Last month, Robert F. Kennedy, Jr., the Secretary of Health and Human Services, demanded that Susan Monarez, the newly confirmed director of the Centers for Disease Control and Prevention, fire senior officials at her agency and accept wholesale the recommendations of a handpicked panel of vaccine advisers whom he had installed. Monarez refused, and Kennedy asked for her resignation, just weeks after saying that he had “full confidence” in her “unimpeachable scientific credentials.” She appealed to G.O.P. lawmakers, including Senator Bill Cassidy, a physician who chairs the Senate health committee and who had cast a crucial vote in favor of Kennedy’s confirmation after receiving what one can only imagine were extremely believable assurances that he wouldn’t do what he is now doing. The White House resolved the standoff by showing Monarez the door. (A headline in “Intelligencer” captured Cassidy’s posture: “Key Republican Almost Annoyed Enough at RFK Jr. to Act.”)

Then the C.D.C., which has bled thousands of employees since Kennedy took office, was further roiled by the resignations of several high-ranking officials. Nine former C.D.C. directors and acting directors published an essay in the Times arguing that Kennedy’s actions “should alarm every American,” and more than a thousand current and former Health and Human Services employees called for Kennedy’s resignation. On Thursday, at a contentious hearing before the Senate finance committee, Kennedy accused Monarez of lying, in a Wall Street Journal op-ed, about why she was fired. She wrote that his agenda “isn’t reform. It is sabotage.”

There won’t be a day when Americans awake to news that vaccines are prohibited, or that the National Institutes of Health has been shuttered. No agent will come knocking on your door to make sure that you’re drinking raw milk and cooking with beef tallow. But Kennedy has already propagated an insidious revolution within the agencies under his control, using a playbook familiar to illiberal leaders—culling expertise, silencing critics, and weaponizing administrative procedure to grant a veneer of legitimacy to his actions.

When maga met maha, Donald Trump vowed that Kennedy would “go wild on health.” Promises made, promises kept. Kennedy has gutted the C.D.C.’s independent vaccine-advisory panel and appointed a noted vaccine skeptic to study the causes of autism. The N.I.H. has distributed billions less in funding and awarded thousands fewer grants than in a typical year; although a Senate committee recently voted to increase the agency’s budget for the next fiscal year—in defiance of a forty-per-cent cut requested by Trump—officials are concerned that they will be blocked from getting the money to researchers. Government scientists have reported that their work has been undermined, and Kennedy has suggested that he may bar employees from publishing in “corrupt” medical journals, in favor of “in-house” publications. Claiming that he had “listened to the experts,” Kennedy cancelled half a billion dollars in funding for mRNA technology—a genuine triumph of Trump’s first term that not only is our best defense against future pandemic pathogens but also shows potential as a treatment for autoimmune conditions and deadly cancers.

The effects of Kennedy’s maneuvering could be most acute when it comes to covid. During the past year, the virus has sickened millions of Americans and led to tens of thousands of deaths in the U.S. The C.D.C. estimates that infections are now increasing in dozens of states; in New York City, there are reports of patients flooding medical practices with inquiries about their symptoms, and about whether they’re eligible to get immunized, in the wake of new restrictions announced by the Food and Drug Administration. (Vaccine eligibility is usually determined by the C.D.C., but, in another departure from precedent, the F.D.A. usurped that role.) At the end of August, the F.D.A. approved updated covid shots targeting an Omicron descendant known as LP.8.1., but authorized them only for people aged sixty-five and older and for younger individuals with certain high-risk conditions. Earlier this year, before disbanding the C.D.C.’s vaccine panel, Kennedy unilaterally announced that the agency would no longer recommend covid vaccination for healthy children or pregnant women. (Kennedy’s newly appointed panel is scheduled to meet this month to discuss immunization protocols for covid and other diseases.)

The federal government’s vaccination recommendations are more than just a biomedical bully pulpit—they have implications for who can access a vaccine and what it will cost them. Health insurers generally aren’t required to cover vaccines that the C.D.C. hasn’t recommended, and uncertain reimbursement can affect whether pharmacies and doctors’ offices carry a product. Some doctors may also be wary of the liability associated with administering vaccines to people for whom they were not officially approved; although doctors have traditionally been protected from legal exposure related to harms resulting from vaccination, Kennedy has warned that those who “diverge from the CDC’s official list are not shielded from liability.” Meanwhile, it’s unclear whether pharmacists, who administer most vaccines to adults in the U.S., are protected. “These pharmacists at CVS and Walgreens who were giving the vaccine are in a conundrum,” Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said recently. “And that’s Robert F. Kennedy, Jr.,’s goal—to make things confusing.”

Kennedy’s reign might end tomorrow if not for the President’s unwavering support. Trump, who has sometimes seemed conflicted about the anti-vax sentiment in his coalition that prevents him from claiming more credit for Operation Warp Speed, has thoroughly capitulated to the political reality that Kennedy is a useful ally. The two men share a talent for misrepresenting facts and an animosity toward institutions. But the nation’s institutions—political, academic, scientific—are the reason that it has long been the world’s unrivalled biomedical leader.

The question now is how much more hollowing out Americans will tolerate, and whether the nation’s self-correcting mechanisms are still operational. In “Democracy in America,” Alexis de Tocqueville warned of a path by which institutions in a country like the U.S. might degrade—not by violent seizure but by the consolidation of control through “a network of small, complicated rules” that marginalizes innovators and experts. What kept this from happening here—what made America great—were “habits of the heart”: the everyday engagement of citizens that sustains institutions by holding leaders to account. Habits fade, but they can also be revived. ♦