The scariest thing about measles is probably not the related deaths, of which there have been two already this winter, the first in the United States in a decade. It may not even be the one-in-10,000 risk of irreversible lifelong paralysis, known as subacute sclerosing panencephalitis. Instead, it’s the much more common effect the virus can have on what’s called immunological memory — creating an immune amnesia that can devastate your ability to fight off future infections.
During the pandemic, when some worried Americans panicked over signs that Covid could damage immune response, they were mocked by minimizers for believing the novel virus was effectively airborne AIDS. The hyperbole applies more appropriately to measles: Before mass vaccination, the rapaciously infectious virus so ravaged the immune systems of children that despite its relatively low direct mortality rate, the virus could have been implicated in as many as half of all childhood deaths from infectious diseases, including pneumonia, sepsis and meningitis.
In the United States of our grandparents and our great-grandparents, 90 percent of children got measles, it’s now believed, killing 6,000 Americans on average each year around the turn of the 20th century and about 500 each year by midcentury, after better diets and antibiotics for complications came into the mix. In undernourished and immunologically naïve populations, the disease can be considerably deadlier, and measles eradication programs believed to be responsible for 60 percent of global improvements in childhood survival from vaccination over the last 50 years. One hundred million lives were saved worldwide by those vaccines, The Lancet calculated last year — two million lives, on average, every year.
That is an awful lot of lives for Robert F. Kennedy Jr., the new secretary of health and human services, to dismiss with a wave of his hand, instead choosing to sit down at Steak ‘n Shake to celebrate the company’s new beef-tallow fries — recalling that, in his childhood, “everybody got measles,” and implying that immunity from those infections was preferable to the kind you get from a shot.
If that debate sounds familiar, it should, since arguments about natural versus vaccine immunity helped give shape to debate about whether the public-health establishment was overly cautious about Covid, too. As we exit what Siddhartha Mukherjee recently called America’s “privatized pandemic,” the country is feeling its way toward a new anti-establishment equilibrium — and anointing a new class of health leaders distinguished by their vocal skepticism and distrust.
In the aftermath of the pandemic, we’ve talked a lot about the loss of public trust in science, but the collapse of trust in government, especially among the young, might be even more worrisome. (The pandemic really did a number on us.) One result is that many more Americans now seem to believe they should be in charge not just of choices about their own health but also of the entire health information ecosystem that informs those choices, as well. Many regard well-being as something you can mold on your own at the gym or perhaps buy at the supermarket, in the supplement aisle — so long as you did your own research (at least listened to a good podcast) and brought your own list.
What is on that list isn’t necessarily important, as long as it runs against the establishment grain. Mehmet Oz is about to be confirmed as the head of the Centers for Medicare and Medicaid Services, for instance, though only 21 percent of the health recommendations he offered on his television program were judged by a group of researchers to have even “believable” evidence to support them. Kennedy stated that “there is no vaccine that is safe and effective” (he later claimed that the quote was “misused”) and has responded to the Texas measles outbreak not by urging everyone to get vaccinated but by shipping vitamin A. He has also praised steroids and cod liver oil — neither of which are part of routine treatment protocols, and neither of which have produced persuasive research suggesting they should be integrated into those protocols.
The MAHA movement rallies itself under the banner of reform, and it does raise undeniably important questions about why the richest country in the world is so much less healthy than its peers. But what it really heralds is a new age of public-health libertarianism, which is to say, a pretty explicit war on all the things that make health a “public” good, sustained by mutual aid, in the first place. At least, it marks the direction of change: away from solidaristic responsibilities and toward something both more suspicious and more solipsistic, by which individuals draw down biomedical capital accrued over many decades without feeling any real need to replenish the well.
Many MAHA priorities are worthwhile, at least in theory: chronic disease, obesity, diet and exercise and environmental contamination of various forms (ineffective but habit-forming pharmaceuticals, too). But in substituting individual behavior, diet and the your-body-is-a-temple model of human flourishing for germ theory, aerosol spread and what are often called the social determinants of health, the country’s new health leadership team is committing that cardinal American error: seeing individuals as perfectly autonomous and inviolable units, and defining everything outside individual control as either an irrelevant consideration or a violation of bodily autonomy.
In 2019, few Americans outside the anti-vaccine fringe would have told you that the country’s public-health apparatus was an overweening safetyist menace — or objected to the running of that apparatus, which hummed along in the background like white noise. All it took to wipe our memory of that relatively comfortable old status quo was a global pandemic that infected and killed at generational scale. Which does make you wonder how much the backlash even concerns the old systems, however imperfect they might have been, and how much it represents a simple objection to the turmoil of the pandemic itself.
Life is full of risk, as those most outraged about pandemic policies will often remind you, and we plot our way through it by way of choices defined by trade-offs — that is all true.
But the backlash does not merely concern Covid policies. Last week, the nomination of Dave Weldon to be the director of the Centers for Disease Control and Prevention was withdrawn, presumably because his anti-vax history made him unacceptable in the midst of a measles outbreak. But the same week the National Institutes of Health froze funding for research into vaccine hesitancy, implying that the agency was no longer worried about falling immunization rates or what could be done to reassure parents about risks. It is reportedly considering dramatically rolling back funding for H.I.V. prevention, and perhaps eliminating an in-house think tank devoted to reducing medical error and elevating standards of care. In just its first weeks under President Trump, the N.I.H. doled out a billion dollars less for research than last year — even though, by some estimates, every dollar spent is estimated to produce five dollars in social gains, and even though nearly all of the more than 350 drugs approved between 2010 and 2019 can trace their development to federal funding. The F.D.A. canceled the routine meeting of an advisory council devoted to formulating the next flu vaccine, in the midst of the worst flu season in more than a decade, with perhaps as many as 120,000 American influenza deaths since October.
As the United States watches the worrying spread of bird flu across the country, we aren’t even vaccinating our poultry, though 166 million commercial birds have died since the outbreak began, spiking egg prices and leaving Americans in front of empty grocery shelves with a foreboding sense of pandemic 2.0. (Kennedy has proposed simply letting H5N1 rip through the country’s bird population unimpeded, an idea floated by the new agricultural secretary as well.) At Johns Hopkins — where, until recently, the soon-to-be head of the F.D.A., Marty Makary, has held an endowed chair at the School of Medicine — $800 million in cuts to the United States Agency for International Development have forced the firing of more than 2,000. Johns Hopkins is not unique. Around the country, scientists are racing to delete the term “mRNA” from their grant proposals, worrying that any hint of a reference to the miraculous Covid vaccines that Trump raced to market the first time around will imperil funding for the countless promising possible future applications of the technology, some of them potentially even more miraculous.
How miraculous? There are currently trials testing the use of mRNA vaccines in cancer treatment, not to mention influenza and AIDS, with especially promising results so far for glioblastoma and pancreatic cancer, two of the deadliest forms. The five-year survival rate for pancreatic cancer is just above 10 percent; in two recent studies, funded in part by the N.I.H., mRNA vaccines prompted an immunological response in half of participants; among those, none experienced a relapse within 18 months, and three-quarters were still cancer-free three years later.
The truth is, we don’t know whether those results will hold up or scale. That, of course, is what research is for.
The post The Entire Future of American Public Health Is at Risk appeared first on New York Times.
