In September, after months of mostly out-of-sight maneuvering, the Make America Healthy Again movement stepped forthrightly into the policy spotlight. The flurry of news marks a chapter’s end in the saga of Robert F. Kennedy Jr.’s public health reign: In just five days in September, we got the most substantive meeting of his reconstituted Advisory Committee on Immunization Practices, now stuffed with vaccine skeptics, and a much- anticipated Department of Health and Human Services announcement on the causes of autism, rolled out to much fanfare by the president.
So it’s not a bad time for a first-act assessment. The ACIP session on Sept. 18 and 19 had loomed for months as an enormously consequential event, with the panel considering changes to the conventional immunization schedule, opening up the possibility that the country’s basic, familiar vaccine protocol would be taken apart or sabotaged. The meeting is now behind us, an absolute embarrassment of bad science, disingenuous argumentation and basic bureaucratic dysfunction. (See here and here and here for some colorful summaries.)
But the meeting also produced some concrete outcomes, in the form of votes on two sets of recommendations. And in the grand scheme of things, those were actually kind of fine. At first blush, this looks like a bit of a puzzle, especially for those most worried about MAHA’s war on public health. Kennedy has been crusading against vaccines for decades, and his elevation to health and human services secretary brought forward the possibility of drastic change, even revolution. So where is it?
To many watching closely, the meetings were a disaster. To those paying a little less attention or just skimming the headlines, it looked a little different. The panel voted to separate into two shots what had been available as a single shot for measles, mumps, rubella and varicella (better known as chickenpox) for children under the age of 4 and voted to change the recommendation for Covid shots, which few Americans plan to get anyway, so that only people age 65 or older and those with certain medical conditions would be officially encouraged to be vaccinated and all others just prompted to discuss the matter with their doctors. The panel punted on making any changes to recommendations about the hepatitis B vaccine, which has long preoccupied anti-vaxxers and vaccine skeptics. This meant that aside from the chickenpox tweak, the routine immunization schedule has been left, for now, unchanged.
The shambolic news conference introducing the much-hyped autism “report” on Sept. 22 could be described in almost exactly the same way, as a cloud of chaos around what qualifies, all things considered, as a relatively cautious set of policy changes. Speaking extemporaneously in front of his visibly uncomfortable public-health leadership team, President Trump wove from subject to subject and ranted so ignorantly and irresponsibly about vaccines, he felt compelled to make a joking apology to Kennedy. “I hope I didn’t ruin his day,” he said — a hint that the group had planned to avoid the subject of vaccines entirely in the news conference, whatever Kennedy’s feelings about them.
But the sound and fury accompanied the introduction of a fact sheet that did not detail the supposed risks of vaccination, warning only about possible consequences of Tylenol use in pregnancy (and doing so in relatively qualified terms). This is not messaging I would have co-signed, and it isn’t in line with the science as I read it. But it also isn’t the aggressive and explicit war on vaccines that many Americans — me included — feared. It has more in common with Trump’s chaotic 2020 Covid news conferences, which highlighted hydroxychloroquine and disinfectants, and seems to illustrate Steve Bannon’s battle plan for the information war, applied now to science and public health. That is, flood the zone with excrement.
The muddled messaging will have consequences for public health. Fewer pregnant women will now feel comfortable taking Tylenol, burdening them with additional pain and increasing their fetuses’ risk for many developmental complications from maternal fevers. The administration’s casual vaccine skepticism will probably reduce routine immunization rates further, though perhaps not so significantly. It will also probably make some women feel some amount of guilt over their children’s developmental conditions.
But the pattern also raises two distinct and important questions about the future of public health under Kennedy’s leadership. First: How much comfort should American liberals take in the bumbling incompetence and self-contradictory incoherence of MAGA and MAHA when it comes to science, and how much should we fear the ideological drive that that incompetence often stymies?
And second, if this pattern of alarming communication disarray and relatively reassuring policy caution represents the basic approach, at least for now, what would that tell us about the true nature of MAHA’s agenda? Is Kennedy not actually serious about the supposed threat from vaccines to public health, invested in only sowing doubt about them? Is it possible that we should trust that MAHA wants not the end of mass vaccination but simply more informed parental consent? Or are these small shifts in policy the result of careful political calculus and only the first steps in a strategic longer-term plan to nudge and massage public opinion southward before making a more aggressive move?
My view is somewhat speculative, given how little daylight has been shed on the deliberations — not only for the public but also for many quite senior scientists working in the various subagencies of the Department of Health Human Services, some of whom have complained that they have essentially no access to agency leadership or insight into its decision making. But my read is roughly this: Kennedy is a canny operator, mindful of the limits imposed by public opinion and coalition politics, and it seems likely that the ACIP meeting and the autism report were the products of strategic consideration. Perhaps he saw and took seriously the polls showing that a very clear majority of Americans support routine vaccinations (though the share is steadily declining). Almost certainly he understood the fractured nature of his anti-establishment coalition of subordinates, given that the Food and Drug Administration chief, Marty Makary, and the National Institutes of Health boss, Jay Bhattacharya, have publicly commented that they do not believe there is any link between vaccines and autism.
But if you are hoping that some version of this initial vaccine détente will hold in any enduring way, I think you are likely to be disappointed. Since the autism news conference, Trump has posted on social media an even more unhinged rant on these subjects, advising women — in all caps — not just to skip Tylenol during pregnancy but also to avoid giving it to their young children for any reason, to delay the hepatitis B vaccine until at least 12 years old (rather than 1 month, as ACIP seemed to be considering) and to space out the other vaccines much further than the advisory panel was recommending. Kennedy has hired as a new senior adviser to the Centers for Disease Control and Prevention an avowed anti-vaccine activist, Mark Blaxill, who claims that every vaccinated child qualifies as “injured.” And a health and human services senior adviser, Drew Downing, publicly disclosed that the agency was working to add autism to the list of compensable injuries in the Vaccine Injury Compensation Program — a move that Paul Offit, a former longtime member of ACIP, told me would effectively destroy the vaccination apparatus in this country.
Outside of vaccines, the news has been just as discouraging. On Thursday the president suddenly announced the imposition of 100 percent tariffs on some pharmaceutical imports, and the country is bracing for a spike in health insurance premiums. Over the weekend, he shared on Truth Social an A.I.-generated video purporting to show Fox News cutting to him announcing an all-purpose breakthrough medical technology called a MedBed, a futuristic cure-all “Matrix”-style pod that conspiracy theorists have long suspected the federal government of hoarding rather than distributing to the public. (He later deleted the post.)
This looks less like a strategic coalition accommodating itself to political realities and more like the rallying of a posse, and it all came just since the news conference, a little over a week ago. The first act of MAHA might not have produced all that much wreckage just yet. But the signals are pretty bleak for the acts to come. On vaccines, Republicans’ trust in federal institutions of public health has ticked up this year, according to surveys by the Kaiser Family Foundation. But the decline in trust among Democrats is much larger. And overall only 37 percent of Americans trust Kennedy.
Good news
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In Science, a major potential breakthrough for gene editing — a technique (demonstrated on Friedreich’s ataxia, a rare inherited neurodegenerative disease) with broad (or perhaps even universal) implications.
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Nature reporting on a major gene therapy result for Huntington’s disease. The disease has long been incurable, but in this small-scale trial its progression was slowed by 75 percent over three years.
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According to a report in JAMA Internal Medicine, rising cancer rates for young adults might be “more apparent than real,” reflecting expansive screening and diagnosis rather than a true increase in incidence. (Perhaps another data point for the argument that diagnosis patterns explain much more than you might think.)
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Relatedly, apparent partisan divides in mental health may not be as large or robust as assumed, particularly when survey questions are shifted away from triggering therapy signifiers. (Maybe another apparent trend that can be at least partly explained by divergent diagnostic patterns.)
Future reading
Too often, in trying to make sense of the much-debated but somewhat undertheorized political present, we resort to reductive historical analogies. In his forthcoming “Hyperpolitics: Extreme Politicization Without Political Consequences,” Anton Jäger offers a different framework, sketching out the contours of a new social and political era, defined by an unsettling collision of mass hysteria and policy inertia. We will see how long that sense of inertia holds; perhaps it was an illusion even in the recent past. But for now, “Hyperpolitics” is among the best and most dazzling efforts to model the political present in all its maddening strangeness.
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