Episode 180: The April Fool's Tragedy

Chris Dall: Hello and welcome to the Osterholm update, a podcast on COVID-19 and other infectious diseases with Doctor Michael Osterholm. Doctor Osterholm is an internationally recognized medical detective and Director of the Center for Infectious Disease Research and Policy, or CIDRAP, at the University of Minnesota. In this podcast, Doctor Osterholm draws on nearly 50 years of experience investigating infectious disease outbreaks to provide straight talk on the latest infectious disease and public health threats. I'm Chris Dall. Reporter for CIDRAP news. And I'm your host for these conversations.

Dr. Cory Anderson: Welcome back, everyone, to another episode of the Osterholm Update podcast. I'm Doctor Cory Anderson, a CIDRAP researcher and co-director of our Chronic Wasting Disease program, and I have the honor of filling in for our usual host, Chris Dall, today as he takes some well-deserved time off this week. In the meantime, we have a lot to cover this episode. The Trump administration's assault on federal and state health agencies is continuing at an unprecedented pace, all while the US is dealing with a growing measles outbreak, the ongoing spread of H5N1 avian flu, and the lingering effects of the COVID-19 pandemic. What we have seen in just the past two weeks alone is unlike anything we've seen before, and it's changing by the hour. Early last week, Trump administration officials announced that the centers for Disease Control and Prevention was clawing back $11.4 billion in funding that had been awarded to state and local health departments for COVID response. Around that same time, the National Institutes of Health terminated dozens of grants and awards that funded COVID related research in response to a CIDRAP news inquiry about the CDC funding cuts. A spokesperson with the Department of Health and Human Services, or HHS said the following, quote, the COVID-19 pandemic is over and in HHS will no longer waste billions of taxpayer dollars responding to a nonexistent pandemic that Americans moved on from years ago, unquote.

Dr. Cory Anderson: Then, on Thursday of last week, HHS announced plans to cut 10,000 employees spread across its 28 divisions. This was in addition to the roughly 10,000 individuals who had already left HHS over the past couple of months, through early retirement or deferred resignation programs. These layoffs officially began on Tuesday of this week, and it's no exaggeration to say that organizations like the CDC, FDA, and NIH have been gutted. How these layoffs and funding cuts will affect public health at the federal and state level is just one of the topics we'll be covering on this April 3rd episode of the Osterholm Update. We'll also update you on the growing measles outbreak in the US, discuss H5N1 avian flu, and take a look at COVID, flu, and respiratory syncytial virus trends. And we'll answer an ID query about the impact of COVID lockdowns and bring you the latest installment of This week in public health history. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.

Dr. Osterholm: Well thanks, Cory. And we really appreciate you filling in here for Chris on his vacation. For all of you who are listeners to the podcast. You've heard Cory actually, serve as moderator in a previous podcast and is one of the really talented individuals we have in the CIDRAP staff. So, Cory, thank you very much. Quite honestly, I wish we weren't doing this podcast. This is going to be a tough one to work through, but it's one we've got to discuss. It's one that we have to understand what's happening and what we can do about it. And I will make every effort today not only to describe the problem, but to give you some things that you can do to make a difference. But before we begin, let me just say that what happened on Tuesday, unfortunately, I believe will go down in history as the April Fools tragedy. It was simply beyond anyone's wildest imagination of not only what happened, but how it was carried out. Absolutely disgusting. Now, Cory has outlined for us just how the chaos that has hit public health agencies, thanks to RFK's efforts to reduce and reorganize the federal agencies that deal with health policies and research. And what that now looks like. These announcements are very bad news. Ultimately, the cuts in workforce and budget means the health agencies will not be able to carry out their work in preventing, measuring or responding to health crises and that they will now have thousands fewer experts guiding our nation's public health policies.

Dr. Osterholm: Before we go any further, though, I want to just make one thing very clear. The idea of trying to contain government waste and the control of the federal budget by focusing on federal employees is just a waste of time. Why do I say that? I will get into a much deeper dive on this topic in a few moments, but let me just remind everyone that if you look at the budget for the Health and Human Services Department in our federal government. Slightly less than 1% of all the expenditures is for all the federal salaries. 1%. So, if you eliminate every employee in the federal government who works in HHS, you could maybe shave off 1% of the cost. Of course, that doesn't count all the cost of not having people there to do their job, making it possible to get Social Security checks, to have their Medicare, all those things that we talk about. So just keep that in mind 1%. So, if you're going to tackle a cost containment issue, why would you go after something with only 1% of the total budget? As I said in just a minute, I'll dive deeper into the impact that these cuts will have on the mission and effectiveness of the affected agencies. But before we get there, it's important to consider that beyond the dramatic headlines and political rhetoric, these layoffs and budget cuts that will lead to further layoffs have real consequences for the people who have dedicated their careers in public health.

Dr. Osterholm: Trust me, no one goes into public health to get rich or to get famous. Now think about all those affected high level scientists and directors of health programs and mid-career leaders and innovators and early career professionals who just landed dream jobs in their field, only now to lose them overnight. Think of the students who will be graduating from public health training programs in the coming months, who face an absolutely uncertain future in an underfunded, villainized field. The layoffs in Washington, Atlanta and state and local health departments will, unfortunately lead to a job market where highly skilled professionals have few options. And I will describe in a moment how some of the professionals who were let go actually had that unfold in their lives. It was absolutely despicable what happened. Imagine a senior scientist at the NIH who was told, you're not fired, but you now have to go work on a remote Indian reservation somewhere in the United States in such a way that you wouldn't be doing the work that you did before. That was not a real, legitimate and honest way to try to deal with employment status. I feel for my colleagues and friends and mentees who are in the midst of this upheaval. It breaks my heart. I know public health professionals to be compassionate, skilled and brilliant people. We enter into this career to serve our communities. We bring our backgrounds in science, math, medicine, social sciences, communication, and program management to address some of the world's most complex challenges.

Dr. Osterholm: We take pride in the many achievements of our field, and take ownership of all the ways that we must improve and adapt to do our work even better. We deserve better than the sudden budget cuts and the disruptive stop work orders. We deserve better than being accused of being lazy or not capable of doing our jobs. I know that these layoffs are intended to reduce government costs, but as I just said, it's naive to think that this is what will happen, when in fact, all the salaries in the entire department make up less than 1% of the budget. Right now, I'm grieving the personal costs of layoffs with all my public health colleagues. I want to dedicate this episode to the entire public health workforce, especially the talented and dedicated folks at the federal, state, and local level who have given so much to the field only to be pushed out. We see you and we will stand with you. And let me just add one caveat to set the tone for the rest of this podcast. As you have heard me say time and time again, my job is to call balls and strikes. I am not here to provide a partisan message. I'm here to call balls and strikes, and I will do that to the very best of my ability. But I also will point out very clearly, just like the old oil fram commercial of the 1960s in which the line was, you can pay me now or you'll pay me later.

Dr. Osterholm: I will promise you, every mistake that we're making right now will cost us dearly into the future. Now let me move on to something a little bit lighter. For those of you who want to tune out for a few seconds. Go right ahead, I understand. I hear that frequently. I also hear very frequently, please do not miss the information on light. I'm very happy to report today on April 3rd here in Minneapolis-Saint Paul. Sunrise is at 6:49 am, sunset at 7:43 p.m.. That's 12 hours, 54 minutes and 26 seconds. Wow. That's a lot of sunlight and it's gaining at three minutes and six seconds a day. Now, in terms of our dear, dear friends in Auckland, New Zealand, a place that has become a favorite watering hole in New Zealand for podcast listeners at the Occidental Belgian Beer House on Vulcan Lane. Today, sunrise for you is at 7:35 a.m., sunset at 7:12 p.m. you have 11 hours, 36 minutes and eight seconds of sunlight. It's still quite a bit of light out there, but you're losing sunlight at two minutes and 18 seconds a day. I promise you, as we get closer to more sunlight, you get closer to less sunlight. We will do everything we can to share our sunlight picture with you.

Dr. Cory Anderson: Mike, let's start again with the latest from our nation's capital. And it's a lot as I laid out in the introduction. The restructuring at HHS was announced last week, and while the exact number of layoffs is changing by the minute, it appears that the organization is following through on its intention to reduce its workforce from 82,000 to 62,000. In addition, some HHS divisions are being merged and others are being relocated or even eliminated. These layoffs and resignations have included some of the best and brightest in public health. Top FDA vaccine scientist Peter Marks, Naiad director Jeanne Marrazzo, who was serving as the replacement to Anthony Fauci, and Kevin Griffis, who directed the CDC's Office of Communications, just to name a few. Mike, what was your reaction to all of these moves?

Dr. Osterholm: I wish I could tell you that I was shocked, but I wasn't. Because in fact, we have been hearing from this administration for the past weeks that in fact, they would carry out this kind of activity. I think many people just felt that that really couldn't happen. But it has. Now, let me just add a perspective here as we talk about these personnel issues in trying to initiate cost savings for a more efficient government. At the very outset, let me be really clear. Our government, however you want to look at it, has not become a bloated entity. In 1950, in this country, a period of time when people looked at our federal government as a friend, as someone to help them get past World War II, all number of programs that were brought to being at that time. When the US population was 151,325,000. That's 151,325,000. There were 1.4 million federal civilian workers. Now, in 2025, we actually have 340 million people in this country, 2.2 times higher than we did in 1950. And we have 2.4 million federal civilian workers. That is almost 1.7 times higher than the actual number of workers in 1950. But remember, the population grew by 2.25 times. So, in fact, today we have fewer workers per million population than we had in 1950. This is not some blowout situation. And as I pointed out a moment ago, if you look at any federal agency, particularly HHS, their salaries make up less than 1% of the total expenditure of that particular department.

Dr. Osterholm: I don't know how you could look at this and say, we're doing something to make the government more effective. Then I just have to add one last piece. You know, all of us can agree that there are better ways to do things. We should be learning all the time. Improvement in performance should be a standard. So, am I afraid of us approaching that issue with our government, our schools, our universities, whatever? No. But imagine a business person today leading a large organization who decides I'm just going to let it rip. I don't know exactly who I'm cutting. I don't know what programs I'm addressing or not addressing. I'm just going to take this machete in here and be very proud of the fact that I just eliminated 10,000 or 20,000 people. They wouldn't be a CEO very long. I can't imagine they'd do very well in a major business school in this country. Yet that's what's happened right now. There hasn't been any attempt to identify how to be more effective, how to be more productive, how to be more of keeping with what citizens want and need. Nope, that's not what happened. They took a machete to this situation, and they did it to show that they could. And as I pointed out earlier, they then took some of the key people who they were just trying to punish by then saying, no, you're not fired, but you're just going to go work for the Indian Health Service in some remote location.

Dr. Osterholm: So, this is truly, truly a travesty. As you know, I have now set the tone for this episode, and I wish I could try and put a positive spin on things, but we've spent five years together with this podcast family. I would be doing everyone a disservice, and I would not be honest if I had any message other than what I'm sharing with you today. What is happening today in the field of public health, as well as other government entities is simply devastating. And again, this is just balls and strikes. As you mentioned, Cory, there have been cuts to several public health agencies with the intention of reducing the HHS workforce from 82,000 to 62,000. 10,000 from layoffs and another 10,000 from the deferred resignation offers. These cuts are laid out on a fact sheet on the HHS website entitled HHS Transformation to Make America Healthy Again. With this restructuring, the 28 divisions of HHS will now be consolidated into 15 and ten regional offices will become five. Among the cuts and reorganization include 3500 full time employees cut from the FDA. CDC will cut 2400 employees, including 1400 being CDC employees and 1000 being employees of the Administration for Strategic Preparedness Response, which was just moved to CDC.

Dr. Osterholm: 1200 employees will be cut from the NIH. 300 employees will be cut from the Center for Medicare and Medicaid Services. There will be a new organization called the Administration for a Healthy America that will combine what Kennedy referred to as alphabet soup. The Administration for a Healthy America will merge the following offices. The office of the Assistant Secretary for Health, Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Agency for Toxic Substances and Disease Registry and the National Institute for Occupational Safety and Health. I have to add one caveat to this last organization, NIOSH or the National Institute for Occupational Safety and Health. They were incredibly important in the voice during COVID, laying out what the risks were with airborne disease transmission of this virus. To see them neutered, as they are right now, I think, frankly, is absolutely frightening. The DOGE's fact sheet claims that no additional cuts are currently planned, but the department will continue to look for ways to streamline its operation and agencies. Needless to say, anyone who still has a job in the federal government wakes up every morning wondering if there will be a letter on their computer saying so long. In that light, employees begin receiving their termination notices this past Tuesday. And though I wish we could report exact numbers of how many people have been terminated and from which HHS divisions, things are changing by the hour.

Dr. Osterholm: So, we really don't have a clear picture of what's going on in that regard. But I can share more about what exactly we do know. First, we know that the way these termination notices were carried out is brutally cruel. Many HHS employees did not know that they were terminated until they showed up to work that morning and couldn't use their badge to get into their building. The photographs circulating online of the long lines of federal employees waiting outside their workplace to find out if they could get in the door is simply heartbreaking. Second, we know that we've lost a lot of top officials at the agency who have incredible scientific expertise. Some of these individuals were offered reassignments to remote offices across the country, and others were terminated altogether. Some of the individuals that were terminated on Tuesday and divisions hit particularly hard include at the FDA, the chief veterinary officer of the FDA. He was working on the bird flu response. At least six senior leaders in the veterinary medicine center, the head of the Office of New Drugs. He was offered a position in patient affairs, but he declined the offer. And even the head of the tobacco center was let go. Yet were led to believe that this was an important aspect of a healthier America.

Dr. Osterholm: At the NIH at least five directors of the NIH is 27 institutes and centers have been reassigned, including Jeanne Marrazzo, the director of the National Institute of Allergy and Infectious Disease. Cory, you mentioned her earlier. She has been nothing short of a superstar in the NIH oversight activities. In addition, other notable NIH individuals receiving their walking papers included Cliff Lane, deputy director for clinical research. Emily Erbelding, director of the Division of Microbiology and Infectious Diseases. She received an email putting her on leave, and also with a proposal to work at an Indian Health Service reservation in one of their several remote areas. And finally, the deputy director and scientific director of the National Institute on Aging and the extramural division directors at NIAID were also put on leave. At the CDC, at least nine directors were placed on leave and offered reassignment to the Indian Health Service. This included senior leaders who oversee global health, infectious diseases, chronic disease, HIV, sexually transmitted disease, tuberculosis, outbreak forecasting, and information technology. In addition to the employees who were laid off, many have been reassigned in recent weeks due to the state of the federal government or due to essentially being forced out. This includes Peter Marks, one of the top vaccine scientists in the country, who served as deputy director of the FDA's center for Biologics Evaluation and Research from 2012 to 2016, and has led this group since playing a central role in Operation Warp Speed.

Dr. Osterholm: On Friday, he was told he could either quit or be fired. He later sent his resignation letter to the acting commissioner of the FDA, Sara Brenner. In his letter, he was very clear about his concerns about the direction RFK Jr is taking the FDA writing that, quote, undermining confidence in well-established vaccines that have met the high standards for quality, safety and effectiveness that have been in place for decades at FDA is irresponsible, detrimental to public health, and a clear danger to our nation's health, safety, and security. As you can tell, Marks did not mince words. He went on to say, and I quote. However, it has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies. Mark's concerns echo those of Kevin Griffis, who resigned from his position of director of the CDC's Office of Communications, a position he's held since 2022. I know Kevin well. He is an outstanding communicator and been very helpful to the overall aspects of communication. At HHS. Griffis published an op ed in The Washington Post last week explaining the reasoning behind his decision, leading the piece by saying, I left my job because I believe public health policy must always be guided by facts and not fantasy.

Dr. Osterholm: He goes on to explain the disastrous response at Kennedy is leading against measles before, quote, urging public health experts to come together to invest in organizations and provide independent, trustworthy sources of information on vital public health matters, unquote. I couldn't agree more with Kevin's statement, and it is something my colleagues and I have been discussing in depth in recent weeks. Kennedy has claimed that all of these recent cuts will save the U.S. about $1.8 billion per year. But this is so incredibly shortsighted. Every dollar we invest in public health saves us $5.60 in future health care related costs. And that doesn't even begin to consider the additional savings in indirect costs. And of course, the priceless value of lives saved and the quality of life improved. The bottom line is that these cuts aren't saving us money in the long run. And again, my heart breaks for all of those who have lost their jobs and in the ways in which it has happened. As I mentioned in the dedication, these employees who were laid off are my colleagues, my friends, my students. My heart hurts for them. They've dedicated their lives to public health and they all deserve so much better. We are in the midst of a great tragedy in public health, and every day I am growing increasingly afraid of the consequences that we will face because of it.

Dr. Cory Anderson: We talked a few episodes ago about how the impact of cuts at the federal level was going to trickle down to states. Now we have the administration clawing back more than $11 billion that had already been awarded to state and local health departments to help with the COVID response. Minnesota alone had $226 million in contracts terminated with no advanced warning. How are state and local health departments going to pick up the slack from a depleted CDC, if they're being bled of public funding?

Dr. Osterholm: Cory, this is incredibly concerning to me, and again, is a real challenge. Personally, as you just mentioned, $11 billion in COVID response funding that was awarded to state and local health departments has been cut by the federal government. These cuts were very sudden, so state and local departments had no time to prepare for this significant loss of funding. Here in Minnesota, $226 million, or about 25% of our total budget, was cut literally overnight. This resulted in the layoffs of about 170 Minnesota Department of Health employees, rescinded work offers for an additional 20 employees, and at risk notices being sent to an additional 130 employees, according to a press release from the Minnesota Department of Health, some of the impacts of these cuts will include significant reduced support for nursing home follow up, slower response times to outbreaks, suspension of partner led emergency preparedness efforts and vaccine clinics, reduced laboratory support for health care systems and hospital that could result in delays in lab results and patient care, inability to update the state's immunization information system, meaning it will remain outdated. And finally, it included funds that were originally intended for tribal health. As I've shared with you in a previous podcast, today, most states in this country have as the basis for their funding for infectious disease work, that of federal funds. In a state like Minnesota, 90% of all the resources needed to address all aspects of infectious diseases, whether it be surveillance, outbreak response, etc. all originate from the CDC. Now, given that and knowing that these cuts are not the only cuts that are going to be made, we are about to enter a very dark age in the state of Minnesota, as well as most states in this country in terms of domestic preparedness.

Dr. Osterholm: I am absolutely certain, beyond any shadow of a doubt, we will regret this loss of support more than I can put into words. And unfortunately, it's going to have to take the time for new outbreaks to occur, people to die, public attention paid to these outbreaks that are not being controlled. And at that point, then unfortunately, and only then I think, will people wake up and say, is this what we really want? Is this what we really need? As I mentioned a moment ago, the funding that was cut was being used for COVID-19 related projects. Many have justified these cuts by saying the pandemic is over and therefore the work is no longer needed. But this couldn't be further from the truth. Many of the projects that were cut were focused on improving our preparedness for future public health emergencies and pandemics. And as listeners of this podcast, you have heard me say dozens of times before, there will be a next pandemic. Decisions like this are making us less and less prepared by the day. Now is the time to contact your state lawmakers and let them know that you want to see increases in state funding for public health in response to these federal cuts. State and local governments won't be able to pick up all the costs of what was lost, but any increase in funding is better than nothing. Make your voice heard and please continue to advocate for public health. Remember, this is a point that's relevant to all the 50 state health departments and the more than 3000 county and local health departments.

Dr. Cory Anderson: As I also noted in the introduction, dozens of NIH grants for COVID related research have been terminated. That includes funding for research aimed at developing new COVID treatments. This administration seems to feel that COVID doesn't matter anymore. But isn't there still a lot we can learn that could help us for the next pandemic?

Dr. Osterholm: Cory, again, this is personally and professionally very challenging to hear about. The NIH updated its list of research activities that they will no longer be supporting to include all projects related to COVID-19. This will mean that about 600 projects worth a combined $850 million will be completely cut. Also on the list of terminated research activities are any projects related to China, South Africa, transgender issues, vaccine hesitancy, climate change and DEI. It's unclear what exactly is considered a DEI project, but researchers at the National Science Foundation have been told to remove words like barrier, bias, disability, equity, exclusion, female, historically, inclusion, socio economic, trauma, and women from their grants in order to be eligible for funding. Isn't that amazing to think that these are the key words that we're talking about? Another concerning category of projects added to the NIH list was any project that the HHS director feels should not be funded. With RFK Jr in this position, I can't imagine what this will mean for vaccine research. Similar to the cuts to COVID response funding at state and local health departments, the federal government has justified the decision not to fund COVID research by stating that the research is no longer needed now that the pandemic is over. But just as with state and local health department funding, these projects weren't just looking at treating and preventing COVID. They were looking forward to the next public health emergency. Many of these projects, as you mentioned, Cory, were also funding research into treatments for long COVID, which has so many of our listeners know on a personal level, is still having devastating impacts on so many lives.

Dr. Osterholm: Finally, these cuts will likely mean the termination of most ongoing mRNA technology research. This will put us in an incredibly vulnerable position in the event of an influenza pandemic, where chicken egg embryo vaccine is not likely to be able to scale up for years before those vaccines would be widely available. mRNA technology could make a big difference that way. It is painful to see so many years of research and preparedness efforts quickly undone by this administration. I wish I had a more optimistic outlook on this to share, but the harsh reality is that the consequences of these actions will have devastating impacts in the months and years ahead. And let me just close by reminding everyone, it was just several months ago that the Chinese reported finding a new coronavirus, a MERS like virus where we know with MERS, the case fatality rate can be as high as 35%. What made this virus so different and very important is it also had an ACE2 receptor, meaning the kind of receptor that we saw on the SARS-CoV-2 virus that made it able to easily infect people. In this situation having a MERS virus with such a high case fatality rate potential, along with now the same potential for spread that we saw with SARS-CoV-2, Imagine how devastating a virus like this gaining a foothold in the human population could be, and we're not going to do any more research to get ready for it. Irresponsible.

Dr. Cory Anderson: One final item out of Washington. Last week, we learned of what appears to be a final nail in the USAID coffin as the Trump administration detailed its plan to move the agency into the State Department and reduce its staff to 15 people. Your thoughts, Mike?

Dr. Osterholm: Well, Cory, I have to remind our audience just one more time. If you take all the financial contributions that our government makes to improving health around the world, and specifically many low- and middle-income countries. It constitutes less than 1% of our entire federal budget. So again, eliminating all of this is not going to impact on the overall budget concerns that have been expressed. So, I just want to emphasize that because the value of what we get for this kind of public health diplomacy is priceless. And so just from that perspective, I think it's just a critical issue to understand. This, again, is not a real issue. So, Cory, this is not surprising as USAID was among the first organizations dismantled by this administration, but it's still incredibly challenging nonetheless. Prior to the Trump administration taking office, the organization employed about 10,000 people who were doing lifesaving work around the world. But sadly, it is clear that this humanitarian work being done was just not a priority to this administration. This was made clear earlier this month when the administration sent surveys to USAID funding recipients, asking them to answer questions about how their projects contributed to this administration's interest. The questions included, can you confirm that this is not a DEI project, and that there are no DEI elements of that project? Two: Can you confirm this is not a climate project or include such elements?

Dr. Osterholm: Three: What impacts does this project have on limiting the flow of fentanyl, synthetic drugs and other precursor chemicals to the US? Four: Does this project directly impact efforts to strengthen U.S. supply chains or secure rare earth metals? And finally, does this project directly contribute to limiting illegal immigration or strengthening U.S. border security? Now, think of all the purposes of using support to reduce morbidity and mortality at a local level around the world. Do these questions really serve any useful purpose? No, but they sure were able to draw up red flags that meant that these projects were clearly in the works to be cut. It's no surprise that when we see that these were the questions being asked to determine the value of USAID, that the administration determined that these programs should be cut. These programs aren't about border security. They aren't about securing resources for the United States. They're about saving lives. We have covered some of the estimated human impact of these USAID cuts in previous episodes. But in light of these additional cuts, I think it's worth repeating. It is estimated that with the termination of these USAID programs, we will see an additional 13 to 18 million cases and 71,000 to 166,000 malaria deaths annually. We will see an additional 28 to 32% increase in the annual incidence of tuberculosis and multidrug resistant TB, we'll see an 89% increase in case incidence and an additional 2 to 3 million deaths per year of vaccine preventable diseases.

Dr. Osterholm: And finally, we could expect up to 200,000 additional cases of paralytic polio per year over the next ten years. And these are just some of the projected infectious disease impacts. We also can project that this year alone in the 48 countries with the most maternal, newborn and child deaths, 17 million women will lose access to lifesaving maternal care. 11 million newborns will lose access to the postnatal care in the first two days following birth. 15 million children will lose access to treatment for pneumonia and diarrhea. And finally, 1 million children will not be treated for severe malnutrition. These numbers are unfathomable, and I know I've put a lot of numbers out there, but I just hope it's the magnitude of what I'm talking about is beginning to sink in. I will never be able to understand how any administration can see this as wasteful government spending. To think that less than three months ago, we had 10,000 people doing this incredible work around the world, and today we have just 15 individuals left in USAID. This is so sad. The world deserves better. We are required to do better, and we're not.

Dr. Cory Anderson: Now let's turn to the growing measles outbreak. We've been focused on Texas and New Mexico, but we're starting to see rising cases in Kansas and other states. And last week, The New York Times reported that doctors in Texas are starting to see complications in measles patients caused by excessive vitamin A, which RFK Jr is touted. Mike, what are the latest numbers on the outbreak, and are you concerned that this could start to spiral without more consistent messaging on vaccination from the federal government.

Dr. Osterholm: Well, Cory, this situation is truly a crisis. In children's health from multiple angles. And it's ironic, considering that RFK Jr.’s former position with an organization that supposedly defends children's health. I'll start by reviewing the latest updates from the measles outbreak that began in Texas. As of Tuesday, April 1st, according to the Texas Department of State Health Services, the outbreak in the western portion of the state has reached 422 confirmed cases and 42 hospitalizations. New Mexico is reporting 48 cases and two hospitalizations as of April 1st. There are also nine cases in Oklahoma that are connected to initial measles exposures from the Texas outbreak. As of March 26th, there were 23 confirmed cases of measles in Kansas. The initial source of the outbreak in Kansas has not yet been identified, but genetic sequencing found a link to the cases in Texas and New Mexico. Other states continue to report measles cases related to international travel, including an outbreak in Ohio of at least 11 persons. CDC is only updating their national case numbers on Fridays, but based on their numbers from March 28th and adding the updated case counts from Texas and New Mexico this week, there are at least 500 confirmed cases and two deaths in the United States from measles this year. This is incredibly frustrating considering that the country eliminated measles decades ago. Anti-vaccine and anti-scientific rhetoric from figureheads like RFK Jr have a direct impact on diminishing vaccination rates and have made communities more vulnerable to measles outbreaks. But their harm to children's health doesn't stop there.

Dr. Osterholm: RFK Jr and others have overpromised the effectiveness of the preventives and therapies for measles that actually have considerable risk. One that you mentioned, Cory, is toxicity caused by an overdose of vitamin A. Vitamin A, specifically in the form of cod liver oil, was touted by Kennedy as miraculous against measles. It's clear his words had a substantial impact on the public, as reports from drugstores in West Texas say that cod liver oil and vitamin A are flying off the shelves. Doctors in Texas are already reporting evidence of hospitalized children with liver damage related to vitamin A toxicity. You only have to follow the money to see that people are profiting off of this. By offering pop up clinics and telehealth visits to families seeking to prevent or treat measles with something seemingly more natural and safer, like vitamins. As you alluded to, Cory. These harms to children are all caused by the destructive messaging from people like RFK Jr, and will only worsen if we don't get more meaningful communication out there about the safety and effectiveness of MMR vaccines. We have even more evidence this week that science is being silenced. ProPublica reported that a US forecast detailing an updated risk assessment for measles transmission in the US, and enhanced communication on the importance of vaccination was abruptly stopped. This is not the radical transparency that Kennedy claimed the agency will provide under his leadership. This is, frankly and straightforward, simple censorship.

Dr. Cory Anderson: On a related note, there were two stories last week regarding the MMR vaccine. One story involved a fake website that was nearly identical to the CDC's official vaccine safety page, but contained vaccine misinformation. The other covered an individual who has reportedly been tabbed to lead a federal study that will examine whether there is a link between the MMR vaccine and autism. What can you tell our listeners about these stories, and what do they tell us about how far RFK Jr's attempts to undermine vaccines may go?

Dr. Osterholm: Well, let me just begin by saying expect the unexpected, because what we're going to see, I think, in the days ahead about information and disinformation are things that right now we probably can't even yet imagine. I'll remind our listeners that disinformation is purposely meant to mislead others. That's exactly what was intended with both of these situations. The first instance you mentioned, Cory, was a web page that was put up by the Children's Health Defense. That was a clone of the CDC page on vaccine safety. We will put up a link in the show notes of the post from the info Epi lab on Substack, where you can see the two pages side by side. Remember, the Children's Health Defense is an organization that Mr. Kennedy has played a key role in for a number of years. The page uses the CDC logo, colors, and format, but lists false information regarding vaccine safety and prevents autism as a likely consequence of vaccination. This is so clearly disinformation, as the site name was, quote, real cdc.org, unquote. The CHD was purposely trying to mislead people with false information and posing as a legitimate public health organization.

Dr. Osterholm: The website has since been taken down, but we will see what ramifications come about beyond this. With RFK Jr at the helm, I don't see any significant legal action being taken. Chris, you also noted that David Gere has been reported to have been hired by HHS to lead the efforts to, quote, study, unquote, the link between autism and vaccines based on this individual's history and surrounding administration. I can already guess what the conclusions of these so-called studies will be. For context, David Gere worked alongside with his father, Mark Gere, writing articles that suggested a link between autism and vaccines and promoting harmful and expensive medical practice for autistic children, which eventually resulted in him losing his medical license. David Gere, who had no medical or research background, has been hired as a data analysis, it is clear that David Gere was chosen for this position because he has demonstrated a lack of integrity and disregard for rigorous scientific research. He knows the answer that this administration is looking for, and he will work backwards from there. Once he identifies it.

Dr. Cory Anderson: Mike, what's the latest on H5N1 avian influenza?

Dr. Osterholm: Well, Cory, I'm not completely sure because there has been a relative blackout in information forthcoming from the federal agencies and the past 6 to 8 weeks. But this is what we do know. We've now passed the one-year mark since H5N1 was first detected in dairy cattle in the US, and I can't say my outlook is all that different. It's another episode of updates on growing case counts, as avian influenza is showing no signs of stopping its relentless crawl through vulnerable animal populations. The USDA confirms more infected dairy herds in Idaho and California, bringing the cumulative national totals to 995 herds in 17 states. H5N1 virus was also recently detected in Minnesota through the USDA's bulk tank testing program. The interesting part about the Stearns County herd is that it was previously infected with the virus in July 2024. It's unclear whether the herd has been residually infected since then, or is this a new outbreak? Either way, the USDA has yet to add this detection to their cumulative case count. In terms of poultry, three more live bird markets in New York have tested positive for H5N1, along with nine other flocks, mostly concentrated in states just south of the Great Lakes, Illinois, Indiana, Ohio and Pennsylvania. The two largest, these last 12 outbreaks have occurred in commercial turkey meat facilities, affecting a total of over 31,000 birds. The USDA has yet to publish the detection of a commercial egg layer in Kosciusko County, which has a flock size of over 25,000 hens. In terms of other animals, we continue to hear about domestic cats affected by H5N1 after eating raw food from several different manufacturers. There are also some detections in mice, skunks, fox, black bears, a bobcat, and even a bottlenose dolphin.

Dr. Osterholm: It's becoming abundantly clear that this virus can and will jump to species that are exposed to it. The big question is what does that mean for humans? We're still not sure. In terms of international news, UK officials have reported the world's first case of H5N1 in sheep, which were being housed at the same farm as positive birds. Maybe no surprise here, huh? Additionally, officials in India have reported eight H5N1 outbreaks in commercial and backyard poultry flocks, affecting more than 602,000 birds across the eastern region of the country. Since the Trump administration's billion-dollar rollout plan was announced a month ago. The USDA has announced that they're opening a $100 million funding opportunity for projects focusing on avian influenza prevention, therapeutics, vaccines and research, with proposals due May 19th. The USDA has also initiated another part of the plan, which aims to assess wildlife hazards and review current biosecurity plans and measures. Priorities for assessing these services will be given to egg layer facilities in the highest egg producing states, clearly upholding the administration's main goal of lowering egg prices. So, to conclude, where we're at with H5N1, there are still many, many unknowns about this. Will we, in fact, see eventual transmission to humans that will result in human-to-human transmission? We don't know. After a year, we've not seen it. As some of you recall, a year ago when it first appeared, I was concerned. I raised the issue that this may not be readily transmissible to humans. Surely, we have seen such cases occur, particularly with conjunctivitis. But will we get classic influenza respiratory transmitted virus? I don't know. This is one of those stay tuned moments. And unfortunately, we're not doing much at a government level to stay tuned.

Dr. Cory Anderson: How about flu, COVID and RSV?

Dr. Osterholm: Well, Cory, I think we're actually going to find a way to put some positive spin on this week's episode. It's that we're almost officially done with flu season. COVID activity continues to decrease and RSV seems to be in the rear-view mirror. Let's dive into the numbers, starting with influenza. If we look at outpatient visits for flu, they're currently at 3.3%, still above the national baseline of 3% when we finally declare the flu season over. This is down from 3.9% last week and 4.3 the week before our last episode. This is the 17th week above baseline, and while we're not quite there yet, I anticipate that within two weeks we'll have another small piece of good news to report officially that the flu season is over. Flu activity is decreasing in every age, every region, and every metric. If we look at influenza diagnostics in the emergency department, visits are down from 3% two weeks ago to 1.7% now. And finally, new hospital admissions are down 43% compared to our last episode, with just under 13,000 new admissions last week. So far this season, there have been an estimated 580,000 flu hospitalizations and 25,000 deaths, 159 of those being pediatric deaths and 25 of those pediatric deaths occurring just in the last two weeks.

Dr. Osterholm: If you remember, in our last episode, we discussed that influenza B tends to increase prevalence towards the end of the season. We're continuing to see that hold true of the nearly 2000 specimens that had subtyping performed last week. 6.4% were influenza B, compared to 3.3% of specimens throughout the entire season. So, to wrap up the flu update before we move to COVID. Hang in there. We're getting very close to the end of the flu season. I'm hopeful we'll have good news with this on our next episode. Now looking at COVID, we continue to see more of the same since our last episode, with every metric decreasing in every region. The national wastewater level is considered low and decreasing. The South is the only region with moderate wastewater concentrations and the other three are low. Emergency department visits for COVID are also low and decreasing, and hospitalizations continue to decrease as well. Over the last week, 1% of inpatient beds are about 7000 patients and 1% of ICU beds. About 1049 patients were occupied by COVID patients. This is about 10% lower than our last episode. Weekly deaths also continued to decline, but not as much as we'd hoped. The most recent week with complete data was the week of March 1st, when we lost 602 lives to COVID.

Dr. Osterholm: For reference, last spring, late May and early June was when we saw the lowest weekly death total since the beginning of the pandemic. At that time, there were just over 300 deaths per week. We're hoping that this is the number that we will soon reach. Also, getting back to that 300 or fewer deaths. Now, this is probably a good time to say that I don't know what's going to happen with COVID vaccines this fall. I wish I did, but unfortunately my crystal ball is as murky as ever. Finally, to wrap up a quick RSV update, the national waste water concentration is low and showed a slight increase over the last week, but is still lower than it was two weeks ago. Emergency department visits are low and decreasing, and hospitalizations are also decreasing. Increasing. Last week, about one half of 1% of both inpatient and ICU beds were occupied by RSV patients. This is about 3500 inpatient and 630 ICU beds, which is a 17 and 25% decrease from our last episode, respectively. I'm not too concerned about RSV at this moment. And that being said, going forward, we'll take a break from providing RSV updates until we see a significant change in cases, possibly later this fall.

Dr. Cory Anderson: Now it's time for our ID query. And this week we received several questions prompted by an interview on the New York Times podcast The Daily with the authors of a new book titled In COVID's Wake How Our Politics Failed Us. One of the questions they're asking in this book is whether stay at home orders and many other pandemic era policies were really worth it. Were those policies based on good evidence? Did closing schools, businesses and places of worship do more harm than good. And whether or not you've read the book, Mike, I think our listeners want to know how you might answer those questions.

Dr. Osterholm: Well, Cory, this is a very important topic and one that I've done a lot of thinking about. Having just finished my new book that will be coming out later this summer, this is one of the areas that we covered in some detail. Let me just be really clear. When we talk about the concept of a lockdown, it has any number of different definitions, but I will use it as a government mandated activity that someone must do, or is required to do to get a certain level of service. It doesn't take into account all the things that private sector companies did, organizations did, schools did whatever. This is about government. And let me just start off by saying I was really surprised the third week of March in 2020, when I saw public health recommendations to governors and mayors and how to respond to the pandemic through lockdowns. Now more of a reactive tactic than one born of long-term reasoning. Government had not used statewide lockdown mandates in the previous hundred years for influenza pandemics, nor had we prepared for actions like lockdowns. And it showed. And I tried to make this point clear. And actually, on March 21st of 2020, Mark Olshaker, the coauthor of my book Deadliest Enemies and the coauthor of the book to come out this summer, published an op-ed in the Washington Post entitled Facing COVID-19 Reality A National Lockdown is No Cure.

Dr. Osterholm: Our bottom line significantly reducing the number of serious illness and deaths would require a near-total lockdown until an effective vaccine is available, probably at least months from now. Well, the whole point we were trying to get at is that people were not envisioning what was going to happen more than two or 3 or 4 weeks down the road. Imagine a hurricane comes through your community. It's horrible for those hours that that is on land. The highly destructive winds, tidal flooding, etc. but you can go into recovery within a day or two of that hurricane. Well, if you have a flu pandemic that's going to last 2 or 3 years, you have to be able to do whatever you're going to do for that time period. Now, why was a lockdown put into place? First of all, it was really about health care. And when I say about health care, what we're talking about is that hospitals were being overrun and we needed to decrease the number of cases in the community just to have any possibility of providing helpful and adequate medical care to those who are infected with COVID. Grant you there were many instances where hospitals were overrun, and the question was, what do you do about it? The reason Mark and I argued about not doing lockdowns was the fact that you couldn't maintain that for 2 to 3 years, and it didn't happen.

Dr. Osterholm: It turns out that looking at the lockdowns that were put into place in the United States by government. An analysis of that shows they were relatively short lived. The University of Oxford actually did a study looking at lockdowns in the United States and found that of the 40 states that issued stay at home orders between late March and early April, all but one lifted them or heavily scaled them back by the end of June. So, this is June of 2020. This wasn't 2021, 22 or 23. And yet, I hear over and over again about how lockdowns were in place for this extended period of time. Now, were some venues shut by the choice of the individuals? Absolutely, yes. But the point was, these weren't real lockdowns. Now, what we were trying to do is minimize that increased number of cases in the community over time. In other words, if any given one-year time of the pandemic, there would be a thousand cases, for example, of COVID. Wouldn't it be better if you had those spaced out equally through all 12 months, as opposed to all of them occurring within a month or two.

Dr. Osterholm: And what the whole point of our recommendation was, use snow days, use some kind of a process that says when we hit a certain level, we're going to ask the community to minimize their contact as best they can. So, we can then over the course of the next two to 3 or 4 weeks, hold down the number of new cases, i.e., then making it more likely that we're going to have the ability to adequately treat patients in the hospital. And so had we done that, and had we shared with individual communities what their numbers were for hospitalizations, they would likely have been in a better place to understand and accept okay, for the next week or two, like a snow day, we'll stay home and hopefully drive those numbers down. Because remember that this is a long-term situation. We were never going to stop it until we had an effective vaccine or there was evidence of some kind of herd immunity, which never did show up. And let me just give you one example where there was a lockdown and what happened. The Chinese actually had the ability to lock down certain areas of their country. And by lockdown, I mean people didn't leave their homes. Items were brought to their homes was food, etc., medicines, whatever. And when they finally released these communities from these lockdowns, extreme lockdowns, there was a major, major increase in the number of COVID cases and a major acceleration in deaths.

Dr. Osterholm: Meaning that they were still vulnerable to the virus. And as long as it was floating around out there, whether they got it in year one, year two, year three or even year four, they still got it and they died. And so there never was the idea that a lockdown would stop the pandemic. What it was meant to do is slow down what was happening. And in that regard, I think it was unfortunate the term lockdown got used because that really conveyed a certain level of restraint in the community that just didn't happen. And what do I mean by that? Take Minnesota. In our state, when the governor issued a stay-at-home order, he was clarified a day later to indicate that it did not include essential workers. And oh, by the way, 82% of our workforce was considered essential workers. So even here we were given the title of having a lockdown for two months, when 82% of our workers were said, yep, you can still go ahead and do what you do. So, I felt like this book that came out really didn't even understand what they were talking about. It was a misunderstanding of what a lockdown was, and more importantly, it was a misunderstanding of what the effects of those could be over time.

Dr. Cory Anderson: Now it's time for this week in public health history. And for this episode, we're going to highlight GAVI, an organization that has helped purchase with significant U.S. funding support critical vaccines for children in developing countries. We learned last week that GAVI is among the programs that the Trump administration is terminating support for. Mike, what can you tell our listeners about GAVI?

Dr. Osterholm: Well, let me start out by saying, you know, listening to your description of this and revisiting it time and time again, it brings tears to my eyes, literally. Again, like the programs, the USAID GAVI has been one of the really major successes in the world to alleviate pain and suffering and to provide a higher quality of life for many who otherwise wouldn't have it, but for the fact that GAVI existed. So, I have to tell you, Cory, when this news broke, I was devastated. I hadn't anticipated this one. For those of our listeners who are less familiar with Gavi, the Vaccine Alliance, I'll provide some of the history and impact, and I think you'll understand why I had such a strong and frankly, very negative reaction. James P. Grant, a hidden hero in foreign aid and worthy of a public health history segment himself, was the UNICEF director in the 1980s and 90s. He had an unstoppable vision to vaccinate all children across the globe and set actionable targets and strategic plans to improve access to immunization, especially in the Global South. His work resulted in substantial improvements in childhood vaccination coverage, but after his death in 1995, progress plateaued. Efforts, known as the Children's Vaccine Initiative began in 1990 to develop a temperature stable, oral, single dose vaccine for childhood illnesses. The initiative sought to leverage public and philanthropic funds to transform how vaccines were created and delivered in the developing world. But unfortunately, CVI wasn't able to fulfill its goals as originally designed. However, a new group was formed at the World Economic Forum in the year 2000, with lessons learned from CVI and ready to take on this important issue. Originally titled the Global Alliance for Vaccines and Immunization, GAVI was formed to facilitate strategic public private partnerships with global health actors and the biomedical industry.

Dr. Osterholm: While new vaccines were being developed at this time, they were high cost and designed to roll out in well-resourced healthcare settings, leaving much of the world without access to this innovation. GAVI has a unique economic standing that can negotiate lower cost bulk pricing for low income countries and incentivize pharmaceutical companies to develop new technologies with implementation of low resource settings in mind. While this effort has been criticized by their effectiveness at strengthening local health systems and subsidizing an already lucrative pharmaceutical industry, it is without question that GAVI has made a tremendous impact on the global health. It is estimated that since 2000, GAVI has vaccinated more than 1 billion children and prevented more than 19 million deaths. GAVI currently vaccinates more than half of the world's children. The US has provided funding and technical support to GGAVI since its inception. The US is GAVI’s third largest financial contributor, making up 13% of the total funding. GAVI's own estimate states that the US pulling funding for the next five year cycle could result in the deaths of more than 1.2 million children. For context, there are 1.3 million children living in Minnesota today. Imagine in the next five years if all of those children were to be lost because of lack of access to vaccine. It is just devastating. It's incredibly frustrating to watch these initiatives be shuttered. But I think we all need a reminder that we have the capacity to do so much good when we collaborate, when we care for others. When we share our resources, we can do incredible things. Things seem impossible right now in public health, but we can look to our hidden hero, Jim Grant, for inspiration. He was known by his colleagues to relentlessly repeat the phrase it can be done. It can be done.

Dr. Cory Anderson: Mike, what are your take home messages for today?

Dr. Osterholm: Well, Cory, I have to say that I struggled long and hard with these to try to get it down to three and to also provide the context. My first conclusion and I put this in quotation marks. We are entering the dark ages of public health and medical research. Collectively, we will bend more than we ever thought possible, but we will not break. We have to continue to remember how important that is. I think everything that I shared with you today surely supports this point, and it's going to get worse. But we can't give up. We can't give in. My second point is good news. We're really in the best shape we've been in collectively with respiratory illnesses in this country since the beginning of the pandemic. If you add up COVID, RSV and influenza activity combined, while there still are some spots in the country with each one of these activities going on, overall, they're all being reduced week after week. Enjoy it. Finally, become a committed advocate for public health in your world. There have been over 300 bills submitted to state legislatures, county commissions, city councils and school boards to do everything from mandate that RNA vaccines cannot be used, dispensing away with any kind of vaccine mandates for childhood preventable diseases, making it impossible to wear any kind of respiratory protection even in the face of a pandemic. And last but not least, to authorize that ivermectin and hydroxychloroquine be sold over the counter. Already we're seeing that one take off in a number of states. All the podcast family can stand up right now. Find out what's happening in your community. Find ways to join others to make sure that those school boards are covered, that those City Council meetings are covered.

Dr. Osterholm: Make sure that the legislative sessions that are dealing with funding for local and state public health are adequately supported. Find those who are like you, who want to see us, not give in and give away everything. So, all I can say is, at this time, act as if your life or that of a loved one is at risk. Because frankly, it is. That, to me is the first effort that we can put forward to say we will not stand by and let this happen to us. Now we still need to do more and the courts are surely helping right now. I promise you that CIDRAP would be coming forward with something and we're close to announcing it. We have some major efforts we're going to put forward that directly address the issues at hand. But in the meantime, do something or find like people like you. However, it may be in neighborhoods, in social settings, occupational areas, whatever, where you can say, okay, we're going to get together and we're going to start to track what's happening legislatively. We're going to find out what is actually being done, and we'll speak up and speak out. So, three points. We're entering a dark age, but we can't give in. We can't break. Respiratory infections getting a lot better. And finally, we must take our destiny into our own hands. And at the local and state level, there is much that you can do to make sure that bad legislation does not get passed and that good legislation is supported.

Dr. Cory Anderson: Do you have a closing song or quote for us today, Mike?

Dr. Osterholm: Boy, did I struggle with this one for a long time. And then it dawned on me what I needed to do. This was one that we've actually used twice before. It's a quote we used in August 13th of 2020, a live episode, and we used that in April 8th, 2021. Episode 50 Sitting in Limbo. This is a quote from Edward Everett Hale. As I've shared with you in the past, Mr. Hale was an American author, historian, and Unitarian minister best known for his writings such as The Man Without a Country, published in The Atlantic Monthly. He was in support of the Union during the Civil War, and he was the great grandnephew of Nathan Hale, the American spy during the Revolutionary War. The quote that I want to leave us with today is one that really follows on to what I just shared with you my belief that hearing all this bad news should give you every incentive to want to do something about it. So here it is, Edward Everett Hale. I am only one, but I am one. I cannot do everything, but I can do something. And because I cannot do everything, I will not refuse to do something that I can do. Edward Everett Hale. Please consider this quote as your mantra moving forward. Not all of you are going to be in the same position to be able to help, but organize. Find out what's happening in your local area. Support your health department. Find out what they need.

Dr. Osterholm: Find out what your school officials need to be able to maintain the current status of vaccines in their schools. In short, get involved. Care. This has been a tough podcast. I know I covered a lot of very negative information, but then again, I just went through, as you did, April Fool's tragedy. A date that will, in my mind, live forever. As the moment that we realize just how bad things were going to get. But we're not done. We're not done. We're coming back. And we will come back. And time will pass. And with it, while things may get worse, they will also get better. That's us. That's what we need to do. And I would just add, if all that we talked about today makes you feel uncomfortable, makes you feel uneasy, makes you feel depressed. Welcome to the club. But frankly, we don't have time to sit around and lick our wounds. We need to be active. Now, one other thing about that there still doesn't mean that you forget about being kind now more than ever. Kindness is so important. Thank you for being with us again, being with the podcast family any time, even when it's a difficult discussion, is a very, very special privilege in our part. We never take it for granted. I want to thank the podcast team for assisting and putting all this together. And I want to thank you. Be kind, be safe, and be kind.

Chris Dall: Thanks for listening to the latest episode of the Osterholm Update. If you enjoy the podcast, please subscribe, rate and review wherever you get your podcasts, and be sure to keep up with the latest infectious disease news by visiting our website cidrap.umn.edu. This podcast is supported in part by you, our listeners. If you would like to donate, please go to cidrap.umn.edu/support. The Osterholm Update is produced by Sydney Redepenning and Elise Holmes. Our researchers are Cory Anderson, Angela Ulrich, Meredith Arpey, Clare Stoddart, and Leah Moat.