Since Robert F. Kennedy Jr. took office, more than a year ago, I’ve been trying to understand the MAHA movement from the inside. I’ve sat in on MAHA Institute roundtables, roamed the conference halls of anti-vaccine gatherings, and talked with grassroots supporters across the country. They tell me their concerns about toxic chemicals and ultra-processed foods and the worrying rise in childhood chronic conditions. But when I share what I’m hearing with my colleagues in medicine and public health, many chide that engaging with MAHA is completely pointless. For them, the whole movement is nothing more than a subversive anti-vaccine, anti-science syndicate.

That assumption is wrong. MAHA is an opportunity, and one the public-health sector—academics, doctors, and leaders of advocacy groups—cannot afford to squander. Yes, MAHA’s anti-vax wing is very loud and litigious. But for many in the MAHA movement, their top issues lie elsewhere: environmental pollutants, the cost of health care, and a bone-deep conviction that health institutions have been captured by the industries they’re supposed to regulate. These are not fringe, unscientific concerns. They are concerns that millions of Americans have been angry about for decades, long before the MAHA label even existed. And they are concerns that many in public health share—if only they could see beyond that label, and make common cause.

MAHA’s greatest achievement to date is not policy but politics. It has shown that people are hungry for a movement that fights for their health visibly, loudly, and in plain language.

That’s why a movement just two years old draws support from four in 10 Americans, according to polling from KFF. MAHA supporters cite the cost of health care as their top priority, followed by restricting chemical additives in food and limiting corporate influence in food policy. At the same time, nearly eight in 10 MAHA supporters consider long-established vaccines such as those for measles, mumps, rubella, and polio safe, and only 4 percent cite vaccines as their reason for supporting the movement. That disconnect alone shows that MAHA is not synonymous with a solely anti-vaccine constituency. It represents and reflects something far larger.

[Tom Bartlett: The Trump administration casts out the ‘soul’ of MAHA]

When I sat down with Nancy Fuller, a lifelong Democrat and, more recently, a MAHA supporter, at a Christian coffeehouse in rural Ohio, she told me that what she likes about the movement is its willingness to try. Ever since her son was diagnosed with autism, decades ago, she has wondered whether environmental exposures or maybe vaccines were to blame, and she has spent years watching health institutions dismiss parents like her as ignorant or uninformed. In her view, public health steps up to the plate only when it already knows the outcome. Whether the issue is autism, AI, or something else, MAHA swings at anything and everything. That means more misses—and occasional hits—on issues everyone else had decided were too complicated, too compromised, or too politically inconvenient to touch. MAHA has never been shy about naming problems loudly and promising to take them on, even—and sometimes especially—when that means going after powerful corporations and other major institutions that others had learned to work around.

This is not a model public health should replicate wholesale. Many of MAHA’s swings have been genuinely reckless—pushing unproven and often dangerous wellness hacks, fabricating falsehoods about vaccine ingredients, and making claims that run counter to all credible evidence. But public health has been too cautious, setting the bar for evidence too high. On ultra-processed foods, environmental toxins, and drug prices, public health’s problem was rarely insufficient data. It was insufficient nerve.

Public health was not always so timid. The field was born as a potent political force, arguing for safer workplaces, cleaner water, better housing. Somewhere along the way, it shrank into the background, with many of its leaders preferring to see themselves as a technical and technocratic enterprise that operates outside the fray. The problem with invisible shields is that nobody knows they’re there. When the field was forced out front, as it was during the coronavirus pandemic, many Americans experienced public health not as a shield, but as a scold—speaking in acronyms and waving data-filled reports. In COVID-19’s shadow, trust in essential health agencies including the National Institutes of Health and the Food and Drug Administration has dropped to all-time lows. Fewer than half of Americans now have confidence in the CDC to carry out its core responsibilities, a nearly 40 percent drop from the start of the pandemic.

Now essentially out of power, the public-health community has been justifiably alarmed by what’s happened over the past year. The administration has prioritized politics over sound public-health policy in determining what’s approved by the FDA or what research is funded by the NIH. Severe staffing cuts at the CDC have weakened the response to health threats such as screwworm and Ebola. Many key leadership posts at the agency remain empty—the CDC has had a confirmed director for only 29 days of this administration. On immunizations, RFK Jr.’s Department of Health and Human Services altered the childhood-vaccine schedule in ways that reflect ideology, not epidemiology. It also overhauled the Advisory Committee on Immunization Practices, the expert body that has guided U.S. vaccine policy for decades. In response, the American Academy of Pediatrics distanced itself from the CDC and positioned itself as an independent, evidence-based guide for childhood vaccinations. More than two dozen states have already broken rank with the CDC’s recommendations. The result is a fracturing of vaccine guidance, a reflection of the fact that Americans no longer trust a single institutional voice on vaccines.

Public health has had some success at stopping the damage. In March, a federal judge sided with the AAP in its case against HHS, blocking the new vaccine schedule and ruling the ACIP overhaul a violation of proper scientific procedure. (HHS has appealed the ruling.) In effect, this overturned most federal actions on vaccines of the past year. Many in public health have treated that win as vindication. But court cases cannot substitute for winning in the court of public opinion.

One step to winning back the public’s trust would be a serious reassessment of the field’s financial relationships. The AAP’s own donor page lists at least 10 pharmaceutical companies as supporters, including six that manufacture vaccines the AAP recommends. And the six health organizations that sued HHS collectively received millions of dollars in donations from the pharmaceutical industry. Each organization maintains that these gifts are used to fund education or advocacy programming, not to influence policy recommendations or approvals.

[Nicholas Florko and Tom Bartlett: MAHA swing voters are an illusion]

In a low-trust environment, however, the appearance of a conflict is still bad, and RFK Jr. has made this entanglement the centerpiece of his critique. Public health’s refusal to acknowledge it has handed him an argument he doesn’t deserve to keep winning. If these societies can accept money from anyone, it’s worth asking why the donor pages are dominated by the very companies whose products they evaluate and recommend. If public health wants to save vaccine infrastructure in this country, it has to end these entanglements.

The distrust that fuels MAHA is far older than the movement, and it will not evaporate in three years. The conditions that allowed MAHA to flourish—the trust deficit, the corporate entanglements, the gap between research and community, the invisibility of public health in people’s daily lives—have been festering for decades.

Public health must recognize there is opportunity in entropy. The path forward for the field is simple, but requires public health to do something it has been reluctant to do: Show up. Visibly. Politically, but not in a partisan way. There are fights that are strongly supported by both sides, including air quality in neighborhoods sharing zip codes with industrial facilities, lead and toxins in the water kids are drinking, and the poor quality of the food Americans eat and its clear negative impact on our health. These are issues where public health can stand next to communities, name what is harming them, and fight like it means something. What MAHA understands—imperfectly and sometimes dishonestly—is that people do trust institutions, but not because those institutions have good data. They trust them because they feel like those institutions are on their side.