Attacks on Public Health: What and Why

Sam Friedman

THE TRUMP REGIME has attacked public health fairly massively as part of its overall efforts to transform the United States into an authoritarian state, ready for inter-imperialist war, that can attempt to weather climate change without a revolution.

This attack on public health may seem to be in irrational contradiction to having a healthy military and an economy able to compete with China’s growing imperialist power. I will argue that although these contradictions exist, the attacks do have strategic purpose — particularly given the ideologies of those sections of the ruling class most involved in these strategies and these attacks.(1)

Although I will not discuss it in any depth here, I want to start with the obvious: The regime’s policies that are most likely to devastate public health are not usually considered as public health attacks.

These policies include ramping up fossil fuel production and slashing away at efforts to reduce greenhouse gas production or other ecological damage; its imperialist approach to the rest of the world, which risks devastating wars that may kill vast numbers of people; and its efforts to expel and incarcerate immigrants and make international borders impermeable, which will condemn hundreds of millions of people to ill health and death as climate change forces people to try to move.

In addition, there are its attacks on the medical services sector, including drastic reductions on, and restrictions in access to, Medicaid and Medicare. These have been covered by the mainstream media, so I will not belabor them here.

In brief they will hurt millions of people, lead to hospital and clinic closures and layoffs (on top of loss of workers who are undocumented and are either incarcerated, deported, or terrorized away from coming to work), lead to even more daft levels of work for those healthcare workers who remain employed.

Table 1. Total Death Rates by Rate/Ethnicity 2019

	White	Black	Hispanic	Asian	American Indian or Alaska Native	Native Hawaiian/Pacific Islander	Multiple Races
	739.9	884.0	523.8	372.8	782.5	659.0	326.95
Rate relative to Whites	1	1.19	0.71	0.50	1.06	0.92	0.44

Notes: These figures show deaths per 100,000 population by race and are age-adjusted to the total U.S. population in 2000.

Persons of Hispanic origin may be of any race, but are categorized as Hispanic; other groups are non-Hispanic. Race and Hispanic origin are reported separately on the death certificate in accordance with standards set forth by the US Office of Management and Budget. Causes of death include all ICD-10 codes.

Sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 2018-2023 on [CDC WONDER Online Database]. Data are from the Multiple Cause of Death Files, 2018-2023, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on January 30, 2025.

Downloaded July 29, 2025.

Chaotic Cuts

The public health workforce has been attacked. Thousands of highly experienced and dedicated scientists and technicians at the Centers for Disease Control and the National Institutes of Health, among other agencies, have already lost their jobs. The chaotic ways in which the cuts are being implemented makes it hard to be sure how many, and this seems to change frequently as decisions are reversed or reinstated.

Data have been removed from public access, and perhaps destroyed. Although academic and other institutions were able to copy much of this data in advance and make it available, availability for the future has been ended for much information needed to make people safe.

We do not know yet whether data will be twisted or in other ways “cooked” to fit the wishes of the Trump regime. And much data on gender and race/ethnicity are suppressed going forward.

Further cuts loom as budgets for state and local public health agencies are also being slashed. Since a sizeable proportion of professional personnel in state and local public health agencies have been seconded to them while remaining on CDC payrolls, or paid for by funds provided from Washington, the ability of states, cities and counties to protect public health will be reduced substantially.

Again, no one knows how this will work out. It is possible that state or local money will be used in some cases to reduce the impact of such budget cuts, but that will depend on local politics and the degree of mass organizing and action by the working class and others.

Ideological Wars

Cuts are particularly targeted to slash research and prevention around infectious diseases. This starts with the vicious ideological wars against vaccines being coordinated by the Secretary of the Department of Health and Human Services, RF Kennedy, Jr., but also includes budget cuts, termination of research grants, and appointment of personnel hostile to vaccination to the Advisory Committee on Immunization Practices, which oversees vaccination approval and affects how insurance companies do or not pay costs of vaccinations.

Another set of cuts has targeted programs to reduce racial/ethnic disparities in health. I discuss these more below.

Some of the worst effects on public health will be in other countries. Although this may be of little concern to the Trump regime and the sections of the capitalist class who support it, any internationalist — and any human being with even a shred of decency — has to recoil in anguish and horror at the devastation these attacks will create.

Based on the cuts that had been announced by the middle of March, the Secretary-General of the United Nations described the damage that will take place (WHO Director-General’s opening remarks at the media briefing — 17 March 2025; part of this speech was quoted in an earlier article in this journal, “Plague Pusher Policy.”

I will quote him at some length to give a fuller picture:

“To be clear, I’m not talking about the decision by the United States to withdraw from WHO. I will not comment on that today.

“I’m talking about cuts to direct U.S. funding for countries through USAID, the US CDC and other agencies. The impact of these cuts will be even greater — and we are already seeing them.

“There are now severe disruptions to the supply of malaria diagnostics, medicines and insecticide-treated bed nets due to stock outs, delayed delivery or lack of funding.

“Over the last two decades, the U.S. has been the largest bilateral donor to the fight against malaria, helping to prevent an estimated 2.2 billion cases and 12.7 million deaths.

“If disruptions continue, we could see an additional 15 million cases of malaria and 107,000 deaths this year alone, reversing 15 years of progress.

“It’s a similar story with HIV. The suspension of most funding to PEPFAR — the President’s Emergency Plan for AIDS Relief — caused an immediate stop to services for HIV treatment, testing and prevention in more than 50 countries.

“Eight countries now have substantial disruptions to antiretroviral therapy and some will run out of medicines in the coming months.

“Disruptions to HIV programmes could undo 20 years of progress, leading to more than 10 million additional cases of HIV and 3 million HIV-related deaths — more than triple the number of deaths last year.

“On tuberculosis, 27 countries in Africa and Asia are facing crippling breakdowns in their response, with shortages of human resources, disruptions to diagnosis and treatment, data and surveillance systems collapsing, and vital community engagement work deteriorating.

“Nine countries have reported failing procurement and supply chains for TB drugs, jeopardizing the lives of people with TB.

“Over the past two decades, U.S. support for TB services has helped to save almost 80 million lives. Those gains, too, are at risk.

“On immunization, WHO’s Global Measles and Rubella Network of more than 700 laboratories, which was funded solely by the U.S., faces imminent shutdown.

“This comes at the worst possible time, when measles is making a comeback.

“Last year there were 57 large or disruptive measles outbreaks, and that number has been increasing for the past three years. Since 1974, measles vaccines have saved nearly 94 million lives, but those gains are also at risk.

“The sudden cuts to U.S. funding are also affecting efforts to eradicate polio, to monitor the emergence of diseases such as avian influenza, and to respond to disease outbreaks and humanitarian crises.

“Almost 24 million people living in such crises are at risk of not being able to access essential health services. More than 2,600 health facilities in 12 humanitarian crises have already suspended services at least partially, or will do very soon.

“In many countries, the abrupt loss of U.S. funding threatens to reverse progress in disease control, immunization rates, maternal and child health, and emergency preparedness.”

Since then, some cuts have been rescinded, and others have been announced. Budgets for next year have not been finalized, but seem to be grim indeed, although there is some hope that some cuts to PEPFAR may be reduced.

Table 2. HIC diagnoses per 100,000 among adults and adolescents in the United States

	White	Black/African American	Hispanic/Latino/a	American Indian/Alaskan Native	Asian	Native Hawaiian/Other Pacific Islander	Multiple Races	Total
	5.3	41.8	20.4	10.9	4.4	14.8	19.9	12.7
Risk relative to Whites	1.9	7.89	3.85	2.06	0.83	2.79	3.75	2.40

Note: This pattern has remained reasonably stable for many years now, and pretty much reflects the pattern among each risk category. What is clear is that the racial system has led Black, Native American, and Latino/a people, as well as people who identify with multiple races, to have higher HIV rates than White people. These disparities are similar for AIDS incidence and for AIDS mortality.

Why Are They Doing This?

Understanding the reasons behind government actions is never easy, and it is particularly difficult with the Trump regime that deliberately obscures its intentions and many of its motivations, in part by reversing course so often and in part by what appears to be a policy of frequent lying as a smokescreen and a propaganda tool.

Despite this, I will attempt to discuss the reasons behind the attacks on public health as a matter of ideology, self-interest, tactics, and deeper strategy.

Underlying this discussion is my analysis that the American ruling class, and particularly those sections most visibly behind the Trump regime (the other lumpenbourgeoisie like real estate interests, fossil fuels, and the “tech bros”), are caught in a series of long-term crises and are reacting in desperation.(2)

Most salient, perhaps, are the threat to their interests of an ascendant Chinese capitalist imperialism dominating many fields of production and scientifically out-pacing the United States in fields much broader than its highly-visible challenge in artificial intelligence and other “hi tech” industries. (Nature Index 2025 Research Leaders: “United States losing ground as China’s lead expands rapidly.”)

The U.S. ruling class has no solution to China’s challenge to Washington’s imperial and economic power; the climate crisis and the broader ecological crisis, and the economic malaise of capitalist economies since 2008.

These have led it to lose much of its ideological hegemony over people in the United States — and this, in turn, means that authoritarian rule appeals to our rulers just as it does to the ruling class forces in many other countries such as Russia, China, Hungary, Brazil and Argentina.

Lens of Racism and Irrationalism

Although ideology is never entirely separate from self-interest, it does have considerable independence and force in its own right. People — including ruling-class creepoids — identify options and think about their worth and feasibility through the lens of their ideas.

Racism, including eugenic racism, is one of the most visible characteristics of Trump and many of his high-ranking regime officials and his supporters (See Caplan A., Tabery J., “Donald Trump Wants to Make Eugenics Great Again. Let’s Not.” Scientific American. October 17, 2024; Metraux J.,”Eugenics Isn’t Dead — It’s Thriving in Tech.” Mother Jones, January 2, 2025.)

Racial animosity, entitlement and arrogance have been characteristic of Trump’s campaign and many of his policies, including his outlandish belief that Afrikaners in South Africa are facing genocide and his granting them asylum in the United States — nothing he has ever offered to Sudanese, Haitians, Palestinians, or anyone truly facing murderous oppression.

Racism of course is baked into the structures and traditions of the United States, both reinforcing and reinforced by the campaign against immigrants. It is also a major impediment to working class activism.

To a far greater extent than any Administration since the 1920s, the Trump administrations have made racism a major thrust of what they say and what they do. Their attack on DEI is one manifestation of this.

Their attacks on public health will exacerbate the structural racism of this country, and make the lives of millions more hazardous and shorter as a result. This will be added grief on top of a situation already marked by oppressed racial/ethnic groups having shorter lives and more disease.

Tables 1 through 3 illustrate that Black and Native American people have shorter life expectancies than white people, and that they and Latinos have suffered most from the HIV/AIDS and COVID-19 pandemics.

Further, oppressed groups tend to have sharply lower incomes and wealth than do their oppressors — although the low incomes of working class people who happen to be white also expose them to this risk — so that the cuts in Medicaid, Medicare, Indian Health Service and Veterans Administration funds and access will disproportionately increase their rates of untreated sickness and of death. (I discuss how this will benefit the ruling class later in this article.)

Anti-scientific beliefs also run rampant.(3) Elsewhere (Friedman in New Politics #79) I have discussed at some length the roots of irrational thought in the ruling class and in popular classes, including their origins in the irrational and chaotic operations of the economy and empires under capitalism (drawing on writings by Marx and by Engels on the social roots of religion.)

Here, I want to focus only on vaccine policy. Vaccines have saved hundreds of millions of lives during my lifetime, and continue to do so to the extent that they are used.

Indeed, the only decision Trump made during his first term in office that I would endorse is his decision to authorize and fund Operation Warp Speed, which discovered and rolled-out the vaccine for COVID-19.

This of course is deeply ironic and tragic, since Trump and other reactionaries have savagely attacked this vaccine ever since, and indeed have enlisted some people who see themselves as socialists in these attacks.

Supporters claim to be basing their opposition to vaccines on science, but the articles they cite are deeply flawed — and mainly published in journals that play fast and loose with the scientific method and often ignore issues around data quality.(4)

These attacks on vaccines mobilized many right-wingers and others to support Trump in the 2024 election. This is one of several harmful campaign promises that the current Administration seems to be honoring, having appointed RFK Jr. to be Secretary of Health and Human Services.

Kennedy fired the entire membership of the Advisory Committee for Immunization Practices (ACIP), which makes recommendations on the safety, efficacy and clinical need of vaccines, replacing them with people with anti-vaccine views. He has also limited the population groups for whom COVID vaccines are recommended, which will affect their access to the vaccine and the amount they have to pay for it.

Kennedy also seems to be taking aim at programs and research dealing with infectious diseases in general (which, as discussed above, tend to hurt oppressed and working class people much more than their oppressors and exploiters).

The consequences of these attacks on vaccines can already be seen by the spreading measles outbreak in the United States. (I am particularly attuned to this, because I had a particularly bad case of measles when I was a child that would have hospitalized and perhaps killed me had my fever not broken when it did.)

With COVID-19 still around, and still mutating to develop new strains, and with Bird Flu a looming threat for causing a new pandemic, these attacks on vaccines and infectious disease programs are deeply irrational from the perspective of human health.

A new pandemic, and indeed the spread of existing diseases like measles that had been all but-eliminated by vaccines, will cause immense suffering.

Many top officials in the Trump administration, including Trump himself, seem to believe in eugenics — the belief firmly held by Adolph Hitler, and many Jim Crow racists, that some people’s genes (or “bad blood” in Trump’s words) make them inferior and that human progress depends on increasing the number of people with “good blood.” They think that people who succeed economically or are white have “good blood.”

People who succeed economically or are white have “good blood.” For such eugenicists, then, deaths or lowered fertility due to the attacks on public health have value in themselves — they can be seen as “improving the gene pool.”

Table 3. Death Rates per 100,000 from COVID 2020through 2022 by rate/ethnicity

Race/Ethnicity	Death Rate	Rate of death, rate relative to White death rate
White	268.5	1.00
Black	441.9	1.65
Hispanic	466.0	1.74
Asian	196.9	0.73
American Indian/Alaska Native	552.4	2.06
Native Hawaiian or Other Pacific Islander	462.78	1.73

Note: This pattern has remained reasonably stable for many years now, and pretty much reflects the pattern among each risk category. What is clear is that the racial system has led Black, Native American, and Latino/a people, as well as people who identify with multiple races, to have higher HIV rates than White people. These disparities are similar for AIDS incidence and for AIDS mortality.

Tactics and Strategy

On a tactical level, as discussed above, attacking public health is most likely to disable and kill working class voters, with a particular impact on Black, Brown, and Red people.

These are people who are more likely to vote Democrat than Republican (Kim Moody “Analyzing the 2020 Election: Who Paid? Who Benefits?” in ATC 211). Indeed, it is arguable that the differential deaths and disabling Long COVID cases (including those captured in Excess Death statistics — who outnumber those recorded as direct COVID deaths) among these groups from the pandemic may have benefitted Trump in the election.

Although readers of this journal may be deeply skeptical about the Democratic Party, and (correctly) see it as our enemy, the reactionaries in the Trump regime probably understand the tactical electoral advantages they gain from poor public health.

On a more strategic level, working class and minority communities burdened with disease, and with caring for the disabled and the children of the dead and disabled, are less able to resist capitalist demands. Cuts in access to health insurance, and increases in costs, may also weaken resistance.

Beyond that, attacks on workers’ economic health will deepen the “poverty draft” that leads some among them to enlist in the military, police or ICE, thus strengthening the coercive power of the State.

Attacks on public health leading to deaths among retired people, or those with disabilities serious enough to impede their economic productivity, also have strategic value for capital. Such deaths mean that Social Security and other income support funds can be used for investment rather than consumption by the “unproductive.”

Another way of saying this is that more surplus value can be invested rather than consumed. The capitalist class also has other economic and imperial arguments to favor cutting public health, although these are somewhat contradictory.

Capital benefits from having healthy workers! However, as I argued above, American capital has to funnel all the surplus value it can into investing in the competition with China and, even though some capitalists and politicians may not realize it, into fighting climate change.

In developing strategy to do this, of course, capitalist strategists are guided by their ideology, which sees “free markets” and competition as better ways to get things done, and more likely to lead to profitable innovation, than government action.

This is why (in addition to greed) they favor tax cuts so much — putting investable capital in the hand of corporate elites rather than government elites.

Cutting public health is part of the costs of redirecting surplus value to the investors. It has the side advantage, from their perspective, of forcing a large number of technically trained experts into the labor market, where companies can hire them relatively cheaply.

Fighting Back

As with much of the rest of the Trump regime’s agenda, people have been resisting the attacks on public health in many ways. Some of these have been the routine methods of testifying before government agencies, lobbying, getting Democratic politicians to write legislative proposals that get ignored, writing op-eds and blogs, and routine demonstrations.

Others have been more substantial, such as the mutual aid that people in the Los Angeles basin organized during the fires earlier this year. Mutual aid pretty much always has value for the people directly involved, but in this case it also had political implications as the networks established during the fires became important resources and communications channels for the mass street (and other) opposition to ICE. (Personal communications from anonymous sources).

Previously existing groups organized around specific health conditions have been seeking ways to defend their programs and to fight back more generally. These include groups with whom I am in ongoing communication, growing out of AIDS efforts such as harm resistance groups and ACT UP New York, as well as groups like Peoples CDC and a variety of Long Covid groups.

Even though their ability to engage in street actions is limited by their physical condition, a number of Long Covid activists were active in mutual aid around the Los Angeles fires and around the struggles against ICE.

Other groups organized around the problems disabled people face have also been engaged, although I am less aware of what they have been doing.

Health workers’ unions have been seeking ways to fight back, including seeking out ways to help undocumented people get care. They are also facing prospects of hospital closings, staff cutbacks, and increases in work pace and work time due to budget cuts and the attacks on Medicaid, Medicare, and other programs mentioned above.

Nurses’ unions have been quite visible in these efforts. So far, however, none of them have found ways to develop truly mass actions with the power to resist the attacks.

However, as is widely known on the left, these struggles alone will not suffice to defeat the attacks by a desperate ruling class on public health. That will take much greater struggles that involve mass strikes and confrontations in the street in which much of the working class and members of oppressed communities get involved, as discussed in many other articles in this magazine.

The more limited efforts such as mutual aid and strikes against specific cutbacks are nonetheless important since they can build solidarity, give us experience in struggle, and show the many ways in which the existing system is both unfair and vicious.

None of this will be easy. But it is necessary to prevent widespread and unnecessary death and misery.

Notes

1. This is the third article I have written on the Trumpoid attacks. The first was Sam Friedman. 2025. ATTACKS ON SCIENCE: IS THERE AN UNDERLYING LOGIC. New Politics Summer, 2025. Whole number 79. V. XX No. 3. 21 -29. The second, titled “Trying to comprehend the apparently idiotic: Reflections of a public health researcher on current government attacks on public health research,” focuses on the attacks specifically on public health research, and will appear in Logos in September.
   back to text
2. Samuel Friedman, “The Government Attack on Public Health Research,” Logos: A Journal of Modern Society and Culture, (Fall, 2025) Vol. 24., No. 3, https://logosjournal.com/article/the-government-attack-on-public-health-research/
   back to text
3. Some people analyze racism as a form of anti-scientific belief, and in some ways it is. However, as I and many others have noted, racism is also highly rational as a strategy and an institution for the ruling class and its State. I have most recently analyzed this in Friedman SR, Williams LD, Jordan AE, Walters S, Perlman DC, Mateu-Gelabert P, Nikolopoulos GK, Khan MR, Peprah E, Ezell J. “Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs.” Int J Environ Res Public Health. 2022 Jun 17;19(12). doi: 10.3390/ijerph19127453. Review. PubMed PMID: 35742699; PubMed Central PMCID: PMC9224240.
   back to text
4. Friedman, S. (2025). “The Left is Not Immune: Some Thoughts on COVID-Related Lab Leak and Vaccine Fixations.” Capitalism Nature Socialism, 36(3), 1–20. https://doi.org/10.1080/10455752.2025.2530506
   back to text

November-December 2025, ATC 239