dDonald Trump may be president for four more years, but the impact of his administration on public health could be catastrophic for a long time to come. While we don’t know exactly what will happen, there is no doubt that over the next four years there could be attempts to reduce the authority and autonomy of federal health agencies such as the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention. US Disease Prevention. (CDC) — something the president-elect tried during his first term. Yet despite Trump’s bravado about letting RFK Jr “run loose” and “do what he wants” on health care, sweeping shutdowns or rebuilding of federal agencies are unlikely to be feasible. A more fundamental issue is the likelihood that another Trump term will further undermine scientific regulators — turning the cracks in public trust that his first administration helped cause into real chasms.

The concern is not only about what the Trump Administration 2.0 will do, but also about what it will say. RFK Jr., one of the so-called “Misinformation Dozen,” was already the most influential figure in the anti-vax movements. Now, it looks like he’ll have the president’s ear. The culture of conspiracy will likely cascade through and beyond government with well-known misinformation– merchants rumored to be in line for top healthcare roles. For example, Dr Joseph Ladapothe surgeon general of florida, is rumored to be in the running to lead the US Department of Health and Human Services. That people who hold views that stray far from the scientific mainstream are seen running some of the most revered institutions is a sign of how contrarian or cavalier a Trump 2.0 administration could be when it comes to public health. Rather than promising to “make America healthy again,” the new Trump administration may end up leaving America — and the world — sicker than before.

Spread of vaccine hesitancy

Vaccines are some of the most successful public health interventions in history, saving at least 154 million lives in the last 50 years. If Trump’s record is any indication, he himself may not really be the problem when it comes to vaccines. During the years of his first administration, vaccine coverage it was as high—or, in some cases, the highest—it had ever been (though this was a continuation of the upward trajectory rather than a result of any particular Trump policy). Childhood vaccination rates have since it slipped In the US And with a second term for Trump and the worrying prospect of the likes of Kennedy and Lapado leading or at least influencing policy, it is hard to imagine that vaccination rates will not continue to decline. Certainly vaccine hesitancy will increase – an intensification of the trend we have observed, in the US and globallysince the beginning of the pandemic.

There may not be absolute vaccination bans. “I’m not going to take anybody’s vaccines,” Kennedy recently said. The problem is the doubt that Kennedy sows. Misinformation persists. This was it more than 25 years since Andrew Wakefield published his fraudulent paper falsely linking the MMR vaccine to autism. However, his shadow still looms large, and the US is already dealing with recent outbreaks of measles, with vaccine hesitancy driven by misinformation a key factor. Globally, unfounded autism fears are still cited as a reason why some parents refuse vaccines for their children. Kennedy did false statements that vaccines cause autism, and the spread of misinformation has even been linked to a deadly outbreak of measles in Samoa in 2019 (for which Kennedy denied responsibility).

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The US currently recommends updated vaccines against COVID-19 for everyone. In this sense, the US is more favorable to maintaining widespread immunity than most other countries globally. But it is hard to imagine that this level of official support for additional COVID-19 vaccines will continue next year.

Some of the most exposed vaccines are probably those for HPV. Kennedy spread misinformation about HPV vaccine Gardasilincluding unfounded claims to which it is linked autoimmune diseases. Decreased HPV vaccine coverage would be a public health travestybecause they help reduces 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 sufficiently tested for safety. Let’s be clear: COVID-19 vaccines, HPV vaccines, and all others that are approved and recommended in the US and globally are safe and effective. But more research and testing is never a bad thing—so cutting back on organizations like the CDC and NIH (as Kennedy wants) would hardly help make the market for drugs and health products safer.

Then there is fluoride. Trump said Kennedy’s idea to ban the addition of fluoride to some public water sources — a long-standing practice that improves dental health — “sounds OK.” Although it is was not without controversy, inclusive organizations CDC and the World Health Organization have stated that fluoride in drinking water can help prevent tooth decay and is safe within limits. But this problem could predict which officially recommended public health measures might be eliminated or undermined, and which alternative health remedies might take their place.

Kennedy suggested he would stop the FDA “war”. on things including ivermectin, hydroxychloroquine, psychedelics, nutraceuticals, and even sunlight. Like Kennedy, Ladapo encouraged the use of ivermectin (an antiparasitic treatment used mainly by veterinarians) and hydroxychloroquine, both of which are disappointed by the medical community. As his former running partner, Nicole Shanahan may follow Kennedy in playing a prominent role in shaping Trump’s health care agenda. Like Kennedy, Shanahan is known for amplifying unscientific claimsinclusive dangerous claims that sunscreen it is harmful and unprotected sun exposure can cure many conditions.

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There may be some positive public health outcomes in the coming Trump years. The ambition to reduce the amount of processed foods in the US diet and especially the number of additives and artificial ingredients in children’s dietsis an important one. However, there are better ways to accomplish this than undermining public trust in the FDA and other health agencies. Better regulation of the junk food industry, investing in health education and making healthy and natural alternatives more accessible, especially to those on low incomes, would be a better approach.

It is likely that such high-level advocacy of scientifically unproven alternative treatments could mean that a Trump administration sees a continued rise in “neo-quack” and “conspirituality” (when conspiracy meets spirituality) under the banner of “welfare”. Misinformation it spreads like a virusand perhaps unsurprisingly, some of those who proved instrumental in Trump’s victory are at the top of the media most susceptible to the spread of misinformation, from Elon Musk’s X TO The Joe Rogan Podcast.

Neglecting the next pandemic

In an interview with TIMETrump has indicated he will likely disband the Office of Pandemic Preparedness and Response Policy, an executive office established by the Biden Administration to prepare for future outbreaks. Doing so would be a dangerous move. Several countries, incl Great Britain. and Australiaconduct pandemic surveys and find that more and better training is needed, not less.

H5N1 continues to spread among U.S. cattle, and with each infection the risk of spread to humans increases. The current administration was seriously lacking in terms of surveillance of the virus among dairy cattle and in terms of ensuring that those in close contact with infected herds have and use personal protective equipment. However, things are unlikely to improve in the coming years.

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Kennedy actively promoted drink raw milk—a dangerous practice for all sorts of reasons, including being a potential one risk factor for human H5N1 infection. Of deeper concern is that the Trump Administration may roll back some of the recent Biden-Harris initiatives designed to address growth H5N1 threat.

A broader problem is that the American protectionism at the heart of the MAGA ethos can only go so far to effectively protect the country from global disease threats. Whether it’s H5N1, mpox, Middle East Respiratory Syndrome (MERS), or a significantly mutated and more immune-resistant strain of COVID-19, the best way for any country to protect its population is to try to tackle outbreaks from the source. This requires global support, resources and cooperation through agencies like the World Health Organization, which Trump will almost certainly cut.

These are just three of the areas of public health that could be affected over the next four years. There are many more. While it may not have turned out to be as much of a voting issue as first thought, abortion and women’s reproductive health is a looming concern for many. So is the prospect of four more years in which Trump could pick up where he left off by trying to erode the Affordable Care Act and cut Medicare and Medicaid funding.

There’s a lot to look forward to as Trump, Kennedy and their cronies sink their teeth into public health.