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In 2022, Florida weathered a bad outbreak of meningococcal disease, a type of fast-moving bacterial infection that can become fatal after entering the bloodstream or the lining of the brain and spinal cord. As the number of ill people climbed into the dozens, public-health officials scrambled to address clusters of cases, including one among college and university students. Campuses are primed for outbreaks: The bacteria spread through the kind of intimate or prolonged contact that’s rampant on campuses, where people are “kissing and sharing drinks, being in close quarters in dorm rooms and parties,” Sarah Nosal, the president-elect of the American Academy of Family Physicians, told me. College attendance is considered its own risk factor for infection, and many states—including Florida—require the meningococcal vaccine for students living on campus.  

Soon, though, Florida’s policy may change. Earlier this month, the state’s surgeon general, Joseph Ladapo, announced his intention to end all vaccine mandates: “Every last one of them is wrong,” he said. Some vaccine rules—including the one applying to the meningococcal vaccine—are written into the state’s laws, but Ladapo has said his office will partner with Governor Ron DeSantis’s to push for necessary changes.

A canceled mandate alone may do little to change the risk of meningococcal outbreaks on Florida’s college campuses. The CDC still recommends these vaccines for preteens and teenagers, and currently almost all American kids in that age group get at least one dose. But Florida’s rebellion against vaccine mandates is part of a larger erosion of the immunization status quo, as childhood-vaccination rates in the United States decline, Robert F. Kennedy Jr.’s Department of Health and Human Services chips away at long-standing vaccine policy, and more families seek exemptions from state requirements.

These changes won’t affect only young children, who are supposed to get numerous shots in their first 15 months of life. If vaccination rates fall—due to changing federal recommendations, states eliminating mandates, increasing anti-vaccine sentiment, or some combination of all of the above—middle schools, high schools, and college campuses may also become particular breeding grounds for once-controlled illnesses.

Nosal’s youngest child is still in college, so the idea of outbreaks on campuses hits close to home: If her child got a preventable illness because she hadn’t been encouraged to vaccinate them against it, or because campus-vaccination rates were too low to squash transmission, she’d be devastated, she told me. (The AAFP in September broke with federal guidance by recommending COVID-19 shots for all children, adults, and pregnant people.)

Meningococcal disease (which includes meningitis) is a very real concern for teenagers and young adults in a less vaccinated world. “You can be fine one minute and dead four hours later,” Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia, told me. Thanks in no small part to vaccination, meningococcal disease is rare in the United States. But it’s been on the rise since 2021—last year’s count of 503 confirmed and probable cases was the highest recorded since 2013—and the ages of 16 to 23 are a risky time for contracting these infections, relatively speaking. The CDC currently recommends that kids get their first meningococcal vaccine at age 11 or 12, then another when they’re 16; only about 60 percent of kids in the U.S. get both doses by the time they’re 17. Even fewer get a separate vaccine that targets a meningococcal subtype responsible for many cases among teens and young adults. (The CDC does not routinely recommend this shot for teens without special risk factors for infection, instead leaving the choice up to patients and their doctors.)

In recent years, the CDC’s Advisory Committee on Immunization Practices, the expert group that shapes the agency’s national vaccine recommendations, has considered dropping its recommendation for a first dose administered at age 11 or 12, since meningococcal infections are rare among preteens. Some experts have argued that axing that dose could set off a dangerous domino effect. Sarah Schaffer DeRoo, a primary-care pediatrician with Children’s National Hospital who has studied meningococcal disease and vaccination among college students, told me she worries that any disruption to established recommendations could cause confusion and contribute to further drops in vaccination rates, and more unvaccinated students means more chances for these infections to take root.

That consideration predated Kennedy—who recently dismissed all sitting members of ACIP and installed a variety of vaccine skeptics in their place—and the rejiggered committee may not implement it. (“Looking ahead, the new ACIP will continue to evaluate the latest gold-standard science before making future updates,” an HHS spokesperson said in a statement.) But Kennedy’s HHS has already shown willingness to reduce the number of immunizations children receive, such as by removing COVID-19 shots from the vaccine schedule for healthy kids.

If the committee continues to wind back vaccine recommendations, adolescents and teens could also be affected by vaccination decisions made on behalf of much younger people, Walter Orenstein, who formerly ran the United States Immunization Program, told me. Herd immunity only holds when protection is so high throughout an entire population that contagious illnesses are virtually unable to spread. If childhood-vaccination rates plummet, giving pathogens new targets in unprotected babies and young children, outbreaks won’t necessarily stay contained to those age groups. People of all ages—particularly those who are immunocompromised or under-vaccinated, but also some who are just plain unlucky—are bound to get sick too.

“If we stopped all vaccinations today, we won’t have huge outbreaks tomorrow,” Orenstein said. It would take time for the susceptible population to grow. But over time, largely forgotten illnesses could reestablish a foothold. If measles-mumps-rubella vaccination declined by 10 percent, for instance, the U.S. could see more than 11 million measles cases over the next 25 years, according to a 2025 modeling study. (Even at current vaccination rates, the disease may again become endemic and result in about 850,000 cases over the next 25 years, the study projected.)

Older kids and young adults would not be spared. Despite measles’ reputation as a childhood disease, about one-third of the cases recorded in the U.S. so far this year were among people 20 and older. And at least 8 percent of people sickened by measles this year had gotten one or more doses of the MMR vaccine—living proof that vaccinated people are also at risk when illnesses are given room to maneuver.

“This is what I call the new epidemiology of measles,” Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy, told me. The fact that adults are already catching measles suggests outbreaks could easily emerge in high schools and on college campuses, particularly if vaccine coverage wanes—the last thing any school wants, given the disease’s extreme contagiousness.

Mumps is another concern, Offit added. It spreads best among people in close contact, such as students. Immunity can also wane over time, even among people who get vaccinated, which raises the chance of campus clusters. Across the board, if vaccination rates fall, “we’re going to be spending a lot more time dealing with outbreaks,” Osterholm predicted. “We’re going to have an increasing number of cases and, unfortunately, an increasing number of deaths among kids” of all ages.

To forgo vaccinations proven to prevent deadly and debilitating diseases is to accept the possibility of these grim outcomes—which parents haven’t had to think about for decades, as mass immunization has invisibly done its job. “That is the choice we’re making,” Nosal said. “We just don’t completely understand that choice because we haven’t seen it.” At least not yet.

Since Robert F. Kennedy Jr. pushed out the CDC’s director and three other senior officials resigned in protest, public-health experts—including a former CDC director, a renowned vaccine expert, and at least one departing official—have broadcast an unprecedented loss of faith in the agency. The public, they say, should no longer trust the advice the CDC gives.

That message has put CDC staffers left behind in an awkward position. Nine current and former employees told me they appreciated the need to sound the alarm about Kennedy tampering with the agency’s vaccine-evaluation machinery. But a blanket warning about the CDC implicates more than the agency’s vaccine recommendations; it casts doubt on the ongoing work of the rank and file across the agency.

The reality of what’s unfolding inside the CDC is more complicated than widespread meddling, according to the employees I spoke with. And that makes navigating the information coming out of the agency even more of a challenge for everyone on the outside.

So far, “it’s where data meets vaccine policy that this administration is causing the biggest reputational damage,” Fiona Havers, a vaccine-policy expert who led the CDC’s studies of COVID and RSV hospitalizations before resigning from the agency in June, told me. Earlier this year, Kennedy fired all 17 members of the agency’s Advisory Committee for Immunization Practices and replaced them with his own handpicked alternatives, many of whom have long histories of spreading vaccine misinformation. Havers told me that HHS personnel outside the CDC have also started reviewing some agency materials before they’re published; this process has led to changes to scientists’ language involving vaccinations and treatments for measles and RSV, Havers said.

I asked HHS to comment on whether the review policy for such materials has changed, but the department’s communications director, Andrew Nixon, declined to answer that question. “Secretary Kennedy has been clear: the CDC has been broken for a long time,” Nixon wrote in an email. “Restoring it as the world’s most trusted guardian of public health will take sustained reform and more personnel changes.”

The administration has interfered with work in other politically sensitive fields. Earlier this year, when President Donald Trump issued executive orders refuting the existence of gender and disavowing diversity, equity, and inclusion, CDC staff withdrew papers submitted to journals and removed and edited data on certain populations from select data sets. They also changed protocols for research involving these populations, current and former employees told me. (A number of workers I spoke with for this story asked to remain anonymous due to fear of professional retaliation.)

[Read: ‘This is not how we do science, ever’]

When it comes to publicly accessible material, the CDC’s website may be particularly prone to including misleading information, because on any of the site’s pages with no named authors, “there’s no way to verify that that came directly from a scientist and wasn’t tampered with,” a current employee who has worked in noninfectious-disease epidemiology at the CDC for about a decade told me. That said, most pre-2025 guidance documents on the CDC’s website are likely reliable, as is newer guidance on less politicized topics (for example, the Yellow Book website that provides information about travel medicine), a subject-matter expert who staffs one of the agency’s many disease-specific hotlines told me.

The bulk of the data removed and edited earlier this year will be restored following a legal settlement this month. Jennifer Layden, who led data-modernization efforts as director of the agency’s Office of Public Health Data, Surveillance, and Technology before resigning in August, told me that the agency’s data sets otherwise remained largely unaltered. “We are working extremely hard to protect the data,” a senior official still at the agency told me. Other significant parts of the CDC’s work are basically fine, according to current and former employees I spoke with. Much of it is invisible to the general public, which may help keep it safe from political interference. For example, since January, disease experts scattered throughout the agency have answered more than 1,500 calls from providers caring for patients with malaria, parasitic diseases, free-living amoebas, diphtheria, and botulism, according to numbers from the CDC. The agency’s epidemiologists also continue to assist state, local, and tribal health departments when they’re faced with particularly challenging outbreaks, such as the rabies infections that have turned up in unusually high numbers this year. (This past winter’s measles outbreak was arguably an exception: CDC researchers didn’t arrive in Lubbock, Texas, until a child had already died in nearby Seminole.) The subject-matter expert I spoke with, who takes calls from clinicians and health departments nationwide, told me that their work had not been interfered with, perhaps in part because the infections they advise on are so rare.

CDC scientists often write technical articles for publication both in the agency’s own journals and in external peer-reviewed journals. Submission numbers, at least to the agency’s journals, have been down in recent months: Fewer scientists are available to write the articles due to staff scarcity in the wake of layoffs, and some research is newly off-limits under Trump’s executive orders. Still, several epidemiologists told me that agency scientists’ published work about subjects other than vaccine-preventable disease—on overdoses and vector-borne diseases, for example—remains their own. I heard several times that an awful lot of people at the CDC would quit before they’d put their name on scientific material that they’d been forced to fabricate.

Across the board, however, departments are under strain as the administration strips away the CDC’s resources. Since Trump withdrew the U.S. from the World Health Organization in January, the CDC’s global-health experts have been largely unable to receive the timeliest information about disease trends worldwide, and they’ve been prevented from collaborating on infections and conditions that easily traverse borders, according to several global-health epidemiologists still employed by the CDC. “We look like idiots,” an epidemiologist in the agency’s Global Health Center told me. Early in the year, the Trump administration, guided by Elon Musk and his team at the Department of Government Efficiency, clawed back $11 billion in funding from the CDC and took a chain saw to its staffing. A recent analysis of HHS worker departures by ProPublica found that anywhere from 4 to 20 percent of staff across several CDC centers and offices was forced out as part of a so-called reduction in force, or RIF. According to ProPublica, the real losses are likely much higher, as the analysis does not include the more than 1,100 workers who have received layoff notices but remain on administrative leave.

[Read: ‘It feels like the CDC is over’]

Workers have so far been able to cover for absent colleagues and funding, but that could change if months turn into years, or if the agency’s budget is cut as much as proposed 2026 budgets suggest it will be. After about a third of Layden’s staff was laid off, she told me, she felt she couldn’t be effective in her role. Workers left behind in these scenarios “can still provide the guidance and the direction and support” to the health departments and other partners they serve, but “they may not have enough bandwidth to do it as well, or help as many states,” she said.

Kennedy seems poised to bend the CDC further to his will. In a recent Wall Street Journal op-ed, he wrote that the agency has “squandered public trust” and allowed its core purpose to be “corroded” (and that his leadership will restore the CDC’s reputation). Two days later, in a hearing before the Senate Finance Committee, he said the CDC needed to be purged of “officials with conflicts of interest and catastrophically bad judgment and political agendas.” The CDC’s new acting director is Jim O’Neill, Kennedy’s deputy at HHS, who has no medical or scientific training and a history of spreading COVID-related misinformation and conspiracy theories. (In an emailed statement, the HHS spokesperson Gregory Angelo cited O’Neill’s previous tenure at HHS during the aughts, and described him as “a proven leader with a deep understanding of HHS and its many divisions.”) Kennedy has not yet given any indication of who might be tapped to replace the director he ousted. “If the administration appoints an ideologically driven leader, we’re at higher risk for political interference in other areas of CDC,” the Global Health Center epidemiologist told me.

In making broad statements about the CDC’s credibility, public-health experts—who overwhelmingly oppose Kennedy’s anti-vaccine agenda—risk playing into his hands. “I absolutely understand why they are saying what they are saying,” the noninfectious-disease epidemiologist said about the CDC’s current critics. “My fear is that we’re going to throw the baby out with the bathwater.” No other entity gathers nationwide data on health trends like CDC does; before this year, it was unparalleled as a reservoir of public-health expertise. If clinicians and public-health officials don’t trust that they’ll get good advice when they call for help with unusual cases, the risk that small outbreaks will become big ones, and that more people will die, rises. If researchers lose faith in the agency’s data on health trends, or if the general public doesn’t believe what’s published on the CDC website, people have few other options to turn to for reliable, centralized information on crucial health matters.

[Read: RFK Jr.’s victory lap]

The continuing exodus from the CDC also poses a numbers problem. Multiple employees I spoke with said that, for now, if nobody has noisily quit the agency over something it’s made or done, that product is likely trustworthy. “I don’t think at this point we’re going to tolerate pressure in silence,” a medical epidemiologist who has been at the CDC for a decade told me. But what happens when everyone who can noisily quit already has? The agency might exist in name, but its reputation may be ruined for good.

At 38 weeks pregnant with her second child, Hannah Robb has no time to waste on red tape. Yet she’s lost hours in her struggle to figure out whether and when she can get a COVID booster. Her doctor said she could—and should, she told me. According to her doctor, she wouldn’t need a prescription; according to her local New York City Walgreens, she would. When Robb finally arrived at her appointment at the pharmacy, prescription in hand, she wasn’t sure whether the shot, which can cost $250 out of pocket, would be covered by insurance; so far, no one has billed her, so she assumes it was. “It’s hard to know what’s right and what’s wrong until you show up to the pharmacy and see what they’ll do,” Robb told me.

Similar scenes are playing out at drugstores across the country. The Trump administration’s recent swerves in COVID-vaccine policy have left many Americans—including pharmacists and physicians—confused about where the shot will be available, who is eligible to receive it, and who will be covered by insurance. Pregnancy raises the stakes of that confusion: Pregnant women face an elevated risk of becoming severely ill from COVID, as do newborns, who cannot be immunized against the coronavirus before they’re six months old. The federal government’s guidance on pregnancy and COVID vaccines is now so tangled that Jennifer Lincoln, a board-certified ob-gyn in Oregon, told me that people have asked her whether they should hide the fact that they’re pregnant to more easily receive a shot.

Previously, the COVID-vaccine approval process went something like this: The FDA reviewed the safety and efficacy of updated versions of the shots, then approved them for certain groups of people. Next, the CDC translated the FDA’s guidance into public-health recommendations, on which individual states based their own immunization policies. Although states ultimately determine who is eligible and whether a prescription is necessary, the Affordable Care Act requires insurers to cover any vaccine the agency recommends. Annual COVID shots have, until now, been recommended by the CDC for all adults, including pregnant women, and have thus been covered by insurance.

The process this year has taken a wildly different trajectory. In May, the FDA announced that it would narrow eligibility for annual COVID vaccines to only adults over 65 and people with certain high-risk conditions, including pregnancy. Days later, Health and Human Services Secretary Robert F. Kennedy Jr. announced that the CDC would no longer recommend COVID vaccines for healthy children or healthy pregnant women, claiming, inaccurately, that no evidence supports the use of the booster in children. The CDC clarified that healthy children could get the vaccine after consulting with their doctor, and last month, the FDA approved three updated COVID vaccines that healthy children can receive (again, after a medical consult). But neither agency has offered any new guidance about pregnancy and COVID vaccination since then. (The Department of Health and Human Services, which oversees both the CDC and the FDA, did not respond to a request for comment.)

The chaos has left pharmacies in a bind. At the beginning of this year, roughly half of states based their policies on the CDC’s recommendations, Brigid Groves, the American Pharmacists Association’s vice president of professional affairs, told me. (Other states, she said, incorporate the guidance of the FDA, the state health department, and other groups that issue vaccine recommendations.) According to Groves, after the CDC changed its recommendations, pharmacists in those states lost the authority to vaccinate pregnant people. Even in states whose policy deviates from the CDC, each pharmacy can set its own boundaries on who can be vaccinated, and individual pharmacists may fear liability for vaccinating pregnant customers, Groves said. Last month, CVS stopped offering COVID vaccines entirely in three states. A CVS spokesperson told me that COVID vaccination has resumed in the three states where it was paused, and that people must attest to their eligibility when scheduling an appointment.

[Read: A massive vaccine experiment]

Doctors are unhappy with the confusion. Last month, the American College of Obstetricians and Gynecologists (ACOG) reaffirmed its stance that women should get a COVID vaccine or booster while pregnant, trying to get pregnant, postpartum, or lactating. “To act like they’re not high-risk just by virtue of being pregnant shows no actual understanding of data and science,” Lincoln said. Pediatricians are concerned too. The COVID vaccine “protects both the mom and the baby” because the mother’s antibodies are passed to the fetus, says James Campbell, a pediatrics professor at the University of Maryland who is also the vice chair of the American Academy of Pediatrics’ committee on infectious diseases. According to the CDC, newborns have a higher COVID-related hospitalization rate than that of any other age group besides people 75 and older. “The younger the child, the more likely that they’re going to be hospitalized,” Campbell told me.

A long-awaited meeting of the Advisory Committee on Immunization Practices—the group that informs the CDC’s recommendations, which Kennedy recently repopulated with several members who are hostile to vaccination—may clarify later this week where pregnant women stand. But in the meantime, states in favor of offering the vaccines are taking matters into their own hands. In recent weeks, 16 states have moved to expand access to COVID vaccines, some by granting state health departments the authority to set vaccine policies or allowing pharmacists to defer to medical organizations such as ACOG rather than the CDC. Massachusetts became the first state to require insurers to pay for all vaccines recommended by the state health department, regardless of CDC guidance. Several West Coast states have allied to develop joint vaccine recommendations; some states in New England appear to be doing the same. Jennifer Kates, a public-health expert at KFF, a nonpartisan health-policy organization, told me she expects more blue states to follow suit.

Policy is far from the only factor that will determine whether Americans—pregnant or otherwise—receive their COVID shots this fall. COVID vaccines have never been particularly popular among pregnant women; since 2023, uptake has hovered below 15 percent. People tend to be more anxious about what they put into their body during pregnancy, especially vaccines, Lincoln said. One 2024 study found that mothers worried that getting a COVID shot while pregnant would endanger their baby; a 2023 KFF poll found that a quarter of American adults thought COVID vaccines had “definitely or probably” been proved to cause infertility. Today, copious evidence shows that vaccination protects both mother and child. But fears about the safety of getting the shot during pregnancy have been stoked by politicians and public figures airing anti-vaccine talking points on the national stage. “I hear an increase in vaccine hesitancy in my clinic every week,” Anne Waldrop, an ob-gyn and a clinical professor focusing on maternal fetal medicine at Stanford, told me. Meanwhile, Kennedy has reportedly asked health officials to compile data linking COVID vaccines to poor pregnancy outcomes—a measure that seems destined to provoke even greater anxiety. (HHS responded to the report by restating its commitment to transparency, and the White House reiterated its support for Kennedy’s leadership.)

[Read: Why RFK Jr.’s anti-vaccine campaign is working]

When health care becomes complicated, the standard response is to ask your doctor for advice. Yet even some providers aren’t offering straight answers. Francesca Cohen, who is 37 weeks pregnant, told me that her obstetrician never recommended that she get a COVID booster. “I live in Austin, Texas. I assume they have a mix of perspectives in their patient base,” she said. When Cohen brought up the vaccine, her provider shared ACOG’s guidance and said that the choice was up to her. Cohen is still deciding.

*Illustration sources: How Wee Choon / Getty; Grace Cary / Getty; Sergey Ryumin / Getty (edited)

When Connecticut legalized recreational marijuana in 2021, the state’s lieutenant governor, Susan Bysiewicz, boasted that the new law was “crafted to repair the wounds left by the War on Drugs.” The move followed the same rationale that had motivated legalization in 18 other states: fewer resources exhausted on policing a drug that legalization advocates view as largely unharmful, fewer lives derailed by what they argue to be excessive lockups. In a sense, the plan worked: Possession arrests have fallen precipitously in the years since. But as Connecticut’s number of legal neighborhood weed shops has grown, so too has a problem that the state, like others that have eased marijuana laws, was seemingly ill-prepared to deal with: the rise of illegal marijuana shops.

Such shops are largely indistinguishable from state-sanctioned ones. They look the same and operate in the same neighborhoods, but they’ve never gone through the required licensing process to become a seller. (Beyond asking for paperwork, you’d be unlikely to know if you were shopping in an illegal store.) And they have become a headache for local law-enforcement agencies that want to crack down. “This is an epidemic within the state of Connecticut,” Ryan Evarts, a sergeant at the Norwalk Police Department, told me. The problem has become so pronounced that some states, including Connecticut, have recently passed laws giving law enforcement greater powers to police these shops.

The result has been a strange new inversion: states with some of the loosest marijuana restrictions in the nation arresting and charging sellers of a drug that was made legal at least in part to move away from such charges. Since the beginning of last year, Connecticut has arrested dozens for selling pot out of illegal shops. From April to June 2025, California, supposedly a bastion of recreational cannabis, arrested 93 people for illegally selling, growing, and distributing weed, according to the state’s Department of Cannabis Control—the largest number of weed arrests in a three-month period since the state legalized the drug. Similar arrests have also been made within the past year in Illinois; Arizona; New Jersey; New York; Ohio; Washington, D.C.; and Washington State. It’s not just the owners of smoke shops who have been targeted—so have rank-and-file employees, according to news reports.

[Read: The GOP’s tipping point on weed]

There is a justifiable public-health rationale for going after these shops. In most states, legal weed must be independently tested for contaminants, such as lead and cadmium. Illegal products may not undergo such testing, in turn putting consumers at increased risk of long-term health complications, such as cancer. Some of these stores are also allowing cannabis to land in the hands of children, which is particularly concerning given research showing that cannabis can harm the developing brain. Multiple smoke shops in Connecticut that were raided had been caught selling products to minors.

Illegal sales of cannabis are bad for the states financially, too. Officials have invested time and money into setting up legal cannabis programs; by levying taxes on legal marijuana sales, states have turned recreational cannabis into a windfall. California expects to bring in more than $700 million in tax revenue from marijuana this year alone. States have a clear reason to crack down: Illegal weed sales might go untaxed. And if businesses can continue selling cannabis under the table, it dilutes the incentive for shops to go through the often long and arduous process of getting a cannabis-retailer license.

Police officers have also warned that some illegal cannabis shops are involved in and potentially funding other, more criminal enterprises. Police found guns and other drugs—including hallucinogenic mushrooms, fentanyl, and crack cocaine—during several recent arrests in Connecticut, according to press reports. In California, where the governor has created a task force on illegal cannabis, recent busts are part of a larger effort to disrupt criminal groups, including “Chinese organized crime,” Kevin McInerney, a commander at the Department of Cannabis Control, told me. McInerney did not cite any examples of operations explicitly tied to Chinese organized crime, but last year, ProPublica reported that America’s illegal cannabis market is dominated by “Chinese mobsters who roam from state to state, harvesting drugs and cash and overwhelming law enforcement with their resources and elusiveness.”

But not everyone is enthusiastic about using police to regulate the cannabis black market. “You can’t arrest your way out of problems like illicit markets,” Daniel Nagin, a criminology expert at Carnegie Mellon University, told me. “Targeted arrest strategies are effective only in a limited set of circumstances, like going after known high-rate offenders.”

Drug-policy advocates I spoke with emphasized that some operators of illegal weed shops may not have the resources to secure a coveted place in the legal market. A license to operate a cannabis shop in Connecticut can run up to $25,000, not including additional fees. Owners also must have measures in place to ensure that cannabis is not stolen or diverted, including programs to track each piece of cannabis that enters and leaves their store, as well as more traditional security systems, such as video-surveillance systems and a silent alarm.

If the problem is merely too few legal cannabis shops, the solution may seem simple, at least among those who argue that recreational marijuana should be legal: a loosening of the rules around cannabis licensing. “The solution isn’t to crack down harder, but to create more inclusive pathways into the legal market and to decriminalize cannabis at all levels,” Adrian Rocha, the director of policy for the Last Prisoner Project, a criminal-justice-reform group focused on drug policy, told me. For those who still break the law, other enforcement measures—such as fines—should solve the problem, Maritza Perez Medina, the director of federal affairs at the Drug Policy Alliance, told me.

But such arguments for how to deal with the problem of illegal weed fall flat. Los Angeles still has a problem with illegal dispensaries, even though the city has more than three times the number of legal dispensaries serving about the same population as Connecticut. And fines and other regulatory tools have time and again proved ineffective in stopping illegal behavior. Some shops in Connecticut, for example, have been busted more than once for selling illegal cannabis products. Even shutting down dispensaries doesn’t always fix these problems: When New York City closed an illegal smoke shop in the Bronx, it simply reopened next door.

Regardless of who is selling black-market weed and what their motivations are, if illegal sales continue to grow, they have the potential to put the legalization movement in jeopardy. Even in states that have already enacted law changes, one could imagine residents—and politicians—getting so sick of hearing about lawless cannabis shops, including those with guns and who are selling to kids, that they question the merits of legalization more generally. Throwing people in jail may not be ideal. But so far, no one has quite figured out a better plan.

Pesticides once appeared to be a clear target for Robert F. Kennedy Jr.’s desire to “make America healthy again.” Before becoming the health secretary, he described Monsanto, the maker of the glyphosate-based herbicide Roundup, as “enemy of every admirable American value,” and vowed to “ban the worst agricultural chemicals already banned in other countries.” Since he came to power, many of Kennedy’s fans have waited eagerly for him to do just that.

Kennedy has yet to satisfy them: In the latest MAHA action plan on children’s health, released last week, pesticides appear only briefly on a laundry list of vague ideas. The plan says that the government should fund research on how farmers could use less of them, and that the government “will work to ensure that the public has awareness and confidence” in the EPA’s existing pesticide-review process, which it called “robust.”

Unlike Kennedy’s concerns about vaccines, his concerns about pesticides have echoed those found in a body of legitimate research. Studies have found associations between exposure to some herbicides and pesticides and cancer, hormone disruption, and other acute and chronic health conditions. These include neurodevelopmental impacts in children, such as autism—which Kennedy has also promised to tackle.

Right now his department’s promised report on what has caused rates of autism to rise over recent decades is expected to highlight Tylenol use, whether during pregnancy or, as my colleague Tom Bartlett reported, based on Kennedy’s correspondence with a fringe researcher, in early childhood. Researchers generally point to a change in diagnostic criteria as the primary reason rates have spiked so dramatically. They also consider autism a complex condition that does not appear to have a single cause: Studies suggest that genetics play a bigger role than environmental factors in determining a person’s risk, though both seem likely to contribute and may work in concert. A serious effort from the government to understand its causes would require investment in long-term, large-cohort, and detailed studies that might cast light on the contribution of many environmental factors, including pesticides.

Several studies have found neurological impacts associated with pesticides. UC Davis’s MIND Institute put out a study in 2014 that found autism risk was much higher among children whose mothers had lived near agricultural-pesticide areas while pregnant. A 2017 paper found that zip codes that conducted aerial spraying for mosquitoes—a pesticide—had comparatively higher rates of autism than zip codes that didn’t. Others have linked pesticides to a range of behavioral and cognitive impairment in children.

Rebecca Schmidt, a molecular epidemiologist and professor at UC Davis, has been researching potential risk factors for autism as part of the school’s long-term MARBLES study of mothers and children. Schmidt and her colleagues study families with at least one child already diagnosed with the condition—to see what environmental and biological factors may raise the risk of subsequent children being diagnosed. (Younger siblings of a child with autism have on average a 20 percent chance of also having it.) Her own research, she told me, has not seen as dramatic of results for pesticides as the 2014 paper—which she also worked on—reported, though other labs have found associations of their own between prenatal pesticide exposure and autism.

These studies, like most studies that assess environmental exposures, typically cannot determine causality between agricultural-pesticide exposure and autism risk. Investigating links between pesticides and health outcomes is challenging; researchers can look at geographic proximity to sprayed fields, but drilling down to find out how much pesticide actually ended up in a person’s body requires herculean diagnostic efforts, such as frequent urine sampling. And the conclusions drawn from these studies can only point to associations between certain exposures and the likelihood of developing the condition: Showing direct causality would involve willingly exposing pregnant mothers and infants to pesticides and seeing what happens, which scientists cannot do, for obvious reasons. But based on what she knows now, Schmidt told me, “pesticides are probably not a good exposure for any pregnant person, or even children,” since their brains are still developing.

In investigating autism causes, Kennedy could also consider another environmental factor: air pollution. Breathing air pollution does have robust evidence linking it to neurodevelopmental effects in children, including autism. The Trump administration’s policy changes since January have predominantly tipped the country toward more air pollution, not less, while its climate-policy rollbacks will contribute even further to the burden of air pollution from wildfires. Meanwhile, some evidence also suggests a link between flame-retardant exposure and behavioral-developmental problems in children. Other studies have found possible links between pre- and postnatal exposure to PFAS, or “forever chemicals,” and autism.

All of this means that following the science would give Kennedy many places to look. “We’ve been working on this for over a decade,” Schmidt told me. “Every time we do a study, it raises new questions. And so it’s a complex picture that takes time to tease apart.” Designing and completing strong studies of any of these factors is challenging and costly. If the federal government did want to put its resources toward finding the causes of autism, Kennedy would do well to increase funding for large, national studies that follow people for years.

The latest MAHA plan does say that the National Institutes of Health, along with other agencies, will develop a way to evaluate “cumulative exposure,” or the impact of the cocktail of chemicals Americans are regularly interacting with—including pesticides. It does not say how that research will be funded or which of the tens of thousands of in-use chemicals the agencies would focus on.

Since taking office, Kennedy has mostly avoided even rhetorically linking specific environmental exposures to health concerns. An earlier MAHA report had more to say on pesticides, but The New York Times and Politico reported that Republican lawmakers as well as the farm lobby expressed concern about its potential impact on farmers. At a Senate hearing, Kennedy said that there are “a million farmers who rely on glyphosate” and told lawmakers that “we are not going to do anything to jeopardize that business model.” At a Heritage Foundation event last month, Kennedy’s senior adviser, Calley Means, said on a panel that corn and soybean farmers are not the “enemy,” but rather that the “deep state” is. (Corn and soy are two of the most heavily sprayed crops.) In response to a request for comment, HHS pointed me to last week’s MAHA plan, as well as the EPA’s work to evaluate environmental risks while phasing out animal testing.

This shift has raised the ire of some of Kennedy’s most ardent fans. Zen Honeycutt, the founder of the advocacy group Moms Across America who has been a major Kennedy supporter, said shortly after the MAHA plan was unveiled last week that her vote for the Republican Party is not guaranteed: “We will be actively campaigning to get people into office coming in the midterms that will protect our children, and we are not beholden to political parties.” In a statement later that day, she said that eliminating specific mentions of glyphosate and atrazine, another widely used pesticide that appeared in the first report and has concerning health implications, is “a tactic to appease the pesticide companies.”

Some of Kennedy’s defenders rightly point out that he is not in charge of the EPA, which regulates pesticides, or the U.S. Department of Agriculture, which oversees farming policies. Even if he cannot regulate pesticides himself, he is in charge of the National Institutes of Health, “and the NIH can study the causes of the effects of these chemicals on Americans. Those studies can drive the marketplace and policy change,” Vani Hari, a food activist, MAHA influencer, and vocal supporter of Kennedy, told me. (In particular, she wants to see the United States, as some other countries have, eliminate the practice of spraying glyphosate on crop fields right before harvest, which farmers do to dry out the crops.) Kennedy understands the threat these chemicals pose, she told me: “When there is an opportunity to add influence, he will. He’s not afraid to speak up.”

I asked whether she would be disappointed if the forthcoming autism report doesn’t mention pesticides and instead focuses on Tylenol and folate deficiencies. She told me she doubted that the autism report would overlook pesticides. “I don’t see that even happening,” she said. Yet in his few months in office, Kennedy has had many chances to let science guide him and has let them pass—on the health benefits of seed oils, the safety of abortion pills, children’s mental-health screening, and, most notably, vaccine policy. This may be one more.

When she succeeded Anthony Fauci as the director of the National Institute of Allergy and Infectious Diseases, Jeanne Marrazzo felt that she’d landed “probably the most important infectious-disease job in the world,” she told me. After decades of working in academia, she now had the power to influence, nationwide, the science she knew best—overseeing 4,500 employees at a $6.5 billion institute, the second largest by budget at the National Institutes of Health, the world’s largest public funder of biomedical research.

Marrazzo had been on the job for only a year and a half, however, when the Trump administration placed her on administrative leave. She lost access to the NIH campus and, at least through official channels, to her staff, she told me; she could no longer sign into her laptop or phone. On paper, she would remain NIAID’s official director, but in practice she had been pushed out.

That was at the beginning of April. In a near instant, she went from days filled, morning ’til evening, with meetings, phone calls, and lively scientific discussions to “no structure,” she told me. The first month or two, she “was too stunned to do much” at all, she said, beyond wrestling with feelings of humiliation over the situation she’d been forced into.

Marrazzo isn’t alone in purgatory. She is one of roughly 100 officials whom the Department of Health and Human Services placed on administrative leave—or sent to, as some of them call it, HHS’s rubber room—in the winter or in spring, without explanation or a sense of when or how their status might change, according to a senior HHS official with direct knowledge of their circumstances. (Several of the HHS officials I spoke with requested anonymity to avoid retaliation from the Trump administration.)

Their status is distinct from that of many HHS employees who remain on leave as part of the administration’s deferred resignation program (who will be out of their jobs at the end of September), or who were part of a reduction in workforce and are stuck in limbo as litigation stalls their termination. But together, all of these on-leave officials constitute a group of thousands, estimates Abigail André, the executive director of the Impact Project, which has been tracking federal workers’ fates during President Donald Trump’s second term.

Their sheer number suggests that the United States government has spent tens, if not hundreds, of millions of dollars since the start of April on idled health workers. “I’m being paid to not work,” Aryn Backus, a health-communications specialist with the CDC’s now-dismantled Office on Smoking and Health who has been on leave for months as part of the contested reduction in workforce, told me. In some cases, federal officials are being paid a lot to not work. I spoke with nearly a dozen officials indefinitely stuck in the rubber room whose annual salaries range from about $150,000 to $400,000. (When reached over email, HHS Press Secretary Emily G. Hilliard declined to respond to my questions about officials who remain on administrative leave, citing a restraining order and providing no further context when asked.)

In the past, administrative leave from the federal government has generally been used as a designation employers can assign when allegations about an employee’s performance or conduct have been raised. It has been known to drag out before—in some cases, for years, amid lengthy personnel investigations. But as a rule, prolonging administrative leave past a few days is regarded as “just not an appropriate use of taxpayer dollars,” one senior NIH official told me. And what’s played out recently—leaving dozens of people on administrative leave for months, in the absence of alleged misconduct and without a clear path toward resolution—is unheard of, a senior NIH official who has been on administrative leave since the spring told me. In July, the Office of Personnel Management released new guidance, effective in 2026, that will limit administrative leave connected to workforce reassignment to 12 weeks. But it did not specify whether that time limit, which can be jointly waived by OPM and the Office of Management and Budget, would apply retroactively to officials who have been on leave for months already. (OPM and OMB did not respond to a request for comment.)

Firing federal employees is generally difficult, especially without clear cause. That stability minimizes turnover, even when administrations shift. But the Trump White House has used administrative leave as a workaround, seemingly as a way to select the individuals they are most eager to prune, officials told me. For many senior HHS officials, in particular, placement on administrative leave “was just a pretext to get us out of the office,” Emily Erbelding, the director of the Division of Microbiology and Infectious Diseases at NIAID, who has been on administrative leave since April, told me. This way, as she sees it, the Trump administration wouldn’t risk being sued for wrongful termination, but could nudge officials toward resigning on their own.

Once the department places officials on leave, its options are limited, the senior NIH official told me: It “can keep us, fire us illegally, or reassign us and have us quit.” So far it’s mostly just ignored them. On March 4, all seven former members of the NIH’s now-defunct Sexual and Gender Minority Research Office were put on administrative leave on vague terms: No potential reassignments were mentioned, and none of the officials have received correspondence from the agency or department since, two officials told me. A few weeks later, dozens of officials across HHS—many of them in leadership roles, including Marrazzo and the directors of several other institutes, divisions, and centers—were told that they would be put on leave, and that the department was proposing to reassign them, several officials told me. The notice also mentioned that the Indian Health Service was “a critical area of need.” At the end of August, a small number of those people received notice that they had been reassigned to a Health Resources and Services Administration position in Missouri, three officials told me. At least one of them chose to retire instead. But most of those who were sent the Indian Health Service letter received only a request for their CVs in the spring, and have heard nothing since.

These officials say they were never given an explanation for being put on leave. Many of them focused on topics that the administration has said it doesn’t want to fund (infectious disease, HIV, sexual health, DEI, gender research) or led institutes that the administration or Republican members of Congress have proposed altering, eliminating, or consolidating. NIAID’s leadership was especially hard-hit, and several officials I spoke with saw those leave placements as part of the administration’s revenge campaign against the U.S.’s response to COVID, and the public-health experts who drove it, Fauci among them. (Fauci’s wife, Christine Grady, was also among the NIH officials placed on administrative leave in April; she chose to retire.) In Erbelding’s case, she told me she suspects that the administration may have singled her out in part because she led a division that had awarded funds to the Wuhan virology lab at the center of the controversial lab-leak theory on the pandemic’s origins, which Trump and his allies have embraced as fact. NIAID had also been one of the institutes most vocally challenging the administration’s funding cuts. Marrazzo knew she had a target on her back: As early as February, she told me, she stopped furnishing her office with personal items, anticipating that she’d soon have to port them home again. (Earlier this month, Marrazzo and Kathleen Neuzil, who once directed the NIH’s Fogarty International Center and was placed on leave under similar circumstances as Marrazzo, sent whistleblower complaints to the Office of Special Counsel, accusing the Trump administration of illegally forcing them out of their jobs.)

Some officials, like Grady, have retired, while others, like Neuzil, have found positions outside of government and resigned. But the administration’s actions have also made their particular job market tough, Aryn Backus told me. Universities have been stripped of funding; pharmaceutical companies are wary of the FDA’s shifting regulatory landscape. All of the officials I spoke with told me they’d been actively seeking other employment for months, but had found few prospects. Multiple senior NIH officials also told me that the agency has made their job search harder. As employees, they still need approval from their supervisor to give talks, volunteer, or otherwise participate in events related to biomedical research. But some have struggled to get it, they told me. The clearest explanation they’ve received, from ethics officials who help manage such requests, is that Matt Memoli, the NIH’s principal deputy director, to whom several of them still report, has insisted that the rubber-room officials submitting these requests have been reassigned and are no longer under his purview. “Leadership is not acknowledging that we report to them, so they are not responding or approving,” one of those officials told me.

In theory, some of these officials could still return to their jobs. Backus joked that she feels snared in a prolonged situationship with the federal government: “It’s like waiting for my toxic ex to call.” But for now, she doesn’t have a position to return to, because the administration eliminated the office she was part of. Others, like Marrazzo, don’t see the appeal anymore. Running an institute at the NIH once meant deciding how to guide the country’s investment in health research, based primarily on the needs of the public and on the merit of the projects being funded; that job functionally no longer exists, she said. And under politicized leadership at HHS, “going back there right now sounds awful,” the senior NIH official told me. “My worst nightmare.”

The occupants of the rubber room do recognize that their situation—paid leave—could be worse. Some told me they will not resign: If the Trump administration wants them out so badly, it must cut them. “I want to force them to come up with an exceptional reason why I’m not good enough to keep serving the American people,” one official told me. But being stuck in limbo also has costs. As a scientist who has now, for months, been unable to present at national conferences or publish scientific papers—the core products of research—“my self-esteem is in the dumpster,” that official said. And, multiple officials told me, their lawyers say that they don’t have sufficient grounds to sue HHS over damages such as wrongful termination, unlike those who have been officially separated from their jobs.

Five and a half months in, Marrazzo is now filling her days with what productivity she can: traveling, speaking, job hunting—and far more reading, birding, and “thinking about next steps” than she has ever been accustomed to. It doesn’t feel like enough. “I’ve never not worked,” she told me. “It feels like slacking.” And her status haunts her. She regularly encounters people who are surprised to learn that she is still on administrative leave: They assume that she resigned, or was fired by the administration. The NIH has appointed an acting director to lead NIAID in her absence; the institute’s website currently lists her as the former director. She’ll gently correct people who call her that; at the same time, “I don’t know how to introduce myself,” she said. When she gives talks, she lists herself as the institute’s director on her introduction slide, and appends an asterisk that notes that she’s on leave. Officially, the title is still hers. But she is no longer quite sure what that means.

For parents, especially of young children, the question “What’s for dinner?” has high stakes. The answer can determine whether you’ll get to bed early or spend the night struggling to feed a shrieking toddler. It can stoke anxiety about budgeting and dread for the next appointment with the pediatrician.

Parents are worried not just about getting food on the table, but whether that food is good for their kids. That’s partly why Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again campaign resonates with so many people: If the American food supply can be purged of its unhealthiest elements, surely it will be easier for parents to feel good about feeding their children. But instead, MAHA may be piling on the stress.

Kennedy and other MAHA figures consider a long list of foods unhealthy, and only some of their reasoning is supported by science. They condemn seed oils, which Kennedy believes are toxic but are widely shown to be safe. They also decry ultra-processed foods, which health researchers have serious concerns about. The MAHA movement has raised concerns about other ingredients with unknown health effects: synthetic additives, pesticides, and chemicals in the environment.

Even before MAHA, many parents faced enormous pressure to feed their kids in a healthy way. Online parenting communities are rife with guidance: avoid added sugars, buy organic, limit processed foods, and so on. MAHA’s guidance overlaps with many of these principles, but it carries more weight because it comes from the health secretary himself. “What MAHA did was turn that mom-powered movement into a message that could not be ignored,” Michelle Magno, a Texas-based mother of three, told me.

Those who choose to take that message seriously should brace for extra work. Seeking out MAHA-aligned foods is a scavenger hunt that parents have little time to play. When shopping, Summer Scolaro, a Texas-based mom of two toddlers, aims to buy organic produce, minimally processed foods, and foods with low sugar, no seed oils, and no artificial dyes or flavors. Her purchases are informed by the “Dirty Dozen” and “Clean Fifteen,” lists that have long been popular on social media and that rank foods that are most and least contaminated with pesticides, respectively. (According to these lists—which are published by the Environmental Working Group, a nonprofit that has drawn criticism from scientists—grapes and strawberries are dirtier than pineapples and avocados.) “It takes multiple places to get what I want,” Scolaro told me. Zen Honeycutt, the North Carolina–based founder of Moms Across America, a nonprofit that advocates for removing GMOs and pesticides from the food system, told me that buying only organic foods simplifies her shopping because the label encompasses many of MAHA’s criteria. But organic foods are not necessarily seed-oil-free, and only certain brands tick both boxes.

Organic and MAHA-coded foods, as I’ve written previously, can be more expensive. Plus, because organic products aren’t made with artificial preservatives or irradiated (to kill microbes and insects), they tend to spoil faster, which can mean more frequent trips to the grocery store or more money wasted on food that goes bad. Many of the MAHA moms I spoke with told me that they shop at a mix of big-box stores and specialty groceries to balance their health standards with their budgets; some said they eschewed vacations and new clothes to save money for healthy food. “It’s not just the cooking—it’s the planning, the shopping, the prepping, and then hoping they’ll actually eat what’s on the plate. Some days it feels like a full-time job in itself,” Scolaro, who is a Pilates instructor and the founder of a lifestyle brand, told me.

[Read: The MAHA trend in groceries will backfire]

Feeding infants according to MAHA principles gives parents an even narrower road to walk. In recent years, as American moms have been enthusiastically encouraged to breastfeed, many experts have emphasized that making sure infants are fed, period, should be parents’ highest priority. MAHA hems and haws over this point. The Trump administration’s “Make Our Children Healthy Again Strategy” report, released this week, says that the health and agriculture departments will work to increase breastfeeding rates (and the supply of milk from human donors), but offers few specifics. Pediatricians widely recommend exclusively breastfeeding for the first six months of an infant’s life, but many parents can’t, for a range of medical, economic, and personal reasons—not least that feeding and pumping are incredibly time-consuming. Baby formula is the recommended alternative, but it relies on seed oils to mimic the fatty acids in breast milk. (Earlier this year, the Trump administration launched Operation Stork Speed to scrutinize infant formula, but seed-oil-free formula alternatives are hard to come by.) Before he became health secretary, Kennedy raised the alarm about trace amounts of heavy metals that are found in some American baby formulas; after his nomination, as part of Operation Stork Speed, he directed the FDA to increase testing. (The Department of Health and Human Services did not respond to requests for comment.)

American moms have long taken on the responsibilities of primary caregiver, health-care administrator, household manager, and cook on top of their paid work. MAHA strains them further by creating more labor, more costs, and more questions about what is actually healthy for kids. “When parents are stressed and angry and irritable, the kids get stressed. It can affect their appetite and their eating behavior, and then that makes the parent even more stressed,” Eugene Beresin, a psychiatry professor at Harvard, told me. Stressed parents are also more likely to feed their kids fast food, and their kids are more likely to be picky eaters, he said. In order for families as a whole to be healthy, “you really have to support the mothers,” Kathryn Schubert, the CEO of the Society for Women’s Health Research, an advocacy nonprofit, told me.

So far, though, the federal government has offered little to help parents fulfill MAHA ideals. The new report includes a plan to send “MAHA boxes” full of fresh food to poor American families, but it depends on the Supplemental Nutrition Assistance Program, from which the Trump administration has slashed funding; in fact, one in five children is expected to lose food assistance because of the cuts, according to the Center on Budget and Policy Priorities, a nonpartisan think tank. Nor do any of MAHA’s plans meaningfully address systemic factors, such as poverty and historical discrimination, that can prevent children from accessing healthy food in the first place. Nearly 14 percent of households across the country experienced food insecurity in 2023. In these homes, the conflict between budgeting and feeding kids well creates huge psychological stress for parents, which can lead to anxiety and depression, fueling the vicious cycle of stress and unhealthy eating, Beresin said.

Certainly, the new strategy report gestures toward making fresh produce cheaper and more accessible. Its proposals to support grocery stores in stocking more produce, introduce markets to food deserts, serve healthy meals to students and veterans, and limit junk-food ads targeted at children all sound promising, but the report offers few specifics on implementation. To date, MAHA’s most significant policy changes include banning the food dye red 3 and getting companies to voluntarily phase out synthetic dyes—changes that some MAHA moms say don’t go far enough to support children’s health.

[Read: RFK Jr. is repeating Michelle Obama’s mistakes]

I’ve criticized many of Kennedy’s MAHA initiatives, including his promotion of raw milk and beef tallow, his misplaced focus on food additives, and his baseless campaign against vaccines. But I felt empathy for the MAHA moms I spoke with. We want the same thing: to keep our kids nourished and safe. I, too, try to cook at home when I can; I fret about feeding junk to my toddler. Near the end of our conversation about the organic, home-cooked meals she made for her kids when they were younger, Lisa Sulsenti, a New Jersey–based chiropractor who co-hosts a podcast called MAHA Moms, asked me: “I think we put a lot of stress on ourselves to be the perfect mom. Do you think that?” I couldn’t help but agree.

Good politicians are rarely modest. The job requires an uncanny ability to sell each bit of incremental progress as a success in and of itself. That’s especially true for someone like Robert F. Kennedy Jr., who dares to take on America’s health problems and faces considerable skepticism from a large number of Americans—including many of those who work beneath him at the Department of Health and Human Services. Kennedy’s overarching goal of addressing chronic disease could take many lifetimes to achieve. But in just under seven months, Kennedy said at an event on Tuesday, he has “accomplished more already than any health secretary in history.”

He’s right that the clip at which he’s shaken the government’s health agencies is remarkable by any measure—dizzying for his supporters and critics alike. He has successfully pressured many food companies to promise to remove certain synthetic dyes from their products. He has persuaded states to adopt their own MAHA-friendly policies. He’s tapped into a vocal post-COVID culture that’s cheering him on. And, especially in recent weeks, he has pushed to remake America’s vaccine guidelines.

What happens next, however, is where things will get even more interesting. RFK Jr. has spent a lot of time attempting to diagnose and explain America’s health woes. Kennedy’s team dedicated much of his first few months in office to writing a report that lays out why American kids are so unhealthy. Earlier this week, Kennedy released the MAHA strategy for how it will go about tackling the problems of chronic disease in kids.

The 20-page document is essentially a to-do list of 128 recommendations, including calling for the FDA to “promote innovation in the sunscreen market”and promising to further investigate the purported causes of vaccine injuries. By Kennedy’s telling, its release was a triumph. “There never had been an effort like this across all the government agencies,” Kennedy said at Tuesday’s event, where he unveiled the strategy alongside several members of Trump’s Cabinet.

But the new report underscores how much easier it is to describe the problem of America’s health woes than to solve them. The document highlights how exposure to a number of chemicals in our environment and our food might affect health. It calls for the development of a “research and evaluation framework” to explore this issue. But the report doesn’t articulate any strategy for what will be done about it once the research is complete. The report falls into a similar trap on issues with decades of research already focused on them, such as autism.

Some steps in the report can presumably be accomplished quickly, and may indeed improve America’s health, even if modestly. On Tuesday, Kennedy laid out several goals he expects to achieve before the end of the year. They include defining ultraprocessed foods, requiring nutrition courses in medical schools, and closing a loophole that allows food companies to introduce new chemicals into the country’s food supply without oversight if they self-declare that the ingredients are “generally recognized as safe,” or GRAS.

Kennedy and his team can be slippery when discussing goals, however. During Tuesday’s press conference, FDA Commissioner Marty Makary ran through a list of what the agency has achieved under his watch—and mentioned the same loophole that Kennedy had cited a few minutes earlier. As Makary put it, the FDA already “took action” on that issue. And he’s right: In March, Kennedy directed the agency to “explore rulemaking” to remove the loophole, but Makary seems to be claiming credit for considering taking action. During a Senate hearing last week, Kennedy similarly said that he had tackled the GRAS loophole. If the administration can claim victory after merely considering an action, it could presumably declare that America is on its way to becoming healthy again because the new report’s recommendations were written down on paper. (“We look forward to taking action to close the GRAS loophole,” an HHS spokesperson said in an email.)

All this exposes a hole in the MAHA movement. Many of its overarching goals are laudable. As Jim O’Neill, the acting CDC director and Kennedy’s top deputy at HHS, said at the press conference: “All Americans deserve to be healthy, and we are going to get there.” But exactly how RFK Jr. will even measure America’s collective health remains to be seen. He seems to hope that rates of chronic disease will shrink to the levels seen during his childhood: “76.4 percent of Americans are suffering a chronic disease,” he said on Tuesday. “When my uncle was president, it was 11 percent.” Perhaps America won’t be healthy again until we achieve similar statistics, or until each of the MAHA strategy’s recommendations are achieved. Perhaps America won’t be healthy again until Kennedy simply decides to declare victory, regardless of what the next three years bring.

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For nearly a decade, the immunologist and biochemist William Parker has tried, with little success, to persuade other scientists to take seriously his theory that acetaminophen—better known by the brand name Tylenol—is the primary cause of autism. Researchers have long failed to find a causal link between autism and any medication, and these days, most of them believe that a change in diagnostic criteria is largely behind the dramatic uptick in autism rates over the past 30 years. But late last month, Parker received a phone call from Health Secretary Robert F. Kennedy Jr., who wanted to learn more about his work. In fact, he’s heard from Kennedy several times since then. Parker also spoke recently with Jay Bhattacharya, the director of the National Institutes of Health. To hear Parker tell it, the nation’s top health officials have taken great interest in his ideas.

Over the past few weeks, Kennedy has reportedly been looking into an alleged connection between autism and Tylenol use during pregnancy. Parker’s preoccupation is slightly different: He believes that children’s use of Tylenol causes autism. Parker has for years operated on the fringes of academia. He runs his own small, independent laboratory, which he started after he lost a lab at Duke University’s medical school. (Duke did not renew Parker’s contract after he began focusing on autism in his research, though an email that an administrator sent to Parker in 2021, which I reviewed, said only that keeping the lab open wasn’t in his department’s “strategic best interest.”) Parker’s attempts to publish in academic journals have regularly been rebuffed. One reviewer tore into a recent submission from Parker, writing in their assessment that his hypothesis was “outrageous” and “illogical”; the paper was rejected. The past couple of weeks have been a wild reversal for Parker. “Nothing was happening and—boom!” he told me. “It’s beautiful.”

In April, Kennedy promised that Americans would know by September what causes autism and how to eliminate it. How exactly he would do that in five months was a mystery, especially considering that researchers have for decades tried to determine what genetic and environmental factors might be responsible. (Both seem likely to play a role, though studies have suggested that about 80 percent of a person’s autism risk is found in their DNA.) Kennedy had already brought in David Geier, a researcher who has published deeply flawed papers linking autism to vaccines, to uncover any irregularities in a CDC vaccine-safety database. Plus, Kennedy has a well-established history of anti-vaccine activism, and in particular of linking immunization to autism, despite reams of research indicating otherwise. He appeared poised to pin the blame for autism on childhood shots.

[Read: RFK Jr.’s autism time machine]

Last week, Laura Loomer, a far-right activist who seems to have a direct line to the White House, strongly hinted on X that Kennedy’s autism report, which has yet to be released, might implicate acetaminophen. A few days later, The Wall Street Journal, citing unnamed sources familiar with the discussions, also said that the report would likely link the drug to autism. Those stories focused on prenatal exposure to acetaminophen, which is considered the safest pain reliever and fever reducer available for pregnant women. In 2015, the FDA issued a tepid notice about the risks of using acetaminophen during pregnancy, mentioning conflicting results about a possible link to ADHD but nothing about autism. Since then, a handful of experts, including the dean of Harvard’s school of public health, have published papers suggesting an association between prenatal use of acetaminophen and neurodevelopmental disorders, including autism.

A spokesperson for Kenvue, the company that makes Tylenol, told me in an email, “We have evaluated available science and continue to believe that there is no link between acetaminophen use and autism.” (The spokesperson also noted that Parker has consulted in an ongoing lawsuit over cases of ADHD and autism allegedly caused by Tylenol use during pregnancy. Parker told me that he did offer consultation, but he didn’t testify in the case and didn’t accept any compensation—“not even a penny.”) The email also cited an FDA fact sheet, updated last month, that notes the agency has not found clear evidence of any harms of acetaminophen use during pregnancy.

Parker’s theory is that giving acetaminophen to babies and young children, not pregnant women, is what’s behind nearly all cases of autism. For more than an hour, he walked me through his research, citing studies that show how acetaminophen alters cognition in male mice, highlighting the increase in children’s use of the drug once aspirin stopped being recommended for them in the 1980s, and referencing a 2008 study led by an epidemiologist who believed that his son’s autism was caused by the acetaminophen he was given after getting an MMR shot.

[Read: Life before the measles vaccine]

Considering that the large majority of children receive acetaminophen—one study found that 95 percent of infants are given the drug at least once in their first year of life—acetaminophen alone clearly doesn’t cause autism. Parker contends that a constellation of factors, including genetics, inflammation, and stress, enable acetaminophen to trigger autism in certain children. In his first paper on the topic, published in 2017, he and his co-authors couched their words carefully, maintaining that it was “one explanation for the increased prevalence of autism.”

In the years since that paper’s publication, Parker has grown more confident. He now sees acetaminophen as the only possible explanation for the rising number of autism cases. When I asked him how certain he was of his conclusion, Parker told me, “We’ve thought about this a lot and it’s 99.99” percent. The only way he sees to increase that certainty to 100 percent is to stop giving American children acetaminophen. When that occurs, Parker told me, the number of autism cases will drop by about 95 percent and the remainder will likely be reclassified as some other disorder. He claims that autism, as we know it, will essentially end. When I asked Jeffrey Morris, a biostatistics professor at the University of Pennsylvania, about Parker’s prediction, he replied that “bold claims require rigorous, reproducible evidence”—and so far, judging by the response from fellow scientists, Parker hasn’t met that standard.

Parker acknowledges that his work has not been embraced by mainstream autism researchers. Viktor Ahlqvist, the author of a 2024 Swedish study that concluded that acetaminophen use during pregnancy was not associated with autism, told me that developmental outcomes in early life are “notoriously difficult to study,” and that many apparent correlations—say, acetaminophen use and autism—don’t hold up to scrutiny. When I asked Parker to give me the names of scientists who support his theory, he couldn’t think of anyone. (He said Kennedy asked him for names too.) I contacted several longtime autism researchers, none of whom had heard of Parker. His 2023 paper trumpeting the dangers of acetaminophen has been cited a mere 11 times, according to Google Scholar. (By contrast, a 2007 paper Parker wrote on beneficial bacteria in the appendix has been cited 500 times.) For someone who is 99.99 percent certain he knows what causes autism and how to end it, Parker has hardly made a mark.

And yet, American health officials appear to have sought his advice anyway. Parker showed me screenshots of emails arranging a Zoom between him and Bhattacharya, as well as a document he emailed to Bhattacharya’s assistant summarizing his research findings. (According to Parker, on their Zoom call, Bhattacharya said Parker had given him a lot of homework and he would be in touch.) Parker also shared his call log, which included five calls with Kennedy. (The Atlantic verified that the phone number is in fact Kennedy’s.) On Sunday, I asked Parker when he had last spoken with Kennedy. “What time is it now?” he said. Kennedy had called a few hours earlier—Parker told me he’d wanted to discuss the Swedish study. A spokesperson for Health and Human Services declined to say whether Kennedy or Bhattacharya had spoken with Parker. “We are using gold-standard science to get to the bottom of America’s unprecedented rise in autism rates,” the spokesperson wrote in an email. “Until we release the final report, any claims about its contents are nothing more than speculation.”

[Read: ‘This is not how we do science, ever’]

For Kennedy, the allure of Parker’s theory seems obvious. The secretary has not only pledged to find out the causes of autism but also stressed that the Trump administration will be able to eliminate them. Parker supplies a ready solution that nicely dovetails with Kennedy’s hostility toward vaccines, and pharmaceutical interventions against disease in general. Parker isn’t claiming that vaccines cause autism, but according to his theory, they could lead to the stress and inflammation that create the environment for what he insists is the true trigger.

Four days after Kennedy first called Parker, at an August 26 Cabinet meeting, Trump asked his health secretary to provide an update on his promise to discover the cause of autism. Kennedy told the president that he had found “certain interventions now that are clearly, almost certainly causing autism.” Trump, who likes to hint at insider secrets, chimed in that there “has to be something artificially causing this, meaning a drug or something.” Parker took that exchange as a sign that his research might have finally found a sympathetic audience.

Two and a half years ago, Ashish Jha was the White House’s COVID-19 response coordinator, a job that meant getting as much of the country as possible on board with the federal government’s approach to public health. For much of this summer, he’s been doing the opposite of that.

As Robert F. Kennedy Jr., the secretary of the Department of Health and Human Services, dismantles nearly every core component of the country’s vaccine infrastructure—defunding vaccine research, restricting access to shots, spreading mistruths about immunizations, purging experts who might threaten his anti-vaccine agenda—“I’m spending all my energy trying to help states come up with how they’re gonna manage this situation,” Jha told me. He, like many others in public health, wants Kennedy removed, and for the government to push back against HHS’s new direction. The best way to achieve that, he said, “is for states to do a sharp break with ACIP and CDC, and basically declare CDC defunct.” In June, Kennedy dismissed the entire roster of ACIP—the CDC’s Advisory Committee on Immunization Practices, which for decades has used scientific evidence to guide the agency’s nationwide vaccine recommendations—and has since been restocking the panel with anti-vaccine researchers who lack relevant expertise. The CDC “no longer has any credibility as a public-health entity,” Jha said. “States have to do it themselves.”

And some states are. This week, Washington, Oregon, and California announced that they would form a coalition to issue their own vaccine recommendations. Hawaii joined soon after. Several states in the Northeast might do the same. Several professional medical societies, including the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, have revolted against the government, and last month published immunization guidelines that diverge from the current CDC’s. These secessions—each driven by a loss of faith in the scientific soundness of the CDC’s recommendations—seem designed to destroy the agency’s credibility. “I’ve told folks, ‘In the not too distant future, you won’t be able to believe anything that’s on the CDC’s website regarding vaccines,’” Nirav D. Shah, who served as the CDC’s principal deputy director until February, told me.

Kennedy’s recent actions may just be the opening salvo. “We’re on the threshold of an even more transformative period,” Jason Schwartz, a vaccine-policy expert at Yale, told me. Kennedy has promised that, with a report assembled in a few short months, HHS will soon end the years-long debate on the drivers of autism—which Kennedy has repeatedly and baselessly linked to vaccines, despite decades of evidence debunking that claim. Kennedy is also reportedly eager to yank mRNA COVID vaccines off the market—which would remove any option to immunize children under 12, including highly medically vulnerable ones, against the coronavirus. Later this month, his handpicked ACIP could vote to restrict several more immunizations, including ones that protect babies against hepatitis B, measles, mumps, rubella, chicken pox, and RSV. (Kennedy has maintained that people who want COVID vaccines will be able to get them. When reached for comment, Emily Hilliard, HHS’s press secretary, wrote that “ACIP remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic.”)

“We’re watching a massive experiment unfold,” Bruce Gellin, who directed the National Vaccine Program Office from 2002 to 2017, told me. A united front is one of the best defenses against infectious disease: The science supporting vaccination holds true everywhere, and pathogens don’t respect state borders. “It doesn’t make any rational sense for a kid in Pennsylvania to get a different vaccine recommendation than a kid in Ohio,” Jha said. But a version of that is what the country is about to try. The federal government has functionally abdicated its role in keeping Americans safe from dangerous illness. In the vacuum it has left, states will chart their own paths, almost certainly in diverging directions. Florida this week announced that it would abandon vaccine mandates entirely. The country’s defensive shields against disease are shattering, in ways that could take decades, even generations, to mend.

In the U.S., the job of deciding which vaccines people must get has largely fallen to the states. But for decades—essentially since the 1960s, with the inception of ACIP—states have mostly chosen to hew to what the CDC says about how and when people should immunize. And in the 1990s, the nation’s medical experts, realizing the costs of divergent advice, aligned their recommendations with the CDC’s too.

After a major measles resurgence began in 1989, scientists moved to add a second dose of the MMR vaccine to bolster protection—but the American Academy of Pediatrics and the CDC’s vaccine-advisory panel disagreed on the optimal time to administer it. “It caused a lot of confusion,” Walter Orenstein, who directed the country’s National Immunization Program from 1993 to 2004, told me, as providers felt torn between following their professional society and the government. And so “every major medical organization came together to issue a single immunization schedule”—one that would harmonize with ACIP’s. Although states still make independent decisions about how to require shots in schools, the nation has long stood behind one grand, unifying theory of how its people should approach infectious disease.

That synchronization was premised on an agreement that scientific evidence, above all else, would guide vaccine recommendations. That same premise is now pushing professional societies and states to diverge from the CDC’s guidance. This week, the governors leading the West Coast contingent of defections issued a joint statement saying the CDC had “become a political tool that increasingly peddles ideology instead of science.” In a statement outlining its own vaccine recommendations, the AAP specifically called out Kennedy’s flagrant disregard for expertise, noting that AAP leaders would, in contrast to the CDC, “continue to provide recommendations for immunizations that are rooted in science.”

When I asked HHS about states’ recent departures from precedent, Andrew Nixon, the department’s director of communications, answered only about “blue states,” criticizing them for pushing “unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era.” But HHS has also signaled its support for states that align with Kennedy’s push for less vaccination. Last month, the department sided with West Virginia’s governor in a fight with its board of education by urging the state to allow religious exemptions for school vaccine requirements; this week, HHS doubled down on that position, issuing guidance that states participating in the federal Vaccines for Children Program, which offers vaccines to kids whose families can’t otherwise afford them, “must respect state religious and conscience exemptions from vaccine mandates.”

Kennedy seems to believe that the evidence is on his side. At a congressional hearing yesterday, he repeated his past claims that mRNA vaccines are dangerous and deadly, despite overwhelming evidence showing that the shots have saved millions of lives and come with only rare risks. And he is surrounding himself with people who won’t argue otherwise. In the past seven months, he and his allies have ousted several top health officials whose read of the evidence hasn’t aligned with his—most recently, Susan Monarez, who directed the CDC until last week, when Kennedy and Trump fired her after she reportedly refused to preemptively rubber-stamp recommendations from the secretary’s bespoke ACIP. (Kennedy, in this week’s hearing, described this recounting of events as a lie.) And they have installed into positions of power at HHS several researchers—many of them lacking vaccine or infectious-disease backgrounds—with fringe vaccine views.

The government’s scientific advisers, too, are now ideological allies rather than independent experts. ACIP, which as recently as June was filled with 17 scientists whose backgrounds spanned vaccinology, pediatrics, infectious disease, public health, and more, now includes individuals who have advocated for pulling mRNA shots from the market, denounced COVID vaccines at an anti-mandate rally, and publicly argued that their child was injured by the MMR vaccine. Within scientific branches of government, the currency of checks and balances has always been data; Kennedy and his allies have forcibly dismantled those guardrails. “They’ve replaced everybody who could push back on the administration,” Fiona Havers, a former CDC official who quit the agency in June in protest of Kennedy’s anti-vaccine actions, told me. The true power of the federal government’s various health agencies, several federal health officials told me, rests with the scientific expertise of its people. But as of this year, expertise is no longer the hallmark of HHS.

Kennedy has done more than simply meddle with recommendations. Over the past century or so, the federal government has thrown its weight behind every major part of the country’s vaccination pipeline: funding vaccine research, scrutinizing and regulating shots, advising the public on how to use them, and helping monitor vaccine safety and performance. Kennedy has introduced a clog into just about every part of this system. The infrastructure that offers Americans routine protection against up to 18 different infectious diseases “took decades to build,” Havers said. “Kennedy has managed to destroy it in a very quick amount of time.”

Many of those changes are reversible, in theory. Personnel can be rehired; ACIP members’ term limits will run out; new leaders can rewrite policies. Those people and policies, though, will not be effective if the public overall has become less inclined to listen to them. Governors, physicians, and public-health experts are arguing for a calculated rift with the federal government because it’s necessary to meet the political moment, Jha told me: Restoring the CDC’s integrity requires first persuading the public to discount it. Eventually, these experts acknowledge, if they regain control of the federal health apparatus, they’ll have to ask the public to trust in those same agencies again. In the interim, they are hoping most Americans will keep looking to scientific and medical experts as a source of constancy—even as they embroil themselves in a fight with the nation’s leaders.

That gamble might not pay off. When experts moved to harmonize the country’s vaccine schedules in the 1990s, the recent outbreak had laid out the stakes and benefits of synchronization clearly. “It wound up being easy,” Orenstein told me. The differences between the AAP’s recommendations and the government’s “were fairly minor” too. This time, though, the schisms between the CDC and the states and professional societies go far beyond the timing of an additional dose of vaccine. They’re about whether scientific evidence should guide the country’s approach to immunity—and, ultimately, how much say the federal government has in how Americans protect themselves.

The likeliest catalyst for a quick realignment would be a severe uptick in disease—local epidemics, another pandemic. Even then, many of the experts I spoke with fear, the country’s vaccine infrastructure, having been razed, could not easily contain those outbreaks, and the U.S. would struggle to rebuild its health agencies to their former strength. “The more of the system is destroyed, the longer it will take to rebuild,” Gellin told me. And the more lives will be needlessly lost in the meantime.

Already, states and health-care providers are having to fight to preserve access to vaccines. Recommendations for immunization may be relatively straightforward to adjust state by state. But if the FDA alters the licensure of certain vaccines—or strips it away entirely—the shots might simply not be available, even in parts of the country where people are told to get them. The FDA has already limited approval for COVID vaccines enough that the current AAP recommendations for the shots won’t be easy to follow this fall, for instance. Some state laws also prevent pharmacists from administering vaccines that haven’t been recommended by ACIP—a snarl that’s prompted pharmacies to limit access to COVID vaccines in more than a dozen states. Insurers, too, have traditionally followed CDC recommendations when choosing what vaccines to cover. States have some leeway to change these dynamics: This week, Massachusetts became the first state in the country to require its insurance carriers to cover vaccines recommended by its Department of Public Health “and not rely solely on CDC recommendations.” Today, New York’s governor signed an executive order to allow pharmacists to prescribe and administer COVID-19 vaccines, even without ACIP’s okay. Still, the federal government’s vaccine safety net is impossible to replace. More than half of American kids are eligible for the federal $8 billion Vaccines for Children Program, which relies entirely on the guidance of ACIP to decide which immunizations to cover.

Kennedy, meanwhile, is finding other ways to crater the availability of shots. He has already canceled funding to vaccine makers, including Moderna—but policy changes, too, could deter companies from manufacturing more shots or developing new ones. The secretary also recently announced his intention to remodel the Vaccine Injury Compensation Program, put into place in the 1980s to limit pharmaceutical companies’ exposure to lawsuits over vaccines’ health effects—and, by extension, to protect the stability of the nation’s vaccine supply. Some experts worry that Kennedy could make it easier for claims to be paid out, potentially, in part, by pushing to add autism to the list of compensable health issues—an anti-vaccine concession that could rapidly overwhelm the system, and leave manufacturers more vulnerable to liability, Gellin told me. Vaccines have never been a terribly lucrative product for pharmaceutical companies; under financial and political pressure, their market could quickly collapse. “Even in good times there’s fragility in this complex system,” Anne Schuchat, who served as the principal deputy director of the CDC until 2021, told me.

The consequences of the current fracturing may not be apparent right away. Immunity takes time to erode. “If we stop vaccinating today, we would not have outbreaks tomorrow,” Orenstein said. When the fallout lands, Kennedy could be long out of the government, and limiting the damage he’s done will be someone else’s problem.