D.Donald Trump may only be president for four more years, but the public health impacts of his administration could be disastrous for a long time to come. While we don’t know exactly what will happen, there is no doubt that the next four years may see attempts to reduce the authority and autonomy of federal health agencies such as the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention. (CDC) — something the president-elect is trying in his first term. However, despite Trump’s bravado about letting RFK Jr. “run wild” and “do whatever he wants” on healthcare, a sweeping shutdown or rebuilding of federal agencies is unlikely to be possible. A more fundamental problem is that another Trump term could further weaken scientific regulatory authorities and turn the cracks in public trust that his first administration helped create into literal chasms.

The concern is not just what the Trump 2.0 Administration will do, but also what it will say. RFK Jr., the so-called “Disinformation DozenHe was already the most influential figure in the anti-vax movements. Now it looks like he’ll catch the president’s ear. Conspiracy culture will likely spread from within and beyond government through well-known misinformation-merchants It is said to be suitable for senior healthcare roles. For example, Dr. Joseph LadapoFlorida Surgeon General, rumor He will compete to lead the U.S. Department of Health and Human Services. The fact that people who espouse views far from the scientific mainstream are thought to head some of the most respected institutions is a sign of how contrarian or arrogant the Trump 2.0 administration could be when it comes to public health. Instead of promising to “Make America Healthy Again,” the new Trump administration may leave America and the world sicker than before.

Vaccine hesitancy is spreading

Vaccines are some of the most successful public health interventions in history; At least 154 million people have lived in the last 50 years. If Trump’s record is any indication, he may not be the real problem when it comes to vaccines. During his first administration vaccination coverage It was as high—or in some cases, as high—as it has ever been (although this was a continuation of the upward trend rather than the result of any Trump policies). Childhood vaccination rates since you slipped With Trump’s second term in the US and the worrying prospect of people like Kennedy and Lapado driving or at least influencing policy, it’s hard to imagine that vaccination rates won’t fall further. Vaccine hesitancy will of course increase; The intensification of the trend we see, in the US and globallysince the beginning of the epidemic.

There may not be an outright ban on vaccines. “I’m not going to take anyone’s vaccines,” Kennedy said recently. in question. The problem is the doubt Kennedy sowed. Misinformation persists. happened more than 25 years Since Andrew Wakefield published his fake article falsely linking the MMR vaccine to autism. But its shadow still looms large, and the United States is already experiencing recent measles outbreaks. Vaccine hesitancy based on misinformation is a major factor. Worldwide, unfounded fears of autism are still cited as the reason why some parents refuse to have children. They refuse to vaccinate their children. What Kennedy did false claims vaccines have been revealed to cause autism and have even been linked to the overspread of misinformation. deadly measles epidemic In Samoa in 2019 (Kennedy denied responsibility).

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The US currently recommends updated COVID-19 vaccines for everyone. In this sense, the United States is more positive than many other countries globally regarding the maintenance of widespread immunity. But it is hard to imagine this level of official support for additional Covid-19 vaccines continuing next year.

Some of the riskiest vaccines are probably HPV vaccines. Kennedy spread Misinformation about HPV vaccine Gardasilincluding false claims in connection with autoimmune conditions. Declines in HPV vaccine coverage transvestite for public healthbecause they help Reduce the risk of cervical cancer by up to 90%.

The Wild West of “Wellness”

Kennedy and his followers falsely claim that many vaccines and drugs have not been adequately tested for safety. Let’s be clear: COVID-19 vaccines, HPV vaccines, and all other vaccines approved and recommended in the U.S. and globally are safe and effective. But more research and testing is never a bad thing; so shrinking agencies like the CDC and NIH (as Kennedy wanted) would do little to make the market for drugs and healthcare products safer.

Then there is fluoride. Trump said Kennedy’s idea of ​​banning the addition of fluoride to some public water supplies (a long-standing practice to improve dental health) “sounds good.” although It was not without controversy, organizations including HKM And World Health Organization They stated that fluoride in drinking water may help prevent cavities and is safe within certain limits. But this issue could be a harbinger of what officially recommended public health measures might be eliminated or weakened, and what alternative health solutions might replace them.

Kennedy suggested he would Stop the FDA’s “war” on things like ivermectin, hydroxychloroquine, psychedelics, nutraceuticals, and even sunlight. like Kennedy, Ladapo encouraged use ivermectin (an antiparasitic treatment used primarily by veterinarians) and hydroxychloroquine; Disproved by the medical community. As a former friend of the president, Nicole Shanahan He could follow Kennedy, who played a key role in shaping Trump’s health agenda. Like Kennedy, Shanahan knows this: strengthening unscientific claimsincluding Dangerous claims about sunscreen It is harmful and unprotected sun exposure can improve many conditions.

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There may be some positive public health consequences in the coming Trump years. A desire to reduce the amount of processed foods, especially processed foods, in the U.S. diet Additives and artificial ingredients in child nutritionis an important one. But there are better ways to achieve this than undermining the public’s trust in the FDA and other health agencies. A better approach would be to better regulate the junk food industry, invest in health education, and make healthy, natural alternatives more affordable, especially for those on low incomes.

Such high-profile advocacy of scientifically unproven alternative treatments may mean that the Trump administration sees the continued rise of “neo-quackery” and “new quackery.”conspiracism” (when conspiracy meets spirituality) under the banner of ‘wellness’. Misinformation spreads like a virusand it is perhaps no surprise that some of those who proved instrumental in Trump’s victory are at the forefront of the media most susceptible to the spread of misinformation. Elon Musk’s X with Joe Rogan’s podcast.

Ignoring the next epidemic

In an interview with TIMETrump has indicated that he will likely disband the Office of Pandemic Preparedness and Response Policy, an administrative office established by the Biden Administration to prepare for future outbreaks. Doing so would be a dangerous move. Many countries including United Kingdom. And AustraliaThey are conducting pandemic research and finding that more and better preparation, not less, is needed.

H5N1 continues to spread It occurs among cattle in the United States, and the risk of spread to humans increases with each infection. current management was seriously missing in terms of surveillance of the virus among dairy cattle and ensuring that those in close contact with infected herds have and use personal protective equipment. However, things are unlikely to get better in the coming years.

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Kennedy actively promoted drinking raw milk—a dangerous practice for any number of reasons, including that it is a potential practice risk factor for human H5N1 infection. More concerning is the fact that the Trump Administration may roll back some of the recent Biden-Harris initiatives. designed to handle growth H5N1 threat.

The broader problem is that the American protectionism at the heart of the MAGA ethos may go so far as to actually protect the country from global disease threats. Whether it is H5N1, mpox, Middle East Respiratory Syndrome (MERS), or a significantly mutated and more immune-resistant strain of COVID-19, the best way to protect the population of any country is to try to combat epidemics at the source. This requires support, resources and cooperation at a global level through institutions like the World Health Organization, which Trump will almost certainly scale down.

These are just three of the areas of public health that could be affected over the next four years. There is much more. Although not as much of a vote-determining issue as initially thought, abortion and women’s reproductive health are a looming concern for many. Likewise, there’s a possibility that Trump could pick up where he left off for another four years trying to erode the Affordable Care Act. Cut funding for Medicare and Medicaid.

There is much to anxiously await as Trump, Kennedy, and their minions sink their teeth into public health.