RFK Jr.’s HHS Strategy: How ‘Alarm Fatigue’ Threatens Public Health

The signals are fading. A recent survey from the University of Pennsylvania’s Annenberg Public Policy Center reveals a troubling trend: when presented with conflicting vaccine recommendations from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), a mere 11% of Americans would defer to the CDC. This isn’t simply a matter of vaccine hesitancy; it’s a symptom of a deeper malaise – a growing inability of public health warnings to cut through the noise.

Robert Shpiner, a clinical professor of medicine at UCLA with over four decades of experience in critical care, frames the issue starkly: we’re experiencing “alarm fatigue.” In the intensive care unit, constant monitoring generates a stream of alerts. Even as essential for responding to genuine emergencies, the sheer volume of alarms – up to 95% of which are false or clinically insignificant according to research published in the journal Critical Care – can desensitize clinicians, leading them to miss critical signals. The same phenomenon, he argues, is now unfolding across American public health.

A Cascade of Crises

This erosion of public trust didn’t happen overnight. It’s been a deliberate, if not entirely planned, process. The current situation is largely attributable to the actions taken by Health and Human Services Secretary Robert F. Kennedy Jr. Beginning in June 2025. His decisions – firing the entire Advisory Committee on Immunization Practices (ACIP) and replacing them with vaccine skeptics, significantly reducing the recommended childhood immunization schedule (from 17 to 11 vaccines), and terminating $500 million in mRNA vaccine research contracts – each constituted a significant disruption.

These actions culminated in the worst measles outbreak in over three decades, with more than 2,200 cases reported in 2025 and three deaths. The potential loss of the United States’ measles elimination status – achieved in 2000 – was dismissed by a principal deputy at the CDC as “just the cost of doing business.” The sequence of events, rather than a single, overwhelming crisis, has gradually lowered the threshold for what is considered shocking, effectively normalizing a state of perpetual disruption.

The Annenberg Public Policy Center’s research reflects this shift. Public trust in the CDC has fallen from approximately 75% to 60% in a single year – a decline that signifies more than a simple polling fluctuation. It represents a real-time erosion of institutional credibility.

Beyond Vaccine Debates: A Systemic Issue

The problem extends beyond vaccination. The deliberate stacking of crises – changes to vaccine schedules followed by the dismantling of surveillance databases, and then controversial statements from surgeon general nominees questioning the settled science of vaccines – has created a sense of numbness. As Shpiner points out, outrage has become a genre, easily dismissed as a predictable reaction from certain segments of the population.

This isn’t about simply raising the volume of public health messaging. Vigilance, in the face of constant alerts, inevitably degrades. The solution, Shpiner argues, lies in building robust systems – checklists, redundancies, and escalation pathways – that function even when individuals are overwhelmed. These structural responses are crucial for ensuring a consistent and reliable response to public health threats.

Emerging Structural Responses

Fortunately, some structural responses are already taking shape. The West Coast Health Alliance, formed by the governors of California, Oregon, and Washington, is coordinating independent guidance, bypassing federal agencies. Academic medical centers are establishing sentinel surveillance networks to compensate for the CDC databases that are being dismantled. And electronic health record vendors are exploring ways to aggregate anonymized data to provide real-time trend analysis.

These initiatives represent the “checklists” Shpiner advocates for – systems designed to function even when human capacity is strained. The Annenberg survey also reveals a glimmer of hope: while trust in the CDC’s political leadership has declined, two-thirds of Americans still maintain confidence in the career scientists working at U.S. Federal health agencies. This suggests that the public hasn’t lost faith in science itself, but rather in its potential for political manipulation.

Lessons from the Early AIDS Epidemic

Shpiner draws a parallel to the early days of the AIDS epidemic in the 1980s, when a lack of surveillance systems hampered the ability to track and respond to the emerging crisis. The infrastructure that exists today – the systems that informed Covid-19 surge planning – was built precisely to prevent a recurrence of that scenario. Dismantling these systems, he warns, risks repeating past mistakes.

What to expect moving forward

The challenge now is to prevent alarm fatigue from silencing the response to these changes. Outrage, while a natural reaction, is fleeting. Systems, however, are a deliberate choice. The focus must shift from individual reactions to building robust, structural safeguards that can withstand political interference and ensure a consistent and reliable public health response. The protocols, as Shpiner concludes, are already being written.

Robert B. Shpiner, M.D., is a clinical professor of medicine (pulmonary and critical care) and associate professor of neurosurgery at the UCLA David Geffen School of Medicine.