There’s a guilty pleasure, I suspect, that some are feeling at the prospect of Donald Trump and his Cabinet of vandals ransacking Washington. For too long we have lived with a government that is unresponsive. As a doctor, I experienced this most directly at the beginning of the pandemic. I wanted to test people with cough for COVID, but I wasn’t allowed to. I had to get permission from the state Department of Health, which was waiting on a faulty CDC (Centers for Disease Control and Prevention) test kit. The Food and Drug Administration, meanwhile, delayed private labs from offering tests. We are lucky that the virus arrived a few weeks late in Hawaii, or our first wave may have been as deadly as the one in New York.

I was hoping to see accountability under the Biden administration. That never happened, and as far as I can tell, basic pandemic errors like the one around testing haven’t been fixed. Instead, resentments simmered on, Biden’s party lost, and now the vandals are coming to sack the city.

In the van is Robert F. Kennedy Jr., a man no one would know about if not for his last name. Born into celebrity, and trained in law rather than science, he fancies himself an expert on medical matters, opining on everything from vaccine safety to obesity drugs. This was always ridiculous, but mostly harmless, until he cultivated his best talent, which is turning resentment into political capital. His anti-vax outfit became a $20 million per year business during COVID, during which Kennedy himself acted as a kind of one-man propaganda cyclone.

Prior to all that, Kennedy visited Samoa, where he complimented the work of anti-vax activists during a plunge in vaccine coverage. The subsequent epidemic, which killed dozens of children, was a “mild measles outbreak,” according to Kennedy. It was Hawaii doctors and nurses who helped clean up the mess, vaccinating the island and beating back the virus.

None of this is disqualifying to Kennedy’s fans, who don’t object to a serial liar being put in charge of the nation’s main science institutions. Lies have become so ubiquitous in our culture that we are growing numb to them, and for a very few of us they’re useful, as long as they create a stupefying buzz.

As regards the federal agencies involved, though, important work simply can’t be done in an atmosphere of conspiracy. The FDA reviews and approves new medicines and tests. These decisions impact the day-to-day health of tens of millions of people. The National Institutes of Health (NIH) is the greatest engine of science in the world, funding the study of everything from antibiotic-resistant bacteria to the biology of cancer cells. The CDC tracks epidemic disease. You want to know which food to throw out after an E. coli outbreak hits a grocery chain? That’s the CDC. You can’t replace these functions with a fun, counterintuitive podcast. You need institutions that work.

Genuine accountability for the federal COVID failures would be healing. The NIH should face questions about potentially dangerous research, including collaborations with labs overseen by dictatorships. The FDA should be answerable for faster testing, especially for novel pathogens. The CDC might be stripped of their leadership in emergency response, with that function rethought entirely.

Kennedy is unlikely to do any of these things. He’ll peddle in grievance, and he’ll wriggle his way around his own contradictory statements. His mere presence will undermine the people in government who are doing good work, and 19th-century ideas about infections will flourish. If he succeeds, vaccine coverage against deadly diseases like polio and measles will plummet nationally, and then we’ll be one big Samoa.

A wiser spirit has governed Hawaii. We avoided the worst aspects of the pandemic, both the epidemic waves with high mortality and the culture of resentment that pitted neighbor against neighbor. We did the two most important things well: We slowed the spread of disease early in the pandemic, and we vaccinated people when that tool became available. Hawaii had the lowest mortality in the country. And exiting the pandemic maelstrom, we made a doctor our governor.

We’re not a perfect place, but I’ve never been prouder to serve as an M.D. here. We’re going to need our sense of togetherness in the next few years. If the federal health agencies fail to protect kids from infectious diseases, we will have to meet that duty on our own. Our islands’ health will depend on it.

Jonathan Dworkin is an infectious diseases doctor on the Big Island; he received the Mayor’s Award of Recognition for service to the City of Honolulu during the COVID pandemic.