Even among the chaos generated by Donald Trump’s recent cabinet picksbwo99 slot, one stands out for the extensive suffering and lasting institutional damage it may cause: his choice of Robert F. Kennedy Jr. to lead the Health and Human Services Department.

Modern public health is one of civilization’s great achievements. In 1900, up to 30 percent of infants in some U.S. cities never made it to their first birthday. Since that time, vaccines, sanitation and effective medications have eliminated many previously commonplace illnesses and consigned others to extreme rarity. It’s easy to take much of that for granted, especially as those days have receded from living memory, but those achievements are fragile and can be lost.

The danger isn’t merely that Kennedy — who has almost no experience in government or large-scale administration, and who has shown a sometimes breathtakingly loose connection to the truth — would be incompetent or misleading. At the helm of a department with over 80,000 employees and a $3 trillion budget, one that oversees key agencies such as the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health, he would have control over the nation’s medicines, food safety, vaccines and medical research. With that power he could inflict significant harm to the public health system — and to the public trust that would be needed to rebuild it once he’s gone.

Kennedy has brought attention to some worthwhile public health concerns, such as the downsides of ultraprocessed foods and the value of exercise. But beyond those reasonable issues, he has filled the internet and the airwaves with views on vaccines, food safety, medicines and supplements that are a mix of grave misrepresentations and far-fetched conspiracies.

His opposition to vaccines has attracted the most attention. He doesn’t say just that they merit closer scrutiny, as some “vaccine skeptics” claim. Last year he told a podcaster that “there’s no vaccine that is, you know, safe and effective.” When it later became expedient, he denied that he had ever said such a thing. The truth is that he has long promoted the lie that vaccines cause autism, and the extravagantly false claim that “researchers have done very little to study the health” of children after they get shots for once-common diseases.

Outside of the medical community, few people still know about all the diseases whose safe and effective vaccines he is lying about, so let me remind you about one of them: diphtheria. Once known as “the strangling angel of children,” it causes its young victims to slowly and painfully suffocate, turn blue and gasp as a thick film fills their throat. They lie dying for many agonizing days. The disease has been all but wiped out, but in Spain a few years ago, it cost the life of an unvaccinated boy of 6. His distraught antivax parents promptly vaccinated their surviving child.

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