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On Christmas Eve of 2020, my father was admitted to the hospital with sudden weakness. My mother was not allowed to join him. She pleaded with the staff—my dad needed help making medical decisions, she said—but there were no exceptions at that grisly stage of the coronavirus pandemic. I contemplated making the trip from Maryland to New Jersey to see whether I, as a doctor, could garner special treatment until I realized that state and employer travel rules would mean waiting for a COVID test result and possibly facing quarantine on my return. In the end, my father spent his time in the hospital alone, suffering the double harm of illness and isolation.

These events still frustrate me years later; I have a hard time believing that restrictions on hospital visitation and interstate travel helped more people than they hurt. Many Americans remain angry about the pandemic for other reasons too: angry about losing a job, getting bullied into vaccination, or watching children fall behind in a virtual classroom. That legacy of bitterness and distrust is now a major political force. Robert F. Kennedy Jr. is on the precipice of leading our nation’s health-care system as secretary of Health and Human Services. The Johns Hopkins professor Marty Makary has been tapped to lead the Food and Drug Administration. And the Stanford professor Jay Bhattacharya is expected to be picked to run the National Institutes of Health. These men have each advocated for changes to the systems and structures of public health. But what unites them all—and what legitimizes them in the eyes of this next administration—is a lasting rage over COVID.

To understand this group’s ascent to power and what it could mean for America, one must consider their perception of the past five years. The world, as Kennedy, Makary, Bhattacharya, and their compatriots variously understand it, is dreadful: SARS-CoV-2 was likely created in a lab in Wuhan, China; U.S. officials tried to cover up that fact; and the government responded to the virus by ignoring scientific evidence, violating citizens’ civil rights, and suppressing dissent. In the face of this modern “dark age,” as Bhattacharya has called it, only a few brave dissidents were willing to flip on the light.

Makary, Trump’s pick for the FDA, presents as being in the truth-to-power mold. A surgeon, policy researcher, and—full disclosure—my academic colleague, he gained a loyal following during the pandemic as a public-health critic. Through media outlets such as Fox News and The Wall Street Journal, Makary advocated for a more reserved use of COVID vaccines: He suggested that adults who had recovered from a COVID infection, as well as children more generally, could forgo some doses; he is also skeptical of booster shots for everyone and vaccine mandates. Makary, too, thinks that public-health officials have been lying to the American people: “The greatest perpetrator of misinformation during the pandemic has been the United States government,” he told Congress last year, referring to public-health guidance that emphasized transmission of COVID on surfaces, downplayed natural immunity, encouraged boosters in young people, and promoted the efficacy of masking.

[Read: The sanewashing of RFK Jr.]

Bhattacharya, a doctor and health economist, rose to fame in October 2020 as a co-author of the Great Barrington Declaration, which advocated for a “focused protection” approach to the pandemic. The idea was to isolate vulnerable seniors while allowing low-risk individuals to return to their normal lives. Much of the public-health community aggressively criticized this strategy at the time, and—as would later be revealed—NIH Director Francis Collins privately called for a “quick and devastating” takedown of its premise. Twitter placed Bhattacharya on a “trends blacklist” that reduced the reach of his posts, according to internal documents released to the journalist Bari Weiss in 2022. Among conservatives and lockdown skeptics, Bhattacharya has come to be seen as a fearless truth teller who was silenced by the federal government and Big Tech. (In reality, and despite his frequent umbrage, Bhattacharya was not ignored. He met with the Trump administration and was in communication with Florida Governor Ron DeSantis.)

In response to their marginalization from polite scientific society—and long before they were in line for key government positions—Makary and Bhattacharya have each sought out a public reckoning. They both called for the medical establishment to issue an apology to the American people. Makary demanded “fresh leadership” at an FDA that had made serious blunders on COVID medications and vaccines, and Bhattacharya asked for the formation of a COVID commission as a necessary first step in “restoring the public’s trust in scientific experts.” They even worked together at the Norfolk Group, a cohort of like-minded scientists and doctors that laid out what they deemed to be the most vital questions that must be asked of the nation’s public-health leaders. The gist of some of these is: Why didn’t they listen to “focused protection” supporters such as Bhattacharya and Makary? The report wonders, for instance, why Deborah Birx, a member of the White House Coronavirus Task Force, avoided meeting with a cadre of anti-lockdown advocates that included Bhattacharya in the summer of 2020. (“They are a fringe group without grounding in epidemics, public health or on the ground common sense experience,” Birx wrote in an email to the vice president’s chief of staff at the time.)

This sense of outrage over COVID will be standard in the next administration. Trump’s pick for surgeon general, the doctor and Fox News personality Janette Nesheiwat, has called the prolonged isolation brought about by shutdowns “cruel and inhumane,” and said that the collateral damage caused by the government’s actions was “worse than the pandemic” for most Americans. His nominee for secretary of Defense, Pete Hegseth, pushed for herd immunity in May 2020 and encouraged anti-lockdown protests.

[Read: Donald Trump’s most dangerous Cabinet pick]

Bhattacharya, at least, has denied having any interest in revenge. Last year he helped write an op-ed that cautioned against initiating a “Nuremberg 2.0” and instead presented scientists like himself and Makary as “apostles of evidence-based science” who are simply “calling for restoring evidence-based medicine to a pride of place in public health.”

Taken on its own, I’m sympathetic to that goal. I consider myself a fellow member of the “evidence-based medicine” movement that values high-quality data over blind loyalty to authority. I’m also of a similar mind as Makary about the FDA’s long-standing dysfunction. The COVID skeptics are correct that, in some domains, the pandemic produced too little knowledge and too much bluster. We still don’t know how well various social-distancing measures worked, what the best vaccination policy might be, or what the true origins of the virus were. I remember following the debates about these issues on Twitter, which functioned as a town square for doctors, scientists, and public-health leaders during the pandemic years. Mainstream experts tended to defend unproved public-health measures with self-righteousness and absolutism: You were either in favor of saving lives or you were one of the skeptics who was trying to kill Grandma. Nuanced conversations were rare. Accusations of “misinformation” were plentiful.

[Read: COVID science is moving backwards]

Robert F. Kennedy Jr. was indeed spreading misinformation with a fire hose. (For example, he has falsely said that the COVID shots are the “deadliest vaccine ever made.”) Bhattacharya and Makary have been far more grounded in reality, but they did make their own share of mistakes during the pandemic—and they haven’t spent much time rehashing them. So allow me to reflect on their behalf: In March 2020, Bhattacharya argued that COVID’s mortality rate was likely to be much lower than anyone was saying at the time, even to the point of being one-tenth that of the flu. “If we’re right about the limited scale of the epidemic,” he wrote, “then measures focused on older populations and hospitals are sensible.” Bhattacharya continued to be wrong in important ways. A pivotal assumption of the Great Barrington Declaration was that as more healthy people got sick and then recovered, the residual risk of new infections would fall low enough that vulnerable people could safely leave isolation. This process would likely take three to six months, his group explained. SARS-CoV-2, however, is still circulating at high levels nearly five years later. At least 1.2 million Americans have died from COVID. Had effective vaccines not arrived shortly after the 2020 declaration, senior citizens might be in hiding to this day.

As for Makary, his most infamous take involved a February 2021 prediction that the United States would reach herd immunity within two months. “Scientists shouldn’t try to manipulate the public by hiding the truth,” he wrote in The Wall Street Journal. The Delta and Omicron waves followed, killing hundreds of thousands more Americans.

When I reached out to Bhattacharya, he said his early guess about COVID’s mortality rate was meant only to help describe a “range of possible outcomes,” and that to characterize it otherwise would be false. (Makary did not respond to my questions for this story.)

The incoming administration’s COVID skeptics have also expressed sympathy for still-unproved theories about the pandemic’s origin. If you want to become an evidence apostle, believing that SARS-CoV-2 came from an NIH-funded lab leak seems to be part of the deal. Kennedy wrote multiple books purporting to link Anthony Fauci, in particular, to the creation of the virus. Similarly, Makary appears in a new documentary called Thank You Dr. Fauci, which describes “a bio-arms race with China and what could be the largest coverup in modern history.” (Fauci has denied these claims on multiple occasions, including in congressional testimony. He called the idea that he participated in a cover-up of COVID’s origins “absolutely false and simply preposterous.”)

A certain amount of sycophancy toward the more bizarre elements of the coalition is also common. Makary and Bhattacharya have both praised Kennedy in extravagant terms despite his repeated falsehoods: “He wrote a 500-page book on Dr. Fauci and the medical industrial complex. A hundred percent of it was true,” Makary said of a volume that devotes multiple chapters to casting doubt on HIV as the cause of AIDS. Earlier this month, Bhattacharya called Kennedy a “disruptor” whose views on vaccines and AIDS are merely “eccentric.” (Bhattacharya has also suggested that the vaccine skeptic and conspiracy theorist Robert Malone would be an “amazing leader” for the country’s health agencies.)

Anger about the government’s response to the pandemic swept the COVID contrarians into power. Resentment was their entrée into Washington. Now they’ll have a chance to fix some genuine, systemic problems with the nation’s public-health establishment. They’ll also have the ability to settle scores.

Robert F. Kennedy Jr. is wrong about a lot of things in public health. Vaccines don’t cause autism. Raw milk is more dangerous than pasteurized milk. And cellphones haven’t been shown to cause brain cancer. But the basic idea behind his effort to “Make America Healthy Again” is correct: America is not healthy, and our current system has not fixed the problem.

Joe Biden entered office promising to “beat” the coronavirus pandemic, cure cancer, and get more people health care. Arguably no one on Earth can talk more passionately about funding cancer research than Biden, whose son Beau died of brain cancer in 2015 and who, in 2022, announced an initiative to halve U.S. cancer deaths in the next 25 years. Robert Califf, Biden’s FDA commissioner, has been particularly stalwart in arguing that the agency must play a role in reversing a “catastrophic decline” in Americans’ life expectancy, and has repeatedly warned of “an ever-growing epidemic of diet-related chronic diseases,” such as cardiovascular disease and type 2 diabetes. A 2019 study found that just 12 percent of Americans are considered metabolically healthy, based on their waist circumference, blood sugar, blood pressure, and cholesterol.

Of course Biden’s White House was never going to end cancer or obesity in four years. But many of its policies barely scratched the surface of America’s wide-ranging health problems. Despite Califf’s dramatic language about the country’s diet problems, for example, the FDA’s efforts to improve the situation have mostly revolved around giving Americans more information about healthy foods.

The public-health bureaucracy that the Trump administration will inherit is more focused on and skilled at treating America’s health problems than preventing them. That shortcoming—despite the billions of dollars spent every year at these agencies—has damaged the credibility of the public-health establishment enough that Kennedy is now Donald Trump’s nominee for secretary of Health and Human Services. Marty Makary, Trump’s pick to lead the FDA, has similarly risen in prominence by second-guessing "medical dogma" in the U.S. and beyond. And Trump’s pick to lead the CDC, former Representative Dave Weldon, has criticized the agency’s vaccine policies and once attempted to block its vaccine-safety research because of what he claimed were conflicts of interest. A set of men who have made careers of distrusting our existing health-care agencies may soon be empowered to try to blow them up.

The Biden administration, to be fair, had less time to deal with America’s deeper health issues, because it was forced to deal with at least a few calamities. Much of Biden’s term was spent navigating the country out of the pandemic. On the whole, his administration achieved most of its COVID goals. The Biden White House provided Americans with free COVID tests and mounted a vaccination campaign that resulted in more than three-quarters of the country getting a shot. Still, the pandemic left the CDC beleaguered by claims that it was simultaneously too slow and too aggressive in its efforts to fight the virus. During Biden’s presidency, the agency promised to “share science and data faster” and “translate science into practical policy,” but it has struggled to respond to the continued spread of bird flu. Public-health experts have slammed the CDC for not sharing enough information about the virus’s spread, including a human case in Missouri earlier this year, and farmers have been reluctant to implement the agency’s recommendations for preventing transmission of the virus from sick cattle to humans.

Some of those calamities were self-inflicted. The FDA is entrusted with ensuring that our food and medicines are safe, and it generally does spot issues quickly after they occur. But for months, the FDA failed to act on a whistleblower complaint alerting regulators to deplorable conditions at an infant-formula factory that eventually caused nationwide formula shortages and two infant deaths. The FDA is also supposed to decide what tobacco products can be sold, but it has failed to police the illegal market for vapes and nicotine pouches, such as Zyn. And for all the administration’s talk of being guided by “science and truth,” the White House seemingly bowed to political pressure and abandoned a plan to ban menthol cigarettes at the very end of a long rule-making process. The past four years have revealed that crucial parts of the agency’s remit—most notably its oversight of tobacco and the food system—have been neglected by agency leadership; in 2022, independent reviews of the FDA’s food and tobacco centers found that both lacked clarity on mission and goals.

At the same time, the administration has failed to deliver on its loftier ambitions. Biden quietly dropped some of his bolder ideas, such as his campaign promise to create a public-option insurance plan. The Advanced Research Projects Agency for Health, a new government agency that funds high-risk, high-reward research and is essential to Biden’s cancer goals, is in its infancy, and Republicans in Congress are already eager to cut its budget. And some promises, such as Biden’s grand goal to help change America’s diet, have been approached more like trivial pursuits.

The administration branded its 2022 hunger and nutrition conference, for instance, as the largest and most important gathering on nutrition policy since the Nixon administration. That 1960s conference led to millions of children gaining access to school lunch and to the creation of the Special Supplemental Nutrition Program for Women, Infants, and Children (or WIC), which provides food to about 6 million Americans each month. The Biden administration’s summit ended with a pledge to end hunger and improve America’s diet by 2030, but the steps taken toward tackling those goals—such as developing a plan to add warning labels to unhealthy foods—have been modest. And all the agency has done so far on that project is conduct research on the labels’ potential design. The FDA has also pledged to lower the sodium in foods, but the targets it’s set for the food industry are entirely voluntary.

These efforts are understandably careful and bureaucratic. The agency’s caution over warning-label design comes amid threats from the food industry to sue over any label deemed unjustified. Indeed, in the U.S. legal system, regulators have trouble mandating that companies do much of anything without it being branded as unconstitutional. But the Biden administration’s efforts look comically inadequate given the scope of America’s health problems.

RFK Jr. is promising a break from the status quo. This is not to say that he, should he be confirmed as health secretary, has a better plan. Most of his ideas amount to little more than pronouncements that he will take sweeping actions immediately once Trump is sworn in as president. The reality is that many of those efforts would take months, if not years, to implement—and some might not be feasible at all. He has signaled, for example, that he will clear house at the FDA’s food center, despite rules that prevent government bureaucrats from being fired willy-nilly. He also has pledged to ban certain chemicals from food, which he’s argued are contributing to American’s lower life expectancy. But for every chemical the FDA bans, it will have to go through a lengthy regulatory process, which would likely be challenged by food companies in court. Kennedy’s notion of significantly altering the system of fees that drug makers pay the FDA to review their products would likely send the agency into a budgetary crisis.

If Kennedy gets confirmed to lead HHS, he will quickly be confronted with the reality that governing is a slow and tedious process that doesn’t take kindly to big, bold ideas, even with an impatient leader like Trump calling the shots. At the outset of his first term, Trump declared war on drug companies, which he claimed were “getting away with murder” due to their high prices. Trump’s then–health secretary, Alex Azar, in turn spent the next four years trying radical fixes that included requiring drug makers to post their prices in TV ads, importing drugs from Canada, tying American drug prices to other countries’, and eliminating the rebates that middlemen negotiate for insurance companies. But each idea got bogged down in bureaucracy and lawsuits. Trump’s early attempts to contain COVID by blocking international air travel similarly did little to keep the virus out of America, despite his claims at the time that the policy “saved us” from widespread outbreaks.

Biden benefited from Operation Warp Speed's rapid push to create vaccines, but it was his team of technocrats that finally got them distributed. And they eventually lowered drug prices too, in a much simpler way than Trump was proposing. But technocracy has also failed to address our most pressing—and most visible—health problems. Trump’s picks have little experience navigating the Rube Goldberg puzzle that is American bureaucracy. They certainly aren’t afraid of trying something new, but we’re about to find out how far that will get them.

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In the almost three weeks since his victory in the presidential election, Donald Trump has more or less completed nominations for his Cabinet, and he and his surrogates have made a flurry of announcements. The president-elect and his team have spent much of November baiting and trolling their opponents while throwing red meat to the MAGA faithful. (Trump, for example, has appointed Elon Musk and Vivek Ramaswamy to a nonexistent “Department of Government Efficiency,” an office whose acronym is a play on a jokey crypto currency.) And though some of Trump’s nominees have been relatively reasonable choices, in recent days Trump has put forward a handful of manifestly unqualified and even dangerous picks, reiterated his grandiose plans for his first days in office, and promised to punish his enemies.

We’ve seen this before. As I warned this past April, stunning his opponents with more outrages than they can handle is a classic Trump tactic:

By overwhelming people with the sheer volume and vulgarity of his antics, Trump and his team are trying to burn out the part of our brains that can discern truth from fiction, right from wrong, good from evil … Trump isn’t worried that all of this will cause voters to have a kind of mental meltdown: He’s counting on it. He needs ordinary citizens to become so mired in moral chaos and so cognitively paralyzed that they are unable to comprehend the disasters that would ensue if he returns to the White House.

Neither the voters nor the members of the U.S. Senate, however, should fall for it this time. Professor Timothy Snyder of Yale University has written that the most important way to resist a rising authoritarian regime is not to “obey in advance”—that is, changing our behavior in ways we think might conform to the demands of the new ruling group. That’s good advice, but I might add a corollary here: People should not panic and exhaust themselves in advance, either.

In practice, this means setting priorities—mine are the preservation of democracy and national security—and conserving mental energy and political effort to concentrate on those issues and Trump’s plans for them. It’s important to bear in mind as well that Trump will not take the oath of office for another two months. (Such oaths do not matter to him, but he cannot grab the machinery of government without it.) If citizens and their representatives react to every moment of trollery over the coming weeks, they will be exhausted by Inauguration Day.

Trump will now dominate the news cycle almost every day with some new smoke bomb that is meant to distract from his attempts to stock the government with a strange conglomeration of nihilistic opportunists and self-styled revolutionaries. He will propose plans that he has no real hope of accomplishing quickly, while trying to build an aura of inevitability and omnipotence around himself. (His vow to begin mass deportations on his first day, for example, is a logistical impossibility, unless by mass he means “slightly more than usual.” He may be able to set in motion some sort of planning on day one, but he has no way to execute a large-scale operation yet, and it will be some time before he has anywhere to put so many people marked for deportation.)

The attempt to build Trump into some kind of unstoppable political kaiju is nonsense, as the hapless Matt Gaetz just found out. For all of Trump’s bullying and bluster, Gaetz’s nomination bid was over in a matter of days. Two of Trump’s other nominations—Pete Hegseth for defense secretary and Tulsi Gabbard for director of national intelligence—might be in similar trouble as various Republicans begin to show doubts about them.

Senator James Risch, for example, a hard-right conservative from deep-red Idaho and the ranking Republican on the Senate Foreign Relations Committee, declined over the weekend to offer the kind of ritualistic support for Hegseth and Gabbard that Trump expects from the GOP. “Ask me this question again after the hearings,” Risch said on Saturday. “These appointments by the president are constrained by the advice and consent of the Senate. The Senate takes that seriously, and we vet these.”

What Risch seems to be saying—at least I hope, anyway—is that it’s all fun and games until national security is involved, and then people have to get serious about what’s at stake. The Senate isn’t a Trump rally, and the Defense Department isn’t a backdrop for a segment on Fox & Friends.

Similar thinking may have led to Scott Bessent as Trump’s nominee to run the Treasury. Bessent would have been an ordinary pick in any other administration, but in Trump World, it’s noteworthy that a standard-issue hedge-fund leader—and a man who once worked for George Soros, of all people—just edged out the more radical Trump loyalist Howard Lutnick, who has been relegated to Commerce, a far less powerful department. Culture warring, it seems, matters less to some of Team Trump when real money is involved.

None of this is a case for complacency. Hegseth and Gabbard could still end up winning confirmation. The anti-vaxxer Robert F. Kennedy Jr. could take over at the Department of Health and Human Services. Meanwhile, reports have also emerged that Trump may move Kash Patel—the very embodiment of the mercenary loyalist who will execute any and every Trump order—into a senior job at the FBI or the Department of Justice, a move that would raise urgent questions about American civil liberties.

But Trump cannot simply will things into existence. Yes, “the people have spoken,” but it was a narrow win, and Trump again seems to have fallen short of gaining 50 percent of the popular vote. Just as Democrats have had to learn that running up big margins in California does not win the presidency, Republicans are finding yet again that electoral votes are not the same thing as a popular mandate. The Senate Republican conference is rife with cowards, but only a small handful of principled GOP senators are needed to stop some of Trump’s worst nominees.

The other reality is that Trump has already accomplished the one thing he really cared about: staying out of jail. Today, Special Counsel Jack Smith moved to dismiss the January 6–related case against him. So be it; if enough voters have decided they can live with a convicted felon in the White House, there’s nothing the rest of us can do about that.

But Trump returning to office does not mean he can rule by fiat. If his opponents react to every piece of bait he throws in front of them, they will lose their bearings. And even some of Trump’s voters—at least those outside the MAGA personality cult—might not have expected this kind of irresponsible trolling. If these Republican voters want to hold Trump accountable for the promises he made to them during the campaign, they’ll have to keep their heads rather than get caught up in Trump’s daily dramas.

Allow me to add one piece of personal advice for the upcoming holiday: None of the things Trump is trying to do will happen before the end of the week. So for Thanksgiving, give yourself a break. Remember the great privilege and blessing it is to be an American, and have faith in the American Constitution and the freedoms safeguarded within it. If your Uncle Ned shows up and still wants to argue about how the election was stolen from Trump four years ago, my advice is the same as it’s been for every holiday: Tell him he’s wrong, that you love him anyway, that you’re not having this conversation today, and to pass the potatoes.

Related:

Pam Bondi’s comeback Another theory of the Trump movement

Here are three new stories from The Atlantic:

Revenge of the COVID contrarians The end of the quest for justice for January 6 Caitlin Flanagan on the Democrats’ billionaire mistake

Today’s News

Special Counsel Jack Smith filed motions to drop the federal election-subversion and classified-documents cases against Trump, citing a Justice Department rule against prosecuting sitting presidents. A California judge delayed the resentencing date for Lyle and Erik Menendez, the brothers imprisoned for killing their parents in 1989, to give the new Los Angeles County district attorney more time to review the case. The Israeli cabinet will vote tomorrow on a proposed cease-fire deal with Hezbollah, which is expected to pass, according to a spokesperson for Israeli Prime Minister Benjamin Netanyahu. The Israeli ambassador to the U.S. said on Israeli Army Radio that an agreement could be reached “within days” but that there remain “points to finalize.”

Dispatches

The Weekly Planet: Climate negotiations at COP29 ended in a $300 billion deal that mostly showed how far the world is from facing climate change’s real dangers, Zoë Schlanger argues. The Wonder Reader: One of the most humbling parts of being alive is realizing that you might need to reconsider some long-held habits, Isabel Fattal writes.

Explore all of our newsletters here.

Evening Read

Illustration by The Atlantic. Source: Getty.

Everyone Agrees Americans Aren’t Healthy

By Nicholas Florko

Robert F. Kennedy Jr. is wrong about a lot of things in public health. Vaccines don’t cause autism. Raw milk is more dangerous than pasteurized milk. And cellphones haven’t been shown to cause brain cancer. But the basic idea behind his effort to “Make America Healthy Again” is correct: America is not healthy, and our current system has not fixed the problem.

Read the full article.

More From The Atlantic

“Dear Therapist”: No one wants to host my in-laws for the holidays. The right has a Bluesky problem. The leak scandal roiling Israel What the broligarchs want from Trump

Culture Break

Everett

Watch. Every generation has an Oz story, but Wicked is the retelling that best captures what makes L. Frank Baum’s world sing, Allegra Rosenberg writes.

Try out. Group fitness classes aren’t just about exercise—they’re also a ridiculous, perfect way to make friends, Mikala Jamison writes.

Play our daily crossword.

P.S.

I often tell people to unplug from the news. (Hey, I get paid to have opinions about national events, and yet I make sure to stop watching the news now and then too.) If you’d like a break that will not only get you off the doom treadmill but refresh and recharge you, allow me to suggest binge-watching the new Ted Danson series on Netflix, A Man on the Inside. It’s charming and funny, and it might bring a tear to your eye in between some laughs.

Danson plays a recently widowed retired professor who takes a job with a private investigator as the “inside man” at a senior-citizen residence in San Francisco. (As someone who watched the debut of Cheers 42 years ago, I feel like I’ve been growing old along with Danson through his many shows, and this might be his best role.) He’s tracking down a theft, but the crime isn’t all that interesting, nor is it really the point of the show: Rather, A Man on the Inside is about family, friends, love, and death.

My wife and I sometimes found the show almost too hard to watch, because we have both had parents in assisted living and memory-care settings. But A Man on the Inside never hurts—it has too much compassion (and gentle, well-placed humor) to let aging become caricatured as nothing but tragedy and loss. It is a show for and about families, just when we need something we can all watch over the holidays.

— Tom

Stephanie Bai contributed to this newsletter.

When you buy a book using a link in this newsletter, we receive a commission. Thank you for supporting The Atlantic.

At a rally in Las Vegas in September, the reggaeton star Nicky Jam came onstage in a Make America Great Again hat and endorsed Donald Trump. “We need you. We need you back, right? We need you to be the president,” he said. But after a comedian at Trump’s rally at Madison Square Garden last month called Puerto Rico “a floating island of garbage,” the singer—whose father is Puerto Rican and who was raised partly on the island—had second thoughts.

“Never in my life did I think that a month later, a comedian was going to come to criticize my country and speak badly of my country, and therefore, I renounce any support for Donald Trump,” Nicky Jam said.

He had no right to be surprised. Trump himself had previously gone after Puerto Rico—he punished its leaders for criticizing him after Hurricane Maria, and sought to swap it for Greenland—but even if Nicky Jam had missed or forgotten that, he had to know who Trump was.

Nicky Jam was ahead of the curve. Since the election, Trump has moved swiftly to do things he’d said he’d do, and yet many people—especially his own supporters—seem stunned and dismayed. This is absurd. Surprise was perhaps merited in late 2016 and early 2017, when Trump was still an unknown quantity. But after four years as president, culminating in an attempt to erase an election he lost, Trump has demonstrated who he is. Somehow, the delusion of Trump à la carte—take the lib-owning, take the electoral wins, but pass on all of the unsavory stuff—persists.

In an article about how Trump’s transition is “shocking the Washington establishment,” Peter Baker of The New York Times writes: “Nine years after Mr. Trump began upsetting political norms, it may be easy to underestimate just how extraordinary all of this is.” He’s right that the aberrant nature of the picks may be overlooked, as I have warned, yet it is also true that the actual unpredictability of them is overestimated.

[From the January/February 2024 issue: Trump isn’t bluffing]

On K Street, Politico reports, health-care-industry lobbyists can’t believe that Trump has nominated Robert F. Kennedy Jr. to lead the Department of Health and Human Services. They were “expecting a more conventional pick,” even though Trump emphasized Kennedy’s “Make America Healthy Again” agenda late in the campaign, and even though Kennedy said that Trump had promised him control of HHS. To be sure, Kennedy is a shocking and disturbing pick, as Benjamin Mazer and my colleague Yasmin Tayag have recently written for The Atlantic, but his nomination should not come as a surprise—especially for people whose entire business proposition is being highly paid to advise clients on how Washington actually works. (The influence peddlers reportedly hope that senators will block Kennedy. The fact that they’re still waiting for someone else to solve their problems is further evidence of how little they’ve learned, years into the Trump era.)

Meanwhile, the New York Post, a key pillar of Rupert Murdoch’s right-wing media juggernaut, is similarly jittery about the Kennedy choice. Back when Kennedy was a thorn in President Joe Biden’s side, threatening to run against him in the Democratic primary, the Post’s editorial board was all too happy to elevate him. Now the board condemns his nomination and tells us that it came out of a meeting with him last year “thinking he’s nuts on a lot of fronts.” The columnist Michael Godwin, who beamed on November 9 that Trump’s victory “offers the promise of progress on so many fronts that it already feels like Morning in America again,” was back a week later to complain that “it’s not a close call to say” that Kennedy and Matt Gaetz, Trump’s pick for attorney general, are “unfit” for the roles.

The lobbyists and editorialists are in good company, or at least in some sort of company. On Capitol Hill, Republican senators say they are shocked by many of Trump’s Cabinet picks. Senator Susan Collins of Maine, who notoriously professed surprise when Justices Neil Gorsuch and Brett Kavanaugh voted to overturn Roe v. Wade, is “shocked” at the Gaetz nomination. Gaetz’s House Republican colleagues are “stunned and disgusted.”

Reactions to Pete Hegseth’s nomination as secretary of defense are less vitriolic, if no less baffled. “Wow,” Senator Lisa Murkowski of Alaska told NBC. “I’m just surprised, because the names that I’ve heard for secretary of defense have not included him.” Senator Bill Cassidy of Louisiana was even blunter. “Who?” he said. “I just don’t know anything about him.”

[David A. Graham: The Trump believability gap]

If this is true, the senators could perhaps do with some better staff work. Hegseth was a real possibility to lead the Department of Veterans Affairs in the first Trump administration; more to the point, he was a prominent figure on Fox News, which is a dominant force in the Republican Party, from whose ranks Trump has repeatedly drawn appointees.

Staffers at the affected agencies have also expressed shock and horror at the prospect of an Attorney General Gaetz, a Defense Secretary Hegseth, or a Director of National Intelligence Tulsi Gabbard.

Ordinary Americans may also be taken aback. As I reported last month, Trump critics were concerned about a “believability gap,” in which voters opposed some of Trump’s big policy ideas, sometimes quite strongly, but just didn’t trust that he would really do those things. Although they perhaps deserve more grace than the Republican officials and power brokers who are astonished, they also had ample warning about who Trump is and how he’d govern.

Throughout his presidential campaign, Trump vowed to deport undocumented immigrants en masse. He’s appointing officials such as Stephen Miller and Tom Homan who are committed to that, and yesterday morning, Trump confirmed on Truth Social a report that he would declare a national emergency and use the military to conduct mass deportations. And yet, when the roundups start in January, many people are somehow going to be taken by surprise.

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.

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Robert F. Kennedy Jr., the nominee to be the next secretary of Health and Human Services, is America’s most prominent vaccine skeptic. An advocacy organization that he founded and chaired has called the nation’s declining child-immunization rates “good news,” and referred to parents’ lingering doubts about routine shots as COVID-19’s “silver lining.” Now Kennedy may soon be overseeing the cluster of federal agencies that license and recommend vaccines, as well as the multibillion-dollar program that covers the immunization of almost half the nation’s children.

Which is to say that America’s most prominent vaccine skeptic could have the power to upend, derail, or otherwise louse up a cornerstone of public health. Raising U.S. vaccination rates to where they are today took decades of investment: In 1991, for example, just 82 percent of toddlers were getting measles shots; by 2019, that number had increased to 92 percent. The first Trump administration actually presided over the historic high point for the nation’s immunization services; now the second may be focused on promoting vaccines’ alleged hidden harms. Kennedy has said that he doesn’t want to take any shots away, but even if he were to emphasize “choice,” his leadership would be a daunting test of Americans’ commitment to vaccines.

In many ways, the situation is unprecedented: No one with Kennedy’s mix of inexperience and paranoid distrust has ever held the reins at HHS. He was trained as a lawyer and has no training in biostatistics or any other research bona fides—the sorts of qualifications you’d expect from someone credibly evaluating vaccine efficacy. But the post-pandemic era has already given rise to at least one smaller-scale experiment along these lines. In Florida, vaccine policies have been overseen since 2021 by another noted skeptic of the pharmaceutical industry, State Surgeon General Joseph Ladapo. (Kennedy has likened Ladapo to Galileo—yes, the astronomer who faced down the Roman Inquisition.) Under Ladapo’s direction, the state has aggressively resisted federal guidance on COVID-19 vaccination, and its department of health has twice advised Floridians not to get mRNA-based booster shots. “These vaccines are not appropriate for use in human beings,” Ladapo declared in January. His public-health contrarianism has also started spilling over into more routine immunization practices. Last winter, during an active measles outbreak at a Florida school, Ladapo abandoned standard practice and allowed unvaccinated children to attend class. He also seemed to make a point of not recommending measles shots for any kids who might have needed them.

Jeffrey Goldhagen, a pediatrics professor at the University of Florida and the former head of the Duval County health department, believes that this vaccine skepticism has had immense costs. “The deaths and suffering of thousands and thousands of Floridians” can be linked to Ladapo’s policies, he said, particularly regarding COVID shots. But in the years since Ladapo took office, Florida did not become an instant outlier in terms of COVID vaccination numbers, nor in terms of age-adjusted rates of death from COVID. And so far at least, the state’s performance on other immunization metrics is not far off from the rest of America’s. That doesn’t mean Florida’s numbers are good: Among the state’s kindergarteners, routine-vaccination rates have dropped from 93.3 percent for the kids who entered school in the fall of 2020 to 88.1 percent in 2023, and the rate at which kids are getting nonmedical exemptions from vaccine requirements went up from 2.7 to 4.5 percent over the same period. These changes elevate the risk of further outbreaks of measles, or of other infectious diseases that could end up killing children—but they’re not unique to Ladapo’s constituents. National statistics have been moving in the same direction. (To wit: The rate of nonmedical exemptions across the U.S. has gone up by about the same proportion as Florida’s.)

All of these disturbing trends may be tied to a growing suspicion of vaccines that was brought on during COVID and fanned by right-wing influencers. Or they could be a lingering effect of the widespread lapse in health care in 2020, during which time many young children were missing doses of vaccines. (Kids who entered public school in 2023 might still be catching up.)

In any case, other vaccination rates in Florida look pretty good. Under Ladapo, the state has actually been gaining on the nation as a whole in terms of flu shots for adults and holding its own on immunization for diphtheria, tetanus, and pertussis in toddlers. Even Ladapo’s outlandish choice last winter to allow unvaccinated kids back into a school with an active measles outbreak did not lead to any further cases of disease. In short, as I noted back in February, Ladapo’s anti-vaccine activism has had few, if any, clear effects. (Ladapo did not respond when I reached out to ask why his policies might have failed to sabotage the state’s vaccination rates.)

  

If Florida’s immunization rates have been resilient, then America’s may hold up even better in the years to come. That’s because the most important vaccine policies are made at the state and local levels, Rupali Limaye, a professor and scholar of health behavior at Johns Hopkins University, told me. Each state decides whether and how to mandate vaccines to school-age children, or during a pandemic. The states and localities are then responsible for giving out (or choosing not to give out) whichever vaccines are recommended, and sometimes paid for, by the federal government.  

But the existence of vaccine-skeptical leadership in Washington, and throughout the Republican Party, could still end up putting pressure on local decision makers, she continued, and could encourage policies that support parental choice at the expense of maximizing immunization rates. As a member of the Cabinet, Kennedy would also have a platform that he’s never had before, from which he can continue to spread untruths about vaccines. “If you start to give people more of a choice, and they are exposed to disinformation and misinformation, then there is that propensity of people to make decisions that are not based on evidence,” Limaye said. (According to The New York Times, many experts say they “worry most” about this aspect of Kennedy’s leadership.)

How much will this really matter, though? The mere prominence of Kennedy’s ideas may not do much to drive down vaccination rates on its own. Noel Brewer, a behavioral scientist and public-health professor at the UNC Gillings School of Global Public Health, told me that attempts to change people’s thoughts and feelings about vaccines are often futile; research shows that talking up the value of getting shots has little impact on behavior. By the same token, one might reasonably expect that talking down the value of vaccines (as Kennedy and Ladapo are wont to do) would be wasted effort too. “It may be that having a public figure talking about this has little effect,” Brewer said.

Indeed, much has been made of Kennedy’s apparent intervention during the 2019 measles crisis in Samoa. He arrived there for a visit in the middle of that year, not long after measles immunizations had been suspended, and children’s immunization rates had plummeted. (The crisis began when two babies died from a vaccine-related medical error in 2018.) Kennedy has been linked to the deadly measles outbreak in the months that followed, but if his presence really did give succor to the local anti-vaccine movement, that movement’s broader aims were frustrated: The government declared a state of emergency that fall, and soon the measles-vaccination rate had more than doubled.

As head of HHS, though, Kennedy would have direct control over the federal programs that do the sort of work that has been necessary in Samoa, and provide access to vaccines to those who need them most. For example, he’d oversee the agencies that pay for and administer Vaccines for Children, which distributes shots to children in every state. All the experts I spoke with warned that interference with this program could have serious consequences. Other potential actions, such as demanding further safety studies of vaccines and evidence reviews, could slow down decision making and delay the introduction of new vaccines.

Kennedy would also have a chance to influence the nation’s vaccine requirements for children, as well as its safety-and-monitoring system, at the highest levels. He’d be in charge of selecting members for the Advisory Committee on Immunization Practices, which makes recommendations on vaccines that are usually adopted by the states and result in standardized insurance coverage. He’d also oversee the head of the CDC, who in turn has the authority to overrule or amend individual ACIP recommendations.

Even if he’s not inclined to squelch any determinations outright, Kennedy’s goal of giving parents latitude might play out in other ways. Brewer, who is currently a voting member of ACIP (but emphasized that he was not speaking in that capacity), said that the committee can issue several different types of rulings, some of which roughly correspond to ACIP saying that Americans should rather than may get a certain vaccine. That distinction can be very consequential, Brewer said: Shots that are made “routine” by ACIP get prioritized in doctor’s offices, for instance, while those that are subject to “shared clinical decision-making” may be held for patients who ask for them specifically. Shifting the country’s vaccination program from a should to a may regime “would destroy uptake,” Brewer told me.

Those would seem to be the stakes. The case study of vaccine-skeptical governance that we have in Florida may not look so dire—at least in the specifics. But Kennedy’s ascendancy could be something more than that: He could steer the public-health establishment off the course that it’s been on for many years, and getting back to where we are today could take more years still.

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Donald Trump appears to experience the world through the glow of a television screen. He has long placed a premium on those who look the part in front of the camera. Paging Dr. Mehmet Oz.

Trump has picked Oz to lead the Centers for Medicare and Medicaid Services. CMS, as the agency is known, falls under the Department of Health and Human Services (HHS). Last week, Trump nominated Robert F. Kennedy Jr. to serve as HHS secretary. As you may have guessed, Kennedy and Oz are not only friends but kindred spirits. Oz is a global adviser at iHerb, a for-profit company that offers “Earth’s best-curated selection of health and wellness products at the best possible value.” He and Kennedy, two relative outsiders, are now positioned to enjoy a symbiotic relationship within Trump’s chaotic ecosystem.

Oz was last seen running for a Pennsylvania Senate seat in 2022. He lost to John Fetterman, who, despite dealing with the aftereffects of a stroke, carried the state by five points. Throughout that race, Oz struggled to combat the perception that he was a charlatan and carpetbagger who primarily lived in New Jersey. (Fetterman’s team repeatedly tagged Oz as an out-of-touch elitist, trolling him, for example, when he went grocery shopping for crudités and lamented high prices.) After that electoral defeat, Oz’s political dreams seemed all but dashed. But he wisely remained loyal to Trump—a person who has the ability to change trajectories on a whim.

In the pre-Trump era, it might have been a stretch to describe CMS administrator as an overtly political position. But Oz’s objective under Trump couldn’t be clearer. In a statement, Trump, using his reliably perplexing capitalization, telegraphed that Oz will bring a certain ethos to the job—a little MAGA, a little MAHA. Oz, Trump promised, will “cut waste and fraud within our Country’s most expensive Government Agency, which is a third of our Nation’s Healthcare spend, and a quarter of our entire National Budget.” And, because he’s Trump, he mentioned Oz’s nine daytime Emmy Awards.

Some 150 million Americans currently rely on the agency’s insurance programs, including Medicaid, Medicare, and Obamacare. Oz has been a proponent of Medicare Advantage for All. Though that sounds like the Medicare for All initiative championed by progressives such as Senator Bernie Sanders, the two programs are quite different. At its core, Medicare for All would set the U.S. on a path toward nationalizing health care. Trump would never go for that. But Medicare Advantage already exists within America’s patchwork private/public system, and Oz might push to strengthen it. He could also face budgetary pressure to weaken it. Oz’s own health-care views haven’t remained consistent. Though he once praised the mandatory universal models of Germany and Switzerland, as a Republican politician he threw his support behind privatized Medicare.

When asked about Oz’s nomination, Fetterman, his former opponent, told CNN: “As long as he’s willing to protect and preserve Medicaid and Medicare, I’m voting for the dude.” Some people were pissed. Victoria Perrone, who served as the director of operations on Fetterman’s Senate campaign, called out her old boss on social media: “Dr. Oz broke his pledge to ‘do no harm’ when he said red onions prevent ovarian cancer. My sis died of OC in 6/2022. This is a huge personal betrayal to me. We know he won’t protect the Medicaid that paid for her treatments,” Perrone posted on X. “I feel like I’ve been duped and 2 years of working on your campaign was a waste,” she added.

The above argument is illustrative of another reality Trump acknowledged in announcing his pick: “Make America Healthy Again” keeps growing. Oz, Trump declared, “will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake.” He went a step further, promising that Oz will bring “a strong voice to the key pillars of the MAHA Movement.” Oz holds degrees from Harvard and Penn, and he worked as a professor of surgery at Columbia. In spite of that pedigree, Oz has spent years facing credible accusations of medical quackery for his endorsement of dietary supplements. In 2014, he received a dramatic dressing-down on Capitol Hill. Senator Claire McCaskill read three statements that Oz had made on his eponymous show:

“You may think magic is make-believe, but this little bean has scientists saying they’ve found the magic weight-loss cure for every body type: It’s green coffee extract.”

“I’ve got the No. 1 miracle in a bottle to burn your fat: It’s raspberry ketone.”

“Garcinia cambogia: It may be the simple solution you’ve been looking for to bust your body fat for good.”

Oz’s defense that day was that his job was to be a “cheerleader” for the Dr. Oz audience. “I actually do personally believe in the items I talk about in the show. I passionately study them. I recognize oftentimes they don’t have the scientific muster to present as fact, but nevertheless, I would give my audience the advice I give my family,” he testified.

He emerged from that hearing largely unscathed. Two years later, Oz would go on to read what he claimed were Trump’s medical records on that same show. He famously praised Trump’s testosterone levels and supposed all-around health. Four years after that, once Trump was president, Oz sent emails to White House officials, including Trump’s son-in-law Jared Kushner, pushing them to rush patient trials for hydroxychloroquine, an unproven treatment for COVID.

In the next Trump administration, those are the sorts of exchanges Oz could be having with Kennedy—or with Trump himself. How did we get here? Oz landed this gig because he’s good on TV, yes, but also because, when he entered the political arena, he fully aligned himself with Trump. The 47th president rewards loyalty. If there’s one thing that’s become clear from his administration nominations so far, it’s that.

Some of Trump’s appointments will be less consequential than others. Anything involving the health and well-being of tens of millions of Americans is inarguably serious. Oz’s confirmation is not guaranteed, but his selection has already confirmed that nothing about Trump 2.0 is mere bluster.

Related:

Trump is coming for Obamacare again. (From January) Why is Dr. Oz so bad at Twitter? (From 2022)

Here are three new stories from The Atlantic:

Another theory of the Trump movement What the men of the internet are trying to prove Arash Azizi: The problem with boycotting Israel

Today’s News

Republican members of the House Ethics Committee blocked the release of the investigation into the sexual-misconduct and drug-use allegations against former Representative Matt Gaetz. Jose Ibarra, who was found guilty of killing Laken Riley on the University of Georgia campus, was sentenced to life in prison without possibility of parole. Trump tapped former WWE CEO Linda McMahon, who previously led the U.S. Small Business Administration during Trump’s first term, to be the secretary of education.

Dispatches

The Weekly Planet: Drought is an immigration issue, and Trump’s climate policies are designed to ignore that, Zoë Schlanger writes.

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Evening Read

Video by Joanne Imperio / The Atlantic. Sources: Archive Films / Getty; Internet Archive; Prelinger Associates / Getty.

Put Down the Vacuum

By Annie Lowrey

The other night, a friend came over. A dear friend. A friend who has helped me out when I’ve been sick, and who brought over takeout when I had just given birth. Still, before he arrived, I vacuumed.

I thought about this while reading the Gender Equity Policy Institute’s recent report on gender and domestic labor. The study finds that mothers spend twice as much time as fathers “on the essential and unpaid work” of taking care of kids and the home, and that women spend more time on this than men, regardless of parental and relationship status. “Simply being a woman” is the instrumental variable, the study concludes.

Read the full article.

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Illustration by The Atlantic. Sources: Getty

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Stephanie Bai contributed to this newsletter.

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A Nestle executive said on Tuesday that the company is not too worried about the possibility of Robert F. Kennedy Jr., who has been highly critical of packaged and processed food in the U.S., becoming the next leader of the Department of Health and Human Services (HHS).

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As president-elect, Donald Trump has the right to name the people he wants in his Cabinet. Some of Trump’s nominations, such as Senator Marco Rubio to lead the State Department, are completely ordinary. A few are ideological red meat for Republicans. Others are gifts to Trump loyalists.

Four of these nominees, however, are dangerous to the security of the United States and to the well-being of its people: Pete Hegseth (Defense), Tulsi Gabbard (Office of the Director of National Intelligence), Matt Gaetz (Justice), and Robert F. Kennedy Jr. (Health and Human Services). The Senate must turn back these nominations, and do so en bloc.

The Gaetz and Kennedy nominations are apparently already in trouble, and more than enough has been written about them. Gaetz is an accused sexual predator (he has long denied the allegations); ironically, he is the least dangerous of this pack. Yes, as attorney general he would green-light every raving demand from MAGA world for investigations into Trump’s enemies, but in a strange blessing, he is also likely to be completely incompetent. The Department of Justice, as Trump himself learned during his first term, is packed to the rafters with very sharp lawyers who would almost certainly jam up any of Gaetz’s unconstitutional orders. Gaetz’s tenure at Justice would be a national humiliation and destructive to the rule of law, but it would also likely be very short.

The RFK Jr. nomination is, in a word, pathetic. Most of his views are little more than pure anti-science kookery, and if he is confirmed, Americans—and especially their children—will be in peril from this anti-vaccine crusader. But he would be a danger to the health of individual Americans (especially those who watch too much TV and spend too much time on the internet) rather than to the continued existence of the United States.

Which brings me to Gabbard and Hegseth.

Tulsi Gabbard, as I wrote last week, is unqualified for the job of DNI, but she is also a security risk: I have held security clearances for most of my adult life, and had I worked in any federal office next to her, I would have had no compunction about raising her as an “insider threat” because of her political views and her shady international connections. (As a member of Congress in 2017, she held meetings with the Syrian dictator Bashar al-Assad outside of U.S. government channels—an obvious problem for anyone seeking a senior role in national security.)

Gaetz, Kennedy, and Gabbard are terrible choices. The Hegseth nomination, however, is easily the most dangerous and irresponsible of all of Trump’s picks. (Gabbard is a significant hazard, but she would not have a gigantic army at her disposal, and she would not be involved with the control of nuclear weapons.) Like the other three in this group, Hegseth is shockingly unqualified for the job he’s been asked to take, but in this case, the Senate is faced with a proposal to place a TV talking head at the top of the Pentagon and insert him into the nuclear chain of command.

Hegseth has made personal choices that make him unfit to lead the DOD, including his extramarital affairs (which apparently helped tank his chances to lead the Department of Veterans Affairs in Trump’s first administration) and a payoff to a woman who claimed that he’d sexually assaulted her. He denies the assault allegation, but in any case, adultery is a criminal violation of the Uniform Code of Military Justice and can be a career-ending mistake for a member of the armed forces.

I will leave aside whether Hegseth’s tattoos identify him as a white supremacist. Hegseth denies the claim. But some of Hegseth’s ink is popular with extremists; that’s why one of his own military comrades reported him as an insider threat in the first place—and not, as Hegseth and some whining conservatives claim, because he is being persecuted as a Christian. I knew many people in federal service with patriotic tattoos. (I have one myself, and no, it’s none of your business where it is.) I am also a Christian who wears a cross—one that I had blessed in a church—every day. That’s not what any of this is about.

Hegseth’s defenders seem unable to understand that neither Hegseth nor anyone else has a right to be the secretary of defense: If the nominee made choices earlier in life that would now undermine his effectiveness in the job, then that’s his problem, not the Pentagon’s. But even if Hegseth were not an example of a sexist, MAGA-bro culture—his statements about women in the military are particularly noxious—the Senate is still faced with the problem that he’s utterly unqualified.

A former Army major, he has no serious background in national-security or defense issues beyond his military service. (And how that service ended is apparently now a matter of some dispute.) He has not worked anywhere in the defense world: not in any of its agencies, not with any of its industries, not with any of its workforce in any capacity. He has never managed anything of any significant size.

Not only would he be incapable of administering America’s largest government department, but he’d also be in a position of terrifying responsibility for which he is unprepared. Imagine an international crisis, perhaps only a year or two from now. President Trump is facing a situation that could be rife with danger to the United States and our allies—perhaps even one that involves nuclear threats. At this dire moment, Trump turns to …

Pete Hegseth and Tulsi Gabbard?

The Senate must do everything in its constitutional power to stop this. Trump won the election, but no president has an absolute right to his Cabinet nominations: The Constitution requires the Senate to consent to those nominations. Trump has already warned that if the Senate balks, he will subvert this process by using “recess appointments,” in effect a demand that the Senate take a walk and let Trump do whatever he wants—to consent, in other words, to autocracy.

Incoming Majority Leader John Thune and others who still might care about their duty to the nation have time to go to Trump, right now, and tell him that these four nominations are DOA. They could tell Trump that it is in his own interest—the only interest he recognizes—not to risk multiple defeats. And if the Senate folds and decides to take these up one at a time, Trump will wear them down, likely accepting that Gaetz must be a Succession-style “blood sacrifice,” in return for which Trump gets everyone else. For Thune—who, one assumes, does not wish to begin his tenure as a statelier version of Senator Tommy Tuberville, the MAGA obstructionist who held up military promotions for months—accepting such a deal would be a huge strategic error.

Whomever Trump nominates as replacements will likely be dangerous in their own way. But these four nominees have to be stopped—and right now.

Related:

The thing that binds Gabbard, Gaetz, and Hegseth to Trump The perverse logic of Trump’s nomination circus

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