Back in the day, in the 1970s and early 1980s, a mysterious disease spread through overlooked communities in America, primarily affecting intravenous and gay men.
The disease, which caused a sudden and devastating collapse of the immune system, did not resemble anything that doctors had noticed before. The patients arrived at the hospital with rare infections, such as Kaposi’s sarcoma and fungal pneumonia.
But despite the increase in cases, public aptitude officials have remained silent for years. Few Americans saw it as a national emergency, especially since the disease was limited to the margins of society, at least at the beginning.
As the government and the public understood the risk in 1986, following the “Surgeon’s General Report on AIDS” through Dr. C. Everett Koop, tens of thousands of Americans have already died.
Looking back on this and other public health crises, it becomes clear that medical science alone is not enough to save lives. To avoid similar tragedies, public health leaders and elected officials will first have to perceive the role of denial in people’s belief about health. Threats. They will then have to expand effective methods to triumph over it.
Denial is a powerful, sometimes subconscious, defense mechanism that protects Americans from uncomfortable or painful realities. By repressing objective facts or experiences, especially those that cause worry or anxiety, other people are given a sense of stability in the face of overwhelming threats.
Historically, denial was vital to daily life. With little protection against illnesses like smallpox, tuberculosis or plague, people would have been immobilized by fear if not for the ability to repress reality. Denial, mixed with superstition, took the place of facts, allowing society to function despite the ever-present risks of death and disability.
Today, even with great advances in wisdom and medical technology, denial continues to influence individual habit with destructive consequences.
For example, more than 46 million Americans use tobacco products, despite their links to cancer, heart disease, and respiratory diseases. Similarly, tens of millions of other people refuse vaccines, ignore clinical consensus, and expose themselves, their communities, and their communities to preventable diseases. Denial also extends to cancer screenings. The curves show that 50% of women over 40 forget their annual mammograms and 23% have never had one. They are not up to date on colorectal cancer screening, and 20% have never been screened.
These examples demonstrate how denial leads individuals to make choices that jeopardize their health, even when life-saving interventions are readily available.
When individual denial escalates to a collective level, it fuels widespread inaction and worsens public fitness crises. Throughout fashionable medical history, Americans have continually underestimated or dismissed emerging fitness threats until the consequences become ignored.
Early warnings about the HIV/AIDS epidemic were largely ignored, as the stigma surrounding affected populations made it less difficult for the general public to deny the seriousness of the crisis. Even among at-risk populations, the long period between infection and the onset of symptoms created a false sense of security, leading to risky behaviors. This collective denial allowed the virus to spread unchecked, leading to millions of deaths around the world and a public health challenge that persists in the United States today.
Even now, four decades after the virus was identified, only 36% of the 1.2 million Americans at high risk for HIV take PrEP (Pre-Exposure Prophylaxis), a medication that is 99% effective in preventing the disease.
Chronic diseases like hypertension and diabetes mirror this pattern of denial. The long gap between early signs and life-threatening complications—such as heart attack, stroke and kidney failure—leads people to underestimate the risks and neglect preventive care. This inaction increases morbidity, mortality and healthcare costs.
Whether the factor is an infectious disease or a chronic illness, denial causes harm. It allows medical disorders to take hold, delays care, and causes tens of thousands of preventable deaths each year.
Our nation’s responses to COVID-19 and mpox (formerly known as monkeypox) similarly illustrate how denial hampers effective management of public health emergencies.
By March 2020, as COVID-19 began to spread, millions of Americans dismissed it as just another winter virus, no worse than the flu. Even as deaths rose exponentially, elected officials and much of the public failed to recognize the growing threat. Critical containment measures—such as travel restrictions, widespread testing and social distancing—were delayed. This collective denial, fueled by misinformation and political ideology, allowed the virus to take root across the country.
By the time the severity of the pandemic was undeniable, hospitals and health systems were overwhelmed. The opportunity to prevent widespread devastation had passed. More than 1 million American lives were lost, and the economic and social consequences continue today.
MPOX presents the recent maximum example of this worrying trend. On August 14, the World Health Organization declared MPOX a global fitness emergency after identifying the immediate spread of the Clade 1B variant in several African countries. This strain is particularly more fatal than past variants, having already caused more than 500 deaths in the Democratic Republic of Congo, mainly among women and young people under the age of 15. Unlike previous outbreaks primarily related to gay transmission, clade 1B spreads through heterosexual touch and closure. Interactions of the circle of relatives, expanding their success and putting everyone at risk.
Despite these alarming developments, awareness and concern about mpox remains low in the United States. International aid has been limited, and vaccination efforts have fallen far behind the growing threat. As a result, by the time the WHO issued its emergency declaration, only 65,000 vaccine doses had been distributed across Africa, where more than 10 million people are at risk. Already, cases have appeared in Sweden and Thailand, and the U.S. may soon follow.
Even with the added danger of the new variant and the proven efficacy of the JYNNEOS vaccine, only one in four high-risk individuals in the United States has been vaccinated against mpox.
Our slow and delayed reaction to Covid-19, MPOX, HIV/AIDS, and nearly every chronic disease demonstrates how widespread denial is, the lives it continues to claim, and the urgency of addressing this hidden defense mechanism. The most productive way to triumph over denial – whether jointly or jointly – is to clearly highlight the dangers. Simply warning others of the dangers is not enough.
A strong leadership is to break this subconscious barrier.
Dr. C. Everett Koop’s public health campaign on AIDS in the 1980s demonstrated how clear, consistent messaging can shift public perception and drive action. Similarly, former Surgeon General Luther L. Terry’s landmark 1964 report on smoking educated the public about the dangers of tobacco. His report spurred subsequent efforts, including higher taxes on tobacco products, restrictions on smoking in public places and health campaigns using vivid imagery of blackened lungs—leading to a significant decline in smoking rates.
Unfortunately, government agencies fail, hindered by bureaucratic delays and communications too cautious.
Public officials tend to wait until all the main points are certain, detecting uncertainties and asking for a consensus of committee members before recommending actions. Instead of being transparent, they focus on providing the least dictated recommendation for their agencies. People, in turn, are careful and do not take into account the recommendations.
Early in the COVID-19 pandemic, and more recently with mpox, officials hesitated to admit how little they knew about the emerging crises. Their reluctance further eroded public trust in government agencies. In reality, people are more capable of handling the truth than they’re often given credit for. When they have access to all the facts, they usually make the right decisions for themselves and their families. Ironically, if public health officials focused on educating people about the risks and benefits of different options—rather than issuing directives—more people would listen and more lives would be saved.
With viral threats increasing and chronic diseases on the rise, now is the time for public health leaders and elected officials to change tactics. Americans want and deserve the facts: what scientists know, what remains unclear and the best estimates of actual risk.
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