Where Are The Leaders?

January 20, 2026

“The ultimate measure of a man is not where he stands in moments of convenience and comfort, but where he stands at times of challenge and controversy.” – The Rev. Dr. Martin Luther King, Jr.

Trigger warning: For those who think it’s facile and overwrought to make comparisons between 2020s America and 1930s Germany, you may want to skip this essay. Also, I urge you to read William Shirer’s The Rise and Fall of the Third Reich. Maybe it will become clearer to you.

For the second time in five years, Minneapolis – and America – is in crisis. For the second time, an unarmed civilian was murdered in broad daylight by uniformed officers of the state, an act that was captured on video and circulated around the world. For the second time, the people of the city are responding to state-sanctioned violence with resistance, with vigilance, and with mutual aid. But this time, the response of so-called leaders could not be more different.

In 2020, just a few days after George Floyd was choked to death by a Minneapolis police officer, the CEOs of nearly every major company in the state issued a statement condemning his killing and the systemic racism it so vividly demonstrated. They also committed to taking actions to address racial inequities and social justice. Now, I know from my own experience then that within the companies we led, and the communities we served, there were widely divergent opinions about Mr. Floyd’s killing, policing, and the issues of equity and inclusion. So this wasn’t necessarily an easy step for these CEOs to take in that moment. It was an act of courage, an expression of principle over expedience.

Contrast that to now. There has been near silence from business leaders about the murder of Renee Good by an ICE agent, and about the mass deployment of para-military forces engaged in widespread acts of harassment, intimidation, and violence in Minneapolis and many other communities in our state. And let’s be clear: this has little to do with immigration. It is about intimidation.  Citizens and non-citizens alike are being indiscriminately kidnapped and assaulted. For goodness sake, four of those detained are members of the Oglala Sioux Nation! (Oh, and despite the rhetoric about going after criminals, DHS’ own data shows that fewer than half of those captured have any criminal record at all, and only about 5% for violent crimes. Less than at a reunion of January 6th rioters.)

Where are our leaders, as our community is under assault? As our nation is engaging in neo-colonial undertakings around the world and alienating our friends and allies? As the rule of law is being dismantled in front of our eyes? Where the hell are our leaders?

Many would argue that the main responsibility of a CEO is to maintain the value of their company, to act in the best interests of its owners, the shareholders. Others would expand that to include other stakeholders such as customers and workforce. But the leader’s duty is to their company, first and foremost.

Even taking that view of a business leader’s obligations, it’s hard to argue that the ICE surges, and more broadly the Trump Administrations upending of legal processes, is good for business. It can’t be good for business if employees and customers alike are afraid to leave their homes. It can’t be good for business if trust in institutions is further undermined. It can’t be good for business if contracts can be arbitrarily canceled, if economic policy is conducted by the whim of a president who is at least narcissistic and at worst unstable, if society is becoming further and further fragmented.

My first thought was that the silence is due to fear. This would be understandable, given the demonstrated tendency of Trump to use the full force of the federal government to punish anyone who disagrees with him. Indeed, unlike the business community, elected officials in Minnesota have been strong in their condemnations of the administration’s actions and they are paying for their courage. (Well, at least some of them, including Minneapolis Mayor Jacob Frey and Gov. Tim Walz. Not sure what’s happening on the other side of the aisle.)

Then, I discovered the writings of Ernst Fraenkel, a Jewish lawyer who fled Nazi Germany in 1938 for the US. In his book The Dual State, he noted that the fascist regime built its totalitarian power gradually. Prof. Aziz Huq writes in The Atlantic, “As Fraenkel explained it, a lawless dictatorship does not arise simply by snuffing out the ordinary legal system of rules, procedures, and precedents. To the contrary, that system – which he called the “normative state” – remains in place while dictatorial power spreads across society. What happens, Fraenkel explained, is insidious. Rather than completely eliminating the normative state, the Nazi regime slowly created a parallel zone in which ‘unlimited arbitrariness and violence unchecked by any legal guarantees’ reigned freely. In this domain, which Fraenkel called the “prerogative state,” ordinary law didn’t apply.” Like the proverbial frog in the pot of heating water, we don’t recognize when we have slipped over completely to rule by executive prerogative until it is too late. This is especially likely when the loss of legal guarantees applies only to marginalized groups: Jews and Communists in 1930s Germany, people of color in 2020s America. It is easy for those in positions of privilege and power to be in denial.

We do still have much of our normative state. Large companies are allowed to engage in mega-mergers, individuals are still allowed to challenge government actions in court, people file their taxes and get passports and vote. But make no mistake: what we are seeing in Minneapolis today is an example of the prerogative state. When George Floyd was killed, the legal system followed normal procedure and justice was done. When Renee Good was killed, the Department of Justice simply decided it was justified, they would not investigate, and they would not help the state of Minnesota do so either. Our companies may be able to conduct business more or less normally for now. But for how long?

I’m not suggesting we are on the verge of a full-fledged fascist dictatorship (though it is a possibility that is distressingly more realistic than I would have ever imagined). I am suggesting that unless something is done, further erosion of the rule of law is almost certain. And as we have seen throughout history, that can be successfully resisted.

Whether out of fear or denial, our business leaders have been silent. We need them to speak up. We need them to resist. Perhaps it is starting. Last week the Minneapolis Chamber of Commerce, not exactly a hotbed of radicalism, released a statement that, while measured, was clear in calling out the current harassment being conducted by ICE and the need for redress when government acts unconstitutionally. There’s still a lot of crickets, but I hope more voices will follow. Because as Dr. King also said, “In the end, we will remember not the words of our enemies, but the silence of our friends.”

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Posted by Marc Gorelick

Taking the Public Out of Public Health

January 13, 2026

It is perhaps an indication of what a nerd I am, but one of the thrillers I vividly recall from my childhood was a short movie I saw in 6th grade about the World Health Organization’s Smallpox Eradication Program. Seriously. I was spellbound by the story of health workers traveling around Bangladesh, Ethiopia, and Somalia, the last countries known to have the disease, tracking down reports of individuals who might have contracted the disease and then vaccinating everyone around them who was at risk.  They were on the brink of completely eradicating one of humankind’s deadliest foes – smallpox having nearly wiped out the indigenous population of the Americas after its arrival with Europeans in 1492, and killing an estimated 300 million people in the 20th century alone – and victory was finally declared in 1980. Man, what an exciting public health adventure!

Ask any expert about the greatest public health advances in human history, and vaccines are almost sure to be in the top three, along with clean water/sanitation and maternal health. And now, as with so many other things in 2020s America, we appear to be moving backwards. Earlier this month, the US Department of Health and Human Services dropped 6 vaccines – hepatitis A and B, rotavirus, COVID-19, influenza, and meningococcal disease – from the list of those routinely recommended in childhood, reducing that number from 17 to 11. It’s a move that is frankly bewildering. It is opposed by essentially all experts in child health and infectious diseases, including the American Academy of Pediatrics (AAP) and the Center for Infectious Disease Research and Policy (CIDRAP).

Now, in the spirit of full disclosure, I have had a certain skepticism about routine vaccines in the past. When I started my pediatric training in the mid-1980s (yes, I am that old), we basically gave 3 shots for a total of 7 diseases, a recommendation that had been in place for nearly 20 years. During my residency one more was added, for Haemophilus influenzae type b (Hib). Then starting in the mid-1990s, the number seemed to explode. By 2005 there were 13 diseases on the schedule. As a pediatrician, and as a parent, it raised some questions. The earlier vaccines were for things that had significant mortality or morbidity. Smallpox vaccine is kind of a no-brainer. And stories of polio panics and the thrilling race to deliver diphtheria antitoxin to Nome via dog sled to contain a deadly oubreak, now fortunately historical artifacts, showed just how dangerous and terrifying those illnesses were. But chicken pox? Flu? Do we really need vaccines for those?

Decisions like those require a careful balancing of many considerations. How effective are the vaccines, what are the side effects, what are the costs? How many and which people are at risk of the diseases, what is the morbidity and mortality? What are the treatment options? In short, what are the risks and benefits? And as importantly, who bears the risks, and who reaps the benefits? Vaccines are one of those things where there is both and individual and a societal benefit. Herd immunity refers to the concept that for most infectious diseases, there is a certain pool of susceptible individuals required to maintain the disease in the population. If enough people are immune, either from prior infection or from vaccines, then the disease ceases to spread in that population. Those who cannot be vaccinated or develop natural immunity (immunosuppressed, cancer, etc.) are thus protected. Routine immunization may therefore be justified even when few people are at risk of more severe disease, if costs and risks are sufficiently low and herd immunity can be expected. These newer vaccine recommendations made sense in that context.

These are not simple decisions. They require lots of data, and a balanced view across many stakeholders with varying perspectives. Which is exactly how these decisions have been made since the mid-1960s, when the Advisory Committee on Immunization Practices was established by the US Surgeon General.

Until now.

It was bad enough that DHHS Secretary Robert Kennedy, Jr., fired all of the members of ACIP and replaced them with individuals of varying levels of expertise, and nearly all with demonstrated anti-vaccine bias. But the most recent de-listing of vaccines was done without even their input. It was done by the Secretary to comply with an executive order from the White House.

Anti-vaccine activists like Kennedy often cite safety concerns. Clearly, safety is paramount. It is one of the major things considered before vaccines are approved. And with post-licensing monitoring and the provisions of the National Childhood Vaccine Injury Act of 1986, vaccines may be among the most closely scrutinized pharmaceutical products in the country. Yet no new evidence of significant safety concerns has emerged for previously recommended vaccines. Indeed, the most widely circulated concerns, such as MMR-linked autism, have been so thoroughly debunked it’s hard to believe even hard-core conspiracy theorists truly believe them.

Safety is not really the issue here. I suspect this is part of a larger agenda. The most recent announcement emphasized the need for individual decision making about vaccines. Each person needs to decide what is right for them and their child. But this has always been an element of medical care. These vaccines are recommended for routine use. Individuals have the option of not following those recommendations, and often do, though a recommendation that all children should receive a particular vaccine, versus a recommendation that a vaccine should be considered, carries a lot of weight when parents are deciding. So what is the rationale for reclassifying some of these vaccines as recommended for every child, and others only recommended based on shared clinical decision-making?

A look at some of the diseases that have been demoted gives some hints. One of them is COVID-19. This has become a libertarian lightning rod for reasons that have nothing to do with the safety of the vaccine. But a large part of the rationale (though not the only one) for giving the vaccine to all children, even though the majority of children are not themselves at high risk, is to reduce the chance that a child will spread the disease to higher-risk contacts. The compelling rationale for universal COVID-19 vaccines for kids is societal protection, rather than protection of the individual. The same is true for hepatitis A (another reclassified vaccine).

Even more telling is the case of hepatitis B. The most common routes of infection in the US are perinatal transmission from an infected mother, and sexual or bloodborne transmission later in life. The recommendation for universal newborn immunization was based in part on the fact that many infected individuals are asymptomatic, and therefore unaware they are at risk of transmission to their infant. It also recognizes that whether we like it or not, adolescents frequently experiment with risky behaviors; early childhood vaccine offer them protection. I suspect that removing hep B from the recommended-for-all list is a way to further stigmatize and marginalize at-risk groups.

By putting more of the emphasis on what the risks and benefits are for the individual, rather than for the individual and others, DHHS and CDC appear to be engaging in an ideologically motivated effort to de-emphasize the societal benefit of vaccines. It’s taking the public out of public health.

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Posted by Marc Gorelick

I’m Back

January 8, 2026

Well, it’s been a minute…It’s hard to believe my last post here was over 3 years ago. Not that I’ve been idle. I’ve had an “official” blog at Children’s Minnesota, and I’ve written a book, Saving Our Kids, that lays out a public health approach to the gun violence crisis that I talked about in my last Starting With Curious post. But to be honest, I felt that despite the disclaimers about the views here being my own, it was difficult to keep it completely separate from my role as a CEO. I thought having this blog on hiatus was best for my organization.

But as of this past summer, I am retired! I can more freely write about things affecting the health and wellbeing of kids. And man, is there a lot to write about.

I’m back!

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Posted by Marc Gorelick