How Bad Could Trump's Assault on Public Health Get?

Yahoo

29-01-2025

Five years after a novel virus rocked the world, killed millions, and continues to sicken people, amidst ongoing outbreaks of bird flu and mpox and tuberculosis, public health and scientific research are being gutted in America—and it's happening more quickly than even experts thought possible.
In its first days, the Trump administration ordered a communications blackout for all U.S. health agencies, including the U.S. Department of Health and Human Services (HHS), the U.S. Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the U.S. Food and Drug Administration (FDA). For some departments and agencies, the order amounted to a shutdown. Trump officials have attempted to halt all meetings, travel, and external communication, and the agencies are exercising extreme scrutiny over all publications, including the revered Morbidity and Mortality Weekly Report (MMWR), which alerts the world to new and ongoing outbreaks and other major health issues. The NIH shut down new research projects—a multi-billion-dollar industry with deep economic implications across the nation—unless they are 'mission critical.' Employees at the CDC and NIH were told on Friday they can't even buy basic supplies to continue their work. The CDC was ordered on Sunday night to immediately stop working with the World Health Organization (WHO), in an apparent breach of the one-year notice required to leave the organization. Trump also signed orders to halt global health funding immediately, reinstate a gag order on abortion among global partners, and attempt to define gender in a way that excludes trans and intersex people. On Tuesday, the U.S. Office of Personnel Management offered federal workers a buyout: salary paid until September 30 for anyone who resigns before February 6—a tempting offer for those who already fear for their jobs, but one that could leave some agencies barely functional. (That's if the buyouts even hold up, since it's not clear the administration is allowed to make such an offer.)
'This is less than a week into it all,' Saskia Popescu, assistant professor of epidemiology and public health at University of Maryland School of Medicine, told me over the weekend. As millions wait to see whether the communications and funding restrictions are lifted, the halts are already having significant implications for those who work in public health and research. 'I have friends already being let go,' Popescu said. At the health agencies, staffers are holding their breaths to see if their jobs or contracts are cut. 'I'm deeply concerned we're going to entirely scrap so much of the funding for this work, that there's virtually nothing left,' she said. When Popescu decided to enter the field of public health, she knew the difficult, often underpaid work was vulnerable to political interference. But she never expected an attack of this scale—and speed.
The people Trump has nominated to lead these agencies haven't even been confirmed by the Senate yet, which means the greatest changes may be yet to come. 'I did not expect the current changes. I thought the issue will be if and after Kennedy is confirmed,' Dorit Reiss, professor at UC Hastings College of Law, told me—referring to Robert F. Kennedy Jr., Trump's strongly anti-vaccine pick for head of Health and Human Services.
The sheer speed and breadth of the changes already witnessed has astonished many in the field. It's a seismic disruption to life in the United States, with immense immediate and long-term risks. And there could be more on the way.When the health agencies went dark, those who work within were just as confused as those on the outside. The halt on communications was especially bewildering. 'That's what we do, we communicate with the public about health matters,' said one HHS contractor who asked for anonymity given the communications restrictions.
The MMWR, for example, offered the first warning of HIV/AIDS in the 1980s, revealing an unusual cluster of infections in gay men back in 1981. The weekly chronicle is one of the most respected research publications in the world. When the Trump White House, during the first administration, sought to control the publication, the scientific community objected loudly: If the MMWR is compromised, how can the public trust anything agencies say? Yet now, the MMWR's message hasn't been altered so much as silenced entirely, and for an indeterminate amount of time. Last week, a planned issue including an update on the bird flu outbreak was spiked, and it's not clear when publication will resume.
The ban has also thrown meetings between federal officials and regional, state, and local health departments into question, the contractor said. 'Can I do any support work when a health department has a question? It's unknown.' It's also not clear how HHS would communicate the emergence or intensification of an outbreak, since publications like the MMWR are a major avenue for doing so, they said. 'But like I said, the directive was so poorly communicated, no one knows what we're allowed to say or do.'
Even internal communications are truncated, because the potential for having those conversations revealed through the Freedom of Information Act looms over every interaction. The atmosphere is grim and terrified. 'Most of us get into this work because we want to help people,' the contractor said, and 'this is more than just a job. So this is hard for a lot of us.'These striking moves in the administration's opening days have left people questioning attempts during the transition period to downplay nominees' radicalism and quell panic about possibly public health disruptions. Brown University School of Public Health dean Ashish Jha raised eyebrows two days before the inauguration when he argued, with numerous inaccuracies, that while leaving the WHO entirely would be the wrong choice, Trump allies were right to want to pressure the organization into 'reforms.' When Trump nominated RFK Jr. to oversee HHS in November, multiple news stories insisted that he would not be able to ban or take away vaccines, highlighted Kennedy's recent de-escalation in rhetoric, or reported reassurances from Trump himself that vaccines wouldn't be touched. (Further reporting revealed that he could, in fact, strip protections from vaccine-makers, effectively undermining the market.)
The main question now is how far Kennedy will go, Politico reported on Friday: Will he limit or ban vaccines, or will he only undermine confidence and undertake lengthy, expensive studies on disproven theories? One source told Politico that Kennedy's anti-vax base is angling for him to 'totally take away vaccines.' They're also clamoring to replace or entirely disband vaccine advisory committees, change or remove routine childhood vaccination recommendations, and gut legal protections for vaccine-makers.
'I can say that Kennedy has been aggressively anti-vaccine for twenty years, that that is where he put his efforts, that is where his heart seems to be, and that is unlikely to change—he is an anti-vaccine zealot, and will do what harm he can to the vaccination program,' said Reiss.'I certainly expect him to aggressively target vaccines, which is why I hope he won't be confirmed,' Kennedy's confirmation hearing starts on Wednesday.
While Kennedy is still reportedly considering his options on vaccines, his approach to infectious disease seems unchanged. 'We're going to give infectious disease a break for about eight years,' Kennedy has said, talking about research done at NIH. He already seems to be proving true to his word: Last week, he skipped the meeting where Trump transition officials and Cabinet nominees planned how to respond to crises—including new pandemics.
On Tuesday, the portals for Medicaid in all 50 states went down as officials implemented a new ban on federal grants and loans. The program covers 70 million Americans—but if any of them were concerned about what was going on, they wouldn't find any answers at the Centers for Medicare and Medicaid Services, which is still under the communications blackout. Its news releases haven't been updated since January 17.