How Missouri Canceled a Pro-Life, Anti-Mandate Health Director

After the first hour of his confirmation hearing for the job of leading Missouri's health department, it was clear that Donald Kauerauf knew he had a problem.

It was January 31. Kauerauf, a career public official from Illinois who had come out of retirement last year to lead Missouri's Department of Health and Senior Services, had repeatedly described himself as opposed to mandates for masks and vaccines — and yet, during the Monday hearing, as Kauerauf listened to state Senator Mike Moon load up yet another question based on anti-vaccine conspiracy theories, the health official could only try to dodge the metaphorical bus bearing down.

"Can I just say one thing?" Kauerauf said, interrupting Moon's next question. "I want to do this job. I want to be the health director. When the governor's office contacted me, you know, I thought long and hard about this. I think there's ability in Missouri for us to do great things."

That may have been the case, but less than 24 hours later, Kauerauf had tendered his resignation, and the man who appointed him, Missouri Governor Mike Parson, had gone public with his own outrage, calling the outcome "nothing short of disgraceful, unquestionably wrong, and an embarrassment to this state and the people we serve."

Parson's remarkable statement didn’t name particular lawmakers, but noted that the state is now missing a permanent health director because "the Missouri Senate chose to indulge a few men's egos" — is a sign of a deepening discord in the state's conservative-dominated government.

As Kauerauf found out, it's a place where being a pro-life, anti-mandate Republican just isn't enough.


"Red flags"

Kauerauf's appointment as head of the DHSS came after his predecessor, the bowtie-wearing, period-tracking Randall Williams, resigned the post abruptly in April of 2021, just as the availability of COVID-19 vaccines began changing the landscape of pandemic health orders.

A few months later, in September, Parson announced the hiring of Kauerauf, who had spent more than 30 years working in various roles in Illinois government, serving as the assistant director of the Illinois Department of Public Health before his retirement in 2018.

From the outset, Kauerauf established that he took his job seriously, and even if that didn't involve health mandates, he stated plainly in media interviews that "masks work" and that Missouri's vaccination rate was "atrocious" and needed improvement.

However, something changed in January. On private Facebook groups and Telegram channels, dedicated anti-vaccine groups began sharing lengthy posts of copy-and-pasted arguments demanding Kauerauf's removal and alleging he supported forced vaccinations. On Telegram, some of those first posts came from an account listed for Preston Smith, who appears to be the same Preston Smith who authored a piece about Kauerauf in a Topeka, Kansas-based Christian publication called the Metro Voice News.

Smith's story, titled "Donald Kauerauf: questions and concerns about confirmation vote on Monday," presented the same claims and dubious connections that would ultimately explode into view at Kauerauf's confirmation hearing days later.

As with the Telegram and Facebook posts, Smith emphasized Kauerauf's ties with Illinois and connected that point to both Kauerauf's wife, who works for the Illinois Department of Public Health, and to an app-based, rapid testing system for COVID-19 used at the University of Illinois called ShieldT3.

What does any of that have to do with Kauerauf's role in Missouri? Well, nothing — but online, nothing can become something with incredible efficiency.

Kauerauf retired from Illinois government about three years before COVID-19 struck the world. There is also no evidence connecting Kauerauf's wife to the development or operation of ShieldT3. But posts like the one published by Smith threw these supposed "red flags" to the wall and connected what stuck: The ShieldT3 program became a "COVID passport," which, taken with a news story about Kauerauf supporting a "test to stay" system for schools, became a dire threat to Missouri, where such a system "could be used to give access to grocery stores, government buildings or any place, and negative tests would deny entry," Smith wrote.

On Telegram, the Smith account was more direct. In a series of shared posts demanding Kauerauf resign last week, the accusations flew: "There is a plan to force every man, woman and child in Missouri to be vaccinated. If allowed, this plan will bring swift & painful retribution to those who refuse."

The winding conspiracy theories led to organizing. In the days before the January 31 hearing, Telegram and Facebook posts included phone numbers for the members of the senate committee and instructions for protesting the confirmation.

Among the organizers for the Pray Against Tyranny event was Bev Ehlen, state director of Concerned Women for America. She had appeared on a January 28 segment of the Marc Cox Morning Show on 97.1 FM to explain that one of Kauerauf's remarks in a previous media interview — about seeking to reach 100 percent vaccination in Missouri — was evidence that he planned to force people to their shots.

"How you can get fully vaccinated without forcing it," she noted, "I don't know."

What she did know was that Kauerauf was suspect. On the day of the confirmation hearing, Ehlen appeared on a Springfield-area radio talk show on 104.1 FM, telling host Nick Reed that Kauerauf had not made enough statements about the "sanctity of human life," and "can't prove he's not pro-life."

"The more we learn about Kauerauf, the more sinister it becomes," she said. "All these pieces are pointing to some tough times ahead with this man, with his medical system world view, being head of our Department of Health and Senior Services."

Like so many in the online anti-vaccination groups and conspiracy communities, she was just asking questions — but that day, those questions would find real-life relevance in a Missouri Capitol hearing room.


"I'm not being facetious"

In a matter of days, Kauerauf's confirmation hearing went from routine legislative function to a fight for the soul of the Missouri Republican Party. More than 100 protesters gathered in the Capitol rotunda on January 31, many with signs that echoed the conspiracy logic and social media posts that vilified the health director.

One sign seemed to feature all of them, cramming multiple lines of text around an ominously shaded photo of Kauerauf: "This is the face of evil," the sign said, as well as, "His main goal: vaccine passports installed by the Shield app on your phone" and "Join the pure bloods and say no to the death jab."

Things were little better inside the hearing room. As the crowd chanted and sang outside the door, Kauerauf's first questions came from the committee chairman, Republican senator Tony Luetkemeyer, who noted the "outpouring of feedback from constituents back at home and around the state about your nomination."

Luetkemeyer put Kauerauf on the spot: Did he support mask mandates? Did he support mandatory vaccines at the state level?

On masks, Kauerauf said of his position, "It's been clear from very beginning, against mandates. They don't work, and you shouldn't recommend them." It was the same with mandated vaccines. "Completely disagree," he told Luetkemeyer. "The whole decision of forcing this on health care is not well thought out."

"So," Luetkemeyer summarized, "my correct understanding of your testimony is, then, that the comments that you made publicly were to encourage people to be vaccinated, but not to imply that those vaccinations should be mandated by the state?"

"That's correct," Kauerauf said.

But the next senator wouldn't be so easily answered. Mike Moon, a Republican state senator from Ash Grove, would spend more than an hour grilling Kauerauf using the same arguments and documents passed around Telegram and Facebook days before.

Moon, too, was just asking questions. It just so happened that many of them involved Kauerauf's wife.

"Is your wife Judy Kauerauf?” Moon asked at one point. "Do ya’ll talk? I say that because of this, I'm not trying to be facetious — was she not involved in the development of Shield and using Shield in the state of Illinois?"

Thus began an energetic back-and-forth, with Kauerauf repeatedly saying "no" and Moon floundering with material he didn't understand, or care to, and in that ignorance created new allegations — Moon asked, wasn't it true that Judy Kauerauf was "involved in the development" of Illinois' Shield testing program? "No," replied Kauerauf. But didn't Illinois use Shield while Kauerauf worked for the Illinois health department? "No."

Moon tried again: Isn't "test to stay," a type of program Kauerauf supported, the same thing as Shield in Illinois.

"No," Kauerauf said, and began explaining that "test to stay" is an antigen test and an optional program for school districts that want to give students a way to be cleared quickly to stay in class instead of resorting to quarantine — but suddenly, Kauerauf stopped mid-sentence. He seemed to recollect his thoughts. After a moment, he continued.

"Do you understand 'test-to-stay,' senator?" he asked Moon. "The premise behind that? I'm not being facetious, I just want to make sure."

It was a small rhetorical victory for Kauerauf, and he went on to describe how the test-to-stay program "is a good option for keeping kids in school" and that the districts which had used the system had "not seen an increase in cases." Moon retorted with a hypothetical: Even if the test-to-stay programs were optional to schools, the students who didn't want to be tested would still feel peer pressured to comply, creating what he called “as kind of a coercive action.”

Moon then brought up another piece of evidence — one he likely gleaned from the same sort of posts shared in the anti-vaccine Telegram and Facebook groups. Returning to Kauerauf's supposed connection to the Illinois Shield program, Moon asked if he was familiar with the program's "do to do" model.

"No," Kauerauf answered again.

The phrase wasn't part of a media quote or any health policy at DHSS. However, it had appeared on a slideshow presentation, detailing the Illinois Shield program, which Preston Smith included in his list of “questions and concerns” published in the Metro Voice News days prior; the story appears to have played a key role in collecting the various conspiracy theories about Kauerauf and launching them into the appearance of legitimacy.

Heavily marked up by Smith's red underlines, the December 2020 presentation on Illinois' use of the Shield program described a "do to do" model as an “expectation” which “requires one to 'do' what is expected in order to be able to 'do' what one intends."

Here's how Moon explained the concept to Kauerauf: "It's steered toward, you do take the tests or take the vaccine in order to do what you intend to do." Moon continued: "That sounds sort of Nazi-ist in my thoughts. I wonder, do you support a program like that?"

Kauerauf responded, again, that he didn't know anything about the program and that Missouri school districts made individual choices about the way their testing and vaccine programs were implemented. But it was already too late for him.

The battle was over.


"A few men's egos"

The day after Moon's performance, the Senate Gubernatorial Appointments Committee refused to vote on Kauerauf's nomination to make his appointment as head of DHSS permanent — effectively booting him from the job. The Missouri Constitution requires a department director appointed out of session to be confirmed within 30 days of the Senate convening.

The rejection of Kauerauf is permanent, as the state constitution stipulates that a nominee who fails confirmation is banned from holding the same position — for life.

During the February 1 hearing that effectively ended Kauerauf's tenure, Moon took center stage once again. He accused Kauerauf of being dishonest in denying awareness of Illinois' Shield testing program and noted that his staff had uncovered a different document, describing a "test to stay" program, that included the name of Kauerauf's wife in its opening acknowledgments.

The document, a report by the Rockefeller Foundation published in January, did in fact include the name of Kauerauf's wife — along with more than a dozen other acknowledgments. She was not listed as an author of the report. She was not described as developing the Shield program. The document had no references to Missouri or its health policies. When the report was published, Donald Kauerauf had already been out of Illinois government for more than two years.

None of those facts stopped Moon. He plunged the conspiracy knife deeper, pivoting to his dissatisfaction with Kauerauf's opposition to abortion — that is, his complaint that Kauerauf "didn't give me a good explanation of what pro-life meant.”

The impending collapse of Kauerauf's confirmation triggered alarm in the office of Governor Mike Parson. In the midst of the freewheeling conspiracy share-a-thon that was the January 31 hearing, Parson's office released a carefully measured statement "refuting the misinformation surrounding" Kauerauf's qualifications and defending the governor’s choice.

Seeking to "set the record straight," the governor's statement declared that Kauerauf "is strongly pro-life and anti-abortion and against government mandating mask wearing and COVID-19 vaccinations."

The next day, as the committee slammed the door closed on Kauerauf, Parson's office released another statement. Aside from the announcement of an interim director appointed to the position, the content of the governor's message was utter political rage. The tone was apoplectic.

"It's unfortunate," the governor's statement began, "that we now have to disrupt state operations and the leadership at an entire department because the Missouri Senate chose to indulge a few men's egos."

The statement continued, with Parson calling the events of the previous two days "nothing short of disgraceful, unquestionably wrong, and an embarrassment to this state and the people we serve." He said that Senators had resorted to "tarnishing a man's character by feeding misinformation, repeating lies, and disgracing 35 years of public health experience" and that their conduct is "not what it means to be conservative."

But Parson's reaction also seemed to speak directly the constituents who had shown up to protest Kauerauf based on claims about his position on abortion. Opposition from the religious far right is a rare fit for Parson, a devoutly Christian former sheriff who has celebrated anti-abortion policies and worked to eliminate access to non-religious reproductive health services.

Parson opted for demonstrating his faith with boldness. In the statement, he called Kauerauf "outspokenly pro-life and morally opposed to abortion" and said that "Missourians know that I share these beliefs and would not have nominated someone who does not share the same Christian values."

Parson said Kauerauf "did not deserve this, and Missourians deserve better." He concluded the statement, "I pray that honor, integrity, and order can be returned to the Missouri Senate and that it comes sooner rather than later."

Sorting through the pieces, there is little honor to be found in the downfall of Don Kauerauf. It took a handful of isolated statements from Kauerauf supporting vaccinations and testing, a couple of connections to Illinois, numerous anti-vaxxers just asking questions and doing their own research online, and a few key senators willing to amplify the noise into a religious and political test that no one could pass — and which Kauerauf was ill-suited to defend.

Parson may be waiting for integrity to return, but, in the meantime, what Missouri has now is a governing Republican party at war with itself, and reality.

Follow Danny Wicentowski on Twitter at @D_Towski. E-mail the author at [email protected]

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