Trump Chaos Is Killing Us
Republicans will probably go first. But that's no cause to cheer.
by Richard Conniff
Donald Trump has a history of delivering self-inflicted wounds, and yet somehow managing for the damage to land hardest on his closest followers. It’s happening again now, with Red states and MAGA voters prominent among those feeling the pain.
Republicans are narrowly focused for the moment on the economic cost. Just in his first three weeks in office, Trump has blocked grants made through Biden-era clean energy programs without taking time to notice that 80% of the manufacturing grants were headed to Republican districts. He has slashed federal reimbursement for indirect costs (laboratories, lights, equipment) on NIH research grants without considering that this wipes out thousands of jobs and $1.1 billion a year just in the top 10 states that voted for him in 2024. And he has killed the U.S. Agency for International Development (USAID) oblivious to the mostly Republican farmers dependent on its $1.8 billion food aid program to export billion of pounds of the crops they grow.
But economics are the least of the problems Republicans will face because of Trump’s mindless attack on the federal government. What they—what we—need to worry about is the strong likelihood, because of Trump, that Americans will die needlessly—many Americans, mostly children, and mostly, at least initially, in Republican states.
Amid the appalling mayhem he has caused so far, Trump’s broadside attack on public health stands out for its ferocity. It culminated yesterday in the firing of 10 percent of staff at the Centers for Disease Control and Prevention. Those firings focused, incredibly, on the frontline “disease detectives” of the Epidemic Intelligence Service. These are young, highly trained, and often heroic men and women who work in communities around the country and abroad to identify and contain outbreaks before they can reach your family or mine.
What’s even more damaging, Senate Republicans on Thursday approved the anti-vaccine conspiracy theorist and profiteer Robert F. Kennedy Jr. as Secretary of Health and Human Services. Trump has already done massive damage to public health. But Kennedy will find new and deadlier ways to “go wild” on what remains.
(Four of the Republican senators who voted for Kennedy are themselves physicians, but evidently forgot their Hippocratic oath to do no harm. The only Republican to dissent was Mitch McConnell, who suffers from the effects of polio acquired as a two-year-old in 1944, before a vaccine became available.)
Let’s talk about what’s stake here. The U.S. public health system is one of this country’s greatest achievements. It has improved (and even saved) the lives of you, me, and almost every other human being alive today in this country and around the world. Donald Trump, for instance, has been a major beneficiary of the work these agencies perform. He was born just as the first antibiotics began routinely preventing minor infections from blossoming into deadly sepsis. He was a child when federal and state programs eliminated smallpox from this country and later, together with the World Health Organization, helped eradicate it worldwide. He grew up as the first vaccines for whooping cough, polio, and measles sent incidence of these deadly childhood diseases to near zero.
These advances in public health are one reason Trump and so many others his age are still alive and able to work. When he was born in 1946, life expectancy for an American male was under 65. It’s now 79 in the United States and 73 worldwide. In any other era, this public health achievement—a doubling of human life expectancy in little more than a century--would rank among the greatest success stories in all of human history, and largely an American success story at that.
All the vaccines mentioned above, and many more since then, are the work of American scientists, eagerly supported by U.S. public health agencies and an American public that understood the terrible diseases being prevented. Penicillin, the first antibiotic, originated in England, but it took U.S. government research to boost the supply from less than enough to treat a single patient in 1941 to the tens of thousands of doses carried by Allied troops onto the beach at Normandy on D-Day 1944.
Trump’s attack on public health will hit Red states and his own MAGA voters hardest. This has already happened once before, in his first term, when he pushed partisan rhetoric and nonsense remedies instead of a straightforward public health response to the Covid pandemic. The notion that the virus and countermeasures against it were primarily political weapons against Trump hardened into Republican dogma, via Fox News and other conservative media. So much so that the Biden Administration’s subsequent efforts to promote Covid vaccination looked to one Republican congressman like government agents “going door-to-door to take your guns … to take your Bibles.”
As a result, just in the first nine months after vaccines became widely available, 234,000 adult Americans died needlessly of Covid because they went unvaccinated, according to a Kaiser Family Foundation study. Multiple other studies have since demonstrated that Republicans and Fox News viewers were far more likely to forego vaccination, and they disproportionately sickened and died as a result.
It will be worse next time. Republican resistance to Covid vaccines has expanded into distrust and even open antagonism toward vaccines more broadly. Significantly fewer Republicans now get the annual flu vaccine, for instance, compared with pre-Covid vaccination levels. More seriously, fewer new kindergarten students receive the full complement of recommended childhood vaccines.
Coverage for the measles-mumps-rubella (MMR) vaccine nationwide is now two points below the 95% level considered necessary for public safety—with 10 states that voted for Trump in 2024 among the least protected. Altogether, 280,000 children remain vulnerable to measles, a highly contagious disease that’s now rebounding in the United States. Just in the past three weeks, state health agencies have reported cases—all of them in unvaccinated individuals—in Alaska, Georgia, Texas, Rhode Island, and New York City. (The now-muzzled CDC appears to have resumed reporting these incidents, but without the normal age breakdowns.)
Contrary to the modern myth that it is a trivial disease, measles routinely kills one in 1000 victims, from respiratory and neurologic complications. Last year, 40% of U.S. victims needed to be hospitalized. Whooping cough is also preventable by vaccination but making a comeback in this country, with more than 35,000 cases and 10 deaths last year.
It is a terrible moment for Trump to be putting national health programs under the direction of Robert F. Kennedy Jr. The likely result will be a much larger repeat of the experience in American Samoa, where Kennedy helped drive down acceptance of the MMR vaccine, leading to an epidemic in which 83 people died, most of them children under age five. He has shrugged off any responsibility.
Red states are also geographically more vulnerable. The first homegrown malaria cases in more than 20 years happened last summer in Texas and Florida. Both also had locally-transmitted cases of dengue fever, formerly considered a tropical disease. Zika, Chikungunya, and other tropical diseases also appear to be moving up “into the Caribbean and U.S. Gulf states,” says Texas pediatrician and public health advocate Peter Hotez. He’s currently developing a privately-funded program to screen mosquitoes, ticks, and other disease vectors in the Gulf states for dangerous viruses—the sort of job the federal government used to handle.
Progressive voters may not feel much empathy for Red states caught in this bind. As one of them put it on Twitter: “If you voted for Trump, you f---ed yourselves. We told you so.” But these are our neighbors, our parents, our children, and our fellow Americans. Instead of driving them deeper into their partisan foxholes, our challenge is to join together on the common ground of protecting public health.
No one can say just which diseases will get here next, what kind of damage they might do, or who they may kill. The highly pathogenic H5N1 avian flu, for instance, has so far infected 150 million birds in this country, including wild aquatic populations and commercial and backyard poultry flocks. Since jumping from birds to mammals, it has infected 944 U.S. dairy herds and caused 67 human cases including one death. Last week, the CDC posted—and then promptly deleted—news that housecats could transmit the disease to humans. This week the CDC reported previously undetected cases in dairy veterinarians. What if this virus makes the next genetic leap and becomes capable of human-to-human transmission? Trump is destroying the public health defenses we will need to contain the threat.
Other infectious disease threats approach not just one at a time, but in a steady stream. A study in the journal Nature identified 335 diseases that emerged between 1940 and 2004, a rate of more than 50 per decade, notably including HIV/AIDS, Zika, SARS Covid, and Ebola. Two decades later, the rate of emergence appears to be accelerating.
President Trump’s answer so far has been to drive away experienced researchers and turn instead to partisan figures distinguished mainly by their blind opposition to science. For all of us, especially in Red states, it’s a recipe for making the Covid pandemic look like a mild preview, with darker, deadlier plagues lying just ahead.
Richard Conniff’s latest book is Ending Epidemics: A History of Escape from Contagion. He survived measles as a child, before the development of an effective vaccine. Research assistance on this story was provided by Samantha Kiernan of the Peter Gruber Rule of Law Clinic, Yale Law School.
Not to mention the 10 states that have not expanded Medicaid, the federal-state program that provides health care for low-income people. They are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming. The cumulative effect of this insanity will fall mostly on their supporters. Cosmic irony.
Tragic and terrifying