This week, Illinois Governor JB Pritzker offered an extraordinary viral response to President Trump’s vow to dispatch troops into Chicago. Critically, Pritzker cast Trump as a malignant, active threat to his Illinois constituents—he called them “my people”—and vowed to use every ounce of his power to protect them from harm by the President of the United States. The move’s resonance showed that governors who creatively resist Trump’s malevolent despotism will be seen nationally as leadership figures by voters hungry for politicians to rise to the urgency of the moment.
Trump’s firing of the director of the Centers for Disease Control—which is unleashing an effective decapitation of our public health system, leading experts to fear the nation’s vaccine apparatus is slowly collapsing—provides Democrats with another opening to do exactly this. For ambitious state-level Democrats eager to break through as checks on Trump’s reign of destructiveness, this could represent the next frontier of resistance.
Pritzker’s health department in Illinois is currently exploring the possibility of purchasing Covid-19 vaccines in bulk straight from manufacturers in response to the mess in Washington, a senior Illinois health official confirms to me. Meanwhile, a coalition of mostly-blue states led by Massachusetts Governor Maura Healey is planning to coordinate on the purchase and distribution of pediatric vaccines, should the federal government restrict access to them, according to a source familiar with ongoing discussions. This will likely include big states like New York and Pennsylvania.
One hopes and expects that there will be much more of this going forward. Democratic governors have numerous ways to fill the public health leadership void that Trump is creating, according to public health experts I interviewed.
That void is enormous—and deeply unsettling. The White House fired CDC director Susan Monarez after she came under pressure to support Health and Human Services Secretary Robert F. Kennedy Jr.’s rescinding of various approvals for the Covid-19 vaccines—which was announced this week—and to support vaccine restrictions more broadly as well. Monarez, a Trump appointee and a well-regarded government scientist, refused, seeing this as a betrayal of vaccine science that could threaten countless lives.
Worse, after Monarez was fired (which her lawyers are fighting, though the White House has announced a replacement) a disconcerting spectacle ensued. A parade of top CDC scientists resigned, offering dismaying predictions about the future of vaccines in the United States. Indeed, this is only the beginning. As The Bulwark’s Jonathan Cohn notes, Kennedy has many other tools to do truly immense damage to the vaccine system.
So what can governors do in response to this unnerving state of affairs?
First, says Wendy Parmet, a health policy professor at Northeastern University, governors can scale up clinic systems to make it easier for people to get vaccines, should Trump’s government keep making that harder. This week the Food and Drug Administration narrowed approval for Covid-19 vaccines to people over 65 and those under 65 with a high-risk medical condition who consult with doctors. Experts fear the latter will restrict access even to those adults under 65, who previously could get shots at pharmacies.
Scaled-up state-sponsored clinics could make life easier for that below-65 population by making doctors more accessible to consult and recommend a Covid vaccine, Parmet notes. “States can step up with vaccine clinics overseen by physicians who would administer vaccines even when pharmacies may be unable,” she says.
Alternatively, a more ambitious version of this would entail states buying up large amounts of Covid vaccines from manufacturers and building out distribution systems similar to those employed during the pandemic, says the University of Michigan’s Sam Bagenstos, general counsel to the HHS under President Joe Biden. In this scenario, states could seek to provide the vaccines not just to high-risk adults under 65, but also all other adults who want them.
Crucially, the narrowed FDA approval, which largely impacts the marketing of vaccines, doesn’t stop doctors from prescribing them “off label” to others who want them, Bagenstos says. That means Democratic governors can step in with a dramatic counterpunch against depraved Trump-Kennedy efforts to widely discourage vaccine use.
“All that would have to happen is for some state to purchase a whole bunch of vaccines,” Bagenstos says, “then have the state’s chief health officer prescribe the vaccine to anyone who wants them—and then provide the vaccines out of the state’s own stock.” Or the state can provide them to doctors who would then prescribe them.
Something like this might happen with the aforementioned Illinois initiative exploring potential ways to buy the vaccine straight from manufacturers. “We have to build up an apparatus to shield us from the recklessness of Robert F. Kennedy,” a senior Illinois health official tells me.
Here’s another idea: Numerous blue states’ top health officials can assemble into a group similar to the Democratic Attorneys General Association. In this way they can discuss ways to coordinate multi-state vaccine policy and/or speak with one voice on these matters.
Along those lines, another possibility would entail all these health officials putting out a comprehensive, multi-state joint statement of recommendations on vaccines that places science and empiricism at its center. As Paul Krugman notes, the fundamental rejection of medical science that is central to Trump’s agenda could also badly compromise our national future. So Democratic governors should let the millions and millions of Americans who are deeply discomfited by all this know that someone in a position of authority is working to avert that national fate, that someone is awake at the public health switch.
“It’s important that the American people know that their state leaders have their backs,” said Gregg Gonsalves, an associate professor of public health at Yale. “It’s crucial for the American people to know that in many places at the local and state level, public health is alive and well.”
This is a partial list. But here’s the basic point: Democratic governors should scour every corner of the law to find creative ways to show that in their America, public officials will go to the wall to defend the health and well-being of their constituents from the potential mass illness and death that Trump and Kennedy appear eager to unleash.
Democratic governors can use their bully pulpits to truly explain the stakes of this moment. Here Noah Smith’s formulation is useful: We are at risk, he says, of becoming the “richest third world country,” a place where “politics is starting to look decidedly like something you’d encounter in a dysfunctional middle-income nation.” The unshackled strongman whims currently wrecking our institutions and demolishing the professionalized bureaucracy are central to this story, and Democratic governors can tell it.
In short, if Trump and Kennedy are going to divide the country over public health, Democrats should polarize the living heck out of this debate as well—but on their terms.
The message should be that in their America, officials cherish our public health system as a pillar of American greatness and see vaccines as a miraculous human achievement, rather than indulging in juvenile conspiracy theories disparaging “deep state” medical professionals. In their America, public officials will genuinely prioritize their constituents’ well-being and flourishing, rather than faithlessly betray the people who rely on them by playing vile little games around what the science actually says. In their America, officials who have been granted the public’s trust will honor that sacred compact. They will simply not stand for Trump-Kennedy efforts to Make Polio and Measles Great Again.
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