Donald Trump Wants You to Die

The attack on public health begins

One enduring theme of the MAGA movement has been hostility toward the “deep state” — what people outside the movement might call professional civil servants. Trump and company believe that the deep state is out to get them, which is paranoid. But they’re not wrong to believe that public employees who see themselves as working for the nation rather than for whoever currently occupies the White House pose a problem for their agenda.

So what will MAGA do, now that it’s in power? Many observers, myself included, have focused on plans to convert a number of civil service jobs into political appointments. But just a few days into the new regime it’s clear that the assault on professional government will be much broader than that — that it will involve an effort to intimidate and politicize civil servants, too.

And early indications are that one prime target will be agencies devoted to protecting public health.

About the broad attack on the civil service: The Trump administration has ordered an immediate end to all diversity, equity and inclusion efforts across the federal government. That’s pretty shocking, especially because it’s open-ended. What counts as D.E.I.? Is it forbidden even to mention anything involving race, gender or socioeconomic status? Probably.

But the really shocking thing is that all federal employees have been ordered to become informers — threatened with “adverse consequences” if they fail to report on colleagues who surreptitiously engage in what the administration considers D.E.I..

And just like that, the federal government has become our own private East Germany.

Public health agencies, even more than the rest of the government, are in the firing line. You can’t talk seriously about health policy without taking race and gender into account; yet according to the New York Times, one contractor collecting demographic data for the Centers for Medicare and Medicaid Services has already been told to stop work, and the results of an already completed survey won’t be released.

But wait, there’s more: federal health agencies, including the Food and Drug Administration, the Centers for Disease Control and the National Institutes for Health, have been ordered to pause all external communications, including health advisories and scientific reports.

NIH, in particular, appears to have been effectively put in lockdown, with even routine meetings canceled and employees forbidden to travel.

Is this just a temporary phase, with normal health policy returning soon? Don’t count on it.

After all, Trump is trying to install Robert F. Kennedy, an anti-vaccine crank, as head of Health and Human Services. In general, public health policy, which used to be nonpartisan — in the past Anthony Fauci, whom President Biden preemptively pardoned to protect him from possible persecution, served both Democratic and Republican administrations — has become a political flash point. Right-wing hostility to medical science caused a strong partisan divide in willingness to get vaccinated against Covid. Here’s Charles Gaba’s plot showing a strong negative relationship between how many people in a county voted for Trump in 2020 and how many got the Covid vaccine when it became available:

Source: Charles Gaba

This same hostility to medical science probably lies behind a truly alarming decline in the percentage of children vaccinated against measles, mumps and rubella (95 percent is generally considered necessary to prevent outbreaks):

Source: KFF

And let’s not forget that when the Covid pandemic was raging, Trump seemed far more interested in preventing people from hearing bad news than he was in holding down the death toll.

So my prediction — which I hope proves false — is that when NIH and other health agencies emerge from the current freeze they will have been emasculated and politicized, prohibited from releasing information and research whose implications the Trump administration doesn’t like, banned from making policy recommendations that are inconvenient for Trump or at odds with the prejudices of the MAGA base.

And many Americans will die as a result.

Some historical perspective may be useful here. As everyone knows, Trump has a thing about the McKinley era, when, he believes, America was truly great. What I’m sure he doesn’t know is that America circa 1900 had incredibly high rates of death from infectious disease:

Source: JAMA

We were able to mostly conquer infectious disease in part thanks to advances in the scientific understanding of disease, in part because of the development of vaccines. But these scientific advances by themselves wouldn’t have been enough. Progress depended crucially on public policy, ranging from the provision of clean water to vaccine mandates.

If MAGA had been around at the time, do you have any doubts that it would have opposed all of these public health measures and accused their proponents of being part of some dark conspiracy?

And when — not if — the next pandemic strikes, do you expect our battered, politicized public health agencies to keep Americans properly informed? If Trump is still in charge, do you expect him to respond effectively, as opposed to minimizing the threat and muzzling anyone who might contradict him? It’s hard to feel optimistic about any of these concerns.

So, is America great again?

MUSICAL CODA