Since Robert F. Kennedy Jr. For more than a year, I have been trying to understand the MAHA movement from the inside. I sat at MAHA Institute roundtables, walked the halls of anti-vaccination rallies, and spoke with grassroots advocates across the country. They tell me of their concerns about toxic chemicals, ultra-processed foods, and the alarming rise in chronic childhood diseases. But when I share what I’m hearing with colleagues in medicine and public health, many chide me as saying that getting involved with MAHA is completely pointless. To them, this entire movement is nothing more than a destructive anti-vaccine, anti-science syndicate.
That assumption is wrong. MAHA is an opportunity that the public health sector, including academics, physicians, and advocacy leaders, cannot afford to waste. Yes, the MAHA anti-vaccination group is very loud and suing. But for many in the MAHA movement, their biggest problem lies elsewhere. It’s about environmental pollutants, health care costs, and the bone-deep belief that health care institutions are in the hands of the industry they’re supposed to be regulating. These are not special unscientific concerns. These are concerns that have angered millions of Americans for decades, long before the MAHA label existed. And those are concerns shared by many in the public health community. If only they could look beyond those labels and create a common purpose.
MAHA’s greatest achievement Up until now, it has been politics, not policy. This shows that people are hungry for a movement that fights for health visibly, loudly and in plain language.
That’s why the movement, which is just two years old, has the support of four in 10 Americans, according to a KFF poll. MAHA supporters cite health care costs as their top priority, followed by limiting chemical additives in food and limiting corporate influence in food policy. At the same time, nearly eight in 10 MAHA supporters believe long-established vaccines for measles, mumps, rubella and polio are safe, and just 4% cited vaccines as a reason for supporting the movement. This disconnect alone shows that MAHA is not synonymous with an exclusively anti-vaccine group. It represents and reflects something much larger.
When I sat down with Nancy Fuller, a lifelong Democrat and recent supporter of MAHA, at a Christian coffeehouse in rural Ohio, she said her favorite thing about the movement is its willingness to take on challenges. Ever since her son was diagnosed with autism decades ago, she has wondered whether environmental exposures or maybe vaccines were to blame, and has spent years watching medical establishments dismiss parents like her as ignorant or clueless. In her view, public health only takes action when the outcome is already known. Whether your problem is autism, AI, or something else, MAHA has you covered. That means more failures, and the occasional hit, on issues that everyone else deemed too complicated, too compromised, or too politically inconvenient to touch. MAHA has never been shy about calling out problems and pledging to tackle them, sometimes especially if it means attacking powerful corporations or other key institutions that others have learned to work around.
This is not a model that public health should replicate across the board. Many of MAHA’s swings are truly reckless, promoting unproven and often dangerous health hacks, fabricating lies about vaccine ingredients, and making claims contrary to all credible evidence. But public health is being too cautious, setting the bar for evidence too high. Public health issues such as ultra-processed foods, environmental toxins, and drug prices rarely lacked data. I didn’t have enough nerve.
Public health hasn’t always been so timid. The field has emerged as a powerful political force advocating for safer workplaces, cleaner water, and better housing. Somewhere along the way, it receded into the background, and many of its leaders preferred to think of themselves as technical and technological enterprises operating outside the fray. The problem with an invisible shield is that no one knows it’s there. When the field has been forced to the forefront, as during the coronavirus pandemic, many Americans have experienced public health not as a shield but as a rebuke, spoken in acronyms and brandished with data-laden reports. In the shadow of the coronavirus, trust in essential health institutions like the National Institutes of Health and the Food and Drug Administration has fallen to an all-time low. Fewer than half of Americans now trust the CDC to carry out its core responsibilities, a decline of nearly 40 percent since the beginning of the pandemic.
Although now effectively out of power, the public health community is understandably alarmed by what has happened over the past year. The administration has prioritized politics over sound public health policy in determining what the FDA approves and what research the NIH funds. Drastic staffing cuts at the CDC have weakened the agency’s response to health threats like screwworms and Ebola. Many of the CDC’s key leadership positions remain vacant, and the agency has only officially had a director for just 29 days in this administration. When it comes to immunizations, RFK Jr.’s Department of Health and Human Services changed the pediatric vaccine schedule in a way that reflects ideology rather than epidemiology. It also overhauled the Advisory Committee on Immunization Practices, an expert group that has guided U.S. vaccine policy for decades. In response, the American Academy of Pediatrics distanced itself from the CDC and positioned itself as an independent, evidence-based guide to childhood immunizations. More than 20 states have already broken the CDC’s recommendation rankings. The result is a breakdown in vaccine guidance, reflecting the fact that Americans no longer trust a single, organized voice on vaccines.
Public health has had some success in containing the damage. In March, a federal judge sided with the AAP in a lawsuit against HHS, blocking the new vaccination schedule and ruling that the ACIP review violated proper scientific procedure. (HHS has appealed the ruling.) In effect, this would reverse most of the federal government’s actions regarding vaccines over the past year. Many in the public health community are treating this victory as vindication. But a trial is no substitute for victory in the court of public opinion.
A step toward regaining public trust would be to seriously review fiscal relationships in this area. AAP’s own donor page lists at least 10 pharmaceutical companies as supporters, including six that make vaccines recommended by AAP. And the six health organizations that sued HHS collectively received millions of dollars in donations from the pharmaceutical industry. The organizations maintain that these donations are used to fund education and advocacy programs and are not used to influence policy recommendations or approvals.
But conflict remains bad in an environment of low trust, and RFK Jr. puts this conflict at the center of his critique. Public health officials refused to acknowledge that, giving him an argument he didn’t deserve to continue winning. If these organizations can accept funds from anyone, it’s worth asking why their donor pages are dominated by the very companies whose products they review and recommend. If public health wants to save the country’s vaccine infrastructure, it must break free of these shackles.
The mistrust fueling MAHA is far older than the movement and will not disappear in three years. The conditions that allowed MAHA to thrive – a lack of trust, corporate bondage, a gap between research and community, and the invisibility of public health in people’s daily lives – have been worsening for decades.
Public health must recognize that there is opportunity in entropy. The path forward for the field is simple, but public health requires us to do something we have been reluctant to do: be proactive. Visibly. Political, but not in a partisan sense. There are strong arguments on both sides, such as air pollution in zip codes with industrial facilities, lead and toxins in the water our children drink, and the poor quality of the food Americans eat and its clear negative effects on our health. These are issues where public health can stand with the community, name what is harming the community, and fight it as if it means something. What MAHA understands, albeit imperfectly and sometimes dishonestly, is that people trust institutions not because they have better data. They trust those institutions because they feel they are on their side.
