In a rare political statement from a scientific journal, the New England Journal of Medicine released an editorial Wednesday lambasting the Trump administration’s response to the COVID-19 pandemic and calling on Americans to vote President Donald Trump out of office next month.

November’s election will have life-or-death consequences for people across the country regardless of party alignment, the journal’s editorial board said.

“Reasonable people will certainly disagree about the many political positions taken by candidates,” the journal’s editors wrote. “But truth is neither liberal nor conservative. 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. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

This is the first time in the journal’s 208-year history that the editors have ever published an editorial about elections, Editor-in-Chief Dr. Eric Rubin told CNN. The editorial was collectively signed by every editor on staff, something that’s only happened on four other recent occasions, Rubin added.

The United States has “failed at every step,” leaving the nation with more than 500 coronavirus-related deaths per million people ― a shocking statistic compared to China’s reported 3 deaths per million, the editors wrote.