How Will Trump's Covid Contrarians Handle the Next Pandemic?

New York Times

27-11-2024

President-elect Donald J. Trump had already succeeded in rattling the nation's public health and biomedical establishment by the time he announced on Tuesday that he had picked Dr. Jay Bhattacharya to run the National Institutes of Health. But amid growing fears of a deadly bird flu pandemic, perhaps no one was more rattled than experts in infectious disease.
Dr. Bhattacharya, a Stanford University medical economist and outspoken opponent of lockdowns, masking, school closures and other Covid-19 mitigation measures, and Mr. Trump's other health picks have one thing in common. They are all considered Covid contrarians whose views raise questions about how they would handle an infectious disease crisis.
Robert F. Kennedy Jr., Mr. Trump's choice for health secretary, has said he wants the N.I.H. to focus on chronic disease and 'give infectious disease a break for about eight years.' Dr. Martin Makary, the president-elect's choice to run the Food and Drug Administration, incorrectly predicted in 2021 that the nation was 'racing toward an extremely low level of infection.'
Dr. David Weldon, a Republican former congressman who is Mr. Trump's choice to lead the Centers for Disease Control and Prevention, has espoused the debunked theory that thimerosal, a mercury compound in certain vaccines, causes autism. As a congressman, he introduced legislation that would strip the C.D.C. of its role in ensuring vaccine safety, saying the agency had a 'conflict of interest' because it also promotes vaccination.
And Dr. Mehmet Oz, the talk show host who has been picked by Mr. Trump to run Medicare and Medicaid, prodded officials in the first Trump administration to give emergency authorization for the malaria drug hydroxychloroquine to treat Covid-19. The F.D.A. later revoked the authorization when studies showed the drug carried risks, including serious heart issues, to coronavirus patients.
'If the worst case scenario happens and we have a serious public health crisis, the body count is going to be enormous because these guys don't have the skills or the will to do anything about it,' said John P. Moore, a virologist and professor at Cornell University's Weill Cornell Medical College.
None of Mr. Trump's picks have deep expertise in infectious disease, and each will have to be confirmed by the Senate. 'At the end of the day, if they are confirmed, we are going to have to figure out a way to work with them,' said Dr. Carlos del Rio, an infectious disease expert at Emory University.
Mr. Trump's own commitment to pandemic preparedness is unclear. During his first administration, he dismantled a White House office that had been set up by his predecessor, President Barack Obama, to deal with emerging global health threats. Last year, President Biden created a White House Office of Pandemic Preparedness, which Mr. Trump cannot abandon because Congress mandated it by legislation in 2022.
There is no way, of course, to predict the arrival of the next pandemic. At the outset of the coronavirus pandemic, experts called it the worst public health crisis in a century. But most do not believe that it will be 100 years before another one. The current outbreak of the H5N1 virus, commonly known as 'bird flu,' in cattle and poultry is of particular concern.
So far, there have been no reports of human-to-human transmission of H5N1, which is far more deadly than SARS-CoV-2, the virus that causes Covid-19. But 55 people in the United States, mostly poultry and dairy workers, have already been infected. Experts fear that as more people get infected, the virus will have an opportunity to mutate in a way that could make it easily transmissible from one person to another.
'As Donald Trump gets ready to return to the White House on Jan. 20, he must be prepared to tackle one issue immediately: the possibility that the spreading avian flu might mutate to enable human-to-human transmission,' Dr. David Kessler, who ran the Biden administration's Covid vaccine distribution initiative, wrote in a New York Times guest essay.
In an interview on Wednesday, Dr. Kessler said he was particularly concerned that longtime officials at agencies like the C.D.C., N.I.H. and F.D.A. would leave their agencies, depriving the Trump administration of their deep expertise.
'We're not going to get though four years without infectious disease, of that you can be sure,' Dr. Kessler said. 'The one thing I've learned is it never comes at you from where you're expecting. But it will come at you. The most important thing is, on this they need expertise. There is no learning on the job.'
Dr. Paul A. Offit, an infectious disease expert and pediatrician at Children's Hospital of Philadelphia, said he was particularly worried about another coronavirus with pandemic potential. The world has experienced three within the past 20 years. SARS (severe acute respiratory syndrome), erupted in China in 2002. MERS (Middle East respiratory syndrome), spread from camels to people in the Arabian Peninsula in 2012. Covid-19 emerged in 2019 in China.
Dr. Offit said cutting the N.I.H. budget for infectious disease research, as Mr. Kennedy has suggested, would be shortsighted. He noted that research into the mRNA technology that enabled the quick production of coronavirus vaccines had begun more than 20 years before the pandemic, with N.I.H. funding. The scientists who pioneered the work, Dr. Katalin Karikó and Dr. Drew Weissman, won a 2023 Nobel Prize.
Dr. del Rio said he agreed with Mr. Kennedy that more research is needed into chronic disease — but not at the expense of infectious disease. 'This dichotomy between infectious disease and chronic disease is a false dichotomy,' he said.
Researchers, public health officials and scientists employed by the government have been reluctant to speak about the president-elect's selections. Dr. Francis Collins, the former head of the National Institutes of Health, who continues to work as a researcher in his genetics lab, and who called Dr. Bhattacharya a 'fringe epidemiologist,' declined to comment.
Dr. Bhattacharya is one of three lead authors of the Great Barrington Declaration, a manifesto issued in the fall of 2020, before Covid vaccines were available. The manifesto contended that the coronavirus should be allowed to spread among young healthy people who were 'at minimal risk of death,' while prevention efforts were targeted to older people and the vulnerable.
The goal, the authors said, was to 'minimize mortality and social harm until we reach herd immunity,' the point at which a virus cannot spread easily from person to person because most people are immune. Public health leaders dismissed it as dangerous and a recipe for millions of American deaths.
Instead, experts including Dr. Anthony S. Fauci, the now-retired head of the Institute for Allergy and Infectious Diseases that is part of N.I.H., argued that vaccination was the safest path to containing the deadly pathogen. Dr. Fauci predicted that it would take until the end of 2021, after a successful vaccination campaign, for the nation to reach herd immunity.
In the end, both sides were wrong. Coronavirus deaths in the United States hit a second spike at the end of 2021 and into early 2022, when the Omicron variant raced through the population. In the years since then, a number of public health experts have acknowledged that perhaps the lockdowns and masking and school closures went on for too long.
'I would agree that the mitigation strategies were probably wrong and they were probably there for too long,' said Dr. del Rio, the Emory University infectious disease doctor, referring to the masking and lockdowns that Dr. Bhattacharya opposed. 'But the Great Barrington Declaration was also wrong and we need to accept that.
'Clearly during Covid we all made mistakes," he added, 'and one thing we need to learn is to all be humble so that we don't make them again.'