During the height of the AIDS epidemic in the US, >the ACT UP–linked art collective created a poster with a large red handprint and the slogan “The Government Has Blood on Its Hands, One AIDS Death Every Half Hour.”

Close to 40 years later, another US administration has blood on its hands. As it was then, it is now: this is death by public policy. And it is more than that. As the great actress and AIDS activist Elizabeth Taylor said in the 1990s, “In a society that claims to value human life above all, the deliberate withholding of the means to self-protection is more than passive neglect. It is a measured act of premeditated murder.”

It is clear that many, many people have and will continue to die from what the Trump administration has brought us in just a year: the closure of USAID; the destruction of HIV, tuberculosis, and malaria treatment and prevention efforts; polio eradication; and the gutting of maternal and child health programs around the world, among countless other crimes. As Atul Gawande said in The New Yorker in early November 2025: “As of November 5th, it [was] estimated that U.S.A.I.D.’s dismantling has already caused the deaths of six hundred thousand people, two-thirds of them children.”

Secretary of State Marco Rubio has denied any suggestion that the policies he has presided over have been responsible for any deaths at all. Meanwhile, Russell Vought, the director of the Office of Management and Budget, brushed the accusation off as well when pressed on the issue in Congress. That lack of contrition would be bad enough, but it’s worse than that. As ProPublica reported, some administration officials actually celebrated their bloody efforts with a little fete for themselves last February: “In a corner conference room, it was time to party. They traded congratulatory speeches and cut into a sheet cake.”

These people are ghouls. Death Eaters.

But they were just getting started—and they’re bringing their murder spree home to the United States—specifically, to America’s children.

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April 2026 Issue

Since his appointment, Robert F. Kennedy Jr. has been hell-bent on destroying the US childhood vaccine program. Last year, he purged the Advisory Committee on Immunization Practices, replacing its members with his cronies, which led to the withdrawal of the recommendations for the birth dose of the hepatitis B vaccine, as well as for Covid vaccination for infants and pregnant mothers. None of this was based on science: It was based on RFK Jr.’s whims, his decades-long pathological crusade against vaccines.

Then, last week, RFK did what would have seemed unthinkable even a year ago: He announced by fiat that the US will no longer recommend hepatitis A, hepatitis B, meningococcal disease, rotavirus, influenza, or respiratory syncytial virus vaccinations for children except in certain circumstances, and then only after consultation with a healthcare provider. Again, there is no basis for this in science or sound public health. While it may take some of these infections, like HBV, a few years to take root again, others, like rotavirus, will surge back more quickly.

While other vaccines remain part of the recommended schedule, these attacks are meant to sow confusion and distrust among families about immunization across the board. We have already seen a drop in coverage for measles, mumps, and rubella vaccines to dangerous levels that will allow outbreaks of these dreaded diseases to occur and for them to reestablish themselves as endemic diseases in this country. And in “the nothing to see here,” “we’re not trying to hide anything” department, the Centers for Medicare and Medicaid Services has told states they no longer have to report vaccination coverage to the federal government. All of this is vicious in outcome—the suffering of children and families—and brazen in execution: We are doing this simply because we can, and you can’t stop us.

It is almost impossible to conceive of this level of villainy in the public sphere—and I say that knowing just how much suffering Americans are capable of inflicting on their own people .Which leads us to the question: Now what? Professional societies and coalitions of states are fighting back, as are scientists, clinicians,and advocacy groups—whether by creating alternative recommendations for childhood vaccination, taking RFK Jr. to court, or confronting him and his minions in the court of public opinion. We’ll all keep doing this. But RFK is hell-bent on destroying vaccination in this country, and he has the federal government at his disposal. We’re fighting a very uphill battle.

RFK Jr. is now turning his sights on the US Preventive Services Task Force, which has been responsible for ensuring that Americans have free access to screening tests such as mammograms and colonoscopies. This week, he also cut $2 billion in funding for addiction and mental health services through the Substance Abuse and Mental Health Services Administration. It is clear that this man will not relent until the entire US public health infrastructure is left in a smoldering heap. This is what we’re up against.

I want to ask a distinctly more uncomfortable question: Who will ever hold these people responsible? Those who presided over the AIDS epidemic in the US never had to answer for letting a plague flourish in their own backyard. With many more deaths attributable to this administration, will they ever be held accountable?

I want to make a proposal. We will need a Truth and Reconciliation Commission for Public Health after these people are out of office. No one is getting sent to jail (our politicians don’t have the stomach for it, and I am no fan of the carceral state in any case). But we need a full accounting of what these people have done, live on television (hello, C-SPAN) starting in 2029. This panel must be independent and fearless, and we need to make it happen. The number of deaths and the sheer scale of suffering these people have caused need some reckoning.

Rubio, Vought, and RFK can be first up. But next in line are people like Marty Makary, Vinay Prasad, and Tracy Beth Hoeg at FDA, Jay Bhattacharya and Matthew Memoli at NIH, and Jim O’Neill and Martin Kulldorff at HHS. That these people could go back to their academic careers and political lives as if none of this ever happened is entirely possible given America’s history, but it would be supremely unwise to permit it, as it would just create the conditions for this to happen again, and again. And again.

Many of these individuals have set themselves up as persecuted mavericks over the past five years, particularly with their insistence that the measures taken during the Covid pandemic to mitigate it were worse than the virus. They’ve built up this narrative to immunize themselves against scrutiny, and they will use this storyline—particularly and most recently promulgated by Stephen Macedo and Frances Lee at Princeton in their book In Covid’s Wake and heralded by publications like The New Yorker, The Wall Street Journal, and The Economist—as a shield against any accountability. Their colleagues in academia who championed them, propped them up, and defended them will also scorn any public truth-telling. I can also imagine that, faced with families who have lost children to preventable diseases in 2029, all of these folks will snap back by using such blame-shifting excuses as “but you masked children for years during Covid-19.” But this dog won’t hunt.

Most scientists, clinicians, and public health experts see all of these people for who they are now—they are in charge, with hands on the levers of power over life and death, and the scope and scale of the carnage they have presided over leave them no moral high-ground; their crusade has always been scientifically and ethically bankrupt.Perhaps the idea of accountability seems fanciful at this moment. But we have to confront the horrors of these years we are living in. Outside of public health, the need for truth and reconciliation is acute as well, on immigration and “internal security” for a start. The excesses of this administration are beyond the bounds of what we’ve seen before (even if entirely consistent with our nation’s past) and require a wholesale investigation, with a chance to hear from the victims and the perpetrators.

Otherwise, we are normalizing this for posterity. And yes, the push for the normalization of terrible things is the American way. But it doesn’t mean we cannot advocate for some form of restorative justice moving forward. It is our duty. It will be our legacy. Without it, we have not only ceded the present to these people but have left history to their plunder as well.