It’s been a bumpy year for public health. Even so, last week’s precedent-breaking news that the F.D.A. wouldn’t even bother to consider Moderna’s new mRNA flu vaccine for approval felt like a dark revelation.
Hundreds of millions of dollars had been invested to develop the shot. The clinical trial had been conducted according to terms backed by the agency in 2024, and last year the company reported that the new vaccine showed 26.6 percent greater efficacy than the standard flu shot, which is of course the point of these things.
But none of that seemed to matter, at least at first. The official explanation for the decision didn’t pass muster, as the F.D.A. commissioner, Marty Makary, was perhaps acknowledging when he suggested, in response to a public backlash, that the F.D.A. might eventually approve the vaccine — and then confirmed, today, when news broke that the agency would in fact proceed with a normal review. The original judgment had been such a departure from protocol that it seemed to threaten the whole pipeline of future vaccine development, by destabilizing the regulatory framework that drugmakers rely on. Even after the reversal, it was hard to know how much any company should trust an F.D.A. ruling, and indeed many had already announced they would be pulling back on vaccine research. What could have possibly been the motivation? Perhaps a style of retributive policy-making animated by pandemic spite — a desire to play favorites and punish enemies according to longstanding grievances rather than even to pretend to consider the science itself.
Maybe none of this should be all that surprising. Under Health and Human Services Secretary Robert F. Kennedy Jr., the entire federal public-health apparatus was assembled in the spirit of Covid resentment, which, more than any principled program of reform, has been the glue holding an otherwise fractious Make America Healthy Again governing coalition together. On the flu vaccine, Makary seemed to be hashing out those differences in public with his deputy Vinay Prasad, the head of the Center for Biologics Evaluation and Research, who had personally made the decision to reject Moderna’s application in the first place. And over the past year, the agency has applied capricious-seeming standards to questions of drug approval, in a pattern of political behavior that Americans have grown unhappily familiar with in the age of MAGA: a mix of cruelty and incompetence giving rise to erratic and unreliable decisions that often reflect access and partisan alliances rather than any good-faith tabulation of national costs and benefits.
But though it draws its name from MAGA, the MAHA coalition has always held itself up as something different — a more coherent project, growing out of deepening public disenchantment with scientific and medical authority and aimed at restoring public trust.
This was always a self-aggrandizing mythology, if one that beguiled many along the way into believing that MAHA was a genuine mass movement, rapidly colonizing the very center of American social and political life. The year has offered one corrective after another to that view — in fact, regarding information about vaccines, trust in the C.D.C. has fallen from 63 percent in September 2023 to 59 percent in April 2025, and all the way to 47 percent last month, with a larger share of Democrats abandoning their faith in the agency than Republicans seeing it restored. But the Moderna judgment punctured the myth in several additional ways.
First, it showed that the MAHA movement is less an unstoppable powerhouse than a dysfunctional governing coalition, doing considerable damage to faith in vaccines and public health but incapable of staging even superficially persuasive vaccine-advisory meetings or reliable judgments about something like a new flu vaccine. (After what seemed like a definitive if arbitrary decision, we got a major public backlash and then a sudden agency reversal.) Second, we learned that the vaccine agenda MAHA has put forward while in power is actually much less popular, and much more alienating, than you’ve probably been told — meaning that much of what MAHA does is going to be met with less applause and more outrage. And, third, it’s clear that the coalition itself is rived by inherent contradictions and ideological rivalries, and is held together less by a shared positive vision of reform than by still-burning rage about the pandemic emergency — about those who were in charge, the appeals they made and the tools they turned to five or six years ago.
Almost certainly, you would not have heard of Moderna were it not for Covid: this is the company that developed mRNA vaccines over a single weekend in January 2020, helping save millions of American lives and becoming one of the great biotech stars of a pandemic that the second Trump administration now insists was mishandled in almost every particular — going so far as to cut pandemic preparedness as a public health priority. The administration is cutting back on biodefense, too, even though one central anxiety about A.I. is that it could make it much easier to engineer bioweapons.
The initial flu-vaccine decision is similarly shrouded by the pandemic, which elevated both Moderna and its mRNA vaccines to positions of scientific prestige and promise — making them targets for those nursing grievances about Covid policies. In May, H.H.S. canceled a nearly $600 million award to Moderna to develop an mRNA vaccine against bird flu, despite widespread worry about that flu’s potential for giving rise to a new pandemic. In August, the agency effectively pulled the plug on all respiratory-illness research involving mRNA, ending 22 projects totaling $500 million and effectively declaring that this administration wanted nothing to do with future applications of mRNA.
Broader funding cuts have been called an “atomic bomb” for research, producing a “generational loss of innovation, technology and economic power.” Moderna has halted Phase 3 trials for mRNA vaccines against herpes, shingles and Epstein-Barr. These are some of the most prevalent viruses in the world, and some research has suggested that Epstein-Barr, in particular, may be linked to multiple sclerosis and perhaps other conditions as well. Why pursue solutions to these problems without confidence that genuine breakthroughs would get an honest hearing?
Typically, a judgment of this kind would have been delivered by midlevel agency regulators. This time, senior staffers wanted to consider the application, perhaps because they understood the broader implications of a blanket rejection and, even if they harbored legitimate doubts about mRNA technology, understood that dismissing an application without even reviewing the relevant data didn’t exactly look like “gold standard science.” So instead the judgment was made — and the document signed — by Prasad the charismatic contrarian devoted to “evidence-based” medicine now in charge of approvals for a large share of new biopharmaceuticals and vaccines.
For almost a year, Prasad has been on a tear, putting the kibosh on several different rare-disease drugs from his perch at C.B.E.R. In July, he was briefly forced out of the agency after overruling F.D.A. scientists about next-generation mRNA vaccines and after a controversy over a drug for muscular dystrophy. The Wall Street Journal editorial board called the Moderna news his “kill shot” and decried the preceding year of capricious judgments as “moving goal-posts” and “arbitrary government at its worst.” Both Prasad and his boss, Makary, long criticized their predecessors for overruling the judgment of scientists themselves, but despite all their talk of gold standard science they have taken to doing precisely the same thing. “It’s hard to recall a regulator who has done as much damage to medical innovation in as little time as Vinay Prasad,” the editorial board wrote.
Early on in the pandemic, Prasad, was a soft Covid minimizer who wanted to see mitigation efforts brought to an end. Back then, he was actually a fan of mRNA shots, arguing that anyone worrying over their broad-scale efficacy was engaging in fearmongering. In February 2021, he lambasted a New York Times article that warned that “vaccines alone will not end the pandemic,” even though in just the three weeks since it had been published more than 78,000 Americans had died. Nearly three-quarters of a million more deaths would follow.
Over the course of the pandemic, Prasad hardened his criticism of mitigation and grew more unequivocal and less nuanced about the difficulties of public health emergencies. When asked in 2024 whether it was possible to forgive those who had led the Covid response, Prasad replied, “I don’t believe in forgiveness, because in my opinion, these pieces of [expletive] are still lying.”
That sentiment is not peculiar to Prasad, who is less an exceptional character than a representative figure in R.F.K.’s MAHA alliance — an outsider critic, swept into power on a wave of pandemic backlash, and poorly suited to the work of helping to actually run the public-health establishment rather than merely finding fault with it. In fact, when you peel back the layer of Covid resentment, it’s not exactly clear what the alliance of MAHA disrupters really stands for — at least in aggregate.
What do I mean by that? Just among that leadership team, there are some who believe that the F.D.A. has long underregulated drugs, for instance, and others who believe it has overregulated them; there are some who believe the country has been robbed of biomedical advances by corruption and self-dealing and others who believe the country is already quite profoundly overmedicated; some who have argued that only randomized controlled trials can be trusted as scientific evidence, others who want to cut down the number of trials required of new drugs going forward and still others who have suggested that anecdotal evidence is sufficient to justify shifts in guidance and policy. Is it “gold standard science” to say, offhandedly, that schizophrenia could be treated by the keto diet? Is it “evidence-based medicine” to cite discredited science to blame Tylenol use by pregnant mothers for an illusory explosion in rates of autism?
This is not exactly an ideologically unified team, in other words, but a loose anti-establishmentarian alliance held together by disdain for the previous regime. And it is not just the flu-vaccine reversal that shows the cracks. One year in, the agency is undergoing a significant personnel shake-up, with high-profile deputies already on their way out — including the deputy H.H.S. secretary, Jim O’Neill, who had been serving as the acting director of the C.D.C. following the ouster of Susan Monarez in August, and under whom a 24-year-old DOGE alum without any apparent medical experience became the deputy chief of staff. The nomination of the MAHA influencer Casey Means to be the surgeon general has been floating in limbo for months, and it is no longer clear what kind of administration priority it is to get her confirmed. Last week, Dr. Mehmet Oz began explicitly urging unvaccinated Americans to get shots for measles, in an apparent departure from the R.F.K. line, and Kennedy himself is hoping to pivot his messaging ahead of the midterms, my colleague Sheryl Gay Stolberg has reported, retreating from the war on vaccines and turning from the evils of Big Pharma to those of Big Food.
We’ll see whether that pivot actually holds, or whether the MAHA fight against vaccines continues on other fronts. (R.F.K. allies are said to be organizing battles against states’ vaccine laws as I type.) A year ago, food would have probably been a more popular initial crusade for Kennedy, given that many more Americans broadly share MAHA’s concerns about what we eat. Coming a year in, though, a pivot to food looks more like a possible acknowledgment of political defeat.
This is not to suggest that all is fine with American vaccination rates — one has only to glance at the recent measles outbreak to know that things aren’t fine. But in making sense of the MAHA mandate, it’s also important to be careful about the scale of change, and clear about how much support routine vaccination still has in this country.
In one poll published last week by Echelon Insights and Impact Research, 89 percent of respondents said they believed vaccines were essential for public health; in another, published in October, 86 percent of even self-identified MAHA parents said it was important for children in their communities to be vaccinated for measles. In yet another, published in the fall, 77 percent of Americans said they would be at least somewhat likely to recommend to friends and family that their newborns follow the normal vaccination schedule. Only 15 percent said they were unlikely to do so.
These are not signs of a public that is screaming for a burn-it-all-down approach. And one doesn’t have to look only to surveys, since we can study actual rates of inoculation, too: they have fallen since the pandemic, but only by a few percentage points. In the 2019-20 school year, 95.2 percent of kindergartners were vaccinated against measles, mumps and rubella; in 2024-25, the figure is 92.5 percent.
From a public health perspective, these are somewhat worrying numbers, since every unvaccinated child is at risk of some quite scary infections. But from a political perspective, they suggest something very different — that in crusading against vaccines, R.F.K. Jr. and his MAHA coalition have badly misunderstood the public mood. Perhaps, in treating R.F.K. as a crusader who found his moment and MAHA as a new silent majority, many of the rest of us have misunderstood it, too.
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