Vaccines and immunisation

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    Second child dies of measles in Texas amid rising outbreak

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    A second child with measles has died in Texas amid a steadily growing outbreak that has infected nearly 500 people in that state alone.The US health and human services department confirmed the death to NBC late Saturday, though the agency insisted exactly why the child died remained under investigation. On Sunday, a spokesperson for the UMC Health System in Lubbock, Texas, said that the child had been hospitalized before dying and was “receiving treatment for complications of measles” – which is easily preventable through vaccination.The family of the child in question had chosen to not get the minor vaccinated against the illness.Michael Board, a news reporter at Texas’s WOAI radio station, wrote on Sunday that official word from the state’s health and human services department was that the child died from “measles pulmonary failure” while having had no underlying conditions.Citing records it had obtained, the New York Times described the child as an eight-year-old girl.That marked the second time a child with measles had died since 26 February. The first was a six-year-old girl – also hospitalized in Lubbock – whose parents had not had her vaccinated.The Trump administration’s health secretary, Robert F Kennedy Jr, on Sunday identified the two children to have died with measles as Kayley Fehr and Daisy Hildebrand. Daisy was the one who died more recently, and Kennedy said in a statement that he traveled to her funeral on Sunday to be with her family as well as the community in its “moment of grief”.Kennedy for years has baselessly sowed doubt about vaccine safety and efficacy. He sparked alarm in March among those concerned by the US’s measles outbreak when he backed vitamins to treat the illness and stopped short of endorsing protective vaccines, which he minimized as merely a “personal choice” rather than a safety measure that long ago was proven effective.In his statement on Sunday, Kennedy said: “The most effective way to prevent the spread of measles is the MMR vaccine,” which also provides protection against mumps and rubella. He also said he would send a team to support Texas’s local- and state-level responses to the ongoing measles outbreak.A third US person to have died after contracting measles was an unvaccinated person in Lea county, New Mexico, officials in that state announced in early March.Dr Peter Marks, who recently resigned as the Food and Drug Administration’s vaccine while attributing that decision to Kennedy’s “misinformation and lies”, blamed the US health secretary and his staff for the death of the child being buried on Sunday.“This is the epitome of an absolute needless death,” Marks said Sunday during an interview with the Associated Press. “These kids should get vaccinated – that’s how you prevent people from dying of measles.”Marks also told the AP that he had warned US senators that the country would endure more measles-related deaths if the Trump administration did not more aggressively respond to the outbreak. The Senate health committee has called Kennedy to testify before the group on Thursday.One of that committee’s members is the Louisiana Republican and medical doctor Bill Cassidy, who frequently speaks about the importance of getting vaccinates against diseases but joined his Senate colleagues in voting to confirm Kennedy as the US health secretary.Cassidy on Sunday published a statement saying: “Everyone should be vaccinated.”There is “no benefit to getting measles”, Cassidy’s statement added. “Top health officials should say so unequivocally [before] another child dies.”Measles, which is caused by a highly contagious, airborne virus that spreads easily when an infected person breathes, sneezes or coughs, had been declared eliminated from the US in 2000. But the virus has recently been spreading in undervaccinated communities, with Texas and New Mexico standing among five states with active outbreaks – which is defined as three or more cases.The other states are Kansas, Ohio and Oklahoma. Collectively, as of Friday, the US had surpassed 600 measles cases so far this year – more than double the number it recorded in all of 2024. Health officials and experts have said that they expect the measles outbreak to go on for several more months at least – if not for about a year.Texas alone was reporting 481 cases across 19 counties as of Friday, most of them in the western region of the state. It registered 59 previously unreported cases between Tuesday and Friday. There were also 14 new hospitalizations, for a total of 56 throughout the outbreak.More than 65% of Texas’s measles cases are in Gaines county, which has a population of just under 23,000, and was where the virus started spreading in a tightly knit, undervaccinated Mennonite community.Gaines has logged 315 cases – in just over 1% of the county’s residents – since late January.The Associated Press contributed reporting More

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      Mehmet Oz confirmed by US Senate to lead Medicare and Medicaid

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      Former heart surgeon and TV pitchman Dr Mehmet Oz was confirmed on Thursday to lead the Centers for Medicare and Medicaid Services (CMS).Oz became the agency’s administrator in a party-line 53-45 vote.The 64-year-old will manage health insurance programs for roughly half the country, with oversight of Medicare, Medicaid and Affordable Care Act coverage. He steps into the new role as Congress is debating cuts to the Medicaid program, which provides coverage to millions of poor and disabled Americans.Oz has not said yet whether he would oppose such cuts to the government-funded program, instead offering a vision of promoting healthier lifestyles, integrating artificial intelligence and telehealth into the system, and rethinking rural healthcare delivery.During a hearing last month, he told senators that he did favor work requirements for Medicaid recipients, but that paperwork shouldn’t be used to reaffirm that they are working or to block people from staying enrolled.Oz, who worked for years as a respected heart surgeon at Columbia University, also noted that doctors dislike Medicaid for its relatively low payments and some don’t want to take those patients.He said that when Medicaid eligibility was expanded without improving resources for doctors, that made care options even thinner for the program’s core patients, which include children, pregnant people and people with disabilities.“We have to make some important decisions to improve the quality of care,” he said.Oz has formed a close relationship with his new boss, Robert F Kennedy Jr. He’s hosted the health secretary and his inner circle regularly at his home in Florida. He’s leaned into Kennedy’s campaign to “make America healthy again” (Maha), an effort to redesign the nation’s food supply, reject vaccine mandates and cast doubt on some long-established scientific research.The former TV show host talks often about the importance of a healthy diet, aligning closely with Kennedy’s views.skip past newsletter promotionafter newsletter promotionWhile Oz has faced some criticism for promoting unproven vitamin supplements and holistic treatments – staples of the “Maha movement” – he’s regularly encouraged Americans to get vaccinated.Oz will take over the CMS days after the agency was spared from the type of deep cuts that Kennedy ordered at other public health agencies. Thousands of staffers at the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes for Health are out of a job after mass layoffs that started on Tuesday.The CMS is expected to lose about 300 staffers, including those who worked on minority health and to shrink the cost of healthcare delivery. More

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      ‘The goal is to disassemble public health’: experts warn against US turn to vaccine skepticism

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      As vaccine hesitancy increases in the US, isolated, tight-knit and religious communities have frequently been at the center of high-profile outbreaks.Such is the case in west Texas, where a rural community is the center of an expanding measles outbreak that has already claimed the lives of two Americans – the first deaths from the disease in nearly a decade.However, as the conspiracy theories of Maga conservatism marry the bugbears of the US health secretary and vaccine skeptic Robert F Kennedy Jr, the one-time fringe view of vaccines has become increasingly mainstream – with activists in right-leaning population centers taking lessons learned from the Covid-19 pandemic into the realm of childhood inoculations.One need look no further than Sarasota, Florida, for a full-throated political denunciation.“Generally, people are weak, lazy,” said Vic Mellor, an activist based near Sarasota, and a close ally of former Trump national security adviser Michael Flynn.Mellor owns the We the People Health and Wellness Center in nearby Venice. Mellor, in a shirt that shouts “VIOLENCE MIGHT BE THE ANSWER”, is a self-professed attendee of the January 6 insurrection at the US Capitol.“And that lazy part just makes them ignorant … Covid has proven that obviously this is true. I mean, all the facts are starting to come out on Covid now – that it was a hoax. That is just an extension of where this hoax began decades earlier with the vaccines, OK? This is all a money grab, this is all a power grab.”The pandemic was real, and it started Mellor down the road of questioning vaccines. Where he once opposed only the Covid-19 shots, he now opposes vaccines entirely – arguing they harm children despite experts on vaccines considering them one of mankind’s greatest medical achievements.“This is not an isolated, rural, religious community, which I think is what a lot of people associate with an anti-vaccine mentality,” said Kathryn Olivarius, the author of Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom, and a historian of disease at Stanford University. “This is in the heart of everything.”Sarasota has become a proving ground for the Maga right. Among nail salons, mom-and-pop Cuban restaurants and roadside motels lining US 41, known locally as the Tamiami Trail, a visitor can find the gates of New College. This was once a public university prized for its progressive liberal arts education. Now it is part of the new conservative experiment in remaking higher education led by activists aligned with Donald Trump and the Republican Florida governor, Ron DeSantis.Along the same road is the Sarasota memorial hospital, an aberration in American healthcare – it is publicly owned with open board elections. The normally sleepy election became contentious when insurgent “health freedom” candidates, supported in part by Mellor, entered the race. Three won seats on the nine-member board in 2022.Even the name of this stretch of sun-bleached asphalt is up for debate. This year, a state Republican lawmaker – who has also introduced bills to limit vaccine requirements – briefly proposed changing its name to the “Gulf of America Trail” – a nod to Trump’s renaming of the Gulf of Mexico.Arguably the most salient artifact of this activism in Sarasota is the least visible: vaccination rates against measles.Measles vaccination rates for kindergarteners have plummeted over the last two decades – from 97% in 2004 to 84% in 2023, according to state health records. Sarasota is roughly on par with the vaccination rates in rural Gaines county, Texas – the center of the ongoing measles outbreak that sickened 279 people in in that state alone. Notably, both Gaines county and Sarasota have large home-schooling communities, meaning vaccination rates could in fact be lower.It is well known in research circles that right-leaning states across the US south and west have worse health metrics – from obesity to violence to diseases such as diabetes. That reality was supercharged during the pandemic; as vaccine mandates became a fixation on the right, Republican-leaning voters became more skeptical of vaccines. In turn, places with politically conservative leaders experienced more Covid-19 deaths and greater stress on hospitals.Measles is one of the most contagious diseases known to medicine. At least 95% of the population needs to be vaccinated to prevent outbreaks of the disease. But despite a supremely effective vaccine that eliminated the disease from the US in 2000, vaccine hesitancy has increasingly taken hold.skip past newsletter promotionafter newsletter promotionConservative activism alone can’t be blamed for declining measles vaccination rates. The measles vaccine in particular has been subject to a sustained firehose of misinformation stemming from a fraudulent paper linking the vaccine to autism in 1999. For years, this misinformation was largely nonpartisan. And Florida’s anti-vaccine movement was active even before the pandemic – with a vocal contingent of parents arguing against strengthening school vaccine standards in 2019.What appears new in Sarasota is how local conservative activists have brought opposition to vaccines into the heart of their philosophy. By Mellor’s telling, he and a loosely affiliated group of Maga activists began to adopt anti-vaccine beliefs as the pandemic wore on – helping organize major health protests in the area in recent years, such as mask mandate opt-outs and the “health freedom” campaign for hospital board seats.Mellor said his nearby property, the Hollow, was a gathering place during the pandemic (it is also a part-time gun range). He cites ivermectin, an anti-parasitic drug that became a fascination of the right, as the reason “we didn’t lose people at all” during the height of the pandemic. Available clinical evidence shows it is not effective against Covid-19.Kennedy has fit neatly into this realignment. He enjoys trust ratings among Republicans nearly as high as Trump, according to polling from the health-focused Kaiser Family Foundation. Kennedy has already spread dubious information about measles vaccines in public statements (notably: from a Steak ’n Shake in Florida) – a response one vaccine expert said “couldn’t be worse”.“While children are in the hospital suffering severe measles pneumonia, struggling to breathe, [Kennedy] stands up in front of the American public and says measles vaccines kill people every year and that it causes blindness and deafness,” said Dr Paul Offit, the director of the Vaccine Education Center and an attending physician in the division of infectious diseases at the Children’s Hospital of Philadelphia. Severe side effects from the vaccine are possible, but they are much rarer than disability and death from measles.“This is what happens when you have a virulent anti-vaccine activist, a science denialist, as the head of the most important public health agency in the United States,” said Offit. “He should either be quiet or stand down.”The same poll found trust in public health agencies has fallen precipitously amid Republican attacks. More than a quarter of Republican parents report delaying childhood vaccines, the poll found, a rate that has more than doubled since 2022. There is no analogous trend among Democratic parents. Despite how claims espoused by vaccine skeptics can be easily refuted, their power has not been undercut.“The anti-vaccine business is big business,” said Offit, pointing to the myriad unproven “treatments” offered by promoters of vaccine misinformation, some of which are offered at Mellor’s We the People health center. “We have been taken over by a foreign country, and the goal of that foreign country is to disassemble public health.”The misery of measles did not take long to appear in Texas – measles-induced pneumonia has already led pediatricians to intubate children, including at least one baby, according to the Associated Press. About one to three people out of 1,000 who are infected by measles die from the infection, and one in 1,000 suffer severe brain swelling called encephalitis, which can lead to blindness, deafness and developmental delays.“We actually don’t have the perspective people in the past had on these diseases,” Olivarius. “I have spent many, many, many years reading letters and missives from parents who are petrified of what’s going to happen to their children” if there are outbreaks of yellow fever, polio or measles, Olivarius said about diseases now largely confined to history – thanks to vaccines.“The lesson from history is these are not mild ailments,” she said. “These are diseases that have killed hundreds of millions of people – and quite horribly too.” More

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      ‘It’s back to drug rationing’: the end of HIV was in sight. Then came the cuts

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      This year the world should have been “talking about the virtual elimination of HIV” in the near future. “Within five years,” says Prof Sharon Lewin, a leading researcher in the field. “Now that’s all very uncertain.”Scientific advances had allowed doctors and campaigners to feel optimistic that the end of HIV as a public health threat was just around the corner.Then came the Trump administration’s abrupt cuts to US aid funding. Now the picture is one of a return to the drugs rationing of decades ago, and of rising infections and deaths.But experts are also talking about building a new approach that would make health services, particularly those in sub-Saharan Africa, less vulnerable to the whims of a foreign power.The US has cancelled 83% of its foreign aid contracts and dismantled USAid, the agency responsible for coordinating most of them.Many fell under the President’s Emergency Plan for Aids Relief (Pepfar) programme, which has been the backbone of global efforts to tackle HIV and Aids, investing more than $110bn (£85bn) since it was founded in 2003 and credited with saving 26 million lives and preventing millions more new infections. In some African countries it covered almost all HIV spending.View image in fullscreenThere is a risk, says Lewin, director of Melbourne University’s Institute for Infection and Immunity and past president of the International Aids Society, of “dramatic increases in infections, dramatic increases in death and a real loss of decades of advances”.There is no official public list of which contracts have been cancelled, and which remain. It appears that virtually no HIV-prevention programmes funded by the US are still in operation, save a handful principally providing drugs to stop pregnant women passing on the infection to their babies. Countries report disruption to the most basic measures, such as condom distribution.Some treatment programmes have been spared, but not those whose focus conflicted with the Trump administration’s war on “gender ideology” or diversity, equity and inclusion (DEI), such as those working with transgender communities. Doctors, nurses and other healthcare workers have been laid off, while worried patients are hoarding drugs or stretching supplies, according to UNAids surveillance. UNAids itself has lost more than half of its funding.Even programmes that have survived the cull have faced turmoil since February, with instructions to stop work rescinded but with no certainty that funding will continue.View image in fullscreenIn only one example, the Elizabeth Glaser Paediatric Aids Foundation says it has had to halt HIV treatment for 85,000 people in Eswatini, including more than 2,000 children, and tests for thousands of pregnant women and babies to prevent transmission and begin life-saving medication.Access to drugs represents an “immediate crisis”, Lewin says. “If people with HIV stop the medications, then not only do they get sick themselves, which is tragic, but they also then become infectious to others.”As clinics on the frontline of treating the disease scrabble to secure access to basic drugs, scientists at this month’s Conference on Retroviruses and Opportunistic Infections in San Francisco were hearing that HIV might soon be preventable with a once-a-year injection.The drug lenacapavir was already generating huge excitement in the field, after trial results showed that a six-monthly jab could prevent HIV. New results from the manufacturer Gilead suggest that a tweak to the formula and how it is given could see its protective effects last even longer.Nevertheless, Lewin says, the mood at the meeting, packed with many of the world’s leading HIV specialists, was “dire”.As well as programme cancellations, there are “huge concerns around science and what’s going to happen to the [US] National Institutes of Health, [whose] funding of science has been so significant on every level”, she says.Some scientists in receipt of US funding have been told to remove their names from DEI-linked research, she says, even though DEI is fundamental to the HIV response.View image in fullscreen“I don’t mean that in a sort of touchy-feely way, I mean that’s what we need to do: you need to actually get those treatments to these diverse communities.”In 2022, 55% of all new HIV infections were within “key populations”, such as gay men, other men who have sex with men, sex workers, transgender people, prisoners and people who inject drugs.Prof Linda-Gail Bekker, of South Africa’s Desmond Tutu Health Foundation, has seen US funding for three trials of potential HIV vaccines involving eight countries cancelled and only reinstated after an appeal to the US supreme court.“We’re running around like chickens without heads to at least get one going, because the vaccines are sitting in the fridge and will expire,” she says.She led the lenacapavir trial that showed it offered 100% protection to young women in sub-Saharan Africa, but now worries about HIV/Aids prevention “falling off the radar completely”.The global community had been making headway towards the United Nations’ goal of ending Aids by 2030, she says, with a five-year plan to use “amazing new innovative tools and scale them up”, which would have led to “less dependence on foreign aid and more self-reliance” as new infections fell and attention shifted to maintaining treatment for people with HIV.“All of that is hugely at risk now because, without these funds, our governments will have to step up but they will concentrate on treatment,” she says. “We know they will do that, because that is what we did for the first 30 years.”Efforts to control Aids were entering “the last mile”, which was always likely to be more expensive, she says. “The people who were happy to come into health facilities, they would have come into health facilities.”It would be difficult to rely on government funding to reach the remaining groups, she says, not only because of fewer resources but also because in some countries it means targeting groups whose existence is illegal and unrecognised, such as sex workers or sexual minorities, and young girls may be reluctant to use government clinics if they are not supposed to be sexually active.“I feel like the odds are very stacked against us,” says Bekker, adding: “We’re obviously going to have to re-programme ourselves [and] formulate a different plan.”Pepfar had pledged funding to the Global Fund to Fight Aids, Tuberculosis and Malaria, to deploy 10m doses of lenacapavir in low-income countries. While the Global Fund has promised to maintain its commitment, it might receive fewer than the planned number of doses, Bekker fears.“Six months ago, I was saying the best thing we can do with lenacapavir is offer it to everybody in a choice environment. [Now] I think we’re gonna have to say who needs [injectable] prep,” she says, “and the rest have to do the best they can.“How do we make that decision? And what does that look like? It is back to sort of rationing.“When we started ARVs [antiretroviral drugs] way back in 2000,” Bekker recalls, “you would go, ‘you get treatment; you don’t, you don’t, you don’t’.“It feels terrible … but you have to get over that. You have to say it will be infection-saving for some people. And we’ve got to make it count.”View image in fullscreenFor Beatriz Grinsztejn, president of the International Aids Society, the disruption is critical and threatens many vulnerable people. But, she adds, it could present “an important opportunity for ownership – otherwise we are always left in the hands of others”.She worries about the impact of cuts to funding on younger scientists, with their potential loss from the research field “a major threat for the next generation”. But, she adds, the HIV community is “powerful and very resilient”.There have already been calls for new ways of doing things. It is “time for African leadership”, members of the African-led HIV Control Working Group write in the Lancet Global Health. There are now plans for Nigeria to produce HIV drugs and tests domestically.Christine Stegling, deputy director of UNAids, says it began “a concerted effort” last year to develop plans with countries about how their HIV programmes could become more sustainable domestically “but with a longer timeframe … now we are trying to do some kind of fast-tracking”.Governments are determined, she says, but it will require fiscal changes either in taxation or by restructuring debt.The goal of ending Aids by 2030 is still achievable, Stegling believes. “I think we have a very short window of opportunity now, in the next two, three months, to continue telling people that we can do it.“I keep on reminding people, ‘look, we need to get back to that same energy that we had when people were telling us treatment can’t be available in the global south, right?’ And we didn’t accept it. We made it happen.“We have national governments now who are also very adamant, because they can see what can happen, and they want to make it happen for their own populations.” More

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      JD Vance and those threats from within | Letters

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      Among the justified furore around America’s new position in the world, one part at least triggers a bit of nostalgia (JD Vance stuns Munich conference with blistering attack on Europe’s leaders, 14 February). JD Vance’s description of the “threat from within” brings back memories of Margaret Thatcher’s designation of those who disagreed with her as “the enemy within”. I still have a badge with that somewhere. Maybe it’s time I dusted it off.Steve TownsleyCowbridge, Vale of Glamorgan As JD Vance lectures European leaders about freedom of speech, Louisiana is banning health officials from promoting vaccinations and libraries across the US are having to purge their shelves of any books that make mention of subjects that Republicans dislike. No hypocrisy there, then?Tony GreenIpswich, Suffolk Britain thought it had a special relationship with the US. Seems we got dumped on Valentine’s Day.Emma TaitLondon Your report (‘Guess who’s back?’: the inside story of Nigel Farage’s quest for power, 15 February) confirmed what I already suspected: Reform is basically a party run by millionaires, for the benefit of millionaires, with a good dollop of nativism added to the mix.Alan PavelinChislehurst, Kent Re remarks in school reports (Letters, 14 February), my favourite is from around 1971, courtesy of a great history teacher: “Intelligent answers, a mastery of the facts would help.” I’m sure CP Scott would have agreed with him.Kevin McGillPrestwood, Buckinghamshire More

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      The Guardian view on supporting vaccines: humans can work miracles – so why wouldn’t we? | Editorial

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      It is easy to become so used to scientific and social advances that we take them for granted. But sometimes we should pause to celebrate – to feel genuine awe – at the wonders that we have seen. Amid all the wars, the disasters and the crimes of the last half century, we have witnessed nothing short of a miracle.Vaccination, in addition to clean water, sanitation and improved nutrition, has been one of the greatest contributors to global health. It is responsible for much of the astounding fall in child mortality, which plummeted by 59% between 1990 and 2022. It has saved more than 150 million lives, mostly of infants, since the Expanded Programme on Immunisation was launched by the World Health Organization in 1974. Initially designed to protect children against diseases including smallpox, tuberculosis, polio and measles, the scheme has since been extended to cover more pathogens. Then, in 2000, came the Global Alliance for Vaccines and Immunisation (Gavi), a public-private organisation that provides financial and technical support for vaccination in poorer countries and negotiates with manufacturers to lower costs.The results have been remarkable. Prevention is better – and cheaper and easier – than cure. Smallpox was declared eradicated in 1980. Almost all the world is now polio-free. Cases of many other diseases have been slashed. Much more can be done: an estimated 5 million children have been protected against malaria since routine vaccinations were launched a year ago. And from a scientific perspective, we are entering a golden age of vaccines.Yet this is a dangerous moment in other ways. The climate crisis is spurring disease outbreaks. Conflict has dramatically increased the number of unprotected children. Vaccine scepticism has grown. Now cuts to funding threaten to turn the clock back. The trashing of USAid will hinder delivery and has halted a groundbreaking programme to create new malaria vaccines. Robert F Kennedy Jr – who once claimed that “no vaccine is safe and effective” and who tried to persuade the US government to rescind authorisation for the coronavirus vaccine at the height of the pandemic – was confirmed this week as health secretary.Now the UK, one of Gavi’s founding donors and the country which has given most to its core programme, is considering a significant cut to its support. This would be a grave error. While some aspects of Gavi’s approach have faced sensible scrutiny in the past, it has vaccinated over 1 billion children and done so cost-effectively: 97 pence in every pound it is given goes on vaccine programmes. Its success is also evident in the number of countries which have graduated from being beneficiaries to paying their own way; some, including Indonesia, are becoming donors in turn. And Gavi’s stockpiles help to keep people safe in wealthier countries too, as well as ensuring that poorer nations are healthier and more stable.For all these reasons, Gavi has long enjoyed bipartisan support in the UK, which has given it more than £2bn over the last four years. Now, more than ever, its funding must be sustained. The world is full of apparently intractable conflicts and complex moral dilemmas. Few decisions are truly simple for governments. But this one is a no-brainer. It should astonish us that we can so easily save lives. It should be self-evident that we must continue to seize that opportunity. More

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      Robert F Kennedy Jr has mass appeal despite his extreme ideas. This theory explains why | Darren Loucaides

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      “Back at home in the United States, the newspapers are saying that I came here today to speak to about 5,000 Nazis,” Robert F Kennedy Jr told a large crowd in Berlin. Estimated at 38,000 people, the crowd was a mix of hippies, anti-war types, Green party voters and anti-vaxxers, rubbing shoulders with a smattering of skinheads. It was late August 2020 and a group called Querdenken had rallied this motley crew together in defiance of Covid-19 restrictions.“Governments love pandemics,” Kennedy said. “They love pandemics for the same reason they love war – it gives them the ability to impose controls that the population would otherwise never accept.”Last month, in Senate confirmation hearings for his appointment as the US secretary of health and human services, Kennedy was questioned on having previously compared the Center for Disease Control’s work to that of “Nazi death camps”, calling Covid-19 a bioweapon genetically engineered to target black and white people while sparing Ashkenazi Jews and Chinese people, and blaming school shootings on antidepressants. “He has made it his life’s work to sow doubt and discourage parents from getting their kids life-saving vaccines,” said the Democratic senator Ron Wyden. “It has been lucrative for him and put him on the verge of immense power.”Kennedy has gone from courting the conspiratorial fringes of the internet to the halls of the White House. He could be confirmed within days. With hindsight, the Berlin speech he gave five years ago was the moment a dangerous new political phenomenon went global. It’s called diagonalism.Coined by the political theorist William Callison and the historian Quinn Slobodian, diagonalism describes the union of disparate groups across the political spectrum around a suspicion of all power being involved in conspiracy. Diagonal movements see big tech, big pharma, banks, climate science and traditional media as accomplices in totalitarianism, evidenced by Covid mandates through to innocuous intergovernmental proposals such as the “great reset” and 15-minute cities.For diagonalists, the control of electoral processes by powerful interests means that governments are de facto illegitimate. And so they advocate for distributed power – not to empower any community, but the individual. By definition they are susceptible to far-right radicalisation. Callison and Slobodian trace their use of the term back to Querdenken – which roughly translates as “lateral thinkers” – the group that organised the Berlin rally addressed by Kennedy.Kennedy recalled his uncle’s visit to the same city decades earlier, even repeating the historic line “Ich bin ein Berliner”. “And today again, Berlin is the frontline against global totalitarianism,” he said, before working through a bingo card of conspiracy theories. An extended “quote” Kennedy read from Hermann Göring’s testimony at the Nuremberg trials, including that “the only thing a government needs to make people into slaves is fear”, was copy and pasted across social media for months afterwards – even though there is no record of Göring saying those words.But Kennedy’s Berlin speech and the Querdenken rally itself were not merely notable for the controversy they caused. In drawing together veterans of anti-war and anti-globalist groups alongside health influencers, environmentalists and the far right, Querdenken became the blueprint for diagonal movements. Through its anti-power conspiratorial framing and the mirroring of methods used by decentralised grassroots movements, Querdenken was able to draw diagonal lines across pre-existing political allegiances, cultural divides and single issues, such as the climate or vaccines, to forge a mass coalition of support. Kennedy himself epitomises this new coalition – one that was nascent at the time, but is now at the heart of Trumpism.As a former environmental lawyer, Kennedy spoke with eloquence and passion in the past about corporations contaminating rivers and polluting the skies, the plight of asthma especially afflicting black people, and the existential threat of the climate crisis. In the Berlin speech, Kennedy mingled conspiracy theories with genuine concerns and anxieties held by the public. He said he saw “people who want leaders who are not going to lie to them, people who want leaders who will not make up arbitrary rules and regulations to orchestrate the obedience of the population. We want health officials who don’t have financial entanglements with the pharmaceutical industry, who are working for us and not big pharma.”In her book Doppelganger, Naomi Klein writes powerfully on how diagonal movements and influencers often identify real issues that progressives had grown timid about – the sway of oligarchical wealth over politics, the rise of digital surveillance, the impact of rampant capitalism on our mental and physical health. But instead of articulating the actual causes or plausible solutions, they have constructed bogus metanarratives. Rather than increasingly antidemocratic billionaires, it was an organised cabal of global elites, unaccountable deep-state bureaucrats who secretly ran the world – or, at the furthest end, blood-sucking satanists, as QAnon followers believed. A mirrorworld had emerged. And it is demagogues such as Trump who have benefited.“Despite claims of post-partisanship, it is right-wing, often far-right, political parties around the world that have managed to absorb the unruly passions and energy of diagonalism,” says Klein, “folding its Covid-era grievances into preexisting projects opposing ‘wokeness’ and drumming up fears of migrant ‘invasions’. Still, it is important for these movements to present themselves (and to believe themselves to be) ruptures with politics-as-usual; to claim to be something new, beyond traditional left-right poles.”While the crowd that listened to Kennedy’s speech that day in 2020 was a heterogeneous mix, a few miles away, a mob of far-right activists and QAnon supporters tried to storm the Reichstag, home to Germany’s parliament, after one of their number falsely announced Trump was in Berlin to liberate the country. The violent scenes would be replicated in the more deadly assault on the Capitol on 6 January 2021. This was the extreme end of diagonalism exploding into life. (An investigation I led into Covid-sceptic groups found that by then, Querdenken and others had become obsessed with Trump – and gravely radicalised.)If Robert F Kennedy Jr is confirmed to Trump’s cabinet, a once-staunch environmentalist and defender of women’s reproductive rights turned conspiracy theorist and super-spreader of health misinformation will dictate health policy in the US. Diagonalism has ascended to the pinnacle of global power. The mirrorworld is becoming our reality.

      Darren Loucaides is a writer based in Barcelona and London

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