Trump's War On Public Health and the Lessons of The Black Angels

Gutting the Center for Disease Control, knee-capping university research, and dismantling USAID mean diseases our grandparents fought are resurging

In Kansas, the largest tuberculosis outbreak in modern U.S. history is unfolding—a crisis that should be setting off alarms about the consequences of eroding public health infrastructure. The administration has frozen public health communications, gutted the agency’s budget, removed vital health data, and interfered with scientific research, including reports on tuberculosis. Trump’s control over the CDC’s Morbidity and Mortality Weekly Report (MMWR) has allowed political appointees to suppress critical findings about public health threats.

The Trump Administration's Assault on Public Health

This outbreak is the largest documented TB outbreak in the U.S. over a one-year period since the CDC began tracking TB cases in the 1950s. It has already surpassed the total number of TB cases Kansas typically reports in an entire year. Yet, the Trump administration's efforts to weaken the CDC and dismantle public health protections threaten the response to this crisis.

As of February 7, 2025, there are 67 confirmed active TB cases and 79 latent TB infections associated with this outbreak, with at least two deaths reported. Most cases are concentrated in Wyandotte County (60 active cases) and Johnson County (7 active cases) in the Kansas City metro area. The outbreak is still active, with the potential for additional cases to emerge, as the Kansas Department of Health and Environment (KDHE) oversees 384 individuals connected to the outbreak at various stages of TB testing, diagnosis, and treatment.

The Looming Threat of Drug-Resistant TB

The danger this creates for all of us is profound. Beating TB requires prolonged and consistent treatment. The medicine spoiling on docks means that TB will be able to mutate in patients suddenly cut off. That can lead to drug-resistant strains, sending us back to the drawing board in fighting this disease. The Bacille Calmette-Guérin (BCG) vaccine, developed over a century ago, remains the only licensed TB vaccine, but its effectiveness is limited, especially in adults. A new vaccine candidate, M72/AS01E, has shown promise in trials, but without strong public health infrastructure, its deployment could be delayed or undermined. The treatment of TB also requires strict adherence to lengthy antibiotic regimens and any disruption—like those caused by funding cuts or the sidelining of scientific expertise—risks creating multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB).

What History Teaches Us

This is what happens when a nation forgets the lessons of its past. The last time America faced a tuberculosis crisis of this magnitude, it was Black nurses—known as the Black Angels—who stepped into the breach when white nurses fled. These women, many of them recruited from the Jim Crow South, worked at Seaview Hospital in Staten Island, where tuberculosis patients were sent to die.

I know about the Black Angels for two reasons: my Grandmother, Leola Gilmore Smith, was one of them, and Maria Smilios has captured their stories in a must-read book called The Black Angels: The Untold Story of the Nurses Who Helped Cure Tuberculosis.

They were given the most dangerous jobs, denied basic protective equipment, and yet they not only kept the hospital running, but also played a crucial role in the clinical trials that led to a cure for TB. These nurses were seen as disposable, just like the patients they cared for, yet their work ultimately saved millions of lives. It was precisely because they could see the humanity of their patients that they noticed the small responses - a restless leg beneath a heavy quilt- that helped guide researchers toward the treatments that were working.

Author Maria Smilios sees the disastrous parallels in public health policy today, driven more by contempt and racism than science.

Here is the link to the full podcast interview:

The Fight Ahead

Now, we find ourselves at another crossroads where elected leaders are abandoning the poor, the brown, and the immigrant population, unconcerned about their health and unaware that disease won’t respect the borders of countries or be constrained by the intent of racist policies.

Public health is under siege by political actors who would rather push conspiracies than invest in science. If we do not defend the institutions that protect us, we risk unleashing a new wave of disease that could have been prevented. The Black Angels did not flinch in the face of danger. Neither should we.