The Axe Hanging Over America's Disease Detectives
Americans have plenty to worry about these days when it comes to infectious-disease outbreaks. This is the worst flu season in 15 years, there's a serious measles outbreak roiling Texas, and the threat of bird flu isn't going away. 'The house is on fire,' Denis Nash, an epidemiologist at CUNY School of Public Health, told me. The more America is pummeled by disease, the greater the chance of widespread outbreaks and even another pandemic.
As of this week, the federal government may be less equipped to deal with these threats. Elon Musk's efforts to shrink the federal workforce have hit public-health agencies, including the CDC, NIH, and FDA. The Trump administration has not released details on the layoffs, but the cuts appear to be more than trivial. The CDC lost an estimated 700 people, according to the Associated Press. Meanwhile, more than 1,000 NIH staffers reportedly lost their jobs.
Perhaps as notable as who was laid off is who wasn't. The Trump administration initially seemed likely to target the CDC's Epidemic Intelligence Service, a cohort of doctors, scientists, nurses, and even veterinarians who investigate and respond to disease outbreaks around the world. Throughout the program's history, EIS officers have been the first line of defense against anthrax, Ebola, smallpox, polio, E. coli, and, yes, bird flu. Four recent CDC directors have been part of the program.
The layoffs were mostly based on workers' probationary status. (Most federal employees are considered probationary in their first year or two on the job, and recently promoted staffers can also count as probationary.) EIS fellows typically serve two-year stints, which makes them probationary and thus natural targets for the most recent purge. EIS fellows told me they were bracing to be let go last Friday afternoon, but the pink slips never came. Exactly why remains unclear. In response to backlash about the planned firings, Musk posted on X on Monday that EIS is 'not canceled' and that those suggesting otherwise should 'stop saying bullshit.' A spokesperson for DOGE did not respond to multiple requests for comment.
This doesn't mean EIS is safe. Both DOGE and Robert F. Kennedy Jr., Donald Trump's newly confirmed health secretary, are just getting started. More layoffs could still be coming, and significant cuts to EIS would send a clear message that the administration does not believe that investigating infectious-disease outbreaks is a good use of tax dollars. In that way, the future of EIS is a barometer of how seriously the Trump administration takes the task of protecting public health.
Trump and his advisers have made it abundantly clear that, after the pandemic shutdowns in 2020, they want a more hands-off approach to dealing with outbreaks. Both Trump and Kennedy have repeatedly downplayed the destruction caused by COVID. But so far, the second Trump administration's approach to public health has been confusing. Last year, Trump said he would close the White House's pandemic office; now he is reportedly picking a highly qualified expert to lead it. The president hasn't laid out a bird-flu plan, but amid soaring egg prices, the head of his National Economic Council recently said that the plan is coming. Kennedy has also previously said that he wants to give infectious-disease research a 'break' and focus on chronic illness; in a written testimony during his confirmation hearings, he claimed that he wouldn't actually do anything to reduce America's capacity to respond to outbreaks.
The decision to spare EIS, at least for now, only adds to the confusion. (Nor is it the sole murky aspect of the layoffs: Several USDA workers responding to bird flu were also targeted, although the USDA told me that those cuts were made in error and that it is working to 'rectify the situation.') On paper, EIS might look like a relatively inconsequential training program that would be apt for DOGEing. In reality, the program is less like a cushy internship and more akin to public health's version of the CIA.
Fellows are deployed around the world to investigate, and hopefully stop, some of the world's most dangerous pathogens. The actual work of an EIS officer varies depending on where they're deployed, though the program's approach is often described as 'shoe-leather epidemiology'—going door to door or village to village probing the cause of an illness in the way a New York City detective might investigate a stabbing on the subway. Fellows are highly credentialed experts, but the process provides hands-on training in how to conduct an outbreak investigation, according to Nash, the CUNY professor, who took part in the program. Nash entered EIS with a Ph.D. in epidemiology, but 'none of our training could prepare us for the kinds of things we would learn through EIS,' he said.
In many cases, EIS officials are on the ground investigating before most people even know there's a potential problem. An EIS officer investigated and recorded the United States' first COVID case back in January 2020, when the virus was still known as 2019-nCoV. It would be another month before the CDC warned that the virus would cause widespread disruption to American life.
More recently, in October, EIS officers were on the ground in Washington when the state was hit with its first human cases of bird flu, Roberto Bonaccorso, a spokesperson with the Washington State Department of Health, wrote to me. 'Every single outbreak in the United States and Washington State requires deployment of our current EIS officers,' Bonaccorso said.
EIS is hardly the only tool the federal government uses to protect the country against public-health threats. Managing an outbreak requires coordination across an alphabet soup of agencies and programs; an EIS fellow may have investigated the first COVID case, but that of course didn't stop the pandemic from happening. Other vital parts of how America responds to infectious diseases were not spared by the DOGE layoffs. Two training programs with missions similar to that of EIS were affected by the cuts, according to a CDC employee whom I agreed not to identify by name because the staffer is not authorized to talk to the press.
The DOGE website boasts of saving nearly $4 million on the National Immunization Surveys, collectively one of the nation's key tools for tracking how many Americans, particularly children, are fully vaccinated. What those cuts will ultimately mean for the future of the surveys is unknown. A spokesperson for the research group that runs the surveys, the National Opinion Research Center, declined to comment and directed all questions to the CDC.
And more cuts to the nation's public-health infrastructure, including EIS, could be around the corner. RFK Jr. has already warned that certain FDA workers should pack their bags. Kennedy has repeatedly claimed that public-health officials inflate the risks of infectious disease threats to bolster their importance with the public; EIS fellows are the first responders who hit the ground often before public officials are even sounding the alarm bells.
Ironically, the work of the EIS is poised to become especially pressing during Trump's second term. If measles, bird flu, or any other infectious disease begins spreading through America unabated after we have fired the public-health workforce, undermined vaccines, or halted key research, it will be the job of EIS fellows to figure out what went wrong.
Article originally published at The Atlantic
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Wall Street Journal
26 minutes ago
- Wall Street Journal
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Boston Globe
an hour ago
- Boston Globe
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Get The Gavel A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr. Enter Email Sign Up Vaccines are one of the greatest achievements of biomedical science and public health, preventing enormous suffering and premature death. Decades of strategic vaccination campaigns virtually eliminated diseases previously common in the United States, including diphtheria, tetanus, polio, smallpox, measles, mumps, and rubella. Advertisement Public health leaders have long warned that Kennedy, with the imprimatur of President Trump himself, intends to reverse decades of progress and instead spread disinformation that will lead to injury and death. As measles and other preventable diseases spread in other states, Massachusetts can mitigate the damage by strengthening state vaccine policy. Advertisement Oami Amarasingham Deputy director Carlene Pavlos Executive director Massachusetts Public Health Alliance Boston This is a public health emergency in the making I read about Robert F. Kennedy Jr.'s latest outrage last week ('RFK Jr. fires vaccine panel advising CDC'). I guess it wasn't enough that he terminated the government's contract with Moderna to produce a vaccine to protect the public from the real and looming threat of the bird flu virus, which experts fear Congress must move to impeach Kennedy and remove him from his position. As the Globe's I realize the Trump administration is a five-alarm fire of malicious actions designed to destroy our most important governmental and social institutions, so it is head-spinningly difficult to respond to each new threat in a timely and effective manner. But this is truly a national, indeed international, emergency in the making. Jim Fathy Newton So much for the assurances of the nomination process Health and Human Services Secretary Robert F. Kennedy Jr's. firing of all 17 members of the CDC's Advisory Committee on Immunization Practices is the latest example of the futility of the congressional nomination process. When he was Advertisement Now, more than ever, we know that confirmation hearings mean nothing in providing insight into how a nominee will manage. They are only good for showing us how they have misrepresented themselves. We're only about five months into this new administration, and it's done little more than sow mistrust in government agencies, making the American people less safe, secure, and healthy. Carl Markey North Chelmsford
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As top US health officials turn against some mRNA vaccines, experts fear for the country's preparedness for the next pandemic and worry that other vaccines will be targeted next. Donald Trump's administration recently canceled a $766m award to Moderna on the research and development of H5N1 bird flu vaccines, and officials have announced new restrictions and regulations for Covid mRNA vaccines – actions that signal a move away from the breakthrough technology. These changes add to other vaccine-related shakeups at health agencies, including layoffs and resignations of top vaccine officials and the abrupt termination of HIV vaccine research. On Monday, Robert F Kennedy Jr, secretary of health and human services, announced he was disbanding the independent advisory committee on vaccines for the US Centers for Disease Control and Prevention (CDC). 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Because mRNA sounds similar to DNA, some people mistakenly think it interferes with their genes. Conspiracy theorists also claim the vaccine causes people to die suddenly, or that the shots implant microchips or impart 5G connectivity. Meghan McCain recently endorsed, in a now-deleted social media post, an unregulated supplement company's 'spike detox' for those who 'regret' getting vaccinated. Kennedy, a longtime anti-vaccine activist, called the mRNA Covid shots the 'deadliest vaccine ever made,' incorrectly claiming the vaccines cause more illnesses and deaths than they prevent. Kennedy rose to greater prominence through the pandemic as previously fringe conspiracies about vaccines began dominating more mainstream narratives. 'Anti-vaccine sentiment goes back to the first days of vaccines in the 1700 and 1800s,' said John Moore, professor of microbiology and immunology at Weill Cornell Medical College. 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'That's why, if you look at the numbers of hospitalizations and deaths for children now, especially young children less than four years old, it's really not much different than the beginning of this pandemic,' Offit said. There's also 'extensive evidence' for benefits to pregnant people and their babies, he said. While the FDA recently approved Moderna's 'next generation' Covid vaccine, which was even more effective that their current shot in clinical trials, the agency limited the new shot only for older adults and for people aged 12 to 64 with health conditions putting them at higher risk. The FDA also announced new requirements for mRNA Covid vaccine makers to add additional warnings about the risks of myocarditis, or heart inflammation, based on data the FDA has not made public. During the Biden administration, Moderna received two awards totaling $766m to develop potential bird flu vaccines. Despite the changeover in administrations, Moderna's work continued as normal – until February, when health officials said in an article that the funding was being reviewed. Moderna hadn't received any notification of this review, which recently culminated in having the funding cancelled. Halting the H5N1 vaccine research, which was in phase 3 trials, leaves the US vulnerable in a potential flu pandemic, Nuzzo said. It also means other countries could build upon US investments to procure the vaccines for themselves. mRNA has shown promise in treating pancreatic cancer and other cancers, as well as rare conditions and hard-to-treat infectious diseases. Moderna, for instance, is working on vaccines for melanoma, lung cancer, norovirus, flu, and CMV, or cytomegalovirus, a fairly common infection that can cause lasting health problems for infants. The company also has an RSV vaccine, currently approved for older adults, that could be expanded for other age groups. But those efforts could be hampered by the administration's moves against mRNA and terminations of vaccine scientists and independent advisors who offer vaccine recommendations. 'We don't want to see kids kicked out of school because a 12-year-old girl is not getting her fifth Covid booster shot,' Marty Makary, head of the FDA, said in a recent interview. Yet no states require Covid vaccination for school attendance. Pushing back against mandates is a common tactic from anti-vaccine activists working to dismantle all vaccine mandates, Offit said. In addition to claiming the Covid vaccines are deadly, Kennedy has 'also said no vaccine is beneficial', he said. Kennedy recently unveiled a sweeping and controversial $50m research project on autism, including an autism research database. If that effort somehow links autism to vaccines – despite decades of studies showing no connection – it could open lawmakers up to lawsuits, Offit said. 'He could manipulate the Vaccine Injury Compensation Program,' Offit said. If Kennedy adds autism to the compensable list of injuries, 'it would break the program'. That would mean the people who experience very rare severe side effects from vaccines may then face challenges getting compensated. And it could prompt vaccine makers to stop producing routine childhood immunizations because of legal liability. 'It's a fragile market,' Offit said. Kennedy 'is an anti-vaccine activist, science denialist and conspiracy theorist', he continued. 'I think that he will continue this onslaught against vaccines.'
