The False Premise Shaping Trump’s Public Health Picks

To look at the short list of names Donald Trump is hoping to appoint to the country’s leading public health roles, it’s easy to see that Covid-19 has remade the country and its ideological arrangements — but perhaps especially the Republican Party.

Robert F. Kennedy Jr., Trump’s pick to lead the Department of Health and Human Services, is the most conspicuous example — a reflexive anti-establishment agitator who has trafficked in conspiracy theories about the origins of AIDS, 5G and especially the dangers of common vaccines. Kennedy has been an erratic and unreliable figure for many years; though Barack Obama in 2008 considered appointing him to run the Environmental Protection Agency, he has been knee-deep in vaccine conspiracy for well over a decade, and as recently as April was called by Trump a “Radical Left Lunatic.” But he owes his current selection to pandemic backlash and the intuition, in Trump world, that Covid contrarians should be drafted into a broad insurgency against the institutions of science.

Kennedy has called the Covid vaccines, which have probably saved more than 20 million lives globally, “the deadliest vaccine ever made,” and as recently as during his own presidential campaign, he suggested that the coronavirus might be an “ethnically targeted” bioweapon that preferentially spared Ashkenazi Jews and Chinese people.

But the others named for top public health posts, though not transparent cranks, are also Covid contrarians whose most important qualification for these positions are their crusades against the public health establishment during the pandemic period: Stanford’s Jay Bhattacharya to lead the National Institutes of Health, and Johns Hopkins’s Marty Makary to run the Food and Drug Administration. Dave Weldon, Trump’s pick to oversee the Centers for Disease Control and Prevention, was a vocal vaccine skeptic long before the pandemic.

For many Americans, including me, the performance of that establishment leaves something to be desired. But we may be about to see what a truly contrarian approach looks like instead.

In certain ways, this should be no surprise. Democrats have grown increasingly invested in, and identified with, the management style and worldview of the credentialed elite — with the Republicans, once the party of the country’s establishment, growing a lot more unruly as a party and a coalition.

But there are a few things that are nevertheless strange about what Benjamin Mazer called “The COVID-Revenge Administration” and the way its are united primarily by a “lasting rage” about the initial handling of the pandemic.

The first is that the federal pandemic response was actually supervised by Trump and many of those whom he appointed, the first time around. Americans often tell the story of Covid now as though our pandemic response was run by safetyist liberals in an unreasonable panic. But while Trump was remarkably indifferent to Covid in 2020, he was also, for the entire period we now remember erroneously as “lockdown,” in charge. (Americans often remember that period as stretching for multiple years; in fact, all but one state withdrew its stay-at-home orders within three months.)

The second is that, nearly five years on from the first reported Covid case, it’s not clear to what extent the public as a whole really did hate the country’s initial response to Covid. America exited the pandemic emergency into a period of post-pandemic exhaustion and frustration, one that undoubtedly contributed to public irritation with those liberals many Americans understood to be in charge. But 95 percent of American seniors were vaccinated by the end of 2021, meaning that, vaccine skepticism notwithstanding, nearly all of the country’s most vulnerable people got their shots within a year of them being made available; few federal or statewide political contests during the emergency period hung on questions of pandemic policy, which in 2022 were won overwhelmingly by incumbents; and in 2023, 80 percent of parents still expressed approval for their children’s schooling. In making sense of the country’s rightward shift in 2024, inflation obviously looms much, much larger.

And the third is that, early in the pandemic, many of the leading Covid contrarians, including some of those now at the top of Trump’s short list, were among the most inaccurate voices making claims about what were then probably the two simplest and most important questions facing anyone trying to right-size the pandemic response. Namely, how bad things could get and how long it might last.

When Americans first heard objections to Covid mitigation — from shelter-in-place guidelines to school closures to restrictions on social gatherings — those objections often came from politicians and pundits, emphasizing the economic costs of extended lockdowns. But there was also a subset of scientists making arguments against mitigation, suggesting that the disease might be much more widespread, and therefore much less deadly, than was being widely reported. The implication, made explicit by many, was that Covid-19 was not nearly as scary as the public was being told.

In a claim-staking Wall Street Journal opinion piece published with Eran Bendavid in March 2020, Bhattacharya suggested that, if millions of American lives were at risk without shelter-in-place orders and quarantines, extraordinary measures would be justified. But, he wrote, they weren’t; according to his analysis, the fatality rate for Covid was several orders of magnitude lower than was being reported at the time, and that even if it were to infect every single American, the result might be only about 33,000 deaths. Since the first outbreak, more than 1.2 million Americans have died, officially, from Covid; excess mortality figures are even higher. Recently, Bhattacharya has tried to emphasize that his opinion piece merely floated one estimate for fatality rate. But for every death his estimate implied, there were, in the end, more than 35.

Makary, Trump’s choice to run the F.D.A., seems to have been less outspoken at the very beginning of the pandemic, though he has criticized the initial response in retrospect by telling Congress last year that “the greatest perpetrator of misinformation during the pandemic has been the United States government.”

As Jonathan Howard, a physician, describes in his exhaustive and valuable timeline of Covid minimization, “We Want Them Infected,” Makary himself had gained pandemic prominence with the rollout of vaccines, which he was optimistic would bring about the end of Covid in remarkably short order. In early January 2021, he suggested that perhaps only 20 to 30 percent of the country would need to be vaccinated to reach herd immunity. In the middle of the month, he predicted that the country might reach that threshold by April. By the end of the month, Makary suggested that we were already seeing signs of herd immunity. When he made those comments, over 400,000 Americans had died from Covid; more than 800,000 have died since. We still haven’t hit herd immunity, and our best understanding of the science suggests both that we never will and that we probably never should have expected to.

These are not the only questions to ask about Covid response, of course. And over the course of the pandemic many skeptics and contrarians did raise other questions, some of them important — about why it was so hard for so many schools to reopen for in-person learning in September 2020, for instance, or whether the F.D.A. moved to authorize booster shots for the young with too little data. They’ve asked whether Covid policies might’ve been better tailored to the vulnerability of the elderly and how much we can really tell, in retrospect, which mitigation measures worked and which didn’t. They’ve often argued that vaccine mandates were something between useless and counterproductive and made similar arguments against mask mandates (especially for the very young).

I would add other questions, too, mostly from the other side of the ledger: about testing mishaps, about how the possibility of a lab leak was handled and about how the strength and duration of vaccine immunity was communicated initially, about sick leave and OSHA standards and indoor air quality. But these are all ultimately tactical questions, refracted now through hindsight.

The bigger matter is the question of how the country should have dealt with the Covid-19 threat at the outset. And, at the outset, many of the most outspoken contrarians — today claiming vindication, complaining about censorship even after building huge social-media followings during the pandemic, were telling us that the most important thing to know about the pandemic was that it was simply not a big deal.

Over the course of the pandemic, many continued to argue against restrictions, even as they’d lessened considerably, and even as the disease made a mockery of their predictions about its ultimate toll. In time, the American public has in some ways grown more sympathetic — forgetting the panic of the initial months, taking somewhat for granted that the death toll would land near where it did and assessing the wisdom of those mitigation measures as though they had no effect on mortality at all. (As it happens, some research suggests that those measures could’ve saved hundreds of thousands of American lives.)

But to suggest that mitigation was pointless because the measures were ineffective in preventing mass death is functionally the opposite of arguing that it was pointless because so few lives were at stake. If you’ve switched from one of those lines of logic to the other, it’s probably a sign that the question of disease severity was simply not all that material to your conclusion. Perhaps more to the point: If you had argued in early 2020 that little should be done to stop a pandemic that would ultimately produce between 1.3 million and 1.6 million excess American deaths, you would have had very few takers. And if you had occupied a position of national scientific authority, then, and devised a pandemic response based on the supposition that Covid was only about 1/35th as deadly as it proved to be, you’d deserve criticism for minimizing the threat, not plaudits.

“The problem with pandemics is that people want to forget them,” Michael Lewis wrote last spring in the foreword to “We Want Them Infected.” Of course, many people do want to forget, and understandably. But others want to litigate and relitigate and relitigate, and in some ways the imbalance of motives may be a bigger problem than pandemic amnesia itself, allowing those with the sharper critiques to furnish the frameworks that the otherwise indifferent grasp for when trying to make sense of their own experience.

The result is a sort of epistemological test that self-lacerating liberals currently are facing on various fronts. In the aftermath of Trump’s election victory, it has been tempting for many to treat the outcome as a kind of verdict on any number of questions that did not appear on the ballot — about how severe inflation actually was, or about how bad the pandemic crime wave really got, or even about the relative value of vaccines. To say, even performatively, something like the libs were wrong about everything.

On the pandemic, inarguably, the liberal establishment was both patronizing and imperfect, which is one reason some prominent public health figures have expressed cautious optimism about coming changes to the country’s scientific bureaucracy. On issues unrelated to Covid, the contrarians have some useful instincts — to investigate chronic disease, for instance.

But on the most basic and essential questions about the pandemic, the public health establishment was also, actually, right: Covid was extremely bad, ultimately killing upward of one million Americans and producing a death toll much more in line with worst-case predictions than “just the flu” reassurances; the vaccines were really good, ultimately saving millions of lives globally and, in countries where uptake was more universal, single-handedly drawing the worst of the emergency to a close; and the best way to minimize the ultimate death toll for Americans was to limit the number of infections that happened before those vaccines were distributed, whether that was achieved by trying to “flatten the curve” or Operation Warp Speed or both.

There are many lessons still to learn about the pandemic experience, many of them less neatly packaged in “left” or “right” boxes than the ones each side has tried to emphasize in its aftermath. But if you are looking back on the last five years focused primarily on why we suggested that toddlers should be masked in day care, for instance, you’re essentially saying that, more than one million deaths later, you still don’t think the disease was very much of a problem at all. The still bigger problem would be if the country decided the same.