This Isn’t Reform. It’s Sabotage.

It is, so far, worse than I feared. Last Friday, at the end of a week in which a vaccine skeptic and sometime conspiracy theorist auditioned to lead the country’s nearly $2 trillion, 80,000-person public health apparatus, much of the Centers for Disease Control and Prevention’s website went dark — its weekly mortality reports, its data sets, certain guidance for clinicians and patients, all taken offline. C.D.C. researchers were ordered to retract a huge raft of their own, already-submitted research. Next to go dark was the website of U.S.A.I.D., which Elon Musk announced that he would be working to shut down entirely, after several staffers resisting agency takeover by the billionaire were abruptly put on leave. (When the agency website later popped back online, it featured an announcement that all overseas personnel would be placed on leave and ordered to return.).

This is after the new administration had already suspended the country’s most successful global-health initiative, PEPFAR, which has saved millions of lives globally. The State Department later issued a PEPFAR waiver, but the program appears to have been rendered effectively inoperative by staff cuts; if the pause holds for even 90 days, it would result in over 135,000 additional children being born with H.I.V. The Famine Early Warning System Network was shut down, too.

Sometime between Jan. 6, 2021 and Nov. 5, 2024, many American liberals came to feel that “the resistance” — the reflexive mobilization against President Trump, after his first victory, on behalf of American institutions — had been embarrassing, pointless or even counterproductive, and that it might have been a touch hysterical to worry in grandiose terms about the threat posed by Trump rule. At the moment, it is hard to see it but hysterically: a blitzkrieg against core functions of the state, operating largely outside the boundaries set by history, precedent, and constitutional law, and designed to reduce the shape and purpose of government power to the whims, and spite, of a single man.

Or perhaps two men. The news about U.S.A.I.D. wasn’t delivered by President Trump, for instance. Instead the case against the agency was mounted on X by Musk, who this weekend called it a “criminal organization” saying that it’s “time for it to die”; the email telling staff that the agency’s headquarters would be closed appeared to come from one of Musk’s 20-something government “efficiency” groupies, who had somehow acquired a U.S.A.I.D. email address. Both the manner and the target of the attack offered the same lesson: that soft power was not real power, at all, and that only the hard kind truly counted.

Musk eventually won access to payment systems at the Treasury Department after a similar fight — after an official protesting the move was seemingly pushed out of the agency. “There are many disturbing aspects of this,” the political scientist Seth Masket wrote over the weekend. “But perhaps the most fundamental is that Elon Musk is not a federal employee, nor has he been appointed by the president nor approved by the Senate to have any leadership role in government.” Indeed, to the extent he enjoys any formal authority, at the moment, it is through a loose executive order broadly understood to authorize the initiative only to upgrade government I.T. systems and protocols. “Musk is a private citizen taking control of established government offices,” Masket went on. “That is not efficiency; that is a coup.” Other relatively sober-minded commentators have called it “ripping out the guts of government.” Still others a “Caesarist assault on the separation of powers” and a “constitutional crisis.”

Is it? Well, T.B.D. Much or all of this will be adjudicated in court, in the coming weeks and months, and maybe, ultimately, overturned or undone. Some initiatives have already been halted in the courts, though it’s nevertheless grim to see researchers celebrating that their ability to gain access to data on respiratory illness has been restored. (Even more so to scroll through the long list of “forbidden words” now being purged from C.D.C. research) And trusting that there remain checks and balances sufficient to block what my colleague Ezra Klein called the president’s longstanding desire to be king — or to block Musk’s effort to rip apart the government of the world’s most powerful country, as he did to Twitter — invests a lot of hope in state attorneys general, federal judges and the Supreme Court, not to mention advocacy groups like the A.C.L.U.

Already, it seems absurd to base expectations for Trump’s second term on the ultimate outcomes of the first, and perhaps unfortunate that so many commentators have spent the last year eye-rolling about “resistance historians” and their hyperbolic warnings. When JD Vance talked about the need to reconstitute the federal government with a program of “de-Baathification,” it sounded extreme enough. But in barely two weeks the “anti-woke” ideological agenda has already become a flimsy pretext for a much more sweeping evisceration of state function.

“This is a five-alarm fire,” Congresswoman Alexandria Ocasio-Cortez wrote this weekend, and on Monday she called on her colleagues to block Trump’s nominations in the Senate in protest. In the days that followed, many of her colleagues in the Democratic coalition found their rhetorical footing somewhat, at least calling out the initiative’s overreach — some of them coalescing around a message of “Fire Elon Musk” — rather than treating it with a mix of soft skepticism and performative sympathy.

But many had spent the transition developing a line of rhetorical attack based on food prices rather than the language of fascism, treating the return of Trumpism as an episode of normal politics rather than exceptional or existential ones, and trying so hard to learn the lessons of the so-called “vibe-shift” that they often sounded less like they were preparing for a fight than for a listening tour. Over the weekend, many appeared genuinely shellshocked.

Who isn’t? Perhaps it is even true that Trump won re-election thanks simply to frustration with immigration and the cost of living, however much that talk of vibes helped inflate the importance of a thin quotidian victory and lend credibility to what might otherwise look more like a hostile takeover of government by a marauding few. But where does all that leave the work of opposition? This is one demoralizing effect of staking a presidential campaign on themes of status-quo continuity, while conceding to many of the other side’s critiques (on immigration, on energy, on crime). You end up, after the election, looking a bit lost.

The war on public health is just one facet of this ugly diamond, but through it you can see both the breadth and the cruelty of the whole assault — and how it often hides behind an alibi of “reform.”

All of a sudden, last Friday, you could not view C.D.C. data about H.I.V., or its guidelines for PrEP, the prophylactic treatment to prevent H.I.V. transmission, or guidelines for other sexually-transmitted diseases. You couldn’t find surveillance data on hepatitis or tuberculosis, either, or the youth-risk behavior survey, or any of the agency’s domestic violence data. If you were a doctor hoping to consult federal guidance about postpartum birth control, that was down too. As was the page devoted to “Safer Food Choices for Pregnant People,” presumably because that last word wasn’t “Women.” Throughout the pandemic, conservative critics of these institutions complained that their messaging was unequivocal and heavy-handed. The new message seems to be: You are on your own.

In the end, this is Robert F. Kennedy Jr.’s message, too — beyond his claims about vaccines and G.M.O.s. The man who will almost certainly assume control of the country’s entire public health apparatus is often described as a late arrival to MAGA, and an unlikely ally — a longtime environmental lawyer and anti-corporate activist who was even considered a potential E.P.A. administrator by Barack Obama. But he nevertheless embodies the broader program, as does the MAHA (Make America Healthy Again) movement for which he serves now as a hood ornament.

In the aftermath of the pandemic emergency, Americans grew increasingly distrustful of many of the country’s institutions of health — it wasn’t just faith in organizations like the C.D.C. and F.D.A. which fell, but trust in nurses, doctors and pharmacists, too. But the administration isn’t proposing reform. Kennedy’s core focus is asking sweeping questions about vaccines and about the food system and environmental contamination. This emphasis represents a paradigm shift, from a social and epidemiological view of illness and disease, emphasizing collective responsibility and mutual aid, to one focused on behavior, diet and lifestyle. Which is to say, personal responsibility — in place of public health, health libertarianism.

This shift is not just the work of Trumpist right, as left-wing critics of Joe Biden’s pandemic policy have long argued. But you could see the dynamic quite clearly at Kennedy’s confirmation hearings. Senator Rand Paul, rather than asking any serious questions of the nominee, instead delivered a long and passionate monologue about the need to question medical orthodoxy and the oppressive weight of that consensus, as he felt it, during the pandemic.

His rant was not without merit: Hepatitis-negative mothers probably wouldn’t need to vaccinate their children against the disease on Day 1 of their lives, as the committee chairman, Bill Cassidy, seemed to acknowledge, and early in the pandemic it might have been useful to communicate a bit more clearly about the striking difference in risk faced by the old and the young, as I was writing as far back as the spring of 2020, too.

But these were not the questions that Kennedy was asking most conspicuously at the height of the Covid emergency — about how we might do better with guidance and communication and trust, or whether we had done enough to communicate the age skew of the disease or the strength of “natural” immunity. Instead, he was focusing on the horrors of the new vaccines. Indeed, fighting to stop their authorization, and any future authorization for any future Covid vaccine, not just for little children or those who’d already survived infection, but for any American of any age and suffering any health condition.

This was in May 2021. The rollout had begun just six months before, but vaccines had already saved, it was estimated, nearly 140,000 American lives. In the years that followed, they would save perhaps three million more. That is to say, if Kennedy had been successful, the pandemic death toll in this country could have been about three times as high.

This attempt at public-health sabotage towers over the new secretary’s meddling in Samoa, which may have contributed to the deaths of dozens by measles in 2019, and it came more recently, concerning millions of American lives. It was also what earned him a spot in the Trump coalition — indeed a starring role. The Covid vaccines were a medical miracle, probably the most consequential American one in several generations. Kennedy did what he could to stop that miracle, which he later called “the deadliest vaccine ever made.” When the country encountered a rampaging novel disease, he told us very clearly, he would have preferred we all faced it naked and alone.

This should be disqualifying. Instead, it proved the opposite. In the name of reform and government overhaul, the new administration is approving and ushering in something much more like destruction, with the president imploring his new health secretary to “go wild” in the role. The admonition does not apply just to Kennedy and public health, or even just to Musk and his initiative. A new generation of libertarians is not letting the country’s crisis of confidence go to waste. On Tuesday, Ted Cruz declared, “Abolish the IRS.” Up first, apparently: the Department of Education.