The U.S. Food and Drug Administration’s (FDA) head of vaccine safety says that President-elect Donald Trump’s embrace of vaccine skeptics could be an opportunity for the science community to teach the public about the value of these life-saving drugs. However, if these efforts fail it could lead to “natural…

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Of all the promises, from quixotic to horrifying, that Donald Trump has made about the next four years, the one that seems least likely to be fulfilled is his vow to “defeat anti-Semitism.” He has nominated a slew of cranks who have dabbled in the oldest conspiracy theory of them all, a belief that Jews control the world.

Over the past decade or so, pernicious lies about Jewish villainy have drifted into the mainstream of American life. That’s a fact Trump acknowledges when he talks about his plans to “defend Jewish citizens in America.” But he tends to focus on the problem at college campuses, which constitutes an incomplete diagnosis. It allows Trump to ignore his own complicity in unleashing the worst wave of anti-Jewish sentiment in generations.

In his first administration, Trump provided rhetorical cover for supporters who blared hateful sentiments—those “very fine people,” Kanye West, and others. This time, he’s placing them in the line of presidential succession. If confirmed, this crew would comprise the highest-ranking collection of White House anti-Semites in generations.

Take Matt Gaetz, Trump’s nominee for attorney general. He is a fierce opponent of the Antisemitism Awareness Act, which would curtail federal funding for institutions of higher education that fail to address the hatred of Jews when it flourishes on their campuses. There are principled reasons for rejecting the bill. But in the course of arguing against it, Gaetz revealed himself. He asserted that the legislation’s definition of anti-Semitism would penalize the belief that the Jews killed Jesus. This wasn’t a point Gaetz made in the spirit of protecting free speech. He fervently believes it himself. “The Bible is clear. There is no myth or controversy on this,” he posted on X. This is the canard from which the whole Western tradition of anti-Semitism flows, a belief officially repudiated by the Catholic Church at the Second Vatican Council nearly 60 years ago.

And it wasn’t a stray expression. In 2018, Gaetz invited Charles Johnson, a notorious figure on the alt-right, to attend the State of the Union address as his guest. Johnson is a textbook example of a Holocaust denier. He insists that only 250,000 Jews died—and only of typhus—during World War II. In a Reddit “Ask Me Anything” session, he wrote that he agreed with a commenter “about Auschwitz and the gas chambers not being real.” When confronted with Johnson’s record, Gaetz admitted that he hadn’t properly vetted Johnson before extending him an invitation. Even so, he told Fox Business that Johnson is “not a holocaust denier.” That defense, given all the evidence about Johnson presented to him, is tantamount to an endorsement.

The essence of conspiracism is the description of the hidden hand, the ubiquity of all-powerful evildoers. That is Robert F. Kennedy Jr.’s overriding intellectual habit. He believes that the CIA killed his uncle, and he attributes autism to vaccines. In 2023, he was caught on video suggesting that COVID-19 might be a bioweapon. Espousing such a theory should be disqualifying for the job of running America’s public-health system. But he went further. He said that the disease was designed to attack Caucasians and Black people. “The people who are most immune are Ashkenazi Jews and Chinese.” (In case it needs saying, this is false.) As a well-practiced conspiracist, he knew to append his theory with a disclaimer, adding, “We don’t know whether it was deliberately targeted or not,” as if he were merely asking an innocent question. And when confronted with his own words, he denied any ill intent: “I haven’t said an anti-Semitic word in my life.”

[Read: The sanewashing of RFK Jr.]

But his insinuation echoed the medieval Christian libel that Jews had poisoned the wells of Europe, unleashing the Black Death. Kennedy’s winking accusation also mimics a strain of white-supremacist pseudoscience, which asserts that Ashkenazi Jews are a distinct race from Caucasians. According to this bizarre, and bizarrely prevalent, theory, that’s what makes Jews so pernicious: They can pass for white people while conspiring to undermine them.

Not so long ago, these sorts of comments would have rendered a nominee unconfirmable—or at least would have necessitated an excruciating apology tour. But anti-Semitism is no longer taboo. And it’s telling that Trump has adopted Elon Musk as a primary adviser, because Musk is a chief culprit in the lifting of that taboo.

When Musk bought Twitter in 2022, he reversed a ban imposed by the company’s previous regime that kept anti-Semites and Holocaust deniers off the platform. Under his ownership, anti-Jewish voices became unavoidable fixtures on the site, broadcasting their bigoted theories without any fear of consequences.

One reason they have little to fear is that Musk has displayed sympathy for their worldview. Like them, he harps on the wickedness of George Soros, whom he once likened to the comic supervillain Magneto, a mutant who plots to wipe out humanity. (Like Soros, Magneto is a Holocaust survivor.) This comparison almost explicitly admits its exaggeration of Jewish nefariousness. And if the thrust of his sentiments wasn’t clear enough, he emphatically endorsed a tweet claiming that “Jewish communities have been pushing … dialectal hatred against whites.”

For a time, Musk refuted his critics by smearing them. He accused the Anti-Defamation League, the nation’s leading Jewish civil-rights group, of orchestrating a campaign to destroy him. Eventually, to fend off an advertiser boycott, he apologized, visited Auschwitz, and called himself “aspirationally Jewish.”

The presence of these conspiracists doesn’t suggest that Trump will pursue policies that provoke Jewish suffering. His support for Israel might even win him the approval of a growing segment of organized Jewry. Instead, the danger posed by his appointees is that their mere presence in high office will make American anti-Semitism even more permissible; they will make conspiracies about Jews socially acceptable. Indeed, that might already have happened. Trump just proposed the most anti-Semitic Cabinet in recent history, and that fact has barely elicited a peep.

When I was taking German in college in the early years of this millennium, I once stumbled upon a word that appeared foreign even when translated into English: Diphtherie, or diphtheria. “What’s diphtheria?” I wondered, having never encountered a single soul afflicted by this disease.

Diphtheria, once known as the “strangling angel,” was a leading killer of children into the early 20th century. The bacterial infection destroys the lining of the throat, forming a layer of dead, leathery tissue that can cause death by suffocation. The disease left no corner of society untouched: Diphtheria killed Queen Victoria’s daughter, and the children of Presidents Lincoln, Garfield, and Cleveland. Parents used to speak of their first and second families, an elderly woman in Ottawa recalled, because diphtheria had swept through and all their children died.

Today, diphtheria has been so thoroughly forgotten that someone like me, born some 60 years after the invention of a diphtheria vaccine, might have no inkling of the fear it once inspired. If you have encountered diphtheria outside of the historical context, it’s likely because you have scrutinized a childhood immunization schedule: It is the “D” in the DTaP vaccine.

Vaccine breakthroughs over the past two centuries have cumulatively made the modern world a far more hospitable place to be born. For most of human history, half of all children died before reaching age 15; that number is down to just 4 percent worldwide, and far lower in developed countries, with vaccines one of the major drivers of improved life expectancy. “As a child,” the vaccine scientist Stanley Plotkin, now 92, told me, “I had several infectious diseases that almost killed me.” He ticked them off: pertussis, influenza, pneumococcal pneumonia—all of which children today are routinely vaccinated against.

But the success of vaccines has also allowed for a modern amnesia about the level of past human suffering. In a world where the ravages of polio or measles are remote, the risks of vaccines—whether imagined, or real but minute—are able to loom much larger in the minds of parents. This is the space exploited by Robert F. Kennedy Jr., one of the nation’s foremost anti-vaccine activists and now nominee for secretary of Health and Human Services. It is a stunning reversal of fortune for a man relegated to the fringes of the Democratic Party just last year. And it is also a reversal for Donald Trump, who might have flirted with anti-vaccine rhetoric in the past but also presided over a record-breaking race to create a COVID vaccine. Kennedy has promised that he would not yank vaccines off the market, but his nomination normalizes and emboldens the anti-vaccine movement. The danger now is that diseases confined to the past become diseases of the future.

Walt Orenstein trained as a pediatrician in the 1970s, when he often saw children with meningitis—a dangerous infection of membranes around the brain—that can be caused by a bacterium called Haemophilus influenzae type b or Hib. (Despite the name, it is not related to the influenza virus.) “I remember doing loads of spinal taps,” he told me, to diagnose the disease. The advent of a Hib vaccine in the 1980s virtually wiped these infections out; babies are now routinely vaccinated in the first 15 months of life. “It’s amazing there are people today calling themselves pediatricians who have never seen a case of Hib,” he says. He remembers rotavirus, too, back when it used to cause about half of all hospitalizations for diarrhea in kids under 5. “People used to say, ‘Don’t get the infant ward during diarrhea season,’” Orenstein told me. But in the 2000s, the introduction of rotavirus vaccines for babies six months and younger sharply curtailed hospitalizations.

To Orenstein, it is important that the current rotavirus vaccine has proved effective but also safe. An older rotavirus vaccine was taken off the market in 1999 when regulators learned that it gave babies an up to one-in-10,000 chance of developing a serious but usually treatable bowel obstruction called intussusception. The benefits arguably still outweighed the risks—about one in 50 babies infected with rotavirus need hospitalization—but the United States has a high bar for vaccine safety. Similarly, the U.S. switched from an oral polio vaccine containing live, weakened virus—which had a one in 2.4 million chance of causing paralysis—to a more expensive but safer shot made with inactivated viruses that cannot cause disease. No vaccine is perfect, says Gregory Poland, a vaccinologist and the president of the Atria Academy of Science & Medicine, who himself developed severe tinnitus after getting the COVID vaccine. “There will always be risks,” he told me, and he acknowledges the need to speak candidly about them. But vaccine recommendations are based on benefits that are “overwhelming” compared with their risks, he said.

The success of childhood vaccination has a perverse effect of making the benefits of these vaccines invisible. Let’s put it this way: If everyone around me is vaccinated for diphtheria but I am not, I still have virtually no chance of contracting it. There is simply no one to give it to me. This protection is also known as “herd immunity” or “community protection.” But that logic falls apart when vaccination rates slip, and the bubble of protective immunity dissolves. The impact won’t be immediate. “If we stopped vaccinating today, we wouldn’t get outbreaks tomorrow,” Orenstein said. In time, though, all-but-forgotten diseases could once again find a foothold, sickening those who chose not to be vaccinated but also those who could not be vaccinated, such as people with certain medical conditions and newborns too young for shots. In aggregate, individual decisions to refuse vaccines end up having far-reaching consequences.

Evolutionary biologists have argued that plague and pestilence rose in tandem with human civilization. Before humans built cities, back when we still lived in small bands of hunter-gatherers, a novel virus—say, from a bat—might tear through a group only to reach a dead end once everyone was immune or deceased. With no one else to infect, such a virus will burn itself out. Only when humans started clustering in large cities could certain viruses keep finding new susceptibles—babies or new migrants with no immunity, people with waning immunity—and smolder on and on and on. Infectious disease, you might then say, is a necessary condition of living in a society.

But human ingenuity has handed us a cheat code: Vaccines now allow us to enjoy the benefits of fellow humanity while preventing the constant exchange of deadly pathogens. And vaccines can, through the power of herd immunity, protect even those who are too young or too sick to be effectively vaccinated themselves. When we get vaccinated, or don’t, our decisions ricochet through the lives of others. Vaccines make us responsible for more than ourselves. And is that not what it means to live in a society?

Robert F. Kennedy Jr., the bear-fondling, gravel-voiced Camelot scion, is President-Elect Donald Trump’s pick to lead the Department of Health and Human Services, where presumably he will “go wild on health,” to quote Trump. His nomination has raised concerns among public-health experts because many of Kennedy’s views on health are, well, wild.

To be sure, among Kennedy’s battier ideas are a few reasonable ones, such as reducing obesity and cracking down on direct-to-consumer drug commercials and conflicts of interest among researchers. But these are eclipsed by some troubling ones, such as the ideas that common cooking oils are poisonous, that fluoride doesn’t belong in tap water, and that childhood vaccines are questionable.

What if Kennedy did, in fact, go wild on health, get his way, and remake America in his own image? If his worst ideas come to pass, experts tell me, heart attacks might increase, dental infections might spike, and children might needlessly die of completely preventable diseases.

[Read: RFK Jr. collects his reward]

Even if he is confirmed as health secretary, Kennedy’s influence on some of these domains might be limited. Most public-health measures—including water fluoridation and vaccines—are a matter for states and localities, not the federal government. (This is why different states had such different COVID-19 responses.) But even so, a Secretary Kennedy would have a prominent perch from which to espouse his ideas, and his position would give him a veneer of credibility that he has not earned. Right-leaning states and judges might listen, and adapt local policies to suit his worldview. At the very least, parents who support Trump and Kennedy might take the administration’s views into account when making decisions for their families.

Let’s begin with seed oils, which keep popping up in Kennedy’s speeches and media clips. (He even mentioned them while suspending his presidential bid.) Kennedy has called seed oils, which include common cooking oils such as canola oil and sunflower oil, “one of the most unhealthy ingredients that we have in foods,” and says Americans are being “unknowingly poisoned” by them.

Kennedy believes that seed oils cause “body-wide inflammation” and disease. But this isn’t true, Christopher Gardner, a nutrition scientist at Stanford, told me. In fact, replacing foods high in saturated fat, such as butter, with those high in unsaturated fat, such as canola oil, has been proven again and again to lower cholesterol levels and reduce the risk of heart disease. To the extent that seed oils are bad, Gardner said, it’s because they often show up in highly processed junk and fast food.

And Kennedy’s solution to this supposed health crisis—to replace seed oils with beef tallow—is troubling. (Several of his seed-oil clips end with a promo of red Kennedy swag that reads MAKE FRYING OIL TALLOW AGAIN.) Whatever you do with seed oil, “don’t replace it with beef tallow,” Gardner said. “That’s friggin’ nuts.” Replacing all the oil you eat with beef fat can cause cholesterol to pile into plaques in your arteries, impeding the flow of blood. “That’s how you get a heart attack,” Gardner said.

Kennedy has also said he wants to remove fluoride from tap water, claiming that the compound is an “industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”

There is some risk associated with excessive fluoride intake: Consuming fluoride above a level of 1.5 milligrams a liter—about twice the level that’s in most fluoridated tap water—has been linked to lowered IQ in children. Fluoridated water can also cause light stains on teeth, which affect about 12 percent of people in the United States.

But researchers say these risks are generally worth it because the consequences of removing fluoride from the water are much worse. Fluoride helps strengthen tooth enamel, and it also fights off the acid that attacks our teeth any time we eat carbohydrates. If the teeth lose this battle, decay can set in—and if the decay goes untreated, it can cause excruciating pain and, in extreme cases, pus-filled abscesses. “There will certainly be an increase in dental decay if fluoride is removed from the drinking water,” Gary Slade, a dentistry professor at the University of North Carolina at Chapel Hill, told me. Slade found in a study that fluoride in drinking water reduces decay by 30 percent in baby teeth and 12 percent in permanent teeth.

Some cities and countries have removed fluoride from the water, and kids’ dental health suffered as a result. After Israel ceased water fluoridation in 2014, dental treatments in a clinic in Tel Aviv increased twofold across all ages. In Canada, after Calgary ceased water fluoridation in 2011, second graders there experienced more cavities than those in Edmonton, where water was still fluoridated. After Juneau, Alaska, ceased water fluoridation in 2007, children younger than 6 underwent more cavity-related dental procedures—at a cost of about $300 more a year per child. Some cities have even reintroduced fluoride into the water supply after noticing an uptick in tooth decay among children.

Kennedy is perhaps most infamous for his skepticism of vaccines, and this is also likely the issue where his views are most consequential and worrisome. Although Kennedy sometimes shies away from calling himself anti-vaccine, he is the founder of the anti-vaccine group Children’s Health Defense and once wrote a (now-retracted) magazine story on the (false) link between vaccines and autism. He’s called vaccines “a holocaust” and has claimed that “there’s no vaccine that is safe and effective.” A co-chair of the Trump-Vance transition team has said that Kennedy would be given access to federal health data in order to assess the safety of vaccines.

Though school vaccine requirements are determined by states, a prominent national-health figure casting doubt on vaccines’ safety can influence both state policy and individual parents’ decisions to vaccinate. If vaccination rates do drop, among the diseases that health experts worry will return is measles, the most contagious of the vaccine-preventable diseases.

A person infected with measles is most contagious right before they develop symptoms. They can infect others simply by sharing their air space; tiny droplets infected with measles can hang in the air for two hours “like a ghost,” Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, told me.

Kids with measles are sick and miserable. They’re photophobic—afraid of the light—and may struggle to breathe. Before the measles vaccine came along in 1963, 48,000 people were hospitalized with measles each year in America, many with pneumonia or inflammation of the brain. Five hundred of them died each year. When Samoa suffered a measles outbreak in 2019, 83 people died, out of a population of just 200,000.

Measles can also weaken the immune system, Matthew Ferrari, a biology professor at Penn State, told me. For two to three years after contracting measles, you’re likely to be hit harder by flu and other viruses. In rare cases, measles can cause a chronic form of brain inflammation that leads to a gradual loss of mental faculties and motor skills, and eventually, death.

[John Hendrickson: The first MAGA Democrat]

Measles is such a menace, in fact, that giving people “a choice” about whether to vaccinate their kids, as Kennedy often suggests, is not sufficient. People who have received two doses of the MMR vaccine are 97 percent protected against measles. But about 9 million people, including kids who are undergoing chemotherapy or who are on some kinds of immunosuppressants, can’t get vaccinated. These individuals rely on herd immunity from other vaccinated people, and when more than 5 percent of people choose not to be vaccinated, herd immunity suffers.

“Is it your right to catch and transmit a potentially fatal infection? No, it’s not,” Offit said. “You are part of this society, and you have to recognize that what you do affects other people.” Offit told me he’s already talked with pediatricians who say parents are hesitant to get their children vaccinated because of what they’ve heard Kennedy say.

Of course, there is a way to prevent Kennedy from having this much influence over public health: The Senate could reject his nomination. But that would require Republicans to stand up to Trump, which is a wild idea in itself.

RFK Jr might try to curb access to vaccines if not able to impose an outright ban but will face pushback, experts say.