Vertical Disintegration

A sight to behold: State bureaucracies versus the federal bureaucracy

In “normal” times of political dysfunction—you know, like when the nation and the “free” world are run by gigantic unelected bureaucracies and their elitist special-interest allies—government is like a siloed skyscraper.

From the street level of the local agency, all the way to the ivory tower penthouse inhabited by international “experts,” the floors can be accessed only by a single elevator of directives and funding. The elevator runs one way, there is no staircase, and there is no fire escape.

Some call it proxy government. Others call it cartel federalism. Whatever the label, the functionality is the same: a system that guarantees the growth of government at every level, erecting walls of impenetrable intergovernmental alliances in service of a central, and centralized, national authority.

A better term is vertical integration. In other words, local and state agencies take most of their orders from the federal bureaucracy, which itself answers to globalist elites and international “stakeholders.” It’s a description I’ve always found apt because it conveys a sense of those interlocking and reinforcing bureaucracies as a top-to-bottom vertical enterprise.

However one labels it, it has created a vast de facto central government, elected by no one.

Especially on the state level, unelected bureaucracies would rather curry favor (and jobs) by listening to Washington bureaucratic overlords rather to their own state’s elected leaders. This is less the case when you have a Democrat running the state’s executive show and all the woke stars align, as in Wisconsin.

The exception to the rule of vertical integration is when a president arrives intent on dismantling the deep state and, among other things, replaces agency heads with people who have spent decades opposing those very agencies. The mission becomes reversing the bureaucratic tide, pulling decisions back toward the express will of the people from the diktats of faceless administrators.

Now the dissidents are no longer on the outside looking in; they are riding the elevators up and down. They aren’t building fire escapes for the indentured bureaucrats, though. Instead, they’re locking the doors and leaving the bureaucrats to fight among themselves.

Suddenly, we find bureaucrats firing politically on bureaucrats, like Spy v Spy, a pretty glorious spectacle. State agencies, once docile subsidiaries, are tempted to jump from the skyscraper’s windows, as if they could fly away from the mother ship after so many decades of dependence. And in those moments, we see a new phenomenon—vertical disintegration.

Vertical disintegration is what is in the air these days. Conservatives pleaded for it for decades—states’ rights—now, with the shoe on the other foot, progressives crave it as a last chance for survival.

Jab, counter-jab

Nowhere is this rebellion more visible than in state health agencies. In Wisconsin, the Department of Health Services (DHS) has been engaged in a subtle but unmistakable tug-of-war with the federal Department of Health & Human Services (HHS) under secretary Robert F. Kennedy, Jr.

Vaccines represent the clearest fault line, and we can see the vertical disintegration just by looking at the public messaging.

Here is how Wisconsin DHS presents it: “Vaccination is the first line of defense for your child’s health,” says Stephanie Schauer, director of the Wisconsin Immunization Program. “Each vaccine is approved only after being proven safe and effective. Taking time now to ensure your children have received the recommended vaccines will make them less likely to get seriously ill, meaning less time out of school and away from work. And routine vaccines don’t just protect your child—they help keep classrooms and the whole community safe.”

Meanwhile, Kennedy’s message—underscored in a Fox News op-ed during the Texas measles outbreak—strikes a different chord: “Parents play a pivotal role in safeguarding their children’s health. All parents should consult with their healthcare providers to understand their options to get the MMR vaccine. The decision to vaccinate is a personal one.”

Both positions acknowledge the value of vaccines in disease protection and contributing to community immunity, but Kennedy adds a caveat: The government, he says, has a duty to be honest about vaccine injuries.

“As healthcare providers, community leaders, and policymakers, we have a shared responsibility to protect public health,” he wrote. “This includes ensuring that accurate information about vaccine safety and efficacy is disseminated. We must engage with communities to understand their concerns, provide culturally competent education, and make vaccines readily accessible for all those who want them.”

At the Wisconsin DHS, there is no such caveat or even hesitation. Vaccines are safe and effective. Period. Full stop.

Back in the good-old-days

Way back when, in the golden age of vertical integration, Wisconsin DHS marched pretty much in lockstep with the CDC’s Advisory Committee on Immunization Practices (ACIP). The alignment wasn’t perfect—there were occasional delays or selective adoptions—but in practice, ACIP recommendations became state law, rule, or policy.

By law, Wisconsin DHS has full discretion over school vaccine mandates—ACIP serves as guidance, not a legal leash. The details of which vaccines and how many doses are generally set through state rulemaking. Still, prior to the Trump administration, DHS followed in ACIP’s footsteps.

Interestingly, portions of the Department of Public Instruction’s Wisconsin School Nursing Handbook is currently under revision, but this is how a previous iteration put it: “While requirements vary from state to state, all states have immunization requirements for school attendance, usually based on recommendations of such national groups as the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and/or the American Academy of Family Physicians.”

As recently as the 2024–25 school year, DHS updated its requirements to explicitly bring Wisconsin “closer in line” with ACIP and neighboring states: “The following information is to assist vaccinators, schools, and health partners with understanding the changes to DHS 144, the state law covering school vaccine entry requirements. The purpose of these changes is to bring Wisconsin closer in line to the Advisory Committee on Immunization Practices nationwide recommendations and in line with neighboring states’ school requirements.”

Of course, all that was before May 2025, when Kennedy fired all 17 members of ACIP, accusing most of them of having conflicts-of-interest with big pharmaceutical companies. Most of them did.

“We are taking a bold step in restoring public trust by totally reconstituting the Advisory Committee for Immunization Practices (ACIP),” Kennedy said in announcing the firings...

Conflicts of interest persist, Kennedy said, observing that most of ACIP’s members have received substantial funding from pharmaceutical companies, including those marketing vaccines.

But then Kennedy hit on a key point, one to remember when you get annoyed by progressives who can’t seem to grasp reality or come even close to it: “The problem isn’t necessarily that ACIP members are corrupt. Most likely aim to serve the public interest as they understand it. The problem is their immersion in a system of industry-aligned incentives and paradigms that enforce a narrow pro-industry orthodoxy.”

Kennedy has it a little wrong. In reality they have become immersed in a system of bureaucratic incentives and paradigms that enforce a left-wing ideological orthodoxy, but, either way, there’s a government paradigm—a vertical integration, if you will—that removes government from the people’s control.

Kennedy is trying to bring it back to their control, and the ACIP was an important place to start, given its broad influence on the state level. Most people don’t realize it, but ACIP recommendations are woven into the legal and regulatory fabric of the nation. An Association of State and Territorial Health Officials analysis found nearly that some 600 statutes and regulations across 49 states, three territories, and Washington, D.C., explicitly reference ACIP recommendations. Those include insurance coverage mandates, public health protocols, pharmacist authority, and school entry requirements.

The reaction from blue states to Kennedy’s housecleaning was immediate, though expected. The Democratic governors of California, Washington, and Oregon denounced the move, pledging to stick with the old guidance and maintain Covid-19 vaccine recommendations for children and pregnant women. Reuters reported that some states, like Colorado, began writing laws to broaden their advisory sources beyond ACIP, adding recommendations from other special interests, ur, medical societies. Massachusetts considered legislation to let its own public health commissioner—not ACIP—set childhood immunization schedules, the news agency reported.

Wisconsin’s Democrats can’t rewrite the law, given the state’s Republican legislative majority, and state statutes don’t reference ACIP anyway, but the bureaucracy itself, in a show of resistance and apparent vertical disintegration, has resisted the federal shifts.

For example, as of June, the agency continues to strongly recommend the current Covid-19 vaccine for everyone aged 6 months and older, including pregnant women. DHS also says it independently reviews FDA and CDC guidance, and it assailed the HHS’s changes in recommendations for the Covid vaccine: “The recent changes in CDC guidance were not made based on new data, evidence, or scientific or medical studies, nor was the guidance issued following normal processes.”

Funny, they never “independently” reviewed federal guidance before Kennedy came along demanding “independent judgment, refus[al]to serve as a rubber stamp, and … a culture of critical inquiry—unafraid to ask hard questions.” Any one of those would likely scare a Wisconsin DHS bureaucrat into an early grave.

In May, the CDC did indeed rescind its recommendations for vaccinating healthy children and pregnant women against Covid-19, and the agency shifted to “shared clinical decision-making.” But ACIP has been just the start. The secretary not only dismantled ACIP, he slashed mRNA vaccine research funding, canceling $500 million in mRNA contracts, and said the Vaccine Injury Compensation Program, which is intended to compensate vaccine-injured children, is tilted against the children and their families, with the government itself putting its thumb on the scale.

“The [Injury Compensation Program] is broken, and I intend to fix it,” he wrote on X. “I will not allow the VICP to continue to ignore its mandate and fail its mission of quickly and fairly compensating vaccine-injured individuals.”

The divergence between the state and federal health agencies is stark—Wisconsin holding to establishment and explicitly pro-vaccine recommendations, Washington moving toward personal choice, and informing the public not just about the benefits of vaccines but their risks, too—as well as the reality of injuries.

Lindee Brill: Taking up the fight in Wisconsin

Into the center ring of all this in Wisconsin has stepped Republican state Rep. Lindee Brill of Sheboygan Falls. Brill is one of a handful of state lawmakers who have dared to stand up for true medical freedom, and just recently she and Sen. Rachael Cabral-Guevara (R-Appleton) introduced a bill that would require notification of parents about the existence of vaccination waivers in the state.

As Brill has stressed, her bill wouldn’t change Wisconsin’s immunization laws or waiver criteria; it would simply require schools to inform parents of the existing waiver options at the time of enrollment.

As she was touting this legislation—important in and of itself—the DHS decided to hold a press conference about recently reported declines in vaccination rates among students in the state, and to use those data points to push back against the new leaders of the federal bureaucracy who dare to embrace actual democratic expression and transparency.

At the press conference, revolving around measles cases in Oconto County, the state’s chief medical officer, Dr. Ryan Westergaard, appeared to tie low vaccination rates, at least in part, to the availability of waivers, sweeping in Brill and her bill.

Brill pushed back...

In fact, Brill continued, when a reporter specifically asked what the state was doing to urge manufacturers to separate the measles vaccine from the rubella vaccine—which Brill pointed out is manufactured using cells from aborted children and thus the principal concern for many parents who seek a religious waiver—she said Westergaard dismissed the question, saying he had no knowledge of the state engaging with any manufacturers on the issue.

“This is the core issue,” she said. “While the Department of Health Services is deeply concerned over low vaccination rates, it has shown little interest in understanding or resolving the sincere religious or personal objections many parents have.”

That’s because health bureaucrats view vaccines through rose-colored glasses: All vaccines are safe. All vaccines are effective. All vaccines are magical. They refuse to believe that vaccines cause any significant injuries, certainly not the $5 billion the federal vaccine court has had to actually pay out. They can’t see it, despite a mountain of medical evidence and the growing bottom line of payouts flowing from the findings of the vaccine courts.

For Brill, who right now is leading the state’s fight medical freedom, this was about rights.

“The rights of parents are not negotiable… If DHS is concerned about low vaccination rates, they should work diligently to remedy the root cause of parents’ concern regarding the vaccine, not treat their right…as an inconvenient obstacle.”

Brill also told Children’s Health Defense that narratives attempting to connect “vaccine hesitancy” to rising cases of measles were disingenuous: “I think that narrative puts a very negative connotation on vaccine hesitancy. I believe that ‘vaccine hesitancy’ is ‘healthy hesitancy.’”

The way a narrative is framed makes all the difference, and Brill’s point is a great one. Now she needs a group of courageous lawmakers to join her in standing up to a state agency that by its history, pronouncements, and policies is dead set against personal medical freedom.

Now the bad news

To be sure, a state agency commanded by a federal agency is not a healthy thing, no matter who is running the show in Washington. A state agency should be under the command, if it should exist at all, of the state’s elected executive.

Unfortunately, the state’s elected executive is surely a cheerleader for his resistance-driven DHS. That’s on us, I guess, for electing Tony Evers.

But even that doesn’t tell the whole story, for when you look behind the curtain, there’s a nasty surprise awaiting—the agency is not actually vertically disintegrating, not yet anyway. It may be teetering on the edge, but it’s still partially intact. It may have had to evacuate the skyscraper but turns out that state bureaucracies have friends just around the corner willing to put them up for the night.

Which is to say, none of these angry, resisting state bureaucracies are winging it on their own. Huge left-wing nonprofits and associations tied to the federal bureaucracy are stepping in to fill the void, and to even counter, the team in Washington. It’s a vital role these special interests play: Now state bureaucracies can cite their “expert” recommendations in place of what they now say is the federal government’s sudden conspiracy-theory approach.

On the nutrition side, for example, as I have previously reported, is the Academy of Nutrition and Dietetics (AND). It and its Wisconsin affiliate have been among the major groups arguing for and helping to shape previous governmental nutrition guidelines, and, as such, the state’s Department of Health Services (DHS) is one of their biggest promoters.

The problem is, past guidelines were seriously flawed in their approach to processed foods—a problem Kennedy is trying to fix—and if you’re wondering why, maybe it’s because of the involvement of groups like AND. A 2022 study in Public Health Nutrition,“The corporate capture of the nutrition profession in the USA: the case of the Academy of Nutrition and Dietetics,” broke it all down.

Analyzing documents obtained through Freedom of Information requests from 2014 to 2020, the study found that AND leaders held “key positions in multinational food, pharmaceutical or agribusiness corporations,” and AND also accepted corporate financial contributions. It was also an investor in corporations such as Nestlé, PepsiCo and multiple pharmaceutical companies, all while being one of the more influential professional health associations in the U.S.

On the vaccination side of non-profit/state bureaucratic vertical integration is the American Academy of Pediatrics. Unsurprisingly, one of those concerned about the new data on low vaccination rates and trying to tie them to waivers and to bills such as that authored by Brill was Susan Kressly, president of the American Academy of Pediatrics...

But while AAP supports medical exemptions, the organization thinks exemptions should stop right there: “The [American Academy of Pediatrics] advocates for the elimination of non-medical exemptions from immunizations as contrary to optimal individual and public health.”

After the American Academy of Pediatrics issued its recommendation, Brill was once again right on point, advising her followers on X to “follow the money” and linking to the American Academy of Pediatrics’ website and a listing of its corporate donors, including Moderna, Pfizer, and Merck, some of the largest pharmaceutical companies in the world.

“It’s not about our health,” Brill posted.

We should all be sending great thanks to Brill right now for leading an effort to expose the truth, not to mention calling our legislators to urge them to join her in standing up for medical freedom.

The bottom line is, though, vertical integration is still alive, though somewhat weakened. The big nonprofits and establishment medical associations—special interests all—are stepping in to proxy for the federal bureaucracy while it is sidelined.

None of us should be fooled. All of us should seek reform.

Bureaucratic dangers may be even greater in major state bureaucracies. On paper, the federal workforce has barely grown since 1960. In reality, when you count contractors, grant employees, and military personnel, some have estimated that the number is closer to 10 million. Many “grant employees” draw state paychecks but enforce federal mandates—making them de facto federal staff. This is vertical integration’s classic infrastructure.

As Martha Derthick noted decades ago, grants with strings attached have turned states into federal “agents of its purposes through aggressive use of grant-in-aid conditions and partial preemptions.” Conditional funding, coercive mandates, and intergovernmental entanglements have hardened the vertical structure Brill now finds herself fighting. We can see why Trump’s efforts not just against the federal bureaucracy but against the grant programs sustaining nonprofits and camouflaged federal workers in state government must proceed.

Whether this is a fleeting moment or the start of a sustained disintegration remains to be seen. But the ingredients are there: competing authorities, contested science, legal leeway for states to diverge, and elected officials like Lindee Brill willing to challenge the bureaucratic narrative.

If vertical integration has been the skyscraper of modern governance, Wisconsin’s current moment may mean a few floors are starting to creak.

Under enough strain, perhaps, they just might give way.