one another, having physical 

distancing, even mask-wearing—yes, they reduce spread, 

but they also have a cost. And so, I think those people who 

are trying to again get people to do something that they 

don’t want to do and follow mitigation measures sometimes 

feel like, well, we have to emphasize only the benefit. But 

then, I think we’re not being intellectually honest if we don’t 

also talk about the cost.

 And I believe that our duty, as communicators, has to be 

to give the full truth, not just the truth that we think others 

can handle. Because if we do that, if we try to limit the truth 

and censor those who are trying to tell a fuller story, then 


And I believe that our duty, as 

communicators, has to be to give the 

full truth, not just the truth that we 

think others can handle. Because if we 

do that, if we try to limit the truth and 

censor those who are trying to tell a 

fuller story, then I believe we’re actually 

undercutting public health further  

and eroding trust further.

http://www.amwajournal.org


AMWAJournal.org     16Emerging Issues Following COVID-19: Public Health Communication

I believe we’re actually undercutting public health further 

and eroding trust further.

 The second thing, and again, 3 things here on things that 

we can do differently. The first is to be transparent and intel-

lectually honest. The second is to acknowledge that follow-

ing science is not a sufficient motto—that public health is, of 

course, based on the science, but ultimately, it’s about values. 

There’s been a lot of discussions now as we are moving 

through the emergency phase of COVID-19 about when mit-

igation measures end, and that is in some ways based on the 

acceptable number of infections, acceptable number of hos-

pitalizations, and acceptable number of deaths.

 Some people might say that as long as hospitals are 

not getting overwhelmed again, then mitigation measures 

can end. Others will say that as long as infection levels are 

high, as long as there is long COVID, then we need to keep 

up mitigation measures. I mean, these questions are based 

on the science because modeling, for example, can help us 

to understand where we’re at and where we’re going. But 

this is not just a scientific question, this is a question just as 

much societal value. I think it’s important for us to again be 

intellectually honest about that.

 We also, crucially in public health, have to consider 

where the public is at. There is no point in recommend-

ing something if people literally won’t follow it. My sister’s 

partner is Dutch, and we were recently having a conver-

sation about how in the Netherlands bike helmets are not 

required, and very few people are actually wearing bike  

helmets. And for us, in this country, it seems rather shock-

ing that you have all these people biking but with no hel-

mets. And the point that my sister’s partner was raising is, 

well, let’s say that you actually are now saying that helmets 

are going to be required, but if half or more of the popula-

tion literally are not using helmets, it’s going to be impos-

sible to enforce. And then if people start questioning this 

law or this regulation, you may have the issue of the boy 

who cried wolf. If they don’t trust you on this, and this thing 

cannot be enforced, then why trust you on other issues?

 And I think that’s been one of my considerations in 

thinking through when our mitigation measures need to 

end. It’s a values question, but the value also has to take 

into consideration where people are already. If most people 

are already not wearing masks, if most people have already 

returned to going to indoor restaurants and going to travel, 

it’s not going to work to say, “oh no, don’t do those things.” 

Rather, we need to work on, in a sense, harm reduction.

 We need to help people to do the things that they want 

to do and make it safe for other individuals who are more 

vulnerable, so doing things like recommending same-day 

testing for individuals before they go see their elderly rel-

ative in a nursing home or making sure that people have 

access to vaccines and boosters. And that we’re also making 

treatments readily available and reducing all barriers to 

treatments and making sure that there are lots of other treat-

ments that are actually hugely underutilized like Evusheld, 

the preventive antibody—for example, it was hugely 

underutilized.

 How can we make sure that those things are pretty 

low-hanging fruit? I mean, these are not things that there 

is a societal objection against, but they are things that as a 

policy matter, we can try to make them more available. And 

I think that that’s one way of considering where the public 

is at and knowing that you’re not going to force people to do 

something that they don’t want to do. But you can still work 

around where people are to get to the point that we all need 

to get to, which is protecting the most vulnerable.

 This is another call for understanding and accepting 

the nuance that circumstances have changed. And I think 

part of this nuance is accepting that just because most indi-

viduals have returned to normal doesn’t mean that some 

individuals haven’t, and it also doesn’t mean that societal 

change has to stop.

 Sometimes, especially when you look at social media, 

it seems like there are people who want to simplify and 

say, “well, if you are in favor of people returning to normal, 

that means that you don’t acknowledge that COVID is real, 

or you don’t acknowledge the more than a million deaths 

from COVID, or that you don’t acknowledge the toll of long 

COVID.” I think both of those things can be true at once: I 

think it can both be true that COVID has had this huge, ter-

rible societal impact and continues to have an impact, and 

we need to address societal policy issues like improved ven-

tilation, and paid sick leave, and aiming for universal access 

to health care.

 You can aim for societal change, but at the same time 

also acknowledge that Omicron COVID is going to be with 

us for the foreseeable future, and that we need to empha-

size returning to normal in order to get people to see that 

good health is not just the absence of COVID—both of 

those things can be true at once. And I think we as commu-

nicators should really push back against those who seek  

to simplify and further polarize where we’re at in this  

discussion.

 And so, that makes me move to the third thing. After 

being intellectually honest and talking about values, we 

need to embrace our role to seek the hard truths and to act 

with fairness and empathy. All of you as communicators 

and journalists, you are finding these neglected issues that 

http://www.amwajournal.org


AMWAJournal.org     17Emerging Issues Following COVID-19: Public Health Communication

we begin our conversations with. You are the ones who are 

finding out about health disparities, and you know that if 

you don’t dig around for those data often, they’re not being 

produced. And so, I want to commend you for what you’re 

doing in this sense to really shed light on disparities, on 

social determinants, and on these other neglected issues.

 You also have such a crucial role to play as a communi-

cator in accountability. How is the funding that’s being allo-

cated being spent? There was funding going to classrooms 

for improving ventilation, and all this money going to local 

health departments. Well, where is that money and how is  

it being spent? You are also the ones helping to make the  

connections on these various issues related to social deter-

minants of health, and I think that your role here is  

so important.

 We started this conversation, too, by talking about con-

flict and controversy. Well, I want to put another plug in for 

how a lot of that conflict and controversy is manufactured. 

Often, it’s someone taking one sentence out of context, and 

that they want to make you, or me, or all of us about one or 

the other. And I think that our role as communicators also 

has to be honest and fair and to really point out when some-

thing is being taken out of context.

 I believe, too, that we have a role to be decent to one 

another, and when we fight among each other there is a 

potential harm that it erodes trust for all of us. And frankly, 

there are so many more issues that we must address 

together. We have the reemergence of polio, we have routine 

childhood immunizations falling off a cliff, and we have the 

opioid epidemic driven by fentanyl that’s gotten worse now 

more than ever. We have women’s health at a crossroads 

that’s being threatened across the country, and we have 

mental health that’s long been neglected and getting worse 

at this time. And, of course, we have this issue of robbing 

Peter to pay Paul and not having sustainable infrastructure 

for public health. There are so many issues that we need to 

address together.

 And I hope that coming out of COVID, we’re able to 

come together and address these other issues, digging up 

data where needed, and holding people accountable where 

needed, but also trying to take away that level of anger from 

the conflict and controversy. We’re trying to depoliticize 

public health and getting us all back to the place where 

we’re able to work together on these difficult issues.

 Now, the work ahead, no doubt, is very challenging. I 

want to end with a quote and an appreciation for all of us 

who work in public health and communication. And this 

quote is by Dr Harrison Spencer, a former leader in public 

health—as you will see from this quote. And Dr Spencer 

says that “Public health is filled with heroes, both well-

known and unknown. They are visible on the national or 

international stage, or they work quietly in communities 

with families and individuals. When they do their job, they 

often become invisible.”

 Well, I believe that that is the job that you all do in 

AMWA every day—you help to make the invisible visible, 

and you help people to navigate their lives at very challeng-

ing junctures. And you’re also helping us to push forward 

to a time where we’re able to really value public health as 

the crucial aspect of our overall national security and our 

well-being, and you’re helping to lay bare all these crucial 

issues that many people unfortunately are neglecting. And 

I truly believe that when the long arc of history is written, 

you will be the heroes, and I am so honored to join you at 

AMWA today.

 Thank you.

Acknowledgment
I thank Kavita Garg, Director of Medical Writing at Saliegral 

Global, for her help in bringing the transcript to the page.

Author declaration and disclosures: The author notes no com-
mercial associations that may pose a conflict of interest in rela-
tion to this article.

Author contact: drwenmedia@gmail.com

Author Biography

Leana S. Wen, MD, MSc, FAAEM, is an emergency 

physician, public health professor at George Washington 

University, and nonresident senior fellow at the Brookings 

Institution. She is a contributing op-ed columnist for the 

Washington Post, anchoring the weekly Post newsletter 

“The Checkup with Dr. Wen.” She is also an on-air medical 

analyst for CNN.

http://www.amwajournal.org



