The 208-year old journal was driven to publish a fierce call for the president's electoral defeat, signed by all 34 of its editors, as Trump presided over the deaths of more than 210,000 people—spending the past nine months repeatedly lying about the severity of the coronavirus, claiming the pandemic would go away on its own, undermining the FDA by claiming "the deep state" was keeping the agency from approving treatments and vaccines in order to harm his reelection chances, and openly flouting basic public health guidance that top medical experts agree significantly reduce the transmission of Covid-19.
Understanding a global pandemic as a test of leadership, the NEJM editors wrote that "our leaders have failed that test."
"Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don't wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures."
—NEJM
"They have taken a crisis and turned it into a tragedy," they wrote. "The magnitude of this failure is astonishing."
While the U.S. government had every advantage needed to effectively confront the coronavirus, the editors wrote, "when the disease first arrived, we were incapable of testing effectively and couldn't provide even the most basic personal protective equipment to health care workers and the general public."
"And we continue to be way behind the curve in testing," they added, pointing out that U.S. testing rates are still far behind much less wealthy countries including Zimbabwe, Ethiopia, and Kazakhstan.
The editors made reference to experts including Dr. Rick Bright, who resigned from his position at the National Institutes of Health Tuesday in public protest over the administration's failures. Bright noted in his resignation letter that in January he had recommended the government stockpile two of the drugs Trump received at Walter Reed Medical Center last weekend following his Covid-19 diagnosis, which reportedly enabled him to leave the hospital.
"The United States came into this crisis with enormous advantages," the NEJM wrote. "Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts."
Titling the editorial, "Dying in a Leadership Vacuum," the NEJM condemned Trump for not leading the country in adopting simple and effective mitigation tools such as social distancing and the wearing of face coverings—instead openly mocking Democratic presidential candidate Joe Biden for wearing a face mask in public at the first presidential debate, only to be diagnosed with Covid-19 days later, and hosting packed rallies and gatherings where attendees practiced no distancing.
"Most of the interventions that have large effects are not complicated," the editors wrote. "The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don't wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures."
Editor-in-chief Dr. Eric Rubin told the New York Times that after spending months in which "pretty much every week in our editorial meeting there would be some new outrage" over Trump's actions and inaction, the publication was compelled to respond.
"It should be clear that we are not a political organization," Rubin told the Times. "But...how can you not speak out at a time like this?"
Those in the medical community noted the significance of the NEJM's decision.
The editorial represents only the fourth time since the NEJM was established in 1812 that all of its editors signed an editorial; the others have been an obituary for a longtime editor and pieces about access to contraception, abortion policy, and informed consent requirements in medical care.
The NEJM editorial comes less than a month after the Scientific American, which had previously never spoken out about electoral politics in its 175-year history, published a full-throated endorsement of Biden, calling the presidential election "a matter of life and death."
The NEJM did not explicitly endorse Biden but made clear its belief that the wellbeing of the nation depends on voters rejecting Trump at the ballot box in November.
"Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment," wrote the editors.
"When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent," they continued. "We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs."
