By PAULO CAPEL NARVAI*
Denialism is not disinterested. It is not just the product of remarkable ignorance. It is business. A kind of business denialism.
1.
A few days after Donald Trump, from the Republican Party, was elected for the second time as president of the United States, it was announced, on November 14, 2024, that Robert F. Kennedy Jr. would lead the Department of Health and Human Services (HHS), an agency equivalent, in the federal system of that country, to our Ministry of Health. The HHS's mission is to oversee the main health agencies in the US, including the CDC, the acronym for the Centers for Disease Control and Prevention, the most important public health agency in the country – just to give you an idea of its importance, one of the two samples of the smallpox virus in the world is under the control of the CDC. The other is in an equivalent agency in Russia.
Kennedy Jr. is the nephew of former President John F. Kennedy and the son of former Senator Robert F. Kennedy, both members of the Democratic Party. John was assassinated in November 1963, while serving as president. Robert was assassinated five years later, in June 1968, while running for his party's presidential nomination.
Despite his family's strong ties to the Democratic Party, Kennedy Jr. joined Republican Donald Trump's campaign because he identified with the candidate's denialist positions. Trumpists had no major difficulties in welcoming someone whom a friend described as "the rotten fruit of the Kennedy clan", given his openly anti-vaccination trajectory. Organizations and scientists warned for the meaning of putting Kennedy Jr in charge of health policy. Trump, who has the support of the majority of Congress, ignored them, obtained Kennedy Jr.'s confirmation in the Senate and appointed him to HHS.
One of the “theses” that won Kennedy Jr.’s heart is the farce of the association between autism and the measles vaccine, which originated in an article by British doctor Andrew Wakefield, published in 1998 in the scientific journal The Lancet. The article was produced with fraudulent data and the author's conflict of interest was proven, as Andrew Wakefield had been hired by lawyers to produce data against the vaccine used at the time, so that they could make money by suing the manufacturers. In 2010, the General Medical Council of the United Kingdom, Andrew Wakefield ruled, convicting him. The doctor was considered unfit to practice his profession and his conduct was classified as irresponsible, unethical and deceptive. As a consequence, the magazine The Lancet made a retraction and reiterated that the study's conclusions were false.
None of this, however, dissuaded Kennedy Jr from his belief. On the contrary. In 2021, Kennedy Jr was the executive producer of Vaxxed 2: The People's Truth, sequel to the documentary Waxed, directed by none other than Andrew Wakefield, the acknowledged falsifier of autism and measles vaccine research data.
Knowing about the forgery, why did Kennedy Jr. continue to embrace the forger? Stupidity? No. Business. Denialism has never been, and is not, just ignorance. It is also business.
2.
A 70-year-old lawyer with professional activities in the area of environmental law, Kennedy Jr was nominated because Donald Trump believes he will be able “to ensure that everyone is protected from the harmful chemicals, pollutants, pesticides, pharmaceuticals and food additives that have contributed to the overwhelming health crisis” in that country. For the president, his “minister” of health will defend the interests of citizens against “the food industrial complex and pharmaceutical companies that have engaged in hoaxes and misinformation,” as well as ending “the epidemic of chronic diseases, making America great and healthy again.”
Kennedy Jr. did not hold back and, in thanking the nomination, stated that he intends to “sweep away corruption and end widespread conflicts of interest in our government health agencies.” With this impetus, he promised to “make Americans the healthiest people in the world again.”
However, judging by his statements, there are significant risks that the opposite of what he intends will happen.
The United States, a country where vaccination coverage rates are worse than those recorded in Brazil, even under the mismanagement of Michel Temer and Jair Bolsonaro, will have even lower coverage under Kennedy Jr.'s administration, with the promotion of anti-vaccinationism from government agencies. This political orientation repeats the strategy adopted in Brazil by the Bolsonaro government, characterized by incessant hostility to the SUS and public health actions, which originated in the Planalto Palace, driven by the so-called “Hate Cabinet”. Denialism and anti-vaccinationism transformed into public policy have produced devastating effects on vaccination coverage in all of Brazil.
Another “thesis” enthusiastically embraced by Kennedy Jr. refers simultaneously to the areas of health and the environment. In addition to the repeated opposition to Paris Agreement, the international treaty on climate change, adopted in 2015, the now head of HHS has declared his opposition to water fluoridation which, in his denialist view, is made with “an industrial residue” that produces “arthritis, bone fractures, bone cancer, loss of IQ, neurodevelopmental disorders and thyroid disease”. Although fluoride is a natural element, occurring in the air, soil and water, the representative of Donald Trump’s government for health prefers to believe that it is a poison.
After Donald Trump's election, Kennedy Jr. promised that "on its first day, the administration will recommend that all public water systems in the United States discontinue the measure." This is recommendation because the decision on this matter does not lie with the federal government, but with each local public authority. If this recommendation is accepted, it will be a very serious blow to public health, with notable losses for people.
3.
The public health technology known as “water fluoridation” involves adjusting the levels of fluoride naturally found in all waters to levels that are safe for human health. Scientific knowledge established over more than 50 years ago indicates that when water used for human consumption contains fluoride levels similar to those found in seawater and ocean water, the fluoride is very effective in preventing tooth decay and is safe for people.
In the USA this technology began to be used 80 years ago, in 1945. In 1999 it was considered one of the top ten public health achievements in that country. As a result of its effectiveness, proven by several hundred independent studies, its coverage has been expanding: it was 65% of the population in 2000; it increased to 73% in 2018. goal for 2030 is to reach 77%.
Currently, the USA leads worldwide the use of this technology. Brazil ranks second on a global scale, considering absolute numbers. But Brazil also records, in this area, important macroregional inequalities, with the situation being better in the South than in the North.
In the capital of São Paulo, which in 2025 will complete 40 years of uninterrupted use of water fluoridation, the measure is the main reason for the decline in the prevalence and severity of tooth decay. In 1985, when fluoridation began, only 5% of children in São Paulo were free of the disease at the index age of 12, used by epidemiologists for comparisons. This percentage rose to 40% in 2002 and reached 55% in 2023. The average number of teeth affected by tooth decay declined from 6,5 in 1985 for 1,4 in 2023.
If Kennedy Jr.'s decision were taken into account in the capital of São Paulo, these numbers give an idea of the brutally negative impact on the oral health of children in São Paulo. In São Paulo, and in Brazil, the use of water fluoridation technology for human consumption by Sabesp and other water treatment companies is supported by law 6.050, 1974, corroborated by law 14.572, which established the National Oral Health Policy in 2023. Baixo Guandu, in Espírito Santo, is the first Brazilian city in which the measure was implemented, in 1953. Unlike the USA, in Brazil the decision on the matter is not, therefore, up to the local health and sanitation authorities, but to the National Congress. Its implementation, however, under national laws and regulations, is the responsibility of the water treatment company that manages the sector in each city.
Due to its proven safety and effectiveness, fluoridation of public water supplies is recommended by dentistry and public health entities around the world. Including by CDC of the USA and by World Health Organization (WHO).
4.
But Kennedy Jr also announced that the Trump administration will withdraw the United States from the WHO now. in the first days of government. This decision was harshly criticized, in e out of the US, but was taken on the day of Trump's inauguration, through a “executive order”. The country hosted, in the post-war period, the creation of WHO, established as an organ of the United Nations (UN) on April 17, 1948.
In recent decades the participation US in WHO funding, whose annual budget is around US$6,8 billion, is approximately US$450 million. Much of the WHO's funding comes from donations from non-state supporters. Among the countries, the US's share is around 20%, which makes a huge difference to the budget. But Trump wants to use this money elsewhere. However, the US's exit from the organization weakens not only the WHO, but the UN itself – a well-known instrument for exercising that country's imperial power.
And it will harm, above all, populations around the world, not just the US population, which will be left unprotected by global agreements on epidemics and pandemics. It will have a strong and negative impact on the people of Africa, Asia and Latin America, regions where the WHO is actively involved in efforts to ensure universal health protection.
In the three Americas, the WHO operates through its representative in the region, the Pan American Health Organization (PAHO). This supranational organization has been carrying out decisive activities for public health in several countries for over a century. It has made notable achievements in the prevention and control of epidemics, such as the eradication of smallpox – worldwide effort in which the Brazilian Ciro de Quadros participated, who then dedicated himself to controlling polio in the Americas, having been successful despite facing enormous difficulties, including armed conflicts in El Salvador, Nicaragua and Peru.
Created in 1902, PAHO is headquartered in Washington, D.C., and was integrated with the WHO in the process of establishing the UN world body. To date, it has had 11 directors. Two Brazilians have directed it: Carlyle Guerra de Macedo, from 1983 to 1995, and Jarbas Barbosa, its current director. elected on 2022. O SUS, created in 1988, and the More Doctors Program, both harshly criticized by conservatives in Brazil, had decisive support from PAHO, which also participated in the negotiations that resulted in the National Immunization Program (PMI), in 1973.
Currently, the National Immunization Program makes 48 immunobiologicals available to all Brazilians, free of charge, through the SUS: 31 vaccines, 13 serums and 4 immunoglobulins. The US withdrawal from the WHO severely affects PAHO and, indirectly, all its activities in Latin America, including Brazil.
Anti-vaccination, anti-fluoridation, the resignation of the WHO leadership, all these measures seem to be inconsistent with the role that the US plays in the contemporary world. So why?
Money. Business. Private interests have become so entrenched within the power of the American empire that they are beginning to spread over the instruments of exercising that power, a kind of “anarchy of capitalist production,” losing sight of the public interest – even though, in Donald Trump’s case, it is only the national public interest, as he reiterated unequivocally in his inauguration speech on January 20, 1. Denialism, in its different expressions, from vaccines to climate change, is therefore not disinterested. It is not just the product of remarkable ignorance. It is business.
The jubilant way in which Donald Trump referred to oil at his inauguration ceremony expresses a type of denialism motivated by economic interests and not by ignorance about the climate significance of keep burning oil. It is, therefore, a type of business denialism, in which particular interests prevail over the public interest, destroying public policies and compromising the country's interest in international agreements.
How long will business denialism prevail under Donald Trump? The answer will be in the next four years. Or in a few months.
*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic). [https://amzn.to/46jNCjR]
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