Earlier this week, Donald Trump signed an executive order intended both to reduce the number of vaccines American children receive and to make it harder for them to get those vaccines.

Trump declared that kids didn’t need to be routinely vaccinated against Hepatitis A and B, or against meningitis—all diseases that can prove life-altering or even lethal. And he targeted the MMR vaccine, which in one shot protects children from mumps, measles, and rubella, and has been spectacularly successful over the decades in reducing childhood mortality rates.

Referring to repeatedly debunked theories that Health Secretary Robert F. Kennedy Jr. continues to push, Trump claimed that multi-vaccine shots like the MMR jab trigger autism, and that separating them out would potentially save millions of lives. He also claimed, bizarrely, that these all-in-one inoculations injected soda can–size amounts of liquid into children; in reality, each shot contains a fraction of a tablespoonful of serum.

As happens so often these days, legal experts immediately pointed out that Trump’s decree wouldn’t really carry the force of law, as vaccine policies are mostly determined at the state rather than the federal level, and any changes to vaccine mandates will likely trigger long and bitter legal battles. In other words, this was dismissible as simply routine Trumpian bluster.

But that largely misses the point. Trump sabotages public policy not through careful legal or legislative strategies but by flooding the zone with his gibberish. When he claims that he knows more than the American Medical Association, the American Academy of Pediatrics, the American Cancer Society, and all the other specialist networks that have come out against his proposed vaccination changes, he is deliberately creating enough white noise to further undermine consensus ideas around science, public health, and how political decisions ought to be made around complex issues such as vaccine policy.

In Trump-land, no matter what the issue is, be it vaccines or American history, there is only one ultimate arbiter, and that is Donald J. Trump, the all-knowing Father of the People whose visage now glares out from so many public buildings in the nation’s capital. That omnipresence, that looming menace over all areas of public life, is the quintessence of authoritarian leadership.

For those not caught in the spell of Trump’s increasingly surreal personality cult—witness the AI-generated images he posted last week of himself in military uniform, medals festooning his chest, flanked by Generals MacArthur and Patton, as well as other AI images of him kissing a gold statue of Jesus, arresting a space alien, and merging his face with George Washington’s— it’s highly unlikely that an unenforceable executive order on vaccines, combined with a large dose of Trumpian hyperbole, will undermine their willingness to get their children vaccinated. But for those still in the cult, especially those living in red states such as Florida, whose public health leaders have already done tremendous damage by buying into conspiracy theories around vaccinations, there is a real risk that Trump’s blather will convince some of them to leave their kids unvaccinated. And if and when that happens, it’s likely that large numbers of children will end up getting sickened by diseases that, until recently, they would have been properly immunized against.

Trump’s administration has already gone out of its way to limit healthcare access for millions of Americans, enacting sweeping cuts to Medicaid and refusing to extend tax credits for Affordable Care Act subsidies. In this, the federal government has largely been supported by GOP leaders at the state level. Predictably, the number of uninsured people is rising rapidly, disproportionately in Republican states. In Texas, one in six residents is now uninsured, including more than 10 percent of young children.

There’s no evidence that these trends will be reversed anytime soon. Quite the opposite: As more cuts to public services kick in, so more people will be left outside of the never particularly munificent protections of America’s social safety net.

Given these realities, it’s already hard to get children vaccinated—it’s expensive and time-consuming, and increasing numbers of families don’t have regular access to primary care doctors. Trump’s order, aimed at requiring multiple visits to get shots that used to be delivered simultaneously, will make it even more daunting for working families in states such as Texas to ensure that their children get the vaccinations they need, and thus more likely that hard-to-contain epidemics will break out.