The US Senate has confirmed as Health Secretary Robert F Kennedy, a science denialist who once said there is no vaccine that is safe and effective, who has suggested Covid might have been genetically engineered to spare Jewish and Chinese people, and who spent more than 100 pages in his recent book breathing new life into the idea that HIV does not cause Aids.
All of this is nonsense, of course, but hardly a laughing matter, writes epidemiologist Gregg Gonsalves for The New York Times, adding that he is afraid for America because he knows what happens when science denialism comes into power.
He writes:
In the mid-2000s, I lived in South Africa, then governed by then President Thabo Mbeki, who was also no stranger to the ideas of Aids denialists. Amid an explosive Aids epidemic in the late 1990s, Mbeki stumbled, most likely in late-night surfing of the internet, on to the fringe view that HIV doesn’t cause Aids and that the antiretroviral drugs used to keep it in check – the same type of drugs I take every morning and have for almost 30 years – were poison.
Mbeki, in thrall to these ideas, many of which came from America, refused to allow antiretroviral therapy to be used in the country’s health system. His Health Minister, Manto Tshabalala-Msimang, recommended healthy eating, with lots of beets, ginger and garlic, to ward off sickness.
A Harvard study later found that at least 330 000 people died, and more than 35 000 children were born with HIV as a result of Mbeki’s reign of error on Aids treatment policy.
We are at risk of seeing history repeat itself in the United States, with our own Manto Tshabalala-Msimang-in-waiting in Kennedy Jr, whose science denialism is a more pernicious variant of the South African version.
In his book The Real Anthony Fauci, Kennedy revives debunked canards about HIV – like the idea that it is a “harmless passenger virus” and that gay men’s promiscuity and use of recreational drugs, and even antiretroviral drugs like AZT were the real causes of Aids – while using the “I’m just asking questions” strategy to allow him to deny that he’s an Aids denialist himself.
As a gay man living with HIV, I cannot tell you how grotesque and offensive all this is and how hard it is to wrap my head around the idea that Kennedy will now preside over Aids research, care and prevention programs at federal agencies.
His science denialism has the potential to be worse than that of his South African counterparts. Because it’s not only his Aids denialism we need to worry about, it is his rejection of vaccines and flirtation with the rejection of germ theory, a key foundation of modern biomedicine.
For all of the dangers he presents, I’ve heard a lot of defeatism over the past few weeks as Donald Trump has flooded the zone with executive orders and other actions, which have had their desired effect of overwhelming his opponents. We can’t beat back all this, the logic goes, we’ve got to accept our fate and find a way to accommodate this brave new world under Kennedy and Trump.
But if South Africa holds a cautionary tale for us, it also shows us a way forward.
Twenty-five years ago, Mbeki’s African National Congress had a lock on power and many in the party refused to break with him on Aids, even if his policies were a death sentence for South Africans living with HIV.
Bodies were piling up, while pills to save the dying were out of reach, as a matter of national policy. It all seemed hopeless. How was anyone going to fight, let alone prevail against the party of liberation, which freed South Africans from apartheid?
But there were many who weren’t willing to accept defeat, like Zackie Achmat, a founder of the Treatment Action Campaign (TAC) to demand access to antiretrovirals. He visited me in New York in 2000 and inspired my move to South Africa in the first place.
Activists with the TAC organised in townships and rural areas, teaching themselves the science of HIV to combat the lies their government were peddling, and using that knowledge as the lever to build a mass movement. They knew there were drugs that could save their lives.
The South African Constitution guaranteed the right to health, and they wanted to live. They recruited help from Aids doctors and nurses, scientists working on HIV, lawyers who knew the young nation’s constitution inside out.
In the end, however, it was ordinary South Africans who made the difference.
The relentless campaign to confront the government’s views on Aids kept both the President and his Health Minister in the hot seat for years. By the time internal party politics forced Mbeki and Tshabalala-Msimang to resign, that activism had laid the groundwork for South Africa to establish the largest antiretroviral drug programme in the world.
So there is always hope for something else, something better. It’s in ordinary people organising, as my comrades in the TAC did, against the odds, because failure would come at too high a cost.
It’s in the lessons that many of us learned in the 1980s and 1990s in the United States when we were going to funerals week after week, when we refused to accept death without a fight.
Over the next few years, Americans who hope for something better will have to go toe-to-toe with this administration, at all levels of government, challenging its attacks on science in the courts, finding ways to protect public health through state and local action, educating our communities about what is going on and ways in which they can help push back so that when our own Manto Tshabalala-Msimang leaves in disgrace, we can pick up and build from the ashes.
And it’s already happening: court cases were filed in the first weeks of the administration to challenge harmful executive orders that would hobble National Institutes of Health research, people are downloading and saving data on HIV and LGBT health that the Trump administration is scrubbing from Centres for Disease Control and Prevention (CDC) websites. People are refusing to accept buyout offers to purge them from agencies where they’ve toiled on behalf of the American public for years.
In the bravest of examples, when Trump ordered foreign aid assistance to stop, workers at one US-funded programme in Sudan refused to comply. They weren’t willing to abandon 100 children to starvation. And yes, thousands of people organised to oppose the nomination of Kennedy, and though, unsuccessful, their efforts have left us better prepared for the struggle to come.
Yes, sometimes you persist and you fight “the long defeat”. Because as the healthcare justice champion Paul Farmer once said, you don’t turn your back on those who have the most to lose. And sometimes, just sometimes, you win.
Gregg Gonsalves is an epidemiologist at the Yale School of Public Health.
See more from MedicalBrief archives:
Mbeki slammed for repeating ‘misleading’ HIV/Aids statements
Magashule: ‘Denialist’ Mbeki should be prosecuted for Aids deaths