It is a grim moment for public health in the United States. Antivax groups spread fear among parents with increasing success, leading to declines in childhood immunization and a resurgence of deadly diseases like measles, which has already caused one child’s death in an ongoing outbreak in West Texas. The threat of a bird flu pandemic is looming while right-wing media personalities hype raw milk, which happens to be a potential route for transmitting the virus to humans. Policies aimed at preventing COVID-19 are a thing of the past, but the disease is still very much present and has killed at least 20,000 people in the United States just since October of 2024. Compounding these problems, governors and legislatures across the country have, in recent years, enacted a wide array of policies that undermine public health protections, ranging from banning masks to preventing health departments from running vaccination campaigns.

The return of President Trump to the White House signals a further escalation in the war on public health. Most notably, Trump has appointed Robert F. Kennedy Jr.—a prominent antivaxxer, leader of the “health freedom” movement, and a guy who enjoys doing weird things to dead animals—as the Secretary of Health and Human Services. The Senate confirmed RFK Jr. on February 13. He assumed power amid a Trump-induced maelstrom of destruction in the agency, which has so far included attempts to dramatically cut federal funding of health research and conduct mass firings of scientists at the National Institutes of Health and Centers for Disease Control and Prevention. RFK Jr.’s first weeks on the job coincided with a move by the administration to end an ad campaign that has proven effective at promoting seasonal flu vaccination followed by the cancellation of an advisory committee meeting, which puts next season’s flu vaccine in jeopardy. There may be more antivax policies in the pipeline, and RFK Jr. has signaled that he will use a new presidential commission to “scrutinize” the childhood vaccination schedule.

Recently formed groups like the MAHA Alliance, a super PAC started by former RFK Jr. campaign officials, and Stand for Health Freedom, a membership-based political advocacy organization, provide an infrastructure for this movement to fund and endorse candidates across the country. Seeing an opportunity, many Republican elected officials and a small number of Democrats have embraced the movement’s demands. These have ranged from ending water fluoridation—based on highly overstated evidence of health risks—to banning health departments from doing critical work like vaccine promotion.

So far, nobody seems to have an effective plan to counter the movement’s power and influence. Some public health experts have responded with their standard approach: issuing warnings about misinformation and the consequences of rejecting scientific authority. In January, for example, hundreds of experts signed an open letter urging senators to reject RFK Jr.’s nomination for Secretary of Health because the position instead requires “someone who respects and believes in science.” Certain health commentators and progressives have proposed a different response altogether. Perhaps seeing the movement’s rise to power as inevitable, they want to find common ground with its anti-corporate postures. In supporting the nomination of RFK Jr., Brandon Novick of the left-leaning Center for Economic and Policy Research, for example, wrote that Kennedy “represents a unique shift away from the corporate capture that has pervaded the public health agencies.” While Novick downplayed Kennedy’s antivax positions, he and other pundits see the regulation of Big Food as a key area for collaboration.

Both of these approaches, however, are bound to fail. Anyone who believes that appealing to scientific authority will be sufficiently persuasive or that any meaningful collaboration on issues of corporate regulation can happen fundamentally misunderstands the movement’s appeal, beliefs, and sources of power.

While the U.S. left has a history of organizing around issues related to public health, it also appears to be in a weak position to counter the growing influence of the health freedom movement. Medicare for All served as an important rallying point during the 2016 and 2020 Bernie Sanders campaigns, but left struggles, while important and in many cases impactful, have been more fractured and localized since the beginning of the COVID-19 pandemic: workers fighting for on-the-job protections, for example, and disability rights and civil rights groups resisting mask bans. Public health has long been a core issue for the U.S. left, and it has been rooted in successive generations of militant workers fighting for safer conditions, as well as movements like the Black Panthers and the Young Lords advocating for community healthcare. However, the left has also benefited from being able to take basic public health infrastructure—such as sanitation systems, vaccination, and food safety—for granted, as these were not initially won through militant class struggle but, in most cases, through middle-class liberal reformers persuading capitalists that safeguarding public health aligned with their interests. For the left, therefore, the necessity to fight for maintaining basic public health infrastructure is somewhat new territory and is complicated by a need to fight not only economic elites but also reactionary cultural forces that have been remarkably successful at leveraging the broad social appeal of “personal choice.”

Now more than ever, defending basic public health protections is necessary. It’s also a winnable battle. Trump's relationship with RFK Jr. is a marriage of convenience—the president has no particular loyalty to his newly appointed health secretary or the broader health freedom movement that RFK Jr. represents. The movement can be defeated by exposing it for what it is: unpopular, morally hideous, and—perhaps most importantly—a losing cause that poses a liability to any politician who chooses to embrace it. But that’s not enough. We need to fight for a right to health which includes universal healthcare as well as strong public health measures.

A Dark Worldview

The health freedom movement is often associated with a conspiratorial skepticism towards government and big corporations, an embrace of alternative medicine, and an opposition to a wide range of public health measures. Although health freedom organizations have existed in the U.S. for more than 150 years, advocates are enjoying newfound popularity in the wake of the COVID-19 pandemic and growing antivax sentiments.

The health freedom movement’s worldview is easily misunderstood. It is an eclectic group, and observers may find themselves befuddled by the diversity of pseudoscientific beliefs its members may hold (including such practices as homeopathy or eating mud) or substances they oppose (a seemingly endless, ever-changing list of bogeymen, ranging from sunblock to seed oils). But one thing about the movement should be clear—it is not organized around a principled commitment to bodily autonomy, even if the term “health freedom” might suggest otherwise. While the term encompasses the freedom to refuse vaccination and to make choices that cause harm to others, the right to abortion is notably absent from its ambit, and many in the movement identify as pro-life. In the words of Tiffany Justice, who co-founded Moms For Liberty in 2021 as a vehicle for organizing protests against school mask and vaccine mandates, “Abortion is a lot of things, freedom isn’t one of them.” Joseph Ladapo, Florida’s antivax surgeon general, even went so far as to threaten criminal charges against broadcasters who aired pro-choice television ads.

It is also true that, as critics tend to emphasize, adherents of the movement tend to reject scientific and medical authority. They reject the overwhelming scientific consensus that vaccines do not cause autism. They protested against public health authorities in the context of the COVID-19 pandemic, refusing to adhere to guidelines and mandates regarding mask wearing and social distancing. At the same time, they promoted unproven or ineffective COVID-19 treatments such as ivermectin and hydroxychloroquine, often under the conspiratorial belief that pharmaceutical companies and public health agencies were deliberately suppressing "real cures" to maintain control and profit. 

It is not hard to see why Americans may become skeptical of medicine, given how common it is to have negative experiences with the healthcare system. Healthcare is often unaffordable even for those who have insurance, and medical debt is the leading cause of bankruptcy. Healthcare financing incentivizes doctors to rush, and there may not be adequate time to assuage patient fears, provide enough information to ensure adequate informed consent in medical decision-making, or properly diagnose or treat rare and complex conditions. For the parents of autistic children in particular, medical science has been unable to provide an adequate explanation of the condition, and the weakness of the social safety net means there may be no one to rely on beyond family to meet any support needs that their children may have.

For the many Americans out there with a legitimate axe to grind, some will take the time, like Luigi Mangione, to read principled academic criticisms of the system. But it is probably much more typical for skeptics to encounter the many loud voices claiming that the whole damn enterprise is a conspiracy, and the power to heal comes from within (but may only be unlocked with unregulated supplements priced at $44.99 for a monthly supply). Lauren Fadiman has explained how rational skepticism of a for-profit industry can then grow into something much more sinister: conspiracy.

At this point, it should be clear that potential recruits to the health freedom movement will not be won over by demanding that they defer to authority. Asking them to “trust science,” for example, is not a particularly persuasive message. Because the movement’s rejection of medical authority is one of its major appeals, a more persuasive message would be to emphasize the morally hideous beliefs and practices that lie under its surface and that are used by influencers, podcasters, and leaders like RFK Jr. to profit off of people’s genuine desire for health alternatives. This is a movement whose leaders essentially believe that if you are in a state of sub-optimal health, you are a lesser being who is undeserving of life and fair game for financial exploitation. “These people see you as a disposable pawn” has a certain oomph to it that “trust science” lacks.

Looking beyond the movement’s rejection of science, its dark worldview starts to become clear. At the center, there is a pervasive belief that health is an achievement requiring a long, arduous journey towards bodily purity and personal transformation. This is the story arc of many of the movement’s most popular figures. Bernarr Macfadden, a central persona of the health freedom movement in the early 20th century, escaped a life of poverty and orphanhood through his commitment to exercise and bodybuilding. For Joe Rogan, who regularly conducts sympathetic interviews of antivaxxers on his popular podcast, a dedication to martial arts was a means to overcome intense fears of social rejection. For RFK Jr., it was a triumph over heroin addiction.

Overcoming adversity is, obviously, not a bad thing in itself. The problems arise when the path veers into narcissistic self-obsession and a contempt for all of those ‘unfit weaklings’ who have not experienced the journey. In one particularly extreme case, Joseph Mercola —a major funder of antivax organizations who became incredibly rich by selling dubious health treatments and advice—has recently come to believe that he is a god according to an account from his sister. While presumably not all health freedom influencers view themselves as literal deities, they might as well, since they share a collective mindset marked by an utter contempt for most people and an unwavering belief in their own exceptionalism. This insulates them from the self-doubt that any of us mere mortals might have if we, say, like RFK Jr, had traveled to Samoa and there was even a slight chance that we caused a large number of children to die in a measles outbreak there. It also enables these leaders to drain their underlings of hard-earned money without remorse (sometimes through multilevel marketing schemes) and provide them with dangerous advice.

In fact, a contempt for those who are deemed ‘unfit’ is what shapes much of the health freedom movement’s opposition to medicine and public health protections. The argument goes like this: People who take pharmaceuticals to manage chronic disease or addiction will never be truly healthy because they avoid the necessary and arduous work of personal transformation. The role of government, if there is one, is to impose "tough love" on people who lack the necessary self-discipline to be healthy. In this vein, it should not be surprising that RFK Jr. does not advocate bodily autonomy for people who are poor or addicted to drugs but instead wants to ban food stamp recipients from making unhealthy purchases (a policy that Trump officials support) and treat addiction on “healing farms” where medications like buprenorphine (effective for treating substance use disorder) will presumably be unavailable.

Arguments against mandatory vaccination and other universal public health measures similarly follow from a contempt of those deemed inferior. This is evident in remarkably similar statements by Macfadden and Rogan, two health freedom rock stars in their respective eras. To both men, infectious disease control measures are foolish since those who die of viruses are fat and avoid exercise. Macfadden, writing in 1902, claims that vaccination is unwise because smallpox only affects those who “eat very heartily and exercise rarely.” For Rogan, speaking on his podcast in 2022, COVID-19 did not necessitate public health measures like vaccine mandates, since it should only be a concern to people who are “obese or very overweight.” The real problem, according to Rogan, was their own poor decisions: “[They don’t] understand that whatever you’re doing to your body is way, way worse than what Covid is going to do to you.”

The contempt for the unfit and inferior has eugenic undertones to it, meaning that the lives of certain undesirables—whether they be poor, chronically ill, disabled, and so forth—are implied to be less valuable than those who are ‘healthy’ (whatever that means). And while health freedom rhetoric often blames ill health on poor personal choices, there is also recurring slippage into blaming ‘innate physical differences’ that at times veers into the sort of biological racism that was more commonplace in the 19th century. RFK Jr., who appears particularly fixated on the fallacious idea that racial groups have innate differences in disease susceptibility, has said in the past that “We should not be giving Black people the same vaccine schedule that's given to whites because their immune system is better than ours.” But Kennedy is not alone in expressing these beliefs. In fact, it was not uncommon for health freedom movement members to see high COVID-19 death rates among Black Americans in the first year of the pandemic and falsely attribute these inequalities to Vitamin D deficiency rather than unequal working and housing conditions that made it harder to avoid infection.

It is precisely this obscuring of social injustice that makes the health freedom movement so appealing to corporate interests. In an age of recurring crisis, the ruling class has a need for political strategies that provide cover for the hollowing of government’s ability to meet people’s essential needs or ameliorate ever-growing inequality. Regarding the COVID pandemic, I have previously discussed how the ruling class “hid a plague”—it turned what was initially a societal crisis requiring a publicly coordinated and economically redistributive policy response into a ‘normal’ state of affairs in which the virus was reduced to a mere personal problem. As the Biden administration was ready to 'move on' from the pandemic even amid successive waves of death, federal health messaging obscured the risk of infection, Congress and the White House disbanded critical social safety net programs, and then-CDC Director Rochelle Walensky’s message that “Your health is in your hands” signaled the full pivot to a personal responsibility paradigm for managing the virus. The second Trump administration appears poised to attempt a broader and far more extreme version of this process. The right may try to justify Trump’s evisceration of the public health system, along with Republican attempts to gut Medicaid, by appealing to the false promises of the health freedom movement with its individualistic vision for health that sees government as the enemy rather than as a resource for organizing care needs. Whether this kind of persuasion will be successful on a large scale is still an open question.

False Positive

An important misunderstanding about the health freedom movement is that it has yielded electoral benefits for the politicians who have embraced it. An especially pervasive narrative is that many of the movement’s supporters are left-wing voters and that some have defected to the Republican Party over issues like vaccine or mask mandates. As one journalist put it, health freedom “merg[es] the far-right with what some have called the ‘crunchy granola’ new-age alternative medicine voters on the far-left.” Another story highlighted the trajectory of Melanie Dragone, a “lifelong Democrat” and the leader of a New Jersey health freedom organization who decided to break with the party and vote for Trump in 2024 as a result of RFK Jr.’s endorsement.

In reality, there is little evidence that consequential numbers of leftists or former Democrats have been won over to the Republican Party by the latter’s embrace of health freedom causes. It is not even clear that the Republican politicians who have aligned themselves with health freedom have performed any better with their own party’s base.

In fact, the issues championed by the health freedom movement are not very popular overall, with one recent poll showing that just 18 percent of U.S. adults want to end public school vaccine mandates, 29 percent want to remove fluoride from water supplies, and 24 percent want to purge federal health agencies of staff scientists. It should therefore not be surprising that many of the recent candidates who made health freedom their brand lost their elections. Most notably, Florida Governor Ron DeSantis tried his best to differentiate himself from Trump in the 2024 Republican primary by going hard for health freedom. It did not work out: DeSantis dropped out after an overwhelming defeat in the Iowa caucuses and endorsed Trump.

There is also little evidence that the movement has gained meaningful levels of support from Democrats or leftists. The only data suggesting that health freedom organizations are attracting consequential numbers of Democrats come from the unverified claims of health freedom organizations themselves.

The truth is that health freedom has been an overwhelmingly right-wing cause for a very long time. Compared to Democratic voters, larger shares of Republicans have expressed antivax viewpoints since at least 2001, which is as far back as the survey data goes. And the movement’s leadership has been dominated by the far right for more than fifty years. Members of the conspiratorially anti-communist John Birch Society assumed leadership roles in key health freedom organizations such as the National Health Federation and the explicitly conservative Association of American Physicians and Surgeons. There is simply no parallel of far-left leadership in the movement. It is also worth noting where left-wing groups stand on public health issues: the Green Party has supported vaccine mandates, local Democratic Socialists of America chapters ran vaccination drives during the COVID-19 pandemic, and left-wing labor unions tend to advocate in favor of public health measures.

There is also a potential downside to politicians who decide to cozy up to the health freedom movement. It may be mostly true that political accountability does not exist in the current political era. But it is not entirely true. Bungling public health emergencies can still result in negative consequences for elected officials. After all, Trump lost the 2020 presidential election, and a small but convincing body of social science research makes the case that Trump’s loss can be attributed to his poor handling of the COVID pandemic.

Against Common Ground

Finally, it would be foolish to believe that progressives or public health experts could form any meaningful collaboration with the health freedom movement on issues of corporate regulation. 

Take the narrow issue of working with RFK Jr. to rein in Big Food, a recent focus of many opinion pieces. It is true that, as Secretary of Health, RFK Jr. could direct the FDA to develop new food regulations. But this is such a limited power that it is almost embarrassing to take it seriously as a way Kennedy might approach his lofty ambition of “put[ting] an end to the chronic disease epidemic.”

The FDA has no legal authority to make sweeping changes to the food supply. Instead, the agency can only pursue narrowly focused regulations that either change food labels or ban one specific additive at a time, and even those changes can take years to complete. This kind of bureaucratic tinkering is neither new nor revolutionary—it happened repeatedly during the last two Democratic presidential administrations. The most notable instance was the FDA’s ban on artificial trans fats issued in 2015 during the Obama administration, which illustrates a kind of best-case scenario for the potential health benefits of additive bans.

In that instance, a strong base of scientific evidence showed that trans fats were uniquely harmful to cardiovascular health: They not only raised ‘bad’ cholesterol like other fats, but they also lowered ‘good’ cholesterol in ways other fats do not. Before the ban went into place, an FDA economist projected that trans-fat regulation would prevent between 11,000 and 25,000 deaths annually. These numbers are nothing to scoff at. But to put them into context, they amount to a national reduction in heart disease mortality of just under 3 percent¹—far short of revolutionary (and, at a time when the Trump administration is targeting clean air rules, it should be noted that this is far less than the number of heart disease-related deaths prevented by regulating air pollution).

There is reason to doubt whether banning other additives would provide anywhere near the benefits offered by eliminating trans fats. In general, other additives tend to have weaker evidence of overall harm, and there is often uncertainty about whether the alternatives that would be used in their place are any better. Additive bans may still be a good idea in many cases! But this is simply not the best basket to put all of one’s eggs into if the goal is to make a significant reduction in rates of chronic disease.

It is also unclear how progressives or public health advocates could play a meaningful role in the insular, bureaucratic processes involved in food regulation. Sure, they could write op-eds or submit comments to the FDA website (if Kennedy gets his way, though, public comments will be scrapped), but it is ultimately in the hands of the White House, which reviews regulations and makes the final decision. Specifically, it is Russell Vought, who played a key role in crafting the extraordinarily pro-corporate Project 2025, who oversees regulatory policy in his capacity as the White House Office of Management and Budget’s Director. It would be naïve to think that the opinions of public health experts or progressives will carry any weight with Vought or anyone else in the Trump White House, especially over the voices of corporate lobbyist friends and ever-present electoral concerns about alienating key agricultural states if their exports are adversely affected.

The contrast between RFK Jr.’s antipathy towards Big Food and Trump’s love for all corporations illustrates a deeper contradiction about the health freedom movement. While pillorying industries they deem harmful, the movement owes much of its recent success to its alliances with groups that believe in unhindered corporate power. For example, the major coalition that united against COVID-19 pandemic control measures in 2020 was a who’s who of free market advocacy groups, including organizations like the Heritage Foundation and the American Legislative Exchange Council (ALEC, which writes pro-corporate legislation), both of which have received funding from Big Pharma. The Brownstone Institute—a think tank that grew out of the influential pro-herd immunity “Great Barrington Declaration” treatise on COVID-19 and that has repeatedly championed RFK Jr.’s candidacy for health secretary—was started by Jeffrey Tucker, a child labor advocate and man so single-mindedly committed to the cause of corporate freedom that, according to his daughter, he encouraged his own children to smoke at a young age owing to his belief that Big Tobacco’s products were unfairly maligned.

The fact is that groups like the Heritage Foundation have no real loyalty for the health freedom movement, nor do most of the Republican politicians who have amplified its causes (least of all Trump, who, after all, is a notorious germaphobe and McDonald’s fan who has an inclination to take political credit for developing the COVID-19 vaccines through Operation Warp Speed). By appointing RFK Jr., Trump has rewarded a relatively small segment of his electoral coalition and may also be anticipating benefits from amplifying Kennedy’s views on health as a matter of personal responsibility as a way to rhetorically justify the administration’s attacks on federal health regulation. It is too soon to say just how far Trump will try to go along with RFK Jr. and others in his administration to pursue an antivax agenda—commitments to the health freedom movement during the first Trump administration, such as a proposed committee on vaccine safety that RFK Jr. was poised to chair in 2018, fell through. And there are already some signs that Trump might anticipate RFK Jr.’s antivax views as a political liability, and some health freedom movement leaders expect the new health secretary to sell them out by bowing to White House pressure and not attacking vaccines sufficiently. The truth is that Trump and other pro-corporate right-wing politicians have only associated themselves with health freedom because it appears politically convenient at the moment. The way to limit the movement’s power in the short term is to make supporting it a liability.

Health Must be Communal

Defeating the “health freedom”/Make America Healthy Again movement in the longer term and defending public health from its many corporate threats requires sustained organizing around a different vision of health: not as the result of an arduous personal transformation but as a collective right to many things, including universal healthcare.

As Fadiman has argued, the way out of the politics of hyper-individualism, conspiracy, and mistrust is to make health communal:

But what might restore trust—and perhaps even a shared sense of truth—is a return to something like the healthcare ideology of yore: the notion of health as communal, an effort we are all in together—and the creation of a system that, in tangible ways, actually reflects that ideology. It was not enough during the pandemic to speak of communal responsibility in a country that regularly fails, in so many ways, so many of its citizens. It was not enough to speak of “herd immunity” in the thick of a healthcare ideology that asks—with only rare exceptions—each person to foot the bill for their own well-being. Care must be either communal or consumer; it cannot be both. And the one inevitably comes at the expense of the other.

Beyond Medicare for All, we need a collective right to clean air and water, a job where your boss cannot work you to death during a heatwave, and a neighborhood where you can walk, bike, or roll a wheelchair without being hit by a car. The vision I’m describing here is entirely unoriginal. Within the field of public health, many have worked towards securing a right to health for more than 150 years. Our lives would be unimaginably worse without the many achievements made in this pursuit. In the 19th and 20th century, public health investments came about through political organizing by coalitions of social reformers, unionized workers, doctors, scientists, engineers, and lawyers. From sanitarians who built systems to deal with wastewater and worked alongside activists to achieve a system of housing regulation, to the creation of new government agencies that required basic safeguards for food production, working conditions, and consumer products, to the development of mass vaccination campaigns that have saved at least 154 million lives around the world in the last half-century—public health has made our lives tremendously better. Indeed, our lives have been made worse by previous administrations’ neglect of public health. And our lives will continue to worsen if we give up broadly on public health at this critical moment.

The health freedom movement also offers some lessons about the power of organizing people around immediate health concerns while building broader political engagement toward an expansive, long-term vision. While health freedom offers lies and exploitation, the left has the opportunity to meet those same needs with evidence-based, community-driven solutions that empower people rather than mislead them. By building on historical examples like the Black Panthers’ Survival Programs and the militant occupational safety interventions of the labor movement, we can provide tangible benefits now while cultivating the power needed to achieve a more just and comprehensive system in the long run.

notes

1. Author calculation based on CDC mortality data and a reduction in deaths of 25,000.