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Back in 2020, Americans in the throes of the COVID pandemic learned about “inflection points” — the moment in a crisis, in that case a public health disaster, that marks a threshold for change.
Five years later, public health in the United States is at a very different inflection point.
Mass firings and even a shooting at the Centers for Disease Control and Prevention’s Atlanta headquarters had already left the nation’s health officials rattled and demoralized. Then on Wednesday, Robert F. Kennedy Jr., the secretary of the Department of Health and Human Services, announced that the Food and Drug Administration had approved an updated version of the coronavirus vaccine — but only for a narrow group of people that included older adults and those with certain preexisting conditions.
The approval potentially shuts out millions of people, including healthy adults and children, from protecting themselves from severe illness. The announcement followed upheaval at the Advisory Committee on Immunization Practices, the committee that recommends vaccines for the broader population. In June, Kennedy fired the entire group of people and replaced them with vaccine skeptics.
Then, also on Wednesday, the administration fired Dr. Susan Monarez, the head of the CDC — apparently over vaccines. Monarez’s lawyer said she was targeted because she refused to “rubber-stamp unscientific, reckless directives and fire dedicated health experts.” In a statement, the White House later said that she was “not aligned with the President’s agenda.”
In a sign of protest, several other high-ranking officials also left their jobs, citing concerns about the anti-science direction the agency was taking. “Their desire to please a political base will result in death and disability of vulnerable children and adults,” Dr. Demetre Daskalakis, who worked on immunizations at the agency, said in his resignation letter. Then, dozens of staffers at the CDC walked out of their jobs on Thursday in support of their leaders who had spoken out.
After months of chaos and confusion, America’s public health infrastructure is on the brink of true disaster, killed by a thousand cuts of distrust and dismantlement.
“I think it’ll be a real challenge to undo the effects of the last few months,” Rachael Piltch-Loeb, a scientist at Harvard University’s T.H. Chan School of Public Health, told HuffPost.
Experts and everyday Americans have expressed alarm at the breakdown of crucial public health structures. The CDC’s mandate covers a massive amount of ground, from tracking and preventing infectious diseases to public health awareness campaigns that keep Americans up to date on information that can help them make the best choices for their own health.
In the 1960s, the CDC played a vital role in fighting smallpox that would lead to global eradication in 1977. In the following decades, the agency also discovered causes for Legionnaire’s disease and toxic-shock syndrome. In more modern times, the CDC has helped other countries contain outbreaks of infectious disease — so that they wouldn’t spread further.
“Over time, the U.S. could lose its ability to detect and respond quickly to threats unless that responsibility is shifted to another entity,” Sarah McCool, a public health professor at Georgia State University, told HuffPost.
“Most Americans rarely interact with the CDC directly, but they benefit from the work that it does in areas ranging from investigating emerging disease to monitoring foodborne outbreaks,” she added.
Kennedy’s antics, Piltch-Loeb said, have supercharged what was already a growing problem. “Public health was having a crisis before [Kennedy],” Piltch-Loeb said, “But this is going to undo decades of progress.”
There have always been naysayers and misinformation around public health efforts: Recent U.S. outbreaks like swine flu in 2009 or the spread of mpox in 2022 were met with skepticism. But there’s a difference between what we’ve seen before and what’s happening now: Right-wing politicians have leaned heavily on anti-intellectualism and anti-science, and that thinking has grown exponentially under President Donald Trump.
In 2020, after only a couple of weeks of masking and social distancing during the coronavirus pandemic, many Americans began to defy public health experts’ warnings about COVID — and it was more pronounced among Republicans, particularly as Trump himself promoted conspiracy theories and skepticism. They protested against coronavirus-related closures around the country, spread misinformation about COVID cures, and when the Trump administration launched Operation Warp Speed to fast-track a viable vaccine, his own supporters immediately began to doubt its efficacy.
And with the appointment of notorious vaccine skeptic RFK Jr. to lead the nation’s health policy, that skepticism and distrust have found a home within the institution of public health itself. The calls are coming from inside the building.
“We’ve also seen distrust in public health before,” said McCool. “Usually, however, it was focused on a specific and singular crisis. What’s different now is that skepticism is directed at the very existence and authority of our institutions.”
It is a frightening harbinger of the state of things to come. On Friday, Daskalakis, who resigned from his role as director of the National Center for Immunization and Respiratory Diseases at the CDC, appeared on the New York Times’ podcast “The Daily” to explain why he could no longer stay at the public health institution.
“The CDC that we’re talking about today is not even the CDC of two years ago,” he said. The vaccine expert issued a dire warning about the future of public health in the U.S.
“I am very, very worried about the safety of our country and our health, and I had to say it out loud,” he said. “I think that the data is going to be compromised. The science is not going to be science, it’s going to be some Frankenstein of science and ideology.”
It’s not like Americans could not have seen this coming: During his nomination hearing for HHS secretary, Kennedy was pressed on his views on vaccines, including the fact that in 2021 he said that Black people don’t need to be on the same vaccine schedule as white because their immune systems are better. (During slavery, the myth that Black people don’t feel pain was used to justify using enslaved people for medical experiments.) He is an open proponent of the myth that vaccines cause autism and is one of the founders of the Children’s Health Defense, an anti-vaccine organization.
Still, he was confirmed to his position, including by at least one senator who may be feeling some regret.
In a statement Thursday, Sen. Bill Cassidy — who is himself a physician and also cast the deciding vote for RFK Jr.’s confirmation — said ACIP should postpone its next meeting until the leadership at the CDC can be untangled.
“If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership,” he said.
But it may be too little too late. For individual Americans trying to manage their health, it’s unclear how insurers will approach the coronavirus vaccine going forward. Private health insurers typically rely on ACIP recommendations when making coverage decisions.
“If a vaccine is not officially recommended, insurers may not cover it,” Piltch-Loeb said. “Many people will lose access because they can’t afford to pay and they’ll open themselves up to more severe infection.” Beyond the COVID vaccine, the risk of being bumped from insurance coverage applies to any vaccine that the now-vaccine-averse ACIP panel chooses not to recommend.
And then there are the broader concerns — as Daskalakis told “The Daily.”
“I do think that there’s going to be a vacuum [in public expertise],” he said. “I can’t tell you when it’s going to happen, but infectious diseases always find a way. And we have less visibility in what’s happening with infectious diseases across the entire globe. We’ve been a leader in that space, and that’s ended. … If we’re not there, don’t know what’s going on, it may not be until it lands on our shores that we know what’s happening.”
