One defining feature of the second Trump administration is how, like in a particularly rotten late-empire monarchy, so much depends on the precise details of mental derangement afflicting the national leader and his top courtiers. Probably the most deranged Trump cabinet official, if his tawdry affairs and wildly erratic behavior are any indication, is Secretary of Health and Human Services Robert F. Kennedy Jr.—though the competition is admittedly stiff.
During the 2024 campaign, Trump promised that he would let Kennedy “go wild on health.” At the time, I thought this would be very bad, but if anything it has been even worse. In just a few months, Kennedy has obliterated a vast amount of government capacity and expertise that took generations to build up, gravely undermined American medical science, and above all waged an undeclared war against vaccines. The worst outbreaks of measles and whooping cough (or pertussis) in many years are festering around the country, and not only is the federal government AWOL, but Kennedy is expending great effort to make these outbreaks worse, and add more diseases.
So far this year, there have been something like 25,000 recorded cases of pertussis, and no doubt many more that have not been reported. At least 13 people are dead, almost all of them babies under one year old. Last week, classes were canceled in one Iowa district thanks to an outbreak.
Meanwhile, America is suffering its worst outbreak of measles since it was declared eliminated in 2000, with a reported 1,837 cases at time of writing. Authorities in South Carolina are dealing with two large outbreaks, with hundreds of people in quarantine.
The reason for this simply has to be declining vaccine coverage. The measles and pertussis vaccines are highly effective, and if the coverage rate is maintained above the “herd immunity” rate—about 90 to 95 percent for these viruses, which may require an occasional booster in the case of pertussis—any outbreak will burn itself out. It follows that it is vitally important for even young, healthy people to get vaccinated, to protect those who can’t be vaccinated, like very young babies.
Now, nationally, pertussis and measles vaccinations have not dipped by all that much (at least not yet), but since anti-vaccine lunacy tends to cluster in certain communities—ironically, much like a virus itself, as the beliefs are transmitted from person to person—local vaccination rates can dip below the herd immunity rate. Sure enough, several of the outbreaks have struck anti-vaccine communities, and almost all reported cases of both measles and pertussis have been in unvaccinated people.
By the way, if you have ever doubted the value of vaccines, it is worth watching a video of a baby with whooping cough. Or reading an account of what it’s like to get it as an adult and cough so hard that you break your ribs and pee yourself. Vaccines are one of the great scientific miracles of all time.
At any rate, even once the vaccine wall is penetrated, there is an obvious way to deal with outbreaks of preventable diseases like this. You send out teams of scientists, nurses, and doctors to find the disease and figure out where and how it is spreading. You urge those who are sick to quarantine, trace their recent contacts and recommend the same, and inoculate as many people as possible to rebuild herd immunity. Messaging, outreach, free vaccine clinics, and door-to-door visits to holdouts is the usual approach; New York City successfully squelched a smallpox outbreak in 1947 by vaccinating 6.3 million people in just a few weeks with just such tools.
Kennedy is not leading such a charge. On the contrary, he has devastated the basic functioning of America’s public-health apparatus by implementing massive budget cuts, conducting mass layoffs of experienced staff, and installing fellow crazed lunatics in leadership positions. He fired the entire membership of the Advisory Committee on Immunization Practices, and filled many of the vacant slots with anti-vaccine conspiracy theorists. The committee has since restricted access to COVID-19 shots, recommended separate vaccination for chicken pox, tacitly suggested vaccines might cause autism, and most recently, removed the guidance that all infants should be vaccinated at birth against hepatitis B—which has been standard practice for more than 30 years.
This is absolutely guaranteed to decrease uptake of these vaccines, and therefore increase the spread of the associated diseases—which in the case of hepatitis B, can lead to complications including liver cirrhosis or cancer.
The Centers for Disease Control, which under previous presidents would have coordinated just such a containment effort, has instead greatly dialed back its public communications, one of the most important parts of outbreak control. Indeed, the agency just got a new second-in-command: anti-vax nut Ralph Abraham. As Mother Jones reports, as surgeon general of Louisiana, he failed to control a massive pertussis outbreak that killed two babies, and also promoted ivermectin as a COVID-19 treatment.
A marked characteristic of Kennedy and many of his cronies is a combination of dishonesty, stupidity, and genuine ideological conviction. Testifying before the Senate, Kennedy has repeatedly sworn that he is not actually reducing access to vaccines. He was lying. As The New York Times recently covered in detail, Kennedy has been working for decades to spread anti-vax misinformation, restrict access to vaccines, and convince people (especially parents) not to vaccinate.
This is his life’s work: a madman whose ideas can cause a tremendous quantity of completely pointless illness and death. And now he’s in the precise position to do so. Big thanks to everyone who facilitated this.