Bluesky

It is truly difficult to keep up with the pace of OMB Director Russell Vought and HHS Secretary Robert F. Kennedy’s Jr.’s assaults on public health, biomedicine, and science. Over the past week or so, Vought has decided that he must have control over grant funding at the National Institutes of Health. His larger attempt to put all federal grant funding under his thumb was sidelined by Congress, so he is getting President Trump to issue an Executive Order giving him this authority, whether it is legal or not. Over at Health and Human Services, RFK Jr. has seized control over the US Preventive Services Task Force, and is doing what he did to the Advisory Committee on Immunization Practices last year: gutting it and filling the seats with cronies and crackpots.

The USPSTF is our nation’s premier arbiter of preventive services—overseeing everything from disease screening (e.g., mammograms and colonoscopies) to preventive therapies (e.g., pre-exposure prophylaxis against HIV infection). Insurers are statutorily compelled to cover highly rated interventions without cost sharing for all Americans. Now those ratings will be judged by the charlatans in RFK Jr.’s inner circle.

The damage these two men have done and will continue to do is without parallel in American history. Their actions will cost lives, make people sick, and set back research and innovation in the United States for a generation or more. And it is time to stop treating them like ordinary political actors. Vought and RFK Jr. are out-of-control zealots with no rational policy goals. To treat them otherwise is to invest their deep sociopathy with credibility. Trofim Lysenko, the Soviet agronomist whose policies led to the deaths of millions of Russians, didn’t “have a point,” and you didn’t have to “hand it to him” in his criticism of the orthodoxy of Mendelian genetics. You certainly didn’t have to find a way to “collaborate on shared goals” to make the USSR healthy again. He was a monster. These two men are too.

While I think it’s critical to catalogue what these men have wrought, it’s more important to try to stop them. To the credit of many working in public health, science, and medicine, there has been a growing resistance to Vought and RFK Jr. That pressure helped successfully tank Vought’s recent efforts to take over grant-making, while many professional societies have stepped up to offer alternatives to the lunacy of HHS’s public health recommendations and sued the federal government. There are also brave solo actors who have risked their careers in speaking out.

But there is an opportunity on the horizon to do much more to restore public health, biomedicine, and science in the US. If the Democrats win control over one or both chambers of Congress this fall, they must act decisively to reverse as much of the Trump-era damage as possible.No half-measures will be sufficient; the Democratic inclination for everything to be bipartisan needs to be weighed against the real costs in human lives and suffering that this kind of political deal-making entails. Otherwise, the Democrats will be complicit as deaths continue to mount from this Administration’s policies. We need to play hardball, even if it rubs the denizens of Capitol Hill the wrong way.

There is so much to do. We need to reverse the budget cuts that have decimated federal agencies. Then we should go down the list of Vought and RFK Jr.’s greatest hits and reverse whatever policies we can by statute. Democrats should use reconciliation, tie provisions to must-pass bills, and consider the nuclear option of changing the rules on the use of the filibuster in the Senate. Yes, Trump can veto bills and the usual horse-trading is still going to need to happen, but if you start negotiations at what you can agree on with this GOP, you are already conceding too much. And outside the legislative arena, control over the House and/or Senate offers ways to hold these men and their underlings accountable. Democrats should bring them to testify before committees, subpoena documents from agencies and the White House, and private actors who have been key participants in their efforts, and consider impeachment proceedings for the lot of them.

Perhaps this sounds too brazen, too far from the world of DC realpolitik, and members of Congress will think, “Oh, we couldn’t possibly do that,” or, “Well, we are really focused on affordability for 2028.” But this kind of reticence and evasion masks a fundamental misunderstanding of what has just happened in the US. Covid was a once-in-a-generation pandemic. It killed over 1 million of us here in this country. But Russell Vought and RFK Jr. are deadlier than a virus. The world of hurt inflicted on millions of Americans (and millions more around the globe) by this administration is a catastrophe. It demands an extraordinary response.