Hotez points to a number of recent missteps that have given vaccine skeptics ammunition: unrealistically rosy timelines for a vaccine; the appointment of a former pharma executive with $12.4 million worth of vaccine-company stock options to lead the White House’s new vaccine initiative (he is now divesting); even the name of the Trump administration’s vaccine initiative itself, Operation Warp Speed. “A ridiculous metaphor,” Hotez says, “that plays right into the hands of the anti-vaccine lobby” by emphasizing swiftness rather than safety.

But the U.S. government has mismanaged the broader COVID-19 response too—including the Centers for Disease Control and Prevention’s botched testing plan and the flip-flopping on face masks and the president’s continued boosting of an unproven drug. “How people think about vaccines is very much going to depend on their trust relationship,” says Heidi Larson, an anthropologist and the director of the Vaccine Confidence Project. “Governments can either totally mess up, and they’ll lose their confidence in government and therefore when a vaccine comes along they’re not going to trust it. Or [governments] can do a pretty good job and that will help boost confidence.” The ultimate legacy of this pandemic, then, could be a broad erosion of trust in authorities, endangering public-health efforts into the future.