Donald Trump will be propelled to the White House for a second term amid concerns about inflation kicked off by the pandemic, with a leading vaccine skeptic – Robert F Kennedy Jr – at his side, and proposals from conservative supporters to fundamentally restructure public health agencies central to pandemic-era ire.
Covid-19 was never seen as the central issue of the 2024 presidential campaign season, but in the first post-pandemic presidential election, it reverberated as the anti-vaccine movement ascended to its greatest political heights ever.
Even in his Wednesday morning acceptance speech, Trump alluded to changes he expects as his administration comes into focus.
The vaccine skeptic and conspiracy theorist Robert F Kennedy Jr. is “going to help make America healthy again”, Trump told supporters, before adding: “We’re going to let him go to it.”
Dr Howard Markel, a historian of medicine at the University of Michigan who has studied pandemics, said he was struck by widespread anger, and called the election’s theme “the ghost of pandemic future”.
“Did you ever think,” Markel said he remarked to colleagues, “when you were doing all this hard work and staying up all night that not like 1% or 10%, but like 50% of the country would be saying you destroyed their life and kept them inside, out of harm’s way, during the pandemic?”
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Although it never topped his agenda, the pandemic echoed throughout Trump’s campaign. He adopted the slogan: “Make America healthy again” from Kennedy, answered supporters’ recent questions about Covid-19 vaccine mandates in the military, and spoke with the popular podcaster Joe Rogan about polio vaccines. Project 2025, the Heritage Foundation’s conservative playbook, repeatedly drew on anger about mask mandates.
One prominent concern from experts is the damage that could be wrought by putting a vaccine skeptic at the helm of powerful federal health agencies. Trump has not announced a specific role for Kennedy in the administration, but Kennedy said he was “promised” control over health policy.
His influence appears to have increased amid repeated mentions of “Bobby” in the lead-up to election day.
Kennedy, who had been running as an independent candidate in the 2024 presidential election but dropped out and endorsed Trump in August, is a conspiracy theorist known for spreading unfounded claims. Some of those included the idea that HIV does not cause Aids and thoroughly debunked theories that vaccines are linked to autism.
“The first issue on the table is vaccines,” said Dr Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Even without changing public policy, Osterholm said, if authorities with the imprimatur of the federal government speak out against vaccines, “that discourages people who might otherwise be vaccinated, and at that point that’s as bad as not having a vaccine at all”.
The effects are not theoretical. As recently as last week, the CDC released a report that found fewer than one in six healthcare workers had received updated Covid-19 vaccines in the 2023-24 respiratory virus season, and fewer than half had received flu shots.
Childhood vaccinations have also dipped since the pandemic. In the US, for children born in 2020-21, the rates of children younger than two who had received all their vaccinations fell as the percentage who had received none grew. The largest declines were for children who received both flu shots (-7.8%). Vaccination hesitancy and misinformation both were cited as major reasons by researchers.
“We forget what this country was like 50 years ago – how many children died every year from polio, pertussis, measles,” said Osterholm. “We’re going to see the return of diseases we have controlled for decades and with that many additional severe illnesses in hospitals and deaths – and that’s just from the rhetoric, not even withdrawing vaccines.”
Kennedy has already recommended another vaccine skeptic and the current Florida surgeon general, Dr Joseph Ladapo, as secretary of Health and Human Services (HHS), a massive federal agency that houses 13 divisions and 10 subagencies, including the CDC and the National Institutes of Health (NIH), the largest publicly funded biomedical and behavioral research agency in the world. Ladapo urged Floridians not to get the Covid-19 vaccine and allowed unvaccinated children to go to school amid a measles outbreak in the state.
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“RFK Jr holds a series of false beliefs not supported by scientific evidence, and he’s always a threat to vaccines,” said Dr Paul Offit, director of the Vaccine Education Center and a doctor at Children’s Hospital of Philadelphia. Offit added that proposals in Project 2025 may hold a comparable threat.
Currently, the CDC makes recommendations about which vaccines people should get and when, including for children; the CDC works in tandem with the Food and Drug Administration (FDA), which approves vaccines.
Project 2025, the conservative playbook written in part by Trump’s former director of the office of civil rights at HHS, proposes limiting the CDC’s ability to make policy recommendations, such as producing vaccine schedules.
“Their notion was: ‘Let the parents and doctors decide’ – the notion being that the parents and doctors are just as informed as the people sitting around making those decisions,” said Offit.
Put another way, by Osterholm: “We often say a physician who treats himself is a fool.”
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