When three Texans—a business magnate, a podcaster, and a vaccine scientist—got into a Twitter kerfuffle in June, it was the sort of stranger-than-fiction news story to which Americans have grown accustomed in recent years. But Dr. Peter Hotez, the vaccine scientist in question—as well as a professor and dean at Baylor College of Medicine in Houston—argues that it was much more than that.

The precipitating event was the appearance of Robert F. Kennedy Jr., the Democratic presidential candidate and longtime vaccine critic, on Joe Rogan’s show, the most popular podcast in the country. Kennedy suggested, among other unfounded views, that vaccines cause autism. Hotez, who has a daughter with autism, had been on Rogan’s podcast twice and had come to like the controversial host, but he couldn’t abide debunked claims going out unquestioned to Rogan’s millions of listeners. Vaccine misinformation is not “just some random junk that appears out of nowhere on the internet, or on social media,” Hotez told Texas Monthly. “It’s organized, it’s deliberate, it’s well-financed, and it’s politically motivated.”

After Hotez criticized the episode on Twitter, Rogan challenged the physician-scientist to debate Kennedy on his show. At this point, the world’s richest man felt the urge to weigh in. “He’s afraid of a public debate, because he knows he’s wrong,” Elon Musk tweeted about Hotez. To their combined 166 million followers, Musk and Rogan had impugned a world-renowned expert in vaccine science. Hotez was subsequently subjected to threats and harassment, both online and in person, including one man who stalked him outside his home. With former National Institute of Allergy and Infectious Disease director Anthony Fauci retired from his government post at the end of last year, Hotez thinks he’s become a bigger target. “The faux-outrage machine stoked by Fox News and the far right needs a new monster,” he says. “So I’m Fauci-light.”

Hotez ultimately declined to debate Kennedy. He’d already discussed the topic at length with the aspiring politician years before, and he feared a debate would lend credibility to thoroughly disproven ideas. But that hardly meant Hotez had nothing more to say on the subject. As it happened, when this dispute arose, he had just finished writing a passionate plea for help amid what he considers a “national emergency.” That book, The Deadly Rise of Anti-Science: A Scientist’s Warning, is out today from Johns Hopkins University Press.

Anti-science propaganda is “killing Americans in unprecedented numbers,” Hotez says. “Forty thousand Texans needlessly perished because they refused the COVID vaccine, and two hundred thousand Americans overall.” Deadly Rise traces the evolution of this movement from its “health freedom” origins, which, as Hotez writes, came into its fullest form in Texas, to the tragic deaths of those who succumbed to the coronavirus even after vaccines were widely available. The book is bleak and foreboding. “It was not fun to write,” he says wearily. It’s a concerned scientist’s manifesto, a call to action to defend not just science and scientists, but “American democratic principles and our way of life.”

Though Hotez came gradually to his public advocacy for science and vaccines, he writes in the book that he “had a front-row seat on the modern anti-vaccine movement in America.” After earning his medical degree with a specialty in pediatrics, and a PhD in biochemistry in the late eighties, he set out to develop vaccines for neglected tropical diseases that disproportionally affected poorer populations around the world. Meanwhile, Hotez’s youngest daughter, Rachel, was diagnosed with autism in 1994, when she was not yet two years old.

Four years later, an article that has since been retracted, after its findings were disproven, was published in the medical journal the Lancet that linked the measles-mumps-rubella vaccine to autism. By the mid-2010s, anti-vaccine activism had “caused significant pockets of vaccine resistance to arise across sections of the United States, especially in some urban counties in Texas,” Hotez writes.

Troubled by the reemergence of measles in communities where many had declined to vaccinate their children, Hotez published Vaccines Did Not Cause Rachel’s Autism, his 2018 book that celebrates the effectiveness of vaccines and explains the science behind some of the genetic origins of his daughter’s autism. This made him a target for anti-vaccine groups and a frequent on-air guest for newscasters looking for a trusted source on vaccine science.

But Hotez’s role as a kind of Rorschach test for American political views may have been cemented on February 1, 2022. Lizzie Fletcher, a Democratic congresswoman from Houston, nominated Hotez and his colleague, Dr. Maria Elena Bottazzi, for the 2022 Nobel Peace Prize for their work developing vaccines, including a patent-free COVID vaccine that reached an estimated 100 million people in India and Indonesia. That evening, former Fox News host Tucker Carlson ran a segment on Hotez, calling him “a misinformation machine constantly spewing insanity.”

As Hotez sees it, the bad science connecting vaccines to autism paved the way for the modern “health freedom” movement, which is peddled in legislatures by right-wing politicians and on the internet by multiple activist organizations, including a set the Center for Countering Digital Hate, an international nonprofit, labels “the disinformation dozen.” Hotez says these groups found a receptive audience in Texas, where he writes that “the health freedom movement found its full expression and home.” With that emerged a much larger anti-science groundswell that includes climate-change denial and various other science-centered conspiracy theories, all of which call into question the motivations and intellectual independence of doctors, medical researchers, and other experts.

The final chapters of Deadly Rise put the current anti-science movement into historical context, drawing parallels to authoritarian regimes such as Stalinist Russia and Nazi Germany, which imprisoned leading scientists and academics. These bleak prognoses lead Hotez to propose a “Southern Poverty Law Center for scientists” that could support and defend them from extremist attacks, much as the Alabama-based Southern Poverty Law Center fights for civil rights and against racist extremism. It’s an idea slim on details, and Hotez recognizes this. “The weakness of the book is I’m not sure I have the answer for how to address the anti-science because, in general, the health and scientific sectors don’t know what to do,” he says.

The wary observer might accuse Hotez of speaking in hyperbole and seeking the spotlight for self-promotion, but he makes a convincing argument in response to that: If you knew that 200,000 Americans died needlessly with the next threat right around the corner, and you had both the expertise and the platform to possibly do something about it, shouldn’t you? “I had to step up,” he says. “I felt I was uniquely qualified because of my background and expertise to detail this, even though it took me to a very dark place in American political life.”

A more salient criticism of the book might be that you can’t fight groundless conspiracy with logic, as Deadly Rise seems at times to want to do. Making a personal appeal—as Hotez did in his previous book focused on his daughter—may be more persuasive to those for whom scientific consensus doesn’t carry much weight. But the audience for this book probably isn’t vaccine skeptics anyway. It’s those who don’t take the threats posed by vaccine skepticism seriously enough.

Texas pops up again and again in the book, as do Texan politicians. “We are a state of science and innovation,” Hotez argues. He cites as examples of this Houston’s Texas Medical Center, NASA, the strong science and engineering departments at the state’s universities, and even Tesla and SpaceX, the companies of his occasional critic, Elon Musk.

“The greatness of our state in modern times is built on science and technology, and to try and subvert that for political expediency will set us back and continue to cost lives,” Hotez says. He argues that “everyone’s entitled to their views, even extremist views,” but we must figure out how to uncouple those perspectives from the vaccine propaganda that has cost hundreds of thousands of lives. “I think it starts in Texas,” he says, evincing a trace of the same bluster endemic to his adopted home state.