In more than two centuries of publishing, the New England Journal of Medicine has never weighed in on a U.S. presidential election. That changed this week.

On Wednesday, alongside its usual peer-reviewed scientific studies and analysis, the journal published a blistering editorial taking President Trump and his administration to task over their handling of the coronavirus pandemic. The respected journal broke the nonpartisan position it has held since 1812 with an editorial titled, “Dying in a Leadership Vacuum,” which urged voters to oust Trump over his administration’s failures.

“Our leaders have largely claimed immunity for their actions,” said the piece, which was signed by 34 of the journal’s editors. “But this election gives us the power to render judgment.”

The journal has published only four other editorials signed by all the editors, including an obituary for longtime editor in chief Arnold S. Relman, who died in 2014. The three others, published in 2014 and 2019, tackled contraception access, abortion policy and draft guidance from the federal government on informed consent requirements in standard-of-care research. Never before have the journal’s editors collectively weighed in on an election, let alone a presidential race.

The coronavirus, which has now killed at least 211,000 Americans, changed that. Wednesday’s editorial argued national leaders had the opportunity to limit the virus’s spread and prevent widespread illness, deaths and lasting economic turmoil.

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“Here in the United States, our leaders have failed that test,” the editorial said. “They have taken a crisis and turned it into a tragedy.”

The United States “leads the world in Covid-19 cases and in deaths due to the disease,” the editorial says. Its infection and death rates have outstripped those in China, where the pandemic began; in Japan, which has a large and vulnerable elderly population; and in Vietnam, which has fewer national resources. And testing has also lagged behind much of the world, the editorial said, when measured by tests performed per infected person.

“The magnitude of this failure is astonishing,” the editorial said. “We have failed at almost every step.”

Differing opinions on neutrality in the scientific community have led some journals to regularly weigh in on political issues and others to abstain almost entirely. NEJM’s editors previously remained mum on elections and most other political issues, in part to preserve the perception of neutrality and credibility behind the peer-reviewed science the journal publishes.

Wednesday’s editorial shifted that stance, deriding the administration for undermining experts and relying heavily on layman allies to promote policies that furthered Trump’s political aims.

“Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them,” they wrote. “Instead of relying on expertise, the administration has turned to uninformed 'opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies."

Officials in the Trump administration have tried to discredit and undermine some experts who have criticized the way the federal government responded to the pandemic. Last month, Michael Caputo, the top communications official for the Department of Health and Human Services, claimed scientists at the Centers for Disease Control and Prevention were conspiring against the president and engaged in “sedition.” Others have tried to tightly control information about the state of the pandemic.

Rancor between scientists and Trump allies threatens pandemic response as cases surge

The NEJM isn’t the first science-focused publication pushed to weigh in on the election amid a tense relationship between the Trump administration and the scientific community. Scientific American also published a presidential endorsement for the first time in its October issue, urging its readers to vote for former vice president Joe Biden in November.

“Scientific American has never endorsed a presidential candidate in its 175-year history,” the endorsement said. “This year we are compelled to do so. We do not do this lightly.”

Many doctors and researchers reacted to the NEJM editorial with surprise and praise Wednesday.

“The fact that @NEJM has taken a side in this Presidential election is telling as to how critical of a moment we are in,” Joseph Sakran, a trauma surgeon and director of emergency general surgery at Johns Hopkins Hospital in Baltimore, tweeted Wednesday.

The NEJM editorial does not explicitly endorse Biden, but the medical journal’s editors called for voters to refuse the president a second term.

“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,” the editorial said. “We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”