Infectious disease is probably not an imminent threat to the United States’ survival. Still, after nearly a century of existence, the American public-health apparatus, which has driven some of the most remarkable advances in global longevity and quality of life in human history, is teetering. The country has lost much of its ability to keep microbes from invading its body politic, and progress in life expectancy and other metrics is slowing or even reversing.
It is tempting to lay these changes all at the feet of President Trump and his current health secretary, Robert F. Kennedy Jr., who together have shredded America’s global-health organizations, drawn back public-health funding, fomented vaccine skepticism, and begun to dismantle child-vaccination programs. But the “Make America Healthy Again” moment is in some ways just another step in the long retreat of the civic trust and communitarian spirit that have enabled America’s disease-fighting efforts. If this retreat continues, the public-health era—the century-long period of unprecedented epidemiological safety that has been the foundation for so many other breakthroughs—will come to an end. And that end will have dire consequences for this republic and its future.
In January 2025, a hospital in West Texas began reporting that children were coming in sick with measles. The cases were initially clustered in a Mennonite community, where vaccination rates had been low in recent decades. But soon the outbreak spread around the state, and to others; the reported number of cases reached more than 1,800 by the year’s end. As of this writing, the outbreak is still ongoing, and America is in danger of having its measles-elimination status revoked by the World Health Organization.
On August 8, as the measles outbreak continued to make headlines, a man named Patrick Joseph White entered a CVS in northeast Atlanta and fired hundreds of rounds from a rifle into the CDC’s headquarters across the street. According to Georgia investigators, White had been suicidal, and believed that COVID‑19 vaccines were part of a conspiracy to sicken him and other Americans.
These were but two signs among many that something has broken within the systems that protect the population’s health. Despite all of our advantages, the coronavirus pandemic caused more confirmed deaths per capita in the United States than in any other Western country, and our mortality rate’s recovery has lagged behind others’. Life expectancy in the U.S. is lower than in other high-income nations, and the gulf is widening.