Today, we present a guest post written by Jeffrey Frankel, Harpel Professor at Harvard’s Kennedy School of Government, and formerly a member of the White House Council of Economic Advisers. A shorter version was published by Project Syndicate.

US president William McKinley died in 1901 of gunshot wounds (from an anarchist assassin) that modern medicine could easily have handled.  Without x-rays, his doctors couldn’t find the second bullet, and without antibiotics, they couldn’t fight the sepsis that killed him.

When Donald Trump ants to Make America Great Again [MAGA], his idea of when America was great is evidently the McKinley Administration of 1897-1901.  Why? Trump in February 2025: “He was a strong believer in tariffs, and we were actually probably wealthiest of any time, relatively speaking, at any point in the history of our country.”  The McKinley Tariff dated from 1890, when he was a Senator.  During his presidency, he himself turned against tariffs.)

Americans did not, in fact, especially thrive in the late 1890s.  Although it was the height of the Gilded Age, all was not golden.

Real income was less than 1/7 the level of today [$4,091/$28,129].  The Panic of 1896 exacerbated a long economic depression.  Something like1 % of American households had indoor toilets, versus 99 % today. US child mortality was 23.9 % in 1900, versus only 0.7% today [deaths in the first five years of life].  Life expectancy in 1900 was only 47 years in the US, versus 77 today. (Globally, it was 32 years in 1900, vs. 73 today.)

The most important reason for the lower death rate in the current era is advancement of science, medical treatment, and sanitation, which have come a long way since 1900.  To illustrate how great progress has been since then, consider some triumphs of vaccination.

A short history of vaccines

In 1918-1919, the Spanish Flu pandemic killed an estimated 20–50 million people worldwide.  In 1942, a vaccine that protected against the flu was discovered. It is updated annually, saving hundreds of thousands of lives every year.

In 1930 Max Theiler, an immigrant who worked at Harvard and the Rockefeller Institute, found how yellow fever infected mice; in 1937 he developed a vaccine that eventually eliminated the disease in the US and many other countries.  In 1939, bacteriologists Pearl Kendrick and Grace Elderin, working in a Michigan state laboratory, found a vaccine was effective against pertussis (whooping cough).  These were added to the list of successful vaccines against smallpox, typhoid fever, diphtheria, and tetanus that we benefit so much from today, from childhood on.

In 1952–55, the first effective polio vaccine was developed by Jonas Salk, working at the University of Pittsburgh.  A second type of polio vaccine, developed by Albert Sabin, an immigrant from Poland, was approved for use in 1960.  Polio was eliminated in all but a handful of countries over the next 40 years.

Researchers at Boston Children’s Hospital invented the vaccine for measles in 1954 and introduced it in 1963.  It was so successful that by 2000, measles, which had been one of the biggest sources of child mortality, was declared eliminated in the US and very sharply suppressed in the rest of the world.  But MAGA supporters  and their counterparts in Europe carefully blew on the remaining embers, by refusing the vaccine, until the measles fire started to rekindle in 2018.

In 1967, Barry Blumberg, who worked at Columbia University and Oxford, discovered the hepatis B virus, leading to the development of an effective vaccine.  By 1980, a global strategy led by the World Health Organization [WHO] and the US Centers for Disease Control and Prevention [CDC] had used a smallpox vaccine to virtually eliminate smallpox disease in every country.

The recent COVID-19 vaccines represent perhaps the most impressive triumph of modern science in that they were developed, building on mRNA breakthroughs in under a year and averted an estimated 14–20 million deaths in their first twelve months.  This achievement was made possible, in part, by the work of immigrants: Hungarian-born Katalin Karikó; Lebanese-born Noubar Afeyan and French-born Stéphane Bancel at Moderna, and Indian-born Nita Patel, who led Novavax’s vaccine team.

Many of these discoveries over the last century earned Nobel Prizes.  More importantly, it is estimated that vaccines today save 4-5 million lives per year, cumulating to at least 154 million lives over the last 50 years.

Turning the clock back to 1900

The biggest threat to the progress of the last 125 years comes from the political movement that in the US is known as MAGA.  The campaign is being carried out on many fronts.

1. Drastic cutbacks to foreign aid (particularly by the US) and the dwindling of international cooperation (Trump having announced US withdrawal from WHO), will seriously impede what had previously been anticipated progress toward eradication of some diseases, bring back some that been thought vanquished, and prevent progress on others, thus incurring millions of deaths.
2. The slogan “America first” implies that Americans care only about the welfare of their own fellow citizens. Fighting contagious diseases in other parts of the world, of course, also reduces the threat to one’s compatriots.  But, in any case, MAGA is hard at work increasing contagious disease, not just overseas, but domestically as well.  Starving our public health agencies of money and personnel is one way.
3. The Trump administration has all but declared war against universities, hospitals, and other non-profit science-based institutions.  This war is prosecuted in part by cutting funding such as research grants from NIH (National Institutes of Health) and other agencies.  The effect is to truncate medical research, even trials and longitudinal studies that had been midstream.
4. Trump has also tried to reverse the large expansion in the number of Americans with health insurance accomplished by Obama’s Affordable Care Act.
5. The war on universities dovetails with the war on immigrants. As the school year in the US starts this week, many classroom seats are empty because their would-be occupants have been blocked by the government from entering the country. Similarly, Trump wants to make it harder for foreign citizens to stay on in the US after completing their schooling.  This will hurt the US.  Recall how many of the vaccines and other scientific breakthroughs that have so improved our lives were made in the US by immigrants.
6. Other facets of MAGA mischief include encouraging disinformation about health, exacerbating conspiracy theories, and undermining trust in government. Before Covid-19, we thought that when a serious pandemic struck, it would be a wake-up call. Americans would see the virtues of scientific expertise, medical research, and public health preparedness and give them stronger political support from then on.  Instead, the effect was somehow to undermine trust in science, government, and public institutions.  Most surprisingly, an effect was to multiply the numbers of people who oppose vaccines. They have turned skeptical, not only of the miracle vaccines that modern science gave us in breakneck research during the first year of the pandemic, but even those well-established vaccines that have been so successful at fighting disease over the last century.

In short, one might say that  MAGA is working to turn the clock back to 1900 with respect to foreign aid, international cooperation, public health infrastructure, health insurance, government-sponsored research, the universities at which much of that research takes place, skilled immigrants, and public trust in science, the government, and other institutions.

How can one explain these perverse developments?  The principle of Occam’s razor says to prefer one simple explanation for what one observes, rather than a complicated mix of explanations.  The frontlines in the MAGA assault described here have the appearance of a unified campaign to increase the numbers of people suffering and dying from contagious disease. “Make America Sick Again).  Now there’s a conspiracy theory for you!

This post written by Jeffrey Frankel.