A new survey from the University of Pennsylvania’s Annenberg Public Policy Center has a finding that should stop every public health official in this country: When asked which vaccine recommendation they would follow if the CDC and the American Academy of Pediatrics disagreed, only 11% of Americans said the CDC.
Eleven percent.
I have been a critical care physician at UCLA for more than 40 years. In my specialty, we have a name for what produced that number: alarm fatigue.
In an ICU, monitors track every heartbeat, every breath, every fluctuation in blood pressure. When something goes wrong, alarms fire. The system works — until it doesn’t. When too many alarms sound at once, clinicians stop hearing them. The alerts become background noise.
Research has shown that up to 95% of ICU alarms are false or clinically insignificant. But the remaining 5% can kill. Patients die not because no alarm sounded, but because no one could distinguish it from the last hundred.
This is a precise description of what is happening to American public health. It started in June 2025, when Health and Human Services Secretary Robert F. Kennedy Jr. fired all 17 members of the Advisory Committee on Immunization Practices — the expert panel that guided national vaccine policy for decades — and replaced them with vaccine skeptics. He gutted the childhood immunization schedule, reducing universally recommended vaccines from 17 to 11, and terminated $500 million in federal mRNA vaccine research contracts. He presided over the worst measles outbreak in more than three decades — more than 2,200 cases in 2025, three deaths, a country poised to lose the elimination status achieved in 2000. His principal deputy at the CDC called this prospect “just the cost of doing business.”
Each of these, individually, would constitute a crisis. But they did not arrive individually. They arrived in sequence, each slightly less shocking than the last — because the previous one had already recalibrated what we considered shocking. Public trust in the CDC has fallen from roughly 75% to 60% in a single year. That is not a polling fluctuation. That is institutional credibility draining in real time.
What alarm level are we at now? Most Americans couldn’t tell you. That’s the point.
I believe this numbness is not a side effect of Kennedy’s HHS. It is the strategy. The deliberate stacking of crises so that no single one can hold the public’s attention long enough to generate a political consequence. By the time you’ve organized your outrage about the vaccine schedule, the surveillance databases have gone dark. By the time you’ve written about the surveillance databases, a surgeon general nominee is telling the Senate “science is never settled” when asked whether vaccines cause autism.
The outrage becomes a genre. And once outrage becomes a genre, it can be dismissed as an aesthetic — something certain kinds of people do reflexively, the way others do CrossFit or sourdough.
So, what does the physician do?
In the ICU, the answer is not “pay closer attention.” Vigilance degrades; that is its nature.
The answer is protocol. You build systems — checklists, redundancies, escalation pathways — that function even when the humans in the system are exhausted. You make the response structural so that it doesn’t depend on anyone’s individual capacity for sustained alarm.
The same principle must apply here. Three structural responses are already emerging. California, Oregon, and Washington have formed the West Coast Health Alliance to coordinate guidance independent of federal agencies. Academic medical centers are creating sentinel surveillance networks to replace the CDC databases going dark. And electronic health record vendors — whose systems already flag reportable diseases across hospitals serving most Americans — could aggregate anonymized trend data with minimal development. These are the checklists. They work when the humans are tired.
The Annenberg survey found that two-thirds of Americans still trust the career scientists at the CDC — it’s the political leadership they’ve stopped believing. The public hasn’t lost faith in science. They’ve lost faith in its capture. That distinction matters, because the 77% of Americans who already prefer the American Academy of Pediatrics over the CDC on childhood vaccination aren’t abandoning evidence — they’re finding it elsewhere. The protocols, it turns out, are already being written.
I was an intern at UCLA in the early 1980s when AIDS arrived on our wards. There was no surveillance system to connect the dots. It took months of preventable deaths before anyone recognized we were facing a new epidemic. We built the infrastructure Kennedy is now dismantling precisely so that would never happen again. Those systems gave us the real-time data that shaped Covid-19 surge planning nationwide.
We cannot let alarm fatigue silence the response to Kennedy’s and Trump’s destruction. Outrage is a feeling. Systems are a decision. The ICU taught me the difference, and it is the difference that will determine whether we see the next epidemic coming or whether it blindsides us the way AIDS blindsided my generation.
The alarms are real. Build the protocols.
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. He is the author of the forthcoming novel “The Fifth Horseman,” based on his experiences during the early AIDS epidemic.
