No one wants to admit that we’re sliding into the abyss.

Over the past six months, I’ve watched the harm Donald Trump, Elon Musk, Russell Vought, and their various henchmen have done to American science, public health, and healthcare. I’ve rallied with colleagues to push back, and tried to take heart in the small victories that have arisen in a court case here or a backtracking from an official there. But in the wake of the recent budget bill passed through Congress and the Supreme Court decisions banning national injunctions and allowing mass firings at federal agencies, I think we’ve passed the point of no return.

It’s hard to say this. But the truth is often hard.

I fear we are now going to see the wholesale evisceration of every scientific agency in the United States, along with the Centers for Disease Control and Prevention and the Food and Drug Administration. Add to that the gutting of every healthcare program for the poor, disabled, and elderly. It will be done by budget cuts, by layoffs, and by attrition, as federal workers flee a government overseen by corrupt, compromised charlatans.

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January 2026 Issue

Some might think that the effects of this crisis won’t reach them. They’re wrong. Researchers who think, because they study noncontroversial topics, that they’ll be just fine are deluding themselves: When there are few staff to run the day-to-day business at the National Institutes of Health or the National Science Foundation, the business of all scientific research will slow to a crawl. For those on private insurance who don’t see how Medicaid might affect them? Well, hospitals depend on reimbursement for care through these federal programs, and once these subsidies disappear, hospitals will close or curtail services, which means the care you need may be delayed or require you to go elsewhere to get it.

And in public health, God forbid we have another pandemic, because we’re shutting down critical programs to monitor and respond to imminent threats like H5N1, while the bozos at Health and Human Services and the Advisory Committee on Immunization Practices are taking an axe to immunization in the US and giving once-vanquished plagues a new chance at a run on ordinary Americans. Thanks to the destructiveness of these anti-vaxxers, we already have more measles cases than at any time in the past 33 years. The crisis is already here.

To use the coarse military acronym, it’s all FUBAR—fucked up beyond all recognition.

In the short term, people will be hurt, get sick, and die from all these decisions. In the long term, it will take decades to rebuild what we’ve now lost. The suffering will be protracted across generations.

So what do we do now?

Some of those who are interested in science would be best advised to go elsewhere. Europe and Asia are now safer havens for research; even if they cannot match the sheer size of the investments the US used to make, they are actually trying to make progress instead of destroying it.

In public health and healthcare, it’s going to be about damage control. How do we save the most people from misery, illness, and death? We’re going to have to organize “shadow” bodies to step in to give public health and clinical guidance and information as the federal government slides into conspiracy mongering, pseudo-science, and grift. But it’s going to be hard to replace programs and funding that are being wrecked from above. We’re going to need some creative thinking to figure out how to provide clinical services and public health programs when the feds have abandoned us. Some states can fill some of the gaps, but it’s clear that this is not enough.

There is no other way to do this than to push through. We’re going to have to fight a series of mostly losing battles for the next few years. They will target some of us with retribution as the administration expands its internal security apparatus with the billions allocated for it under the new budget bill. None of this is good.

I understand why people might want to flee this burning building. Yet the idea of leaving the US for more hospitable places feels like a capitulation to me. I take strength in people who have gone before us, like the German anti-Nazi heroes of the White Rose movement, who wrote:

Isn’t it true that every honest German is ashamed of his government these days? Who among us has any conception of the dimensions of shame that will befall us and our children when one day the veil has fallen from our eyes and the most horrible of crimes—crimes that infinitely outdistance every human measure—reach the light of day?

Yes, comparisons to the resistance to the Nazis may still seem overwrought to some. Yet, even if what is happening now in the US doesn’t reach the depravity of those years, it is still absolutely, categorically, morally depraved, worthy of resistance and sacrifice.