President-elect Donald J. Trump’s selections to run the nation’s health agencies are alarming infectious disease experts.President-elect Donald J. Trump had already succeeded in rattling the nation’s public health and biomedical establishment by the time he announced on Tuesday that he had picked Dr. Jay Bhattacharya to run the National Institutes of Health. But amid growing fears of a deadly bird flu pandemic, perhaps no one was more rattled than experts in infectious disease.Dr. Bhattacharya, a Stanford University medical economist and outspoken opponent of lockdowns, masking, school closures and other Covid-19 mitigation measures, and Mr. Trump’s other health picks have one thing in common. They are all considered Covid contrarians whose views raise questions about how they would handle an infectious disease crisis.Robert F. Kennedy Jr., Mr. Trump’s choice for health secretary, has said he wants the N.I.H. to focus on chronic disease and “give infectious disease a break for about eight years.” Dr. Martin Makary, the president-elect’s choice to run the Food and Drug Administration, incorrectly predicted in 2021 that the nation was “racing toward an extremely low level of infection.”Dr. David Weldon, a Republican former congressman who is Mr. Trump’s choice to lead the Centers for Disease Control and Prevention, has espoused the debunked theory that thimerosal, a mercury compound in certain vaccines, causes autism. As a congressman, he introduced legislation that would strip the C.D.C. of its role in ensuring vaccine safety, saying the agency had a “conflict of interest” because it also promotes vaccination.And Dr. Mehmet Oz, the talk show host who has been picked by Mr. Trump to run Medicare and Medicaid, prodded officials in the first Trump administration to give emergency authorization for the malaria drug hydroxychloroquine to treat Covid-19. The F.D.A. later revoked the authorization when studies showed the drug carried risks, including serious heart issues, to coronavirus patients.Robert F. Kennedy Jr. has said he wants to focus on chronic diseases rather than infectious diseases as head of the Department of Health and Human Services. Haiyun Jiang for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

President-elect Donald J. Trump said on Tuesday evening that he had selected Dr. Jay Bhattacharya, a Stanford physician and economist whose authorship of an anti-lockdown treatise during the coronavirus pandemic made him a central figure in a bitter public health debate, to be the director of the National Institutes of Health.“Together, Jay and RFK Jr. will restore the NIH to a Gold Standard of Medical Research as they examine the underlying causes of, and solutions to, America’s biggest health challenges, including our Crisis of Chronic Illness and Disease,” Mr. Trump wrote on social media, referring to Robert F. Kennedy Jr., his choice to lead the N.I.H.’s parent agency, the Department of Health and Human Services.If confirmed by the Senate, Dr. Bhattacharya would lead the world’s premier medical research agency, with a $47 billion budget and 27 separate institutes and centers, each with its own research agenda, focusing on different diseases like cancer and heart disease.Dr. Bhattacharya is the latest in a series of Trump health picks who came to prominence during the coronavirus pandemic and who hold views on medicine and public health that are at times outside the mainstream. The president-elect’s health choices, experts agree, suggest a shake-up is coming to the nation’s public health and biomedical establishment.Dr. Bhattacharya is one of three lead authors of the Great Barrington Declaration, a manifesto issued in 2020 that contended that the virus should be allowed to spread among young healthy people who were “at minimal risk of death” and could thus develop natural immunity, while prevention efforts were targeted to older people and the vulnerable.Through a connection with a Stanford colleague, Dr. Scott Atlas, who was advising Mr. Trump during his first term, Dr. Bhattacharya presented his views to Alex M. Azar II, Mr. Trump’s health secretary. The condemnation from the public health establishment was swift. Dr. Bhattacharya and his fellow authors were promptly dismissed as cranks whose “fringe” policy prescriptions would lead to millions of unnecessary deaths.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Donald Trump’s pledge to let Robert F. Kennedy Jr. “go wild on health” has put three issues on the agenda in the final days of the 2024 campaign.With candidates and voters focused on the economy, immigration and abortion, the 2024 presidential election has been unusually light on health policy. But former President Donald J. Trump’s recent pledge to let Robert F. Kennedy Jr. “go wild on health” has put the issue front and center in the final days of the campaign.With an assist from Mr. Kennedy — an environmental lawyer who has no medical or public health degrees — Mr. Trump put the spotlight on a trifecta of health policies: fluoridated water, vaccines and the Affordable Care Act, the program popularly known as Obamacare, which has provided health coverage to nearly 50 million Americans over the last 10 years.As president, Mr. Trump would have only limited authority to make changes in these areas, even if Republicans won control of both houses of Congress. But he would have the bully pulpit. Here’s what you need to know about the three issues:FLUORIDEOver the weekend, Mr. Kennedy declared on social media that, if elected president, Mr. Trump would advise communities to stop adding fluoride to drinking water. Mr. Kennedy described the compound as “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease.” In an interview with NBC News on Sunday, Mr. Trump said the idea of doing away with fluoridation “sounds OK to me.”What is fluoride and why is it in our drinking water? Fluoride is a mineral that occurs naturally in water, although it can also be a byproduct of industry. Adding fluoride to public water systems began as an experiment in Grand Rapids, Mich., in 1945, after a dentist at the National Institutes of Health theorized that it might prevent cavities in teeth. Over the next 11 years, tooth decay in Grand Rapids dropped by 60 percent.Other communities quickly followed suit. As of 2022, more than 209 million people, or 72.3 percent of the U.S. population served by public water supplies, had access to fluoridated water, according to the Centers for Disease Control and Prevention, which lists fluoridation as one of the “10 great public health achievements of the 20th century.”What do health experts say about fluoride? Experts agree that excessive exposure to fluoride over a long period of time can cause health problems. The risks include dental fluorosis, a condition that leaves the teeth looking pitted or brown; skeletal fluorosis, which can cause joint pain or osteoporosis; and lower I.Q. in children.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Dueling Trump and Harris rallies outside Atlanta offer a case study in how anger and anxiety over Covid-19, a proxy for the larger debate over trust in government, have shaped the 2024 race.Robert F. Kennedy Jr. walked onstage after a parade of pyrotechnics at former President Donald J. Trump’s rally outside Atlanta last week and immediately invoked a name that became a bugaboo of the right and a subject of wild conspiracy theories during the coronavirus pandemic: Bill Gates.Mr. Gates, Mr. Kennedy informed the crowd, had “been indicted in the Netherlands for lying to the public about the Covid-19 vaccine.” Thousands of red-hatted Trump backers roared their approval. In fact, there had been no indictment; according to the Dutch newspaper De Telegraaf, a judge in the Netherlands ruled that a civil suit accusing Mr. Gates of “vaccination damage” may go forward.The next night, at a rally for Vice President Kamala Harris in a different Atlanta suburb, former President Barack Obama blamed Mr. Trump for thousands of coronavirus deaths. More Americans would be alive today, he said, “if we had had a competent administration” that was “trying to do things better instead of talking about injecting bleach into your arm.”As the most divisive American presidential race in recent history barrels toward a close, many Americans have developed what Wendy Parmet, an expert in public health law at Northeastern University, calls “amnesia” about the coronavirus pandemic. The economy, immigration, abortion and threats to democracy now top the list of voters’ concerns.But anger and anxiety about Covid-19 are woven into all those issues, simmering underneath as a proxy for the larger debate over trust in government that has shaped the 2024 race.Last week’s dueling rallies in Atlanta, home to the Centers for Disease Control and Prevention, offer a case study in the lingering effects of the pandemic on American politics. They tell the story of two Americas, red and blue.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The new rules under the Affordable Care Act would include emergency contraception, a newly approved nonprescription birth control pill, spermicides and condoms.The White House announced on Monday that it would propose new rules under the Affordable Care Act that would require insurers to cover over-the-counter birth control at no cost to patients, as it seeks to expand access to contraception and cut out-of-pocket costs.The rules would include emergency contraception, a newly approved nonprescription birth control pill, spermicides and condoms and would affect 52 million American women of reproductive age who rely on private health insurance. They will be subject to a 60-day public comment period and, if finalized, would represent “the most significant expansion of contraception benefits” in more than a decade, said Jennifer Klein, the director of the White House Gender Policy Council.The proposal comes just two weeks before the election as Democrats, including Vice President Kamala Harris, make the case that the threat to reproductive rights extends beyond the Supreme Court’s 2022 decision, in Dobbs v. Jackson Women’s Health Organization, that eliminated the national right to abortion.“At a time when contraception access is under attack, Vice President Harris and I are resolute in our commitment to expanding access to quality, affordable contraception,” President Biden said in a statement. “We believe that women in every state must have the freedom to make deeply personal health care decisions, including the right to decide if and when to start or grow their family.”The court ruled in that case that the “right to privacy” did not confer a right to abortion. In his concurring opinion, Justice Clarence Thomas said the same rationale should be used to overturn other “demonstrably erroneous decisions” that relied on a right to privacy, including Griswold v. Connecticut, a 1965 case declaring that married couples had a right to contraception.“Clarence Thomas said the quiet part out loud, that contraception could very much be at risk and it is at risk,” Ms. Harris told the late-night host Jimmy Kimmel in June.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

In a new book, Dr. Anthony S. Fauci recounts a career advising seven presidents. The chapter about Donald J. Trump is titled “He Loves Me, He Loves Me Not.”Three months into the coronavirus pandemic, Dr. Anthony S. Fauci was at home in northwest Washington when he answered his cellphone to President Donald J. Trump screaming at him in an expletive-laden rant. He had incurred the president’s wrath by remarking that the vaccines under development might not provide long-lasting immunity.That was the day, June 3, 2020, “that I first experienced the brunt of the president’s rage,” Dr. Fauci writes in his forthcoming autobiography.Dr. Fauci has long been circumspect in describing his feelings toward Mr. Trump. But in the book, “On Call: A Doctor’s Journey in Public Service,” he writes with candor about their relationship, which he describes as “complicated.”In a chapter entitled “He Loves Me, He Loves Me Not,” Dr. Fauci described how Mr. Trump repeatedly told him he “loved” him while at the same time excoriating him with tirades flecked with four-letter words.“The president was irate, saying that I could not keep doing this to him,” Dr. Fauci wrote. “He said he loved me, but the country was in trouble, and I was making it worse. He added that the stock market went up only 600 points in response to the positive Phase 1 vaccine news, and it should have gone up 1,000 points, and so I cost the country ‘one trillion dollars.’” (The president added an expletive.)“I have a pretty thick skin,” Dr. Fauci added, “but getting yelled at by the president of the United States, no matter how much he tells you that he loves you, is not fun.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

In a wide-ranging interview, Dr. Monica M. Bertagnolli, the director of the National Institutes of Health, discussed drug patents, trust in science and her own experience as a cancer patient.When Dr. Monica M. Bertagnolli moved into the director’s suite at the National Institutes of Health, she brought with her a single piece of art, a lithograph created by the granddaughter of a cancer patient she once treated. It depicts an abstract geometric female figure and the organs she lost to cancer. Its title: “We Are Not What You Have Taken: A Response to Cancer.”The image speaks to Dr. Bertagnolli, a cancer surgeon who previously led the National Cancer Institute and is a breast-cancer survivor herself.After being nominated by President Biden in the spring and winning Senate confirmation last month, she became the 17th director of the N.I.H., which has a budget of more than $47 billion and occupies a sprawling campus in Bethesda, Md. She is only the second woman to lead the biomedical research agency on a permanent basis.Several weeks into her tenure, The New York Times visited Dr. Bertagnolli at her office in Building 1, a stately brick structure where President Franklin D. Roosevelt dedicated the Bethesda campus in 1938. This interview has been edited and condensed.You’ve been here a few weeks. What are your observations?The research laboratories that get funded out of here are amazing for fundamental science. We need to continue all of that work. But what we’ve had challenges with is really being able to go with our research deeply into clinics at every community where people are treated and cared for.I think we’ve done really well in our major academic medical centers. But if we’re going to really do clinical research in a way that achieves the results we need, we need everybody to have a chance to participate. It sounds like you want more participation in clinical trials from people in rural areas, and you want to infuse the data that we have into the treatment that they get.Exactly.I can’t help but ask if that is informed by your growing up on a ranch in rural Wyoming.Sure. Because I understood that health care delivery was just different for the people I grew up with. From my ranch house to a paved road was 18 miles. And from the ranch house when I was growing up to the next landline for a telephone was about 50 miles.You had a telephone, though?No, we didn’t. Not at the ranch in the summertime. When school would start, my mom would move with the kids down to town. We had a house in town as well. And we’d go back and forth to the ranch on the weekends. We had a telephone in town.Activists are pressing the N.I.H. to use so-called march-in rights to lay claim to patents on drugs developed with tax dollars, as a way of lowering prices. Are you open to that?Absolutely. It’s part of my authorities as N.I.H. director. But I have to really be certain that if march-in rights are ever used, that the result is the intended one — meaning people get better access, because that’s really the goal. We want every single person to have access to the benefits of biomedical research. (After this interview, the Biden administration issued a proposed framework to guide the use of march-in rights by the agency.)The N.I.H. has come under scrutiny for funding gain-of-function research — including in Wuhan, China — that some experts think is dangerous and could lead to the next pandemic. Are you reviewing that kind of research and do you plan to make any changes?The gain-of-function research that you’re specifically referring to is modifications that are done of potential pandemic pathogens, right? What if we can develop a vaccine way before we ever have to see a new virus that’s going to be another Covid-19 virus? That would be a huge benefit. But if we’re going to do that kind of research, we have to make sure that the risks are absolutely minimized and always be mindful that the benefits justify the risks.The White House is weighing recommendations from the National Science Advisory Board for Biosecurity for improving oversight. Where does that stand?To be fair, I don’t know yet. But it’s a huge priority for all of us, and I will be a very active participant, because oversight is critical for that kind of research.The Pew Research Center recently put out a poll showing that Americans’ trust in science has continued to decline — and more so among Republicans than Democrats. Does that worry you?Very much so. Everything we are trying to do in science is about getting better care to people. It’s absolutely impossible to deliver better care to treat people without trust.But I’m thinking of trust, writ large, in institutions like the N.I.H. We’re seeing Republicans on Capitol Hill be critical of the N.I.H. What can you do to bridge that partisan gap and restore Americans’ faith in the institution?Be very transparent, very honest in what we know and what we don’t know. Think about what we’ve all just been through as a nation — the trauma we’ve all been through. It’s ridiculous to think we’re not going to come through a trauma like that without some real consequences. But I also think that we can use it as an opportunity to really build trust in science, because I do believe that science has helped us cycle out of the dark days of this pandemic.You’ve been a patient, and you’ve talked about that. How are you feeling? Can you talk about your status?I am a cancer survivor. I think we all have to be humble in the face of a cancer diagnosis. So my chance of living the rest of my life free from cancer is very, very high. That’s the good news. And the point that I make to everyone when asked about this is that all of the evidence that guided my care came from N.I.H.-funded research.I would be remiss if I didn’t ask you about being only the second woman out of 17 directors. I walked down this hallway and I saw a lot of portraits of men. How does that affect your thinking about the role that you inhabit?I’m very glad to see women getting opportunities to show what women can do. If you look down that hallway, for all those years, there were really talented, capable women out there, too. They just didn’t have the chance.

Five months into her tenure at the Centers for Disease Control and Prevention, Dr. Mandy K. Cohen is trying to put a human face on public health.Dr. Mandy K. Cohen dropped by the Fox affiliate in Dallas in November, just days after the governor of Texas signed a law barring private employers from requiring Covid-19 shots. If she thought promoting vaccination would be a tough sell in a ruby-red state, Dr. Cohen, the new director of the Centers for Disease Control and Prevention, did not give any indication.“I’m not just the C.D.C. director, I’m also a mom,” she said cheerily, noting on live television that her daughters, 9 and 11, had already received the latest Covid and flu shots. She added, “So I wouldn’t recommend something for the American people I wouldn’t recommend for my own family.”It was the kind of stock phrase that Dr. Cohen has repeatedly invoked as she pursues a task that some public health experts fear is impossible: restoring Americans’ faith in public health, and in her battered agency. Five months into her tenure, with the Covid public health emergency officially over, the C.D.C.’s new leader is relentlessly on message.Americans’ trust in the agency, and in science more broadly, was badly damaged by the coronavirus pandemic, and the loss of faith is particularly pronounced among Republicans. In a recent survey by the Pew Research Center, 38 percent of Republicans said they had little or no confidence in scientists to act in the public’s best interests, up from 14 percent in April 2020.At the same time, the C.D.C.’s winter vaccination campaign appears to be falling on deaf ears. On Thursday, the agency issued an alert warning that low vaccination rates for the flu, Covid and respiratory syncytial virus, known as R.S.V., could lead to “severe disease and increased health care capacity strain in the coming weeks.” And partisan divisions over vaccination persist: A KFF poll in September found that seven in 10 Democrats but just a quarter of Republicans planned to get the updated Covid shot.Dr. Cohen preparing for an interview at the Fox affiliate in Dallas. She faces the challenge of restoring Americans’ faith in public health.Desiree Rios for The New York TimesDr. Cohen, whom President Biden selected to succeed Dr. Rochelle P. Walensky, is responding with a nationwide media blitz. Since taking the helm of the C.D.C. in July, she has traveled the country, promoting vaccination in 19 cities in 13 states. She has visited 22 vaccination sites and has participated in dozens of interviews, including an appearance on NBC’s “Today” just before Thanksgiving.She has left a trail of social media posts in her wake, including a series of short videos, called “Check-In With Dr. Cohen,” that typically begin with some variation of the same greeting: “Hi everyone, it’s Mandy Cohen!”In one video recorded on Long Island, Dr. Cohen and a county health official, wearing hard hats and vests, reported on how wastewater can help scientists track viruses and disease. In Dallas, she appeared with another county health official to talk about the importance of data, and with a nurse at a church health fair. And in Chicago, she stood by the president of the American Medical Association as he promoted vaccination.When she speaks to reporters, she frequently brings up her children.“Science is important and yes, the data is important,” Dr. Cohen said in an interview with The New York Times. “But at the end of the day, we’re also all humans. And if we can have a human-to-human conversation about what I would do for my own kids, who I love and I want to be healthy, maybe that can connect us in a different way.”Dr. Cohen is taking over an agency that is in transition. Her predecessor, Dr. Walensky, who began serving at the start of the Biden administration and stepped down in June, commissioned a review of the C.D.C. that identified serious weaknesses in areas ranging from testing to data collection to communications. She then initiated an overhaul of the agency.Dr. Cohen has said she is committed to carrying out that plan, which included setting up a new forecasting and analytics center, as well as structural changes intended to enable the agency to quickly translate its science into coherent policy recommendations. But even her staunchest allies say her top priority must be to change the way the public views her agency.“Restoring trust probably is the No. 1 challenge right now,” said Dr. Judith Monroe, the president and chief executive of the C.D.C. Foundation, an independent nonprofit established by Congress to mobilize private-sector support for the agency’s work. “Because where’s your platform if folks don’t trust what you say?”Experts agree that C.D.C. officials and other public health leaders made serious messaging missteps during the pandemic. Officials bred mistrust by speaking “with certainty when there wasn’t any” and later changing their recommendations, said Brian C. Castrucci, the president and chief executive of the de Beaumont Foundation, a public health nonprofit that is partnering with Frank Luntz, a pollster and political strategist, to study attitudes toward public health.Mr. Luntz, who rose to prominence working for Republicans, said his research had found that a significant portion of the public — as much as 20 or 25 percent — was now unreachable, because public health officials used language that “sounded like it was lecturing, and almost abusive toward people who had legitimate doubts.”Based on Mr. Luntz’s surveys and focus groups, the foundation has developed messaging guidance, including a “communications cheat sheet,” to help public health officials reach Americans of all political stripes. Dr. Tom Frieden, who served as C.D.C. director under President Barack Obama and has participated in the project, said Dr. Cohen’s communications style was in keeping with its findings.“You’re there to empower people with information, not berate people to change their behavior,” he said. “I think Dr. Cohen gets that.”The morning before she was to leave for a two-day, three-city swing through Texas, Dr. Cohen huddled with her top aides and her infectious disease team at the C.D.C. headquarters in Atlanta for an update on the flu, Covid and R.S.V. — which circulate during what the agency now calls the “winter respiratory virus season.” One benefit of that moniker: Winter viruses are less politically toxic than Covid.Dr. Cohen handed out a challenge coin in Dallas, one stop during a two-day, three-city swing through Texas.Desiree Rios for The New York TimesThe news was mixed. Hospitalizations from the flu were up slightly from last year. The rate of Covid vaccination was much lower than that of flu vaccination among health care workers — not a good sign. A new monoclonal antibody shot to prevent R.S.V. in infants was in short supply, but 77,000 more doses had just been released. Texas was seeing an uptick in R.S.V.But there was something else on Dr. Cohen’s mind. During her travels, she had been hearing from people who worried about side effects from vaccination and wanted more information about what federal health officials were doing to monitor vaccine safety. The C.D.C., she told her colleagues, needed to be able to “tell a clear and concise story.”To that end, Dr. Cohen is changing the language that the C.D.C. uses to describe itself. Testifying last month before a House subcommittee in what was her first appearance before Congress in her new post, she described the agency as a “critical national security asset” — a phrase that might have particular appeal to House Republicans, who have proposed cutting the C.D.C.’s funding by $1.6 billion, or roughly one-sixth of its budget.But M. Anthony Mills, a senior fellow at the conservative American Enterprise Institute who studies public trust in science, said the national security frame might not appeal to ordinary Americans who distrust the C.D.C. and other agencies like the National Institutes of Health and the Food and Drug Administration.“For Americans who believe N.I.H. lied about funding research that caused the pandemic, suspect the pharmaceutical industry is in bed with the F.D.A. and see public health efforts as an infringement on their freedom, that constellation of concerns doesn’t have much to do with national security,” he said.Unlike Dr. Walensky, who had no prior government experience and made headlines for seeking out media training, Dr. Cohen is not a stranger to Washington or the spotlight.Dr. Cohen, the former secretary of health and human services in North Carolina, succeeded Dr. Rochelle P. Walensky as C.D.C. director.Desiree Rios for The New York TimesShe was a top official at the Centers for Medicare & Medicaid Services during the Obama administration. Later, as secretary of health and human services in North Carolina, she laid the groundwork for the Republican-controlled legislature to accept an expansion of Medicaid, and she helped steer the state through the pandemic.After news reports that Mr. Biden was planning to pick Dr. Cohen for the director’s post, more than two dozen congressional Republicans signed a letter accusing her of politicizing science. They cited her tenure in North Carolina, where she called for students and staff members in K-8 schools to wear masks and threatened legal action against a school district over its Covid policies.But while her relationships with Republicans in North Carolina may have been tense, they never veered into vitriol, said State Representative Donny Lambeth, a Republican and a chair of the Health Committee in the North Carolina House of Representatives.“She was cool, calm and collected almost every time we had her in front of us,” Mr. Lambeth said. “She did not get rattled.”There were few fireworks during her congressional testimony last month. When Representative Daniel Crenshaw, Republican of Texas, pushed her to admit that the C.D.C. had been wrong during the pandemic, she politely ignored the request.Representative Jeff Duncan, Republican of South Carolina, wanted to know if she had regrets about Covid restrictions from her time in North Carolina. Dr. Cohen did not admit to any. When he asked her pointedly if she would impose such restrictions today, she ducked the question, telling him instead that she was looking forward to a new chapter at the C.D.C.“The good news,” she said, “is we’re in a new place.”

Mississippi has long had high childhood immunization rates, but a federal judge has ordered the state to allow parents to opt out on religious grounds.For more than 40 years, Mississippi had one of the strictest school vaccination requirements in the nation, and its high childhood immunization rates have been a source of pride. But in July, the state began excusing children from vaccination if their parents cited religious objections, after a federal judge sided with a “medical freedom” group.Today, 2,100 Mississippi schoolchildren are officially exempt from vaccination on religious grounds. Five hundred more are exempt because their health precludes vaccination. Dr. Daniel P. Edney, the state health officer, warns that if the total number of exemptions climbs above 3,000, Mississippi will once again face the risk of deadly diseases that are now just a memory.“For the last 40 years, our main goal has been to protect those children at highest risk of measles, mumps, rubella, polio,” Dr. Edney said in an interview, “and that’s those children that have chronic illnesses that make them more vulnerable.” He called the ruling “a very bitter pill for me to swallow.”Mississippi is not an isolated case. Buoyed by their success at overturning coronavirus mandates, medical and religious freedom groups are taking aim at a new target: childhood school vaccine mandates, long considered the foundation of the nation’s defense against infectious disease.Until the Mississippi ruling, the state was one of only six that refused to excuse students from vaccination for religious or philosophical reasons. Similar legal challenges have been filed in the five remaining states: California, Connecticut, Maine, New York and West Virginia. The ultimate goal, according to advocates behind the lawsuits, is to undo vaccine mandates entirely, by getting the issue before a Supreme Court that is increasingly sympathetic to religious freedom arguments.No major religions, including Roman Catholicism, which strongly opposes abortion, have objected to vaccination. But the plaintiffs in these cases say their religious objections stem in part from the use of fetal tissue in vaccine development. A few childhood vaccines, including those that protect against chickenpox and rubella, were developed with cells obtained from aborted fetuses in the early 1960s. Those cells continue to grow in laboratories today.The legal push comes as childhood vaccine exemptions have reached a new high in the United States, according to a report released last month by the Centers for Disease Control and Prevention. Three percent of children who entered kindergarten last year received an exemption, the C.D.C. said, up from 1.6 percent in the 2011-12 school year.Idaho had the highest rate of exemptions, at 12.1 percent, while West Virginia had the lowest, at less than one-tenth of 1 percent. Mississippi’s rate was nearly as low, at two-tenths of 1 percent. At the time, Mississippi allowed exemptions for medical reasons, as all states do, but it did not yet allow parents to opt out on religious grounds.A broad majority of Americans continue to believe in the value of childhood vaccines. But in a Pew Research Center survey conducted in March, 28 percent of respondents said that parents should be able to choose not to vaccinate their children, up 12 percentage points from four years ago.In California, a group of parents backed by Advocates for Faith & Freedom, a nonprofit group devoted to religious liberty, filed suit in federal court in October seeking to restore the state’s “philosophical” exemption, which was eliminated after a measles outbreak in 2015. A federal judge recently allowed a similar case to go forward in Maine, which ended its religious exemption in 2021.Connecticut, which also did away with its religious exemption in 2021, has faced legal challenges backed by We the Patriots USA, a group based in Idaho. In August, a divided federal appeals court rejected a constitutional challenge to the state law, and on Friday, a federal judge dismissed a second lawsuit. Brian Festa, a founder of We the Patriots, said in an interview that his group would ask the Supreme Court to take up the question.“We’re looking for a broader ruling from the high court that says all children in the United States should be allowed exemptions to childhood vaccinations,” Mr. Festa said, adding that allowing exemptions for medical but not religious reasons was “a major constitutional problem.”MaryJo Perry said that her path into advocacy began after her youngest son, now 20, experienced seizures following routine vaccination.Imani Khayyam for The New York TimesPreventing DeathsPublic health experts regard vaccination as a singular triumph. The World Health Organization says up to five million deaths worldwide are prevented each year by vaccines for diseases like diphtheria, tetanus, pertussis, influenza and measles. In the United States, measles alone once killed 400 to 500 people each year and whooping cough deaths numbered in the thousands, while polio left more than 15,000 paralyzed, according to the C.D.C.If vaccination rates dip much below 95 percent, public health experts warn, those diseases will become more than just a memory.“It’s a dangerous game we’re playing,” said Dr. Paul A. Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “If we eliminate school vaccine mandates, measles will be the first vaccine-preventable disease to come back, and it will come roaring back. Why would we want to put children in harm’s way again?”The Mississippi case offers a window into the political forces shaping these trends. The plaintiffs in the case included members of Mississippi Parents for Vaccine Rights, a group founded in 2012 by MaryJo Perry, who said in an interview that her path into advocacy began after her youngest son, now 20, experienced seizures following routine vaccination.Seizures are a rare occurrence after vaccination. A large-scale study of more than 265,000 children identified 383 who had vaccine-related seizures, or less than two-tenths of 1 percent. Nearly all children who have post-vaccination seizures recover completely.Ms. Perry said that while her son had not had ongoing issues, the experience was terrifying. She said her son’s pediatrician repeatedly requested a medical exemption from the state health department but was refused. (Dr. Edney said that Mississippi’s current practice was to grant a medical exemption if a doctor requested one.)“I felt like it was a nightmare, like I was being terrorized by my own government,” Ms. Perry said.“About 99 percent of our kindergartners have been fully vaccinated, and Mississippi has not seen a case of measles in over 30 years,” said Dr. Anita S. Henderson, a pediatrician in Hattiesburg, Miss.Imani Khayyam for The New York TimesYears of ActivismMississippi had a religious exemption until the state’s Supreme Court struck it down in 1979, reasoning that protecting Mississippi schoolchildren “against the horrors of crippling and death” from polio and other infectious diseases superseded religious claims. The state has had high childhood vaccination rates as a result.“For many, many years, it was one of the few things that Mississippi has done well,” said Dr. Anita S. Henderson, a pediatrician in Hattiesburg and a past president of the state’s chapter of the American Academy of Pediatrics. “About 99 percent of our kindergartners have been fully vaccinated, and Mississippi has not seen a case of measles in over 30 years.”Ms. Perry and members of her group tried for years to change the law. They marched with signs and empty strollers around the State Capitol and held lobbying days to push Mississippi’s Republican-controlled Legislature to add a “personal belief” exemption to state law. But the legislation never passed.In 2016, Ms. Perry met Del Bigtree, a former television producer who had partnered on a documentary with Andrew Wakefield, the British doctor behind the discredited theory that vaccines are linked to autism. Their film, “Vaxxed,” took aim at the drug industry and was a hit with Ms. Perry’s group. Mr. Bigtree later traveled to Mississippi to testify on behalf of legislation that the organization was supporting to expand vaccine exemptions.In an interview, Mr. Bigtree said the success of the film prompted him to found the Informed Consent Action Network. The group, based in Texas and known by the acronym ICAN, says its mission is to give people “the authority over your health choices and those of your children” and to put an end to “medical coercion.” It funded the Mississippi lawsuit, and tax filings show it spends millions of dollars on legal work.Del Bigtree founded the Informed Consent Action Network, which says its mission is to give people “the authority over your health choices and those of your children.”Desiree Rios for The New York TimesMr. Bigtree says his work is nonpartisan. But on Jan. 6, 2021, he addressed a “medical freedom” rally not far from the pro-Trump crowd that stormed the U.S. Capitol.“I would stand on the stage at the Democratic National Convention if they would allow me,” he said in the interview, adding: “I don’t want mandates. It’s a free country. Everybody should be able to make whatever choice they want.”But public health experts say that the purpose of vaccination is to protect entire communities and that making immunization a personal choice puts vulnerable people, including those who cannot get vaccinated for medical reasons, at risk. Last year, a measles outbreak in Ohio infected 85 children, nearly all of them unvaccinated. No one died, but 36 children were hospitalized.States have long had the legal authority to require vaccination as a condition of school enrollment. As far back as 1905, the Supreme Court ruled in Jacobson v. Massachusetts that a state had the right to “protect itself against an epidemic” by requiring citizens to be vaccinated against smallpox or pay a fine.But the coronavirus pandemic, and in particular the arrival of Justice Amy Coney Barrett on the Supreme Court, brought a “dramatic shift” in public health jurisprudence — especially in cases involving religious liberty, said Wendy E. Parmet, an expert in public health law at Northeastern University.Ms. Perry believes vaccine mandates are a gift to drugmakers.Audra Melton for The New York TimesA Legal VictoryThe Mississippi case was filed last year, and Dr. Edney, the state health officer, was one of the defendants. Ms. Perry was not a plaintiff; her children are grown. But she connected some of her members with Aaron Siri, a New York lawyer who handles much of ICAN’s legal work.During a hearing in April in Federal District Court in Gulfport, Paul Perkins, a Baptist pastor, testified that the state’s vaccination requirement prevented him from enrolling his own daughter in the Christian academy that he runs. Jeana Stanley, a doctor of physical therapy, and Brandi Renfroe, a court reporter, testified that even though they and their husbands worked in Mississippi and considered that state home, they had moved just across the border to Alabama so their unvaccinated children could attend school.“I put my trust in God for healing,” Dr. Stanley wrote in an affidavit, adding that she and her children avoided “physicians, medications (both over the counter and prescription) and vaccines.”The case put Dr. Edney and the Mississippi State Board of Health at odds with the state attorney general, Lynn Fitch, a Republican who argued that an existing religious freedom law required the state to offer religious exemptions.At the hearing in April, the judge, Halil Suleyman Ozerden, an appointee of President George W. Bush, ordered the state to begin accepting requests for religious exemptions, setting a mid-July deadline for Dr. Edney to set up a process for offering them.“Freedom wins again,” Mr. Siri wrote on Twitter.The judge made his ruling final in August, finding that Mississippi’s vaccination requirement had violated the constitutional rights of the plaintiffs, who he said had “sincerely held religious beliefs about vaccination.” Dr. Edney said he decided not to appeal. He said he feared that the case would go to the Supreme Court and that the state’s vaccination requirement would be struck down entirely.Instead, he said, the state is working to ensure that parents seeking exemptions have “deeply held” beliefs, including by requiring them to watch an educational video about “the millions of lives that have been saved and continue to be saved” by vaccination.Mr. Bigtree hailed the suit as a “landmark, historic case.” In the wake of its victory, his group trumpeted its support for similar legal challenges in other states.Ms. Perry said Mississippi Parents for Vaccine Rights was working to elect candidates who are “pro-medical freedom.” She said she saw the court ruling as the culmination of a decade of her hard work, coupled with a new political climate.“We’ve had many parents for years wanting to sue, and it was just not the right time,” she said. “Covid kind of set the stage in the judiciary for it to happen.”

Households may now order another four at-home tests, or eight if they have not placed an order since the program was revived in September.Just in time for the holiday season, the Biden administration is offering Americans a fresh round of free at-home coronavirus tests through the Postal Service.The administration revived the dormant program in September, announcing then that American households could order four free tests through a federal website, covidtests.gov. Beginning Monday, households may order an additional four tests — or eight tests if they had not ordered any in the previous round.Hospitalizations and deaths from Covid-19 are far below what they were during the worst stretches of the pandemic, which has claimed the lives of about 1.1 million people in the United States.Hospital admissions of patients with Covid ticked up this summer, but they began declining slightly in September and have held fairly steady in recent weeks. About 16,000 people were admitted to hospitals with the virus in the week that ended Nov. 11, according to the Centers for Disease Control and Prevention.Private insurers had previously been required to cover up to eight at-home tests per month, but that requirement ended in May with the expiration of the public health emergency for the coronavirus, making it harder for many Americans to get tests without footing the bill.Separately from the Postal Service program, the federal Department of Health and Human Services says it is providing more than four million tests per week to nursing homes, schools, community health centers and food banks.