MAHA! The Deliberate Collapse of Public Health

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Measels
Graphic by Terelle Jerricks

 

“Measles is back in America!” Infectious disease expert Peter Hotez said on MSNOW’s All In. “And by the way, measles is not the only one. Whooping cough, pertussis, is back. We’ve had a sixfold rise from 2023, 2024.” There have been 49 measles outbreaks this year, with 2,065 confirmed cases in 43 states as of Dec. 30, up from 285 cases last year, another sixfold rise. A single outbreak in South Carolina in December topped 175 cases, mostly unvaccinated patients. Vaccination rates are down dramatically since before the pandemic, particularly in red states.

But it’s not just the return of infectious diseases we thought had been vanquished decades ago. America’s biggest health weakness has been made worse, while our strengths are being savagely attacked. It’s the exact opposite of the twin GOP promises to “Make America Great Again” and “Make America Healthy Again.”

America’s weakness is that it’s the only advanced industrial country without universal health care, a weakness partially remedied by Obamacare (the Affordable Care Act) and enhanced coverage under Joe Biden in response to COVID-19. Both are now being rolled back. Our strengths lie in three things — high vaccination rates (even protecting the uninsured), and top-flight medical education and biomedical research, which draw talent from around the world. We’ve also been a leader in global public health, with USAID vaccinations responsible for preventing 91 million deaths since 2001, according to a Lancet study.

But the GOP is rapidly destroying these strengths, while deepening our weakness. Alongside the rising infections, millions of Americans are losing their health insurance this month, with prices more than doubling for many plans. Life-threatening medical misinformation is being spread by the administration, vaccine protections are being rolled back, biomedical research is being decimated, and funding for medical education is being slashed. USAID has been destroyed, with a global death toll of more than three-quarters of a million deaths last year, almost half a million of them children. Altogether, it’s a wholesale attack on the nation’s health — both now, and for decades into the future.

 

Measles Rises as Vaccinations Fall

As measles cases spike, vaccination rates are plummeting — especially in red states — meaning things will only get worse. The share of U.S. counties with herd immunity (at least 95% vaccinated) has plunged from 50% per-pandemic to 28% today, according to a recentWashington Post analysis, while most counties lacking herd immunity got worse. And there isn’t a single county with herd immunity in Idaho, Louisiana, Oregon, Tennessee, Utah or Wisconsin.

While California’s statewide average is 96%, there isn’t herd immunity for all counties, or more importantly, all schools. In the Southland, it’s true for five counties: LA (96.2%), Orange (97.1%), Ventura (96%) and Riverside (95.4%), and Imperial (96.9%), but not for San Diego (94.1%) or San Bernardino (92.9%).

Locally, almost all schools have herd immunity — South Shores, Taper Avenue, and Bandini at 98%, for example, White Point at 96% and Point Fermin and Leland Street at 95%. But this isn’t true for all. Fifteenth Street Elementary only has an 85% vaccination rate. Others below herd immunity include Philomena (87%) in Carson, Stevenson (93%) and Garfield (92%) in Long Beach, and Van Deene Avenue (90%) and Halidale (94%) in Torrance.

RFK Jr.’s Broader Attack on Vaccines

While there’s more to disease resurgence than RFK Jr., his policy hostility and spreading of disinformation surely played a role, not least by installing staff that’s actively rolling back vaccine standards and funding. In 2023 he said, “There’s no vaccine that is, you know, safe and effective,” and although he’s denied saying it, it’s clearly driving his multi-prong attacks on vaccines, which has included replacing all the scientists on the Center for Disease Control and Prevention’s 17-member vaccine advisory panel with a mix of anti-vaxx ideologues and incompetents he handpicked himself. He actually once said, “There’s even good evidence that even Spanish flu came from vaccine research,” a ludicrous claim since the virus wasn’t even identified until decades later.

In reality, vaccines have saved millions of lives in America and around the world. Last August, a CDC report concluded that the U.S. Vaccines for Children program from 1994 to 2023 will, over time, “have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs.” That’s an enormous savings in lives, health and money that RFK Jr. and his anti-vaxx colleagues would happily destroy.

A year ago, we warned that he was a double-barrel threat to America, “Dangerous enough that 77 Nobel laureates — 31 in medicine — wrote a letter to senators urging them to reject him, saying RFK Jr.’s appointment ‘would put the public’s health in jeopardy and undermine America’s global leadership in the health sciences.’”

A year later, that’s proven to be true. To cite one example: In a Nov. 28 memo, Dr. Vinay Prasad, the Food and Drug Administration’s top vaccine regulator, informed staffers that the agency’s “career staff have found that at least 10 children have died after and because of receiving COVID-19 vaccination.”

But that was a lie. The final Dec. 5 memo states that under an established World Health Organization framework, zero deaths were deemed “certain” to have been caused by COVID-19 vaccines, two were judged to be “probable/likely,” while five were “possible,” according to Dr. Jeremy Faust at Inside Medicine. He went on to note that even if all the probable and possible deaths were counted, per-dose death rate would be “far smaller than the per-dose risk of anaphylaxis deaths from common medications like ibuprofen.”

In contrast, a 2023 study found that from May 30, 2021, to Sept. 3, 2022, “at least 232,000 [COVID-19] deaths could have been prevented among unvaccinated adults.” That’s 23,200 times as many lives saved as Prasad falsely claimed had been lost.

RFK Jr. has also canceled hundreds of millions of dollars in federal investment for mRNA vaccines. His handpicked advisory committee has stopped recommending COVID-19 vaccines for healthy people younger than 65, unless they consult a health care provider, a barrier certain to reduce vaccine access. And it’s reversed three long-standing policies:

  • It rescinded recommendations for any flu shots containing thimerosal, a preservative that’s been in use for nearly a century, which keeps multidose vaccine bottles free of bacteria and other contamination.
  • It revoked a longstanding recommendation of the MMRV vaccine (measles, mumps, rubella, and chickenpox) for children under 4.
  • It revoked the 1991 recommendations for hepatitis B vaccination for all newborns, which has reduced chronic hepatitis B infections in children and adolescents by 99%. A 2022 study found that U.S. children who received the vaccines as newborns were 22% less likely to die from any cause
  • It drastically cut the slate of recommended vaccines from 17 to 11, eliminating hepatitis A, hepatitis B, meningococcal disease, rotavirus, influenza, and respiratory syncytial virus, the leading cause of hospitalization in American infants. This was done without the scientific review process that’s been used for decades.

All these changes went against what the CDC’s own experts advised.

Overall, Hotez said, RFK’s agenda is “all about bringing back disease and making vaccines unavailable,” and once you realize that, “all of his public statements, all of his actions begin to make sense. But he’s doing it in a very clever way, in a nefarious sort of way, which is that he’s not doing this all at once. He’s doing this step-by-step-by-step, with every couple of weeks, he targets a new vaccine.”

 

Health Insurance Costs Skyrocket

In contrast to RFK’s slow-drip approach, another health threat is very much front of mind — the first mass health impact of Trump’s “Big Beautiful Bill” that took well over $1 trillion away from health care spending to provide tax cuts for the rich. Most of that came from Medicaid cuts, delayed to take effect after the 2026 midterms, to shield Republicans from voter backlash. But over $200 billion in cuts to ACA marketplace tax credits kick in this month. A KFF study in the fall projected prices more than doubling on average for 22 million Americans. The impact will be softened or obscured in multiple ways, but millions are expected to lose insurance altogether, as costs soar astronomically.

Here in California, the state has gone to great lengths to soften the blow to its Covered California enrollees. First, it allocated $190 million to backfill lost federal subsidies for its lowest-income enrollees, a small fraction of the $2.5 billion in federal subsidies in 2025. Costs will be covered completely for those below 150% of the federal poverty level ($23,475 for an individual, $48,225 for a family of four) and partially for those making less than 165% ($25,822.50 and $53,047.50, respectively).

Second, Covered California sent enrollees notices with current plan details but also listed another plan on the exchange with a lower premium, Executive Director Jessica Altman told CNN in December. “Most people in Covered California … have plans available to them that cost less than the plan they have today,” she said. Their research found that, on average, families can save 23% on Gold and Platinum plans, and 39% on Silver plans.

As of Dec. 27, re-enrollments were holding steady. But new enrollments this year are down significantly since last year (32% statewide and 33.3% in LA County), and it will be several months before the full picture is clear, as many people who auto-enroll may stop making payments they can no longer afford.

Plan-level changes are significant. As of Dec. 27, “More than a third of new consumers are enrolling in Bronze plans, compared to only one in five at this time last year,” the website said. “This is largely due to a reduction in new enrollees choosing Silver plans (69% in 2025, compared to 52% of new enrollees in 2026).” However, the drop in Silver plans (66,814) is much larger than the increase in Bronze plans (3,451). The bigger driver simply seems to be reduced enrollment overall. At the high end, Platinum plans are down (1,872), almost twice as much as Gold plans are up (1,072).

It’s too early to tell how bad it will be, but there’s no doubt that costs will skyrocket, and millions nationwide will again be uninsured.

 

The Attack on Education and Research

Another major attack on America’s health comes from attacks on medical education and research. The former are difficult to quantify and to disentangle from broader attacks on education, as well as attacks on foreign students. For example, international student enrollment is down 17%, a significant number of which would have been involved in medical education. Education cuts at all levels have a cumulative impact on how many doctors, nurses, and medical researchers ultimately graduate from college, and while exact figures are lacking, it’s safe to say there is no level at which education isn’t being cut, and our future health isn’t being harmed.

Attacks on medical research have been tracked more precisely, specifically, the Trump administration cancellations of National Institutes of Health grants, the kinds that have contributed to more than 99% of FDA-approved drugs between 2010 and 2019. According to Grant Witness, 5,843 NIH grants have been disrupted, of which 4,598, for a current loss of $724 million. But this figure is misleadingly low. Disrupting grants this way destroys the value of money already spent, while costing trial participants as well.

A November report found that funding cuts to NIH grants between February and August 2025 affected more than 74,000 participants in 383 clinical trials, approximately 1 in 30 total NIH trials. This included 118 cancer trials, 97 trials studying infectious diseases, 18 trials studying cardiovascular diseases, and 48 trials studying reproductive health.

What’s more, NIH has another $5.1 billion earmarked for colleges or universities that has yet to be spent. And going forward, Trump has cut NIH funding by 40% in his proposed 2026 budget. And there have also been wide-ranging cancellations of grants by the Environmental Protection Agency and the National Science Foundation. As a result, a recent Nature survey found that more than 75% of U.S.-based scientists are considering leaving the country, mostly for Europe or Canada. There hasn’t been an exodus of scientific talent like this since Germany just after World War II, another ominous reminder of what America has become under Trump.

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