The unprecedented turmoil at the top U.S. health agencies, under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., is sure to have a long-term impact on the well-being of Americans. Although Kennedy’s mantra has been to “Make America Healthy Again,” the most visible changes he and his allies have made within the Department of Health and Human Services in 2025 appear, in practice, designed to do the opposite.

The consequences of Kennedy’s first year in office — marked by sweeping cuts in funding and personnel at the agencies under his purview, the erosion of expertise and the mainstreaming of anti-vaccine rhetoric into national policy — will unfold over years or even decades. However, several key metrics could serve as early indicators of how quickly Kennedy’s influence, combined with President Donald Trump’s broader agenda, will shape Americans’ health.

From the spread of preventable diseases to access to both established and emerging drugs and vaccines to health care coverage, here are a few things I’ll be paying attention to in 2026:

Kennedy faced his first significant test within days of his confirmation: a rapidly spreading measles outbreak in West Texas. Unfortunately, he failed the exam. He waffled for weeks, failing to forcefully encourage vaccination, while simultaneously promoting unproven treatments for the virus. Meanwhile, the Trump administration’s deep cuts to the Centers for Disease Control and Prevention left local health authorities struggling to contend with the outbreak.

By July, measles cases had reached 1,288, their highest level since the virus was declared eliminated in the U.S. in 2000. By late December, the number of cases had grown to 2,012, of which approximately 87% were associated with an ongoing outbreak. Cases have been reported in several states, and at least three unvaccinated people are reported to have died from the disease.

The situation has continued to deteriorate as we head into 2026, as evidenced by an accelerating outbreak in South Carolina that, by mid-December, had infected more than 135 people and sent hundreds more into quarantine. The question for 2026 seems to be not whether, but when, the U.S. will lose its measles elimination status — and how severe the consequences may become amid future outbreaks.

The measles outbreak was fueled by vulnerabilities in the vaccine safety net that helps keep everyone protected. Eliminated diseases remain eliminated only if enough people — typically around 95% of the population — are immunized. Data indicate that acceptance of routine childhood vaccines is softening, and the share of children entering kindergarten with all their shots has gradually declined over the past five years. During the same period, many more children received non-medical exemptions from required vaccinations.

The question now becomes how Kennedy’s influence over both public opinion and actual policy might amplify those twin trends. Last summer, he overhauled the influential CDC advisory panel that makes recommendations on the use of vaccines nationwide, appointing members who more closely align with his anti-vaccine views. The panel has since restricted the use of certain vaccines, most notably by revoking the longstanding advice that all newborns be vaccinated against hepatitis B. The group is also poised, under Trump’s direction, to review the entire childhood immunization schedule, raising concerns about rollbacks of other established protections.

Meanwhile, lawmakers, emboldened by Kennedy’s actions, have sought to pass laws that make it easier for parents to obtain exemptions that allow their children to forgo routine vaccinations. Kindergarten exemption data for this school year could provide our first indication of whether these efforts have significantly affected parents’ decision-making.

During the Biden administration, the number of uninsured Americans fell to record lows, largely due to the introduction of pandemic-era subsidies that made insurance purchased through the Affordable Care Act more affordable. The looming expiration of those tax credits at the end of this year led to months of congressional gridlock over whether and how to extend them. Democrats advocated extending them, while Republicans debated whether they should be preserved in a more limited form or discarded altogether.

Lawmakers failed to reach a consensus before Congress adjourned for the year. The expiration of the credits means millions of Americans will see their insurance premiums roughly double in January. Negotiations will continue after the holiday break, and if a deal is reached, health policy experts at KFF say the Trump administration could help consumers by making the subsidies retroactive to Jan. 1 and extending the sign-up deadline to allow enrollees to switch to more affordable plans.

The stakes are high: The number of Americans receiving coverage through ACA plans has more than doubled since 2020 to more than 24 million. Without the subsidies, some 4.2 million people are projected to forgo coverage.

Early numbers from the Centers for Medicare & Medicaid Services suggest that fewer new customers are enrolling in ACA plans, but they also indicate a slight increase in returning customers compared with this time in 2024. And, of course, the ultimate unknown is how many Americans will end up uninsured — and how that could affect the nation’s long-term health and strain its infrastructure.

U.S. consumers have long benefited from the country’s leadership in biomedical innovation, a position predicated on a gold-standard regulatory body that carefully evaluates scores of new drugs, vaccines and medical devices each year.

But that typically predictable approval process has been disrupted by turmoil and ever-shifting policies at the Food and Drug Administration. As FDA Commissioner Marty Makary puts existing vaccines and other long-used drugs under new scrutiny, there is reason to worry that the approval thresholds for newer ones could become unreasonably high.

At the same time, Makary is intent on speeding up new drug approvals. He is reportedly planning to reduce the number of late-stage studies required for FDA approval from two to one. He has also introduced a controversial “national priority review voucher,” which promises reviews within weeks for companies that align with Trump’s focus on affordability, domestic manufacturing, and unmet public health needs.

All of this is unfolding at a time of significant churn at the FDA, both at the leadership level and among the career scientists who review new products. The question for next year is whether the flow of new therapies can increase without compromising safety and efficacy — a difficult balance to strike.

These key health measures use real-time data to capture the immediate impact of a transformed HHS. But it is essential to ensure there is a full accounting of the many other areas — including opioid deaths, maternal mortality, and drug prices — that could be affected by the seismic shifts to our nation’s health infrastructure.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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I was one of the researchers in the well-known Stanford prison experiment in 1971, demonstrating the destructive dynamics that are generated when one group of people — randomly assigned as “guards” — is given near total power over a group of “prisoners.”

In six short days, inside a simulated prison environment, authoritarian forms of mistreatment emerged and numerous emotional breakdowns ensued among otherwise psychologically healthy college-student volunteers. In the decades since, I have studied these dynamics in real correctional settings: jails, prisons and immigration detention centers throughout the United States.

Among the things I have learned is that the damaging dynamics unleashed inside such places are not self-correcting. Quite the opposite. Absent transparency and accountability, dehumanization and degradation intensify. Indeed, if left unchecked, the destructive forces that are set in motion almost invariably lead to greater and greater levels of mistreatment.

Because they make up what Justice Anthony Kennedy years ago called a “hidden world of punishment,” what goes on inside these facilities largely escapes public awareness and scrutiny. Many of these sites operate outside the conventional bounds of the rule of law. Lawless institutions in particular do not merely tolerate mistreatment: They engender, normalize and amplify it.

A recent HBO documentary, “The Alabama Solution,” dramatically illustrates many of these forces at work. Based on a six-year investigation and contraband cellphone footage that courageous incarcerated men supplied from inside one of America’s most dangerous and dysfunctional prison systems, filmmakers Andrew Jarecki and Charlotte Kaufman give their audience a gut-wrenching view of something that few outsiders ever see: that hidden world of punishment laid bare, vividly depicting the depth of institutional cruelty and indifference to suffering that characterize many of our nation’s penal facilities.

The Alabama prison system on which the film focuses is one I know well. I was an expert witness in a federal lawsuit in which Judge Myron Thompson found the entire system to be unconstitutional. I spent many days in that role documenting the egregious living conditions inside the state’s prisons and interviewing prisoners about the neglect and mistreatment to which they were subjected. Remarkably, the system was so dangerously out of control that there were a number of days when my scheduled fact-finding missions had to be canceled because, as prison officials told me, they “could not guarantee my safety.” If they could not guarantee the safety of an expert witness with a court order to come inside, we should all wonder whether and how they could guarantee the safety of the 30,000 prisoners under their control. The new documentary provides all too chilling answers to that question.

The film also gives lie to a common stereotype that prisoners cannot be believed about the terrible realities they face in their daily life and regularly exaggerate the suffering and indignities they endure. In my experience, the opposite is true. If anything — perhaps because they do not want to fully relive the trauma or worry that skeptical outsiders will not believe them — they tend to understate what really goes on inside. As viewers of “The Alabama Solution” will see, the brutal reality is actually much worse than most people can imagine. And it is infinitely worse than the rosy accounts from many officials and politicians — who are themselves responsible for creating and maintaining these horrific places.

I wish that I could say that the egregious conditions and shocking treatment depicted in the film were limited to just one prison or prison system. The truth is that, although Alabama may be an outlier in some respects, scenes like those depicted in the film play out all too often in jails, prisons and detention facilities across the country. There are currently nearly 2 million people confined inside the nation’s bloated carceral system, which costs taxpayers more than $180 billion annually to maintain. Yet in far too many of these places — operating away from public view and meaningful legal regulation — callousness, cruelty and mistreatment prevail instead of rehabilitation, programming and treatment. Far too many people emerge from them traumatized by the experience, if they are fortunate enough to emerge at all.

Rather than reforming these institutions and minimizing their reach, federal and state governments are expanding their dehumanizing penal practices beyond the prison walls. We are daily witnessing the metastasizing of an increasingly lawless system of state-sanctioned oppression in society at large, one in which anonymous government actors operate unrestrained by due process safeguards, subjugating and terrorizing people with impunity — as has long been common inside prisons and jails. Only the restoration of transparency and the rule of law can reverse the perilous direction in which our country has been moving and shift the tide back toward justice and humanity.

Craig Haney, a professor of psychology at UC Santa Cruz, is the author of “Criminality in Context: A Psychological Framework for Criminal Justice Reform.” He wrote this column for the Los Angeles Times.

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A minority of Somalis have brought shame to our community

There is a Somali proverb that came to mind when reflecting on the bitter language that has been coming from President Trump recently: the barking hyena warns you, but the silent hyena harms you. In Somali wisdom, the quiet hyena is more dangerous than the loud one. The loud hyena is noisy so you know it is coming. Someone who tells you the truth, even if it hurts, is like a loud hyena, giving you a warning. I would argue that President Trump is a loud hyena, though his truth is mixed with untruth. His simplistic stereotyping was uncalled for, and it is not right to call any human being garbage.

But it is true that the Somalis involved in large-scale fraud should face the consequences of their poor choices. And it is true that we Somalis need to ask ourselves what role we may have played in becoming the target of such hostile criticism.

It’s time to stop blaming others for our wrong choices. Blaming is self-sabotage; it keeps us stuck in our problems and prevents us from taking steps toward solutions. It’s time to get rid of the victim mentality.

Many Somalis lived through decades of state collapse, with corrupt and violent conditions. We saw how rules were enforced unfairly and were used to harm rather than protect people. This experience with broken systems and injustice created rule skepticism. On top of that, moral obligations to one’s clan often outweighed obligations to obey formal laws. Sometimes clan loyalty helped people survive. But these strategies didn’t work in Somalia, and they won’t work here either.

Here in the United States, Somalis need to shift their mindset. The government does not exist for personal gain. Too often we approach a situation thinking: “What can I get?” But is it time to ask, “How can I contribute?” It is time to build up the communities that have welcomed us.

Research consistently shows that most immigrants are law-abiding and often commit less crime than native-born citizens. Yet a minority of Somalis who have failed to integrate have chosen to engage in fraud or corruption. They have brought shame to the community.

We need to remember that when we became citizens here, we took an oath of allegiance to the United States. Such allegiance involves fulfilling our civic duties and following the law in our new home.

Badeh Dualeh, St. Paul

 

Urging a transparent reassessment of the Summit Avenue bike trail

Our new mayor hit the ground running to deliver on her promise for transparency and hard work. As we celebrate her victory, I write to urge a transparent and objective reassessment of the planned Summit Avenue raised bicycle trail.

It is crucial that we expand the range of alternatives being considered and commit to a truly unbiased process — one where the outcome is not predetermined, but instead reflects a fair comparison of all options.

The assessment must include an honest evaluation of the real impact on our tree canopy,  and a thorough analysis of this impact should be a key element of the promised Environmental Assessment Worksheet (EAW). The assessment must also include an evaluation of safety to pedestrians and bicyclists in view of the fact that e-bicycles, which have become ubiquitous, pose new dangers.

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We also need a clear understanding of the true costs involved. Citizens deserve the chance to voice their opinions on whether a full reconstruction of Summit should be prioritized — especially given the City’s looming financial challenges — or if a more targeted approach, such as a mill and overlay for sections most in need, might be more prudent. Selective reconstruction should be considered where inspections show it is truly necessary.

If the planned Summit Avenue bicycle trail is genuinely the superior option on its merits, let’s allow the facts to speak for themselves. This way, we can resolve the debate once and for all and move forward as a community.

Anastasia (Tess) Galati, St. Paul

 

Mayor Carter’s graceful exit

Kudos to outgoing Mayor Melvin Carter for the way he is exiting office in the aftermath of his surprising re-election defeat.

The class  that he has displayed is a sharp contrast to the graceless behavior of the current occupant of the White House after he lost his bid to stay there four  years ago as well as that of one of his acolytes, Mike Lindell, now seeking the gubernatorial position here.

Both the president and the pillow maker could learn from the mayor how to handle the agony of defeat and provide an example to others, rather than the way they have tainted the democratic process as perpetrators of petulance.

Marshall H. Tanick, Minneapolis

 

Accountability?

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Letters: Both Tim Walz and Donald Trump do the Minnesota Somali community a grave disservice

The US Government Accountability Office reports that the federal government loses a billion dollars to fraud everyday – so why are only Democrats and Somali-Americans in Minnesota in trouble?

The GOP is all over Tim Walz, holding him responsible for the fraud that happened in Minnesota, when Donald Trump resides over the federal government that loses a billion dollars every day to fraud.

But this is par for the course when it comes to Trumpers and accountability. Trump is on tap saying he sexually assaults women, but then when women come forward and say Trump did sexually assault them, Trumpers go after the women and claim Trump is the victim.

Trumpers have a very bizarre approach to accountability.

Frank Erickson, Minneapolis

The U.S. economy has been marked this year by the paradox of a rising stock market but a slowing labor market. Could the explanation be a productivity boom, led in part by artificial intelligence? That seems possible given last month’s report that the economy grew a robust 4.3% in the third quarter.

The report, delayed by the government shutdown, came in well above most forecasts. Consumer confidence is down in surveys, but you wouldn’t know it from the healthy 2.4 percentage-point contribution to third quarter GDP. Healthcare, prescription drugs and international travel were leading contributors, with healthcare accounting for a third of the increase. Is this an Ozempic boom?

Airlines have reported that wealthier customers are traveling abroad more, and a buoyant stock market lifted by AI may make them feel richer. If your stock portfolio is up 20% over the year, why not holiday in Rome?

One concern is that spending is uneven, with many companies reporting a pullback by lower- and middle-income consumers. General Mills said last month that consumers earning less than $100,000 a year are buying more food at price promotions. Chipotle in October reported a slowdown in spending among younger and less affluent customers.

Another concern is inflation. The core personal consumption expenditure price index (less food and energy) rose 2.9% in the third quarter, versus 2.6% in the second. Yet disposable personal income increased only 2.8% and the savings rate fell to 4.2%. People aren’t going to feel better about the economy until their incomes keep up with rising prices.

An increase in net exports supplied 1.6 percentage points to growth. Much of this owes to a decline in imports, following the import boom early in the year as businesses tried to front-run tariffs. A decline in imports isn’t healthy if it means higher prices for consumers or U.S. businesses that become less competitive because they pay more for components. Business investment in equipment continued its healthy growth (AI?), though overall private investment was down owing to declines in residential housing and business structures.

Trumponomics boils down to a bet that the pro-growth impact of deregulation and tax reduction can offset the damage from tariffs, which are tax increases. Imagine how well the economy would be doing without tariffs.

— The Wall Street Journal

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