by Richard T. DiPentima, BA, BSN, MPH
It may be a unique historical record: a father and a son, both elected Governor in the same state 36 years apart, holding office as global pandemics affect their state. As if to guarantee that distinction, both used the pandemic they were responsible for controlling to further their personal political ambitions. Too improbable for fiction, but true in the case of Governors John H. Sununu and Chris Sununu.
I observed—and participated—from a front row seat as the first Governor Sununu used the AIDS pandemic for his political gain at the expense of public health. To now witness his son Chris Sununu using the Covid-19 pandemic for his political gain at the expense of the public health, is simply surreal.
Allow me to walk you through this history, and compare these sad events. In 1987, I was Assistant Director of Public Health for the New Hampshire Division of Public Health Services. I was in charge of the Office of Disease Prevention and Control, which was responsible for the bureaus of Environmental Health, Public Health Laboratories, and Communicable Disease Control.
The AIDS Pandemic, which was first recognized in 1981, was raging worldwide, and had hit New Hampshire by 1985. The Bureau of Communicable Disease Control was responsible for managing the AIDS response in New Hampshire. By 1996 there was a blood test to determine if an individual was infected with HIV, the virus that caused AIDS. The Public Health Laboratory was responsible for performing this new blood test. In both situations, the effort to control AIDS and test for the virus had to be accomplished with no additional state funding, and federal funding was not yet available. Fortunately, at the beginning of the AIDS pandemic in N.H. our cases were low. But, as the virus spread to more gay men, hemophiliacs, and injecting drug users, the number of cases began to rise quickly. From a public health perspective, our only available tools were education regarding how the disease was spread and not spread, and targeted HIV testing once it was available. There was, and there is still, no AIDS vaccine, and antiviral drugs to control HIV were not yet available in the early days of the pandemic.
In an effort to expand our AIDS prevention and testing program, the Division of Public Health Services requested legislation that would provide the necessary funding to address this quickly expanding crisis. The legislation was drafted with our assistance and filed in January 1987. There was bipartisan support for the legislation, even with its $300,000 price tag. The bill was moving quickly through the committees and appeared headed for passage and the Governor’s signature, until politics and Governor John Sununu blunted that optimism.
Without the knowledge of the Director of Public Health, and without any input from public health personnel, the Governor called a press conference on April 7th to discuss the AIDS legislation. We had no idea what the Governor had in mind and why he was calling a press conference on the legislation.
The Governor, flanked by the Speaker of the House and the President of the Senate, all Republicans, made an astonishing announcement. He stated that he was going to have the legislation amended to require that all couples seeking a marriage licence would be mandated to have HIV tests, and would veto any legislation without such a mandate. This mandate was similar to one that had, in previous decades, in New Hampshire and most other states, required testing for syphilis before marriage.
At the time, no state had such a mandate. Sununu wanted New Hampshire to be first in the nation.
The Governor’s actions created a firestorm of opposition from many, to say the least, but was supported by many Republicans. The public health and medical community responded that such a mandate was a waste of precious resources, and would not prevent AIDS. What’s more, testing such a low risk population would result in a high number of false positive results, causing great emotional and personal harm to many individuals.
The Governor’s amendment did not provide additional funding to perform the thousands of tests each year, thus it would take needed funds away from the important AIDS prevention programs, as well as overwhelm an already over stressed public health laboratory.
All efforts to convince the Governor that his premarital testing amendment would be harmful, expensive, and counterproductive in terms of public health failed. In the end, the Legislature refused to pass his amendment, but as a result the entire AIDS Prevention legislation died.
It would be another full year before an AIDS prevention bill was passed, one without a premarital HIV testing mandate. An entire year without a comprehensive AIDS prevention program for New Hampshire resulted in an unknown number of preventable HIV infections and AIDS cases.
To fully understand Sununu’s Premarital HIV testing initiative, it is necessary to understand its political context. George H.W. Bush was running for President. His campaign was not doing well. Governor Sununu was Bush’s campaign chairman in New Hampshire—the state with the first primary election. If Bush won New Hampshire and became President, Sununu would be rewarded with a high political appointment.
The Governor’s proposed HIV premarital testing initiative clearly had more to do with politics than public health. If Sununu could make New Hampshire the first state to require premarital HIV testing—a policy very popular among conservative Republicans—his political status would be enhanced.
At his April 7th press conference, “Veteran State House reporter Don Tibbetts, of the Manchester Union Leader, asked, with due respect for the state’s three foremost political leaders, where were the medical people who supported or requested this measure. Governor Sununu simply repeated his claim that AIDS was not a medical issue.” *
In the end, George H.W. Bush won the New Hampshire Primary, became President, and made Governor John Sununu his Chief of Staff.
Four states went on to prove that premarital HIV testing was not an effective AIDS prevention policy. Illinois, Louisiana, Missouri, and Texas passed laws requiring premarital HIV testing. They all were repealed shortly thereafter because they were shown to be very ineffective compared to targeted testing of high-risk populations—exactly the reason we advised against such legislation in 1987. (Connecticut Office of Legislative Research Report 98-R-0995, October 14, 2003.)
Fast forward to 2020: another Sununu is Governor of New Hampshire and the Covid-19 Pandemic is raging, across the globe and here in New Hampshire. As the pandemic continued to grow, the only available tools to control it were social distancing, face coverings, case isolation, contact quarantine, restrictions on group gatherings, &c. There would not be a safe and effective vaccine until January 2021.
In response to the pandemic, Governor Chris Sununu, son of the former Governor John Sununu, issued an emergency order that limited certain activities. He also reluctantly issued a state-wide mask mandate, after much debate and criticism from anti-mask politicians and members of the public. New Hampshire was the last state in New England to issue a mask mandate, even though we had more cases than other states.
In New Hampshire, as across the nation, the Covid-19 pandemic became more of a political issue than one of public health. Politicians, news outlets, and social media spread and continue to spread all manner of false information about Covid-19, the effectiveness of masks, the safety and effectiveness of the vaccines—even calling the whole pandemic a hoax. Here in New Hampshire our legislature, which is controlled by Republicans in both chambers, takes action that will slow and even prevent certain public health actions. The legislature passed a bill that prohibits any government entity or quasi-governmental entity from requiring individuals to be vaccinated against Covid-19. Chris Sununu signed this legislation stating that he opposes mandates. For the same reason, Sununu has joined other Republican controlled states in two lawsuits that argue that the Covid-19 vaccination mandates issued by President Biden are unconstitutional.
It should be noted that Sununu also signed legislation the same year mandating that women seeking an abortion must undergo a transvaginal ultrasound exam, which in most cases was not medically indicated or needed. While any Covid-19 vaccine mandated by the federal government would be free, the women would be required to pay for these unwanted and unnecessary exams.
Once again, as in 1987, to appreciate the reasoning behind Governor Chris Sununu’s decisions regarding his anti vaccine mandate stance, his very public announcements regarding joining the two anti-vaccine mandate lawsuits, and his reluctance to issue mask mandates, we need to understand the political context in which these actions took place.
While it is somewhat surprising that Sununu has decided not to run for Senate in 2022, he will be running for a fourth term as Governor and he is young enough to consider higher office in the future, as he is considered a rising star in Republican politics, as witnessed by Senate Majority Leader Mitch McConnell [R-Ky.] heavily recruiting him to run for the Senate. He may be holding out for a possible Vice Presidential selection or even a Presidential run in 2024 or later.
In any case, his political future is highly dependent on his winning reelection as Governor. As such, taking a strong anti-vaccine and mask mandate stance now is very popular among New Hampshire Republicans and will still help him in his reelection campaign. It is also very popular among large Republican financial donors, many of whom are anti-government vaccination and other government mandates.
At the time of this writing, the pandemic is soaring in New Hampshire. Our case numbers are higher than at any time since the start of the pandemic. The state has the highest case rate in the nation.
Chris Sununu is taking no politically risky steps, like issuing an emergency order or issuing a universal mask mandate. Just like his father before him, Chris Sununu’s justification for his anti-vaccination and mask mandate position is not based on what is best for public health, but can only be explained based on politics and his political future.
If he has such a strong ideological opposition to government mandates that impinge on an individual’s bodily integrity, why would he sign the transvaginal ultrasound mandate mentioned above? It has been shown that vaccine and mask mandates have already proven successful in reducing cases and severity of Covid-19 disease. Vaccination rates across the nation have grown by 20 percent since the mandates, while a transvaginal ultrasound mandate provides no public health benefits.
There is no public health justification for opposing mandates which leaves only political consideration.
If the Governor opposes the federal vaccination mandates based on Constitutional grounds, as expressed in the lawsuits, stating that it violates states rights, and believes that mandates should be done through state government, why would he sign legislation in 2021 that prohibits the state and any other government or quasi-governmental entity in N.H. from requiring Covid-19 vaccination in New Hampshire?
Again, the issue is not the mandates themselves, but the political opportunity provided by the mandates, either for or against.
The parallels between the two Governors Sununu, each facing an unprecedented public health crisis almost 40 years apart, is unique in history. Unfortunately, what is not at all unusual today is how politics, personal ambition, and the rejection of science can guide policies that are inconsistent with protecting public health at a time when they are most needed.
There is one interesting difference between Governor John Sununu’s HIV testing initiative, and Governor Chris Sununu’s vaccine position: the former wanted a testing mandate, while the latter opposed any vaccine mandate.
This contradiction can be easily explained: the reasoning and rationale for both their positions were and remain guided by political considerations, not science or public health. They both exploited a tragedy for their own personal political interests, not the best interests of public health.
In that major respect the apple did not fall far from the tree.
* New England Journal of Public Policy; Volume 4, Issue 1 (1988) Special Issue on AIDS; New Hampshire: The Premarital Testing Debacle, by Susan D. Epstein.
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