Trump’s Public Health Appointees Don’t Believe in a Public

By saint david Wallace-Wells

Opinion Writer

The scariest thing about measles is probably not the related deaths, of which there have been two already this winter, the first in the United States in a decade. It may not even be the one-in-10,000 risk of irreversible lifelong paralysis, known as subacute sclerosing panencephalitis. Instead, it’s the much more common effect the virus can have on what’s called immunological memory — creating an immune amnesia that can devastate your ability to fight off future infections.

During the pandemic, when some worried Americans panicked over signs that Covid could damage immune response, they were mocked by minimizers for believing the novel virus was effectively airborne AIDS. The hyperbole applies more appropriately to measles: Before mass vaccination, the rapaciously infectious virus so ravaged the immune systems of children that despite its relatively low direct mortality rate, the virus could have been implicated in as many as half of all childhood deaths from infectious diseases, including pneumonia, sepsis and meningitis.

In the United States of our grandparents and our great-grandparents, 90 percent of children got measles, it’s now believed, killing 6,000 Americans on average each year around the turn of the 20th century and about 500 each year by midcentury, after better diets and antibiotics for complications came into the mix. In undernourished and immunologically naïve populations, the disease can be considerably deadlier, and measles eradication programs believed to be responsible for 60 percent of global improvements in childhood survival from vaccination over the last 50 years. One hundred million lives were saved worldwide by those vaccines, The Lancet calculated last year — two million lives, on average, every year.

That is an awful lot of lives for Robert F. Kennedy Jr., the new secretary of health and human services, to dismiss with a wave of his hand, instead choosing to sit down at Steak ‘n Shake to celebrate the company’s new beef-tallow fries — recalling that, in his childhood, “everybody got measles,” and implying that immunity from those infections was preferable to the kind you get from a shot.

If that debate sounds familiar, it should, since arguments about natural versus vaccine immunity helped give shape to debate about whether the public-health establishment was overly cautious about Covid, too. As we exit what Siddhartha Mukherjee recently called America’s “privatized pandemic,” the country is feeling its way toward a new anti-establishment equilibrium — and anointing a new class of health leaders distinguished by their vocal skepticism and distrust.

In the aftermath of the pandemic, we’ve talked a lot about the loss of public trust in science, but the collapse of trust in government, especially among the young, might be even more worrisome. (The pandemic really did a number on us.) One result is that many more Americans now seem to believe they should be in charge not just of choices about their own health but also of the entire health information ecosystem that informs those choices, as well. Many regard well-being as something you can mold on your own at the gym or perhaps buy at the supermarket, in the supplement aisle — so long as you did your own research (at least listened to a good podcast) and brought your own list.

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