This spring in West Texas, it’s as if the seasonal winds blew us back in time. We’re catching national attention for calamities that seem straight out of the 1930s: grim dust storms and a measles outbreak, which started about 65 miles from my home in Midland. Sometimes on social media, local moms share dark jokes: Wasn’t expecting to be living like a Depression-era American Girl doll in 2025.

Like those moms, I’ve been caught off-guard by much that’s unfolded over the past decade. If you had told me in 2011, when my oldest daughter was born, that driving a Tesla and being a crunchy granola mom would become right-coded by her 14th birthday, I’d have laughed. And if you had told me — the mom who always listened to her pediatrician — that I’d grow more skeptical of the advice offered by public health authorities over the next decade, I’d have thought you had the wrong person.

But a lot has changed. Many Americans have lost trust in public health agencies and the advice they offer, especially in more conservative parts of the country like mine. That declining trust is showing up in personal choices: In 2018, some 46,000 Texans requested vaccine exemption forms from the Texas Department of State Health Services. In 2024, more than 93,000 did.

If I had to do it all over again, I’d still follow my pediatrician’s advice and vaccinate my children. But in the years since Covid, I increasingly understand the thought process of my neighbors who do not.

There’s a tendency to assume the worst about people who don’t trust public health authorities’ advice about vaccines. At best, they’re dismissed as backward and stupid; at worst, selfish and unempathetic. I feel the pull to dismiss some people as all those things, such as the pastor in Fort Worth who bragged that his church’s school had the lowest measles vaccination rate in Texas. But while smugness might feel good, it doesn’t help anyone understand the average vaccine-hesitant person’s perspective, and it doesn’t solve our collective problem. Eroded trust in our public health institutions harms us all, and in order to get back on track, we need to understand how we got here.

There have long been people who don’t follow the recommendations of public health agencies, including those who want school vaccine exemptions. Wanting everyone to have freedom of medical choice isn’t a right-wing political stance; it is a call for personal liberty that goes all the way back to the antebellum and Civil War days. It’s entwined in health care debates ranging from vaccine exemptions to transgender medical care to abortion rights and medically assisted suicide. Balancing the foundational American value of personal liberty with other competing values is complicated and messy, and sometimes excruciatingly tragic.