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President Biden has gone too far with his "trust the science" philosophy on COVID-19 vaccination and masking, and he needs to take back control over his message to the public, Leana Wen, MD, said Tuesday.

"'Follow the science' -- his mantra all along -- is not enough," said Wen, who is visiting professor of health policy at George Washington University's Milken Institute School of Public Health, at the annual Population Health Colloquium hosted by Thomas Jefferson University. "Yes, we need to be listening to scientists, but listening to scientists does not mean that scientific agencies get to be the end-all-be-all when it comes to health policy decisions."

For example, "when we look at the guidance from the CDC back in May that essentially ended mask mandates, that was a huge mistake," said Wen, who is also the former health commissioner of Baltimore. "It happened because the CDC was allowed to do something that really made no common sense or scientific sense, and that kind of momentous decision should not have been made by a single scientific agency, but actually should have been made by the White House."

The decision on whether to promote booster shots has been the same way, she added. Although many people agree that boosters are beneficial, "they were disagreeing about what's most important: preventing hospitalization, or preventing any disease? That's not about science; that's about values. I want to see the president stepping up and saying, 'This is why we care about this ... I am reflecting the public will, and I get to make this decision,'" Wen said. Public health agencies definitely have a clear role in determining whether a particular strategy or treatment is safe and effective, but "I think we have taken 'follow the science' way too far. The pendulum has swung in the opposite direction, and President Biden needs to take that back."

The pandemic also has made communicating scientific ideas more complicated, said Kavita Patel, MD, a primary care physician at Mary's Center, a community health center in Silver Spring, Maryland. "We've never had a time where we've had, in a pretty rapid fashion, preprint articles that are coming out with no peer review, and because of the internet and social media, findings become front-page headlines literally within minutes," she said. "We've never had that at the same time we're trying to develop policy to deal with those scientific findings; it's just never happened before."

That situation also shows how clunky peer review is, said Patel, who also served as a policy director for President Obama. "Peer review is important, but peer review takes time and so the idea that we have these preprints that are not peer reviewed sometimes escapes the public in terms of its understanding -- it escapes many health professionals, candidly. I've had to remind people...that's not peer-reviewed, and they're like, 'Well, it's a Mayo Clinic study,' -- that doesn't matter, it's not peer-reviewed. But at the same time, nobody has the appetite to wait, so we've never had such fast moving parallel processes that should be better coordinated."

One thing about the pandemic is clear -- "I think our country is done; I don't think we can manage any more restrictions," said Patel, who also served as a policy director for President Obama. "What we have set now, this is it. So mandate or not, we're going to have to kind of go forward with what we have and continue to try, but I don't think our country has an appetite to live like this any more. I really don't."

Wen agreed, adding that mandates seem to be the answer from here on out. "We have tried education and we've tried incentives; the only thing left is mandates, and mandates are very, very effective," she said, noting that during a recent interview on CNN -- where Wen is an on-air analyst -- the CEO of United Airlines said that after a mandate was implemented, the vaccination rate of employees at his company rose from 70% to 99%. "It was also compelling because he was asked, 'Well, do you think this is a deterrent? Are some people not going to work for United any more?'" she said. "He said that actually it's a great recruiting bonus for them, because there are so many people who are now saying, 'We're happy; we want to work for a company that takes the safety of its employees to be first and foremost."

In a separate colloquium session, Paul Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia, said that the country was far from reaching herd immunity for COVID-19. "You need to have 90% of the population that is immune" to achieve herd immunity, said Offit, who explained that there is a mathematical formula for determining that percentage based on how infectious the virus is. Between people who have been fully vaccinated and those who have been naturally infected and have some immunity, ""you probably have right now, at least 75% population immunity; nonetheless, that hasn't significantly slowed the spread of this virus yet. I think if you if you can get to 90% ... then I think we can slow the spread of this virus some."

Offit, who is also professor of vaccinology at the University of Pennsylvania in Philadelphia, added that there are some hopeful signs that a slowdown is beginning. "If you look over the last couple of weeks, you're starting to see a decline in cases and and a decline in hospitalizations," he said. "You haven't really seen a big decline in deaths, but that usually follows hospitalizations."

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