Hate behaves like an infectious pathogen: it spreads through rhetoric, adapts into new ideologies, and thrives where stigma and discriminatory policies exist. Recent attacks — including the Berlin Pride assault and the August 2025 CDC shooting — illustrate how hate causes both acute violence and long-term health harms, especially for LGBTQ+ people and public-health workers. The author argues public health must treat hate as an emergency by building surveillance, rapid-response support, cross-sector partnerships, and by confronting misinformation as a measurable threat.
Hate as a Public-Health Emergency: Treating Violence Like an Epidemic
people mourning a terror attack
In 2016 I wrote in The Advocate after the Pulse Nightclub massacre that hate behaves like an infectious agent: violence is the epidemic and hate is the pathogen driving it. Eight years later, the outbreak has not slowed. Instead, hate has persisted and adapted — finding new transmission routes, fresh reservoirs, and more opportunities to spread. Recent attacks, from the Berlin Pride assault to the shooting at the Centers for Disease Control and Prevention (CDC) in Atlanta, make one thing painfully clear: we still refuse to treat hate with the urgency of a public-health emergency.
Why Hate Acts Like a Pathogen
As an infectious-disease physician and public-health official, I recognize the patterns of spread, mutation, and exploitation of weak systems. Hate moves the same way. It transmits through rhetoric and social networks, it mutates into new ideologies, and it flourishes where stigma is codified into policy and discrimination is normalized. When we fail to intervene, hate — like an unchecked pathogen — produces preventable injury, trauma, and death.
Hate has clear vectors (politicians, influencers, extremist networks), reservoirs (discriminatory laws, stigma, misinformation ecosystems), and symptoms (mass shootings, assaults, harassment, chronic stress, and erosion of community resilience). Framing hate only as a social or political problem ignores its measurable, long-term health consequences.
Real-World Outbreaks
The Berlin Pride attack is a textbook acute outbreak: a celebration meant to build community immunity and counteract chronic exposures of stigma became a target. Pride functions as harm reduction, prevention, and care — and hate targets it for that reason.
Gun violence became intensely personal for me in August 2025, when the CDC shooting shattered a window in my office. That attack was not an isolated incident but the foreseeable outcome of years of escalating anti‑science and anti‑public‑health rhetoric. Language that dehumanizes scientists, clinicians, nurses, and public-health staff makes violence thinkable. In the CDC incident, roughly 500 rounds were fired into an agency tasked with safeguarding our health, and Officer David Rose was killed while defending others. The shooter’s beliefs, rooted in misinformation, led to violence against a public-health institution.
Health Consequences Beyond Immediate Violence
Violence is the most visible result of hate, but it is not the only one. Hate creates and deepens chronic health disparities. LGBTQ+ people face higher rates of depression, anxiety, substance-use disorders, and suicide attempts — not because of who they are, but because of how society treats them. When racism intersects with homophobia and transphobia, Black and Brown LGBTQ+ people face compounded risk.
Trauma from attacks like Berlin and Pulse embeds itself in bodies and communities: elevated cortisol, disrupted sleep, worsening cardiovascular health, and long-term mental-health consequences. Public-health workers who survive or witness violence carry new fears about workplace safety; communities that attend Pride or other public events may never fully recover their sense of security.
Structural Discrimination Is Chronic Exposure
Policies that restrict gender-affirming care, ban LGBTQ+ content, or criminalize queer and trans existence act as ongoing exposures that weaken community protections and increase vulnerability to acute outbreaks. Across Europe and the United States, resurgent anti‑LGBTQ+ legislation and anti‑science narratives are part of the same ecosystem that enables attacks like Pulse, Berlin, and the CDC shooting.
What Public Health Must Do
Public health cannot be neutral in the face of hate. We must name it what it is — an emergency — and deploy the tools we use against biological pathogens. Key public-health responses should include:
- Surveillance: Track hate-motivated violence and hate-driven misinformation with the same rigor we apply to infectious disease surveillance.
- Rapid-response teams: Provide trauma-informed care, mental-health services, safety planning, and long-term recovery support after attacks.
- Cross-sector collaboration: Coordinate between public-health agencies, LGBTQ+ organizations, law enforcement, scientific institutions, and policymakers to prevent and respond to outbreaks of hate.
- Misinformation mitigation: Treat coordinated disinformation campaigns as a public-health threat with measurable consequences and intervene through education, trusted messengers, and policy.
If we fail to act, hate will continue to spread, mutate, and inflict preventable harm. We can reduce risk, strengthen community immunity, and save lives — but only if we treat hate as the public-health emergency it has become.
About the author: Demetre C. Daskalakis, MD, MPH, is chief medical officer at Callen-Lorde Community Health Center in New York City. He resigned from a senior leadership role at the Centers for Disease Control and Prevention after Donald Trump and Robert F. Kennedy Jr. politicized science at the agency.
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