DDonald Trump may only be president for four years, but his administration’s public health impacts could be catastrophic for a long time. Although we don’t know exactly what will happen, there is no doubt that the next four years could be marked by attempts to restrict the authority and autonomy of federal health agencies like the Food and Drug Administration. (FDA) and the United States Centers for Disease Control and Prevention. (CDC) – something the president-elect tried during his first term. However, despite Trump’s bravado in letting RFK Jr “run amok” and “do whatever he wants” on health care, sweeping shutdowns or rebuilds of federal agencies are unlikely to be feasible. A more fundamental problem is the likelihood that another Trump term could further weaken scientific regulators, turning the cracks in public trust that his first administration helped cause into chasms.

The worry is not just about what the Trump 2.0 administration will do, but also what it will say. RFK Jr., one of the so-called “Dozen of misinformation”, was already the most influential figure in the anti-vax movements. It now appears he will have the ear of the president. Conspiracy culture likely to spread within and beyond government, with well-known misinformation-the merchants he is rumored to be in the running for high-level healthcare positions. For example, Dr Joseph Ladapothe Surgeon General of Florida, is rumor to be in the running to lead the U.S. Department of Health and Human Services. The fact that people who espouse views far removed from the scientific mainstream are considered to be at the helm of some of the most revered institutions shows 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 could end up leaving America – and the world – sicker than before.

Spread of vaccine hesitancy

Vaccines are among the most effective, cost-saving public health interventions in history at least 154 million lives over the past 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, vaccination coverage was as high – or in some cases the highest – it has ever been (although it was more a continuation of the upward trajectory than the result of any particular Trump policy). Childhood vaccination rates have since slipped In the United States And with a second Trump term and the worrying prospect of people like Kennedy and Lapado leading or at least influencing policy, it’s hard to imagine that vaccination rates won’t decline further. It is certain that vaccine hesitancy will increase – an intensification of the trend we are witnessing, in the United States and around the worldsince the start of the pandemic.

There may not be an outright ban on vaccines. “I’m not going to take vaccines away from anyone,” Kennedy said recently said. The problem is the doubt that Kennedy sows. Misinformation persists. It was over 25 years old since Andrew Wakefield published his fraudulent article falsely linking the MMR vaccine to autism. However, its shadow still looms large, and the United States has already faced recent measles outbreaks, with Vaccine hesitancy driven by misinformation is a key factor. Globally, unfounded fears about autism are still cited as a reason why some parents refuse vaccines to their children. Kennedy did false allegations that vaccines cause autism, and its spread of misinformation has even been linked to a deadly measles epidemic in Samoa in 2019 (for which Kennedy denied responsibility).

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The United States is currently recommending updated COVID-19 vaccines to everyone. In this sense, the United States is more supportive of maintaining widespread immunity than most other countries in the world. But it’s hard to imagine this level of official support for additional COVID-19 vaccines continuing into next year.

Perhaps some of the highest risk vaccines are those against HPV. Kennedy spread misinformation about the HPV vaccine Gardasilincluding the unsubstantiated allegations to which it is linked autoimmune diseases. A drop in HPV vaccination coverage would be a a parody of public healthsince they help reduce the risk of cervical cancer by up to 90%.

The Wild West of “well-being”

Kennedy and his supporters falsely claim that the safety of many vaccines and drugs has not been adequately tested. Let’s be clear: COVID-19 vaccines, HPV vaccines, and all other vaccines approved and recommended in the United States and around the world 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 do little to 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 supplies — a long-standing practice that improves dental health — “seems acceptable.” Although it is did not take place without controversy, organizations, including CDC and the World Health Organization have stated that fluoride in drinking water can help prevent cavities and is safe within certain limits. But this question could foreshadow what officially recommended public health measures might be removed or weakened, and what alternative wellness solutions might replace them.

Kennedy suggested he would stop the FDA “war” on things like ivermectin, hydroxychloroquine, psychedelics, nutraceuticals and even the sun. Like Kennedy, Ladapo encouraged the use ivermectin (an antiparasitic treatment mainly used by veterinarians) and hydroxychloroquine, both of which have been tested demystified by the medical community. As a former running mate, Nicole Shanahan could follow Kennedy in playing a leading role in shaping Trump’s health care agenda. Like Kennedy, Shanahan is known for amplify unscientific claimsincluding the dangerous claims that sunscreen is harmful and unprotected sun exposure can cure many conditions.

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There could be positive public health outcomes in the coming Trump years. The ambition to reduce the quantity of processed foods in the American diet, and in particular the number of additives and artificial ingredients in children’s foodis an important question. 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, investments in health education, and more affordable healthy, natural alternatives, especially for low-income people, would be a better approach.

It is likely that such high-profile advocacy for scientifically unproven alternative treatments could mean that a Trump administration sees the continued rise of “neo-quackery” and “spirituality » (when conspiracy meets spirituality) under the banner of “well-being”. Disinformation spreads like a virusand it is perhaps not surprising that some of those who proved instrumental in Trump’s victory find themselves at the forefront of media outlets most susceptible to the spread of disinformation, since Elon Musk’s X has Joe Rogan’s 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 created by the Biden administration to prepare for future outbreaks. This would be a dangerous step. Several countries, including the United Kingdom. And Australiaare investigating the pandemic and finding that more and better preparation 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 sorely lacking in terms of monitoring the virus among dairy cattle and in terms of ensuring that people 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-an unsafe practice for all sorts of reasons, including the fact that it is a potential risk risk factor for human infection with the H5N1 virus. Of more concern is the fact that the Trump administration could reverse some of the recent Biden-Harris initiatives. designed to accommodate growth H5N1 threat.

A larger problem is that American protectionism, at the heart of MAGA philosophy, cannot go so far as to actually 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 fight epidemics at the source. This requires global support, resources and cooperation through agencies such as the World Health Organization, which Trump will almost certainly scale back.

These are just three of the areas of public health that could be impacted over the next four years. There are many others. While it may not have proven to be as much of a vote-defining issue as initially thought, abortion and women’s reproductive health are a looming concern for many. So does 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 funding for Medicare and Medicaid.

There’s a lot to look forward to as Trump, Kennedy and their cronies take on public health.