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If the United States learned any lesson from HIV, it should have been that negligence can be a death sentence. In the early 1980s, the virus’s ravages were treated as “something that happens over there, only to those people,” Juan Michael Porter II, a health journalist and an HIV activist, told me. But the more the virus and the people it most affected were ignored, the worse the epidemic got.

Reckoning with that reality changed the course of the HIV epidemic—and transformed how American public health was practiced. AIDS forced public-health officials to confront how stigma can speed disease; it emphasized that not just mandated tests and quarantines but education, engagement, and community partnership could dampen transmission. It showed how activism could challenge and advance science—and how focusing care on vulnerable populations, domestically and abroad, was key to stopping a disease’s spread.

The Trump administration is now tearing down that legacy. It has cut funding and programs for HIV research, treatment, and prevention so deeply that “we’re watching the field burn to the ground,” Rebecca Fielding-Miller, a behavioral scientist and an HIV researcher at UC San Diego, told me. In doing so, it is also razing the foundational public-health principles that HIV work laid.

Just six years ago, President Donald Trump’s first administration declared its commitment to end HIV in the U.S. by 2030, by funneling more resources into at-risk communities—an initiative that, over the past few years, has successfully reduced new infections. When reached for comment this week, a White House spokesperson told me that “the fight to end the HIV/AIDS epidemic will continue” and that by centralizing work on HIV/AIDS under the newly created Administration for a Healthy America, the Department of Health and Human Services “will be better positioned to end this epidemic by 2030, which is a priority for this Administration.”

But researchers and activists described the president’s recent actions as a clear about-face—and potentially petty, if not outright vindictive. Trump and his allies have soured on fighting infectious diseases generally—and on the public-health establishment that came up during the peak of the AIDS era and then helped define the nation’s COVID response. Several researchers told me they suspected that the administration’s attacks on infectious-disease research have been partially driven by the president’s distaste for Anthony Fauci, who led the National Institutes of Allergy and Infectious Diseases from 1984 to 2022, and who was a key political adviser during the pandemic. (Fauci’s primary focus for decades was HIV. He declined to comment for this story.)

Current National Institutes of Health officials have echoed that idea, as they have watched several prominent leaders at NIAID—as well as Fauci’s wife, who until last week served as the agency’s chief of the department of bioethics—be dismissed from the agency. At best, the administration’s actions appear to be motivated by callousness and ignorance; at worst, they’re a kind of calculated enmity that will have widespread collateral damage.

Just months ago, the end of the HIV epidemic in the United States seemed within sight. Infection rates, although still substantial, remained in decline; of those living with the virus, nearly 90 percent knew their HIV status, and more than 75 percent were receiving care. The widespread availability of antiretroviral drugs has turned what was once a death sentence into a survivable chronic condition. Since the 1990s, HIV’s mortality rate has dropped nearly tenfold; for years, people living with HIV have been pursuing relationships with partners who remained HIV negative, and birthing children free of the virus. “I am as old as the nation’s HIV epidemic,” Nina Martinez, who has been living with HIV since 1983, when she acquired the virus through a blood transfusion at six weeks old, told me. “And I am alive after 41 years because I had access to treatment in childhood.” Six years ago, Martinez became the first American with HIV to become a living kidney donor.

Holding down HIV rates, though, has demanded continuous management. Each year, the federal government dedicates more than $28 billion to combatting HIV, the large majority of which goes to care and treatment. Since January, the Trump administration has been dismantling that infrastructure. It has cut funds to hundreds of HIV-related research grants, forced multiple clinical trials focused on HIV to halt, and pulled support back from studies that include LGBTQ populations, still among those hardest hit by the virus. It has all but obliterated the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest funder of HIV prevention in the world. It cut billions of dollars from federal grants to states that had been used to track infectious diseases, among other health services. (A federal judge has since temporarily blocked the cuts.)

And last week, as a part of a mass restructuring of the Department of Health and Human Services, the administration slashed the U.S. Office of Infectious Disease and HIV/AIDS Policy, ousted three top officials at the NIAID (two of them longtime HIV researchers), gutted the CDC’s Division of HIV Prevention, and reassigned the director of the agency’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. NIAID, which, under Fauci’s leadership, went from one of the agency’s least well-resourced centers to one of its largest and best funded, has now been stripped of its leaders, cannot fund high-priority research, and is vulnerable to further political attacks. Its future looks fragile, several officials told me. (The White House said that HHS “is consolidating and streamlining operations to provide better service to the American people.” )

If the U.S. and other countries continue to slash HIV funds, the virus could cause up to 10.8 million new infections and nearly 3 million deaths within the next five years, recent estimates suggest; as many as 500,000 of those deaths could be children’s. Cut off from antiretroviral therapy, people living with HIV—even those who have reached undetectable status—can experience rebounds in their viral load within weeks, to levels that make it possible to pass on the pathogen and to eventually develop AIDS. One online tracker has calculated that since the start of the funding freeze on PEPFAR—which supported more than 20 million people living with HIV, most of them in sub-Saharan Africa—more than 30,000 adults, cut off from lifesaving treatment, and 3,000 children, including those newly born to infected mothers, may have died.

Highly effective treatments can decrease the risk that pregnant women living with HIV will pass the virus to their baby to less than 1 percent. Skip drugs for just a few weeks, though, and those rates rise to roughly 30 percent. “You end up with an infected infant and a dead mother, then a dead infant as well,” Lynne Mofenson, a senior HIV technical adviser to the research program at the Elizabeth Glaser Pediatric AIDS Foundation, told me. Without treatment, up to half of babies with HIV will die before their second birthday. The Trump administration has issued PEPFAR a limited waiver meant to restart some HIV-preventive services for pregnant women. But that trickle of aid has taken weeks to restart, and many clinics have already closed. And among the federal employees laid off in last week’s purge were teams of experts that managed programs designed to reduce mother-to-child HIV transmission.

Here in the U.S., the immediate toll might be less stark than abroad. But experts still expect domestic HIV-transmission rates to rise under the new administration, which has slashed much of the CDC’s HIV workforce, including entire branches devoted to behavioral and clinical surveillance, research, and prevention communication. At a minimum, those cuts will compromise the nation’s ability to educate the public on preventive behaviors—which “people need in order to keep themselves safe,” Martinez, who is also a former CDC official, told me. And should transmission rates rise in the U.S., a shrunken public-health workforce will be far less equipped to track and contain outbreaks, Joseph Cherabie, the medical director of the St. Louis STI/HIV Prevention Training Center, told me. The Foundation for AIDS Research has estimated that severe cuts to the CDC’s HIV-prevention funding could lead to as many as 14,000 additional AIDS-related deaths in the U.S. by 2030.

Many researchers expect that more assaults on HIV are ahead. Republicans have proposed deep cuts to Medicaid, which helps ensure access to HIV care and treatment. And several experts told me they worry that the Ryan White HIV/AIDS Program, a multibillion-dollar initiative that provides medical care, drugs, and support services, could be at risk, too. Scientists also worry that some people may attempt to ration their pills, which will render the regimens less effective and allow the virus the leeway to evolve wide-scale drug resistance, Wafaa El-Sadr, the director of ICAP at Columbia University’s Mailman School of Public Health, told me. (ICAP, a global health research center, recently received a termination notice from the NIH for a grant that supports several clinical trials studying HIV prevention in New York and Eswatini, a southern African country with the highest HIV burden in the world.)

Some four decades into the fight against AIDS, “we were actually talking about eliminating HIV globally,” Mofenson told me. Now, though, decades’ worth of progress seem to have “just disappeared overnight.” That includes the work the public-health establishment has done to collaborate with affected communities. “It has taken us decades to be able to build the trust,” El-Sadr told me. “Now it’s like we are rolling back the years.”

Before HIV, America had a strong handle on some of the country’s worst infectious diseases. Public-health officials could deploy vaccines against smallpox, measles, and polio; they could catch and isolate the sick. But AIDS, both chronic and infectious, and concentrated among marginalized populations, defied those strategies.

Before researchers understood how the virus could and could not be transmitted, misinformation fueled discrimination, and vice versa: Children with HIV were barred from schools; rumors swirled that poppers, a party drug, were a root cause of AIDS (a debunked idea that the current secretary of Health and Human Services, Robert F. Kennedy Jr., has nevertheless suggested is true). But pressuring people to hide their infection status—even punishing them for revealing their illness—meant that the virus had more liberty to silently spread. To curtail a disease that was spreading so quickly, and that was so tightly linked to behavior, public-health professionals had to directly seek out partnerships among those most at risk. People who had the virus couldn’t just be treated as transmission “threats”; they needed protection, privacy, and support.

At the same time, communities dealing with AIDS needed the cooperation of public health’s professional class and of the government to advance care and treatment. Activists pressed for attention and investment in stopping the disease: more, larger clinical trials; speedier access to drugs; subsidized medical care. “Without better drugs, we were all gonna die,” the AIDS activist Rebecca Denison said in a recent talk, but “even if better drugs were discovered, those who couldn’t access them would still die.”

The modern architecture of public health has been built on these insights. As Mitchell H. Katz, a former director of San Francisco’s public-health department, wrote in 2005, housing assistance and other support services—crucial components of the HIV response—still prop up programs for people with mental illness or drug addictions. Under pressure from activists, the FDA began to make certain experimental HIV drugs available outside of clinical trials, and sped up their approval pipeline—then later borrowed from that same blueprint when reviewing treatments for Alzheimer’s, cancer, and other diseases. After strides in treating AIDS in the U.S. prompted the country to extend help abroad, the federal government expanded international funding for diseases such as tuberculosis and malaria. HIV was also, perhaps, the 20th century’s starkest reminder of “the importance of engaging with communities, if you’re government, at all levels,” James Curran, an epidemiologist at Emory University, who in 1981 led the CDC task force that investigated the first known cases of AIDS in the U.S, told me. Whenever that public-health tenet has been dismissed, disparities have deepened—including in each of the country’s most recent infectious threats: COVID-19, mpox, H5N1 bird flu, and now even measles.

The Trump administration, however, is abandoning many of these core principles. Since January, its actions—especially those that have disregarded LGBTQ populations and research efforts aimed at improving health equity—seem bent on disenfranchising some of America’s most marginalized groups. And by going after HIV more directly, the administration is cementing its commitment to letting infection spread in the communities that can least afford to be neglected. Although some HIV inequities have lessened, the virus still disproportionately affects certain groups of Americans—among them, transgender women, men who have sex with men, and people of Black and Latino descent.

The strategy of “if we don’t pay attention, it will die off and disappear” has never worked for infectious disease, Porter said. If the Trump administration continues to ignore the reality of infectious disease, and whom it most affects, it will only legitimize stigma, and worsen its effects, Denison said. Many of the same groups most at risk of contracting HIV are also vulnerable to other sexually transmitted infections, and other infectious diseases—tuberculosis, viral hepatitis, even seasonal flus—tend to concentrate among groups that have been historically neglected or distanced from medicine. That the nation’s new leaders are willing to upend HIV’s legacy also signals how little interest they have in sparing any realm of public health from destruction. (AIDS, after all, was—and still is—one of the world’s most devastating and deadly diseases.) As the Trump administration reveals what its priorities are, its leaders are also making clear whom they are willing to sacrifice along the way.

On Sunday, Robert F. Kennedy Jr. met with the families of two girls who had died from measles in West Texas—and raised doubts about the safety of vaccines. “He said, ‘You don’t know what’s in the vaccine anymore,’” Peter Hildebrand, whose 8-year-old daughter Daisy’s funeral had been held just hours earlier, told me. “I actually asked him about it.”

The Secretary of Health and Human Services had traveled to the small, remote city of Seminole, where 1,000 mourners for Daisy filled the wooden pews of an unmarked Mennonite church. After the service, coffee and homemade bread were served at a traditional gathering known as a faspa. Kennedy was there, he wrote on X that afternoon, to “console the families and to be with the community in their moment of grief.”

The slow-brewing crisis, in which more than 600 people have been infected with measles and three have died—America’s first deaths from the disease in a decade—has left Kennedy in an awkward position. For many years, he has been the country’s most prominent anti-vaccine activist. Americans “have been misled by the pharmaceutical industry and their captured government agency allies into believing that measles is a deadly disease and that measles vaccines are necessary, safe, and effective,” he wrote in a foreword to a 2021 book. Since taking office, though, he has moderated his tone, at times endorsing the shots’ importance to public health. In his public post from Seminole, Kennedy did so once again, describing his department’s efforts to supply Texas pharmacies and clinics with “needed MMR vaccines,” which he called “the most effective way to prevent the spread of measles.”

Yet there’s ample reason to believe that Kennedy hasn’t really changed his views: “I have worked with Bobby for many years, and I can confidently say that he has a heart that is incapable of compromise,” Del Bigtree, the communications director for Kennedy’s independent presidential campaign, said on X, in an effort to reassure some angry and confused supporters. “He is at a poker table with the slyest serpents in the world,” he added; “we should not ask him to show his cards.” (Bigtree also called the MMR vaccine “one of the most effective ways to cause autism,” despite the fact that study after study has disproved the link.) Indeed, when I spoke with Hildebrand by phone on Monday, I learned that Kennedy was questioning vaccines behind the scenes, even in the midst of his condolence trip to Texas.

“He never said anything about the vaccine being helpful,” Hildebrand told me. He did not want to go into more detail about his conversation with Kennedy, saying he’d been advised (he didn’t say by whom) not to make any public comments. But he seemed to view the secretary’s statement as confirmation that the MMR vaccine is untrustworthy. Notwithstanding his daughter’s death, he claimed that the children of another member of his family, who were vaccinated, still got sicker in the recent outbreak than two of his own children who had gotten measles and recovered. “So the vaccine ain’t about shit,” he said. A Health and Human Services spokesperson would not confirm what Kennedy had said to Hildebrand. “Secretary Kennedy is not anti-vaccine, he is pro-safety,” the spokesperson wrote by email. “He has consistently made that clear.”

[Read: His daughter was America’s first measles death in a decade]

Among vaccine skeptics, the death of Daisy Hildebrand, like the earlier death of 6-year-old Kayley Fehr, is being reframed as the consequence of a tragic and egregious medical error. Children’s Health Defense, the anti-vaccine nonprofit Kennedy founded, has pushed the theory that Fehr wasn’t given the correct antibiotic for pneumonia soon enough to save her life, apparently basing that judgment on medical records the Fehrs provided to the organization. Covenant Children’s Hospital, where Fehr was treated, has called such claims “misleading and inaccurate,” while pointing out that patient-confidentiality laws prevent the hospital from going into detail about the girl’s treatment. Robert Malone, a doctor and former researcher known for sharing concerns—and misinformation—about COVID-19 vaccines, posted on his Substack that Daisy’s death was “a case of a child suffering from pre-existing conditions who was misdiagnosed.” (Texas’s health department says that the girl had “no reported underlying conditions.”)

[Read: The vaccine scientist spreading vaccine misinformation]

Hildebrand, too, blames doctors for the deaths. “I’m willing to do any- and everything I can to make sure the hospitals start getting some ‘act right’ in them so nobody else has to go through this,” he said. “They pretty much murdered them.” In the case of his daughter, he believes the hospital should have given her budesonide, a steroid often prescribed for asthma, among other conditions, that has been touted by Kennedy for treating measles. “They didn’t give her the budesonide breathing treatment that we’d been asking for,” Hildebrand said. “They were saying that the IV steroids they were giving her were better.” A spokesperson for University Medical Center in Lubbock didn’t respond to a request for comment.

According to Michael Mina, a physician and an immunologist who studies measles, budesonide is not a first-line treatment for measles. “The use of budesonide to try to treat measles simply does not, biologically or mechanistically, make sense,” Mina told me. “Where it could potentially make sense is treating a co-infection that’s occurring in conjunction with measles, but that is far from a measles therapy. This is not something that we should be treating measles with.” Mina added that it is “much better to prevent measles in the first place through vaccination.”

Hildebrand said that, before they took Daisy to the hospital, his family was given advice on her care by, among others, Ben Edwards and Richard Bartlett, two West Texas doctors whom Kennedy has praised as “extraordinary healers” treating measles patients in Seminole. Edwards and Bartlett are pictured in a photo that Kennedy posted from his meeting with the two families, which occurred after the funeral at a steak dinner at the West Texas Living Heritage Museum, in Seminole. Like Kennedy, Edwards has raised doubts about the safety of the MMR vaccine and instead promoted treatments such as cod-liver oil, which is high in Vitamins A and D. At one point, he was offering free cod-liver oil to Seminole residents at an ad hoc clinic next to a coffee shop.

Hildebrand said his family had been in touch with Bartlett and Edwards. Daisy was given Vitamin A. “It all seemed to work,” he told me. “When she started needing oxygen so bad, we didn’t have the equipment at home, and neither did they have all the equipment at their clinics, so obviously we had to look for further help at the hospital.” In an email, Edwards denied that Daisy Hildebrand was one of his patients. “No, I did not treat her, but plan to get the medical records to review to see if standard of care was followed or not,” he wrote. “As you know, standard of care antibiotics were not given to the first little girl that died, which lead [sic] directly to her death.” Bartlett could not be reached for comment; a clinic where he used to work said he was no longer employed there.

Dean Boyer, the funeral director who handled the services for both girls, was present at the dinner where Kennedy met with the Hildebrands and Fehrs. He said he overheard the secretary’s conversations with both sets of parents. “He never asked pointed questions: Are you vaccinated? Are you not? He just told them how sorry he was,” Boyer told me. “He even met with the kids alone, just sat—a ‘pawpaw minute’ is what I called it.” Boyer praised Kennedy for attempting to keep his visit under wraps. “He tried to get in as quiet as he could, because he didn’t want attention.”

It’s true that Kennedy mostly dodged reporters, but of course his trip was not a secret. After the dinner, he posted a long message on X about the “warmth and love” he felt from the community and about how he had “bonded with many of these resilient, hardworking, resourceful, and God-loving people.” He also shared several photos of himself embracing the families, one with a boy on his knee, another with his arm around Hildebrand. Whereas some of Kennedy’s earlier comments about the outbreak have seemed callous—calling it “not unusual,” for instance, or suggesting without evidence that Kayley Fehr might have been malnourished—these conveyed the image of a government official who cared.

When I spoke with Hildebrand, he said he didn’t know that the secretary had posted photos of his family, or that Kennedy had given out Daisy’s full name. He said that he hadn’t wanted “any of this on the internet from the get-go,” but he didn’t blame Kennedy. Instead, he directed his ire at reporters. “Most of y’all are fake media, and I don’t need my daughter’s name out there to be reported crap on,” he told me. “I just don’t need anybody talking negative about my daughter. She’s in the ground.”

When you inhale a microscopic speck of soot, its journey may go like this: The particle enters your nose and heads into your lungs, penetrating even the tiny air sacs that facilitate gas exchange. Next it may slip into your bloodstream and flow into your heart, or past the blood-brain barrier. Most of us inhale some of these tiny particles every day. But inhaling enough can turn the act of breathing into an existential hazard, prompting or worsening asthma, COPD, respiratory infections, and permanent lung damage. In the heart, the specks can trigger heart disease, heart attacks, and most of the cardiovascular disorders you can think of. Air pollution is also associated with depression and anxiety, and with higher rates of suicide. It can trigger strokes and is linked to dementia or—even at average levels in this country—Parkinson’s disease.

These particles can also cross the placenta, where they can reduce an infant’s lung function before birth. A pre-polluted baby is also more likely to arrive prematurely, and at a lower weight. Exposure to bad air in utero is associated with a higher risk of autism, and exposure in childhood has been linked to behavioral and cognitive problems, including lower IQ. A person’s lungs can develop until age 25, and as Alison Lee, a pulmonologist at the Icahn School of Medicine at Mount Sinai, put it to me, “once you’ve lost lung function, you can’t get it back.” Persistent exposure to air pollution can cause permanent harm, creating health problems for children and setting them up to become sicker adults.

It’s hard to picture a person dropping dead from air pollution, yet it happens all the time. In the United States, particulate matter is estimated to kill more than twice as many people as vehicular accidents do—in total, some 100,000 to 200,000 people a year, as an underlying factor of chronic disease or by way of heart attacks, asthma attacks, and other sudden events. Even as air quality in America has improved, researchers have found that relatively low concentrations of particulate matter can cause major hazards.

All of this stems from a toxic and mostly invisible danger, largely the product of burning things for fuel and letting the remnant drift into the air and then into us—which is what happens unless the government regulates that process. The Trump administration, however, has shown little interest in doing so. Through new policies and aggressive cuts, the administration is taking steps that will encourage more pollution while muffling the science that shows the harms. The very air that Americans breathe will likely become less safe.

So far, the EPA has announced that it will pursue a suite of rollbacks of environmental rules, among them a Joe Biden–era update to standards for particulate matter that were meant to be fully in force by 2032 and that the Biden EPA projected would, in that year alone, prevent up to 4,500 premature deaths and 800,000 cases of asthma, reaping up to $46 billion in health benefits. It also plans to reassess a rule limiting the amount of airborne mercury and arsenic that power plants can release. In a statement announcing one of these rollbacks, the EPA said that the U.S. has already made major gains in air quality, implying that these are enough. In response to a request for comment, an agency spokesperson told me that EPA Administrator Lee Zeldin’s priority is “clean air, land, and water for EVERY American.”

The air in the U.S. certainly is cleaner than it was when industrial air pollution billowed into the skies unmitigated. Over the past 25 years alone, particulate air pollution in the country has dropped by more than 30 percent. Yet at least one in three Americans lives in a place where the air is still a health hazard. The particulate-matter standard that Zeldin intends to roll back is still nearly twice as high as the limit the World Health Organization recommends to protect health.

Rolling back rules will take time, but America’s air quality could worsen in the interim. The EPA told businesses last month that they can simply email the agency if they want an exemption from certain pollution regulations and that “the president will make a decision.” However they address those pleas, this opens a back door. The recent cuts to EPA personnel almost certainly mean that enforcement will suffer too. Meanwhile, worsening wildfire seasons, fueled by climate warming, are reversing decades of air-quality progress in this country. And ignoring and even stoking climate change, as Donald Trump’s administration is doing, will produce worse wildfire seasons. The country’s slide back toward its more polluted past “will become a steeper trajectory,” Joan Casey, an environmental epidemiologist at the University of Washington whose work helped expose the connection between wildfire smoke and dementia risk, told me.

The administration’s cuts to scientific research mean, too, that the impact of its deregulation may never be fully understood. In recent months, the government has pulled down some air-quality data and canceled grants; it also plans to dissolve a whole EPA division dedicated to studying how the environment affects public health. These actions create a sort of purposeful naivete: You can’t regulate what you can’t prove is harmful, and you can’t prove harm without research.

And you certainly can’t solve for what you don’t yet know is a problem. The EPA’s newer findings about how air pollution may addle a body—by worsening mental health or triggering more cases of neurodegenerative disease, for example—haven’t yet been included in its risk-benefit assessments of air-quality regulations, Casey added. “I think often we’re underestimating the true impact,” she said.

When I called Marianthi-Anna Kioumourtzoglou, an epidemiologist at Columbia University, she had just learned that the Trump administration had canceled her grant to study how impacts of climate change, including air pollution, alter cognitive function in aging people. (Earlier this year, too, she was dismissed from her appointment to the EPA’s Clean Air Scientific Advisory Committee, along with the rest of the panel.) Even so, the basics on air pollution have been studied enough that Kioumourtzoglou knows how current rollbacks will affect Americans: There will be “more heart attacks, more respiratory adverse health outcomes for sure,” she told me. “Our cognitive functions are going to be worse—the progression of Alzheimer’s, the progression of Parkinson’s.” Pollution-related depression and anxiety may go up. Even slightly increasing the risk or rate of any of these at the population level can diminish quality of life and, ultimately, productivity, she said. A sicker country is a poorer one.

Compared with smoking, for example, an individual’s risk of inhaling a dangerous amount of air pollution and then having their health affected because of it is relatively small, she told me—but “the problem is that few people smoke, and everybody breathes.” If a portion of the population’s cognitive function is diminished, even a little bit, the overall impact is enormous.

Kioumourtzoglou wonders, too, how much further the Trump administration will push the idea that air pollution should not be a concern to Americans. When the Heritage Foundation published a report in December that made the radical case that no definitive link exists between air pollution and poor public-health outcomes, she disregarded it. But after watching other Heritage Foundation goals be enacted, she is concerned that its rationale could be taken seriously by the current administration. The Heritage report attempts to cast doubt on the validity of decades of science by, in part, arguing that studies linking air pollution to health effects fail to prove causation, because they’re not randomized or controlled. (The Heritage Foundation did not respond to requests for comment.)

This is an attack not just on air-pollution research but on an entire scientific approach. Most public-health research is observational by necessity, because exposing people to air pollution in a lab setting to see how sick they get, say, wouldn’t be ethical. Instead, scientists gather data from already-exposed populations and try to parse out how different variables affected people’s health. Over decades, researchers have developed biostatistical methods to determine causal relationships from large groups of studies.

When EPA scientists and regulators link a pollutant and a health outcome, “they’re not making that assessment on one or two or three studies. It’s decades of scientific publications,” Corwin Zigler, a biostatistician at Brown University who served on an EPA scientific advisory panel on air pollution under the Biden administration, told me. He wasn’t surprised by the logic behind the Heritage Foundation report: The leader of the previous Trump administration’s air-pollution advisory panel had begun to sow doubt about basic air-pollution research. In response, the National Academies of Sciences, Engineering, and Medicine undertook a major review of the way the EPA assesses causal relationships, and though it recommended that the EPA’s process be more transparent, it found its methods scientifically robust. Zigler said he has no doubt that particulate matter is causing harm at current levels in the United States: “That’s the scientific consensus. That takes very seriously all of the limitations of any given scientific study.”

Studies about how entire populations are harmed by air pollution are framed in probabilities and percentages, but they represent a multitude of individuals for whom daily living has been made tangibly worse. For Lee, the Mount Sinai pulmonologist, work became personal a few years ago, when her son, now 5, began having asthma attacks that would send him to the emergency room. Asthma is a common-enough ailment that an attack might seem like a routine and manageable health issue. But anyone who’s had a severe one will tell you differently. Over years of reporting on air pollution, I’ve had asthma attacks described to me as feeling like someone is stepping with their full weight on your ribcage, or as though you are suddenly a fish out of water, suffocating on land. It’s a traumatic event. Lee, knowing what she does about air pollution, decided to move her family from New York City to the suburbs a year and a half ago; they haven’t been to the emergency room since.

“Clearly, we know that where you live determines your health,” Lee told me, but few people can make a choice like she did, to upend their life to breathe cleaner air. The Trump administration is also cutting the programs intended to address exactly these geographic disparities, while working to make the air worse for everyone. EPA Administrator Zeldin has said these rollbacks are part of the administration’s plan to “unleash the Golden Age of American prosperity.” But prosperity does not mean choking to death in one’s own home or depriving a child of cognitive capacity. Whatever wealth is promised here is narrowly disbursed at others’ expense.

Updated at 12 p.m. on April 7, 2025

The current U.S. measles outbreak follows, in some ways, a classic pattern: The virus first found a foothold where childhood vaccination is low—among Mennonites in Texas, in this case—before rapidly spreading to other communities and states. It has sickened mostly children and has now killed a second child, whose death was reported this weekend. With cases still ticking up, experts expect the outbreak to persist for a year.

Look closely at the outbreak’s edges, though, and the patterns are more unusual: It’s not just children getting measles. Where Texas’s outbreak has spilled over into New Mexico, for example, half of the confirmed cases and one potential death involve adults, largely unvaccinated. Last year, too, adults older than 20 accounted for more than a quarter of U.S. measles cases. This is all in keeping with what experts have warned: Adults are now susceptible to this childhood disease.

Doctors tend to be unfamiliar with adult measles, because adults used to not get it. In the prevaccine era, the extremely contagious virus blazed through with such frequency that virtually all children were infected with measles before reaching adulthood. Today, vaccine coverage is widespread enough that unvaccinated children can easily live to adulthood without ever encountering the virus, but not uniformly high enough to prevent outbreaks altogether. Vaccinated adults can get occasional breakthrough cases, but the illness tends to be much milder. Unvaccinated adults, however, are a uniquely vulnerable group, because measles only becomes nastier and deadlier with age.

The risk from measles follows a U-shaped curve, Neal Halsey, a measles expert and professor emeritus at Johns Hopkins, told me. On the left are children under 5, whose still-maturing immune systems might struggle to fend off the virus. On the right are adults; the rise in mortality gets steeper and steeper over time, eventually surpassing the mortality in young children. When measles managed to reach isolated villages in the past—such as when a sick sailor brought it to a remote part of Greenland in 1951—outbreaks on “virgin soil” proved especially deadly for adults. Of the 77 people who died in Greenland then, 59 were over the age of 35. Measles may be a classic childhood illness, but it mostly killed adults there.

This age gradient of measles severity persists today. Although the typical symptoms of rash, fever, and cough are the same, adults—even healthy adults in their 20s and 30s—grow more prone to the severe complications that might prove dangerous and even fatal. Pneumonia and encephalitis, or infections of the lungs and brain respectively, are more common. One in four adults with measles will need to be hospitalized, a rate that is roughly two to three times that of school-age children.

Matthew Goetz still has “vivid memories” of adult patients he treated as an infectious-disease doctor during a 1988–90 outbreak in Los Angeles. The first patient wasn’t diagnosed until after a couple of days in the hospital, he recalls, because doctors had little reason to suspect that an adult would have measles. Several more soon showed up. Of the 33 patients eventually admitted to the public hospital where Goetz worked, nine had to be transferred to the ICU. Six developed respiratory failure so severe that they needed a ventilator.

When measles returned to Southern California with the Disneyland outbreak of 2014–15, adults made up more than half of those cases. The two sickest patients of the outbreak, who both needed to be ventilated for pneumonia, were also adults, Kathleen Harriman, an epidemiologist at the California Department of Public Health, told me.

Why measles gets deadlier with age of first contact is still not entirely understood; the adult immune system must somehow be less optimized to fight off the virus. Halsey points out that this pattern is not unique to measles: Chicken pox and hepatitis A are also milder in children than in adults. So is COVID, as we’ve recently seen.

The consequences of measles can linger long after infection too. Measles has a singular ability to induce “immune amnesia,” making survivors potentially susceptible to other diseases they’ve already had or been vaccinated against. This is because the virus attacks immune cells, including memory B cells, which “remember” how to fight known pathogens through antibodies. A 2019 study found that a course of measles infection in unvaccinated children wrecked 11 to 73 percent of their antibody repertoire. This range suggests that immune amnesia’s impact may vary widely from person to person, but the overall trend explains some old and odd observations about postmeasles immune suppression. For example, measles can make autoimmune diseases, in which the immune system mistakenly attacks one’s own body, go into remission. Immune amnesia also explains, at least in part, a long-standing pattern of children becoming more vulnerable to other illnesses after getting measles.

This effect has largely been studied in children, so scientists do not really know how it affects adults. “I would anticipate that it would be very similar—and it also might even be slightly worse,” says Stephen Elledge, a biologist at Harvard and senior author on the 2019 immune-amnesia study. A course of measles tends to last longer and be more severe in adults, he reasons, so the disease may kill off more of their memory cells. He suggests that anyone who gets measles should get revaccinated for other diseases, just in case.

If the measles vaccination rate dips further, adult cases could become even more common. The U.S. eliminated measles in 2000, after many years of achieving a better than 95 percent vaccination rate among kindergartners. This number started slipping in 2020 and is now down to 92.7 percent, which is, importantly, edging toward the measles herd-immunity threshold of 92 to 94 percent. Under this threshold, herd immunity can no longer limit spread enough to protect the unvaccinated. A bigger pool of unvaccinated kindergartners means a greater potential for outbreaks that grow massive enough to threaten unvaccinated adults. And if those unvaccinated kids never get their shots later in life, they will become susceptible adults, growing more vulnerable to measles with age.

For now, the Texas outbreak is already so widespread that the U.S. is likely to lose its measles-elimination status. In the time it will take to get this outbreak under control, more children will certainly get infected, as will more adults.  

When Korean skin care arrived in the United States several years ago, it became the stuff of legend among beauty enthusiasts. They raved about the sunscreen from the Korean brand Beauty of Joseon, which used advanced UV filters and left no white film behind; currently, it costs $18—its closest American counterpart would be about $40 and gloopier. Korean snail mucin promised to hydrate skin and improve fine lines, and prompted a buying frenzy, during which I did drop my own American dollars on a facial “essence” made from the secretions of snails. It has made my skin softer and only grossed me out twice.

Now my snail mucin is caught in a trade war. On Wednesday, President Donald Trump’s announcement of nearly global tariffs included a 25 percent hike on goods imported to the U.S. from South Korea; his administration has also repealed a customs loophole used by certain K-beauty exporters based in Hong Kong. Some skin-care enthusiasts had been preparing for possible trade disruptions—“spent my paycheck on korean skincare because those tariffs are about to go crazy,” one person posted in December. But now, they’re springing into action. “If you love your glow, get it now,” one skin-care influencer said on TikTok. “This is your last chance before it becomes unaffordable.”

Americans’ love affair with K-beauty was fostered by many years of free trade with South Korea, when our mucin came free of additional fees. The new tariffs will be “a good test to see how powerful the K brand is” in America, Andrew Yeo, a senior fellow at the Brookings Institution who studies U.S.–South Korea relations, told me—how much “soft power” Korea has accumulated here. If people have been buying K-beauty products because they love K-beauty (or K-pop or K-dramas), a price hike might not matter. But if they decide Korean products haven’t done that much for their skin, maybe they’ll switch to Neutrogena.  

Beauty enthusiasts have, at times, gone to great lengths to import Korean serums, face masks, moisturizers, sunscreens, and the like from exporters usually based in Korea or Hong Kong. When Joshua Dupaya, a beauty influencer, first got into Korean products in 2016, for instance, he sourced them mostly from “trusted eBay sellers,” he told me. Cosmetics have become a fairly significant part of Korea’s exports—$10 billion globally last year, nearly $2 billion of which went to the United States. And certain K-beauty brands are more beloved here than in their home country. A co-founder of Beauty of Joseon said on a podcast in December, “We’re not really popular in Korea, I have to admit.” (Their Korean brand name means “beautiful woman in Joseon,” referring to the former, long-reigning Korean Joseon dynasty. She said Koreans think the name is “so tacky.”)

Part of K-beauty’s appeal is its price point—$15 for a high-quality moisturizing cream compares favorably with a $20 bottle of CeraVe, and extremely favorably with the $390 La Mer “crème” touted by the upper echelon of skin-care influencers and celebrities. Korean beauty products also contain ingredients that are uncommon in U.S. skin care, but that some American consumers swear by—Centella asiatica (Asiatic pennywort), rice water, ginseng extract, and of course, snail mucin. Their sunscreen is also just objectively better. The FDA is notoriously slow to approve new UV filters, which has meant that sunscreen in America is generally worse than it is in Europe and Asia. Formulations here feel chalkier and oilier, and they can leave white residue behind, because American chemists have a smaller palette of UV technology to draw from. For $12, someone could buy American sunscreen in uninspiring packaging that makes them look like a ghost. For the same $12, they could buy a K-beauty sunscreen in expensive-looking packaging that will not make them look like a ghost. When my friend returned from South Korea with an entire carry-on full of Korean skin care, we applied gobs of sunscreen, feeling like royalty with our advanced UV protection. For skin-care aficionados, K-beauty was an ideal trifecta: a product that feels luxurious, seems effective, and is relatively affordable.

[Read: You’re not allowed to have the best sunscreens in the world]

The tariffs will test whether a higher price outweighs those other benefits. Yesterday, the founder of the Korean company KraveBeauty announced on TikTok that the tariff will hit their next shipment to the U.S. and will have to be passed on to customers. “We’re still calculating what the implications of this new trade policy would be to our business, but this will change pretty much everything,” she said—for her company and others. She said the tariffs could upend her brand’s long-standing policy of keeping all their products under $28; those responding in the comments already spoke of K-beauty in the past tense; many included crying-face emoji.

Trump’s tariffs, of course, apply only to imported K-beauty. In the past several years, a handful of major K-beauty manufacturers have opened factories in the United States and will be able to avoid the tariffs, Yeo told me. But he expects that other Korea-based companies will wait about a year to see if these tariffs last and how U.S. consumers respond to the price hike before they consider relocating to America. “I don’t know if Koreans want to invest that much,” he said. “It depends how bullish you think the U.S. market is.” American demand for K-beauty has grown a lot, but brands will have to decide if they think it’ll keep growing. The U.S. isn’t their only market, and companies may choose to focus on countries such as China instead.

But if the tariff succeeds and more K-beauty is soon made in America, the industry could lose its major selling point: it is not made in America. These non-U.S. formulations are the “whole allure of using Korean beauty,” Dupaya told me. Beauty of Joseon recently began making versions of its beloved sunscreen specifically for the U.S. market, which meant it could use only UV technology approved by the FDA. Fairly or not, American users seem to think they have the same problems as U.S. sunblock. “Garbage,” a skin-care influencer said about one of the American formulations. “Absolute garbage.”

Less than a month before his assassination in 1963, President John F. Kennedy signed his last bill: one aimed at reforming America’s mental-health system. The year prior, Ken Kesey’s One Flew Over the Cuckoo’s Nest had brought attention to the crude treatments in mental institutions, and like the novel’s protagonist, the president’s sister Rosemary had received a lobotomy that left her profoundly disabled. Kennedy sought to end the “reliance on the cold mercy of custodial isolation,” he said in a statement to Congress.

Dedication to improving the country’s approach to mental health became a family project. In 1962, Eunice Kennedy Shriver started a sports camp for people with intellectual disabilities, which became the Special Olympics. In the 1970s, Senator Edward Kennedy tried to fix living conditions in mental institutions; in the ’90s, he helped establish the Substance Abuse and Mental Health Services Administration. Recently, his nephew Robert F. Kennedy Jr., the current secretary of Health and Human Services, subsumed that agency into a new one: the Administration for a Healthy America, which includes mental health as one of its focuses.

RFK Jr.’s policy plans have not yet taken form. So far, he has overseen deep cuts to HHS and begun reorganizing the agency internally. He has met once, reportedly, in private with the Make America Healthy Again Commission, created by the president to address chronic health issues; one of its stated goals is to assess the threat of prescription psychiatric drugs. (HHS did not respond to a request for comment.) When speaking publicly, Kennedy has repeatedly returned to the idea that American doctors overprescribe such drugs.

Kennedy is skilled at picking up on frustrations in the zeitgeist. The sentiment that doctors over-rely on psychiatric drugs, while neglecting side effects or difficulty tapering doses, has been receiving more public attention. Consistent and affordable access to therapists, or to economic and housing support, is hard to come by. Yet to the extent that RFK Jr. has revealed his own thinking on how to address those complaints, his suggestions remain isolated from robust debates about mental-health treatment. His clearest proposal, still, is his campaign promise to create wellness farms where Americans would reconnect with the soil and “learn the discipline of hard work.” That idea is little more than a retreat to well-trodden calls to address mental distress through seemingly natural means, and shows scant interest in the nuances of debate around psychiatric medication, or the ways in which separating people from society for such cures has failed.

Kennedy first brought up wellness farms during his presidential run, and when he painted a picture of pastoral meccas for treating addiction, he joined a tradition that dates back more than 200 years. Take the Retreat, founded in England at the end of the 18th century by a Quaker, William Tuke, who along with the French doctor Phillipe Pinel is considered a father of “moral treatment,” an effort to create humane hospitals. Instead of shackles and corporal punishment, the Retreat provided a stately country home, with acres of land to tend cows and grow food. The doctor Benjamin Rush—who signed the Declaration of Independence—was inspired by moral treatment, and wrote in 1812 that men who “assist in cutting wood, making fires, and digging in a garden, and the females who are employed in washing, ironing, and scrubbing floors, often recover,” whereas those who don’t do any manual labor do not.

Tuke and Pinel believed that farming was especially helpful, and many early asylums in the United States employed a “work as therapy” component, says Neil Gong, a sociologist at UC San Diego. At the time, these institutions were cutting-edge, and those running them believed that the “insane” didn’t have to be locked up in chains to improve. “Mental hospitals started out in the 19th century with very utopian expectations around them and their ability to cure,” says Andrew Scull, a sociologist and the author of Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness. By the end of the 19th century, every state had at least one government-funded institution.

But when moral treatment was generalized to larger populations, it fell apart. (The Retreat was designed to take on only 30 patients.) Over time, government-run asylums became overwhelmed with cases, and rampant with abuse. At scale, institutions “rapidly declined into warehouses where lots of unpleasant things happen to the patients, and where patients tended to get lost,” Scull told me.

Including farming didn’t protect against such issues, either. The Fort Worth Narcotic Farm, a federally funded project opened in 1938, promised to blend honest farmwork with recovery from drug addiction. Only 25 percent of patients, one study estimates, stuck to their treatment plan, and most people treated at federal narcotic farms, according to a 1957 study, used drugs after they left. The U.S. Narcotics Farm, which opened in 1935, was the temporary home of many famous jazz musicians, including Chet Baker. But once people left the farm, the majority—nearly 90 percent—relapsed. It closed in 1976 after a congressional inquiry led by Senator Ted Kennedy found that doctors were testing experimental drugs on the people living there, and sometimes giving patients drugs such as heroin and cocaine as a reward.

The idea of farm-based detox is appealing enough that today, plenty of private rehabilitation centers incorporate nature and farming; pastoral work as mental-health treatment has become a luxury good, Gong told me, but is often combined with a suite of other services, including psychiatric support. Still, there isn’t an overwhelming body of evidence that care farms have ever been effective at improving outcomes. One review from 2019 found no proof that “care farms improved people’s quality of life” and limited evidence for improved depression and anxiety. “To champion the wellness farm seems out of left field when other models like permanent supportive housing or supportive employment have a huge evidentiary base, including cost-effectiveness,” Ryan K. McBain, a health economist at the RAND Corporation, told me. If Kennedy wanted to, he might tap the Center for Medicare & Medicaid Innovation, which evaluates new programs, to assess how effective a state-run wellness farm could be. This month, however, the CMMI announced that it is cutting funding for several of its programs.

The most revealing aspect of Kennedy’s plan isn’t what people would do on these farms, but what they wouldn’t—take any sort of psychiatric drugs. In describing the farms, Kennedy painted a picture of them as detox centers where people would also taper off medications for depression and ADHD. In the moral-treatment times, drugs such as antidepressants and Ritalin didn’t exist; moral treatment was, nevertheless, seen as alternatives to barbaric interventions such as bloodletting and restraint. For Kennedy, the wellness farm is the same: a substitute for, not a complement to, other treatments.

The role that psychiatric drugs play in Americans’ mental-health treatment is a real and active debate. For many people, psychiatric medications can be a crucial part of their recovery. Yet contemporary psychiatrists have plenty of complaints about insurance companies that reimburse more for medication than for other treatments and a pharmaceutical industry riddled with conflicts of interest. In 2025, people working in this field recognize that the ways in which drugs have claimed to treat mental illness have oversimplified or overemphasized biology. Deliberations on the origin of and rightful reaction to mental distress are core to psychiatry: Michel Foucault thought that psychiatry could be a pernicious force to control society; the psychiatrist Thomas Szasz thought that mental illness was a myth altogether.

However, Kennedy hasn’t engaged with any of these topics substantially. Instead, he has muddied the water with false claims, including that antidepressants are associated with school shootings and are more addictive than heroin. In a podcast last year, he said that wellness farms free of psychiatric drugs would be especially helpful for Black children: “Every Black kid is now just standard put on Adderall, on SSRIs, benzos, which are known to induce violence, and those kids are going to have a chance to go somewhere and get re-parented.”

In this way, Kennedy’s wellness-farms proposal shows how his thinking about public health is defined almost entirely by his naturalness bias—that “natural” treatments are always better, and that manual labor and fresh air, or simply the right diet, could resolve complex and widespread health problems. (“They’re going to grow their own food, organic food, high-quality food, because a lot of the behavioral issues are food-related,” Kennedy said about the farms.) This is consistent with his ideas about vaccination—that natural exposure to disease might be desirable, and that dealing with diseases such as measles with diet and sanitation, as the country did in the first half of the 20th century, is preferable.

But we’ve learned plenty in the past 50, if not 200, years. Facilities that take people out of their community have limited capacity, on their own, to be an effective public-health measure. A more radical idea than wellness farms would be treating people in their community, with a mixture of care options that they can choose from. That idea is also closer to what John F. Kennedy had in mind when he signed the Community Mental Health Act in 1963. He didn’t simply want to close government-run mental centers; he aimed to create 1,500 community mental-health centers. This goal went unrealized. Community mental-health care gives a person access to an interdisciplinary case-management team of social workers, nurses, doctors, and psychologists, and to social services such as housing and employment support. Creating that at scale presents a more obvious and necessary challenge than sending people away to a farm to breathe fresh air and till the land.

Robert F. Kennedy Jr. is finally getting his wish of sucker punching the federal health agencies. This week, Kennedy began the process of firing some 10,000 employees working under the Health and Human Services umbrella. Even before he took office, Kennedy warned health officials that they should pack their bags, and on Tuesday, he defended the cuts: “What we’ve been doing isn’t working,” Kennedy posted on X. He is focused on “realigning HHS with its core mission: to stop the chronic disease epidemic and Make America Healthy Again.” But instead of improving how the federal health bureaucracy works, RFK Jr. is throwing his agencies into chaos.

The Trump administration hasn’t released details about which offices specifically were targeted, but the cuts seem to be so deep and indiscriminate that they are going to hamstring Kennedy’s own stated priorities. Kennedy has made clear that he’s singularly focused on reducing rates of chronic disease in America, but the health secretary has reportedly laid off officials in the CDC’s office tasked with that same goal. While cigarette smoking remains a leading cause of chronic disease, the top FDA official in charge of regulating tobacco is now on administrative leave, and everyone working for the CDC office that monitors tobacco use has been fired, according to the former CDC director Tom Frieden. Despite Kennedy’s promises to establish a culture of “radical transparency” at the federal agencies, he also appears to have fired the employees whom journalists and the greater public rely on to provide essential updates about the government’s actions. (In a statement, a spokesperson for HHS said that the personnel cuts were focused on “redundant or unnecessary administrative positions.”)

Kennedy, an anti-vaccine advocate, seems to have targeted more than just the most pro-vaccine voices in the government. During his confirmation hearings, Kennedy said he would “empower the scientists” as health secretary, but here are just a few of the M.D. and Ph.D.s who were reportedly targeted yesterday: the head of the FDA’s Office of New Drugs, the head of the National Institute of Allergy and Infectious Diseases, the director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, the head of CDC’s Center for Forecasting and Outbreak Analytics, the director of the National Institute of Child Health and Human Development, the director of the NIH’s Division of Microbiology and Infectious Diseases, the director of the National Institute of Nursing Research, and the director of the National Institute on Minority Health and Health Disparities.

No plan—not his MAHA agenda, not efficiency, nothing—can realistically explain cuts like these. Instead, the mass firings don’t seem to be a means to an end on the way to overhauling American health. They are an end in themselves.

It’ll take months, if not years, to fully appreciate the effect that the cuts will have on America’s scientific enterprise. The decimation at the FDA is particularly galling. Several of the agency’s top leaders charged with reviewing and approving innovative new treatments have been ushered to the exit. This is likely to lead to slower development of advancements in biomedical science; although the FDA doesn’t fund biomedical research, its leaders play a crucial role in advising pharmaceutical companies on how to conduct research and ultimately get their breakthroughs approved. America was just beginning to reap the benefits of these efforts. There are now gene therapies that can treat genetic blindness. Young children who previously would have been condemned to certain death at the hands of a rare disease, such as severe spinal muscular atrophy, now have a chance at life. The government invested in mRNA technology for decades before it was leveraged to create vaccines that saved us from a once-in-century pandemic.

One particularly dispiriting departure is that of Peter Marks, the longtime leader of the FDA’s Center for Biologics Evaluation and Research. I’d guess that, unlike me, you didn’t spend the early pandemic binge-watching scientific meetings where vaccine policy was debated. Marks was impossible to miss—a bespectacled man speaking from a bunkerlike basement, a painting of a polar bear serving tea behind him. He gets a hefty portion of credit for Trump’s Operation Warp Speed, the effort to turbocharge the development of COVID vaccines, and he came up with the moniker. His center also regulates gene therapies, stem cells, and the U.S. blood supply.

Marks reportedly resigned under pressure from Kennedy on Friday, just before mass firings hit the FDA. The two men—one, America’s top vaccine regulator and the other, its top vaccine-conspiracy theorist—have a long history. In 2021, when Children’s Health Defense, the anti-vaccine organization formerly chaired by Kennedy, petitioned the FDA to revoke authorization for COVID shots, Marks is the one who signed the letter denying the request. It’s reasonable to assume that Kennedy and Marks were never going to see eye to eye on vaccines. But Marks publicly insisted that he wanted to stay in his role, and that he was willing to work with Kennedy. In a resignation letter, Marks wrote that Kennedy demanded nothing short of “subservient confirmation of his misinformation and lies.” (Marks declined to comment for this story.)

Of course, not all 10,000 people who were fired had this type of history with their new boss. But the cuts, in many ways, appear to be rooted in a similar antagonism. In his welcome address to HHS staff in February, Kennedy offered reassurance that he was not coming in with biases, and said that people should give him a chance. “Let’s start a relationship by letting go of any preconceptions that you may have about me, and let’s start from square one,” Kennedy told the crowd. “Let’s establish a mutual intention to work toward what we all care about, the health of the American people.” In firing a huge swath of his staff, Kennedy has made clear what he believes: Anyone with an HHS badge is complicit in the current system, whether or not they have anything to do with the country’s health problems. As Calley Means, a top adviser to Kennedy, said during a Politico health-care summit earlier today, the scientists who were laid off “have overseen, just demonstrably, a record of utter failure.”

Kennedy can argue all he wants that the focus of federal health agencies needs to shift more toward chronic disease. Means and other MAHA acolytes are right that, in some ways, America has gotten less healthy and federal bureaucrats haven’t done enough to solve the problem. But decimating the entire health bureaucracy in this country is not proving his point. Kennedy doesn’t look like he is setting the agencies on a productive new course. He looks like he’s just out for revenge.

Katherine J. Wu contributed reporting.

“It breaks my brain sometimes,” Dennis Rosloniec told me. For half a decade now, the 44-year-old media technician and mountain biker from Green Bay, Wisconsin, has done everything he can to understand the risks of getting COVID. He’s read the published studies. He’s looked at meta-analyses. And here’s the truth as far as he can tell: Each time he’s infected, the chances that something really bad will happen to his body ratchet up a little higher.

Dennis is not immunocompromised. He doesn’t have a chronic illness. He’s not obese or hypertensive or unvaccinated. He’s just a thoughtful autodidact, the kind of guy who references both The Simpsons and the Stoics as he talks. “I’m a fairly large, fit, white dude, for lack of a better term,” he said. But even now, in 2025, Dennis Rosloniec is afraid of COVID. Someone else might say he’s strangely so.

Dennis is still masking quite a bit. He’s wary of attending indoor social gatherings unless they seem especially important. And he’s been taking sundry extra measures to protect himself, based on fledgling research that he’s either heard about or read online, since 2020, when he bought a tube of ivermectin, the antiparasitic drug that was repurposed as a highly suspect COVID treatment, “out of anxiety” while awaiting the vaccines. Later on, he tried iota-carrageenan nasal spray, which he used as a hedge against COVID infection until “the science became sort of iffy on it.” These days, he keeps a bottle of cetylpyridinium-chloride mouthwash in his desk, so he can gargle when he thinks he might have been exposed. And he’s got a prophylactic nasal rinse, which, actually, he’s come to sort of like for reasons that don’t have much to do with COVID. “I breathe better through my nose when I use it.”

As a masker—and as a mouthwash guy and a nasal-rinser—Dennis knows he’s out of step with almost everyone he sees in person. “You feel pressure from the world,” he told me. “It makes you question, Is this really worth it?” But he also knows that certain others share his sense of caution, or even worry more than he does. He interacts with them online, on message boards for “COVID conscious” conversation. Theirs is a kind of shadow world where the fears and obligations felt by everyone in early 2020 never really went away, and lockdowns still persist in private.

Members of these groups say they’re only doing what they’ve always done since the start of the pandemic: In the parlance of the boards, they’re “still COVID-ing.” But some are also going further to protect themselves than they did in 2020, and seeking out new strategies for staying safe. They share tips online for how to fit their N95 masks, or for taping filters to the spouts of snorkels so they can safely visit indoor pools. They talk about the challenges of COVID-conscious parenting, and meet up for COVID-conscious church events on Sunday Zooms. They share lists of COVID-conscious therapists who would never try to tell you that you’re too afraid of getting sick, or that your risk perception is distorted, or that the problem here is not the world’s but your own.

The pressure that they feel from others used to be a little worse. Not so long ago, just the sight of someone in a mask was read as a reproach, a sanctimonious demand that lockdowns should continue for us all. Or maybe it was taken as “a reminder of how awful the last few years had been,” Lauren Wilde, a COVID-conscious therapist in Washington State, told me—“of how many people had died, of how much it sucked to get COVID.” But now that tension has started to subside. When people walk around in masks in 2025, or insist on having lunch outside even in the dead of winter, they find that their cautious habits earn them fewer angry looks. They’re less reviled than they used to be. They’re more often just ignored.   

Amid the nation’s mass indifference, their isolation has only gotten more intense. Their epistemic bubble has been shrinking too. This used to be the group that was most attuned to what “the science” said; the ones who paid attention to the dots painted on the sidewalk, six feet apart. In the past few years, as official rules for social distancing have been revoked, they’ve had to make up new ones for themselves. As standard COVID medicines grew ever more expensive, they’ve had to scour for alternatives. And as basic research on the virus hit a wall, they’ve had no choice but to do their own. “The COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago,” the U.S. Department of Health and Human Services said last week, as local health departments braced themselves for funding cuts.

The COVID-conscious people have not abandoned science, Dennis told me. It’s the opposite: They’ve come to think that science has abandoned them.

If the evermaskers seem a little weirder every year, that’s because, in many ways, they haven’t changed at all. At a basic level, their COVID-conscious attitudes may not be so far from the mainstream. Twenty-one percent of Americans still think of the disease as “a major threat” to public health, according to a recent poll from Pew Research Center. Thirty-nine percent say we’re not “taking it seriously enough.” But if 50 million to 100 million adults harbor such concerns, very few are doing much about them. Masking rates were once as high as 88 percent; now they’re close to nil.

For those who still maintain their masking habit—4 percent, says Pew—the whiplash in social norms has been a shock. When masking mandates went away for public transportation, in the spring of 2022, viral videos showed people cheering as they ripped the fabric off their face. Wilde told me she remembered feeling how “it was like, nothing has actually changed, apart from the fact that someone with authority has said you don’t have to do this anymore. COVID is still risky; it’s still a new disease; we don’t know what happens 10 years after you’ve had it.” Why was everyone so quick to abandon those concerns?

The coronavirus never stopped its killing rampage: Hundreds of Americans die from it every week, even now in March of 2025, when the pandemic emergency is over and the virus is theoretically offseason. Nearly 50,000 people died from COVID in the U.S. last year, too. (The disease remains among the nation’s leading causes of death, on par with traffic accidents and suicides.) Yet even those alarming figures seem to matter less to COVID-conscious people than the vaguer risk of long-term complications. “It’s less about death, because if you die that sucks but you’re dead,” said Tess, a 35-year-old public-health researcher who asked to use her first name only, so that her professional work would not be connected to her COVID advocacy. “It’s disability. It’s living through it.” Tess told me that she already has long COVID, with brain fog and some loss of function in her lungs. “I want to maintain whatever health I have, and not make it worse,” she said.

Nancy, a 69-year-old woman who runs two weekly Zooms for COVID-conscious people from her home, and who requested to be identified by only her first name out of concern for her privacy, said that she and many members of her groups were less afraid of death than of a “reduction in our quality of life.” “Some of the data shows that if you keep catching it over and over and over again, that your chances of developing long COVID increase,” she told me, “and it also gradually weakens your immune system.”

[Read: Long COVID could be a ‘mass deterioration’ event]

Other data tell a different story, though. Some studies do suggest an ever-growing threat of long-term symptoms with each new SARS-CoV-2 infection. But according to the U.K.’s Office of National Statistics, which did perhaps the most thorough tracking of long-COVID rates through late 2022, the risk of long-term complications had been going down with reinfection. And although the coronavirus has produced several major spikes of new infections across the past five years, the proportion of those in the U.S. who report having disabilities has been either stable or increasing at a steady pace (depending on which agency’s data and definitions you consult). That means it hasn’t tracked each COVID wave the way that deaths have. According to one sensible interpretation, the risk of long-term disability was greatest early on in the pandemic, but long COVID’s threat, like the threat of COVID overall, has been fading over time.

The truth, or its best approximation, may be, to some extent, irrelevant. How any given person will perceive a threat is “a deeply psychological phenomenon,” Steven Taylor, a clinical psychologist at the University of British Columbia and the author of The New Psychology of Pandemics, told me, and one that is “influenced by values, your past history, your medical history, and your mental-health history.” (In the U.S., at least, people’s sense of risk from COVID, in particular, also has a strong connection to their politics.) Unless someone’s COVID-cautious habits have been causing major problems in their life, there’s no point in trying to discourage them, Taylor said. “I would let people choose their level of comfort with threats. That’s their decision.”

Yes, the evermaskers have assessed the costs and benefits of keeping up precautions. And yes, they say they’re happy with the trade-off, despite the many people who claim to know they’ve chosen wrong.

“There are some things that I miss,” Tess told me. “I miss a good punk-rock show where we’re all sweaty in the pit and that kind of stuff. That’s not necessarily something I’m gonna do now, but I have an approximation of it when I go to an outdoor punk show and I let everybody else go in the pit.” Nancy told me that she and her husband still have active social lives. They converse with neighbors from a distance: “We just holler and say hi to each other. It’s not like we’re living as monks or something, in total isolation.” And then she has all the people from her Zoom groups. “I think I have more friends now than I ever had in my life,” she said.

Certain challenges persist. Private or domestic disagreements over COVID-conscious choices—how to navigate the holidays, what to say to friends, which rules apply to kids—never go away. Nancy and her husband have two grown children and nine grandkids, all of whom have “gone on” from COVID, as she puts it. “There’s always a child that’s sniffling or coughing and you don’t know what’s going on,” she said. “We don’t like to make a big deal about it, so if we meet with them, we usually meet outside and do things outside together, but it’s hard.” Tess said she separated from her husband last year, in part because at one point he’d taken off his mask at work without telling her, got infected, and then passed along the illness. “Somebody who, literally, I just got married to, who I’m supposed to trust, lied to me, took away my agency, and got me sick,” she said. But moving out has not been easy: Any roommate she might find would need to share her views on COVID safety. (For now, she’s still living with her ex in a small apartment in the Bronx.)

Politics provide another potent source of conflict. Many COVID-conscious people are progressives and identify as advocates for those with disabilities. On Instagram, calls for staying COVID safe may be tethered to appeals to anti-racism, anti-capitalism, and anti-Zionism. For a set of people who feel a broader sense of crisis in America and despair at recent actions of the U.S. government, these concerns are additive. Having to accept the risk of getting COVID, Wilde told me, is just one more way “to feel like someone is trying to force something on you that you don’t want.”

A version of that complaint was once associated with people on the opposite end of COVID caution: those who resisted lockdowns and refused to wear masks. They voiced frustration, like the evermaskers do today, at a government that neglected their concerns, and at a public-health establishment that failed to meet their needs. Like the evermaskers, they felt forced to find their own approach to staying safe while other people yelled that they were wrong. I asked Wilde if she thought there might be some affinities between her own mindset and the one of parents who are opposed to vaccination, still another group of those who have come to trust their own judgment more than the government’s. “There’s a lot of overlap there. There just is,” she said. “That isn’t to say the people who are anti-vax have valid points at all. It’s just saying—and I say this a lot to the people I work with—being human is really hard.”

People tend to make it easier on themselves by remaining settled in the cultural mainstream. Those who break from that current may end up drifting past the limits of what’s agreed upon by scientists. Wilde gargles mouthwash when she feels at risk of an exposure to COVID; she also uses a nasal spray. She understands the weakness of the evidence—published trials of the cetylpyridinium-chloride mouthwash, for example, have found only the barest hints of its potential as a prophylactic—but what other tools does she have at her disposal? “Maybe these things don’t have any impact at all,” she said. Still, they’ve helped her get through some scary situations—and when it comes to scary situations, she treasures any help at all.

Dennis has a similar attitude. “Does it do anything? I’m not convinced,” he said of the mouthwash. “But, you know, it’s something that I can do.” He doesn’t trust everything he sees on COVID-conscious message boards, but at the very least, they let him know that other people in the world see risks the way he does. That’s important in itself. He said he took a recent flight to Ireland, and a small contingent of people were masking on the plane. One couple even tried to kiss each other with their masks in place. “Their faces did this high-five kind of thing … I was like, That’s really sweet. It just made me smile,” Dennis said. “We’re human beings, we want to belong to a tribe, right? We want to feel that sense of belonging.” Five years ago, it felt like everyone was in his tribe; it felt like all Americans were together in their fear of the unknown. Now that fear provides a rarer bond: togetherness in eccentricity, the communion of avoiding crowds.

My house was dark. Tinfoil covered the windows. The only light I could tolerate came from dimmable red bulbs. Ten weeks before, I had tested positive for COVID. On week three of my infection, I went to the emergency room with a debilitating migraine. On my third trip to the ER, I was hospitalized for seven days. I came home to a changed life. All the clichés about headaches are true—a pile of bricks on the head, a vise grip on the temples, an axe through the skull. The pain altered my consciousness. Trying to move or access a thought was like trying to see past a flashlight shining in my eyes.

It was 2024—a point at which most people in America considered the pandemic long since over.  But it wasn’t for me.

Some days, I couldn’t stop crying. It was more than despair at my circumstance: Long COVID can dysregulate mood and has been linked with depression. And the disease hijacked my stress-response system, leaving my body in a constant state of alarm. Any unexpected sound, even getting a text message, would set off a jolt of panic through my body, the same sensation as slamming on the brakes while driving. I lost my ability to cope. I broke a window in my house. I put a hole in the wall.

Researchers know more about long COVID than they once did, but it is still hard to define. The clearest consensus is that it’s a complex collection of symptoms that can affect almost every organ system in the body. Theories of why COVID can linger abound, and include ongoing inflammation, the virus never fully going away, and tissue damage. Many scientists agree that multiple factors likely contribute. Meanwhile, doctors are still struggling to treat the disease; less than half of doctors know how to diagnose long COVID and even fewer—28 percent—report knowing how to treat it, according to one 2023 survey. Long-COVID patients are still reporting that medical professionals don’t believe them, and though in some cases patients’ self-diagnosis might be off the mark, the reality is that many people living with long COVID simply aren’t getting the care they need.

In my case, that person who was in mind-numbing pain, unable to read, unable to write, unable to Google things or look at screens, unable to drive, drained by talking on the phone, spiraling in despair, and barely able to leave the house had to navigate the American health-care system. That I needed care for long COVID only made my predicament worse. From hearing chronically ill and disabled people speak about their experiences, I knew that to be sick in this country is a hell unto itself. But knowing something is true and experiencing it are different. I know that the Grand Canyon is deep, but I have never seen it with my own eyes. For our health-care system, I have been to the bottom.  

According to the latest federal survey as of September 2024, more than one in 20 adults in the United States had long COVID—defined as symptoms that last longer than three months. (The survey does not ask about the severity of symptoms.) Vaccines may help protect against the disease, but getting COVID still means risking long COVID. The coronavirus can leave patients with blood clots, brain dysfunction, organ damage, immune problems, and more; about a quarter of people with the disease report that it significantly disrupts their ability to perform daily activities. There are no FDA-approved medications to treat long COVID. Many medical institutions created specialty clinics to see patients with the disease, but much of what even the best clinics can offer is symptom management. Pinning down recovery rates from long COVID has been difficult, but according to several studies, after two years, the majority of people living with long COVID had not fully recovered.

Three months into my illness, I had been treated for migraines and a concussion—COVID’s impact can mirror a traumatic brain injury—but not long COVID. The tribe that I belong to, Cherokee Nation, runs the largest outpatient facility of any tribe in the U.S., but my primary-care provider there told me she didn’t know how to treat long COVID. I was referred to my tribe’s specialty clinic for rare and infectious diseases. When I managed to get that appointment, however, the provider told me he knew how to treat only pulmonary long-COVID symptoms (which many long-COVID patients don’t have). Nowhere in Indian Health Services, the treaty-based federal program that serves 2.8 million Native Americans nationwide, is there a long-COVID clinic. (An IHS spokesperson said the Biden administration would have needed to set up such a clinic.)

I started looking outside Indian Health Services and found a long-COVID clinic an hour’s drive from my house. When I called, I learned the clinic had shut down. The state where I live, Oklahoma, does not have a long-COVID clinic. My dad found one in Arkansas. Like many long-COVID clinics, it required that patients apply to get in. But after I submitted all the paperwork, I didn’t hear back.

I realized that to access care, I would need to travel. At the time, I was unable to drive, and my symptoms limited how much time I spent outside my house. When I called the Cleveland Clinic, I was transferred four times until I was accidentally forwarded to the customer-satisfaction survey. I spoke with one receptionist who told me her clinic didn’t take patients from out of state, and another who warned that traveling to her clinic probably wouldn’t be worth the time and money. (A spokesperson for the Cleveland Clinic wrote that patients should be able to make an appointment without a referral, and that the clinic and its staff “strive to provide patients with timely access to scheduling and care.”)

In my first telehealth appointment with a nationally recognized COVID clinic, the doctor wouldn’t discuss her recommendations but said I could read them in the patient visit notes. When I explained that my symptoms made reading impossible, she asked me if someone could read the notes for me. Later, my mom read me a copied-and-pasted list of healthy-lifestyle information, such as the benefits of taking a daily probiotic and the importance of getting enough sleep. The list included the doctor’s favorite bedtime teas. I told my mom to stop reading.

A few months into the pandemic, some patients reported that their symptoms weren’t going away. Through their advocacy, long COVID got its name. By 2022, hundreds of long-COVID clinics had opened across the country. There is no standard for what kind of care these clinics provide: Some are multidisciplinary teams, but many are one specialist or one nurse practitioner. This patchwork system of care has only deteriorated as attention on the disease has dwindled.

Many of the long-COVID clinics that popped up during the pandemic have closed. As part of my reporting for this story, I compiled a list of 171 clinics, drawing from the Survivor Corps website, a patient-led resource-and-advocacy group, and from searching online for long-COVID clinics by state. I then called each clinic to verify which ones were still operating. Of those, 79 were still open and accepting new patients, five were not accepting new patients or outside referrals, 61 had closed, and 15 were unreachable after two attempts. Eleven more were advertised as long-COVID clinics but don’t have a medical doctor or nurse on staff; they provide services such as speech or occupational therapy. (My assistant Sydney Anderson and intern Cheyenne McNeil, who have been helping me work through my illness, contributed to this reporting.)

Based on the list we assembled, 22 states have no long-COVID clinics accepting new patients. Given COVID rates in those states, we estimated that almost 3 million people who currently have long COVID reside there. Because of insurance policies, licensing and telehealth laws, and the cost of travel, not having a nearby clinic can easily mean that patients won’t access care. Of the long-COVID clinics that are still open, some have wait lists, do not accept outside referrals, do not take insurance, treat only specific long-COVID symptoms, or do not take patients from outside of their geographical area.

Getting in touch with the long-COVID clinics that are still open is another barrier. I spoke with operators who had never heard of their institution’s long-COVID clinic; I got transferred to the office that schedules COVID tests; I got transferred to disconnected lines; I called numbers that rang and rang and rang and rang. One day, I spent two hours on the phone and spoke with only three people who could provide information. When I called Yale New Haven Health System’s clinic, one of the most well-known in the country, I got transferred to a disconnected line. I called back and got transferred to the customer-satisfaction survey. I called a third time and left a message. I called a fourth time, trying a different number, and spoke with a receptionist who said the clinic was closed. (The clinic is still open; in a statement, Yale New Haven Health said that the phone number for the long-COVID clinic is on its website, that the volume of calls the clinic receives is very high, and that it had not previously heard of patients having difficulty accessing the clinic.)

If you are healthy, this might all sound like the familiar nightmare of customer service to which we have all become accustomed. But for people who are sick, it is a wall that stands between them and the care they need. When you are sick, you look at that wall and think, I am not well enough to climb it.

The closure of long-COVID clinics in recent years has affected patients who need care. I talked with people who, like me, have been living with long COVID later in the pandemic. Ryan Parker lives in Portland, Oregon; is a member of the Northern Cheyenne tribe; and used to work in philanthropy. Like many people with long COVID, Parker tried to work through his illness. He told me he returned from one work trip so sick that he couldn’t get out of bed for a month. Last fall, the long-COVID clinic that was treating him closed. Because of the disease, Maeve Sherry has been disabled and unable to work for three years. They found a long-COVID clinic in Great Falls, Montana, three hours from where they lived at the time, but it closed in December of 2023, they said. There are now no long-COVID clinics in Montana. When Myisha Hill was still struggling to do household chores, take care of her kids, and even talk weeks after a COVID infection, she looked up the long-COVID clinic near where she lives in Las Vegas, she told me. But it, too, had closed. There are now no long-COVID clinics in Nevada.  

A spokesperson for the University Medical Center of Southern Nevada wrote that the clinic closed “amid low demand.” Other clinics echoed this response, saying they suspended operations after patient numbers dwindled. A few clinics also stated that they now refer long-COVID patients to primary care. Several spokespeople told me as a reporter that their clinics were still open, but when I called as a patient, I was told the clinic was closed. And even when clinics are open, patients still face barriers: I spoke with people with long COVID who told me they couldn’t access care because a clinic didn’t take their insurance, their doctor didn’t send a referral, or the clinic rejected them as a patient.

The alternative to enrolling in a clinic is to try to see a regular neurologist or cardiologist. But many specialists have lengthy wait times, and long-COVID patients are twice as likely as the general public to report that this is why they can’t get care. Parker, for instance, is trying to see a specialist for myalgic encephalomyelitis/chronic fatigue syndrome, a form of debilitating fatigue that is common with long COVID. The first available appointment is nine months out.

And when patients are finally seen, the care itself might not be competent. Parker’s primary-care provider suggested that his debilitating fatigue was a product of anxiety. Several doctors have also told Kelly Rider that her problem was just anxiety—and one said it was perimenopause. Sometimes doctors prescribe things that exacerbate symptoms—such as exercise for chronic fatigue. When Diem-Han Dinh’s doctor ordered a stress test, she explained that she was unable to run. He didn’t believe her. At the stress test, she almost fainted.

Eight months into my illness, I boarded a plane and traveled with my mother to Rochester, Minnesota. The long-COVID clinic I finally got into was Mayo. The off-label medication they prescribed didn’t do much, but I learned about my illness and how to manage my symptoms, which has improved my quality of life. Other things have helped too. Thanks to an arsenal of migraine treatments, my headache—although not gone—is less severe. Thanks to eight months of vision therapy, I can now focus my eyes and am practicing reading. And, in writing this article, I have gotten back to reporting. What I had to go through to get here, I would not wish on anyone.

The resources our system of medical care can offer to those wanting to learn about, cope with, and heal from what COVID has done to their body are beyond inadequate, and are likely to get worse. In February, the Trump administration ordered the Department of Health and Human Services to dissolve its advisory committee on long COVID. In March, the department announced it would close its Office for Long COVID Research and Practice, and began canceling grants from the National Institutes of Health for COVID studies.

Sick and disabled people have been pushed to the margins of our society for a long time. There was a moment during the pandemic when I saw our collective concern focused on the ill. Living with long COVID, I sometimes wonder where that concern went. I feel like the wounded antelope picked off from the herd. Everyone else has moved on, while I am stuck in my illness. I could be angry at each individual hypocrisy—each person who preached the importance of masks only to go back to normal without me—but I am not. Instead, I am sad that what is more powerful than our concern for the sick is the indifference of our health-care system.

At the turn of the 20th century, William Wrigley Jr. was bent on building an empire of gum, and as part of his extensive hustle, he managed to persuade the U.S. Department of War to include his products in soldiers’ rations. His argument—baseless at the time—was that chewing gum had miraculous abilities to quench thirst, stave off hunger, and dissipate nervous tension. But he was right: Scientists have since found that gum chewing can indeed increase concentration, reduce the impulse to snack, alleviate thirst, and improve oral health.

Perhaps that’s why people around the world have had the impulse to gnaw on tacky materials—roots, resins, twigs, blubber, tar made by burning birch bark—for at least 8,000 years. Today, gum is again being marketed as a panacea for wellness. You can buy gum designed to deliver energy, nutrition, stress relief, or joint health; scientists are even developing gums that can protect against influenza, herpes, and COVID. Ironically, this new era of chewing gum is manufactured with a distinctly modern ingredient, one not usually associated with wellness: plastic.

By the time Wrigley began his business venture, Americans had grown accustomed to chewing gum sold as candy-coated balls or packaged sticks. The base of these chewing gums was made from natural substances such as spruce resin and chicle, a natural latex that Aztecs and Mayans chewed for hundreds if not thousands of years. Unfortunately for 20th-century Americans, the chicozapote trees that exude chicle take a long time to grow, and if they are overtapped, they die. Plus, cultivated trees don’t produce nearly as much chicle as wild trees, says Jennifer Mathews, an anthropology professor at Trinity University and the author of Chicle. In the 1950s, chicle harvesters began struggling to meet demand. So gum companies turned to the newest innovations in materials science: synthetic rubbers and plastics.

Today, most companies’ gum base is a proprietary blend of synthetic and natural ingredients: If a packet lists “gum base” as an ingredient, that gum most likely contains synthetic polymers. The FDA allows gum base to contain any of dozens of approved food-grade materials—substances deemed either safe for human consumption or safe to be in contact with food. Many, though, are not substances that people would otherwise think to put in their mouth. They include polyethylene (the most common type of plastic, used in plastic bags and milk jugs), polyvinyl acetate (a plastic also found in glue), and styrene-butadiene rubber (commonly used in car tires). The typical gum base contains two to four types of synthetic plastics or rubbers, Gwendolyn Graff, a confectionery consultant, told me.

Everything we love about gum today is thanks to synthetic polymers, Graff said. Polyvinyl acetate, for example, strengthens the bubble film. “If you blow a bubble, and it starts to get holes in it and deflate, that’s usually an indicator that it doesn’t have polyvinyl acetate,” Graff said. Styrene-butadiene rubber creates a bouncy chewiness that makes gum more likely to stick to itself rather than to surfaces like your teeth. Polyethylene can be used to soften gum so it doesn’t tire out your jaw. Gums with only natural polymers “can feel like they’re going to fall apart in your mouth,” Graff said.

Plastic gum, though, also falls apart, in a way: Gum chewing has been linked to microplastic ingestion. In a study published in December, U.K. researchers had a volunteer chew on a piece of gum for an hour, spitting into test tubes as they went. After an hour of gum chewing, the saliva collected contained more than 250,000 pieces of micro and nano plastics—comparable to the level of microplastics found in a liter of bottled water. In a study presented at a recent meeting of the American Chemical Society (which has not yet been peer-reviewed), a graduate student’s saliva contained elevated microplastic levels after she chewed several commercially available gums, including natural ones. The research on gum chewing and microplastics is still limited—these two papers effectively represent analysis of just two people’s post-chew saliva—but gum chewing has also been correlated with higher urine levels of phthalates, plastic-softening chemicals that are known endocrine disruptors.

Scientists are still learning about the health impacts of microplastic ingestion, too. Microplastics find their way into all kinds of foods from packaging or contamination during manufacturing, or because the plants and animals we eat absorb and ingest microplastics themselves. As a result, microplastics have been found in human livers, kidneys, brains, lungs, intestines, placentas, and breast milk, but exactly how our bodies absorb, disperse, and excrete ingested plastic is not very well studied, says Marcus Garcia, who researches the health effects of environmental contaminants at the University of New Mexico. Some research in mice and cultured cells hint that microplastics have the potential to cause damage, and epidemiological research suggests that microplastics are associated with respiratory, digestive, and reproductive issues, as well as colon and lung cancer. But scientists are still trying to understand whether or how microplastics cause disease, which microplastics are most dangerous to human health, and how much microplastic the body can take before seeing any negative effects.

The answer could affect the future of what we choose to eat—or chew. Ingesting tiny plastic particles might seem inevitable, but over the past 10 years or so, Americans have grown understandably fearful about bits of plastic making their way into our food, fretting about microwaving food in plastic containers and drinking from plastic bottles. Gum has, for the most part, not triggered those worries, but in recent years, its popularity had been dropping for other reasons. In a bid to reverse that trend, gum companies are marketing synthetic gum as a tool for wellness. Just like Wrigley, they are betting that Americans will believe in the power of gum to soothe nerves and heal ailments, and that they won’t think too hard about what modern gum really is. For anyone worried about swallowing still more plastic, after all, gum is easy enough to avoid.