Over the past few months, I’ve thought a lot about the late, great astrophysicist and science communicator Carl Sagan. More specifically, I’ve been thinking about his 1995 book The Demon-Haunted World: Science as a Candle in the Dark—co-authored with his wife and collaborator, Ann Druyan—which warns against pseudoscience, misinformation, and superstition overtaking the U.S. For anyone paying any sort of attention to what is happening to the fields of science, medicine, and public health (to say nothing of so many other institutions) under the second Trump Administration, this may sound chillingly familiar. Sagan and Druyan, like other prescient minds, were not imbued with supernatural powers. They simply observed and learned from the past and present to understand where we might be headed. And so, 30 years later, we find all of this coming to a boiling point.
A 2023 report from the Pew Research Center indicates that, while scientists continue to be held in high regard in U.S. society, overall trust in scientists and science has decreased and distrust has grown, particularly among Republicans. For decades, under both Democratic and Republican leadership, the U.S. medical system has become a corporate nightmare, and health care disparities have run rampant. Public health, the field that I work in and know the best, has been underfunded for decades, despite being an essential part of human society. This chronic underfunding weakened the systems needed to address disease outbreaks on a major scale, as we saw during the COVID-19 pandemic, helping the anti-vaxx movement gain power. Distrust in the U.S. medical and public health systems grew further during this time, in part due to very real concerns about the medical system and access to care, which has led to conspiracism that has since been exploited by the so-called Make America Healthy Again (MAHA) movement. As just one example, the motive behind the August shooting at the CDC campus in Atlanta has been attributed to COVID-19 vaccine misinformation. We must also recognize that pseudoscience and anti-science aggression go hand-in-hand with fascism, that the MAGA movement is further amplifying eugenic beliefs that have existed in our society for decades, and that the (unregulated) supplement industry feeds off this misinformation as a profitable grift. Finally, we must acknowledge the very important roles that public health and science have played and continue to play in our society and what we may lose. We have to hold these multiple truths at the same time and take action, because this is not an intellectual exercise. Real lives are at stake.
I want to acknowledge that it is hard to keep track of everything that has happened this past year, and it is understandable why people might not be paying close attention to what is happening to our science and public health systems. We only have so much bandwidth and, as we continue to face the threats of fascism, people need to pick their battles. However, and I write this not just as someone who has spent years studying and working in public health: The fight to preserve public health and science is connected to every other issue that we face. Not in the It’s Always Sunny Charlie Kelly Pepe Silvia conspiracy board way (though, admittedly, I feel like Charlie Kelly more and more each day). Public health intersects with all aspects of our daily lives, though when it is functioning, you don’t necessarily notice it. Disease outbreaks—such as the current pertussis (whooping cough) outbreak in Louisiana that has claimed the lives of two babies thus far and the ongoing measles crisis—do not occur when vaccination rates are high, surveillance systems are robust, and vaccine misinformation is not allowed to run rampant. Clean water is an essential part of healthy human existence. For those of us living in New Orleans, every time a boil water advisory is issued by the Sewerage and Water Board, we are reminded of how precarious our clean water systems are and how much we take having clean water for granted.
When we think about the increasing gun violence in this country, that is a public health issue. Walkable cities, food safety, public transportation, education, environmental regulations, safety regulations, traffic control, mental health outreach: Though you may not think of it, those are all intertwined with public health systems, and attacks on any of these systems are attacks on the others. The undoing of abortion access is part of Project 2025. The anti-vaxx movement and the false links between autism and vaccines are tied into fascism and eugenics. The proposed federal budget for fiscal year 2026—which, at the time of publication, was still being debated by the Senate—eliminates all federal HIV prevention funding and cuts other HIV and STI programs, which will disproportionately harm the LGBTQIA+ community. Cuts to Medicaid coverage of gender-affirming care, which are already happening in Louisiana, are part of a concerted attack against the transgender community. The Executive Order on homelessness and attacks against harm reduction (syringe service programs and such) are related to the Trump Administration’s plans for increased institutionalization and incarceration. The genocide in Palestine, funded by our tax dollars and supported by our government, is a public health crisis in and of itself. And the attacks on our immigrant communities by ICE, which now includes monitoring medical data, further undermine trust in our medical and public health systems and puts us all at risk.
The interconnection of public health and other systems and struggles is something that the grassroots, queer-led AIDS Coalition to Unleash Power (ACT UP) understood so well. Activists, scientists, medical providers, public health leaders, and other community members joined forces. It took many years and much heartbreak, but this coalition achieved incredible victories in health care access and medical treatment for not only people in the U.S. but all over the world. This is a model that we can and should follow, both in conjunction with and separate from the actions of state governments. Washington, California, Oregon, and Hawaii have formed the West Coast Health Alliance, and seven northeastern states so far have formed the Northeast Public Health Collaborative in reaction to federal threats to vaccine access and the dismantling of the CDC. Minnesota has also made moves to ensure access to the COVID-19 vaccine and other immunizations, despite the federal limits and troubling new vaccine recommendations from the Kennedy-overhauled Advisory Committee on Immunization Practices (ACIP).
Louisiana, unfortunately, is not likely to be joining any health alliances any time soon, seeing as the Louisiana Department of Health has ended promotion of vaccines and the Landry administration is in lock-step with the federal government. However, the City of New Orleans Health Department and the City itself have made a commitment to providing vaccine access and to making public health decisions based on science, not political whims. New Orleans has a big election on October 11, and whoever we end up voting into the mayor’s office has the responsibility to not only back up this commitment, but to take action to form alliances with other cities and states in order to ensure that our community has access to vaccines and other essential public health services. While we cannot expect any politician to save us, they do work for us, and the health and well-being of our community is at stake. There is no time for complacency or empty promises, no time to address everything in a silo. All our struggles, all our systems are intertwined, and we cannot overtake fascism or ensure our survival without embracing this fact.
Illustrations by Kate Lacour
