On Aug. 8, a gunman arrived at the main campus of the Centers for Disease Control and Prevention in Atlanta, firing more than 180 shots, shattering 150 windows and forcing staff members into a protracted, panicked lockdown. A police officer was killed, as was the gunman — a suicidal 30-year-old who had ambushed the C.D.C., authorities quickly reported, to make the public aware of his discontent with the Covid-19 vaccine. Four days after the shooting, President Trump’s newly appointed head of the C.D.C., Susan Monarez, wrote in a letter to agency workers that “the dangers of misinformation and its promulgation has now led to deadly consequences.” On Aug. 15 in Stat, Colin Carlson, an epidemiologist, and Sean Kennedy, a former C.D.C. employee, made the analogy I’d been turning over in my mind that week: that the shooting was a kind of one-man Jan. 6 for public health. This time, though, the forces of know-nothing insurgency had already won, with the levers of power for public health now controlled by charismatic agents of distrust.
It’s been a destructive reign since Robert F. Kennedy Jr. was narrowly confirmed as the secretary of health and human services in February — the proposal to cut some agency budgets by almost half, the thousands of layoffs and resignations, the mass firing of the country’s vaccine advisory panel and the weakening of programs designed to protect Americans from cancer, heart attacks, strokes and other conditions. In a resignation letter published in protest on Aug. 27, the head of the C.D.C.’s National Center for Immunization and Respiratory Diseases, Dr. Demetre Daskalakis, lamented the pervasive language of eugenics among Kennedy and other MAHA adherents and the government’s libertarian policy approach, in which “only the strong will survive and many if not all will suffer.”
But the first months of MAHA rule haven’t just been a bulldozer, destabilizing legacy institutions and health policy in ways that even Trump’s former Food and Drug Administration commissioner Scott Gottlieb has warned “could take down the whole pediatric vaccine enterprise” (and splintering American public health to match the country’s state-by-state reproductive health patchwork). They’ve also revealed contradictions and conflicts — both within the MAHA ranks and in its alliance with Trump and his MAGA Republican Party.
To win confirmation, Kennedy promised Senator Bill Cassidy, a Republican, that he wouldn’t interfere with the vaccine advisory panel, then proceeded to do so just a few months later. In Kennedy’s contentious Senate testimony last week, he first agreed that Trump deserved the Nobel Peace Prize for Operation Warp Speed and then declined to say whether he thought the vaccines it produced saved American lives. It had been a struggle to find a viable nominee to lead the C.D.C., and when the administration finally landed on Monarez, she served just 29 days before being fired — for refusing to “rubber-stamp unscientific, reckless directives and fire dedicated health experts,” according to her lawyers. (That mention of “misinformation” in her note to agency employees might not have helped.)
That Kennedy looks to many like a man of destiny owes a lot to the perception that the country is in the midst of a pandemic backlash, but the Covid contrarians he has brought with him to Washington aren’t exactly settling in frictionlessly. Some of his most prominent deputies — including the F.D.A. commissioner, Dr. Marty Makary; the National Institutes of Health director, Dr. Jay Bhattacharya; and the Center for Biologics Evaluation and Research director, Dr. Vinay Prasad — were pretty enthusiastic about mRNA Covid vaccines early in 2021, when they believed the country needed to move on from pandemic anxiety, and they are now party to the defunding of $500 million worth of mRNA research.
Bhattacharya spent much of the pandemic lamenting the politicization of science, only to endorse those mRNA cuts not on scientific grounds but on political ones. Throughout the pandemic, Prasad demanded that the efficacy of various Covid mitigation measures be studied in randomized controlled trials, but has since reportedly told F.D.A. staff members that “randomized controlled trials are not always necessary” and sat quietly as his boss, the F.D.A. commissioner, praised the scientific value of parents’ anecdotes about the behavior of their children. There are those in Kennedy’s Department of Health who favor a “free to try” approach to new medicines and therapies. But there are also those who believe research standards should be much higher and that new drugs with dubious benefits flooding into the market are a sign of deep F.D.A. corruption. And even before the release of the Make Our Children Healthy Again strategy, the Make America Healthy Again commission angered and frustrated many in the MAHA movement for compromising too much with Big Ag.
But perhaps the most striking illustration of coalitional conflict came last week. The day before Kennedy appeared in the Senate to answer for C.D.C. turmoil, Gov. Ron DeSantis of Florida announced that the state would move to phase out all childhood vaccine mandates. In a news conference, Florida’s surgeon general, Dr. Joseph Ladapo, compared school-based routine vaccination requirements to slavery, and on television over the weekend he acknowledged that he had “absolutely not” undertaken any data analysis to even understand what effect the new policy would have on childhood health. It wasn’t a matter of science or public health, he said; “it’s an issue of right and wrong.” The next day, when asked about the policy, Trump flatly called routine vaccinations “not controversial,” praising some of them, in his inimitable way, as “so amazing.” He went on, in a spirit of exasperation: “Look, you have vaccines that work. They just pure and simple work.” Maybe some have questions about the Covid vaccines, but “a lot of people” think they’re “amazing,” too. But the routine shots? People should just take them, he said.
In light of Kennedy’s combative testimony in the Senate, it’s hard not to see MAHA as a kind of crusade, particularly given how much we’ve heard over the past few years about collapsing trust in public health. But the invading army Kennedy has brought with him to Washington is a pretty unruly one. In certain ways, it looks like the chaos we saw so often in the first Trump term, when opportunistic ideologues climbed aboard the MAGA train, only to realize the thing was somewhat beyond their control. At the moment, the MAHA agenda, beyond destruction, is not all that clear. And neither is the size of the coalition — or how to count its members.
Is MAHA anyone who has regrets about pandemic policies and questions about the country’s food system? Or is it only those who want a tribunal for Dr. Anthony Fauci and an end to routine vaccination nationwide? And what does it mean — not just for policy and health outcomes but also for the politics of public health — if a figure who often sounds more like the second kind is acting as a tribune of the first group?
According to a Gallup survey, support for vaccine mandates for children fell from 81 percent in 1991 to 62 percent in 2019 and to 51 percent in 2024. But according to another survey, 74 percent of Americans said that government health agencies should make vaccines “more available” to those who want them, and 22 percent said agencies should make no change; that is, 96 percent of Americans said that government should impose no additional restrictions on vaccines.
In 2024 only 35 to 40 percent of pregnant women and young parents told researchers from Emory and the C.D.C. that they expected to fully vaccinate their children. But last year national vaccination rates for kindergartners remained above 92 percent — a fall from 95 percent before the pandemic but something less than an anti-vax earthquake or unmistakable social revolution.
Because the data points are so ambiguous, the new Florida policy and the upcoming meeting of the newly reformed vaccine advisory panel will offer straightforwardly revealing tests: How far has public trust in vaccines actually fallen, once we get beyond pandemic recriminations and vague anti-elitism? And what share of American parents will choose to expose their children to infectious diseases we know will be spreading more freely?
They will also be a test of another kind. In the aftermath of the Covid emergency, many self-critical liberals have undertaken some retrospective struggle sessions — engaging in point-by-point recriminations about mitigation or arguing that for too long liberals insisted that they were arguing over facts and science rather than acknowledging a contrast of values.
From a certain vantage, each perspective looks valid. There were mistakes in pandemic policy and communication, as I wrote a lot about at the time and revisited since. And there does today seem to be a gap between the safetyist aspects of pandemic-era health measures and the more libertarian preferences of the American public writ large, though it is also the case that in early 2020 many of today’s most outspoken critics of pandemic overreach were screaming that the government response should be more heavy-handed and that many of those contrarians were insisting that the disease didn’t really present a severe public-health threat. (See here for a since-deleted thread in which JD Vance argues against Covid minimization, for instance; here for an account of how many figures on the New Right, from Tucker Carlson to Curtis Yarvin, wanted much tighter pandemic restrictions; here to read Elon Musk predicting “zero new cases” in America by April 2020; and here to see Bhattacharya suggesting it was possible that Covid might kill only 20,000 Americans.)
Both instincts may also rest on the same potentially dangerous delusion, the presumption of natural technocratic authority which in another context the podcaster Alex Hochuli has called “neoliberal order breakdown syndrome”: the desperate conviction that all this culture-war tumult and reflexive distrust could have been avoided if the managerial class had chosen a slightly different set of prescriptions or started using a somewhat different tone of reconciliation.
By temperament, I’m enough of an institutionalist that I feel the tug of neoliberal order breakdown syndrome, too — wishing we could go back in time and tweak guidance about breakthrough infections, for instance, or find some way to restore trust by landing on the right messaging. But watching Kennedy rage in the Senate, insinuating that Bernie Sanders is a tool of Big Pharma and casually dismissing official C.D.C. mortality statistics, what worries me is that the alternative possibility seems much more intuitive: that at least among the most vocal proponents, growing public-health distrust is not primarily the result of policy stumbles but a sovereign ideological force of its own. The question is how much of the rest of the country those ideologues really speak for and how long normie America will tolerate their rule.
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The post Who Is MAHA Even For? appeared first on New York Times.
