Most of what “public health” does for Americans is taken for granted. Before the Covid pandemic, most people probably didn’t think about it at all. Yet the fact that, in most places in the United States, we can count on the water we drink to be safe, that the food we buy is not contaminated with e-coli or listeria, and that we don’t have to deal with dreaded childhood diseases that ripped through our communities only a few decades ago, is a testament to the tireless work of many, unheralded, often unknown heroes. This invisible safety net has been built up over the years, always underfunded and understaffed, always not-enough, but it’s all we’ve got.

And now comes the wrecking ball. If Trump’s first term was a disaster for public health—and his response to Covid, from blocking agencies from rolling out testing and recommending masking early on to embracing the idea that we should let people get infected with the virus is the prime case in point here—at least there were institutionalists at key posts: Scott Gottlieb at FDA, Alex Azar at HHS, even the odious Robert Redfield at CDC, and Francis Collins hanging on at NIH. Each of these men at least had experience in federal agencies or relevant health experience of some kind.

The avatar of Trump 2.0’s public health policy will altogether be something else. Whether or not Robert F. Kennedy Jr. is given a cabinet post, an agency to run, a desk in the West Wing or the Old Executive Office Building or even just remains as an unofficial adviser to the president-elect, he represents a know-nothing, conspiracy-addled future destined to make us sick. Any significant influence of RFK Jr. in Trump’s orbit represents a recklessness that we have never seen in public health in any federal administration in this country’s history.

By now, we’ve heard Kennedy’s views on everything from fluoride in drinking water to childhood vaccines, to threats to recreate the NIH and FDA in the image of his own quackery. Let’s be clear: Kennedy’s views are not “alternative” to orthodoxy, meant to shake up the system—they are verifiably false. They are nonsense.

Let’s take his claims on fluoride as an example. RFK Jr. wrote on X in early November: “Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.” Um—no. In high doses over prolonged periods of time—as with many other substances (even water and oxygen!)—exposure to fluoride can be a problem, but not in the small concentrations we see in drinking water. Lest we forget: Fluoride has been a bugaboo of the far right since the 1950s, when fluoridation was supposed to be part of a communist plot to take over America.

And since conspiracy theories know no borders, we can also look at a natural experiment up in Calgary, Canada, for further evidence. In 2011, Calgary’s’s city council banned fluoridation, and now is set to reintroduce it next year. Why? Because since fluoridation ended, cavities in children’s teeth have become more numerous and larger, often requiring treatment under general anesthesia and/or intravenous antibiotic therapy to fight infections associated with tooth decay. As one researcher at the University of Calgary has said, the decision to ban fluoridation had a clear result: It was a source of “avoidable and potentially life-threatening disease, pain, suffering, misery and expense…especially [for] very young children and their families.”

Current Issue

December 2024 Issue

As for vaccination, Kennedy’s views are long-standing and well-known. He has suggested that “there is no vaccine that is safe and effective,” and he still clings to the long-debunked idea that vaccines cause autism. More recently, during the Covid pandemic, he created a multimillion-dollar anti-vaccine juggernaut to dissuade people from getting vaccinated against SARS-CoV-2.

There is no person right now more vital to the anti-vaccine movement than RFK Jr., and his impact has been deadly. By convincing people to forgo routine pediatric vaccinations, he has endangered the lives of thousands of kids, stoked fear in families with autistic children, and in at least once instance was partially responsible for a devastating outbreak of measles. In 2019, 83 people, mostly children, died of the preventable disease in Samoa. While Kennedy has denied that his words and actions were responsible for the outbreak, he has supported anti-vaccination efforts on the islands, written to the nation’s prime minister about the dangers of vaccines, and visited Samoa to meet with anti-vaxxers and subsequently praised them for their work. As Derek Lowe, a columnist from the United States’ leading scientific journal, Science, has said: “Kennedy’s views on science and medicine are not only wrong, they are actively harmful and destructive. He has used them to make a great deal of money, and he has lied about them to interviewers and reporters whenever he finds it convenient.”

Legal experts have suggested that Trump and Kennedy may not have the authority to do many of the things that Kennedy has proposed and that public health in the US is largely a matter of state and local control outside of the federal remit. But Trump and Kennedy can do a lot of damage without changing a single law, through appointments, executive action, rule-making and the like. Schedule F is an executive order that would allow Trump to shift the status of civil servants to political appointees by fiat, fire them, and then replace them with incompetent apparatchiks. How would this work? Well, if the new president wanted to fire the head of the National Institute of Allergy and Infectious Diseases, a post Anthony Fauci previously held, the position’s status as a civil service job would make this difficult to do. But with the bureaucratic magic of Schedule F, the directorship could be reclassified as a political appointment, the director fired, and the role filled by a loyalist without any qualifications. Now think of the effect of reclassifications, removals, and new hires up and down the public health civil service: It’s a recipe for chaos and destruction, where friends of Trump and Kennedy could be put in place in agency after agency, disposing of decades of experience and expertise in an instant.

In addition to these dangers, with the bully pulpit of the White House, Trump and Kennedy could also, for instance, discourage fluoridation and vaccination and push GOP governors to take up the worst of their terrible ideas. Ron DeSantis would be happy to oblige and already has a head start in dismantling public health in his state. This doesn’t require any federal action, besides the willingness to sow misinformation and lies.

RFK Jr. is the poster boy for the new Trump administration, a rich man who never has had to worry about a thing in his life, putting the lives of ordinary Americans in jeopardy because he thinks he knows better than scientists. In fact, the man who thought it was a good idea to stage a hit-and-run with a dead baby bear and a bicycle in Central Park has shown a lack of judgment across the board for a long while. But he is part of an emerging kakistocracy-in-waiting that will be run by plutocrats and zealots. Our public health system in America is fragile and shouldn’t be a plaything. Once he’s done with his games, all the king’s horses and all the king’s men may not be able to put our public health infrastructure back together again. The damage may be lasting and profound.

But we are not powerless. So much of public health happens locally—and we can protect this precious national resource by speaking up and speaking out, at our city or town council meetings, calling and writing our state representatives, our mayors and our governors. This is going to be necessary work. As my Yale colleague Timothy Snyder has said: “Defend institutions.… Institutions do not protect themselves. So choose an institution you care about and take its side.” This may be your local public health department or Planned Parenthood clinic, a mental health clinic or needle exchange program, or services for LGBTQ+ or immigrant populations in your neighborhood.

These are all part of what makes public health happen day in and day out in our communities. Deprive RFK Jr. and Donald Trump of their power; take it away from them with focus and tenacity. Chip away at their campaign to destroy public health in America. These kinds of small acts will add up and will make a difference. If these men are the disease, let us be the cure.