If that debate sounds familiar, it should, since arguments about natural versus vaccine immunity helped give shape to debate about whether the public-health establishment was overly cautious about Covid, too. As we exit what Siddhartha Mukherjee recently called America’s “privatized pandemic,” the country is feeling its way toward a new anti-establishment equilibrium — and anointing a new class of health leaders distinguished by their vocal skepticism and distrust.
In the aftermath of the pandemic, we’ve talked a lot about the loss of public trust in science, but the collapse of trust in government, especially among the young, might be even more worrisome. (The pandemic really did a number on us.) One result is that many more Americans now seem to believe they should be in charge not just of choices about their own health but also of the entire health information ecosystem that informs those choices, as well. Many regard well-being as something you can mold on your own at the gym or perhaps buy at the supermarket, in the supplement aisle — so long as you did your own research (at least listened to a good podcast) and brought your own list.
What is on that list isn’t necessarily important, as long as it runs against the establishment grain. Mehmet Oz is about to be confirmed as the head of the Centers for Medicare and Medicaid Services, for instance, though only 21 percent of the health recommendations he offered on his television program were judged by a group of researchers to have even “believable” evidence to support them. Kennedy stated that “there is no vaccine that is safe and effective” (he later claimed that the quote was “misused”) and has responded to the Texas measles outbreak not by urging everyone to get vaccinated but by shipping vitamin A. He has also praised steroids and cod liver oil — neither of which are part of routine treatment protocols, and neither of which have produced persuasive research suggesting they should be integrated into those protocols.
The MAHA movement rallies itself under the banner of reform, and it does raise undeniably important questions about why the richest country in the world is so much less healthy than its peers. But what it really heralds is a new age of public-health libertarianism, which is to say, a pretty explicit war on all the things that make health a “public” good, sustained by mutual aid, in the first place. At least, it marks the direction of change: away from solidaristic responsibilities and toward something both more suspicious and more solipsistic, by which individuals draw down biomedical capital accrued over many decades without feeling any real need to replenish the well.
Many MAHA priorities are worthwhile, at least in theory: chronic disease, obesity, diet and exercise and environmental contamination of various forms (ineffective but habit-forming pharmaceuticals, too). But in substituting individual behavior, diet and the your-body-is-a-temple model of human flourishing for germ theory, aerosol spread and what are often called the social determinants of health, the country’s new health leadership team is committing that cardinal American error: seeing individuals as perfectly autonomous and inviolable units, and defining everything outside individual control as either an irrelevant consideration or a violation of bodily autonomy.
