Miranda Yaver, a professor of public health policy at the university of Pittsburgh, writes about Trump’s disastrous choice to run the National Institutes of Health.

She writes:

I first got interested in health policy because of Ronald Reagan, but not in the way you might think. 

Growing up in the San Francisco Bay Area with a mom who worked at the United Way, I was well aware of the HIV/AIDS epidemic. I knew people who were HIV positive. So when HBO released the film adaptation of And the Band Played On, I was riveted. Enraged. Filled with righteous indignation. 

To be honest, it hasn’t really worn off. 

Randy Shilts wrote in his prologue to And the Band Played On (which I reread amid the COVID-19 pandemic) the following:

“The bitter truth was that AIDS did not just happen to America – it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health. This failure of the system leaves a legacy of unnecessary suffering that will haunt the Western world for decades to come…. The story of these first five years of AIDS in America is a drama of national failure, played out against a backdrop of needless death. People died while Reagan administration officials ignored pleas from government scientists and did not allocate adequate funding for AIDS research until the epidemic had already spread throughout the country… People died while public health authorities and the political leaders who guided them refused to take the tough measures necessary to curb the epidemic’s spread, opting for political expediency over the public health.”

So was also the case for the COVID-19 pandemic, which was unleashed upon the world at a time in which the United States’ public health bureaucracy was hotly politicized, chronically underfunded, and constrained by anti-science forces at the head of the Trump Administration. 

And rather than learning from the mistakes of this pandemic, the most dangerous among them are being rewarded with high-level posts from which to spew anti-scientific drivel, which can come with real life-or-death consequences. 

I’m not talking about R.F.K. Jr… this time. Right now, I’m talking about Jay Bhattacharya, who according to Dan Diamond of The Washington Post is likely poised to be the new head of the National Institute of Health (NIH), having been listed by RFK Jr. as a top contender for the position, which falls under the broader umbrella of HHS. 

It has admittedly been an interesting experience to watch the nominations unfold, having written a doctoral dissertation on the problems that arise when agencies are headed by people who oppose the agencies’ core missions, and when Congress and others are ill-equipped or disinclined to hold those agencies accountable. You know, hypothetically. 

So, who is Jay Bhattacharya? Needless to say, he has been a critic of the NIH while being celebrated by noted public health opponent, Florida Governor Ron DeSantis. His other cheerleaders include Peter Thiel, Elon Musk, and Joe Rogan – you know the voices of reason in public health. 

His opposition within the public health community is not about partisanship, but rather the anti-science stances that he embraced over the course of the deadly pandemic, and which have been widely perceived among experts as having prioritized the business community over health outcomes. While I joined with experts in public health and medicine through the organization Brief-19 to disseminate evidence-based analyses of the public health and policy implications of what we were learning from day to day about the pandemic, Bhattacharya downplayed the threat of the virus, instead emphasizing less government control and more reliance on individual choices to self-protect. 

Rugged individualism and self-reliance. Now where have we heard that before? 

To be sure, I have had many quibbles with Ayn Rand and her followers over the years. Some of it is political. Some of it isn’t. 

The reality is that rugged self-reliance just simply doesn’t work in the public health setting. Public health can and indeed must be rather paternalistic, because by definition it’s focused not on individual health, but collective health outcomes and system performance. Choosing not to get vaccinated is bad for you, but it’s really bad for your community. Choosing not to mask or socially distance during a pandemic undercuts not only your and your family’s safety, but it compromises scientifically-grounded public interventions aimed at flattening the curve. This requires that we care not just about “me me me,” but to think more broadly. That isn‘t always easy for Americans. But given that we know that the next pandemic isn’t a matter of “if” but rather “when,” it’s vital that our institutions of public health be staffed with grown-ups who believe in science and understand that effective public health interventions should be prioritized over individual convenience. And they absolutely need to be staffed with people who know better than to elevate pseudoscience and grifters – whether in hedge funds, on podcasts, or widely discredited academics relying on a degree to lend credence to anti-scientific and/or anti-democratic theories. 

Indeed, a prominent supporter of Bhattacharya was his Stanford colleague Scott Atlas, who went against the scientific community in encouraging lower-risk people to become infected with COVID-19 as a means to promote herd immunity, and who urged the reopening of schools even as we knew that there would be risks of increased transmission in those settings. And Bhattacharya contributed to The Great Barrington Declaration, which urged that younger Americans return to work and build immunity against the COVID virus. 

All of this was in the interest of creating a false dichotomy between helping the economy and promoting public health. But the reality is that while people of both parties want a robust business sector, containing a deadly virus is an important precursor. What is the value of having a business open if would-be patrons are sick or dying? What is the value of forcing a business open if staff immediately become exposed and sick? 

Investments in public health pay off. We see this in the insurance setting, which is where most of my own research and teaching are situated. Of course, covering people costs money. But what is the result? People are able to access needed care. They are able to manage chronic and acute medical conditions. They are able to not only survive but thrive. And in light of that, they can be productive in the American economy, while health care providers are relieved of the economic burdens of uncompensated care. 

These are not burdens. They are investments. 

America just emerged – far from unscathed – from a major, deadly pandemic the likes of which we had not seen since the 1918 Spanish flu. And we deserve public health leaders who learned the right lessons from it. Instead, Bhattacharya’s impulse amid the COVID pandemic was to see the core problem as the stifling of dissent (which is to say, prioritizing public health expertise over the legitimization of quackery).

These are not the only reasons why Bhattacharya would be a problematic selection to head NIH. While he boasts impressive academic credentials, he has never before overseen a large bureaucratic organization, while the National Institute of Health has nearly 20,000 staff. To be sure, RFK Jr. and others within Trump’s orbit see it as an advantage to lack government experience, largely because of a deeper distrust of the government apparatus and hostility to government interventions (even those which could honestly be termed “pro-life”). But governmental and managerial competence is vital, and when this is put on the back burner in the domain of public health, there are life-or-death consequences. 

Bhattacharya has ideas for how the NIH should operate, and it doesn’t look good, essentially coming down to its decentralization as well as deprioritizing the expertise of long-serving bureaucrats. This disregard for agency expertise fits well within the Trump Administration’s broader opinions on the administrative state (or what’s left of it after Loper Bright), seeking to clamp down on civil servants who are perceived as being politically disloyal. Prof. Don Moynihan has written extensively on these issues in Schedule F positions, and you should read it.

If we are lucky, as with the first Administration, the degree of incompetence will exceed the high degrees of malevolence, thus stymying the most dangerous policy proposals that have been floated. But we should not have to root for public health incompetence when our lives – not to mention our research funding on a broad array of public health and health policy subjects – depend on the strength of this agency. 

Jay Bhattacharya would deeply damage our efforts to study public health problems facing the country and the world and would signal even further entrenchment of conspiratorial perspectives and political expediency where we most need to follow the science. Tom Nichols wrote a book called The Death of Expertise: The Campaign Against Established Knowledge and Why it Matters. As with my own work on bureaucratic noncompliance amid misaligned agency objectives, I fear that this will be all too relevant in the coming months and years.

Now here is another Trump promise that should keep us up at night: He has said that RFK Jr. will have a large role in his administration, overseeing the appointees in the areas that interest him: public health and food.

Melody Schreiber writes in The New Republic:

In June 2019, Robert F. Kennedy Jr. visited Samoa with his anti-vaccine organization, Children’s Health Defense, meeting with local anti-vaxxers and government officials at a time when the country’s measles vaccine was under attack. Prominent anti-vax voices, including CHD, blamed the vaccine for two infant deaths the prior year, even after the true reason was discovered. Amid the swirling misinformation, vaccine rates plummeted from 60–70 percent to 31 percent.

A few months after RFK Jr.’s visit, measles swept through the freshly vulnerable Pacific island nation, killing 83 Samoans—mostly children. Kennedy doubled down, writing to the Samoan prime minister to questionwhether a “defective vaccine” was responsible for the outbreak. Even two years later, in 2021, Kennedy called a Samoan anti-vaxxer who had reportedly discouraged people from getting vaccinated during the 2019 crisis a “medical freedom hero.” Kennedy has also insisted for years, against all available scientific evidence, that vaccines cause autism, blaming them for a “holocaust” in the United States.

This week, Kennedy told supporters that if Republican presidential candidate Donald Trump wins, he has promised Kennedy “control of the public health agencies,” including the Department of Health and Human Services. Trump transition co-chair Howard Lutnik later denied that Kennedy would have a job with HHS—although, at the same time, he said Kennedy had convinced him to pull vaccines from the market. Trump himself, at his Madison Square Garden rally on Sunday, seemed to lend credence to the idea of Kennedy leading on health: “I’m gonna let him go wild on health. I’m gonna let him go wild on the food. I’m gonna let him go wild on medicines,” Trump said. Trump also said on a three-hour podcast episode with Joe Rogan last week that he’s told Kennedy, “Focus on health, focus—you can do whatever you want.” It’s not clear whether such a promise would have been made in exchange for Kennedy’s political endorsement, which would be illegal.

But if Kennedy were to be put in charge of HHS, he would be leading the executive department that oversees the U.S. Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health, among others. In the meantime, Kennedy is an honorary co-chair on the Trump transition team, and claims to be “deeply involved in helping to choose the people who can run FDA, NIH, and CDC.”

In his own speech at Madison Square Garden, Kennedy took aim at Democrats, saying they were once “the party that wanted to protect public health, and women’s sports”—a bizarre pairing that highlights his recent pivot to attacking trans athletes and gender-affirming care. Kennedy, who ran as a Democratic and then independent presidential candidate before throwing his support behind Trump, is also spreading misinformation on chronic health issues such as obesity, diabetes, drug overdoses, and autism; on Tuesday, for example, he said diabetes could be “cured with good food.” In his Sunday speech, Kennedy characterized Trump as a president who would “protect our children … and women’s sports,” as well as “end the corruption at the federal agencies—at FDA, at NIH, at CDC, and at the CIA”—a constellation of bodies rarely joined together, which he implied are conducting surveillance upon and acting against the interests of the American people.

“This unbridled assault on science and scientists, it’s highly destabilizing for the country,” Baylor College of Medicine dean Peter Hotez, author of The Deadly Rise of Anti-Science, told me earlier this year, a few months after Kennedy announced his run. But it’s not just Kennedy—Trump and other Republicans in Congress are also leading the charge to undermine expertise and further erode public trust in the government, he said. “This is what authoritarianism is all about,” Hotez said, lamenting “the collateral damage that it’s going to do to our democracy” and pointing to the ways Stalin portrayed scientists as public enemies during the Great Purge.

Hotez sees the false claims about vaccines causing autism, which first started gaining momentum in the late 1990s, as phase one of the assault on science. When that was thoroughly debunked, anti-science activists began aligning themselves “around the banner of health freedom, medical freedom,” getting a major boost with the Covid-19 pandemic, Hotez said. “Now we’re seeing the next phase, which is not only targeting the science but targeting the scientists and portraying them as public enemies. That is both scary and worrisome.”

The past five years have seen a “substantial” drop of trust in public health and scientists, especially among Republicans, Robert Blendon, Harvard University professor emeritus of political analysis and health policy, told me. At the same time, the anti-vaccine movement—which previously was not tied to politics—swung wildly to the right. “Republicans have become incredibly distrustful of vaccines,” Blendon said. “The Republican Party after the [start of] Covid has become very anti–public health.” They lashed out against what they perceived to be government overreach, which made them receptive to questions about the safety and effectiveness of the Covid vaccines—and, soon, other vaccines as well, Blendon said. “This led to a tipping point with this enormous resentment among particularly Republican audiences that the government went way too far.”

Trump’s own short-lived support for vaccines during the measles outbreak in 2019 and Covid in 2020 seems to have been a blip; he has spouted anti-vax views since at least 2007. Although Operation Warp Speed produced highly effective Covid vaccines in record time, one of the Trump administration’s only accomplishments of the pandemic, “the Republicans don’t want to claim it,” Trump said in September. At least 17 times, Trump has pledged to defund schools mandating vaccines. While his campaign says this vow applies to Covid vaccines only, Trump doesn’t make any distinctions in his speeches, opening up the possibility of all childhood vaccines being banned—though it’s not clear how he would carry out this plan. (No states requireCovid vaccines for school attendance.)