When a country puts an antivaxxer and supporter of quackery whose worldview with respect to medicine and biomedical science is as utterly divorced from science and reality as that of longtime antivax activist Robert F. Kennedy, Jr. in charge of the nation’s medicine and public health, there are certain predictable outcomes that we can expect to observe over the next few years. The most obvious of these outcomes is the likely return of once-vanquished vaccine-preventable diseases. I was reminded of—and alarmed by!—this likelihood when I came across a modeling study hot off the presses from JAMA last Thursday. The study basically models what might happen as vaccine uptake declines, concluding first that if vaccine uptake declines sufficiently, measles could well become endemic again. (Make measles endemic again? I prefer what I’ve been sarcastically saying about antivaxxers since 2017, namely “Make measles great again.” Because everyone loved the pre-1964, pre-vaccine situation, with millions of cases every year, right?)

Even more alarmingly, though, it’s not just about measles. Measles, being among the most transmissible viruses in existence, is just the canary in the coal mine. It’s come back first, but it won’t be long before other pathogens join it. (Indeed, as I predicted, cases of pertussis—whooping cough—are starting to surge, too.) This study is also about rubella, diphtheria, and even polio. I’ll provide a spoiler alert before I discuss the study in more depth: The model predicts tens of millions of measles cases and millions of polio cases over the next 25 years if vaccine coverage declines sufficiently. (Make polio great again?) It also illustrates how it’s not at all implausible that uptake of various critical vaccines could decline sufficiently to result in this outcome.

Make America Sick

Before I discuss the JAMA study, here’s some obligatory background, with a hint of “I told you so.” (It’s actually more than a hint.) I had started sounding the alarm soon after RFK Jr. bent the knee to Donald Trump last year, suspending his quixotic independent Presidential campaign in return for a prominent role in health policy, which, alarmingly, turned out to be Secretary of Health and Human Services. He’s now in charge of the massive sprawling bureaucracy responsible for overseeing basically all non-military federal public health and health care policy, including such critical infrastructure as the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. Unsurprisingly, he’s appointed a number of antivax grifters and quacks to head up these agencies. I’m talking “America’s Quack” Dr. Mehmet Oz, who is now in charge of CMS and overseeing Medicare, Medicaid, and the insurance exchanges under the Affordable Care Act. I’m talking Dr. Jay Bhattacharya, co-author of that “let ‘er rip” COVID-19 manifesto (with “focused protection” of the vulnerable as an afterthought) the Great Barrington Declaration, in charge of the NIH. I’m talking COVID-19 contrarian and popularizer of the quack myth that medical errors are the third leading cause of death in the US, Dr. Marty Makary, in charge of the FDA. True, President Trump tried to appoint longtime antivax doctor and politician Dr. Dave Weldon to run the CDC, but that appeared to be a quack too far. (How RFK Jr. himself as HHS Secretary was not a quack too far, I leave as an exercise for our readers.) Unsurprisingly, RFK Jr. set about undermining vaccine programs and, instead of “make America healthy again” (MAHA), we’re seeing him make America sick again.

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