A generation or two ago, when Americans had an important but nonemergency medical need, many of them would have called on their family doctor, somebody who had treated them for years. It was a little like going to a family restaurant: The purveyors knew you, knew your tastes and personal quirks, and they were part of the fabric of your community.

These days, patients aren’t visiting the family doctor nearly as frequently. They’re instead heading to what you might think of as drive-thru clinics — some physical, some entirely online — where they order off a menu, undergo a cursory and formulaic interaction with a healthcare provider they’ll never see again, and head off with the product they came to get. It’s like ordering a Big Mac at McDonald’s: When you pull up, you already know exactly what you want.

The very nature of medical care in the United States is changing. It is a transformation driven by the flaws of the preexisting healthcare system, technological progress, evolving patient preferences, and the do-it-yourself consumerism that is the lifeblood of modern medicine as much as any conventional clinical practice. 

In some cases, this drive-thru healthcare approach is filling genuine holes in healthcare access for Americans who are in need, such as people in the United States who live in the states with restricted access to reproductive and abortion services, and who have had no choice but to seek help online from other providers out of state. Beyond that, we’re dealing with a doctor shortage. Wait times to see a physician for all types of care are getting longer and longer — and these new practices promise to put you in touch with one with a simple click of a button. They can also offer competitive prices compared to conventional medicine, even without taking insurance, because they have maximized their efficiency. They’ve eliminated a lot of overhead in terms of physical space or administrative workload. One provider can screen an enormous number of patients and rake in a lot of revenue, which allows the company to reduce their prices.

“The word of the day in health policy is affordability,” said Dr. Ateev Mehrotra, who chairs the Department of Health Services, Policy, and Practice at the Brown University School of Public Health and has studied these practices. “You can see how these can create a more affordable and accessible way” to get healthcare.

But replacing the traditional doctor-patient relationship with something brief and transactional presents real risks to patients and their long-term well-being. Some of the most common reasons for seeking these services — erectile dysfunction medications or hair loss treatments — could be signs of an underlying health condition that would benefit from a more serious conversation with a personal physician.

The trick is in knowing the difference — and that isn’t always easy to do. The US healthcare system in its current incarnation places an enormous burden on individuals to figure out the best way to get the care they need. 

“A lot of quote-unquote empowered consumers are engaging in a lot of do-it-yourself medicine without necessarily understanding the limits of it,” Dr. Sachin Jain, who held several leadership roles in the Department of Health and Human Services during the Obama administration and is currently the CEO of the nonprofit Medicare Advantage insurance carrier SCAN Health Plan, told Vox. “I think even though there are more options for patients today than there were 30 years ago, the degree of fragmentation, in my view, is decreasing quality and truly eroding the patient experience.”

Drive-thru clinics don’t appear to be going anywhere — and that’s exactly why consumers need to be smart about how they use them.

Why drive-thru healthcare is thriving

Drive-thru medical care has emerged as primary care access has shrunk in recent decades. Long-term relationships with a family physician or general practitioner, which were once the foundation of medical treatment, are less common: The number of Americans who say their source of medical care is their personal physician has been steadily declining. As of 2018, nearly half of adults under 30 said they did not have a primary care doctor. By one estimate, 100 million Americans face some kind of barrier (physical or financial) to accessing primary care. More than 30 percent of Americans don’t have a regular source of healthcare, a share that has been steadily growing since 2000.

In hundreds of communities, a doctor shortage is already here. Most of rural America, 80 percent of it, is considered by the federal government to be medically underserved. About 20 percent of the US population lives in rural communities, but only 10 percent of doctors practice there.

“This notion that there’s going to be this available person who’s covered through your insurance, like who schedules visits with you and really gets to know you and is able to provide you with a comprehensive assessment, is just unavailable to most people,” Jain said.

Faced with these barriers, Americans have gravitated toward the convenience offered by urgent care facilities and “minute clinics” in pharmacies or large retail stores. The number of urgent care visits among privately insured Americans doubled from 2008 to 2015. In 2024, more than 80 percent of Americans said they had visited an urgent care or other kind of walk-in clinic; about 7 percent said in 2022 that it was their regular source of care.

The success of those businesses revealed Americans were comfortable with one-time-only healthcare. The idea of visiting a provider for one specific purpose predetermined by the patient started to take hold. As medical marijuana proliferated in the 2000s and 2010s, clinics popped up that offered the kind of routinized service that is now commonplace: Simply answer a few questions, and you’ll get the prescription you desire.

Today, that kind of service is available for an array of medical products and services, including erectile dysfunction pills, testosterone, GLP-1s, birth control, performance anxiety drugs, and Botox. They are finding an audience as Americans desire agency over their own healthcare — driven by the lack of access to conventional healthcare, distrust in the medical establishment, and wellness trends that prioritize self-optimization.

According to one consumer survey, 80 percent of Americans said that they own at least one personal medical device, which could include a blood pressure monitor or smartwatch. Nearly half prefer at-home or virtual care to visiting a doctor’s office. They increasingly consult Google or ChatGPT to investigate their own health before seeing a provider.

“We glorified do-it-yourself medicine through the lens of this idea of consumerism,” Jain said. “What consumerism has really done is it’s created a high degree of fragmentation in a customer base, where they may not fully understand or know what they need.”

Amid those trends, the old-fashioned image of a family doctor you’d call for any range of medical needs looks increasingly out-of-date and out of reach.

“It’s turning medical care into a commodity,” said John McDonough, a public health professor at the Harvard T.H. Chan School of Public Health and author of the new book America’s Wrong Turn: US Health Care in the Neoliberal Era. “You can buy the package of services. You can buy the individual services, and you can go to the store and pull it off the shelf.”

Medical care looks more like Hims and Hers, perhaps the most high-profile examples of this kind of limited-category telehealth. Visit their websites and it looks a lot like ordering at a fast-casual chain restaurant: Have better sex, grow fuller hair, lose more weight, treat menopause, and would you like a side of testosterone with that? In 2025, the company generated $2.4 billion in revenue, an increase of 59 percent from 2024; it now claims more than 2.5 million subscribers.

Many consumers are getting the convenience they desire, but others may feel that the patient experience suffers. Patients on social media who’ve used Hims and Hers, for example, will sometimes complain about how impersonal the interactions feel or worry the service is increasing their dose too quickly.

In a statement to Vox, Dr. Pat Carroll, chief medical officer of Hims & Hers, said:

Millions of Americans face real barriers to healthcare: long wait times, stigma, cost, and provider shortages. Digital health can help close these gaps in care but only when done responsibly.

At Hims & Hers, every treatment decision is made by a licensed, independent provider who reviews a comprehensive medical intake to determine clinical eligibility before anything is prescribed. No shortcuts. As patient expectations rise, that standard should be non-negotiable across the industry.

Why you should be cautious about using drive-thru medical services

The premise of these services is that the patient knows what they want. But even a well-informed patient is not a physician — and, at the same time, these business models are based on doctors selling a specific product, not necessarily on whether they are providing the most clinically appropriate care during this one-time interaction.

“What happened is a number of entrepreneurs started picking off specific pain points, like things that are true pain points for patients, where there’s no clean place to go, and created access,” Jain said. For example, you may not be able to find a dermatologist covered by your insurance but visit a Hims and Hers-type service, and “there’s going to be someone there who’s willing to use their medical license to actually give you the thing you need.”

Patients should be cautious about using these “drive-thru” services, given those misaligned incentives, experts told me. Two of the most popular uses — for men who are seeking treatment for impotence or hair loss — are instructive.

On its face, erectile dysfunction checks all the boxes for this kind of service: It’s a narrow medical question and there is an obvious drug for physicians to prescribe. People who might be embarrassed to bring the problem up can get the treatment they want after answering a few questions from a provider that they will never have to see again, without anybody else needing to know.

But erectile dysfunction can be a more complex medical question than “can you get an erection when you want to have sex?” It absolutely could be something as innocuous as older age, and therefore an ED drug is the right treatment. But it could be a sign of serious underlying health problems such as hypertension, diabetes, depression and anxiety, sleep apnea, and more. 

“Good clinical practice suggests that you have to rule out underlying causes while you’re simultaneously treating it,” Jain said. “I think that’s the kind of stuff that gets lost in clinically sloppy protocols. Oftentimes, these ‘lifestyle conditions’ are the window into broader systemic issues that go untreated or undertreated.”

Likewise, losing your hair can simply be a byproduct of aging and thus responsive to a hair-loss treatment. But it can be an outward symptom of a more serious issue like hypothyroidism or, again, stress and anxiety. Performance anxiety, which some of these services will prescribe a beta blocker for ahead of, say, a public speaking engagement, could be a signal you have deeper issues with anxiety or depression.

Or take GLP-1 drugs, which have become a popular offering for telehealth services. As Vox has reported, these powerful drugs can be effective in helping people lose weight — but they can also have serious side effects, including dramatic loss of muscle mass. They require careful management in terms of eating the right diet and getting on the right kind of exercise regimen. Developing a holistic weight-loss plan would be best done in ongoing consultation with a doctor who knows you and your medical history.

But this is where the economics of drive-thru healthcare fail patients. The doctors who practice in them don’t necessarily make money by offering you the best personalized advice or looking at your health from a whole-person perspective. They make money by prescribing you the medication you came to get; some of these services even ship the drug to you directly themselves.

“The business model is the provider has a drug they’re trying to sell,” Vivian Ho, a healthcare economist at Rice University, told me. Some pharmaceutical ads now even allow you to click through to connect with a provider who will prescribe you the advertised drug.

Secret-shopper research has revealed the limitations of these types of services. When Mehrotra’s team tried out contraception telehealth clinics using different patient profiles, they found these services were generally very good at screening for the specific product that they offer. But the companies did not take a broader look at the person’s sexual and reproductive health.

“They never address the fundamental questions. No one ever asked about STDs. No one ever asked, ‘Did you get your Pap smear?’” Mehrotra said. “There’s some holes here in this.”

Why you may sometimes need a drive-thru clinic anyway

Of course, it’s easy to say that everyone should seek out a primary care physician for some of these services — but, given the access issues faced by many people, it’s not that simple. For a person who needs birth control but can’t get an OB-GYN appointment (wait times were up 33 percent in 2025 compared to 2022), using that uncurious drive-thru clinic might be better than the alternative if the alternative is nothing.

“If a woman wants a freaking birth control, she should have every right to get birth control. … There’s all sorts of research out there about birth control deserts in the world,” Mehrotra said. “So if that’s what she wants, go for it. … You could see how the rationale for these in the context of birth control could be quite viable.”

Jain told me that, in his ideal world, insured patients would at least have a specific general practitioner who would hopefully become their first stop for some of these medical needs. The emergence of direct primary care — where patients pay a flat fee for on-demand access to the same doctor or a group of doctors — could also provide a counterweight to drive-thru clinics. The premise of these practices is that you pay for a subscription to have a doctor on call whenever you need them, and that doctor will already know you and your medical history. But those services tend to target people well-off enough to pay those fees on top of health insurance premiums (or who can afford to just pay for everything out of pocket).

And there may be times when a one-time-only provider is a good option. Going to urgent care or a minute clinic can be convenient for minor medical needs like a strep test or a flu shot. Prior case studies have found that these facilities tend to operate under rigorous clinical protocols that guide the care they offer to their patients. The value proposition is clear: It’s readily available, it’s clinically sound — and it’s cheaper than going to the emergency room.

“When there’s a degree of clinical discipline that is really rigorous and where there’s a high degree of protocolization that ensures people are getting really high-quality care, I have no problem with it,” Jain said. “But a lot of times the work is highly superficial.”

Then there is at least one truly special case, where drive-thru clinics are providing a service to patients when they have no other options available: mifepristone and other abortion drugs in a post-Dobbs America. Requests for telehealth abortion care have doubled since the decision, according to the Center for Reproductive Rights. They have offered a vital lifeline to patients with an urgent healthcare need when the alternative is having to travel out of state: A recent report from the Guttmacher Institute found that the number of American women who lived in a state with a total abortion ban and traveled out of state for an abortion dropped in 2025 while, at the same time, telehealth visits for women in those states were on the rise.

The Supreme Court is still weighing whether to permit doctors to continue virtually prescribing mifepristone. For this special type of drive-thru clinic, the stakes are high. 

“Women in the United States already face real health consequences, including preventable deaths, due to abortion care being denied or delayed,” wrote two women’s rights advocate at Human Rights Watch in May. “Ending telehealth provision would greatly worsen this crisis, especially for women and girls with limited financial resources, or with disabilities, and those living in states with abortion bans or in rural areas.”

But those abortion providers are, in the broader context of DIY healthcare, an exception that proves the rule. Without those services, patients would lose access to lifesaving medical care. 

For other healthcare needs, however, convenience does not always equal quality. Buyer — and patient — beware.

Ricky and Royce Marnell, 28-year-old fraternal twins from Orlando, Florida, have seldom done anything apart. Together, they competed on the wrestling team throughout their childhood and adolescence. On weekends, they’d venture to the nearby park to play football. When boredom struck, they’d head to the garage for a friendly game of ping pong. When it came to college, the brothers attended Florida State University (which they swear was merely a coincidence), where they also roomed together. Although they have different careers as adults — Ricky is a data analyst and Royce is a 3D artist — they find time to collaborate on a podcast about their twinness. They also share the majority of their friends.

Although the twins were in separate classes in elementary and middle school, Ricky took the lead on cultivating friendships. Royce was shy and uncomfortable, and he struggled to form social connections. So when Ricky, the extrovert, made plans, Royce tagged along. “It was also just always easier to lean on Ricky and just be friends with his friends because I didn’t have to put in any work,” Royce tells Vox. “They were always there.”

In college, they moved as a unit, picking up friends wherever they went — at orientation, outside of the dorm, in the elevator. At Ricky’s recent bachelor party, almost all of the attendees were mutual friends made during undergrad.

From birth, twins’ lives are inextricably linked. Brought up in the same environment at the same time, these siblings often inhabit similar educational, extracurricular, and social spaces, contributing to the expectation that twins share virtually everything, from interests to abilities. Because of this overlap, it makes sense twins would have overlap in their social circles, too. But as twins age and forge unique identities in young adulthood, they may find themselves making friends independently for the first time — a shift impacting both the sibling and friend relationships.

The unique experience of being a twin influences friendship

Being a twin doesn’t necessarily help or hinder the friend-making process, experts say. But having a constant companion may influence how twins approach friendship. When twins actively want to be more alike, they develop a common social network, according to research. At the same time, they often acknowledge being too dependent on one another, which might hold them back from making more friends. 

“The research has shown that there’s no difference in the numbers of friends, but the closeness piece may be a little bit different,” says Laurie Kramer, a professor of applied psychology at Northeastern University. “If you have someone who knows you so well…that you really trust and feel like you can confide in, you’re probably not going to need that many other friends in your life to have that kind of deep friendship, intimate friendship with.”

When it comes to twin social circles, there is plenty of overlap, but twin type impacts the extent of the commonality. Studies have found that identical twins share a majority of their friends while cross-gender fraternal twins had far less overlap.

“If you think about identical twins, they are genetically the same. Their similar genes predispose them to like similar places, people, and events. So they naturally gravitate towards the same kinds of people,” Nancy Segal, a psychology professor and director of the Twin Studies Center at California State University Fullerton, tells Vox. “Fraternal twins tend to go in different directions. They tend to have separate friends, and this is a trend that seems to remain fairly stable across the life span.”

Having a shared social network is usually a matter of convenience. One twin is usually more outgoing, Segal says, and may take the lead when making friends, especially if they’re in the same class as children. Even if they move in different social contexts and form relationships independently, it’s hard to avoid the other twin during playdates at home. 

Ironically, when kids are younger, they’re more likely to set clear boundaries with their twin, Kramer says: I want to play with Carly by myself today. Or they may hang out at their friend’s house without telling their sibling. It can be helpful to have these same frank conversations as they get older if they want to forge an independent relationship with a mutual friend.

In middle school, Royce Marnell remembers Ricky attempting to set such a boundary with him. Every day before class, Ricky and his friends would wander the halls with Royce tagging along. Ordinarily, it wasn’t a problem, but every once in a while, Ricky would tell his brother to kick rocks. “Ricky would just whisper in my ear, like, ‘Let me have this morning to myself,’ or ‘I want to talk to them about something and I don’t want you to be there,’” Royce says.

“Dang, I don’t remember doing that,” Ricky says. “I don’t really remember isolating Royce from my friend group because there was always guilt associated with that.”

That guilt was often reinforced by others in their lives: their parents and mutual friends asking why the other wasn’t invited. If Ricky wasn’t available to hang with a friend he made independently, the kid might reach out to Royce as backup. Their social lives, at times, felt out of their control. 

When a classmate only wants to befriend one twin, the rejection can send the other into a tailspin — because despite their perceived similarities, someone clearly prefers one to the other. “The existential questions about who we are and our personalities and [which] people like us, it heightens those concerns in a way that I think people with a different-age sibling just don’t [understand],” Kramer says. (As with all relationships, it can be difficult to articulate those unintelligible, intangible qualities that attract you to someone and repel you from others, even if they are a twin.)

As twins pursue independent lives, their friend groups diverge

By high school, twins start to forge their own paths and consider who they are as a unique individual opposed to a unit. Through a process known as deidentification, twins might play up their differences to minimize competition and jealousy, by, say, enrolling in different classes and extracurricular activities. “We see that during that time, there may be much more of an interest in each twin developing their own friendships,” Kramer says.

In college, this separation intensifies if the siblings attend different schools. On their own for the first time — not as one half of a pair, but as just another student — they embark on a potentially new experience of making friends solo. In her research, Kramer says fraternal twins are more eager to break free from their sibling, as opposed to identical twins who understand the inevitability of independence, but want to delay it.

This interdependence might hold twins back from expanding their social networks. In Kramer’s research, identical twins who attended the same college reported relying on their twin in moments of loneliness, perhaps to their detriment. “Some of them did say that they felt a little bit too comfortable with this arrangement because their sibling was always there and available,” Kramer says. “It didn’t put as much of a pressure on them to go out to be a little more extroverted than they might ordinarily prefer.”

Because the reality is, twins will have to live independently, even if they continue to live near (or with) their sibling. Employers and significant others typically don’t look for pairs. Having the social skills and confidence to forge new relationships without their twin as backup is valuable in the long term.  

It took until college for Jaclyn and Nick Lore-Edwards, 26, to transition from being known as “the twins” to simply “Jaclyn” and “Nick.” Growing up, the siblings had mutual friends; Jaclyn initially formed the relationships in elementary school, and those kids eagerly welcomed Nick. They both had the same interests — theater, books, dance, piano — and genuinely enjoyed being around each other, so they never had a reason to hang out with separate people. Being a twin meant strength in numbers.

“If I’m joining a new club and I don’t know if I’m going to know anyone, at least my brother is there and I can talk to him so I’m not just sitting by myself,” Jaclyn, a video editor and comedian, says. “I feel like that was definitely a big anxiety relief for me to always have him there.”

In addition to going to different colleges, their interests eventually diverged, and Jaclyn and Nick started meeting new people. Nick got involved with campus politics and model UN, while Jaclyn leaned into film and art, and each formed friendships with similarly minded people. Still, the act of making friends on their own was a relatively new experience. Having a twin, they say, was good practice for how to be a friend, not necessarily how to make them. “That was probably the first time I felt I have to do this alone,” Nick, a data scientist, says. “I can’t just rely on my sister to start talking to someone.”

While Jaclyn was the initiator in childhood, Nick thrived on his own in college: He came out as gay and gained confidence in himself. The friends he made knew exactly who he was and loved him for it. Jaclyn sensed that their high school friends, and by some extension her, had lost their luster, that the conversation really wasn’t that deep. “I could feel, when he would come home, maybe a little less interested in being with our friend group,” Jaclyn says. “That hurt my feelings. Me and you are best friends. But it wasn’t about me and our friends. He finally felt, I think, good at college.” Meanwhile, Jaclyn’s social circle was more intimate than Nick’s wide-ranging cohort, she says; her preferred friendship style mirrors that of a twin relationship. “I like having one really close friend or one person to go do stuff with,” she says.

Although they both live in New York City, they’ve still maintained their independent college friend groups. They represent the unique, individual adults they are now, not the packaged duo they once were.

While college was a period of mutual friend-making for Ricky and Royce Marnell, the twins from Orlando, their social lives did eventually split once they entered long-term relationships; their partners brokered their new adult friendships. After spending the first two decades of their lives under one roof, the Marnells now live with their significant others and with that comes responsibilities and obligations beyond their twin. Ricky’s planning a wedding; Royce just moved.

As a result of their progressing romantic lives, their shared experienced one has seemed to fracture. They don’t spend as much time with their mutual friends — if they do, it’s when college pals come to town — and instead most of their socializing is done with their respective partners’ friends. Before Ricky’s recent bachelor party, their group hadn’t gotten together in a handful of years. 

“I wouldn’t say it’s harder to make friends now without Ricky,” Royce says, “but I would say it feels more lonely.”

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

In cities and states around the country, universal childcare programs are finally having their moment. That includes New Mexico, where 15 years of work culminated in a successful ballot initiative authorizing a massive, permanent funding increase for early childhood education. Since that win, however, the state has struggled to increase supply — and it’s still dealing with a childcare shortage. In this month’s Highlight cover story, Sara Mickelson reports for Vox on how the state is screwing up universal childcare, and the lessons it can learn from places that are getting it right. Also in this issue: The case for joining a club. Why “drive-thru” healthcare is booming. How generosity became cringe. And surprising good news for new college grads.

How to screw up universal childcare

By Sara Mickelson

New college grads are doing better than the vibes suggest

By Bryan Walsh

Americans don’t know how to fight AI. So they’re fighting data centers.

By Marina Bolotnikova

How generosity became cringe

By Sara Herschander

Coming June 3

How Americans got hooked on “drive-thru” healthcare

By Dylan Scott

Coming June 4

To make friends, join a club. To join a club, find an activity fair.

By Allie Volpe

Coming June 5

“Elon Musk, Ryan Seacrest, and Chris Anderson of TED, consider yourself challenged,” Bill Gates bellowed from his garden. Beaming, he tugged on a candy cane-colored rope that dumped a barrel of icy cold water over his head. “You have 24 hours. Good luck.”

It was the scorching hot summer of 2014, and the ice bucket challenge — a viral social media trend to raise money for amyotrophic lateral sclerosis (ALS) research that involved soaking yourself with ice water and pressuring others to do the same — was in full swing. Gates had been challenged by Mark Zuckerberg, who’d been challenged by then-New Jersey Gov. Chris Christie, with whom Zuckerberg had appeared on Oprah a few years prior to announce a $100 million donation to Newark schools. 

By the time Musk tweeted out a video of his kids drenching him with their own makeshift ice bucket gizmo a day after Gates, the challenge had already reached tens of millions of people worldwide. Among the participants were Jeff Bezos, Justin Bieber, David Lynch — and Donald Trump.

As if under an icy spell, the world came together in a way it never would again. Today, the ice bucket challenge and the litany of surreal, grainy videos it spawned are a time capsule of a bygone era, or at the very least, a bygone internet. 

In the early 2010s, platforms like Facebook “actually had the potential to be this century’s agora, a marketplace of ideas,” said Asha Curran, who co-founded GivingTuesday, a philanthropic counterweight to Black Friday, in 2012. “The social media environment wasn’t this sort of existential threat to our mental health and our democracy and our isolation that it is now.”

But it wasn’t just a different era for social media. Back then, generosity was trendy for the one percent and 99 percent alike, and Bill Gates — alongside both his then-wife Melinda French Gates and Warren Buffett — was influencer number one. In 2010, the Gateses and Buffett launched the Giving Pledge, a campaign to convince the ultra-wealthy to donate at least half of their fortunes to charity. At the campaign’s peak, about one in seven American billionaires — including Musk, Zuckerberg, and a broad swath of the country’s rising tech billionaire class — pledged to donate at least half of their fortunes to charity. Together, they promised to usher in a new golden age of philanthropy.

They also aimed to inspire giving from Americans of more modest means, who flocked to viral clicktivism campaigns while sporting TOMS shoes and (PRODUCT)RED iPod nanos. The idea was seductive: You too could help save the world while making a show of your generosity. 

Today’s billionaires appear more cynical than they used to be, and the rest of us seem to be, too. Gone are the days when tech overlords challenged one another to charity stunts rather than cage matches. If social media once seemed poised to save the world one hashtag at a time — think #Movember, #Kony2012, and #BringBackOurGirls — then today, it feels considerably more likely to tear us all apart. 

For much of the past decade, fewer Americans have chosen to give to charity each year, while most billionaires appear to be giving away a diminishing share of their ballooning fortunes. The Giving Pledge, which held so much promise in 2010, has lost much of its steam and even come under direct attack from techno-cynics like Peter Thiel. The vibes have turned very bad.

It’s no wonder today’s youths yearn for the hopecore, the millennial optimism, of the early 2010s, that mediascape of messy buns, post-recession electropop, and sincere posting about causes everyone cared about for a week or two. The internet’s Earnest Era propelled a culture of giving even among billionaires, who shared a fear of missing out on the next hashtag cause. But today’s more fractured internet has kneecapped that positivity. To some degree, it made even the idea of trying to save the world cringe. The problem is not so much a giving crisis, as it is an attention crisis, one that’s been exacerbated by rising inequality and the decline of generosity as a collective cultural value, the kind of virtue worth signaling. 

“For a while, you almost needed to pick a charity as part of your online persona,” said Scott Harrison, a nightclub promoter turned founder of Charity: Water, a celebrity darling back when “it was really cool” to give in the early 2010s. He has struggled to fundraise in recent years. “It’s not on trend. It’s not what people are doing. It phased out. The cycle ended.”

I wanna be a billionaire so freaking bad

2010 was a transformative year for generosity for two important reasons: The economy had passed through the very worst of the Great Recession, and for the very first time, more Americans were about to be on social media than off of it. 

Surveys of young people in the early 2010s showed that they were stubbornly, discordantly optimistic despite graduating into underemployment.

One of those millennials was Mark Zuckerberg, who in 2010 was named Time’s person of the year at 26 years old for building a platform “fundamentally changing the way the Internet works and, more importantly, the way it feels.”

Social media made the world feel smaller. When a devastating 7.0 magnitude earthquake struck Haiti in January of that year, it became the first major live-tweeted natural disaster. Lindsay Lohan, Lady Gaga, and Haitian rapper Wyclef Jean were among those soliciting their followers for donations in the aftermath of the quake. Within a week, Jean’s own charity raised $2 million and the Red Cross raised $8 million. Celebrities released a “We Are the World” charity cover, and Americans ultimately gave about 15.3 percent more to international aid that year than they did the year prior. 

People who donated told their friends about it — publicly, online — and they told their friends about it in turn, in a charitable daisy chain that thrived under newly digitized social pressures. If you told the internet about your good deed, you’d look cool. If you were the only one of your friends who didn’t, well, you’d look like a bit of a jerk, in a much more visible way than in the past. 

Then, on June 16, 2010, news broke of Bill Gates, Melinda French Gates, and Warren Buffett’s plan to ask the nation’s billionaires to commit to giving away half of their fortunes. One week later, the Travie McCoy and Bruno Mars song “Billionaire” peaked at No. 4 on the Billboard Hot 100. It was an ode to getting rich not just to get rich, but to give it all away: “Not a single tummy around me would know what hungry was, eatin’ good, sleepin’ soundly.” 

By 2014, the Giving Pledge had 130 signatories, amounting to one in seven of the country’s billionaires, the majority of whom shared their motivations for joining in public letters online.

“People signed it because it was the cool thing to do,” said Aaron Dorfman, CEO of the National Committee for Responsive Philanthropy, a watchdog that advocates for progressive practices in the philanthropic sector.

The Giving Pledge was perhaps the single biggest manifestation of philanthro-capitalism, or the idea that “rich people can save the world” by applying their business acumen to charitable causes, was “all the rage” at the time, he said. While the pledge was not legally binding — and came with few expectations — most signatories “honestly believed they were going to live up to the terms.”

While the rest of the world heaped praise on the Pledgers, Dorfman wrote a series of articles in the Huffington Post critiquing the Giving Pledge when it was first announced. “I remember thinking this is insane. Everybody thinks this is going to be the best thing since sliced bread and it’s just not,” he told me recently. At the time, he believed that the way billionaires gave was too slow and self-serving to actually make a dent in serious global problems. “There’s no way it can possibly make that much of a difference.”

How to #SaveTheWorld, one hashtag at a time

Zuckerberg wasn’t the only millennial to believe he could save the world. 

Facebook, and other platforms like it, helped inspire a boom in viral kindness and giving campaigns in the early 2010s. While celebrities often acted as superspreaders — some, like Justin Bieber, signed a “Hollywood Pledge” modeled after the Giving Pledge in 2011— social media was not the influencer-dominated, algorithmized cesspool it is today.

When Curran helped launch GivingTuesday in 2012, “it immediately crossed what today we would think of as algorithmic bubbles,” she said. The White House blogged about it, and #GivingTuesday quickly became a top trending topic on Twitter. That first year, the hashtag raised at least $10 million for charity in 24 hours, a 53 percent spike from the year prior. 

“We were catching a wave,” Curran said. “The collective nature of social media and the collective nature of generosity were forming this perfect explosion.”

That same year, over 1 million men grew mustaches — and raised over $100 million — for Movember’s annual men’s health awareness campaign, driven in part by a PSA starring the mustachioed actor Nick Offerman. The charity Invisible Children went viral for its 30-minute YouTube video about the Ugandan warlord Joseph Kony, kindling the #Kony2012 craze, a campaign now chiefly remembered for being offensive and ineffective. 

Few charities mastered social media quite as successfully as Charity: Water, which gained a huge following in part by flying tech entrepreneurs to Ethiopia and convincing celebrities to share their birthday fundraisers. Jada Pinkett Smith and Will Smith kicked off the trend in 2010, and a year later Justin Bieber asked his Beliebers to donate $17 each for his 17th birthday. By 2013, Charity: Water had raised over $100 million from thousands of people online, enough to build over 8,000 wells and other clean water projects. 

“The beauty was the average birthday fundraiser brought in 10 of their friends and family,” Harrison said. “It almost had an implied virality, and it cost us nothing.” 

By the time a majority of Americans had smartphones in 2013, the internet was being flooded with selfies and short video trends. (Rest in six seconds of peace, Vine.) The Norwegian Army danced to the Harlem Shake in the snow. And golfers were drenching themselves with cold water as a way to bring attention to their favorite charities online. 

In July 2014, one of those golfers, a man named Chris Kennedy, poured a bucket of ice water on his head for the ALS Association, and then challenged his cousin, whose husband had the disease. She accepted, and the videos began pulsating through her social networks until they reached Pat Quinn and Pete Frates, both young ALS advocates.

From there, “it just continued to snowball,” said Brian Frederick, who the ALS Association brought on to help manage the trend. Over 17 million people participated that summer. “There was a period in August where for eight straight days, we were raising over $10 million a day.” The association had to reserve an entire office in its headquarters just to store all of the checks that people were sending in. 

The association raised about $115 million in just eight weeks, money that helped fund 130 research projects in 12 different countries. But while social media moves at light speed, medical research is a bit slower. Only in recent years have ALS patients begun to see breakthroughs in treatment from that enormous infusion of funding for a rare disease that most Americans had never heard of before 2014. By the time their donations started to pay off, most of them had likely forgotten whatever they’d once known about the disease.

“It dramatically accelerated the fight against ALS. It led to new genes being discovered, new research collaborations, new treatments in the pipeline,” said Frederick, but for most people who soaked themselves with icy water that summer, “that was just a one-time thing for them. They’ll never know that they really did make a difference.”

When generosity became cringe

The ice bucket challenge was the last real do-gooder social media trend of its kind. 

A week after it started coursing through the internet, a police officer in Ferguson, Missouri, shot and killed 18-year-old Michael Brown, drawing an outpouring of grief and outrage on social media. Both the #IceBucketChallenge and #IfTheyGunnedMeDown, the hashtag most associated with the protests that followed Brown’s killing, proliferated explosively and “almost simultaneously” across the internet, the writer Jia Tolentino noted at the time, yet they spread “entirely discreetly: twinned channels of wildfire blazing through quadrants of your attention that barely touch.”

Cracks were beginning to show in an internet that would soon become irrevocably siloed, one where digital attention, which felt so boundless and empowering earlier that decade, would come to feel like a precious commodity, monetized and increasingly stretched thin. With the Ferguson protests, that shift coincided with a massive political awakening and major domestic unrest and anger. To some corners of the internet, the performance of mass apolitical acts of generosity began to feel like an irreconcilable distraction in a competition for finite attention. 

As a result, the viral monoculture of the early 2010s fractured, giving way to an internet driven less by personal connections and more by hyper-targeted algorithms designed to keep you scrolling. “I don’t think people feel empowered by these tools anymore,” Ethan Zuckerman, a digital media scholar and professor at the University of Massachusetts at Amherst, told me. “They feel trapped by them. They feel like they want to escape these tools.” 

The vibe shifted, and the internet’s new feeds rarely rewarded the kind of mass earnestness that drove engagement on early social media platforms.

“I wish that I had known that it was the last time so that I could have marked it in my mind,” Curran said. “I’m not sure that a Giving Tuesday could work if it were launched today.” 

That’s not to say that people aren’t generous anymore. But they are significantly less likely to give to charity than they used to: Fewer than half of American households donate at all these days, down from 66 percent in 2000. Those who do give give an average of 1.2 percent of their income, down from nearly 2 percent in 2017. 

America’s richest families have given more to charity in total dollars over the past decade — enough, in fact, to make up for the decline in everyday donors and then some. But as a percentage of their ballooning wealth, most billionaires — including those who signed the Giving Pledge — appear to be giving less to charity than they used to. 

Rising inequality — and the belief that the wealthier should donate instead — explains part of this decline for everyday Americans, among other factors. But it also reflects a broader pattern in which Americans have largely moved away from performing their giving, or earnestness more broadly, at least online. It’s just not swaggy anymore; it doesn’t give you the insane aura that it used to. 

“It’s not in my feed. You’re not getting hit up for charities from your friends the same way you were,” Harrison said. “I can’t tell you the last celebrity that was in my feed asking me to give to their favorite charity, it’s been years. They are selling lipstick. They are selling protein powders. These platforms were really used as a force for good, and now are used as a force to sell more stuff.”

GivingTuesday is actually a much bigger movement today than it was in 2012, raising about $4 billion last year, but it’s no longer primarily a social media phenomenon. “Neighbor-to-neighbor generosity is more important than ever because that’s the way you escape the algorithmic bubble,” Curran said. “You almost have to get offline entirely.” Americans who do give online increasingly do so through ever more individualized channels like GoFundMe, which got its start in 2010, but has exploded in popularity in recent years. More than three-quarters of Americans say they believe that political polarization has made people more reluctant to give, and 60 percent said they’ve personally shied away from charitable activities that may involve people with opposing political views. In the absence of a shared civic culture, deeply siloed — and often distrusted — platforms like GoFundMe have become many Americans’ chosen way to give.

And where have the billionaires been? For the most part, accumulating wealth far faster than they gave it away. Zuckerberg, who once critiqued philanthropists for waiting until old age to fork up their fortunes, has seen his wealth increase by over 4,000 percent since signing the Giving Pledge, according to a report by the Institute for Policy Studies. That $100 million for Newark schools that he announced on Oprah to such fanfare in 2010? It’s now widely regarded as a colossal failure built on a foundation of philanthro-capitalist buzzwords instead of actual community needs. A few weeks after attending Donald Trump’s inauguration and appearing on Joe Rogan’s podcast, Zuckerberg’s philanthropic initiative announced that it would stop funding causes like education reform and social justice last year. While Zuckerberg gives much more in total charity today than he did 15 years ago, he gives far less as a percentage of his wealth. Zuckerberg pledged $100 million to Newark in 2010, equivalent to about 1.4 percent of his net worth at the time. Last year, he and his wife donated $608 million, but it amounted to just 0.3 percent of his now gargantuan fortune.

In recent years, a cadre of right-wing billionaires led by venture capitalist Peter Thiel has also begun to actively denigrate the Pledge for what they see as a left-wing bias, despite the fact that it has always been intentionally apolitical. “I’ve strongly discouraged people from signing it, and then I have gently encouraged them to unsign it,” Thiel, who accused the Pledge of being an “Epstein-adjacent, fake Boomer club,” told the New York Times. “I don’t know if the branding is outright negative, but it feels way less important for people to join,” he said, claiming that some Pledgers feel “blackmailed” to stay on the list once they sign.

As the rest of America has stratified and become more partisan, so too have the nation’s billionaires. And apolitical promises, like sheer generosity itself, just don’t hold the same allure that they used to. 

“Peter Thiel used to be an outlier, but now many tech billionaires are coming together around this radical anti-social” worldview, said Chuck Collins, program director at the Institute for Policy Studies and author of Burned by Billionaires. “They’re opting out of the social institutions that the rest of us depend on.”

You say performative like it’s a bad thing

Craig Newmark is not like those other tech billionaires. The founder of Craigslist is not and has never been a billionaire at all, he says, despite what Forbes might have to say about it. 

“I am a peasant at heart,” he told me, a few days after publishing an op-ed in the New York Times defending the Pledge against its partisan detractors. “My favorite luxury at my age is a walk-in shower with grab bars.” 

Newmark is a new recruit, having only signed the Giving Pledge himself last December. He was already a prolific philanthropist, having donated hundreds of millions of dollars to military families, cybersecurity, pigeon rescue, and my alma mater. So why add his name now? 

“It seemed to me that signing up for it would be funny,” he said, referring to the “absurd” idea that a “nerd patient zero” like himself could rub shoulders in an elite philanthropy club. “Funny is highly motivating for me. I know I’m not as funny as I think I am, but given the toxicity of our culture these days, anything funny is highly welcome.”

When I pressed him, Newmark conceded that signing the Pledge was also his way of “putting a stake in the ground.” Seeing other billionaires pull away from giving now is “disappointing,” he said, “because the world needs people who have too much money to pitch in” to help improve people’s lives at a time of vast inequality. “There are Americans who are going hungry,” he said, and “that kind of pisses me off.”

But primarily, he insists, he’s just trying to be funny. “We all need positive entertainment these days.”

And maybe that’s the point, because the Giving Pledge, like the ice bucket challenge and #Movember, was built on performance. Newmark is now engaging in that performance with the kind of wry, ironic humor befitting of today’s internet culture, rather than the gravitas and sincerity of the Pledge’s early years. But it was always, to some extent, a performative spectacle. While some signatories have turned out to be extraordinarily generous — MacKenzie Scott and Laura and John Arnold come to mind — there’s little evidence that the Pledge has accelerated their giving or made the ultra-wealthy more charitable as a cohort. 

Having skimmed through dozens of early Pledger letters, I’ve found that many claimed to have already been well on their way to giving it all away prior to making a public commitment. “Until now, I have done this giving quietly,” wrote Oracle co-founder Larry Ellison in 2010. “So why am I going public now? Warren Buffett personally asked me to,” he wrote, for the purpose of “‘setting an example’ and ‘influencing others’ to give. I hope he’s right.”

The Pledge’s original 2010 signatories — including Gates and Zuckerberg —  have donated about $206 billion as of last year, according to the Institute for Policy Studies, most of which went into their private foundations and DAFs, which slowly dole out grants to charity. The Arnolds are the only living original signatories to have given away enough to fulfil their Pledge, and of the 22 Pledgers who have died since 2010, only eight fulfilled their promise to give away at least half of their wealth during their respective lifetimes or in their wills. At the rate that Musk and Ellison are going — they’ve given away 0.06 percent and 0.03 percent of their wealth, respectively, according to Forbes — it seems unlikely that today’s living Pledgers will fare much better. And they’re in good company. Four in five of the wealthiest 400 Americans have given away less than 5 percent of their fortunes as of last year, most under 1 percent.  

Likewise, only about one-fifth of those who participated in the ice bucket challenge actually donated to the fight against ALS. The one in five who did donate gave about $220 million to ALS worldwide, and $115 million to the ALS Association, which raised about $2.8 million in the same period the year prior. While there was a genuine desire to help people through the trend, at the same time, Frederick said, the majority of people were “just doing what their friends were doing.” 

They were virtue signaling, but that’s not such a bad thing — philanthropy, after all, can do good no matter the intention behind the giving. An internet where people feel the need to do charity stunts for clout en masse is still better than one that rewards you for trying to hammer yourself a better jawline. On the rare occasion that earnestness does go viral today, as it did during the Artemis II launch or after Alysa Liu’s ebullient free skate routine, “it just makes me long for a time when communal awe was more prevalent than it is now,” said Curran. But while today’s social media tends to reinforce the idea that Americans “hopelessly hate each other,” she said, “if you get down to the community level, you actually see all these really beautiful things happening.”

Last year, a group of undergraduates at the University of South Carolina decided to revive the ice bucket challenge as a fundraiser for youth mental health. They hoped to raise $100, maybe $200, Alison Malmon, founder and executive director of the charity Active Minds, told me. 

Most of the students were barely out of preschool when the first ice bucket challenge went viral. But suddenly, college kids, beauty influencers, and celebrities were once again racking up views by drenching themselves in frigid water online. The revived ice bucket challenge raised over $500,000 for Active Minds. It never came close to its predecessor’s stratospheric levels of popularity — things just don’t go viral like they used to anymore — but it did, for a moment, revive a sense of earnest do-gooderism that, for over a decade, felt increasingly relegated to the internet’s far fringes. 

The phrase millennial optimism was born a few months later, driven by nostalgia for a bygone and vaguely naive internet culture that most young adults today are old enough to remember, but young enough to romanticize. So far, there’s no indication that Gen Z’s rediscovery of indie sleaze portends a sustained, serious resurgence of viral earnestness culture, from billionaires or from the rest of us. But as MGMT would put it, maybe now it really is time to pretend.

Caitlin Squier-Roper, 45, recently discovered an intriguing club on Instagram: Philly Cooks a Book, a monthly meetup where locals prepare and share an assigned recipe from a specified cookbook. She could’ve enrolled through the group’s social media and shown up to a meeting, dish in hand, not knowing a single soul. So she held off on joining.

It wasn’t until Squier-Roper and her husband Anthony Fernandez, 42, attended the Philadelphia Activities Fair that she decided to get involved. Squier-Roper and Fernandez recently moved to Philadelphia after living in Seattle for over a decade and didn’t have a network in their new city beyond their families. When they heard about the Activities Fair, a one-day exhibition of clubs, civic groups, and community organizations enrolling new members, the couple thought it the perfect opportunity to spread their social wings. 

Thousands of other people had the same idea. 

On a Sunday in April, around 2,300 attendees crowded every inch of available space in a historic downtown civic center to discover, and potentially sign up, for a club. Outside, it was the perfect kind of spring day: abundant sunshine, a light breeze, giving way for the serendipitous pop-ins from curious passersby. Inside, spectators shuffled, shoulder to shoulder, in single-file lines up and down the building’s winding staircase and through two rooms of tables representing more than 40 clubs, including a community for Black artists, a book club but for podcasts, and an a cappella group, stopping to chat with organization leaders and join their ranks. It was in one of these glacial plods around the ground floor of the event space when I met Squier-Roper and Fernandez. They’d already signed up for the cookbook club, the a cappella choir, and a cycling group.

The event itself, structured as it was, was novel for the couple and Squier-Roper said she was nervous to attend. “It seems out of the box and vulnerable,” she told me. But, looking around the room, she was in good company. “It’s helpful to see how many other people are here in the same searching situation,” she said. “It’s pretty cool.”

If Squier-Roper and Fernandez have felt socially adrift as of late, they certainly are not alone. The 2025 American Psychological Association’s Stress in America survey found that about half of US adults reported feeling isolated, left out, or lacking companionship at least some of the time. According to Harvard Graduate School of Education’s Making Caring Common Project’s 2024 survey, 21 percent of respondents said they were seriously lonely, over two thirds of whom felt like they lacked belonging in meaningful groups. 

Loneliness has become something of a buzzword: The US surgeon general and the World Health Organization have issued warnings about its harms, and brands and startups shill their products as the potential solution. Despite the shallowness of viral marketing campaigns and AI chatbots designed to absorb the role of friends, the problem is serious. Decades of research supports the dangers of chronic loneliness and social isolation: increased cardiovascular health risks; links to personality disorders, suicide, cognitive decline, and depressive symptoms; even a higher likelihood of mortality. 

Although many Americans say they’re lonely, and perhaps have become more aware of its negative impacts, they don’t seem to be prioritizing activities that foster connection. According to the American Time Use Survey, people spent nearly half of their waking time — more than  six-and-a-half-hours — alone in 2024, compared to just under five hours in 2003. Young people spent 45 percent more time alone in 2023 than they did in 2010. What are we doing with all this time in solitude? Watching TV, staring at our phones, gaming, mostly.

Against this backdrop, a crop of community-minded organizers stumbled into a similar train of thought: People are disconnected (perhaps I am one of these people). My city has a treasure trove of hobby clubs and civic organizations. If I lead a horse to water, can I get it to drink? From this seed of an idea, a genre of connectedness events was born — the activity fair, stuff to do fair, joining fair. From Philadelphia to Oakland, a wave of well-attended one-day activity fairs are the latest grassroots efforts to combat loneliness and connect people to their communities. These festivals operate under a simple premise: getting people in a room with club representatives is more effective and less overwhelming than scouring the internet, and it lowers the barrier to entry. 

“If there are things to join, people will join them,” Pete Davis, co-director of the documentary Join or Die, told me. But first they have to find them.

A nation of clubs

From the dawn of civilization, humans have hung out in group settings. The Romans had professional organizations known as collegia, medieval Europe had guilds, Victorian England had (exclusively male) social clubs. In the United States, people formed and joined groups of all kinds, from the Freemasons and abolitionist societies to women’s suffrage clubs and the Elks.

But participation in these groups has declined, as political scientist Robert Putnam famously explained in his book Bowling Alone: The Collapse and Revival of American Community, first published in 2000. Putnam found that enrollment in clubs of all kinds had dropped since the 1960s. Conditions have seemingly not improved. The inaugural Social Connection in America report, released last year, found that two-thirds of participants don’t belong to or never attend a meeting of any sort of organization or club. A 2024 survey from the Survey Center on American Life found that fewer than two in 10 Americans were members of hobby or activity groups, neighborhood associations, sports leagues, or parent groups.

Group membership confers many benefits. Research has shown that joining a community group led to reduced loneliness and increased social support for older adults. A scientific review found that sports team participation improved well-being, reduced stress, and increased social functioning. Being in multiple groups makes people happier. 

The regularity with which you meet makes clubs effective friendship-builders: If you see someone frequently enough, it’s easier to forge a relationship with them. Even if full-fledged friendship isn’t the goal, simply making acquaintances is sufficient to stave off loneliness and foster a sense of belonging. As Putnam wrote in Bowling Alone, “As a rough rule of thumb, if you belong to no groups but decide to join one, you cut your risk of dying over the next year in half.”

America has appeared to be club-curious as of late. In the years following the Covid-19 lockdowns, many people have yearned for tangible social connection, with the proliferation of supper clubs, run clubs, silent book clubs, and other activity- and identity-focused groups. “What I’m seeing is really in this last year, such a renewed interest in hobbies, hobbies for health,” said Julia Hotz, the author of The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging.

Participation “on-ramps”

Activity fairs are the natural next step in bridging the gap between the crop of niche and hyper-local clubs and a curious, but overwhelmed, populace. The concept is no different than welcome week activities at college campuses where a quorum of university clubs table and recruit new members. Designed to reach members of the wider community, club fairs operate as a live directory of a city’s offerings, all under one roof. “There’s no shortage of Instagram accounts and apps of things to do, concerts, events,” Brian Adoff, the founder of Join Philly, the group that organized the Philadelphia Activities Fair, told me. “And people still can’t find stuff.”

Adoff has long understood the benefits of clubs. In 2023, he and a friend founded a choir, bringing strangers of all ages to bars for impromptu concerts. Many attendees, he noticed, were attending solo, new to the city, or both, and formed friendships from the group. But it wasn’t until he attended a screening of Join or Die, a 2023 documentary extolling the benefits of joining clubs, compounding on Putnam’s work, that Adoff thought, I want to do this.

When I checked in with Adoff at the Philadelphia Activities Fair, he was standing on a stage overlooking the ground floor of the event, getting a good glimpse of the hundreds of locals learning about the dozens of clubs he’d brought there. 

Join Philly initially began as an online directory of clubs and associations, and the issue wasn’t finding clubs to showcase — there were plenty of those. It was getting people to participate. Sure, locals could scour the internet for a hobby group, but what if they weren’t even sure what to search for? What if they’re a little shy and walking into a room full of people they don’t know makes their stomach turn? Putting the club-curious in the same room as the groups solved some of these issues, a concept Adoff refers to as a participatory “on-ramp.” “That was the first on-ramp,” Adoff said. “How do we make this easier?”

C.C. Tellez, 48, the executive director of Lez Run, an LGBTQ+ running club, found this direct approach effective at quelling prospective members’ concerns. “Online, people like the idea of something, but they’re afraid to take the first step,” Tellez told me over the thrum of the Philadelphia Activities Fair. Tellez was approached in person by people who follow Lez Run on Instagram but were concerned about the pace, about being new. “We let them know we welcome everybody: different paces, different setups, whatever you’ve got going on, we welcome it here,” Tellez said.

“Versions of you”

I first became aware of activity fairs in 2025, when I learned of one happening in Lancaster, a small Pennsylvania city not far from Philadelphia. Hundreds of people crowded into a community center in the middle of winter to learn about a brewing club, rugby team, a mechanical keyboard club. 

The event’s organizer, Sav Thorpe Capizzi, had a lightbulb moment after a friend invited her square dancing a few years ago, something she’d never done before. As she do-si-do-ed with strangers, Capizzi wasn’t worried about how she looked or her skill (or lack thereof). “I just felt so alive in that moment and I was just so grateful to the part of me that just said yes to potentially looking a little foolish,” she told me. “And I was like, ‘Okay, so I need to invite everybody I know to every club I can think of right now.’”

Unaware of any other event geared specifically toward adults, Capizzi sent an email first to the town library, then a guild of crafters, and eventually cobbled together a list of exhibitors. She dubbed her version the Stuff to Do Fair and from that initial event sprung an offshoot in a smaller Pennsylvania town and, also the more robust second-annual Lancaster Stuff to Do Fair. This year, Capizzi doubled the amount of exhibiting clubs to 50 and nearly 600 people attended, she said.

In Capizzi’s estimation, fear of being bad at something is the biggest barrier to entry for any potential new club attendee — feeling like you’re not the kind of person who has the body for roller derby or the wit for improv comedy. Activity fairs give the shy, the uncertain, the hesitant permission to imagine themselves as someone who does. “There’s this air of novelty of all of the versions of you that exist at each of these tables,” she said. “It’s exciting, it’s thrilling, and I think it really gives people the opportunity to see themselves actually becoming the kind of person who enrolls in a class or takes up sketching after so many years.”

An excuse to be social

The Stuff to Do Fair, as well as the Philadelphia Activities Fair and the other club fairs I came across in my reporting, were organized by individuals, and perhaps that’s part of their charm. They’re scrappy and community-driven. But it’s easy to imagine a world in which these events might be sanctioned by local governments to promote public health. Social prescribing, a practice where patients receive a script not for pills but attendance at a community group, has gained momentum around the world, with medical professionals connecting patients to cycling clubs, performing arts groups, or volunteer organizations. Recent research has found social prescribing in the United Kingdom, where it was first developed, has led to improvements in wellbeing, happiness, and life satisfaction.

In place of a medical professional linking individuals to groups and activities that might benefit their mental or physical health, there could be activity fairs. “In other countries where we have more government support for social prescribing programs, what that government support goes to are up-to-date databases of the different activities that exist,” Hotz, the author of The Connection Cure, told me. If online listings and databases are out of date, well-intentioned would-be participants could be easily deterred, however motivated they might be. Solely relying on the internet to disseminate cub information means those with unreliable access or who aren’t tech-savvy are shut out from opportunities, too.

“An activity fair, giving you the information in real time and letting you meet with the people part of it in real time, I think just goes such a long way in making sure that your interest becomes a reality,” Hotz said.

Social prescribing gives people permission to do something meaningful, and to be convivial in the process. And so do activity fairs. “What a joining fair is is answering the question, What are you doing alone that you could be doing together? by having a cooperative recruiting event,” said Pete Davis, one of the directors of Join or Die.

In addition to a traditional screening tour, Davis, and his co-director and sister Rebecca (who was a supervising producer for the second season of Vox’s Netflix show, Explained) helped dozens of community organizers across the country host their own joining fairs in order to promote their film. But even if event planners didn’t work with the Davises directly, their documentary served as a point of inspiration.

Like Adoff in Philadelphia, Jared Joiner watched the Davises’ documentary, and it set the wheels in motion for his own fair in Oakland. That his actual last name is Joiner is not lost on him. “I had not thought about it in this world of joining clubs and joining organizations until the first time that I watched Join or Die and they say ‘joiner’ so many times in it and I was like, ‘Oh my gosh, am I destined to do this work?’” he told me. 

The same day that thousands of Philadelphians signed up for clubs at Join Philly, Oakland hosted its first Join-Up at a brewery in the midst of torrential downpours. Although the event had a smaller footprint — about 250 attendees and 22 organizations — many club representatives told Joiner they ran out of sign-up sheets. 

Catalysts for connection

There’s something to be said about the kind of person who attends an activity fair. “There’s definitely a self-selecting group that’s like, ‘I’m going to get off the couch to go to this thing, so I better sign up for stuff once I’m there,’” Joiner says. But there are a myriad of motivating factors getting those people off the couch in the first place: a recent move, a loss, a birth, a new job, a desire to unplug, to learn a new skill. 

The consequence, deliberate or not, is the forging of new social connections. When our worlds shrink to the confines of our homes and our screens, intentionally exposing ourselves to newfound (or newly rediscovered) activities and new people helps broaden them again. Clubs, with their regular, predetermined cadence and specific focus, are the ideal entry points to connection: Striking up a conversation is simple when you already have something in common — the activity itself. 

Toward the end of my afternoon at the Philadelphia Activities Fair, I ran into Deborah Winter and Terry Borden, both 71, as they finished a lap on the first floor of the exhibition. Winter is moving to Philly soon, and although Borden has been a resident for two decades, they both are still on that never-ending path toward community. “It’s hard to find your people,” Borden told me. 

Through clubs they signed up for — a book club, a skill-share — they hope to find both friendships and more casual relationships, something they’re already practicing. As it turns out, the two women are new friends themselves, recently introduced by a mutual. 

Even if they didn’t branch out at any of their new groups, I thought, at least they could reminisce, some day in the future, about this event, about the time they went out on a limb and joined a few clubs. Maybe the groups were boring or not quite the right fit, maybe they weren’t. But they tried something unfamiliar, together, and that’s something.

After decades of families performing small miracles to afford childcare and sitting for years on waitlists, politicians are finally treating early childhood education like the essential economic infrastructure it is. Around the country, states and cities are pursuing universal preschool and childcare programs. It’s exactly the kind of bold, life-changing social policy that those of us in this field, like myself, have spent our careers fighting for.

If it’s done right. 

Unfortunately, the most ambitious new attempt at universal childcare in America right now is in danger of making a mistake that has derailed past efforts: throwing money at parents without providing enough care for them to spend it on.

New Mexico has touted itself as the first state to offer universal no-cost childcare, thanks to a long, 15-year fight led by parents, childcare providers, advocates, and voters. In 2022, they achieved an iconic, grassroots win, unlocking unprecedented, permanent funding for early education through a ballot initiative. This financing victory accounted for the vast majority of the 130 percent growth in the state’s early childhood budget since 2019, enabling the state to more than double the number of children served in its childcare and prekindergarten programs and to make these programs free for families using them.

But the decisions about how to implement the state’s Universal Child Care program have continued to dig New Mexico deeper into policies that have proven elsewhere to fail. In the rush to claim victory, the state has prioritized expanding demand-side subsidies, giving parents vouchers for free childcare. However, by flooding the market with demand without sufficiently increasing the number of actual places for families to bring their children, or by paying educators enough to stay in the field, the state is creating a textbook policy failure. 

And if New Mexico stumbles, it could drag down similar efforts around the country. 

Why universal eligibility doesn’t equal universal supply

Childcare doesn’t just have an affordability problem; it’s also hard to find, primarily because of high staff turnover and high operating costs. To create a universal system where all families who need care can find it, afford it, and benefit from it, policy must address supply and quality alongside cost.

In most markets, making a service more affordable for consumers and more profitable for producers should trigger an immediate surge in supply. Logic suggests that offering free childcare for New Mexico families would cause new slots to rapidly open as providers look for ways to capture those dollars. 

But as Mildred Warner, a Cornell University professor and leading expert on childcare as economic infrastructure, argues, this sector is defined by a fundamental “market failure to generate sufficient market supply.” Warner’s comparative research across three countries — the United States, Australia, and the Netherlands — found the same pattern: The typical way of funding childcare through vouchers boosts parent demand but doesn’t increase the number of slots available. And in rural and low-income areas, it has been shown to shrink it. 

The reason, says Taryn Morrissey, a professor of public policy and childcare researcher at American University, is that childcare can’t scale like other industries. “You cannot have 100 babies in a lecture hall with one adult,” she told me. States regulate how many children a single adult can care for to ensure safety and the warmth and consistency that young children need from adults. This means that every new slot requires a proportional investment in trained staff and physical space.

This “market failure” is playing out in real time across New Mexico. While the state has successfully opened the floodgates of demand, increasing the number of children receiving childcare assistance vouchers by 78% from 2019 to 2025, the physical infrastructure has not kept pace. In the same six-year period, the state’s total childcare capacity in regulated care (which includes neighbors and relatives and daycare homes and centers) grew by just 1.9 percent, from 70,108 slots in 2019 to 71,455 in 2025. A spokesperson for New Mexico Early Childhood Education and Care Department (ECECD) noted that within this subset, licensed care had grown significantly but was offset by a decrease in home-based care that officials are trying to address.

The early childhood agency’s own estimates, announced alongside the Universal Child Care rollout as targets the state would need to meet, identify a shortfall of nearly 16,000 physical childcare slots and require at least 5,000 new professionals to staff them. Those targets remain unmet. 

For families in rural areas like Gallup and the Navajo Nation, this shortfall is particularly acute. Colleen Roan, an early childhood leader in McKinley County, said that the sheer cost of upgrading older buildings to meet licensing codes makes opening new centers nearly impossible. 

“There is universal childcare, but at the same time, there are not enough providers,” Roan said. “Although it’s universal, it really isn’t accessible across the board. … I hear about individuals being denied, mainly because they are not able to move on with becoming a registered in-home childcare provider.”

Roan’s last point highlights that even the avenue meant to be a lower barrier to entry — registering to serve a few children in your own home — isn’t working in her region. It’s not because safety regulations, like requiring background checks, training, and basic inspections, are too strict. Research suggests lowering standards does not increase supply. The bigger issue is raising the startup capital, the cost of meeting basic zoning and licensing standards, and a lack of help to navigate the process. 

Vouchers come with structural problems for providers

ECECD secretary Elizabeth Groginsky disputed this framing, arguing that the state’s vouchers and broadened eligibility are “explicitly a supply-side strategy” that boosts public investment into the overall childcare sector. Her agency pointed to recent increases in the total number of workers and facilities available as evidence of progress.

“New Mexico’s policies have demonstrably increased the state’s licensed childcare supply and have led to the nation’s steepest gains in child care compensation and workforce growth,” Groginsky said in a statement. 

It’s true that the money invested has made a difference, but the question is how to stretch scarce funding far enough to tackle the problems it’s meant to solve. 

Vouchers put money in families’ hands, but they don’t build buildings, train teachers, or navigate the process of licensing and opening a new business, and the uncertainty around how many parents will utilize them makes providers more reluctant to invest in new capacity.

Policy experts have long warned about this mechanical failure, which is made worse by unpredictable revenue. A 2020 report from the Center for American Progress explicitly outlined why vouchers fail to build supply: Because vouchers are tied to individual children rather than to seats, a provider’s revenue rises and falls with each family’s eligibility, enrollment, and the ability to navigate approval processes. When a child leaves, the funding leaves with them. What providers need instead is fixed operating support that the state can guarantee as a backstop. If states want to increase the supply of care, they must swap vouchers for direct grants and contracts that pay for classroom enrollment, guaranteeing the revenue needed to provide high-quality care to families and wages to educators.

And rather than build around this problem, New Mexico wrote it into law. The 2026 Child Care Assistance Program Act, or Senate Bill 241, codifies the statutory framework for the state’s expanded voucher program and unlocks $700 million for the state’s Early Childhood Trust Fund over the coming years. But the bill contains no parallel provisions for direct facility grants, capital investment, or contracts for classroom enrollment. Instead, it offers a few supply-side levers — a small revolving loan fund for facilities, capital outlay for higher-education-based centers, scholarships for educators — at the margins, rather than as part of the state’s central funding mechanism. 

The infant and toddler bottleneck

A lack of supply doesn’t just leave more frustrated families; it creates a competition that the most vulnerable families are least equipped to win. 

When the state made childcare free for everyone but didn’t build more of it, it invited thousands of new families to compete for the same scarce slots. The families who come out ahead are often the ones who can get on a waitlist months before their child is born, who know which providers to call, and who have a car to tour many programs in one day or to tour those programs during business hours. The families who lose are disproportionately the ones the policy was meant to help: lower-income parents working hourly jobs with less flexibility, less access to information, and fewer backup options when the waitlist doesn’t move.  

This crisis is most acute for families with the youngest children, where slots were the scarcest to begin with. Catron Allred, the executive director of the Early Childhood Center of Excellence at Santa Fe Community College, currently has a waitlist of 600 to 700 children, with the greatest demand for infant and toddler care. She said that her biggest hurdle is finding capital to build more classrooms and people to staff them who are properly credentialed and can cover their 10-hour days. 

“We are competing with public schools who get out at 3 pm and don’t work in the summer,” Allred told me. “This has been sold as not a profession for so long.” 

Groginsky, the ECECD commissioner, noted that infant and toddler care was a problem nationwide and not just in New Mexico and that the state has put “unprecedented public investment” into the childcare sector.  

But the data also makes clear that the failure of vouchers to build supply is having the biggest impact on these youngest children. While the absolute number of infants and toddlers in the program has grown alongside overall enrollment, the gains are far below those of older children. According to the Legislative Finance Committee, the proportion of children under age 2 enrolled in the state’s assistance program has nearly been cut in half, dropping from 21.3 percent in 2020 to just 11.6 percent in 2025.  

Allred’s experience explains why: Infants require more adults to care for them, making them the most expensive slots to provide. 

Other countries have struggled through these problems

We know exactly how New Mexico’s path ends, because Quebec and South Korea made the exact same mistakes decades ago.

To quickly implement universal systems, they took a path that sounds familiar. In 1997, Quebec rapidly expanded subsidies to more providers to meet its bold “$5-a-day” promise for childcare costs. In 2012, South Korea invested billions in demand-side vouchers. In both cases, they prioritized the speed of the expansion over building the supply and workforce to support children.

The consequences of outsourcing universal care to the path of least resistance were severe. In South Korea, the flood of state funds into the private market created a two-tiered system, leaving parents on years-long waitlists for the few high-quality public centers. 

In Quebec, the result was equally cautionary. While the 1997 rollout successfully boosted maternal workforce participation, it took nearly a decade for landmark longitudinal research by economists to empirically prove the developmental cost of that rushed expansion. Because the province scaled up so quickly, relying heavily on lower-quality, hastily assembled care settings to absorb the massive surge in parent demand, researchers tracked lasting negative impacts on children’s non-cognitive development, including increased anxiety and aggression.

To be clear, this data does not suggest that universal childcare is inherently harmful. Rather, it shows that treating childcare merely as a demand-side affordability issue can actively harm the children the policy is meant to serve. Quebec has since become an example of what can work by course-correcting: raising educators’ wages, tightening quality requirements, and heavily prioritizing the expansion of its public education system through non-profit childcare centers.

Treating childcare like essential public infrastructure works

The good news is that we don’t need to study abroad to see the benefits of well-implemented universal childcare. 

Jurisdictions like New York City, Vermont, and San Francisco are proving that, when robust financing meets well-planned policy, children and families win. By treating early childhood education not as a private consumer transaction, but as essential public infrastructure, these governments are building systems that actually deliver on the promise of access.

In Vermont, where Act 76 was passed in 2023 to establish a payroll tax to fund childcare, the state has begun shifting to predictable, stable funding through contracts with childcare providers. The bill officially set the stage for state-mandated minimum pay standards for early childhood educators and created clear career pathways to elevate what is often maligned as “babysitting” into a respected profession. When Vermont’s governor attempted to veto the bill, the state legislature successfully overrode him , recognizing that, without stabilizing the workforce, the entire system would collapse.

San Francisco has also taken a different approach, investing in the workforce first and expanding second. In 2018, voters passed “Baby Prop C,” a commercial rent tax dedicated to early childhood. Rather than immediately using that funding to subsidize more families, the city’s Department of Early Childhood spent years building the supply side, including offering educators a stipend of $4,000 to $39,100 annually to raise wages to that of K-12 public school teachers. Only after years of stabilizing the workforce did the city announce, in early 2026, a massive expansion that guarantees free childcare for families earning up to $230,000 a year. 

Finally, New York City is demonstrating how to phase in universal childcare intentionally. Rather than flooding an unprepared market with vouchers, the city treated expansion like a public works project. They rolled out by age, starting with Universal pre-K for 4-year-olds, then expanding to 3-year-olds. Now, the city and state are methodically rolling out “2K” starting in 2026, with 2,000 seats strategically placed in high-need neighborhoods to ensure the physical supply is in place before expanding citywide. Crucially, the state is backing this up with over $150 million in direct capital funding to build new classrooms.

States looking to make the universal childcare moment work for children can learn from these lessons and from the hard-fought financing victory in New Mexico. But funding is only the first step. Until policymakers stop relying on expanding the limited systems we have and start directly funding the facilities and the educators required to do the work, universal childcare will remain a brilliant promise that benefits only some.

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

For nearly a decade, Lauren served as the animal control manager for a county in North Georgia. It was a round-the-clock, always-on kind of job, in which she and her employees responded to animal cruelty and neglect cases, dog attacks, and animal escapes.

Saving animals was, and still is, Lauren’s passion in life. But some weeks, the cruelty and the stress of the job got to be too much. It came to a head in early 2024 when she showed up to a man’s house and found 27 hound dogs outside exposed to the freezing cold. 

“It was one of the coldest nights, unseasonably, for the state of Georgia,” Lauren told me, and “these dogs are out there with no shelter.” The man was breeding the hounds to be used as hunting dogs, and her department had already told him to get them shelter, but he hadn’t complied. That left Lauren and her colleagues with two choices: let the dogs freeze to death or bring them into the county animal shelter, where they’d remain indefinitely during a cruelty investigation and court proceedings. They took the dogs.

But the shelter was already full, so she and her colleagues had to make a tough call; they euthanized dozens of animals there that day in order to make space for the 27 hounds.

“The shelter worker’s the one that’s got to stand over that body and decide, ‘Is today that animal’s day?’” Lauren said.

“And, I’m sorry, but some of that never leaves you; you carry it the rest of your life,” she said. (Lauren is a pseudonym. She requested anonymity to speak openly on sensitive issues because she’s still involved in Georgia’s animal welfare community.)

Just days later, she responded to a situation in which two dogs had attacked people and were then shot by the police — one dog died, while the other was rushed to a veterinarian’s office. Around this time, the county shelter was also dealing with a severe disease outbreak, and one of her employees got injured while trying to catch a loose animal. 

“How am I supposed to mentally and emotionally deal with all of that at one time?” she told me. Lauren quit a few months later, she said, because the compassion fatigue — the deep emotional and physical exhaustion that can result from intense caregiving — had become too much to handle.

This wasn’t Lauren’s first bout of compassion fatigue. She had worked at an animal shelter in the 1990s where, two to three times a week, she’d have to go into a room and euthanize dogs for hours at a time. 

Animal control and shelter workers, who often work hand-in-hand and share many of the same burdens, “get the trauma heaped on them daily that lasts most people a lifetime, and nobody inside or outside talks about it — it’s the dirty secret of [animal] sheltering,” Lauren told me.

Across the US, animal control officers and shelter staff are overworked and underpaid. Turnover is incredibly high, as many of them become burnt out from bearing the immense emotional and physical burden of the job. Collectively, these workers euthanize an average of over 1,600 dogs and cats each day, while responding to countless cruelty and neglect cases; rounding up millions of strays; routinely putting themselves in harm’s way; and dealing with indifferent, difficult, and even hostile pet owners. 

They are the frontline workers of America’s long-running and ever-evolving pet overpopulation crisis, currently fueled by a decline in spay and neuter rates, the rising costs of veterinary care, and a chronic lack of government funding. 

Then, there are the American consumers, many of whom prefer to buy dogs and cats from breeders, even as millions of animals in need of a good home languish in shelters, where they will be euthanized if they’re not quickly adopted. Last year in the US, almost 6 million pets went to animal shelters. Ten percent were euthanized.

“We live in a throwaway society, be it the animals or their TV,” Lauren told me. “People throw stuff away all the time, and somebody’s got to be there to clean it up.”

“You will not forget the dog’s name”

Animal sheltering, for all its challenges, has come a long way. To see how, just read this New York Times story from 1877, which describes how the city pound euthanized stray dogs by loading dozens at a time into an iron crate and lowering it into the East River for 10 minutes to drown them. 

At the time, large numbers of stray and semi-domestic animals roamed city streets and were generally considered a nuisance for barking, fighting, defecating, rooting through garbage, and biting people. But, in time, the pet overpopulation problem morphed from one of too many stray animals to too many pets. 

By the 1940s, the role of cats and dogs had largely shifted from “working” animals to companions, and advances in veterinary medicine, the growth of the suburbs, and the emergence of large-scale dog breeding operations led to the nation’s pet population doubling in the decade after World War II. But with a boom in the nation’s pet population inevitably came a boom in unwanted pets.

According to one estimate, animal shelters euthanized 13.5 million of these unwanted cats and dogs in 1973. That number had plummeted to 596,000 by 2025, even as the US pet population swelled. Researchers attribute much of this sea change in euthanasia rates to the rise of spay/neuter programs. In the 1970s, shelters and animal welfare groups worked with veterinarians to offer high-volume, low-cost spay/neuter clinics, and since the late 1990s, more than 30 US states have passed laws that require shelter pets to be spayed or neutered before adoption. The growth of animal rescue organizations that facilitate pet adoption has undoubtedly played a big role in reducing euthanasia numbers, too. 

This represents enormous progress. But as the situation has improved for animals, so, too, has our understanding of how gut-wrenching this field’s work can be for the humans who do it.

In the late 1980s, researchers began to interview animal shelter employees about the toll that euthanasia and other parts of the job takes on their well-being. In the decades since, we’ve come to learn that performing euthanasia predicts poorer mental and physical health, including higher levels of work stress; lower levels of job satisfaction; and higher rates of anxiety, depression, and substance abuse than the general public.  

Some of the stress these employees feel is the result of what sociologist Arnold Arluke calls the “killing-caring” paradox, in which they routinely have to kill animals they’ve spent days, weeks, or months caring for and getting to know. 

“You will not forget the dog’s name, you will not forget the animal’s face,” Caitlan Frazier, director of Aransas County Animal Care Services in Texas, told me. She recounted to me the guilt she felt for having to euthanize a litter of newborn kittens, because there was nobody to provide the round-the-clock care they needed (she certainly couldn’t with two kids and nine animals of her own at home).

She told me a story about a dog named Bougie whose bites put her in the hospital for four days. Despite what he put her through, Frazier said, “I still feel guilty with that dog, because I feel like, if I would have given him more time [for training], maybe he wouldn’t have been put down.” 

But many shelter workers also expressed anger toward the people whose actions drive the pet and shelter overpopulation crisis: owners who acquire a pet when they’re not ready for the responsibility or who fail to spay/neuter or vaccinate their animals when it’s available, as well as those who casually breed dogs and cats and then dump the ones they can’t sell onto shelters.

“It’s draining, heartbreaking, and maddening, especially when the animal is young and healthy and you’re euthanizing for space,” Bailey Smith, who works at the Humane Society of Young County in North Texas, told me over email. “I still cry sometimes.” (I should note that every shelter worker I spoke with also considers euthanasia the greatest gift they can give to animals who are severely injured or diseased or are too aggressive to be adopted.)

Other problems also increase animal control and shelter workers’ stress: bearing frequent witness to animal cruelty and neglect, physical injuries inflicted by the very animals they’re caring for, and the always-on-call nature of the job. 

Keane Menefee understands the strains of the job well. He joined the animal control department in Fort Worth, Texas, in 1997 and worked there until 2010, when he quit due to compassion fatigue. The euthanasia work took its toll, but so did the long hours and the horrors he saw in the field, including a girl who had been mauled to death by a dog. He told me stories of night terrors and attempted suicide.  

The job puts “wear and tear on you on every level of your being,” Menefee told me. He now teaches courses for animal control officers, including one on compassion fatigue. 

Another challenge of the job is dealing with members of the public who get angry at animal shelters and their employees about essential parts of their work, including euthanasia.

In 2008, The Oprah Winfrey Show aired an episode about puppy mills, and Menefee went on to talk about the high euthanasia rate at his shelter — a rate that was so substantial, in part, because of puppy mills churning out a large volume of dogs. 

“I wasn’t ready for what was to happen,” Menefee told me. Within hours, he received over 3,000 emails, and virtually all of them were hateful. Some included death threats, with people going so far as to tell them they knew his home address and the school his children attended. 

“I understand the sensitivity” to euthanasia, Menefee told me. “But this is not the animal control’s fault, this is not the shelter worker’s fault.” Many people, he said, just don’t understand how these industries and laws work to create the conditions that make euthanizing perfectly adoptable animals a necessary part of the job. 

What animal shelter workers want you to know 

When I asked people in the animal control and shelter community what’s most needed to bring down pet overpopulation and make their work sustainable, the answer, invariably, came down to money.

Animal control departments are run by city or county governments, and the vast majority of animal shelters are either government-run or -funded. And they work together to manage their region’s pet overpopulation challenges. One thing they all have in common is that they’re all operating on shoestring budgets (as are the privately run shelters, operated by nonprofits), so there’s never enough staff or space to meet the needs of the animals in their communities. But, ultimately, many of the people I spoke with say a lot of the money should go directly to providing pet owners with low-cost spay and neuter, which has been in shorter supply in recent years. 

“Spay/neuter — it’s not sexy, it’s expensive, it’s constant, but it truly is the number one way to curb our [pet] overpopulation crisis,” Shelby Bobosky, who formerly served as executive director of the Texas Humane Legislation Network and now teaches animal law at Southern Methodist University, told me. “Overpopulation is a simple math problem.” 

Bobosky also wants to see policymakers crack down on puppy mills, strengthen animal cruelty laws, mandate spay/neuter procedures, and restrict the sale of animals at pet stores. 

Smith, of the Humane Society of Young County in North Texas, told me more pet-friendly housing and low-cost veterinary care are also critical. About one out of five animals surrendered to shelters are given up because their owner could no longer afford them or couldn’t find accommodating housing.

But Smith also wants to see more responsible, thoughtful pet ownership. “People need to think before bringing a pet home,” Smith told me. “Are they ready for the commitment?” 

The costs can add up quickly: food, spay/neuter, vaccination, training, insurance, and veterinary care — not to mention time giving their animals plenty of daily exercise and attention. While a lot of pets are given up due to affordability issues, a lot are given up for less black-and-white reasons, like their owner simply had too many animals, or they didn’t want to deal with a (non-aggressive) behavioral issue. 

Beyond more responsible acquisition and caretaking, the public can help by fostering animals at home and volunteering to walk shelter dogs. 

“An animal starts mentally deteriorating in a shelter within three weeks of being there,” Frazier said. “If you don’t have that extra enrichment or those volunteers or people coming and doing things with these animals…those animals mentally deteriorate so fast that they can’t even be adopted anymore.”

As for the well-being of the animal control and shelter staff, many told me that just talking about the challenges of the job helps. “I’ve had compassion fatigue three times in the last eight years,” Frazier told me. And if it weren’t for talking with her peers and co-workers, she said, “I don’t know if I’d still be in this job.”

Of the numerous training courses Menefee offers, his one on euthanasia and compassion fatigue gets the most repeat attendees. In the course, he’s direct and open about the mental health struggles he’s endured while working in animal welfare because “it’s not said enough in this industry.” He wants people to know they’re not alone, that they’re not weak, that they can handle the job, but also that there are warning signs to watch out for and things people can do to protect themselves.

But as hard as the job is, many people I spoke with also told me how much meaning it gives their life and about the powerful bonds they have formed with others in the trenches. 

“One of the things I love about this industry is just how close-knit the people who work in it are,” Menefee said. “When these individuals get together, they see that we’re all facing the same challenges and they start telling their stories and they…get some comfort in knowing ‘I’m not alone and I’m not the only one.’”

Our relationship with dogs, cats, and other animals kept as pets is often portrayed as joyful and uncomplicated: They love us unconditionally, and, in return, we promise to provide the best care we can for them. There’s some truth to that, but spend just a moment looking under the surface of this story, and you’ll find a darker side to it: millions of people making millions of choices, many of which put unlucky animals through hell and put the people tasked with caring for them into impossible situations. 

We need a more honest and nuanced story to explain our relationship with pets, and we can start by listening to the ones America’s animal shelter workers have to tell. 

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

For more than a century, the world has run on coal.

When Thomas Edison’s Pearl Street electrical station in Lower Manhattan fired up in 1882, it ran on coal. Coal survived the oil era, the nuclear era, the dash for natural gas, and decades of back-and-forth climate policy. From the 1970s through the mid-2010s, coal supplied somewhere between 35 and 40 percent of the planet’s electricity, a steady if sooty presence powering modern life.

Then last year, it lost the lead. According to Ember’s Global Electricity Review 2026, recently released in time for Earth Day, renewable sources produced 33.8 percent of the world’s electricity last year, compared to 33 percent for coal. It was the first time those two lines had crossed since 1919, when the global grid was still small enough to run mostly on hydropower.

As coal has declined — at least on a relative basis — the sun has risen. When the Paris climate agreement was signed in 2015, solar produced just 256 terawatt hours of electricity globally. Nuclear power plants, at the time, were pumping out about 10 times that, while wind was responsible for three times as much electricity as solar. 

A decade later, solar is producing 10 times more power: 2,778 TWh, roughly what the entire European Union consumes in a year. Its production has doubled in the past three years alone. For 21 years running, solar has been the fastest-growing source of electricity on the planet. In 2025 it surpassed wind for the first time, and is now on pace to pass nuclear this year.

While the world still burns a huge amount of coal — some 8.8 billion tonnes in 2024, according to the International Energy Agency (IEA) — solar alone covered 75 percent of the rise in global electricity demand. Put wind and solar together, and you’ve met 99 percent of it. Fossil fuel power generation — coal, oil, and gas combined — fell 0.2 percent in 2025, the first decline since the pandemic and only the fifth year this century that fossil generation didn’t rise. 

Clean sources are now growing fast enough, on their own, to absorb just about everything the world is adding to its grid. And there’s a decent chance that, thanks in part to what’s happening right now in the Middle East, that transition may speed up.

Why solar is no fluke

It all starts with cost.

Solar module prices have fallen roughly 75 percent every decade for more than 40 years, a pattern so durable it has its own name, Swanson’s law, the observation that the price tends to drop by 20 percent every time the total number of solar panels ever built doubles. This rule has held through supply gluts, trade wars, and pandemics. In the mid-1970s, a solar module cost more than $100 per watt. In late 2025, one panel cost about 10 cents per watt. No other major energy source in modern history has gotten that cheaper, that fast.

The oldest objection to solar — that it goes dark when the sun goes down — is becoming obsolete because we can increasingly store the daytime electricity solar units generate. Battery costs dropped 20 percent in 2024 and another 45 percent in 2025. Global battery deployment grew 46 percent last year, to 250 gigawatt-hours. Solar plants built with enough batteries to deliver power round the clock now sell electricity in the US for around $76 per megawatt hour, cheaper than building new natural gas capacity.

The China story

The world’s long-time manufacturing powerhouse — China — has made this shift possible. Chinese factories now make around 80 percent of the world’s solar panels and an even larger share of the polysilicon, wafers, and cells that feed into them, a dominance built over two decades of state-backed investment, enormous scale, and ferocious price competition. The result is the cheapest energy technology in human history, produced at a pace the rest of the world has not matched. 

Chinese dominance has also made clean power a geopolitical story: tariffs, trade disputes, arguments in Washington and Brussels about whether to build parallel supply chains. For the climate, though, the math is simple. Cheap panels built anywhere cut emissions everywhere.

The demand side has moved too. For most of the last two decades, the global coal story has been a Chinese story. When China’s electricity demand surged, so did coal. When it slackened, so did coal. That relationship cracked in 2025: China’s fossil generation fell 0.9 percent, its first decline since 2015, even as the country’s electricity demand rose 5 percent. India’s fossil fuel generation fell as well, by 3.3 percent, while its renewables grew 24 percent year over year. In both cases, new clean energy capacity outran new demand. Ember found that renewables in China now produce more electricity than every household and service-sector business in the country, combined.

Don’t get carried away — yet

A flat year for coal is not the same as a falling one. Power-sector emissions in 2025 were still close — within a rounding error — of 2024’s levels, which set a record high. In its report, Ember calls this moment “the era of clean growth,” which should be understood as the start of real decarbonization, rather than a final state of decarbonization.

Coal’s share is shrinking — from a peak of 41 percent of global generation in 2013 to 33 percent today — but the fleet itself isn’t going away. China approved more than 40 gigawatts of new coal capacity in just the first three quarters of 2025. Thanks to growth in renewables, these plants are increasingly becoming a backup source, rather than a primary one. But those plants exist, they burn coal when they run, and they’ll burn coal for years.

Then there is the US. The Trump administration’s One Big Beautiful Bill Act ended the residential solar tax credit in December and tightened eligibility for commercial projects. Rhodium Group, a research institute, projects the law will cut US clean-capacity additions through 2035 by more than half. America is in danger of getting left behind.

That sounds bad, and in the short run it is. But policy can slow a market; it has a harder time stopping one when the economics have already shifted. BloombergNEF reported that global energy-transition investment hit a record $2.3 trillion in 2025, up 8 percent from 2024. China alone put roughly $800 billion into clean energy last year; India’s clean-energy spending climbed 15 percent to about $68 billion; the EU has been accelerating renewables spending ever since Russia’s invasion of Ukraine cut its pipeline gas. Even if Washington slows down, the rest of the world is building solar farms and battery plants as fast as the supply chains allow. The US is trying to run against a market it no longer controls.

There is, however, the AI wild card. The IEA estimates global data-center electricity use rose 17 percent in 2025, with AI-specific demand growing faster. In the US, gas is currently the biggest single source of new data-center supply. Artificial intelligence is the one uncontrolled variable that could swamp clean-power gains in the back half of this decade.

Strait talk

The last big oil shock rewrote the global energy system. After the 1973 OPEC embargo, President Jimmy Carter put solar panels on the White House, founded the Solar Energy Research Institute in Golden, Colorado, and signed the country’s first appliance efficiency standards into law. Ronald Reagan undid much of that work, but the seed technologies — photovoltaic R&D, efficiency standards, CAFE rules for cars — kept developing in the background for decades.

This time, the shock is being felt by a system where clean alternatives are already the cheapest option in most places. The US-Iran war has led to the effective closure of the Strait of Hormuz, through which roughly a quarter of seaborne oil and a fifth of global LNG normally flow. The IEA called it the largest supply disruption in the history of the global oil market.

The response has been exactly what cheap clean power makes possible. In March, global solar generation grew 14 percent year over year and wind grew 8 percent; solar alone saved European buyers some $3.5 billion in gas costs for the month. Countries that might have responded to an oil crisis in 2006 by drilling faster are instead moving up construction for solar farms, offshore wind, and grid-scale storage. Where the 1970s planted seeds that took 40 years to sprout, 2026’s shock is meeting an industry already at commercial scale.

The climate case for clean power has always rested on a simple bet: that the technologies would keep getting cheaper faster than the politics got worse. Today, solar is the fastest-growing source of electricity in the history of electricity, while coal looks to be on a terminal decline. Batteries are starting to make it a 24-hour fuel. What comes next is a question of speed — and speed, mostly, is a question of choice.

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Your Mileage May Vary is an advice column offering you a unique framework for thinking through your moral dilemmas. It’s based on value pluralism — the idea that each of us has multiple values that are equally valid but that often conflict with each other. To submit a question, fill out this anonymous form. Here’s this week’s question from a reader, condensed and edited for clarity:

Spring is here, which means the pests are back. My parents’ house has an ant problem. I found weevils in my pantry, and I know people with wasp infestations in their places. Tick season has begun, and last year’s bedbug scare was legitimately traumatic. I don’t like killing insects, but if they’re in my space uninvited and I can’t just take them outside and easily prevent them from coming back, I’ll do it.

But I do feel bad about doing it, even sparingly. I think it’s plausible that insects feel pain, so I try to make it quick, yet I’m still making the choice to kill them and it’s not one I’m proud of. I think that pests, like all living things, have some moral weight — but there’s not room enough for the two of us. Is it bad to kill them? Is there a more ethical way to approach this?

Dear Bugging Out,

I love that you’re sensitive to the potential suffering of Earth’s teeny-tiny, creepy-crawly creatures. I hope you never lose that. But I do hope you lose the guilt you’re feeling.

You’re right to think it’s plausible that insects feel pain. We don’t know for sure yet, but in recent years, scientists have been accumulating evidence that suggests at least some insects possess sentience — the capacity to have conscious experiences that are valenced, meaning they feel bad (pain) or good (pleasure). 

Bees, for example, appear to play — just for fun. They also actively seek out mind-altering drugs like nicotine and caffeine, which suggests there may be a mind there to alter. Plus, bees seem to experience pain consciously, not merely flinch from it by reflex. In a 2022 study, bees approached a sugary snack even though it meant facing uncomfortable heat, weighing costs against benefits in what scientists call a “motivational trade-off.” A pure automaton couldn’t do that; it would flee heat in every situation. The capacity to weigh competing drives is one of the markers of sentience.

Meanwhile, fruit flies have shown signs of anhedonia — the loss of interest in previously pleasurable things (like food) that we know as a symptom of depression in humans. Treat the flies with a human antidepressant and it’ll suppress the depression-like state in the insects, too. 

One of my colleagues confessed to me recently that evidence like this makes her feel super guilty: When she goes around killing these insects in her kitchen, she asks herself whether she’s “a fruit-fly Nazi.”

But the key thing to realize is this: Bugs may have some kind of sentience, and sentience may confer some moral status, but that doesn’t mean that provides the last word on how we should act toward them. 

Just because another creature might have moral weight, that doesn’t necessarily tell you how to treat that creature when its welfare conflicts with the welfare of a creature you know has moral weight: you.  

So, how can you know if or when it’s okay to kill a bug? 

I think the most compelling response comes from Elizabeth Anderson, a contemporary philosopher who subscribes to the school of thought known as pragmatism, which sees moral truths as socially embedded and historically contingent, not fixed and objective.

Anderson points out that for most of human history, we couldn’t have survived and thrived without killing or exploiting animals for food, transportation, and their energy. The social conditions for granting animals moral rights didn’t really exist on a mass scale until recently (although some non-Western societies have long ascribed moral worth to animals).

“The possibility of moralizing our relations to animals,” she writes, “has come to us only lately, and even then not to us all, and not with respect to all animal species.”

Anderson has noted that we feel different levels of moral obligation to different species, and that has to do not only with their intrinsic capacities like intelligence or sentience, but also with their relationships to us. It matters whether we’ve made them dependent on us by domesticating them, or whether they live in the wild. It also matters whether they’re fundamentally hostile to us.

Thinking about pests is a great (if gross) way to bring this point home. If you find bedbugs in your house, nobody expects you to say, “Well, they’re maybe sentient and definitely alive, so they have moral value. I’ll just live and let live!” It is absolutely expected that you will exterminate the shit out of them.

Why? Because with pests, Anderson writes, “there is no possibility of communication, much less compromise. We are in a permanent state of war with them, without possibility of negotiating for peace…Indeed, we have an obligation to our fellow members of society (whether human or animal) to drive them out, whenever this is necessary to protect ourselves.”

Anderson’s point is not that sentience doesn’t matter. It’s that lots of other things matter, too, including our own ability to thrive.

Embracing this value pluralism makes things tricky. It suggests that the best we can do is look at creatures’ intelligence and sentience and relationships to us as clues about how we should negotiate life with (or without) them. But it doesn’t tell us how to weigh those clues — and what to do when they conflict with the interests of other animals, including us.

“There’s no simple formula,” Anderson once told me. “I think that’s a hopeless quest.”

That is, for my money, the most intellectually honest position. The absence of a fixed formula doesn’t mean you should exist in a state of guilty indecision or paralysis. Instead, the best thing you can do is have the integrity to recognize that sometimes life presents you with trade-offs where you have to make a choice. And when it comes to insects, you’re making that choice from a position of considerable power. 

This is the conclusion Robin Wall Kimmerer reaches in her book Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge, and the Teachings of Plants. The scientist describes how she had an algae-filled pond in her yard that she wanted to clear out so her daughters could swim in it. As a member of the Citizen Potawatomi Nation, though, she believes that all life has moral worth. So as she raked out the muck and found that it was full of tadpoles, she plucked them all out so they could go on living. Then she inspected the pond water under her microscope and saw a ton of teensy organisms, each one a moral dilemma. She writes:

As I raked and plucked, it challenged my conviction that all lives are valuable, protozoan or not. As a theoretical matter, I hold this to be true, but on a practical level it gets murky, the spiritual and the pragmatic bumping heads. With every rake I knew that I was prioritizing. Short, single-cell lives were ended because I wanted a clear pond. I’m bigger, I have a rake, so I win. That’s not a worldview I readily endorse.

But it didn’t keep me awake at night, or halt my efforts; I simply acknowledged the choices I was making. The best I could do was to be respectful and not let the small lives go to waste. I plucked out whatever wee beasties I could and the rest went into the compost pile, to start the cycle again as soil.

In a way, it’s an unsatisfying solution — a lot of us would probably sleep easier if nature came inscribed with clear bright lines and moral instructions. But there you have it. Like Kimmerer, I think you should practice a kind of harm reduction. To the extent that you can “live and let live” with insects, that’s ideal. Try to minimize how many you kill. But when you do make the choice to kill them, try to do it in a way that reduces the risk of suffering (think: quick and painless crushing rather than long and drawn-out poisoning).

That’s not only for the bug’s benefit, but for yours, too. Harming any animal can harm our character if we do it mindlessly or callously, because it desensitizes us to life. But when we let ourselves be touched by life, we can maintain our reverence for it. The reverence — not the guilt — is the thing you want to hold onto. 

Bonus: What I’m reading

• This piece on “What It’s Like To Be a Worm” taught me that Darwin was obsessed with…worm sentience! He even argued that earthworms are capable of motivational trade-offs: “Their sexual passion is strong enough to overcome for a time their dread of light…and we have seen that when their attention is engaged, they neglect impressions to which they would otherwise have attended; and attention indicates the presence of a mind of some kind.”
  
• This Aeon essay about the history of eugenics is absolutely fascinating. It reveals that some disabled people actually supported eugenics in the 1930s, seeking out sterilization for themselves. I think internalized ableist logic had a whole lot to do with this.
  
• I loved psychologist David DeSteno’s recent piece, “Anthropic Wants Claude to Be Moral. Is Religion Really the Answer?” If you ask me, we keep making the Enlightenment-era mistake of thinking morality is primarily undergirded by rationality. But if it’s undergirded by emotion, it’s a fundamentally embodied human pursuit and the desire to mathematize it is itself irrational.

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

This story was originally published in The Highlight, Vox’s member-exclusive magazine. To get access to member-exclusive stories every month, become a Vox Member today.

For years, the “Make America Healthy Again” movement was driven by moms.

Concerned about the safety of childhood vaccines and about chemicals in the food their kids were eating, they helped propel Donald Trump to the White House — and Robert F. Kennedy Jr. to the role of the nation’s top health influencer — with a message centered on fear for the next generation. 

Now, that next generation is here.

The latest MAHA advocates to gain public attention are women in their teens or early 20s. Lexi Vrachalus, 20, posts videos of her seed-oil-free, sugar-free meals, snacks, and shopping trips. In a post around Easter, she made her own Peeps with maple syrup and beef gelatin.

Her message: “You can take back health into your own hands,” she told me. “You have the power to heal your body.”

She and other influencers, like the young filmmaker Grace Price and clean-living maven Ava Noe, are creating videos with a younger sensibility than their forebears — think baking sourdough for siblings rather than talking about kids’ vaccines. And their version of MAHA (that’s Make America Healthy Again, for the uninitiated) is breaking through to American teens.

“I get questions from my younger audience like, how can I encourage my parents to eat healthy?” Vrachalus said. “Or, how can I eat healthy when all my parents do is buy junk food?”

On the surface, there’s nothing wrong with young people trying to eat healthy. But educators and misinformation experts are worried about what comes next: Among adults, MAHA influencer culture has served as a funnel for a host of beliefs and behaviors that start with skepticism, veer into suspicion of all authority, and end up with actively dangerous behavior, including a resistance to vaccines that has led to outbreaks of disease.

“There’s this focus on healthy foods and environmental concerns, but running under the surface of some of those more superficial connections is this idea that there’s this cabal,” said Whitney Phillips, a professor of information politics and media ethics at the University of Oregon. “There’s this kind of conspiratorial thinking that ‘they,’ coded as liberal, are lying to you.”

So far, polling shows that young people are less likely to identify with MAHA than Americans in their 30s and 40s. But MAHA-inflected wellness videos are reaching more teens, and there’s evidence that more young people are falling for health misinformation that they see online. 

In a 2024 survey by the News Literacy Project, 80 percent of teens said they saw conspiracy theories on social media platforms, and a majority of those teens said they were inclined to believe one or more of those theories. The second most common type of conspiracy theory mentioned by teens in the survey (after “aliens & UFOs”) was content around Covid-19 and public health issues.

The rise of young MAHA influencers has educators and other experts asking what they can do to help Gen Z and Gen Alpha Americans — a group already deeply distrustful of institutions and authorities — distinguish reality from toxic misinformation. If teachers, families, and policymakers hope to thread that needle, they’ll have to do more than just respond to false claims point-by-point — they’ll need to address the sources of discontent and disaffection that may be pushing young people toward MAHA in the first place. 

The new face of MAHA

If you had to picture the MAHA coalition, you might think about a group of millennial and Gen X moms, banding together over their opposition to vaccine mandates and food additives. Or maybe you’d call to mind someone like Andrew Huberman or Joe Rogan, male podcasters in their 50s extolling the virtues of supplements and protein to an audience of “Huberman husbands.”

And sure, that’s today’s MAHA — a recent Politico poll found that those most likely to identify with the movement were Americans in their 30s and 40s. 

But tomorrow’s MAHA is coming, and the teen girls and young women emerging as MAHA influencers show us what it might look like. 

Vrachalus, for example, has more than 170,000 followers on Instagram — not as many as established voices like Vani Hari with follower counts in the millions, but a respectable reach for a creator, especially one so young. Vrachalus recently made a video with Kennedy, the Health and Human Services secretary, to promote the new federal dietary guidelines. 

When she was diagnosed with anorexia at 13, a dietitian told her she’d have to eat “junk food” in order to get better, Vrachalus told me. Instead, “I started to research, and I realized that basically everything in the grocery store is ultraprocessed junk food,” she said. 

Today, “I heal my body using real food that God created and designed us to eat,” she said.

Ava Noe, 18, has about 26,000 followers on her Instagram account, @cleanlivingwithava. She hopes to show young people that they “don’t have to be a certain age to take their health into their own hands,” she told me. “It’s never too early to start maximizing your health.”

For Noe, that looks like anything from searching for “clean” food at the grocery store to medically controversial practices like making her younger siblings use fluoride-free toothpaste. 

Meanwhile, some older MAHA influencers feature their young children as a way to get their message out to families. Gretchen Adler, for example, a creator with over 500,000 Instagram followers, recently posted a video in which her 9-year-old daughter explains why she makes her own gummy candy from orange juice and gelatin. Storebought gummies, she says, are “pure trash.”

“I’ll always say to show this to your child,” Adler says of her daughter’s appearances on her feed. “That’s the way that we can inspire these people or these young children, is when they see another child that they can relate to.”

The anti-seed-oil to anti-vax pipeline

Young people may be an especially receptive audience for the message that they can take their health into their own hands.

Gen Z Americans “feel very disillusioned by organizations in society and institutions, including, of course, medical institutions in the wake of Covid,” said Melissa Deckman, CEO of Public Religion Research Institute and author of The Politics of Gen Z. 

They are more likely than their elders to rely on friends and family or social media for health advice, and less likely to rely on doctors. They also distrust news outlets that could give them fact-checked information about health claims.

At the same time, young people are concerned about their health, experts say. “I have seen students become more inclined towards trying to think about wellness because they need to, because they’re not doing well,” said Phillips, who has taught university students for 18 years. “College students used to be some of the most carefree people in the world, and that just isn’t what is true anymore.”

The result, some say, is a population especially primed to listen to MAHA messaging delivered by influencers their own age. “These are beautiful young people that are promoting it, and they’re thinking, old people don’t know what they’re talking about. Here’s this cute 22-year-old who’s explaining this to me,” said Bertha Vazquez, who runs Generation Skeptics, a program that trains teachers to respond to misinformation.

However, experts worry that some MAHA content could be harmful, not helpful, for young people’s health. Such content often promotes the idea that consumers need to be vigilant about their food to avoid “toxins,” or that products can be divided into “real food” and “not-real food.” 

“That black-and-white thinking is very dangerous for people that have vulnerability to eating disorders,” Zoë Bisbing, a psychotherapist specializing in disordered eating, told me. 

Vrachalus isn’t convinced that opposing processed food promotes disordered eating. “Our great-great-grandparents, they didn’t have Oreos, they didn’t have ice cream,” she said. “I just don’t think that our great-great-grandparents had eating disorders because they didn’t have fake food.”

But eating disorders aren’t the only concern experts have raised. Some fear that exposure to MAHA content could push young people toward harmful behaviors that Kennedy and other movement leaders have supported, from using beef tallow as sunscreen to avoiding vaccines or chemotherapy. 

 “When they do get a dangerous virus, or they do get cancer, or they do have a child, the big concern is that they will not get the vaccines and the standard care,” Vazquez said.

Vrachalus and Noe don’t talk as much about vaccines or avoiding modern medicine as older MAHA and MAHA-adjacent influencers do. “I’m not anti-Western medicine at all,” Vrachalus told me. “If I break my arm, I’m going to the doctor tomorrow.”

But previous generations of MAHA and wellness influencers have cast doubt on proven treatments from the measles vaccine to chemotherapy, sometimes while pushing dietary supplements that are unproven and unregulated, or foods like raw milk that can cause serious illness.

Some young people are already subscribing to this kind of thinking — 18-year-old Shelby Gwinn, who is studying to be a dietitian, recently told the New York Times that “all pills do is cover up a problem instead of getting to the root cause,” and that today she takes 30 supplements to manage her eczema. “I do think the government should step in if a food company is putting absolute trash or chemicals in their food products,” she said — “but then again, I don’t trust the government.”

There’s a long history of wellness movements shading into conspiracy theory, Phillips told me. This anti-government, anti-medicine thinking began to creep into many wellness spaces, including yoga studios, around the time of the pandemic. 

“The messaging is basically this idea that you can’t trust doctors, you can’t trust the medical establishment,” Phillips explained. “They are trying to poison you.”

Getting young people to trust science again

In a polarized political landscape in which many young people are disillusioned with traditional news sources, conspiracy theories can be especially difficult to counter. That’s doubly true since so many young people really have been failed by their doctors, their government, and their world. 

“There are so many different ways that institutions have really genuinely let people down,” Phillips said. “But being able to make those kinds of critiques is different than this kind of conspiratorial attitude towards institutions.”

Teaching young people to think critically about information, whether it comes from an authority figure or a content creator their own age, may involve separating that information from politics. 

Melanie Trecek-King, a biology professor at Massasoit Community College and founder of the website Thinking Is Power, likes to start with European witch trials. She helps her students evaluate the beliefs about witchcraft that led to these trials, the evidence presented against accused “witches,” and the harms — including torture and executions — that false beliefs caused. 

By choosing examples from the past that aren’t personal for students today, she avoids putting them on the defensive. And once they’ve learned the process of evaluating information and evidence, “then they will make the connection in the real world,” she told me.

Not everyone can take a class like Trecek-King’s. But educators say it’s crucial for science communicators to meet young people where they are, whether that means posting on platforms like Instagram and TikTok or responding to questions about health without judgment or shaming.

“We have to be going to the places where people are,” said Jessica Knurick, a science communicator and content creator who has a PhD in nutrition science. Too often, scientific and medical experts take the attitude that “you should just listen to us because we’re us, instead of talking to people on a human level and understanding where their concerns are,” Knurick said. 

Getting expert information to where teens and other young people can see it will require changing professional norms that discourage doctors and tenure-track scientists from being on social media, Knurick said. It will also require finding ways to compensate experts for their time in a social-media economy that doesn’t always reward sober fact-checking.

But more science communicators and groups that serve young people are rising to the challenge. And it’s possible that young people’s tendency to question everything can be part of the solution.

“These MAHA influencers, they’re so confident in their claims, and you’ll never see a scientist like that,” Vazquez said. “Science is never about 100 percent certainty.”

That’s something educators can teach students, Vazquez said: “If someone’s so cocksure of themselves, then that’s a red flag.”