America is dismantling its institutional immune system

Human bodies survive because immune systems perform three tasks: detect threats, mobilise a response and remember what has caused harm before. Modern societies have an institutional equivalent.

Disease surveillance identifies unusual signals. Public health agencies coordinate responses, while vaccination, regulation and universal access help reduce exposure and vulnerability. Research institutions preserve memory, allowing each generation to benefit from the last.

The politics of systematic dismantling in the United States (US) is now weakening all three functions simultaneously.

The latest breach came on 10 August, when President Donald Trump signed an executive order recasting childhood vaccination. It narrows the vaccines recommended for every child, calls for measles, mumps and rubella to be given as individual products once available, encourages separate appointments for each vaccine, and urges states to reconsider school vaccination requirements.

The order does not ban vaccines. But it gives presidential authority to the suggestion that the way vaccines work now may be excessive or unsafe. That message arrives at the very time when US vaccination coverage is falling and measles is resurgent.

For clinicians, however, vaccination is only one component in a panoply of worries about the systems of care being dismantled.

Losing the capacity to detect

The first function of an institutional immune system is surveillance. Detection requires epidemiologists, laboratories, data systems, inspectors and trusted relationships extending from local clinics to national agencies and international networks.

The Trump administration has restructured the Department of Health and Human Services and reduced staffing across the Centers for Disease Control and Prevention, Food and Drug Administration and National Institutes of Health.

The US has also withdrawn from the World Health Organization. This weakens access to international intelligence about influenza strains, emerging pathogens and outbreaks.

A cluster of infections will be recognised late. Food contamination will take longer to trace. An anomalous laboratory result will not be connected to similar cases elsewhere.

Institutional failure often appears uneventful. Until the day early detection is needed.

Weakening the response

For all that, detection matters only if a system can respond. Vaccination creates population-level protection. Environmental rules prevent exposure rather than treating its consequences. Hospitals and primary care services provide the response capacity when prevention fails.

Each US layer is being weakened.

The Congressional Budget Office estimates that enacted Medicaid provisions (care for the least well-off) will leave 7.8 million more Americans uninsured by 2034. Work-reporting requirements and more frequent eligibility checks mean many people may lose coverage through administrative failure despite remaining eligible.

American clinicians know what follows. Antihypertensive and diabetes medicines are interrupted. Cancer is diagnosed later. Mental health and opioid-dependence treatment become discontinuous. Emergency departments inherit problems that primary care could have managed earlier.

These policies transfer costs from prevention to patients, clinicians and hospitals.

Erasing institutional memory

The adaptive immune system remembers previous threats. Institutions do the same through experienced staff, longitudinal datasets, research programs, professional norms and trusted procedures.

When scientific teams are dispersed, research grants cancelled and advisory processes politicised, more is lost than current output. The system loses its ability to remember why protections were created.

This is the reverse prevention paradox. Successful prevention makes its own value difficult to see. Measles vaccination makes measles unfamiliar. Clean-air regulation makes cleaner air appear natural. Surveillance makes contained outbreaks look insignificant. International health programs make deaths that never occurred politically invisible.

Success can therefore be reinterpreted as evidence that the protection was unnecessary.

The greatest toll may occur elsewhere

The most severe immune failure may be outside America. Disruption to the US Agency for International Development (USAID), the President’s Emergency Plan for AIDS Relief (PEPFAR) and related programs affects international HIV treatment, tuberculosis diagnosis, malaria control, childhood vaccination, nutrition and maternal care.

A Lancet HIV modelling study estimated that a major international funding contraction could produce 4.4-10.8 million additional HIV infections and 770,000-2.93 million deaths by 2030.

These are scenarios, not precise estimates. Other donors will replace some services. But health infrastructure cannot be switched off and restarted like a light. Supply chains fracture, experienced workers leave and untreated infections generate further transmission.

Why Australia should pay attention

Australia is not insulated by geography. Contagion is a global problem not a local issue: and it does not respect borders. We depend on other countries’ surveillance capability, functioning vaccine markets, scientific exchange and rapid information sharing.

Institutional immunity is easier to weaken than rebuild. Fragmentation, short funding cycles, curtailed budgets, politicised expertise and rejection of elites can gradually reduce resilience without producing an immediate crisis.

Indeed, it is not just infections that can travel internationally. So can political ideologies about dismantling government-led systems, replacing vaccine schedules and spinning vaccine hesitancy.

Australia should protect the national institutions that detect weak signals, maintain vaccine confidence, sustain universal healthcare access and preserve scientific memory. We should also strengthen regional surveillance and health partnerships with others as American leadership retreats.

The newly formed Australian Centre for Disease Control, a long time in the making, now looks like an essential, timely piece of national health infrastructure. It is not a cost. It is an investment in Australia’s future health and wellbeing. 

America may discover the value of its institutional immune system only when it confronts the next serious threat without it. Australia seems to have learned that lesson. 

We should remain vigilant and continuously nurture our precious healthcare capabilities. We should also be prepared, in a chaotic world, for any eventuality.

Professor Jeffrey Braithwaite PhD is the Founding Director of the Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University.