For most of the past century, the United States’ track record on infectious disease has been quite good. Thanks to major investments in public health, diseases such as smallpox, polio, yellow fever, malaria, measles, rubella, mumps, diphtheria, and tuberculosis have either been obliterated or become vanishingly rare. America “led the charge,” Aniruddha Hazra, an infectious-disease physician at UChicago Medicine, told me. The nation’s approach to public health was expected to help set the standard for the entire globe’s health.
That era might now be over. In recent years, the U.S. had already begun to neglect its public-health infrastructure, weakening defenses necessary for keeping infectious diseases at bay. Now the Trump administration is going beyond poor maintenance. It’s attempting active destruction.
In two months, the administration has slashed funding for biomedical research; stripped universities of grants; triggered the halt of clinical trials, domestically and abroad; gutted the public-health workforce; canceled or postponed vaccine advisory meetings to the government; and upended the normal practices of federal agencies dedicated to promoting American health. Cuts to foreign aid have marooned HIV and malaria medications in ports and storage facilities; an Ebola outbreak has been left to swell and spread. Domestically, the federal government’s response to a growing measles outbreak has downplayed the protective power of vaccines; Robert F. Kennedy Jr., the new secretary of the Department of Health and Human Services, has suggested that H5N1 bird flu should be allowed to burn through the nation’s poultry; and the administration is reportedly mulling cuts to the CDC’s HIV budget for prevention of the disease in the U.S.
In November 2023, while campaigning for the presidency, Kennedy declared that he wanted the government to “give infectious disease a break for about eight years.” He and the rest of the Trump administration are more than making good on that promise, as they hamper infectious-disease research and the day-to-day work of surveillance and outbreak management. Donald Trump’s America isn’t just giving infectious disease a break. It’s pivoting away from guarding against pathogens to inviting them right in.
In an email, Emily G. Hilliard, HHS’s deputy press secretary, defended Kennedy’s actions, and said that the agency “is committed to promoting radical transparency so Americans can make informed choices regarding their health.” Kush Desai, a spokesperson for the White House, echoed this notion, and blamed “shoddy reporting about the Trump administration’s work” for low public trust in the health-care system.
Before the second Trump administration took office, the United States’ investment in keeping infectious disease at bay had already long been flagging. As the nation succeeded in minimizing infectious threats, people forgot to fear them. Since at least the late aughts, U.S. spending on nearly all aspects of public health has gone flat, or declined; after the start of the coronavirus pandemic, childhood vaccination rates dipped nationwide and failed to bounce back. COVID, rather than reaffirming the country’s commitment to public health, cemented many Americans’ antagonism toward it.
When most of a community buys into public-health interventions, almost everyone can stay safe. But the more people opt out, the more everyone’s health is put at risk. Many Americans have been making that choice more often as of late. During the pandemic, for instance, when calls to vaccinate repeatedly, quarantine, distance, and mask “bumped up against people’s autonomy,” many Americans chose to hew to what they considered best for themselves as individuals, Lisa M. Lee, a public-health expert and bioethicist at Virginia Tech, told me. Public-health guidelines are not scripture, and Americans will still find plenty of reason to debate when restrictions have gone too far, or when health officials have gotten the guidance wrong. But public health inevitably struggles in a nation where the attitude of “I don’t need to worry about what everyone else is doing; I can control my own health” has been hardening for years, Eleanor Murray, an infectious-disease epidemiologist, told me.
That individualistic perspective is now being translated into national policy, even as infectious threats continue to batter the country. After bird flu began to spread rapidly in dairy cattle, then infect farm workers, the Biden administration lagged in its attempts to track and contain the virus, then largely left decisions about testing cows for the pathogen—the most effective way to track its spread—up to individual farmers. (Under Joe Biden, the USDA disputed that its response was insufficient.) By the time the second Trump administration inherited the crisis, H5N1 had already killed an American—but still, the nation’s new leaders didn’t meaningfully step up the response. In the absence of sufficient cow surveillance, the virus has continued to transmit on farms; without more targeted protection of poultry and dairy workers—those most exposed to H5N1—people have continued to fall sick.
As the measles outbreak that began in Texas in January has grown—now to the point where the U.S. has logged more measles cases so far this year than it did in all of 2024—Kennedy has emphasized the importance of autonomy. Vaccinating the unvaccinated is the fastest way to stop a measles outbreak, and Kennedy has publicly acknowledged that vaccines protect individuals and “contribute to community immunity.” But he’s also repeatedly overstated vaccines’ risks and declined to directly urge parents to vaccinate their children. And his continued framing of the shots as a “personal” choice elides their protective benefits to everyone else. The unvaccinated child killed by the measles outbreak last month almost certainly would not have died had she been vaccinated. And she might never have been infected in the first place had vaccine rates been higher in her community.
The Trump administration’s actions, though, have shown flagrant disregard for the possibility of rising infection rates. Kennedy has pushed good nutrition and vitamin A supplementation as viable solutions to the Texas outbreak—suggesting, essentially, that the country’s approach to the disease should be to try to limit the damage of infections rather than prevent them. (Although vitamin A deficiency can worsen a case of measles, that sort of malnutrition is extremely rare in the U.S., and no supplement can prevent a person exposed to measles from catching it.) Meanwhile, the administration’s freeze on foreign aid halted PEPFAR, a program that has, for more than 20 years, helped deliver HIV antiretroviral drugs to vulnerable populations around the world, and saved more than 25 million lives. With that support gone, up to 20 million people living with HIV—more than 500,000 of them kids—may have been cut off from their lifesaving medications.
The administration is also considering a major revamp of domestic HIV funding. Among the targets may be the CDC’s budget for HIV—the source of 91 percent of federal funding for HIV prevention in the U.S., aimed at tracking infections, increasing access to tests and drugs that can help avert new cases, and helping protect at least 1.2 million Americans estimated to be living with the virus. Strip away access to those sorts of crucial resources, and “my patients are going to die,” Jade Pagkas-Bather, an infectious-disease physician at UChicago Medicine, told me. (Hilliard, the HHS spokesperson, told me that “no final decision on streamlining CDC’s HIV Prevention Division has been made.”)
At times, the administration has verged on advocating for exposure to dangerous germs, Murray pointed out. Kennedy, for instance, has praised the benefits of acquiring immunity to measles through infection, saying that those defenses are longer lasting than immunity derived from vaccination—a statement that doesn’t account for the disease’s sometimes deadly and debilitating risks—and baselessly claiming that measles infection might also protect against cancers and heart disease. In recent weeks, he’s also encouraged poultry farms to simply allow the virus to rip its way through their birds—a proposal that could, at the very least, devastate flocks, and at worst, risk the virus morphing into a form that would be able to spread among humans.
In keeping with his original promise, Kennedy has found plenty of ways to limit biomedical research into infectious disease. The administration has forced the National Institutes of Health to defund research that focuses on LGBTQ+ populations—including several projects dedicated to HIV—as well as projects that mention vaccine hesitancy. (In an email, Hilliard defended the funding cuts as “part of a broader effort to redirect resources towards more urgent public health priorities—particularly the ongoing research into the safety and efficacy of vaccines.”) Among the grants rumored to be targeted next are hundreds of studies that involve mRNA vaccines, or work in South Africa, where many global-health projects are centered. Losing those projects might directly lead to more deaths. But the terminations send a subtler message, too, Hazra told me: that many of the already marginalized populations most affected by deadly infectious diseases must fend for themselves.
Abandoning the vulnerable, though, won’t make infectious problems disappear—quite the opposite. Left unchecked, diseases spill into new populations, and across borders. Diseases such as measles and polio have been declared eliminated from the United States. Without continued effort, they may not stay that way. And should those diseases reinfiltrate the country permanently, they will sweep over a population ill-equipped to fight them off again. The health infrastructure that the U.S. would have to marshal against them is already weak. More federal layoffs may be coming that could further shrink the public-health workforce. Biomedical research is being upended across fields. And should proposed cuts to Medicaid funding go through, the country will be even less equipped to deliver care to the people who most need it.
The administration’s actions all emphasize personal freedom. But those values aren’t compatible with a country free of epidemics. Infectious diseases, by nature, exploit individualism; their version of liberty is to find the unprotected, and spread more freely. The U.S. has the money, technology, and expertise to be a country minimally impacted by infectious disease—as it was for decades. Its current leaders have stopped short of saying that they’d embrace a world rife with infectious death. But their actions suggest that those sacrifices are exactly the kind they are willing to make.
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