Is Public Health Dead?

This is one of the questions we tease out answers to in the Democratic Institutions Seminar I teach. It’s helpful for deciding how, exactly, you want to define the institutions. We consider whether Public Health, writ large, belongs in the second tier of democratic institutions, the ones that extend beyond the three branches of government—the free press, the military, public education, and others, depending on who you’re talking with. Every year when I teach this part of the class, I’m joined by colleagues from the School of Public Health, and it’s always the part of the class I look forward to the most.

I think of public health as the science of preventing disease, prolonging life, and promoting health through the organized efforts of governmental agencies, supplemented by people who work in this area at universities and in the public sector. By definition, then, it exists in countries that aren’t democracies. It’s not an institution like the free press that exists only in the context of democracy. But in many ways, a robust public health system is essential to the success of a democracy, on a par with public schools, unions, an informed citizenry, and other entities that make a democracy robust.

There’s also a more subtle connection between public health and democracy that I focused on as a U.S. Attorney. So many of the problems we face that are assigned to law enforcement are better addressed when public health and law enforcement officials work together with their communities. Gun violence is one example. In Birmingham, during my time in office, we worked with our public health colleagues on opioid overdose deaths, a problem that we realized, quite simply, we could not arrest our way out of. That work opened my eyes to a lot of possibilities. The colleagues who join my students to discuss public health are among the best advocates for democracy, just in a way we don’t normally thing of as contributing to that work.

In class we focus on vaccinations as one way of understanding how important this intersectional work can be. And we’ve talked, every year, about the eradication of measles in this country. This year, with measles on the rise, it will be a very different conversation. Scholars who track vaccination opposition identify two key reasons for it:

• Vaccination is a dangerous procedure whose risks outweigh its benefits

• Efforts to pressure or compel people to be vaccinated (or to vaccinate

  their children) violate individual rights

In recent years, the individual liberties argument has predominated, although that may shift with a vaccine opponent running HHS. The American Academy of Pediatrics has deemed the situation so important that they’ve sued Trump’s anti-science pick to head HHS, Robert Kennedy Jr., over recent changes to Covid vaccine recommendations.

In a May 2024 piece for Health Affairs, a number of noted public health experts wrote about the unexpected consequences of court decisions during the Covid pandemic and how they affected public health. They noted that “A more recent study published in Health Affairs examined 123 decisions that granted relief to plaintiffs who challenged public health measures during the pandemic … during the course of the pandemic, courts ‘shifted’ how they reviewed challenges to religious liberty or administrative procedure claims, granting health officials less deference than they had traditionally been afforded. This shift was especially evident and important in the 9 decisions favorable to challengers issued by the United States Supreme Court.” They pointed out that “at least 25 states enacted legislation curbing the legal authority of public health officials. Many judicial decisions also pushed back against broad interpretations of public health officials’ legal powers.”

Opposition no longer comes from the fringes of society. The call, as they say, is coming from inside of the house.

The rule of law isn’t the only cornerstone of our democracy that has been severely damaged during the Trump era. We are seeing it more clearly now, in this second term, with Kennedy in office, hollowing out some of the best of public health while the administration wages war on public health infrastructure inside of government and the universities and research institutions that advance it on the outside. The consequences are serious.

That takes us to the measles, which are on the rise. This chart shows the jump in Texas between February and April.

Measles, eradicated in the U.S. in 2000, 25 years ago, is back. We live in the world of myth v. science, a place where the known cure, vaccination, is abandoned. And for what purpose? It’s hard to see how this can serve even Trump, who thrives on chaos. There have been more measles cases in the U.S. in 2025 than in any other year since it was declared eradicated—and it’s only July. Public health experts say that trend is likely a marker for other deadly diseases whose spread can also be curtailed if not eliminated with vaccines.

Usually, we discuss Trump replacing law and justice with politics, one of the keynotes of his administrations. Here, we’re talking about politics replacing science, and the consequences are deadly. What first emerged as a story about an outbreak in southwest Texas in a Mennonite community has now developed further, with reporting by CDC that there have been measles outbreaks in 38 states. The New York Times reports that, “Because of the contagiousness of the virus, researchers often think of measles as the proverbial canary in a coal mine. It is often the first sign that other vaccine-preventable diseases, like pertussis and Hib meningitis, might soon become more common.” For those of us who aren’t in the medical community, a friend who is a pediatrician explained it to me like this: “Hib meningitis was scary as hell. Often fatal. Lots of hearing loss, etc ... in those that survived. We assumed any baby with fever had a Hib infection and treated it as such until proven otherwise.” What’s coming down the road may be even more serious than measles, although it’s not exactly a picnic with a death rate of 2-3 per thousand. It has long term effects including one, “immune amnesia” that wipes your immune system clean into a blank slate, leaving you with no protection.

Here’s the key point. Just like politicizing the military or the FBI damages public confidence, politicizing vaccination, like the incredibly moment we live through during the Covid pandemic with Trump talking about bleach and Ivermectin, even as lifesaving vaccines were coming online, politicizing vaccines reduces the public’s willingness to take them and critically, to vaccinate their children. Democrats pushed back heavily against the choice of Kennedy, a known vaccine denier. It doesn’t take a lot to lose immunity. For measles, 95% is herd. We’ve dipped below that to a national average of 93%. At the center of the outbreak in West Texas, it was 82%

All of this was predictable, given Project 2025, which called for the moment we’re living in with Medicaid on the chopping block and Obamacare’s promise being overridden. Project 2025 called for prohibiting the CDC from issuing guidance on vaccines and masks, leaving such decisions entirely to parents and medical providers (p. 454). Now, we’re seeing Kennedy put an end to the boards that provide guidance that allows the vaccines that keep us safe to come online every year.

Senator Cassidy, a medical doctor who understands the risk of installing Robert Kennedy Jr. as HHS Secretary, nonetheless voted to confirm him.

The damage this administration is doing to institutions, whether you count public health as a democratic one or not (virtually every year, my class concludes that it is) is immeasurable. And some of it is very personal. Firing career public employees might seem remote to people who don’t work in government. Closing USAID impacts other countries primarily. MAGA has plenty of excuses for what Trump is doing to federal law enforcement. It’s easy for people who want to do so to look away. But public health is different. You can’t ignore measles, which is highly contagious, as herd immunity continues to drop. If you want to talk with friends and family who still haven’t seen the light about what’s happening, public health, unfortunately, is a good place to start.

We’re in this together,

Joyce

Thanks for reading and for caring about what’s going on in the world. Paid subscriptions let me keep putting in the time to do this right, and I’m really thankful for everyone who helps make that possible.