The folding chairs in the Bay Area elementary school auditorium were designed for third graders, not for parents vibrating with anxiety. But the room was packed. I had been asked by the principal — a woman whose sheer exhaustion seemed to humidify the fluorescent air — to field questions about the upcoming measles season. I stood there as a physician and epidemiologist, ready to discuss herd immunity and the social contract: why we vaccinate the strong to protect the kid with leukemia in the back row.
Then a hand shot up in the front. It belonged to a father who looked like he’d just jogged over from a Series B funding round: Patagonia vest, confident posture, the distinct aura of Silicon Valley royalty. He didn’t have a question; he had a deck. He held up a sheaf of papers — studies retracted years ago for fraud — and asked why I was trying to disrupt his daughter’s immune system. But it was his pivot that froze me.
“The problem with your legacy industry,” he said, smoothing his vest, “is that you’re obsessed with morbidity and mortality. Those are lagging indicators. Negative indicators.” He turned to the room, gathering his audience. “In tech, we track the Net Promoter Score. We ask, ‘How likely are you to recommend this product to a friend?’ If your vaccine had a high NPS, you wouldn’t need mandates.”
I realized then that we weren’t having a medical debate. We were witnessing a category error that was about to become national policy. He was proposing that biological survival be treated like a consumer gadget — subject to the whims of brand loyalty and user experience.
Two years later, that philosophy is the operating system of the federal government. Under Robert F. Kennedy Jr., the Department of Health and Human Services (HHS) has redefined the social contract as a customer service interaction. And just this week, the Environmental Protection Agency (EPA) confirmed the total victory of this logic: The agency announced it will no longer include the dollar value of lives saved in its cost-benefit analyses for pollution rules.
Premature death is no longer a metric that counts. The Net Promoter Score approach to governance is complete.
The Demolition of Public Health Infrastructure
The consequences of this shift are no longer theoretical; they are filling pediatric wards. We are currently living through the worst January for measles in more than thirty years.
While 2025 ended with a staggering 2,242 cases, 2026 has begun with a vertical climb. In South Carolina alone, 243 cases have been recorded in just the last ten days, bringing the state’s total to 558 since October. Meanwhile, a parallel fire is burning in the West, where an outbreak across Utah and Arizona has sickened 433 people.
The virus is finding the gaps we deliberately widened. While the national kindergarten vaccination rate has slipped to 92.7%, new data reveals that in high-risk zip codes currently lighting up epidemiologists’ maps, coverage in some schools has plummeted below 30%. The result is a statistical indictment of the shared decision-making model: in the South Carolina outbreak, 96% of the cases are unvaccinated, and 90% are children.
These numbers are the deliverables of the Department of Government Efficiency (DOGE), which has initiated a 24% reduction in the HHS workforce. The DOGE cuts were not surgical; they were bludgeoning. The CDC team dedicated to preventing drowning — responsible for mitigating the leading cause of death for toddlers — was eliminated. In Connecticut, state officials are scrambling to fund swimming lessons for inner-city children without federal grants. In Nashville, the city canceled the purchase of a mobile vaccination van due to funding freezes.
The expiration of Affordable Care Act subsidies has further compounded the crisis, jacking up premiums by over 114% for millions of families. Parents engaging in what HHS calls “shared decision-making” must now also decide whether they can afford the out-of-pocket cost for a shot their government treats with a shrug.
The Net Promoter Score for public health is tanking, but the cost of entry is skyrocketing.
Measles Politics Are an Old Story
We flatter ourselves if we think this commodification of truth is unique. Walk the cobblestones of Leicester, England, in 1885, and you would have found the spiritual ancestors of today’s HHS leadership.
Tens of thousands of protesters marched through that industrial town, carrying child-sized coffins and decapitating effigies of Edward Jenner, the creator of the smallpox vaccine. They, too, cried out for “bodily integrity” and “medical liberty.” They, too, believed that sanitation alone — pure water and fresh air — was a sufficient talisman against the virus.
The Leicester Method they championed relied on rigorous quarantine rather than the needle. It was the 19th-century equivalent of “natural immunity” through rigorous detection and isolation. For a time, it seemed to work, largely because the surrounding towns maintained high vaccination rates. But when the levees eventually broke, the virus found the unimmunized with brutal efficiency.
The British government eventually realized that coercion was backfiring. In 1898, they passed the conscience clause, allowing parents to opt out of vaccination if they registered a formal objection. Paradoxically, the conscience clause helped stabilize the system. By removing the martyrdom of imprisonment, the anti-vax movement lost its radical energy. Vaccination became a standard medical procedure rather than a symbol of state tyranny.
Today, however, the margins are thinner. Measles is a far faster predator than smallpox. With 531 people currently in quarantine in South Carolina alone — missing weeks of school and work — we are seeing the economic and social costs of so-called medical freedom in real time. We may not have the luxury of a conscience clause when the fire is moving at the speed of a sneeze in a crowded classroom.
Trusted Messengers Are Rebuilding Public Health
If the federal government has abdicated its role, who will build the shield? The answer lies in the Progressive Era, a time when the state was weak, and the cities were deadly.
It was not a president who cleaned up the slaughterhouses; it was a crusade of women. Florence Kelley and her Mink Brigade — wealthy society women linking arms with working-class girls — reframed public health as municipal housekeeping. They argued that women could not be good mothers in a dirty city. The National Consumers League didn’t wait for the FDA; they created their own White Label to certify that goods were made in sanitary conditions, bypassing the government to build safety through the marketplace.
Today, we are witnessing the birth of a modern Mink Brigade. As the CDC goes dark, a new, decentralized infrastructure of truth is lighting up.
It begins in the exam room. Pediatricians are actively seceding from federal guidance. The American Academy of Pediatrics (AAP) has effectively replaced the CDC as the primary regulator of childhood health, releasing its own evidence-based immunization schedules that explicitly contradicted HHS’s statements. Doctors like Ellie Brownstein in Utah are ignoring Washington to follow the Academy, telling parents that while the government may equivocate, science has not.
But the most potent response is happening outside the clinic. Just as Florence Kelley used the consumer power of women to enforce standards, today’s public health is being rebuilt by trusted messengers who are bypassing the noise of 24-hour news. Katelyn Jetelina, writing as Your Local Epidemiologist, and the all-woman team of scientists known as Those Nerdy Girls have built massive, loyal online followings by doing what the government no longer can: translating complex science with empathy rather than edict.
These networks are not activists in the traditional sense; they are translators. They are filling the trust gap that the Silicon Valley executive highlighted. By answering questions about bird flu or measles directly — often in the comments sections of Instagram or Substack — they are rebuilding the Net Promoter Score of public health one interaction at a time. They prove that while trust in agencies has collapsed, trust in individuals — the nurse, the neighbor, the scientist-mom — remains resilient.
Public Health Is a Political Agreement
The destruction of the CDC’s credibility is a tragedy, but it is also a clarification. For decades, we allowed public health to become a technocracy — a remote priesthood of experts issuing edicts. We forgot that public health is, at its core, a political agreement. It is a pact that says my child’s health is bound up with yours.
The anti-vaccine movement of the 19th century eventually faded. It wasn’t argued into submission; it was outlived by the undeniable success of the systems it opposed. The children saved by the reforms of the Progressive Era grew up to build the infrastructure we are now watching crumble.
The father in the elementary school auditorium was right about one thing: We do need a new metric. But it isn’t a Net Promoter Score. It isn’t about whether you would recommend a vaccine to a friend. It is about whether we, as a society, have the capacity to care for each other without a federal mandate forcing us to do so.
In the winter of 2026, the government left the building. But the spring will come. It will not arrive via a directive from Washington. It will arrive when a pediatrician refuses to water down her standards just to get out of a tense discussion. It will arrive when a newsletter in your inbox explains the risk of measles with clarity and care. It will arrive when we remember that the body politic is not a metaphor. It is a living thing, and it is only as strong as the care we offer its weakest member.
