Even within the freakshow that is Donald Trump’s cabinet, HHS Secretary Robert F. Kennedy Jr. has a singular knack for dominating the headlines with the most disturbing sort of carnivalesque spectacle. 

In recent months, he’s amplified harmful disinformation linking Tylenol and autism and dismissed the entire CDC vaccine advisory committee, replacing them with skeptics and conspiracy theorists. And even as that agency debated and ultimately scrapped its hepatitis B vaccination recommendation for newborns, Kennedy courted further controversy for his alleged involvement in a tabloid-fodder love triangle. 

But focusing exclusively on RFK Jr.’s transgressions risks overlooking the broader exploits of the Make America Healthy Again movement. While his never-ending font of personal and professional controversies draws national news coverage, a dangerous array of MAHA initiatives flies under the radar—including hundreds of state-level legislative efforts to roll back public health advances.

According to a recent AP investigation, more than 420 such bills have been introduced in states across the US this year, primarily targeting favorite MAHA fixations like immunization, fluoridation, and raw milk. Dozens of measures have already become law. In October, Idaho passed its Medical Freedom Act, making vaccine requirements illegal within the state. Arkansas approved a law expanding raw milk sales in April, while Utah and Florida enacted water fluoridation bans. 

Some of the most extreme legislation thankfully faces slim odds of passage, like the attempt by Minnesota Republicans to ban mRNA treatments as “weapons of mass destruction.” The bill, which was reportedly drafted not by legislators or public health experts but by a Florida-based hypnotist, would criminalize the distribution of the Moderna and Pfizer COVID vaccines as an act of bioterrorism.

Each of these initiatives runs counter to decades of science. US childhood vaccines have prevented more than a million deaths since 1994. Raw milk causes 840 times more illness than its pasteurized alternative—and just last month Illinois saw 11 instances of raw milk-linked food poisoning. Fluoride, meanwhile, decreases cavities by 25 percent.

Why, then, promote such bills at all? While MAHA followers are quick to point out the financial incentives propelling major food and drug companies, their movement is also rife with moneyed interests, including several groups connected to Kennedy himself. The AP also reported on a California farmer, Mark McAfee, who claims to run the world’s largest raw milk operation. He testified in support of a Delaware law legalizing the sale of his product. Unmentioned during his statehouse visit, however, was the fact that his company’s milk has been recalled eight times and linked to a Salmonella outbreak that left 165 people ill. McAfee is projected to take in $32 million in sales this year alone. 

Though state-level anti-science policy may be profitable for its peddlers, it’s profoundly harmful to the American public—and in fact might even yield more long-term damage than RFK Jr’s federal-level wreckage. While future presidential administrations and Congresses can reverse his HHS guidance, repopulate the CDC, and re-fund lifesaving research, state legislation—particularly in states with effective one party rule—can more stubbornly persist.

And unlike many other local policies, regional public health regulations can have irreversible national effects. During the COVID-19 pandemic, lax local restrictions fueled spillover infections across state lines. The ongoing measles outbreak that began in Texas in January has since spread to states including Oklahoma, New Mexico, and Utah—largely through unvaccinated individuals. A virus knows no political boundaries.

Thwarting the circulation of measles, whooping cough, and the disinformation that often precedes their transmission requires urgent public health reform, and in states across the country, officials and healthcare experts are attempting to meet this moment. This October, 15 Democratic state executives created the Governors Public Health Alliance to share data and coordinate preparedness efforts. And earlier this year, the liberal PAC 314 Action launched a $25 million campaign to elect more science-supporting physicians, nurses, and other healthcare workers—not only in Congress, but also in statehouses and governors’ mansions.