New data from the CDC suggests a grim back-to-school tradition emerging: in 2024, kindergarten vaccination rates declined for the fifth consecutive year. Meanwhile, vaccine exemptions reached a record high.
These statistics became all the more disturbing last fall when, shortly after 286,000 children began their educations without proof of full immunity against measles, a man who has bragged about never getting a flu shot was re-elected to the presidency. Since then, the US has contended with its largest measles outbreak in three decades, while the leaders who should be stamping out this crisis are instead fanning the flames.
In just eight months, Trump and Robert F Kennedy Jr, secretary of the Department of Health and Human Services, have made every effort to undermine one of the major civilizing advances of the 20th century – our public health infrastructure. In doing so, they risk endangering millions of people and kickstarting a doom loop of mistrust from which it could take decades to recover.
As usual, the Trump administration’s stance on vaccines is motivated less by sincere populism and more by personal profit. Before Kennedy launched his own presidential campaign on a platform of “making America healthy again”, he earned $20,000 every week helming a non-profit dedicated to fostering vaccine skepticism. Now in the cabinet, he has fired the entire CDC vaccine advisory panel and replaced them with a ragtag crew, half of whom have never published peer-reviewed research on vaccines. Just last week, Kennedy cancelled $500m of federal funding for mRNA vaccines, which prevented 14m deaths during the Covid-19 pandemic. And he has made these rollbacks while retaining a financial stake in ongoing litigation against a vaccine manufacturer.
All the while, the US has seen more than 1,300 measles cases and three deaths this year. In response, Kennedy has alternately endorsed and undermined the most effective method of prevention – widespread immunization.
The evisceration of funding has extended across the sciences, with Trump cutting support for research to a 35-year nadir. At the National Institutes of Health, 1,800 grants have been terminated, a move that the Government Accountability Office deemed illegal. The administration also continues to freeze grants to universities over culture war phantasms like DEI, including $339m at UCLA and $2.2bn at Harvard. So it’s not surprising that 75% of US scientists polled by the journal Nature are considering leaving the country, which raises the prospect of a lost generation of American talent and lifesaving innovation.
Internationally, Trump’s heartless and thoughtless budget cuts are causing devastation. The administration has dismantled USAID, one of the most successful preventers of contagious disease in history. In doing so, it defunded programs that vaccinated more than 800 million children against fatal illnesses like malaria. Researchers have found that 300,000 people have already died because of these cuts, which could lead to another 14m preventable deaths over the next five years – all to gut an agency that managed the equivalent of 4% of the annual national defense budget.
Back in the US, medical associations, local officials and individual doctors are collaborating to buy vaccines directly from manufacturers and lobbying insurance companies to continue covering the costs of those shots. Their efforts reflect a tried-and-true strategy to counter under-immunization. Before the current outbreak, Ronald Reagan-era cuts to public health caused a more widespread measles pandemic, with 27,000 cases in just 1990. But locally led outreach campaigns and grassroots vaccination programs turned back the crisis, as did an eventual restoration of federal funds under Bill Clinton’s administration.
Budget cuts can be reversed, but trust may be more difficult to recover. Long before RFK Jr’s ascendancy, disasters like the CDC’s infamous Untreated Syphilis Study at Tuskegee and the Food and Drug Administration’s glacial response to the Aids crisis cast long shadows over public health institutions. Today, a plurality of Americans are already predicting they will lose faith in medical guidance under the current administration. That would undermine the very basis of public health, which depends on people choosing to follow guidelines grounded in research they did not personally conduct and whose results they are ill-trained to parse.
Repairing that breach will require years of effortful relationship-building, but it might also require rallying Americans with the classic tactic of patriotism. For all of Trump’s bellicose rhetoric, he misses that our nation’s most extraordinary scientific and medical advances have drawn bipartisan enthusiasm in part because they reinforced a perceived American exceptionalism. At the height of the cold war, RFK Jr’s uncle chose to go to the moon, and Richard Nixon brought that dream to fulfilment. After Franklin Delano Roosevelt founded the National Foundation for Infantile Paralysis, Americans helped fund it by mailing in more than 2.5m dimes, hence its christening as the March of Dimes. That money supported Jonas Salk’s development of the polio vaccine. Within two years of its introduction, annual cases of polio had fallen by 90%.
Even Trump, who botched the initial response to Covid-19, managed to oversee the historic Operation Warp Speed. If only he could recognize that this is the kind of achievement which makes America great.
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