But, rather than admit to the lack of scientific rigor, disorganization, and embarrassing revolving door of pseudoscience twitter hacks, Trump signed off on the now defunct committee’s wishes by executive order. Not with evidence, not with science or medicine, but with a swoop of a pen by a President, life saving childhood vaccines are now no longer recommended.

Here is are the life-saving vaccines that were removed from the recommended list by Trump late last Friday night (May 29th, 2026):

• Influenza (seasonal flu) vaccines: removed as a universal annual recommendation for all children; now limited to high‑risk children and “shared clinical decision‑making” (SCDM) in the contested schedule.

• COVID‑19 vaccines: downgraded from routine universal pediatric recommendation to SCDM/high‑risk use.

• Rotavirus vaccines: no longer routinely endorsed for all infants; placed into SCDM/high‑risk categories.

• Hepatitis A vaccine: removed from universal pediatric recommendation; retained only for certain risk groups and SCDM.

• Hepatitis B (birth‑dose) vaccine: the birth‑dose was downgraded from routine to SCDM; some descriptions summarize this as removal of routine Hep B for all newborns.

• Meningococcal vaccines, including MenB: moved from universal adolescent recommendation to SCDM/high‑risk categories.

Every vaccine has demonstrated that it is life saving. Every one of these vaccines is FDA approved. Despite hundreds of millions of people receiving these vaccines around the world, no one has provided evidence showing that the risk of receiving these vaccines is greater than the risk of death and permanent disability caused by getting the virus without a vaccine onboard.

The press release from the White House says this is to be ‘in line with peer nations’. Which ones? The vast majority of European countries have universal healthcare AND recommend most of these vaccines as routine childhood vaccines. Also, the United States is embarrassingly ‘peer less’ in this arena, being the only developed nation without universal healthcare and the worst access to healthcare among it’s ‘peers’. United States citizens are more likely to report skipping or delaying care because of cost, lacking a regular doctor, and using the emergency department for care that could have been handled in primary care.

Despite the White House’s statement that these changes reflect the vaccine schedules of peer countries, they do not. This administration often point to a country (Denmark) that has about half the number of people as Los Angeles County, fully universal healthcare, and a population that has nearly eliminated cancer causing HPV in circulation (through high vaccination) as it’s comparator. Denmark’s health care is nothing like the health care landscape of the United States. For example, in Denmark, Hep B vaccination is not given at birth because they have more extensive and continual screening of parents and family members, we do not have this in the United States. Also the United States has 1.5-3X higher rates of Hep B. Finally, patients in Denmark do not skip or avoid care, because they never have to think about what it will cost them.

What Kennedy and the Trump administration fail to tell their followers is that 27 other European countries do recommend the Hep B shot at birth, they just picked one that doesn’t.

This executive order is needlessly setting up the children of the United States for failure and avoidable long-term illness. There is simply no evidence to back up why this would be the correct course of action.

Meanwhile, Kennedy’s ACIP is nonexistent, there is no head of the FDA, no CDC head, no Surgeon General, rural hospitals are being shut down, an estimated 10-11 million people will lose their Medicaid (conveniently after the midterm elections), and the head of the NIH is a conspiracy theory spouting academic economist who finished medical school class work, but never touched a patient.

An interesting pattern is emerging of RFK Jr. undoing what his uncle did for health and medicine in the United States. John F. Kennedy’s appointed head of HHS established the first ACIP committee, his nephew has now destroyed it. John F. Kennedy established USAID, now dismantled by the administration who hired his nephew, a lawyer, to run health care. John F. Kennedy championed the foundational idea of establishing government-funded health insurance for the elderly and needy. He made healthcare access a central part of his 1960 presidential campaign and continually pushed a Social Security-based medical program. After his assassination, his successor Lyndon B. Johnson ensured that Medicare and Medicaid was established in 1965.

I personally have been in the room while congressional house members have expressed their deep admiration for JFK, while preparing to grill RFK Jr. on his mismanagement of Health and Human Services. It’s time for our representatives to remove the nephew systematically destroying his Uncle’s legacy, destroying health care access for anyone but the most wealthy.

Bobby, you can’t put lipstick on the dead bear in Central Park and call it medicine.

There’s a place between panic and turning a blind eye to major events that take the global stage like the most recent Andes Family Hantavirus outbreak and that’s where scientists step in. Right now the risk of a global outbreak is extremely low, I’m 4/10 concerned that we will see ‘on the ground’ transmission meaning cases that were not acquired on the cruise ship. Here I outline a few more research articles in detail that indicate why it’s a safe bet not to panic but that we SHOULD be aware that this is likely to happen more frequently in the future.

Even if more people from the cruise ship are infected, the risk this virus posses to the general public is still extremely low, and this is why I think so.

Research studies using of people likely to be exposed monitoring (prospective - study linked) and disease detectives trying to piece together what happened after an outbreak (retrospective - study linked) show that simple household contact and even exposure in a hospital setting to actively sick people is not enough to guarantee infection. This is good news, and why most people are cautioning that this outbreak will not likely cause a larger global outbreak. But outlier incidents with limited contact have also been reported. In short, we don’t have enough information to make high confidence predictions about how many more cases we will see. I’d be surprised (happily so), however, if it remains at the current total of 11 cases (3 deceased).

Even if there are a few more cases this does not necessarily mean we will see ‘on the ground’ transmission, but we’re not out of the woods just yet. Relentless international media and social media attention isn’t a bad thing - it puts strong political and social pressure on local and government authorities to prevent additional cases. It’s their job to contain these things, but the recent loss of appetite to fund research and disease prevention in many countries, including the United States, has put many people on edge. In short, the world is watching and we should be.

There Have Been Protocol Breaches But It’s Likely To Be OK

Despite best efforts and procedures accidents can and do happen but for this virus we have a bit more of a forgiving infection pattern. This week in a Dutch hospital there was a protocol breach in handling the blood and urine of a sick MV Hondius passenger. Patient urine from people who are actively symptomatic does contain enough of the virus to be infectious (no urine is not sterile). Now 12 of of the hospital staff members have been placed in quarantine for 6 weeks. Does this mean they will become sick? Not necessarily, in fact it’s unlikely.

A detail often left out by many people on social media posting about the now extremely popular New England Journal of Medicine article from 2020 detailing the spread of the largest outbreak of human-to-human spread ANDV is that there were several hospital employees exposed during that outbreak. In some cases no PPE was used. In one hospital no additional cases were seen despite exposure to actively sick people and only a small handful of cases resulted were seen in another hospital. Most people exposed to actively contagious patients failed to develop disease. Making it very unlikely a disease outbreak will occur from this variant of this virus.

In communicating risk, scientists like myself like to use the words probably and likely which can seem ‘wishy washy’ to the public which raises alarm bells, but that’s not the intent. One way to think of this outbreak is that several unlikely things from several failed quarantines (more opportunities for a virus to mutate the more people it infects) to virus mutation in a way we haven’t seen before would have to happen. So maybe in one of 10,000 or 100,000 timelines that might occur with an outbreak like this.

The smart bet is on this outbreak not being an issue while knowing that if it were to become one we’d see it coming, and some day it is coming and public awareness of this is good.

A Matter of When Not If

Andes family hantavirus infections doubled in the region from 2025-2026 and at some point in the future of humanity - if we keep seeing rising local infections - this virus will eventual adapt to human infection in a way that spreads it more efficiently. Either next week or 500 years from now it’s hard to say, but the longer we see increased infection rates the more likely it becomes.

Hantaviruses are not the only ones ‘out there’ that, in the future, could cause a major outbreak. And just like every medical student at one point starts to feel like a hypochondriac, every scientists I know who has studied the vast diversity of viruses has gone through a brief moment of panic. On the other side of that panic is a deep awareness of how tenuous life actually is and how deeply important continued research in these areas is for continued survival.

If any good was to come of this outbreak it is that public awareness translates into public appetite for ensuring we have programs that protect us and future generations from deadly viruses (and there are plenty out there) that may make the leap to spread human to human.

Stay tuned for my next post on the unique immunology behind why Hantaviruses are so deadly and what this may mean for people who recover from them.

Under HHS Secretary Robert F. Kennedy Jr. typically apolitical scientific institutions have become revolving doors with unqualified appointees, who, when they do decide to stand for something, are unceremoniously ousted.

The final straw? It is rumored that Makary disagreed with the FDA approving fruit flavored tobacco products often marketed to children and relaxing review processes on tobacco products. THIS apparently was a bridge too far for the Trump administration and the Make America Healthy Again (MAHA) movement. It’s clear that what MAHA really stands for is forever chemicals in our water, e.coli outbreaks, and tobacco products targeting children.

It is clear that the recent firing resigning is less about one commissioner’s missteps and more about a governing style that treats regulatory leadership as disposable whenever it becomes politically inconvenient.

Makary’s Departure Reeks of Being Strong-Armed Into Bad Decisions For American’s Health

By all available reporting, Makary did not simply “decide to move on.” He resigned under visible duress, after weeks in which it was openly reported that President Donald Trump had already agreed with RFK Jr’s decision to oust him and that a plan to remove him was in motion. The White House, according to statements from anonymous sources, had grown tired of controversies around drug and device decisions, while RFK Jr. with his historical fascination with roadkill, dead whales and bears, wanted a different kind of FDA all together. Unclear what a man who straps the rotting head of a whale to the family station wagon and has a personal fascination with roadkill has in mind regarding drug safety approval.

Makary’s tenure was undeniably chaotic, and he was marked for removal due to 1. Resistance over abortion‑related drug regulation: Abortion activists have been calling for a re-review of a 25 year old approved drug that has more approved uses than abortion, and have accused him of slow-walking this as if a drug proven safe and effective across numerous countries should be the top priority (not cancer drugs). 2. the push to relax marketing regulations and approving flavored e‑cigarettes, and 3. A series of high‑profile drug evaluations that left both industry and patient advocates confused and frustrated. Despite his foibles, Makary at the very least did not abandon some basic tenants of public health, one being that children shouldn’t be marketed addictive nicotine products.

What’s troublesome is that this ousting supports the pattern that science and medicine under the Trump administration is purely political. Data and health be damned, if RFK Jr and Trump want it, so be it and we will all pay the price.

Enter New FDA Acting Commissioner Kyle Diamantas (no experience, track record of sick kids - yes it is that bad)

Into this vacuum steps Kyle Diamantas, the FDA’s food chief, now elevated as acting commissioner. On paper, Diamantas is experienced in the food‑safety arena; he has already managed complex negotiations with food manufacturers but the additives he has been charged with removing are of little consequence to human health. And this is not the same as being prepared to oversee the pharmaceutical approval and review engine that is the FDA: drug approvals, biologics, high‑risk devices, and vaccines, all while navigating an HHS leadership that has made clear it wants nothing less than to strong-arm agency’s direction.

Despite Diamantas’ experience as deputy food commissioner (starting in early 2025) he is a lawyer by training and lacks any significant background in health, medicine, pharmaceutical development or safety analysis. Testing beef is not the same as developing a next generation protocol for treating malignant cancer.

And frankly under the Diamantas tenure we have seen several major outbreaks of foodborne illness including an e.coli outbreak traced to one farm selling raw milk and cheese that the FDA has failed to shut down while children have been hospitalized with serious complications. The median age of impacted children is 2 years old.

Diamantas’s group did request a voluntary recall, but when RAW FARM failed to comply they did nothing more allowing tainted products to remain on the shelves. It took the Congressional Food and Safety Caucus demanding a mandatory recall of the RAW FARM products (a company promoted by RFK Jr in the past) for them to finally comply with the voluntary recall while issuing a statement that it was “under protest” all while children were still hospitalized from eating their products. RAW FARM has failed the ethics test in a significant way and so did Diamantas.

This shake up will send ripples through the biopharma industry. Most have little to no respect for the people in charge of these agencies at the moment beyond what is required for continuing to do business in the United States. They are the least experienced, most adversarial group of charlatans ever put in a position of this much power. Within just a few short months their missteps have made Americans less healthy, have landed them with costly lawsuits, and resulted in children being hospitalized with a refusal to hold the industry that hurt them accountable.

RFK Jr. entered office at HHS promising to challenge regulatory capture and restore integrity. But what we’ve seen instead is an attack on science and health like the United States has never witnessed before. Makary’s forced departure with no competent replacement in sight puts the FDA in the same position as the CDC, gutted, kneecapped, and at the whims of the most anti-science administration in history.

Every single one of us carries scar tissue from experiencing a recent global pandemic.

We’ve lost loved ones, worked frontlines, felt both abandoned and fatigued by attempting to keep up with messaging that evolved real-time as the scientific understanding of the SARS-CoV-2 virus changed, and the virus itself mutated. Some variants gaining higher transmission capabilities and more deadly symptoms (Delta) before the dominant variant mutated again into a higher transmission rate version (Omicron) which was on an individual level less deadly. But, Omicron, I need to remind everyone who irresponsibly reported “don’t worry it’s less deadly”, on a population level injured and killed more people because of it’s enhanced spreading capabilities.

Many still feel left behind, their debilitating symptoms unaddressed by research with little appetite for the current administration to fund NIH investigation into Long COVID. Others left untouched by the deadly virus or still in denial that viruses exist are rallying around the idea that this zoonotic spill over event, a hantavirus outbreak is nothing more than “another Plandemic”.

Most are asking me: Here we go again?

Not quite.

We have a window of time between initial exposure(s) and when symptoms may start to show up and what is done over the next two (up to four) weeks has the power to change the direction of this outbreak.

Where we are now

The next two weeks are absolutely critical for controlling this zoonotic spillover event. Zoonotic spill over is when a virus typically found in an animal population infects humans. Because we understand the hantavirus well, we know exactly how to stop the spread of it right now. This game is ours to loose but the question remains will egos, human error, and human nature unleash the spread of a new virus across multiple continents? It could, but if good science prevails it will not.

What Is Different About Hantaviruses

Large Family of Ancient Viruses That Has Co-evolved With Rodents: Hantaviruses are a large family of over 50 viral strains (and counting) which have co-evolved with rodents over an estimated 80-100 million years. These are ancient viruses. Their rodent hosts (and bats occasionally) can have very high viral loads but show no symptoms at all. Rodent immune systems make antibodies against the virus but do not control it. Different groups of rodents have different endemic hantavirus strains in their populations (roughly location specific to their coevolved rodent hosts). In contrast, SARS-CoV-2 was a completely novel virus at the time that researchers and medical professionals scrambled to learn about ‘on the fly’. The origin point is not fully understood to this day, though regionally there are several endemic coronaviruses in bat and pangolin populations. In general, we know much more about hantaviruses.

10,000 to 100,000s Of Cases Annually: Hantaviruses infect anywhere from 30,000 to 150,000-200,000 people annually. Most cases are are from hantaviruses that cause hemorrhagic fever with renal syndrome (HFRS) which are endemic to Asia and parts of Europe. About 200 cases of hantavirus pulmonary syndrome (HPS) occur across the North and South America annually. The exact number of cases is hard to pin down due to underreporting. Therefore, unlike SARS-CoV-2 people understand the course of infection for many strains of this virus and what prevention and care looks like - even though we currently have limited to no specific pharmaceutical options.

High Mortality, Low Rate of Spread: Hantaviruses are more deadly than SARS-CoV-2, but they have a lower rate of spread. First, the vast majority of hantavirus species do not spread between people. Unfortunately, the Andes species (ANDV) of hantavirus, which is the cause of the current outbreak does spread between people. The largest known outbreak, the Epuyén outbreak (named for the small town in the Andes mountains where it occurred) led to 34 cases and 11 deaths (32% case-fatality rate). In general, hantaviruses have a case fatality rate of 21-60% depending on the outbreak and virus type. The Epuyén outbreak was contained via simple quarantine measures, but not before the virus displayed a reproduction rate or Ro (how many people are infected by one sick person) as high as 2. For comparison, seasonal influenza typically has an Ro of 1.2 to 1.4. However, spread in the Epuyén outbreak was fueled by family events in enclosed spaces for extended periods of time with actively symptomatic relatives. Furthermore, the contact tracing within these events is noted by the authors of the paper as being difficult and potentially erroneous.

Currently on social media and from some commentators the ‘passing briefly in the hallway during a birthday party’ is being touted as an example of airborne spread. This would be close enough for an effusive greeting to spread a virus by droplet and notably it is common in many areas of the Andes to greet people by a kiss on the cheek - though we do not know if this occurred. SARS-CoV-2 started out at a slightly higher Ro between people but also rapidly mutated to a higher Ro. Both are RNA viruses which have high rates of mutation and ANDV can, like any virus adapt itself to it’s host. Therefore, I’d like to emphasize that although I am not overly concerned: Right now we’re at at critical moment where containment can reduce chances of additional spread and human adaptation.

Limited Information on Behavior of ANDV in Human Populations:

Much like the earliest days of the SARS-CoV-2 pandemic we have limited information on spreading dynamics of the now named strain ANDV/Switzerland/Hu-3337/2026 ("Hu-3337") in human populations. The Epuyén outbreak being the largest human to human outbreak to date. Furthermore, because the Andes family of hantaviruses are difficult to culture in vitro, scientists have had limited ability to study their behavior relative to other viruses. That said, I expect the Ro (reproduction rate) on the cruise ship to be artificially high relative to ‘in the wild’ spread. This is because of close quarters typically seen on a ship, and opportunities for prolonged exposure prior to understanding the seriousness of the viral illness.

What we know now is that this virus typically spread via droplet transmission between people. What we know about most viruses is that there is a period of pre-symptomatic spread. Pre-symptomatic spread is typically higher than asymptomatic spread (career never develops disease). We know that hantavirus is killed by a 10% bleach solution and most household cleaners, sunlight, heat, and a few days outside of the body. Hantaviruses can live longer in cooler, higher humidity environments remaining infectious for up to 5-15 days in certain conditions. We know that rodents are asymptomatic carriers, which begs the question in my mind as a scientist if the virus could adapt to people in the same way. Perhaps if we decide to begin funding scientific research again, a survey of local populations for antibodies and any evidence circulating virus would be of interest.

ANDV Hantavirus Infection Events Have Increased Recently

Since June of 2025 there has been a “surge” in ANDV family hantavirus cases in the with 101 cases reported in the last year, roughly double the historical average in the area. While Argentine officials have increase surveillance for ANDV after the Epuyén outbreak and local hospitals have increased testing, other factors including human encroachment on rodent habitat and climate changes increasing rodent spread or migration into new areas has also been indicated as a factor in increases in local case rates.

In summary, this virus is concerning but unlike SARS-CoV-2 we have ways to get ahead of it, if our leadership makes the right decisions. Admittedly, I am suffering from my own memories of thinking how simple that should have been with SARS-CoV-2, because we have the playbook - it’s our game to lose.

What’s The Worst That Could Happen?

Best-case Scenario: Global Leadership Takes This Seriously

Ideally, professional grade quarantine and testing of every passenger of the MV Hondius until the end of the viral incubation period would ensure we have stopped the possibility of continued human to human spread. I feel deeply for the people who took a once in a lifetime vacation that has turned into a nightmare. But remaining in quarantine ensures ready access to testing and early indication of positivity prior to the development of symptoms. This can lead to rapid access to medical care and likely a higher rate of survival if someone falls sick. It is the choice I personally would make. I expect given the environment of the cruise ship that we will continue to see additional positive cases for up to four more weeks. Therefore quarantine is a potential win-win for protecting other people and getting assistance quickly in a deeply unfortunate situation. I am concerned, however, about the US leadership’s active reticence to discuss quarantine and determination that ‘at home self-quarantine’ should be an option. Despite having very little information about the spreading dynamics of this virus, the vast majority of viruses have a phase of pre-symptomatic spread making it likely that people at home will unwittingly spread this virus to family members or out in their community. Therefore, I think that given current information on the approach in the United States, the moderate-case scenario is a likely one.

Moderate-case Scenario: Risky On-The-Ground Spread

If we do not quarantine passengers that are currently ‘feeling fine’ there is potential that we will see on-the-ground transmission of this virus here in the United States. We may get lucky and this may not happen at all, but self-quarantine measures increase the likelihood of on-the-ground spread. Globally, without quarantine I expect a few more cases (at the global level) to spread on-the-ground in those countries. If person to person transmission occurs here in the United States, local and state department intervention will be important. The CDC may be able to assist but due to the defunding and dismantling of many of their programs and little to no leadership left, their scientists will be fighting with both hands tied behind their backs. Therefore, because of the significant leadership gaps in HHS and CDC, it will be up to local and state health departments to stay on top of these cases and mitigate spread. These agencies have different levels of effectiveness across our country so if those fail significantly in one or two areas we are likely to see a what I consider a poor outcome.

Poor-outcome Scenario: Failure Of Complete Containment

If containment of person-to-person spread fails at the state and local level I expect this to look a bit like the MPOX outbreak where there is spread within specific pockets of people who have come into close contact with each other. At this point I would expect most people to be taking this seriously. A ~40% case fatality rate may in fact make inroads into virus denying communities re: deciding to pay attention, but it’s difficult to predict what will convince people to take their personal health seriously. What concerns me, however, is that the MPOX outbreak was trending poorly and on track for wider spread until CDC and FDA scientists determined they could expand vaccine coverage by giving the dose at 1/5th the amount and subcutaneously (under the skin) rather than intramuscularly (jab in the thigh or arm). We have no vaccine or specific treatment for hantaviruses. In this scenario I believe cases would continue to ‘pop up’ until we developed a vaccine or other intervention to completely eliminate spread. To be clear, I still think this is a relatively low probability scenario.

Absolute Worst-case: “Stuff Of Nightmares” Scenario

A friend of mine occasionally likes to say that worry is a misuse of imagination. But sometimes staring into the abyss is just part of human nature so let’s take it there - knowing full well that this is currently an highly unlikely set of scenarios.

If this virus mutates during any of the above scenarios to adapt better to human to human spread or improves it’s transmission capabilities such that it is airborne, then and only then, do we have a COIVD-19-plus scenario on our hands. In this case I would expect the case fatality rate to drop due to the sheer number of infections, but for there to still be significant loss of life on the order of 2 to10-fold of what occurred at the peak of the COVID-19 pandemic. Air travel lockdowns would be the intelligent choice for global leaders to make, isolating any country where the mutation is found immediately. But that would have also slowed SARS-CoV-2 and it did not occur. At this point the race for a vaccine and anti-viral drugs would be back on, but I am not sure the United States has the political will or capacity to lead it, over 10,000 STEM PhDs have left the federal government since early 2025 and many have left the country. People who continue to ignore the precautions of scientists in a situation like this would be at very high risk of illness or death. Finally, if like SARS-CoV-2 the human-adapted hantavirus becomes incredibly widespread, local rodent populations may become infected and it will become an endemic virus in their population and an ever-present human threat.

It is human nature to catastrophize events like this. It’s a mechanism for preparation and self-protection, but I do believe this is an extremely low probability scenario that we’re more likely to see on a movie screen than our nightly news.

Summary

Right now we are in a moment of ‘wait and see’ and shifting probabilities. The direction this event takes depends on how the people closest to the situation react and how our leadership chooses to lead (or not). In some cases how the people who were passengers of the MV Hondius choose to react can change the current trajectory. If they are given a choice to quarantine, I hope they choose to do so. My heart goes out to them, their families, and everyone directly impacted by this traumatic event.

There are thousands of viruses that are deadly and knocking at the door of global transmission - causing brief outbreaks in far-flung places - testing and re-testing humans as a potential new host species. This event is a reminder to call our representation and insist that we have competent leadership at organizations like the CDC (80% of top positions are vacant, and our interim head is an economist, not a scientist) and HHS. Good leadership is critical to meet the global challenges of virus and disease control before deadly viruses show up in our communities, our homes.

The CDC under RFK Jr has had no director for months. Not since Dr. Susan Monarez was fired for refusing to ‘rubber stamp’ RFK Jr’s requests (i.e. push through RFK Jr’s anti-vaccine agenda without scientific review). Along with her several top officials left the CDC taking collectively with them over 100 years of hard-earned experience in public health management and research.

Then Jay Bhattacharya was named CDC director, but there was another issue, he was already director of the NIH where over 1,100 PhDs scientists have left. The remaining scientists routinely walk out of his in-person meetings when his speeches veer into pseudoscience nonsense which he calls “keeping an open mind.”

Note to Jay: fanciful ideas and no data are what most people call ‘science fiction,’ not a roadmap for running the largest research agency in the world.

It is likely that Jay Bhattacharya is still the person blocking the release of this data, possibly at the behest and certainly with the blessing of RFK Jr, who is his boss.

The CDC originally said it was Jay blocking the MMWR release because he was “concerned with how vaccine effectiveness was calculated.” I want to remind you that Jay Bhattacharya is not a scientist; his PhD is in economics. He authored the “Great Barrington Declaration” during the height of the COVID-19 pandemic, which, if followed, would have killed up to 2.5 million MORE Americans according to best estimates. He did finish medical school, but he never did a residency or practiced clinical medicine.

Well, Jay, and Robert — scientists and “gold standard science” have methods to address your concerns.

Let’s go through a list of questions that would potentially explain ANY logical reason for you to block vaccine effectiveness data for a virus that still causes significant death and disability, paid for already by the US taxpayer, and vetted and prepared by scientists.

Q: Was vaccine effectiveness calculated in a different way than it ever has been before?

A: No.

There is standard equation for vaccine effectiveness. It is used routinely around the world across different groups of people and populations. It is well accepted and considered the current gold standard.

Q: Was the way we collected hospitalization data, illness, or death changed?

A: No.

Q: Did Jay or Robert put forth what their concerns were about this commonly used approach for understanding vaccine effectiveness?

A: No. They have failed to provide any data-based explanation for blocking this report other than “I don’t like it.”

Q: Did Jay or Robert present, discuss, or publish a better way to calculate vaccine effectiveness and show data supporting its superiority in understanding the impact of this vaccine on protecting life and health?

A: No, of course they didn’t.

Scientists love a good debate, it’s what we live for. Scientists thrive on finding ways to improve and do things better. However, that requires a demonstration that it IS better.

If you are thinking about getting a new car, but your older car still runs, you still test drive the new car. You don’t trade in a good car for a newer car with no engine just because someone ‘said so.’ You do your research; in this example, you would test drive the new car to see how it performs.

But what CDC and HHS are doing is even worse. They’re telling us there’s a car they want us to use; they don’t like old car and took it away, but where is the new one? Forget test driving — they haven’t even provided a new car.

We have no car at all now. Instead, we have to walk. We’ve been left with no data.

As of recent weeks, Robert and Jay have been on parade in front of congress, repeating the same lines and lies and pointing to the concept of “gold standard science,” attempting to look productive while rearranging the deck chairs on the rapidly sinking ship of what was once a globally revered scientific system.

All of this at our expense. We’ve paid for this. They won’t release the data. They won’t explain themselves.

What I think is happening is that they are terribly afraid of real “gold standard science” because it tells a story they don’t like. It shows that they are wrong and reveals them as the charlatans they are. So, in their roles at the helms of these great agencies, they’re actively blocking us from seeing it while they scramble for excuses as to why.

Who suffers under that type of egomaniacal self-centered leadership? We do. All of us. Our doctors can’t give us good advice when they’re unable to see the data and we can’t puzzle through the data ourselves to make our own decisions.

In case you were wondering, the SARS-CoV-2 vaccine for last year’s (2025-2026) season showed a great efficacy rate (for a respiratory virus vaccine) of 50% reduction in emergency room visits and hospitalization in adults. This data is, however, hearsay from those scientists on the inside leaking the numbers. These scientists are doing their best to get the word out, letting us know it was good.

If it were up to Jay Bhattacharya and RFK Jr., you’d never have access to that information. Information critical for making a personal decision about your health, and your doctors wouldn’t have the data to counsel you on making the best decisions.

Why are we paying for them to continue to exercise this kind of abuse on the US population? Emergency room visits and hospitalization are expensive; wouldn’t you want an easy way to be able to avoid that?

I would think so, especially now that they’ve made significant cuts to Medicaid as well.

Note to Readers: Thanks so much for hanging in there during my writing hiatus. I was deeply consumed with my day job steering the ship/keeping the engine running there and am excited to get back to providing you with comprehensive and timely updates. See you soon!

I am and always have been an incredibly COVID-cautious person. I have worn a mask consistently in public except for a very rare occasion since 2020. I am still “COVID 0” meaning I have never acquired SARS-CoV-2 to the best of my knowledge. This is backed up by rigorous testing performed on me and all household contacts (we were all negative) the three (3) times I have been sick since 2020. It has been fantastic to not get sick while traveling (I travel at least 10-20 times a year for work) and to spend my holidays completely healthy. I will therefore always mask in several of the situations described below. However, this last year I have relaxed my masking due to changes in data as our population, the world is adjusting to endemic SARS-CoV-2. Therefore, as a long-time advocate for mask wearing, I thought it would be helpful for people to understand how and why I have made the decision to relax my mask wearing strategy.

There are some important disclaimers for this post:

• First, as it always should be for everyone, my personal health decisions reflect my personal risk tolerance. This risk tolerance can and will change if I or a family member need extra protection from pathogens in circulation. I encourage everyone to take their own personal risk assessment seriously, do your homework, talk to your doctor, and to protect any family members and loved ones that may be vulnerable.

• Second, I am rarely exposed to large groups of people and when I do I am selective and thoughtful about when I wear a mask and when I don’t. I don’t work with any vulnerable populations, or the public. Lower rates of interaction mean that I inherently have lower overall risk of virus exposure in any given year. The team I do work with is encouraged to work from home or take a day off when sick, and if someone does come in mask wearing is encouraged if they were recently ill. We also have access to excellent high turn over HEPA air filtration in all spaces.

• Third, this review of my changes in personal mask wearing is meant to be educational and is not medical advice or meant to encourage a change in what you are or are not comfortable in doing. I fully advocate for anyone choosing to wear a mask at any time, or all of the time, and believe that this should be integrated by society and normalized. The world will be a healthier place if we can reduce viral infections.

• Fourth, my choices will change as new data is found/reported/generated. This is the nature of science and science based decision making, changes do occur. For example, we have now had a long period of SARS-CoV-2 virus mutations that has failed to fully evade vaccine protection in a way that lead to disease spikes like those seen in 2022 or 2024. In fact, this winter (2025-26) showed waste water levels lower than that of the summer, using the same methodologies and tracking stations across the United States (see below, circled in orange: source data WASTEWATERSCAN.ORG). But if a new variant that I am concerned about is identified, I will resume more careful habits and of course, let everyone know.

  

Finally, this post is not a call for ‘masks off.’ I am writing this post to communicate my approach to masking, that is specific to me. I don’t personally do well with unnecessary extremism in any direction, I find it difficult to maintain and something that on a societal level can cause knee-jerk reactions in the opposite direction. These thoughtless ‘knee jerk’ reactions and aversions to ‘being told what to do’ are something we are still suffering from as evidenced by low vaccine rates and the plummeting trust in scientists and doctors.

We did what we had to do during an emergency phase of the pandemic, and it certainly saved lives as there was no time for mass public education on complicated science that in many cases was still a moving target. But today, we are still suffering at the hands of the quacks that rode the counter-current of dissatisfaction to popularity and their anti-science rhetoric is verging on causing generational damage to our population’s health as well as science and medicine. Extremism has extreme results, often in unanticipated directions. I personally prefer educated and thoughtful approaches that are not extreme but are truly ‘doable’ and result in real, lasting change.

It is important to recognize that more or less risk tolerance often works on a ‘sliding scale’ for most people. This however can lead to decision fatigue so it is understandable that some people are simply mask off or mask on. Many people I’ve encountered online will never wear a mask and never have, some people have gone completely ‘mask off’ and used to wear one, others will never unmask in public again. Some people I encounter when out and about are well meaning, but still aren’t wearing masks correctly (well fitting, over the nose and mouth) and/or haven’t started using N95, KN95, or KF94s.

My greatest hope in starting this conversation is that it helps people who would like to stay healthy identify key situations where masking can help them to do so, and to encourage them to start to incorporate it into their daily routines without stigma. And I hope that others who feel ready to go maskless do so by confidently being able to think through what might be a high or a low risk situation.

Through this post I hope to educate people on how consider a multi-factorial risk landscape and adjust to it situationally. This is something that comes naturally to me having spent over 25 years working in laboratories where the things around me could kill me if I made a mistake. I’m still here.

I also recognize that few people reading this have spent decades in direct contact with or working around things that could end their lives or seriously disable them. So I understand the extreme aversion to any risk, especially if the risk is not well understood. Many people do drive a car and take that calculated risk daily, wearing seatbelts and observing the rules of the road. And while COVID-19 deaths have decreased, car crashes are still one of the leading causes of death. To paraphrase how I approach any risk: there are people who are old and those that are bold, but few that are old and bold. You’ll find a combination of caution, experience, education, and thoughtfulness and a ‘Swiss cheese model of protection’ is behind every one of my decisions explained below.

As with anything, risks are rarely zero but there are some times where they are extremely low and education is key to making informed personal decisions, and as always, discus any personal decisions and risks with your doctor.

Identifying Risks And How I Interpret Them

There is no magic equation for risk assessment, and all risk assessments are at best situational estimates. They aren’t perfect. Below I outline a few of the key ways I assess risk of infection for myself and how I might adjust my personal behavior.

Is the Virus Around?

For most of the pandemic, especially in the emergency phase it was easy to simply assume the SARS-CoV-2 virus was everywhere. On our groceries, in the air, and that every person could potentially be infectious. This of course wasn’t always true, but it was a quick hack to keeping yourself safe from what turned out to be an incredibly deadly and disabling virus. I ascribed to this thinking, and I know it is what kept me from getting COVID-19 to this day while some of my friends still suffer from lingering effects from the early variants. In reality, before mass vaccination roll-out, the peak of the 2020-21 infection season in January of 2021 only about 1 in 12 people who tested for SARS-CoV-2 were positive. That means every person who had a reason to test or what feeling sick only 1 of 12 were infected with SARS-CoV-2. Some areas have spiked higher, but typically peak global levels have been around 11% positive meaning of the people you’ve encountered out and about fewer than 1 in 10 (many people also do stay home when sick) would have tested positive for SARS-CoV-2 even at peak times of infection.

Studies examining asymptomatic infection find significantly lower positive rates among the general population when random testing of healthy people done a pooled asymptomatic infection rate across 29.7 million tests of 0.25% or 1 in 400 people (more about this later) was found. Furthermore, you can be in a non-infectious phase of illness, unable to infect anyone, and still be testing positive — though that long tail and how infectious people are is still debatable and may be situationally dependent. In general, most people are not contagious 5 days after their fever dissipates.

Going forward I have started to use local health department and wastewater data as an overall filter in my decision making. Wastewater science is a steady and relatively reliable leading indicator for infection rates. It will go up long before people start reaching for a COVID-19 test, and it doesn’t rely on people feeling sick and testing.

Here’s an example of how I might use wastewater data. This data is taken from wastewaterscan.org on February 16th, 2026. I often bounce between the San Francisco Bay Area and Chicago for work, but it looks like I should be more cautious about going out and about in the Chicagoland area right now, masking up more often due to the much higher rates of SARS-CoV-2 in the wastewater. The San Francisco Bay area and the Los Angeles area are relatively low, therefore, I would consider this in my overall decision making process. Because I like to stay healthy in general, I also typically scan through the other viruses tracked by this website and add those into my risk calculation.

In general, this winter has been very low nationally for SARS-CoV-2 in the wastewater, meaning fewer people were sick with this virus on average. How not to interpret this data is that the virus is gone or non-existent, it was still detected. This is simply an indicator that the chance of encountering someone who is infected with the virus will generally be lower in regions with lower wastewater levels.

Analysis of historical wastewater levels can also be helpful, revealing historical trends for virus peaks. For example, historically SARS-CoV-2 levels often start to rise after the 4th of July in the United States after which they have a summer peak, then begin to rise around the Thanksgiving Holiday peaking later in the respiratory virus season. That means these times might be good times to avoid getting infected as historically this is when rates of spread start to increase.

Overall I consider wastewater numbers and historical trends of virus infection when assessing situational risk. For example, during the peak wastewater spikes of 2022-2025 I would simply not go out to eat in a restaurant and was always masked in public. But during the early summer lull of 2025 when wastewater was low nationally, I did venture out into well ventilated spaces more often.

Any recent changes in the virus?

I check for new variants regularly. Because I am a scientist and have access to things like the GSAID database and have enjoyed tracking variant evolution tracking since first mutations were identified, this bit is always interesting to me. The average person however usually has to wait for a breaking news article and even then it can be difficult to tell if some of the headlines are real or clickbait. The wait then is even longer for a government agency to publish on the topic. This is where well researched social media creators have filled a critical communication gap, and I am proud to be part of that crew of people. In general if you’d like to wade into this science yourself you’ll be looking for a few key things:

1. How many mutations are in the receptor binding domain of the S protein? (This is SARS-CoV-2 specific, and if there are more this can mean it will be more immune evasive)

2. Do scientists indicate that it has vaccine evasion or is so significantly different from prior variants that it will be immune evasive?

3. Are there any indications that it has greater residence in the upper airways or high cell binding capacity? (this often correlates to a higher rate of spread)

4. Are there any indications of changes in symptomatic disease in people who are infected?

If there are changes in a variant that make it immune evasive this alone can be problematic, even if the disease is considered more '“mild”. This was what I still consider a significant error in the messaging about the Omicron variant. While it was less deadly on an individual basis, it killed far more people than the Delta variant due to it’s rapid rate of spread and immune evasion. This is one example of where social media rifts developed, some scientists chose to communicate how it was more mild, others continued to explain that this wasn’t well established and that it wouldn’t matter if it was still deadly and spread more effectively. I’m proud to say I got that one right and was in the later crew.

Once a new variant is identified, especially if it is found while people are ‘headed back inside’ for cold winter months, or that end of summer wave in the Northern Hampshire is starting this can mean that a new wave is coming or will be amplified by the new variant. This will shift my masking behavior towards being more often.

Most of us will get to avoid being in a city or town that is 0 for a new variant, so you will likely have a bit of prior notice and a few weeks to shift behaviors towards masking more often.

Recently, we have had a few new variants identified, there was a little immune escape from a variant this winter, but this failed to drive a significant wave of infection relative to prior years. I am keeping an eye on NB.1.8.1, however, I have not seen a pattern yet that is significant enough for me to sound the alarm to the public at large using my social media channels. This may change in the next week or two — just like any good scientist I follow the data.

When did I last get a vaccine?

We all know that vaccines are not magic bullets or silver shields, they fail, there are breakthrough infections. This is especially true when a vaccine only has one version of a virus (or representative protein), and 10 or more variants are in active circulation. The good news is that antigen exposed people (vaccinated, previously infected, or both) have immune systems that have been “educated”. T cells, for example, recognize the virus even if it’s not the exact same protein signature that was in the vaccine. Therefore, the immune evasion (changes in the virus) may allow the virus to get around the first line of defense of the immune system but it can quickly adapt to control virus replication and reduce symptoms, virus load, and impact of the disease.

At this point most of the world has been exposed to SARS-CoV-2 through infection, vaccination or a robust combination of both. Therefore, fewer people are getting very sick from the virus, fewer people are dying from the initial virus infection (data from countries around the world show this clearly), and fewer people are spreading the virus. It should be mentioned that disability from Long-COVID is still a significant risk from infection, but this too is reduced by vaccination, taking precautions such as mask wearing, and in many studies taking Paxlovid. Rates of infection, death and Long-COVID-19 can change if a highly immune evasive, deadly variant shows up, but this is where we find ourselves right now.

I still plan to and will continue to get an annual SARS-CoV-2 booster. Even though the antibody protection wanes (just like it does for influenza vaccines), the few months of protection it affords me in the winter months when infection rates are high is an important part of my ‘Swiss cheese model.’ This means that if mask wearing and situational awareness fail me, I at least have another line of defense onboard that can reduce chances of infection and severe outcomes. When the time comes and I am older or have good reason to (immunocompromised etc.) I will certainly opt for another SARS-CoV-2 booster mid-year.

Despite all of its detractors, the data is clear that the SARS-CoV-2 vaccine does reduce infection. Beyond that it reduces severity of disease which in turn reduces the likelihood of developing Long-COVID. But, about 3 months after getting my booster I do weigh that factor in my mask wearing choices, especially if SARS-CoV-2 is high were I am, and definitely if there is a new variant on the horizon. Remember this is all against the background of being a healthy, 40-something, who has no confounding health factors. If I did have additional health considerations, I would shift my masking to be more often.

What is the air circulation like, and is it crowded?

Now let’s talk about venue. Venue has quite a bit to do with rates of exposure and infection. Is the room you’re in is well ventilated with good air circulation and three-story high ceilings and are people well spread out (like a recent medical conference I spoke at)? Or are there low ceilings, you’re far away from any doors, and people are packed - something like a concert in the basement of a local dive bar that is at the fire code capacity.

One of these venues is clearly higher risk than the other. I also generally feel more comfortable unmasking outdoors or in event spaces that are massive with great air circulation. For example in a sports arena I may be unmasked for a brief period of time, but I will put on a mask when I visit the restroom or if someone feels too close or is actively coughing.

Airborne viruses can spread quickly in crowded spaces given the right circumstances. But it becomes more difficult when you’re trying to assess a local restaurant that is half-full. I try to err on the side of caution here. Often I choose to eat out at off-peak times. I’ll sit with my husband at the bar if no one else is there so we are away from the main crowded areas of the room.

Summer months are great because it’s always much safer to eat outside, that said if the person one table over keeps turning to sneeze in your direction — it could be allergies — but it could be something else. Taking into account the other risk factors discussed above is how I would shift my risk assessment of being in a building or eating out with friends. Is it a peak time for COVID-19? Is the local wastewater high? When was my last vaccine? Are there any new variants ramping up? If the wastewater is low, I have a recent vaccine on board and no new variants are up and coming, I feel more comfortable eating an uncrowded, well ventilated area. This doesn’t mean it’s completely safe, but it will be lower risk.

Hand washing

I tend to be a good hand washer. If you want to avoid viral infection, you should be too. Even before the SARS-CoV-2 pandemic I always had a bottle of hand sanitizer in the driver side door of my car (note: hand sanitizer does nothing for norovirus). The ever empirical scientist I am, I’ve done the n=1 experiment since my college years showing that when I routinely use it before grabbing a bite to eat or heading into the house after a day at work, I do not get sick as often. Some viruses live longer on surfaces than others, influenza A for example is infectious for much longer than SARS-CoV-2 is, but both can spread from fomites (inanimate objects that can transmit infectious disease).

Despite my good habits when I know a wave is coming or see a spike in the wastewater, I ramp up my handwashing alongside of my mask wearing. I also remind myself to avoid touching my eyes, nose, face or mouth until I’ve washed my hands. I’ll also wipe down personal items I routinely touch more often, including phone, laptop keyboard, glasses, and car steering wheel.

Friends, Family, and Other Close Contacts

I am lucky to have friends and family that respect that I don’t want to get sick with SARS-CoV-2 or really any virus if I can avoid it. Well, they either respect me, or they know they don’t want to start a conversation with me about it that will end a long email containing a list of peer reviewed publications and a few extra reasons they should be more cautious themselves. Either way, they are part of my personal risk equation.

Anyone who you regularly come into contact with should be part of your personal risk calculation. Because my contacts are thoughtful and respectful, I am confident that they will let me know if they’re not feeling well so we can reschedule and we do. They don’t mind doing things outdoors and have taken COVID-19 tests when asked too before events. Therefore, even though these precautions are not perfect, they do ultimately reduce the risk of infection and during low-risk periods make me more confident to spend time together without wearing a mask. If you have less understanding people in your life, you may want to adjust your activities and/or mask more often around them if you are indoors.

Always be prepared

Going out for the day and not masking sometimes doesn’t mean I’m unmasked the whole time, situations may change and I really might want a mask on. For example, I might have an off-peak lunch in an uncrowded space with another COVID-19 conscious friend next to an open door but then head to a packed grocery store where I hear a few people coughing. Maybe I’m traveling between home and some meetings with just a few people using public transport, during which I will mask for the trip. Another example is when I finish giving a talk on a stage but then have to walk through a crowd that is going to a wedding reception in the same hotel, I’ll quickly put on a mask until I am back outside. Therefore, I always have a couple of masks with me and keep a couple spare masks in my car.

Summary

Here are a few examples that I would consider low, medium, and high risk for SARS-CoV-2, how they could change.

low risk: An outdoor hike on trail that isn’t crowded and provides plenty of space to walk around other people. This would become a higher risk situation if the people you’re hiking with are actively sick, there’s a new variant on the rise, and of course if you shared a car ride over with them. But if you pass someone on the trail who is sick and they do not cough on you, it still remains a very low risk situation.

intermediate risk: High ventilation, moderately crowded space with intermediate waste water levels of SARS-CoV-2. Depending on the activity and how crowded my immediate area is, and how long I plan on spending there, I may or may not choose to mask. But, if you changed the amount of ventilation, making it a low ventilation, moderately crowded space, with intermediate levels of wastewater virus detection, I would choose to mask, as I did at a recent concert in Chicago. If I do choose to not wear a mask in what I consider an intermediate risk situation, I am always on the lookout for reasons to pop the mask on. For example, four days into a recent international conference I attended (and did not get sick) a woman a row behind me started shaking everyone’s hand around her explaining how she introduces herself to everyone one seat away, then she started actively coughing - I didn’t shake her hand, my mask went on.

high risk: A packed indoor venue with poor air circulation, or for example, a choir concert, gym, or restaurant that is packed full of people while a new variant is actively spreading and local wastewater levels are rising. Here proximity and activities matter. For example, not everyone in the restaurant will become sick, and during a choir concert the audience will have a much lower chance of getting sick, while people close to the sick person singing will have a higher likelihood of becoming sick.

Vaccination and Immune Experienced Populations

As a virus moves from a pandemic emergency phase into an endemic phase infection patterns become more well established and typically fewer people get sick, debilitated by, or die from the disease. This is because the population has encountered the virus, a vaccine or both, and some level of population based immunity has been established. Even if it is not true ‘herd immunity’ an immune experienced population also has reduced virus spread as some people simply won’t become infected (in a given period of time) and others who do will have lower viral loads. The only potentially confounding factor here is that SARS-CoV-2 does cause immune system dysfunction and dysregulation and for some people rapid re-infection has been documented. I am looking forward to additional research on how this impacts virus mutation dynamics and spread among a population.

That said, SARS-CoV-2 is still an incredibly dangerous virus that I wish had been contained when we had a chance. It will continue to reshape the way we live for generations to come. I still remember the day in early 2021 that I realized we would never achieve herd immunity, and the virus would be with us forever. Unlike other respiratory illnesses, SARS-CoV-2 can attack the vascular system of the body, impacting every organ and physiologic function from heart, to brain, to liver to an unborn child. This is why it is so important for people with additional health risks and people who are pregnant to practice good personal safety when it comes to this virus, and request that their family members do as well. Infection with SARS-CoV-2 can also trigger the development of secondary disease and/or Long-COVID at higher rates than other viruses we have in circulation. It is likely as research continues we will uncover additional disease development directly associated with SARS-CoV-2, some diseases take longer than others to develop.

Therefore, although fewer people are getting sick and dying from COVID-19 I still choose to mask on a regular basis. This is also why I spend time analyzing patterns of infection, disease spread, and new variant development. The best way to avoid secondary complications is to prevent infection to start with.

Presymptomatic v. Asymptomatic Virus Spread

I have often seen people confusing presymptomatic and asymptomatic spread of viruses in comments on my posts. Presymptomatic spread is something that happens with nearly all viruses where there is a period before someone exhibits symptoms, but the viral load in their body is high enough that they can begin to spread the illness. Measles for example has a very long presymptomatic spreading period, at least 4 days prior to onset of a rash. Influenza can spread presymptomatically for about 24 hours before someone begins to have symptoms. SARS-CoV-2 can spread for 1-2 days before symptom onset in the rare case up to 4-6 though these numbers were typically seen earlier in the emergency phase of the pandemic. There are of course exceptions to each of these but in general, symptomatic spread of a virus is when most people become ill from contact. In certain situational studies presymptomatic transmission was dominant for SARS-CoV-2, however this seemed to be driven by special circumstances such as close, prolonged contact and/or early variants that had a increase in contagiousness and immune evasion, such as the Delta variant. As virus infection rates have reduced with current variants, more research defining the rates of presymptomatic, asymptomatic, and symptomatic disease spread would help people, as well as institutions better assess true risk. A modeling study that reviewed 130 publications in 2022 found that presymptomatic transmission in households (close contact) could be a major driver of infection, but that asymptomatic infection (never developing symptoms) had a significantly lower rate of infectivity. Another confounding factor in the attempt to understand presymptomatic v. asymptomatic transmission is that not every study performs complete follow-up, in this study about half of the subjects initially classified as asymptomatic cases went on to develop symptoms and were in fact ‘presymptomatic.’

In general, people who do not develop symptoms during viral infection (and they have functional immune systems) have lower viral loads. Asymptomatic infection can occur for many viruses, including those we are vaccinated against. Some people, for example, can have asymptomatic measles infections, but do not, based on our current understanding, have any adverse events though they can spread the virus - but at lower rates. The reason for lower rates of asymptomatic spread is that when the virus is well controlled by an immune response (so you don’t have symptoms) in most cases this means that the person has a lower viral load. During early cases of SARS-CoV-2 this may have not been the case due to how new the virus was and these dynamics are likely now significantly different given that the global population has now encountered several variants of the virus via infection, vaccination, or both. Regardless, even a vaccine inexperienced population of people showed in a 2021 study that household (close, constant contact) rates of SARS-CoV-2 transmission from asymptomatic people were significantly lower than that of people who were presymptomatic or symptomatic. For asymptomatic secondary attack rate (how many people got sick from an asymptomatic household member) the researchers found that it was about 1.8% in China among a vaccine and virus inexperienced population, and 2.2% in other countries. A more recent, though smaller study published in 2024 found that asymptomatic children followed from January 2021 to April 2022 infected household members at lower rates than presymptomatic household members.

Though there is evidence presented in some studies that household transmission rates from children may be similar, the numbers are highly variable. It is important to remember that these studies were done with prior variants and often vaccination naive populations where even an asymptomatic infection (likely driven by a combination of genetic factors) would likely have higher rates of viral load simply due to immune system inexperience. As viruses become endemic spreading rates are reduced due to an immune-experienced population generally carrying a lower viral load, which reduces the likelihood of spread.

Because it is impossible to tell who is asymptomatic, presymptomatic, or even symptomatic with a heavy dose of cold medicine on board, I tend to rely on wastewater numbers for my assessment of what is generally going on in the population around me. As always active symptoms are a good reason to take a step back, put on a mask, and/or leave if you don’t want to risk getting sick.

Places Where I Think More Masking Should Happen

If more people were self-aware and conscious of how deadly diseases can spread, we’d have fewer risks and lower overall viral infections to contend with. It would be fantastic if we lived in a society that allowed for more sick leave, had free vaccination programs, ready access to inexpensive healthcare, and people put on masks as soon as they felt a throat tickle. We’d have far fewer needless deaths and disability from viral infections. However that simply isn’t reality. If I only had two places where I could implement change, I believe that schools and doctors offices/hospitals would be a great start to reducing the spread of infectious disease.

Schools and daycares are places where viruses spread readily. Every year when children go back to school after the summer viral illness spikes across the entire United States population as a result. This is not a new pattern, it was documented before the SARS-CoV-2 pandemic. Now SARS-CoV-2 is one of those viruses that begins to spread more at the beginning of the school year. Viral spread in schools can be reduced in a few ways. 1. Updated ventilation and filtration, 2. Improved handwashing protocols and cleaning protocols, 3. Improved vaccine uptake requirements. But there has to be political and parental will to push initiatives like this forward.

It would also be highly beneficial if we could reduce the number of children being sent to school sick, however, the lack of at-home child care in a world where parents often must work doesn’t allow for this to be a reality in our society today. If children are sent to school sick and or would like to avoid illness at the beginning of the school year removing the stigma around mask wearing during this time would be incredibly helpful for reducing disease spread.

Another place where masking can make a huge difference is with doctors and nurses who work with vulnerable patients. I routinely hear from patients who are uncomfortable when their doctors and other caregivers who fail to wear a mask around them. This should be a wake-up call to doctors and medical administrators.

Patient trust is at an all-time low. And while we do find ourselves in difficult times to navigate (some patients may be upset when a doctor wears a mask), there are ways to make your patients feel heard and comfortable in your care. A simple solution could be giving your patients a box to check if they prefer for you to be masked when they visit. If everyone at your chemotherapy infusion center is asking for this option, it could signal an important step towards building the doctor-patient trust relationship back. Care centers that serve chronically immunocompromised people should consider offering masks to everyone who enters. I personally have requested that my dentist and hygienist be masked for every visit, but some people may feel more shy and not self-confident enough to advocate for themselves given the polarization around the topic. Small changes can help re-establish trust and protect people.

Summary

I sincerely hope that this insight into how I approach my own personal infection risk is helpful for you and your loved ones as you think about how to best protect yourselves from infectious diseases going forward. Remember that everyone should take into account their own personal health history when assessing personal risk and if you have any specific questions, they are best discussed with your own doctor.

It’s a big prediction to make, and I hope that I am wrong, but with as little as one to three mutations in a notoriously mutagenic virus, person to person spread of H5N1 has really just become a matter of “when” not “if”.

That said, it is difficult to predict the mutational leaps a virus may or may not make. So as we head into the winter of 2025-26 I felt like it was a good time to update everyone on my thinking about this virus. I am still not certain when H5N1 will being spreading between people, but what I can say is that we are incredibly close to having a second pandemic in 5 years become a reality.

The reason I believe we are closer than ever is that H5N1 is only one to three mutations away from developing the capacity for human-to-human transmission. Well, really only one mutation, but the additional 2 or so mutations would make it spread even faster, and some of those mutations have already been detected in the wild.

Typically, when highly pathogenic avian influenza viruses make the leap to people, they come with greater transmissibility than a typical influenza and greater pandemic causing potential.

The United States is not prepared to face another pandemic, especially not one where the current mortality rate is up to 50% (likely to drop, but still may be higher than SARS-CoV-2). Political will is also ensuring a lack of preparedness by defunding surveillance, testing, and research supporting rapid development of a H5N1 vaccine that could be rapidly produced, much like the COVID-19 vaccine.

Which Mutations Have To Occur To Touch-Off The Next Pandemic?

The most important barrier is the virus’s preference for binding to avian (bird) sialic acid receptors which are different enough from the human sialic acid receptor that it typically prevents inter-species infection.

However, influenza can and does mutate to overcome this barrier and has in several past pandemics. While earlier H5N1 strains typically required three or more mutations to achieve this, the bovine-derived dominant H5N1 clade in North America 2.3.4.4b has demonstrated this switch with just one change. Researchers found in the laboratory that Q226L could lead to human cell spread. Although I have seen some articles dismiss this as being ‘done in a laboratory’ I would like to remind those other authors that this is how the company Regeneron predicted the next sets of SARS-CoV-2 mutations in 2020 with tremendous accuracy.

But what does ‘one change’ actually mean?

Sometimes an amino acid change (in this case from glutamine (Q) to leucine (L)) requires several nucleotide (DNA or RNA, RNA in this case) changes, however, in this case it only requires one point mutation in the genetic code of the virus to change the Q at position 226 to L. To make maters worse, the influenza virus does not have a good ‘proof reading’ mechanism, leading to one of the highest mutation rates, even among other RNA viruses.

Other mutations that may cause issues can be found at sites in the polymerase genes (PB2 E627K and D701N) and are likely to further increase replication efficiency and adaptation in mammalian hosts. Some currently circulating viruses already possess one or more of these mutations.

Mutation Isn’t The Only Way Influenza Can Adapt

Genetic reassortment is a process in which influenza viruses exchange gene segments when two different strains infect the same host cell. Influenza viruses have segmented genomes, typically eight separate RNA segments, enabling this mix-and-match exchange. During co-infection of a cell, segments from both parental viruses can be packaged together into new viral particles, producing “progeny” with mixed genetic material. These reassorted viruses can display novel traits such as altered host range, transmissibility, sometimes leading to dramatic shifts in virus behavior. Historical influenza pandemics, including 1957, 1968, and 2009 arose through reassortment events that combined genes from animal and human strains. This is a powerful evolutionary mechanism for influenza viruses and a significant concern for public health as it can allow an influenza virus to emerge suddenly with new properties.

In 2024 in Cambodia at least 25 H5N1 infections were reported in the winter, and genetic analysis identified a reassortment of two influenza viruses creating a new virus that contains the surface genes from 2.3.2.1e and internal genes from 2.3.4.4b. There this new strain has mostly replaced older clades in local poultry and represents the principal cause of recent human spillover infections. All cases were a result of direct contact with ill or recently deceased backyard poultry. Unfortunately the case fatality rates remained as high as prior H5N1 outbreaks, at about 50 percent. Identified genetic markers (such as PB2 E627K) were consistent with mammalian adaptation, but sustained human-to-human transmission was not reported.

Is The United States Likely To Be The Epicenter?

It’s difficult to predict when and where a virus will develop mutations that allow it to spread rapidly person to person. However, repeated human infections due to repeated close human - host animal contact increase the chances a virus may develop a beneficial (for the virus) mutation and begin to spread human to human.

Last winter 70 cases were reported in the United States, with the vast majority of them being tracked back to direct animal exposure, typically dairy cattle.

The below graph shows the location of human infections with H5N1 since 1997.

Some indication of potential human-to-human transmission has been seen in people without direct animal exposure (but exposure to an infected person) developing antibodies against H5N1. When your immune system ‘sees’ a virus it will develop antibodies to combat it, though none of these cases were reported to be severe and in many cases the person did not have symptoms.

If the strong northern hemisphere dominance of cases in the United States starting in the 2024-25 influenza season persists, it becomes more likely that the United States will be the epicenter of the next global pandemic. Note: The 2025 cases on this graph represent the end of last year’s influenza season and no cases of H5N1 have been reported for the 2025-2026 influenza season as of this writing.

Furthermore, good public health measures such as surveillance, education, rapid testing, and PPE (masks, gloves, gowns) distribution can rapidly reduce spread of a virus. However, there has been an erosion of common sense public health measures in the United States, making it more likely that if mutations in the virus occur here, significant sustained H5N1 spread could also start in the United States.

The Southern Hemisphere Remains H5N1 Free

Despite Australia suffering through a bad flu season this winter, no region in the southern hemisphere has officially reported H5N1 infections in humans or animals during the 2025 winter. Surveillance updates from Australia, New Zealand, southern Africa, and South American countries indicated that highly pathogenic avian influenza H5N1 was not detected through the peak winter flu season. While seasonal influenza viruses circulated at moderate to high levels in some regions, H5N1 outbreaks remained confined to the northern hemisphere and some regions near the equator. Both national and international organizations, including the WHO and local ministries, confirmed that southern hemisphere surveillance efforts, did not identify any new or confirmed H5N1 activity among people or animals during the 2025 winter.

The lack of any significant spread of H5N1 in the southern hemisphere during the 2025 winter is good news on the pandemic front. The fewer viral infections, the fewer chances a virus has to mutate.

Aside From Being More Deadly, H5N1 Shows An Increased Risk Of Brain Infection

Sometimes it’s difficult to encourage people to pay attention when everything is labeled as being “just the flu”.

For those of us who have had (tested positive) Influenza infection, we know that even as young and health adults you may become incredibly sick. Unfortunately, the strain of H5N1 in wide circulation appears to also be able to infect brain tissue, a new-ish trick for influenza and something we won’t know the implications of until we see wide-spread human infection.

Recent research has shown that certain H5N1 virus strains possess marked neurotropic properties, meaning the virus can invade and damage neural tissue. Experiments have demonstrated that H5N1 can cause fatal neurological disease in mammals, including rodents, cats, and marine mammals. In fact, many veterinarians have reported barn cats from areas with infected cattle dying from seizures, not respiratory issues, while infected with H5N1. Research has shown that H5N1 infection can cause encephalitis, meningoencephalitis, and neuronal cell death, with affected mammals displaying neurologic signs like ataxia (loss of balance) and convulsions.

The virus is capable of reaching the central nervous system through the olfactory nerve and can induce persistent inflammatory injury in brain regions, including the loss of dopaminergic neurons similar to SARS-CoV-2 which leads to brain fog and depression.

Indeed in humans, per this New England Journal of Medicine Report, conjunctivitis, which can have a neurological connection, is a common symptom even in mild cases where the virus is still not well adapted to infecting human cells.

Though most human H5N1 cases currently involve severe respiratory disease, the presence of neuroinvasive behavior in animal models raises serious concerns. While H5N1 is not efficiently transmitted among humans at present, t

he demonstrated ability to infect brain tissue and ongoing mammalian adaptation suggest that future mutations could substantially increase morbidity and mortality should the virus acquire human-to-human transmissibility.

What Can You Do?

If you haven’t gotten your flu shot this year, please consider doing so very soon and as always discuss it with your doctor if you have any questions. If H5N1 does reach pandemic status this year, the H1N1 in the current flu shot may offer some protection. I detail this in a prior introduction to H5N1 research here.

Continue to wear a mask to protect yourself. For example, I always wear one when flying and despite always testing at least twice when I’ve felt sick, I have not yet had COVID-19.

Wash your hands (influenza lasts longer on surfaces than SARS-CoV-2) and be careful not to touch your eyes, nose, or mouth between touching a high-touch surface (hand rail, door handle to a building etc.) and washing your hands. There is some recent evidence that high-salt nasal rinses may reduce symptoms and the number of sick days, just be sure to always use distilled water. If you feel sick, stay home to prevent spread to others and discuss the best course of action with your physician.

And finally, share this article with anyone who you think it may help.

References

• Science (2024). A single mutation in bovine influenza H5N1 hemagglutinin switches receptor-binding preference. https://www.science.org/doi/10.1126/science.adt0180

• Respiratory Therapy (2024). Bird Flu Mutation Could Increase Human Transmission Risk. https://respiratory-therapy.com/disorders-diseases/infectious-diseases/influenza/bird-flu-mutation-increase-human-transmission-risk/

• Phys.org (2025). Analysis reveals H5N1 mutations linked to human adaptive potential. https://phys.org/news/2025-08-analysis-reveals-h5n1-mutations-linked.html

• Frontiers in Cellular and Infection Microbiology (2025). Emerging H5N1 mutations (PB2-D701N, PB2-E627K, HA-S110N, Q226L): Cross-species threats. https://pmc.ncbi.nlm.nih.gov/articles/PMC12333729/

• Centers for Disease Control and Prevention (CDC): Global Summary of Recent Human Cases of H5N1 Bird Flu (August 2025). https://www.cdc.gov/bird-flu/spotlights/h5n1-summary-08042025.html

• Centers for Disease Control and Prevention (CDC): H5 Bird Flu: Current Situation - CDC (September 2025). https://www.cdc.gov/bird-flu/situation-summary/index.html

• World Health Organization: Avian Influenza A(H5N1) - Cambodia (July 2025). https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON575

• CIDRAP: Cambodia announces 15th human H5N1 infection of the year (September 2025). https://www.cidrap.umn.edu/avian-influenza-bird-flu/cambodia-announces-15th-human-h5n1-infection-year

• BlueDot: The curious case of avian influenza in Cambodia (July 2025). https://bluedot.global/the-curious-case-of-avian-influenza-in-cambodia/

• GlobalBioDefense: Cambodia Reports Surge in Human Infections with Avian Influenza A(H5N1) (July 2025). https://globalbiodefense.com/2025/07/08/cambodia-reports-surge-in-human-infections-with-avian-influenza-ah5n1/

• Cleveland Clinic: Avian Influenza (Bird Flu): H5N1, Causes, Symptoms & Treatment (September 2025). https://my.clevelandclinic.org/health/diseases/22401-bird-flu

• Nature: Highly pathogenic avian influenza H5N1 clade 2.3.4.4b genotype exhibits neurotropic behavior and heightened threat (June 2025). https://www.nature.com/articles/s41467-025-60407-y

• Science News: Bird flu has been invading the brains of mammals. Here’s why (July 2024). https://www.sciencenews.org/article/bird-mammal-brain-outbreak-influenza

• PNAS: Highly pathogenic H5N1 influenza virus can enter the central nervous system (August 2009). https://www.pnas.org/doi/10.1073/pnas.0900096106

• New Zealand Ministry for Primary Industries: Surveillance and planning for HPAI (bird flu) | NZ Government (March 2025). https://www.mpi.govt.nz/biosecurity/pest-and-disease-threats-to-new-zealand/animal-disease-threats-to-new-zealand/high-pathogenicity-avian-influenza/surveillance-and-planning-for-avian-influenza/

• PMC: Avian Influenza Virus Surveillance Across New Zealand and Its Pacific Neighbors (March 2025). https://pmc.ncbi.nlm.nih.gov/articles/PMC11949760/

• Gavi, the Vaccine Alliance: Everything you need to know about bird flu (April 2025). https://www.gavi.org/vaccineswork/everything-you-need-know-about-bird-flu

• Nature: Circumpolar spread of avian influenza H5N1 to southern Indian Ocean islands (September 2025). https://www.nature.com/articles/s41467-025-64297-y

On September 3rd, 2025, Joseph Ladapo, M.D. announced that he, backed by Florida Governor Ron DeSantis, will remove all public-school vaccine mandates in Florida.

For those who have been watching Ladapo’s professional activities before and since being sworn in as Florida Surgeon General, this is not surprising. The list of medical ethics violations and attacks on established science is so long it wouldn’t be surprising if he started recommending cigarettes as a healthy alternative to chewing gum.

Since becoming Florida’s Surgeon General, Ladapo has been wielding his position of authority to risk the health and safety of Floridians. Here I review his numerous controversies and deadly outcomes of his recommendations and how the loss of these vaccine mandates will impact the citizens of Florida.

Ladapo’s Long List of Ethical Violations and Harmful Medical Practice

Joseph Ladapo, M.D. has a long history of doing the opposite of scientifically supported, long-standing public health measures, repeatedly. In his most recent press conference, he asked, “who was he to tell a parent to vaccinate their child?” when indeed, as a physician and state surgeon general, this is his job. His resume of activity would normally ensure any other physician would lose their medical license with expulsion from any University system they were associated with. In fact, University of Florida colleagues have spoken out against him, just as his prior UCLA colleagues have, as well as major medical associations. The reason he has not lost his license to practice is that his licensure is governed by the state of Florida, and he is in lockstep with Florida Governor Ron DeSantis in attacks on science and public health.

Let’s review a sampling of Ladapo’s professional conduct in recent years.

Violations and Ethical Complaints:

University of Florida faculty have described Joseph Ladapo's ethical breaches as including violations of research integrity policies, promotion of misinformation, and actions that undermine professional trust and institutional credibility.

• The UF College of Medicine Faculty Council formally rebuked him for "promoting health misinformation" and "breaching the trust placed in him as a faculty member".

• Faculty highlighted violations of section 3.B.3 of UF’s policy on research integrity, citing “careless, irregular, or contentious research practices” and potentially improper authorship or data manipulation.

• The ad hoc faculty committee reviewing his hiring declared there were "numerous irregularities" that violated the spirit and letter of UF hiring procedures, particularly in how peer evaluation was bypassed.

• Colleagues accused him of leveraging his position for "personal and political gain," with disastrous consequences for Floridian health and the reputation of the university.

• The faculty council condemned his alteration and omission of research findings as a form of malfeasance, citing concerns over scientific fraud and integrity violations.

• Some colleagues said his absenteeism, lack of research output, and poor collaboration reflected a breach of academic responsibility and ethical standards expected of tenured faculty.

Overall, UF faculty believe Ladapo’s actions have "decimated the reputation of the University of Florida," elevated risk for Florida’s citizens, and breached the core ethical obligations of the medical and scientific professions.

Ladapo’s Medical Malpractice as Florida Surgeon General:

Ladapo has been putting the health and safety of Florida citizens at risk for years. Most recently Ladapo publicly promoted the “health benefits” (there are none) of drinking of raw milk labeled “for animal consumption only” immediately after 7 people were hospitalized, 6 of them children and 21 people were sickened with E. coli and Campylobacter bacteria infections in Florida. Ladapo continued to promote the benefits of raw milk publicly during hospitalization and miscarriage of a pregnant woman who is now suing the dairy farm.

Ladapo has a long history of endangering people with his professional medical advice, here are some more examples:

Manipulation of State Vaccine Safety Reports:
Ladapo personally edited and released studies that exaggerated cardiac risks from COVID-19 vaccines while removing data that contradicted his claims, regarded by outside experts as politically motivated and misleading.

Contradiction of National Health Recommendations:
Opposed CDC, FDA, and leading pediatric medical organizations on pandemic guidance, vaccines, mask mandates, and social distancing.

Promotion of Discredited Treatments and Theories:
Publicly associated with organizations pushing unproven or disproven COVID-19 therapies (hydroxychloroquine, ivermectin) and supported anti-vaccine initiatives, including encouraging raw milk consumption despite outbreak deaths and medical warnings.

Fluoridation Opposition and Other Pseudoscientific Stances:
Embarked on a campaign to remove fluoride from drinking water, defying strong scientific consensus on its dental health benefits.

Ladapo’s Financial Controversies:

Aside from bringing in a nearly half a million per year salary on the backs of Florida taxpayers, Ladapo has failed not only as a surgeon general but as a professor at the University of Florida, a position from which he draws a significant salary.

Disputes Over Grant Transfers and Research Funds:
Ladapo faced disputes with UCLA and UF over failed NIH grant transfers, with allegations surrounding political and professional bias. This resulted in no promised outside research money being secured at UF.

Lack of Compliance With Tenure Expectations:
Ladapo risked failing post-tenure review criteria due to minimal publications and funding—issues compounded by absenteeism and his controversial academic standing.

What Will Happen To The Children and People of Florida When Vaccine Mandates Are Removed?

Funny, we have a lot of research in this area showing what is likely to happen to the citizens of Florida under Ladapo and DeSantis’s attack on public health.

As soon as this goes into effect, peer-reviewed research predicts a marked increase in childhood disease rates and outbreaks of vaccine-preventable illnesses in the state. What happens in Florida, won’t stay in Florida. An interesting 2022 study from the National Bureau of Economic Research using a college campus as a testing ground for vaccine mandates demonstrated that vaccine mandates not only reduced disease burden and deaths at the college, but reduced disease in the local surrounding community. Now imagine, Florida is that college, and the surrounding community is the United States. Thanks to Ladapo and DeSantis we may have a national resurgence of Polio in a few years. Certainly, this new policy will hasten continued Measles infections which are already well on it’s way to establishing a full year of continued spread thanks to RFK Jr and the ongoing outbreak in Texas.

Historical and modeling data show that eliminating mandates leads to lower vaccination coverage, particularly among the most vulnerable and under-vaccinated populations, resulting in greater susceptibility to contagious diseases such as measles, mumps, rubella, and polio.

Regions that have relaxed mandates or broadened exemption criteria have consistently seen outbreaks, increased hospitalization rates, and rising community transmission, with (former) CDC surveillance linking lower coverage directly to higher rates of illness and preventable child deaths.

Loss of vaccine mandates may impact the health of adults as well. When children are not vaccinated diseases spread more readily and more adults come into contact with viruses and often more virus than if a child had been vaccinated (higher viral load). Exposure to children with high viral load increases “breakthrough” infections wherein a previously vaccinated adult may succumb to the illness, and will certainly be capable of spreading it. Loss of vaccine mandates also puts anyone who is immunocompromised either permanently (organ transplant recipient for example) or temporarily (undergoing cancer chemotherapy, for example), anyone who is pregnant, babies too young to get vaccinated, and the elderly (65+) at high risk of infection and death.

Ladapo and DeSantis are reversing decades of public health progress, threatening not only schoolchildren but also broader community health through reduced herd immunity and the resurgence of diseases once nearly eliminated.

Summary

Joseph Ladapo’s leadership as Florida Surgeon General, backed and protected by Florida Governor Ron DeSantis has led to profound controversy and division. By contradicting scientifically valid guidance and promoting disputed or disproven interventions, his tenure has fostered vaccine hesitancy, confusion, and mistrust of public health authorities. Don’t just take it from me, public health experts argue that these actions will have a disastrous effects on the state’s public health, including preventable illness, deaths, and undermining of the state’s standing as a science-based institution. Plainly, this is another one of Joseph Ladapo’s actions that will kill people. I’m just wondering when the people of Florida stand up for themselves.

References:

https://www.cidrap.umn.edu/campylobacter/raw-milk-linked-21-e-coli-campylobacter-infections-florida#:~:text=Twenty%2Done%20people%20in%20northeast,did%20not%20name%20the%20farm.

https://www.politico.com/news/2023/04/24/florida-surgeon-general-covid-vaccine-00093510

https://www.bmj.com/content/380/bmj.p110

https://facultycouncil-a2.sites.medinfo.ufl.edu/wordpress/files/2023/01/COVID-19-Ladapo-Detailed-Critique-12.22.22_.pdf

https://www.science.org/content/blog-post/hiding-important-information-not-science

https://www.alligator.org/article/2025/03/ladapo-s-a-charlatan-florida-surgeon-general-s-tenure-at-uf-is-lackluster-colleagues-say

https://www.msnbc.com/rachel-maddow-show/maddowblog/joseph-ladapo-university-florida-surgeon-general-rcna199292

https://www.wusf.org/politics-issues/2022-04-03/faculty-committee-says-surgeon-general-joseph-ladapos-hiring-at-uf-had-irregularities

https://www.politico.com/news/2023/11/27/joe-ladapo-university-of-florida-00128541

https://www.alligator.org/article/2024/09/surgeon-general-ladapo-approaches-three-year-uf-tenure

https://cbs12.com/news/local/dr-joseph-abiodun-ladapo-florida-surgeon-general-gov-ron-desantis-university-uf-health-covid-mask-coronavirus-ucla-nyu

https://climate.law.columbia.edu/content/florida-surgeon-general-altered-state-funded-study-covid-vaccine-risk

https://www.scientificamerican.com/article/floridas-surgeon-general-shows-the-danger-of-politicizing-of-medicine/

https://www.wusf.org/health-news-florida/2025-08-13/floridas-surgeon-general-says-he-supports-the-freedom-to-drink-raw-milk

https://www.wlrn.org/light/health/2025-08-13/florida-surgeon-general-raw

https://www.orlandoweekly.com/news/department-of-health-reports-21-infections-tied-to-raw-milk-consumption-in-central-northeast-florida-40104744

https://www.floridahealth.gov/newsroom/2024/11/20241122-fluoridation-guidance.pr.html

https://www.msnbc.com/rachel-maddow-show/maddowblog/florida-surgeon-general-ladapo-takes-aim-states-vaccine-mandates-rcna228838

Makary is a surgeon, and surgeons do not study viruses or human immunology. They have little to no expertise in this space.

Given Dr. Makary’s uneducated hear-say op-ed published Septmber 1st, 2025 in The Wall Street Journal, many of us in the field are wondering…

• Does Makary know that COVID-19 is more deadly than influenza, something the FDA has long held approval for and CDC has recommended vaccines for?

• Does Makary understand that the post-COVID sequalae (long-term health problems) are vastly more significant and more wide-spread in healthy people infected with SARS-CoV-2 than with any other circulating virus infection?

• Does Makary know that the Sars-CoV-2 virus mutates frequently and reinfects people, sometimes multiple times a year?

• Does Makary know that age-adjusted population studies show significant benefits of recent boosters against developing Long-COVID, hospitalization, and death?

Perhaps Makary, a surgeon, is operating under the vague “hand-wavy” idea that ‘vaccines aren’t good for you’ when in fact there is no new safety signal with COVID-19 vaccines and now 5+ years of solid evidence from US studies and studies around the world demonstrate that viral infection is far worse than a vaccine. Something any immunologist or infectious disease specialist could have told you. Something it is the FDA’s responsibility to know and understand.

Makary made 6 points in his opinion piece, let’s review:

“First, the FDA can approve products only if we believe there is substantial certainty that the benefits outweigh the risks. Currently, we don’t have that confidence for, say, a seventh Covid shot for healthy 12-year-old girl who recently recovered from Covid.”

Makary is clearly unaware that PASC (Long-COVID) is common in children as well as adults post COVID-19 infection and that studies from around the world, not just the United States, demonstrate clear benefit of a recent COVID-19 booster at reducing PASC incidence. Makary, unfitting of an FDA commissioner uses hyperbole and a little girl in this statement to trigger an emotional response: No healthy child under any prior recommended COVID-19 booster schedule has had more than 7 vaccines, therefore that data doesn’t exist. This is hyperbolic fantasy attempting to appeal to emotions, not the fact based review you would expect from a Doctor and head of the FDA.

“Second, if your doctor deems that you need a Covid vaccine, you can still get one. The FDA can’t regulate the practice of medicine. The FDA grants marketing authorizations, but doctors are able to prescribe drugs off label to people at low risk. In a few states, pharmacists may require a prescription.”

Yes, the FDA is significantly out of bounds by re-writing these recommendations while RFK Jr’s CDC is in abject disarray. The FDA IS NOW effectively practicing medicine by limiting access for millions of people. Because the access is now governed by state law, tied to pharmacist liability laws people in high-risk exposure situations (health care workers, teachers, and laboratory personnel, etc.) will be unable to get vaccinated. Furthermore, several states such as Florida are completely on hold re: COVID-19 vaccination and therefore people prescriptions may not even be able to get vaccines from major pharmacies due to Makary’s actions.

”Third as part of our approval the FDA is demanding that all companies run a clinical study assessing whether the new Covid shots improve outcomes in healthy subjects. These post-market randomized trials will use a true placebo control (salt water) so we will learn the side-effect profile. The FDA has asked, and the companies have agreed, to monitor if the spike protein—the molecule the vaccine creates in the body—persists after vaccination. Several studies have shown the persistence of spike protein, which some believe contributes to adverse events. The FDA’s mandate is to compel companies to generate evidence to answer questions Americans have.”

There is no evidence that the spike protein persists in the human body at levels that are:

1. detectable outside of sequestered lymphocytes (the immune cells hold onto tiny parts of the protein to keep themselves able to respond to infection) which means it is not in circulation,

2. are present at levels that would be of biological significance, and

3. that the non-biologically active spike protein (can’t bind cells the way it was built) from the vaccines is harmful whatsoever.

Here, Makary is using fearmongering language that mimics debunked anti-vaccine rhetoric and skips over very basic biology and biochemistry.

The vaccine version of the spike protein was engineered to be locked in the biologically inactive ‘down’ conformation meaning it is a biologically inert protein inside the body. It appears Makary may need a refresher in basic biochemistry as well as immunology.

Regardless of what Makary is fantasizing about here he also skips the fact that billions of more spike proteins are present for weeks longer if you are infected with SARS-CoV-2, and it’s in a biologically active form.

“Fourth, some argue that Covid shots are needed for those who live with or take care of immunocompromised or elderly people. But no company has ever submitted data to the FDA to prove that Covid shots, which do not halt transmission, prevent caregivers from infecting vulnerable people. Accordingly, the FDA has never allowed companies to advertise that claim.”

Makary is talking about pharma company data submission to the FDA, something the FDA must request if the claim is being made. These studies were simply not done by the pharma companies in an effort to get approval rapidly during a pandemic, and laypeople should remember that transmission studies are a-typical for FDA vaccine approval. Makary is demanding data that would never normally be part of an approval process.

Regardless, real-world post-approval peer reviewed studies have been done by physician and scientist led independent research groups around the world. Makary is pretending this data doesn’t exist, playing politics with our health, skipping over real-world studies and making false claims.

Furthermore, if Makary listened to experts in the field he might develop an understanding of viral load and infection duration. When there is a break though case of COVID-19 the COVID-19 booster shots reduce both viral load and infection duration reduce the likelihood of viral spread. This is virology 101.

Why is Makary putting people at higher risk both caregivers and the vulnerable? This is not the role of the FDA and his statements here ignore basic science.

”Fifth, some claim that Covid shots mean kids are less likely to miss school and adults more likely to attend work. No vaccine manufacturer has ever submitted data to the FDA to validate these claims either. Similarly some argue that repeat doses prevent long Covid. Again, the FDA has no data to support this claim and has never allowed manufacturers to make it. As part of our new framework we have asked sponsors to measure long Covid symptoms.”

This fifth point of Makary’s makes me wonder if he understands how the FDA works and what it’s role is.

The FDA is supposed to determine if a vaccine is safe and effective. If the FDA wants this data, what they do historically is request this study from the manufacturers.

Enough evidence exists from independent studies in the public to support these claims, if the FDA needs more, they request the study to be done. They don’t simply change recommendations because data wasn’t provided for a study they didn’t ask for.

This is gaslighting at the highest degree: Makary says the public will have no access because no data was asked for and therefore no data was provided by the companies. He is shirking all responsibility of the position of FDA commissioner, while attempting to gaslight the rest of us.

”Sixth, the FDA’s new framework essentially ends mandates. Mandates were contentious, and ultimately a policy error, pushing hundreds of thousands of people out of work, without clear evidence of helping the public. Since the FDA isn’t approving a vaccine for the healthy school-age and working population, college and school mandates will be legally impossible. Accordingly, the FDA is revoking the emergency-use authorization for Covid vaccines. The emergency is over. The FDA will now return to an evidence-based standard”

It is simply a lie to say there is no evidence. Perhaps Makary isn’t aware of CDC MMWR reports as well as studies from around the globe looking at the benefits of COVID-19 boosters. To say this was a policy error is a direct attack on hundreds of thousands of expert-person hours of work in this area that he can’t seem to keep himself up to date on. The icing on the cake here is that he calls this a return to an “evidence based standard” while ignoring an absolutely crushing amount of evidence.

Makary is making a mockery of the US FDA.

He also includes people ‘voting’ with their arms, a cute anecdote that has nothing to do with how medicine should be practiced. Just because someone doesn’t want to go to the dentist, doesn’t mean you stop doing or recommending dental procedures. We all know that’s a dangerous way to make recommendations.

Finally, Makary ends his op-ed by comparing the US to other countries with significantly different health systems. He seems unwilling to be a leader in health that is evidence based, but rather a follower who ignores evidence puts people’s lives at risk. Remember Thalidomide, Doctor Makary? It was only approved in Europe, maiming children there, because the US FDA took an independent stand and fought off pressure to approve it.

This WSJ op-ed makes it abundantly clear that Makary is a coward unwilling to listen to scientists, specialist physicians, public health experts, or review black and white evidence and would rather risk the health of American citizens for a ‘feeling’, or perhaps, his political career.

Here Is What Would Have Been Written To The WSJ By A Responsible, Evidence Based US FDA Commissioner

Vaccination has long served as one of the most profound public health tools for preventing contagious diseases, especially respiratory viruses. As global societies emerge from the acute phase of the COVID-19 pandemic, new opinions challenge whether regular COVID-19 vaccination is still necessary. Yet, the scientific evidence supporting annual COVID-19 booster, alongside yearly influenza vaccines and newly introduced RSV immunizations, remains compelling. This article evaluates the immunological and epidemiological foundations for routine COVID-19 vaccination, comparing disease severity and reinfection patterns, and detailing why an evidence-based, annual approach saves lives.

The Rationale for Annual Respiratory Vaccines

Annual vaccination strategies for influenza are a touchstone in viral disease prevention. Influenza viruses, like SARS-CoV-2, mutate rapidly and evade immune surveillance, which is why every year a new flu shot is recommended, even for healthy adults. The CDC and leading lung, diabetes, and heart organizations all emphasize that “everyone 6 months and older should get a flu vaccine every season with rare exceptions”. Annual influenza immunization has not only reduced the severity of illness, but also hospitalizations and death: between 12,000 and 79,000 U.S. fatalities occur each season, with particularly high impact among vulnerable populations.^[1][2][3]

The RSV vaccine, offered to adults over 60 and those with chronic illness, is a relative newcomer. While initial trials suggest RSV vaccine protection may endure longer than one year, ongoing studies and CDC guidelines continue to refine recommendations. RSV, like influenza and coronaviruses, poses substantial risk, its yearly resurgence leads to significant hospitalizations and deaths each season. Targeted annual or biennial boosters might soon become standard as more real-world data accumulates.^[4][5]

COVID-19 is even more severe. Studies consistently demonstrate that both short- and long-term mortality rates from COVID-19 surpass those from influenza and RSV, even with the milder Omicron variant. In 2021-2022, adults presenting to emergency departments faced a 7.9% mortality rate from Omicron COVID-19, compared with 6.0% for RSV and 2.5% for influenza. COVID-19 remains a uniquely grave threat, further justifying a regular vaccination cadence.^[6][7][8]

Immunology and the Case for Annual COVID-19 Boosters

The immune system’s response to respiratory viruses is dynamic and multi-layered, involving both B- and T-cell arms. Vaccines train the body to recognize viral proteins and mount a rapid, potent defense on subsequent exposures. Unfortunately, both influenza viruses and SARS-CoV-2 continuously mutate, particularly in proteins that vaccines target. A universal vaccine may someday replace annual injections for the flu and COVID-19, but, until then, updated vaccines remain the best defense.^[3][9]

Research shows the antibody and T-cell responses from vaccination or prior infection wane over several months, especially in older adults or those at higher risk. Booster doses invigorate immune memory, lower risk of severe illness and death, and help combat emerging variants that partially evade previous immunity. mRNA vaccines, in particular, leave a “lasting mark” on the immune system, heightening resistance against multiple pathogens and broadening immune response; effects not fully achieved by natural infection.^[9]

Routine boosters have comparable logic. Each year’s flu shot is designed to combat the most prevalent strains. The rationale applies equally to COVID-19, where updated formulations respond to dominant SARS-CoV-2 variants and offer optimal protection for the coming season. RSV vaccines, now recommended periodically for high-risk groups, follow similar logic as evidence evolves.^[2][5][3][4]

Why COVID-19 Shots Should Be Annual And Who Benefits Most

Annual COVID-19 shots should become as routine as influenza vaccination, especially for the elderly, immunocompromised, and those with chronic medical conditions. COVID-19 hospitalization and death rates routinely exceed those of influenza and RSV. In recent comparative studies, 30-day risk for death registered at 1.0% for COVID-19 in older adults, higher than both flu and RSV (0.7% each), while 180-day mortality risk remains increased for COVID-19 throughout follow-up.^[7][8][6]

Recurring booster strategies are not only logical but essential, since SARS-CoV-2 is more deadly and likely to continue to circulate widely. The virus infected the global population at unprecedented speed, and new variants have maintained its transmission potential, especially as immunity wanes and public health measures decline. Where annual flu and (potentially biennial) RSV shots help manage their respective disease burdens, only regularly scheduled COVID-19 boosters can counter both viral evolution and immune decline.

SARS-CoV-2: Reinfection, Long COVID, And Lingering Consequences

Unlike measles or hepatitis B, coronaviruses naturally reinfect humans with regularity. Studies of endemic coronaviruses (229E, OC43, NL63, HKU1) and pandemic SARS-CoV-2 indicate immunity lasts only months; repeat infections occur as new variants emerge or antibody levels drop. The meta-analysis of global reinfection rates found that approximately 1% of all COVID-19 cases are reinfections worldwide, with Omicron waves reaching 14–16% in certain populations, demonstrating that immunity is neither predictable nor long-lasting.^[10][11]

SARS-CoV-2, in particular, stands apart for its capacity to cause “long COVID,” or persistent health problems that can endure for months to years after initial recovery. Whereas flu and RSV sometimes cause lingering symptoms, the scope and prevalence of long-term complications from COVID-19 are substantially greater. A systematic review found up to 80% of those infected experienced at least one persistent effect after recovery.^[12]

Five Major Long-Term Health Consequences of COVID-19

Peer-reviewed research identifies dozens of chronic symptoms, but five major issues recur most frequently:

1. Chronic Fatigue and Post-Exertional Malaise (PEM): Fatigue is the single most common post-COVID complaint, reported by up to 58% of patients. PEM, a hallmark of long COVID, is debilitating and leads to persistent functional impairment.^[13][12]

2. Cognitive Impairment (“Brain Fog”): Problems with concentration, memory, and attention occur in up to 27% of survivors, often lasting for months and limiting work and study.^[14][12]

3. Dyspnea (Shortness of Breath): Lingering difficulty breathing or exertional breathlessness is reported by 24%. Chronic lung issues related to post-COVID autonomic dysfunction further limit physical activity.^[12][13]

4. Headache: Ongoing headaches affect 44% of those with long COVID, frequently co-occurring with insomnia, joint pain, and other neurological symptoms.^[12]

5. Autonomic Dysfunction (POTS): Postural orthostatic tachycardia syndrome (POTS) and other forms of autonomic instability lead to loss of work capacity, poor quality of life, and, in severe cases, permanent disability.^[13]

Other common consequences include hair loss (25%), persistent muscle or joint pain, sleep disturbances, and loss of taste or smell. Long-term health burdens also include increased risk of cardiovascular, kidney, and neurological diseases.

Peer-Reviewed Research

· Fatigue, cognitive disorders, dyspnea, headache, hair loss: Nature, systematic review and meta-analysis.^[12]

· Functional and autonomic impacts: National Academies of Sciences, Engineering, and Medicine.^[13]

· Long COVID prevalence and symptomatology: Brigham and Women’s Hospital summary.^[14]

Annual COVID-19 Shots Are Ethical and Evidence-Based

The lesson of history, for influenza and, soon, RSV, is clear: regular vaccination is essential for controlling viral threats as they evolve. COVID-19 is more deadly than either flu or RSV, with persistent potential for reinfection and severe disease, despite prior infection or immunization. Coronaviruses, including SARS-CoV-2, repeatedly reinfect populations and rarely confer lifelong immunity. The long-term consequences of COVID-19 far surpass those of similar respiratory viruses, leading to chronic health issues in millions.^[8][6][7]

An annual COVID-19 vaccine campaign protects individuals and communities from variants, mitigates long-term disability, and aligns with the highest standards set by years of influenza immunization and emerging RSV research. As scientific knowledge grows, so too should policies that prioritize health, resilience, and informed, recurring vaccination strategies for all at risk.

· CDC and Mayo Clinic: The necessity, schedule, and public health rationale for annual influenza vaccination.^{[15][16][2][3]}

· CDC and Yale Medicine: Guidelines and evolving evidence for RSV vaccine administration.^[17][5][4]

· JAMA Internal Medicine, AAFP, CIDRAP: Comparative mortality and severity of COVID-19, influenza, and RSV.^[6][7][8]

· Nature, BMC Infectious Diseases, National Academies: Reinfection rates and long-term consequences of COVID-19.^{[11][10][14][13][12]}

When all is said and done, Makary is playing a dangerous game with American public health.

He is extending the power of the FDA into dictating the practice of medicine, risking the health and livelihood of millions of Americans all while ignoring evidence, trading on anti-vax-meme science and hyperbolic vibes.

Makary is not the FDA commissioner the US deserves and needs, he is a national embarrassment.

References:

1. https://www.lung.org/blog/reasons-flu-shots

2. https://www.cdc.gov/flu/vaccines/index.html

3. https://www.health.harvard.edu/staying-healthy/why-do-we-need-new-flu-shots-every-year

4. https://www.ajmc.com/view/vaccinating-older-and-at-risk-adults-against-respiratory-syncytial-virus

5. https://www.cdc.gov/rsv/vaccines/adults.html

6. https://www.neurologyadvisor.com/news/covid-19-linked-to-more-severe-outcomes-than-flu-rsv-in-2022-2023-season/

7. https://www.aafp.org/pubs/afp/issues/2024/1000/poems-emergency-department-mortality-rates.html

8. https://www.cidrap.umn.edu/covid-19/va-study-shows-covid-more-severe-rsv-flu

9. https://scitechdaily.com/researchers-discover-mrna-vaccines-leave-lasting-mark-on-the-immune-system/

10. https://www.cidrap.umn.edu/covid-19/meta-analysis-global-covid-reinfection-rate-less-1-depending-variant-country-time

11. https://www.nature.com/articles/s41467-024-44973-1

12. https://www.nature.com/articles/s41598-021-95565-8

13. https://www.ncbi.nlm.nih.gov/books/NBK607399/

14. https://www.brighamandwomens.org/campaigns/physicians/understanding-long-term-effects-of-covid-19

15. https://www.mayoclinic.org/diseases-conditions/flu/in-depth/flu-shots/art-20048000

16. https://www.cdc.gov/flu-vaccines-work/benefits/index.html

17. https://www.yalemedicine.org/news/should-you-get-an-rsv-vaccine

Without new data, data review or reference to any concerns, Marty Makary’s FDA has taken unprecedented action in limiting access to COVID-19 vaccines nationwide.

Major changes in FDA recommendations typically come after scientific review and in light of new data or new safety signals. There have been no safety changes, no new data, and life-saving access to a vaccine that protects against hospitalization and death will now be harder if not impossible for people to get. SARS-CoV-2 kills and hospitalizes more people than Influenza. Healthy people included. But thanks to Makary’s FDA millions now can’t get the vaccine.

This may be further limited by the CDC’s new ACIP committee recommendations. The 17-member ACIP committee which had been deeply vetted and contained globally renown scientific experts was fired earlier this year by RFK Jr and replaced with a 8-member committee with a glaring lack of public health expertise and many of whom have come to prominence by making fake-science statements attacking gold-standard science on Twitter. In short, a bunch of Twitter trolls were just nominated to run public health access to vaccination. Some have a long history of grifting, starting failed drug repurposing companies, others have been fired from their academic positions due to their lack of grounding in the basic realities of science. One in particular seemed surprised and bitter in the last ACIP meeting about the fact that he doesn’t get to call himself a science professor anymore while spouting science fiction nonsense as if it were fact. The impact of this groups recommendations on further limiting COVID-19 vaccine access remains to be seen. But millions have already lost access.

Where Are We Now With COVID-19 Vaccine Access?

The rules for getting a COVID-19 vaccine in the United States were changed by Makary’s FDA just a few months ago, front-running the annual spike in SARS-CoV-2 infections we see every winter in the United States.

New health laws mean that millions of people who will require a prescription to get the 2025-26 COVIV-19 vaccine booster shot. Booster shots are widely, globally, recognized as important in reducing hospitalization, death, and developing life-altering Long-COVID. Also, because booster shots both reduce infection (better than the influenza vaccine) and reduce the viral load (your immune system can control the virus better if infected), they reduce spread which saves lives.

Which States Need a Prescription for COVID-19 Shots?

Large pharmacy chains, such as CVS and Walgreens, now require a doctor’s prescription to give the COVID-19 vaccine in the following states. Here are the 13 states and districts where you now need a prescription:

• Arizona

• Colorado

• Florida

• Georgia

• Kentucky

• Louisiana

• Maine

• New York

• North Carolina

• Pennsylvania

• Utah

• Virginia

• West Virginia

• Washington, D.C.

Please contact your governor and local state health department to let them know how you feel about these changes and how they will impact your health and wellness. My linktree has several peer-reviewed studies supporting the importance of vaccine access. Even more have been published since I last updated it, there are hundreds at this point.

In some states you currently can not access the COVID-19 vaccine at large pharmacies at all, they have paused distribution. This includes Massachusetts, Nevada, and New Mexico. If you live in these states check with your local health department regarding when access will be restored.

Here Is Who Marty Makary’s FDA Says Can Get Vaccinated:

• Adults age 65 and older can still get vaccinated at pharmacies.

• People ages 5 to 64 can get the COVID-19 vaccine only if they have health problems like diabetes, asthma, heart disease, or another issue that makes COVID more risky. SARS-CoV-2 infection can cause life-altering long-COVID in healthy adults and has led to the hospitalization and death of previously healthy people.

• Healthy kids under 5 don’t have any vaccines approved at most pharmacies unless they have health issues. This is directly counter to the American Academy of Pediatric’’ recommendations and this change was not based in science or new data.

A CDC panel called ACIP used to give advice about who should get vaccinated. This year, they haven’t made their recommendations yet and their meeting was just announced for September 18th which may not occur. GOP Health Committee Chair Dr. Bill Cassidy is calling for postponement of this meeting citing the lack of scientific decision making among it’s members appointed by RFK Jr. The next meeting they have scheduled is late October, which given historical trends would be well into the SARS-CoV-2 winter surge.

There is extreme turmoil in the CDC, the head of the CDC was fired late in the night on Wednesday 8/27/2025 by Donald Trump, only a month after he recommended her for the job. Therefore it is unclear when or how or if these vaccine recommendations handed down by Makary’s (another one of RFK Jr cronies) will be altered in the coming months.

Who Has Lost Access to the COVID-19 Vaccine Under Makary’s FDA:

This new rule means lots of people who got the vaccine before can’t get the updated shot easily now.

Healthy Kids, Teens, and Adults Under 65

If you are healthy and don’t have a chronic health problem, you probably can’t get the new COVID-19 vaccine at the pharmacy without a doctor’s prescription (Healthline, CNN). Even getting a prescription can be tough: you need to visit a doctor (which can cost money or take time) and prove you have a health reason that makes you eligible.

Healthy Children Under 5

Families with healthy young children (especially under 5) can’t get a walk-in COVID-19 vaccine at most places. Vaccines for kids are only allowed if children have certain medical conditions. Parents must now talk to their child’s doctor, get special approval, and hope their insurance covers it (Reuters, Healthline).

People Without Proof of Being High Risk

If someone doesn’t have medical records showing their health conditions or doesn’t have health insurance, it’s harder to get the vaccine this year (CNN). Some people in special programs, like Medicaid or Medicare, need to wait for clear advice from health agencies before the vaccine is covered.

People in Restricted States

Even if people have health issues that qualify, living in a restrictive state means needing an extra doctor’s visit for a prescription. This can mean more costs, longer wait times, and confusion for families all over the U.S.

What Can/Should You Do Now?

If you or someone in your family is age 65+ it is more important than ever to get the COVID-19 booster shot. Few people having access to the vaccine will likely increase rates of spread and the number of individuals with high viral load. The higher number of virus particles someone is exposed to (in part dictated by viral load of the person spreading the illness, it is more likely they will develop severe disease.

• Talk to your doctor about getting a prescription so you can get the vaccine.

• If rules are unclear in your state or things change, check with your local health department regullarly.

• Consider writing to state officials, my Linktree provides lists of references regarding the safety and efficacy of SARS-CoV-2 vaccines. More have been published since my last Linktree update, creating a time-tested body of scientific knowledge that has yet to be refuted by any other studies.

• Always talk to your doctor and if it is advisable consider medical tourism to a state that is still allowing COVID-19 vaccination.

• As always handwashing, social distancing, air filtration (even a little desktop air filter), and mask wearing will reduce the spread of nearly all airborne viruses.

What Does This Mean for Public Health?

When fewer people get vaccinated, COVID-19 can spread more easily. Experts (myself included) worry that these changes could mean more people get sick, especially those with weak immune systems or older adults. It’s also harder for people without access to doctors or health insurance. Making vaccines easy to get is important for community safety, helping hospitals, and building trust in health care.

We may be in for a very rocky winter SARS-CoV-2, Cold, and Flu season. I am already seeing doctors and nurses across social media discuss how their hospitals are full, right now, in August.

Full hospitals going into a respiratory virus season where Makary has limited access to a vaccine against one of the most highly contagious respiratory viruses in circulation (only measles is more contagious) seems absolutely insane. But, I’m not sure we expected anything less than a deadly science experiment on the American public to be orchestrated by RFK Jr. Makary, and their ilk of grifter. I am glad to see Bill Cassidy, MD has decided to speak out, perhaps the GOP will listen to a MD from their side of the aisle?

In the mean time, be proactive about your health, be prolific in contacting your state officials, and stay safe out there.

References

CVS and Walgreens restrict COVID vaccines in Colorado (Axios)

Getting a COVID vaccine just got more complicated after new FDA restrictions (ABC News)

CVS withholding COVID-19 vaccines in 15 states and DC (The Hill)

FDA narrows under-65 COVID vaccine eligibility (Reuters)

The FDA overhauled COVID vaccine guidance (LA Times)

Who’s Eligible for Updated COVID Vaccines This Fall? (Healthline)

COVID Vaccines Are Still Saving Lives—But They Will Be Harder to Get (Scientific American)

· These are the conditions that make you eligible for an updated Covid-19 vaccine (CNN)

Robert F. Kennedy Jr. as Secretary of Health and Human Services who is known for his long-standing skepticism of vaccines, has enacted sweeping reforms that have not only undermined established public health practice, but have also led to typically conservative, generations-old medical organizations, taking a public stand to protect the health of all Americans.

Since RFK Jr’s appointment the federal government has enacted - at the risk of sounding hyperbolic - ludicrous changes to vaccine policy. The medical and scientific community at large has now broken with the HHS and the CDC guidelines (a branch of HHS) due to unlawful and nonscientific changes that are widely recognized as a fundamental threat to the health and safety of American citizens.

Illegal HHS Activities Under RFK Jr In The Last 6 Months

Numerous actions taken under RFK Jr.'s leadership are alleged to violate federal law, procedural norms, and scientific standards. The major activities flagged by several long-standing medical authorities include:

• Ignoring public health threats: Actions such as rolling back routine vaccine recommendations—contradicting strong scientific evidence supporting vaccination for the prevention of diseases like measles and pertussis—are described as reckless and a threat to vulnerable populations, particularly children and pregnant women.

• Issuing non-evidence-based recommendations: The new Kennedy-led panel immediately recommended against receiving flu vaccines containing thimerosal, reviving old disputes disconnected from scientific consensus. More than 200 studies across several decades including millions of children have established thimerosal’s safety in vaccines.

• Abuse of procedural processes: The HHS, under Kennedy, canceled regular meetings of vaccine advisory committees without explanation, blocked CDC communications, and ordered studies to investigate disproven links between vaccines and autism. Such maneuvers are seen as direct violations of regulations requiring open and transparent policymaking.

• Unilateral changes to COVID-19 vaccine policy: On May 27, 2025, Secretary Kennedy removed the CDC's recommendation for COVID-19 vaccination for healthy children and pregnant women. These changes were enacted without consulting the federally mandated vaccine advisory groups and without providing a clear evidence-based rationale.

• Dismissal and replacement of expert advisory committees: Kennedy eliminated all 17 members of the CDC’s Advisory Committee on Immunization Practices (ACIP)—the key independent panel responsible for ensuring transparent, scientific evaluation of vaccine schedules. The replacements included several individuals associated with anti-vaccine advocacy and lacking proper expertise.

Top US Medical Agencies Are Breaking From CDC Recommendations

In response to these actions, prominent health agencies have taken unprecedented steps to break with CDC guidance. Leading organizations are now either issue their own independent recommendations or have actively warned against adopting new CDC vaccine policies. Notable agencies include:

• American Academy of Pediatrics (AAP): The preeminent children's health organization continues to recommend COVID-19 immunization for children and pregnant women and has published an evidence-based schedule at odds with CDC directives.

• American College of Physicians (ACP): Representing internal medicine specialists, the ACP has distanced itself from CDC guidance, citing lack of scientific foundation and transparency.

• Infectious Diseases Society of America (IDSA): Experts specializing in the control of infectious diseases have criticized new CDC vaccine policies and joined lawsuits against the administration.

• American Public Health Association (APHA): A leading advocate for public health, APHA has condemned changes as a danger to community well-being.

• Society for Maternal-Fetal Medicine (SMFM): Specialists in maternal health emphasize that the new guidance puts pregnant patients and infants at risk.

• Massachusetts Public Health Alliance (MPHA): This alliance has highlighted public health harms, especially to children and vulnerable populations.

Other groups—such as the American Medical Association (AMA), American Academy of Family Physicians (AAFP), and National Foundation for Infectious Diseases (NFID) have similarly been sidelined from CDC policymaking under the current administration and have expressed deep concern about the loss of adherence to basic scientific standards.

Here is an exhaustive list of the agencies with links to the reasoning behind their departure from CDC based guidelines:

American Academy of Pediatrics (AAP) CDC dropped COVID-19 vaccine recommendations for healthy children and pregnant women; AAP claims decisions are not based on science

American College of Physicians (ACP) Unilateral changes with no evidence-based review and dismissal of expert advisory panel

Infectious Diseases Society of America (IDSA) Replacement of CDC vaccine experts with individuals lacking relevant expertise or holding anti-vaccine views

American Public Health Association (APHA) Flouting of scientific processes and threats to national public health infrastructure

Society for Maternal-Fetal Medicine (SMFM) CDC changes endanger pregnant patients and ignore clinical data showing benefits of vaccination

Massachusetts Public Health Alliance (MPHA) CDC actions risk vulnerable populations and threaten established immunization standards

American Medical Association (AMA) Removal from CDC workgroups, exclusion from policymaking, and rejection of unscientific guideline changes

American Academy of Family Physicians (AAFP) Exclusion from vaccine advisory process and concerns over loss of evidence-based guidance

American Geriatrics Society (AGS) Exclusion and concerns that new recommendations undermine safety of older adults and vulnerable groups

American Osteopathic Association (AOA) Exclusion from CDC's vaccine process, concerns over undermining scientific standards

National Medical Association (NMA) Lack of evidence transparency and marginalization of expert voices

National Foundation for Infectious Diseases (NFID) Exclusion from process and concerns over impact on prevention of infectious diseases

Several Groups Are Suing RFK Jr’s HHS

Six leading medical and public health organizations have joined forces as plaintiffs in a landmark lawsuit against HHS and Secretary Kennedy.

Represented organizations include the AAP, ACP, IDSA, APHA, SMFM, and MPHA. Plaintiffs also include individual physicians, such as a pregnant doctor at risk of losing access to COVID-19 boosters due to the new recommendations.

Research studies conducted both in the United States and globally strongly support COVID-19 boosters to protect both maternal and fetal health. The rate of miscarriage, maternal death and hospitalization, is higher when mothers are not vaccinated or boosted. This is a typical outcome with any severe viral infection and there is no reason to treat infection with the SARS-CoV-2 virus any differently. Removal of this recommendation is not science backed, it endangers maternal health, and is purely political.

The non-scientific, non-medical, illegal (allegedly) and capricious activities of RFK Jr and HHS are shocking enough to have long-standing highly a-political medical organizations taking a stand for patients. This major lawsuit brought by Physicians, Public Health Professionals, and Scientists against RFK Jr’s HHS is currently ongoing: Pediatric & Public Health Coalition v. HHS.

As explained by Dr. Susan Kressly, President of the AAP:

“These decisions are founded in fear and not evidence, and will make our children and communities more vulnerable to infectious diseases like measles, whooping cough, and influenza.”

The ACP president Dr. Jason Goldman adds:

“As physicians, we require reliable, science-based guidance ... developed through an evidence-based and transparent process, to ensure the safety, welfare, and lives of our patients.”

more plaintiff quotes can be found here.

The plaintiffs suing RFK Jr’s HHS include AAP, ACP, IDSA, APHA, SMFM, MPHA, and an unnamed physician, representing over 270,000 medical and public health professionals.

Because it’s difficult to imagine how many people that is, let me pause and give some examples. That is 3-times more people than the maximum capacity of the largest NFL stadium, and more people than the entire population of Fort Wayne, Indiana. All of them US medical and public health professionals.

The focus of the suit is on the unlawful policy changes, dismissal of expert panel, undermining vaccine science, risk to children & pregnant

To summarize some of the claims in the lawsuit against RFK Jr’s HHS: The Kennedy-led HHS and CDC have entered new territory—making vaccine policy decisions by unsupported decree, shunning expert opinion, and sidelining the scientific establishment.

This is physically dangerous now, and for all future generations.

Call To Action: We Are At A Turning Point In US Health And Medicine

Medical professionals, public health professionals, and scientists are at turning point in history. At stake is the very credibility of the nation’s public health system and decades of progress in preventing infectious disease. Our research systems that support health care and medical advances are being destroyed from the inside out.

Regardless of the outcomes of these lawsuits, we are facing a relentless anti-science, anti-health force that prey’s on people’s lack of expertise, fear of what they don’t understand, and relies on buzzwords like ‘all natural’.

If you have not spoken in a public way about the destruction of US Health and Science yet, I encourage you to do so now through any and all formats available. Speak to your neighbors, speak to local groups, and use one of the numerous social media platforms to communicate what is happening and how it will impact Americans both immediately and for generations. If your congressional representative isn’t picking up the phone, start working now to make sure their opponent is elected, especially if it’s a midterm race.

If you do not feel qualified to speak in this area, support those that do. Share their content relentlessly and unapologetically. It will save lives. Find organizations to donate either time or money to, every little bit helps. My current favorite group is CIDRAP which publishes evidence based infectious disease and health information in an easy to read format. They have launched the Vaccine Integrity Project lead by CIDRAP Director Michael Osterholm, PhD, MPH which is ensuring a transparent, evidence based, unbiased set of vaccine recommendations is preserved during this attack on science.

I look forward to seeing more of my colleagues step forward and speak out and I look forward everyone joining the fight against destruction of US science and medicine. See you there.

In discussing the sweeping changes to ACIP I have gotten numerous comments from people who believe that even if the vaccines aren’t ‘recommended’ that they will still be available for those who want them, this is simply not the case. I outline this further below, but first, let’s talk about the upcoming ACIP meeting.

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The newly appointed ACIP is comprised of just 8 members, increasing the individual influence of each voting member significantly.

The new ACIP is having their first meeting June 25th and I think it is important that concerned citizens, scientists, and physicians show up to let them know that they are being scrutinized, closely, like anyone should be if they are making sweeping health decisions for ~340 million people.

To sign up to speak or leave a public comment please go to my substack post here where I provide the links and a ‘how to’.

There are several concerning issues highlighted by the draft agenda, here are a few that were immediately concerning to me.

1. Lack of speaker variety/repeat speakers

There are typically multiple different speakers during an ACIP meeting with deep expertise in their specific topic.

The April 2025 ACIP meeting hosted over 40 different speakers with specific knowledge of and expertise in their areas of presentation. The June 2025 meeting has SIX (6) total speakers with many repeat speakers on a variety of topics.

For example, Adam MacNeil who works in the global tuberculosis branch of the CDC is slated to give an update on COVID epidemiology as well as clinical considerations for clesrovimab, and updates on the effectiveness of maternal (RSV) vaccine and nirsevimab, among several other topics. Typically there would be dedicated experts in each area slated to speak. Best of luck Adam MacNeil and Georgina Peacock, you are the only two speakers scheduled for the entire day of the 25th of June.

2. No scheduled speaker for critical topics on the agenda

No speaker is scheduled, for example, to talk about the safety of COVID-19 vaccines or the safety of material RSV vaccines and nirsevimab. There is also no speaker listed for “MMRV Vaccine Presentation on MMRV vaccine in children under under 5 years of age” or “Proposed recommendations regarding MMRV in children under 5 years of age”. This agenda was published 5 working days before the meeting.

Call me boring but I like my public health agendas without the element of ‘surprise’. The lack of speakers raises serious questions: Is there anyone who will speak in a way that matches the HHS’s well known anti-vaccine agenda (these topics are settled science without known data to the contrary)? Are scheduled speakers being obfuscated? Is this group simply so disorganized they’re publishing half-baked agendas? Or, is it all of the above?

3. Significant time is dedicated re-review of settled science

Entire sections are dedicated to an already approved maternal RSV and MMRV vaccines with no slated speaker covering safety concerns for either.

These vaccines have been approved and are constantly monitored for safety issues with MMRV being approved and administered for over 20 years. It would be surprising if the unnamed speakers have found a safety issue in the data. The source of this data should most certainly be audited, verified, and at the very least be made public, if it exists.

Review of thimerosal in vaccines is also on the list (with no speaker attached). Thimerosal was removed from all vaccines given to children under 6 years old in 1999 citing a ‘precautionary’ move, which was not evidence based. Some multi-dose influenza vaccines still contain thimerosal, but parents can request thimerosal free vaccines. The small amount of mercury in thimerosal vaccines is not absorbed well by the body and mercury exposure through eating fish (which does contain absorbable methylmercury) is a significant source of mercury exposure far beyond an influenza vaccine which can be actively avoided. Notably, there has never been a link between vaccination and autism found and removal of thimerosal from vaccines did not reduce autism rates.

4. HPV and meningococcal vaccine discussions were dropped

ACIP was expected to discuss both HPV and meningococcal vaccines this month. This is especially concerning as the HPV vaccine has been a massive public health triumph, reducing cervical cancer diagnosis by nearly 90% in women. Please remember to point to this fact if anyone around you says that science isn’t curing cancer. Cervical cancer used to be far more common and often a death sentence for women. Ask someone who is a little grey around the ears, they will likely know someone who died from cervical cancer.

I personally knew a girl who died from meningococcal disease her freshman year of college. She was sweet, brilliant (she was going to Princeton), and she had a bad headache. The ER sent her home with tylenol, 12 hours later she was dead. These vaccines are lifesaving. Period. Shortly after her death (and the deaths of other college freshmen in various outbreaks) college campuses one by one began requiring or recommending meningitis vaccines for their incoming freshman as the bacteria (it can also be virus and fungus caused) can spread quickly in close living situations such as college dorms.

The June 2025 ACIP draft agenda in complete reads as nothing more than a disorganized and chaotic swipe at United States public health. The only business as usual (from the outside) things listed is the continued progress forward on a Chikungunya virus vaccine. Perhaps RFK Jr. and his rag-tag crew of science illiterate recognize the Chikungunya virus as dangerous because it is difficult to pronounce.

Here is the agenda as of 6/20/2025:

How does ACIP control vaccine access?

ACIP determines if a vaccine is recommended for routine use for a given population. This recommendation then must be adopted by the director of the CDC. There is no current CDC director, only an interim director appointed by RFK Jr. (who apparently does not show up to all-staff meetings etc.). This recommendation determines if a health care provider required to cover the cost of vaccination, and, if a pharmacist will give the vaccine.

If you walk into a pharmacy and ask for a vaccine (even if you are willing to pay out of pocket) and it was NOT approved by ACIP and then adopted by the CDC director it is most likely that the pharmacist will not give you this vaccine.

I learned this first-hand when I attempted to get one of my COVID-19 boosters on a day between ACIP recommendation and CDC approval. I was denied by a CVS pharmacist and had to come back later.

So not only will millions of Americans not be able to afford a vaccine for themselves and/or their whole families, but even those who can afford it will most likely be denied.

Now, let’s say your family physician can give the vaccine and you can afford it and/or your insurance company will still cover it. Congratulations, you’re in a minority of lucky people. But you are in a privileged minority and vaccine makers do not see that as a good business strategy.

The likelihood that they will continue to make the vaccine or update the vaccine either in the United States (one of the largest vaccine markets) or overseas is very low. If vaccines are still produced, distributed, and updated the are likely to be significantly more expensive than they are today, pricing out more and more people until almost no one has access.

Now, let’s say you’re extremely privileged and you don’t mind paying tens of thousands of dollars for vaccination of you and your family. Because everyone around you will be sick more often with higher viral loads two things will happen. 1) the effectiveness of your vaccine will decrease because unless you are avoiding people and consistently masking you will be exposed to higher doses of virus more often (and so will your children). 2) Viruses mutate faster when they infect more people and have higher viral loads in those who are infected. The fewer people who are vaccinated the faster viruses will mutate around vaccine protection, increasing infection rates even in those who are vaccinated.

I’m willing to bet if you don’t mind paying tens of thousands of dollars to be vaccinated that you may also be benefiting from concierge doctor services. Do expect those to also increase in price and or disappear completely for all but the 0.01% tax bracket. Yes, you the vast majority of the 1% are directly benefiting from public health measures for the 99%.

Make no mistake that the anti-vaccine movement has a crystal-clear understanding of how ACIP control can eliminate vaccine access for the public.

Today is the last day to make a public comment for the June 25-26th ACIP meeting. I implore everyone to do so. I’ve written out instructions here.

(Note to my lovely readers: Please excuse any typos, this was written in haste to ensure a timely publication date.)

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Sorry for the late note! I found this public comment page as I was reviewing the draft meeting schedule for ACIP that was just published on June 18th, 2025. More about that in another post that I will link here when I finish writing it.

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As many of you know the highly vetted, extremely experienced 17 member ACIP panel was fired in complete by RFK Jr. on June 9th and swiftly replaced by a 8 member group (increasing each member’s influence) many of whom have been staunchly against vaccines and have been caught outright lying. ACIP has had a long history of full public disclosure of any an all potential conflicts of interest, the newly appointed advisory panel does not.

Many new ACIP members have not specialized in any relevant area of science or medicine and have only come to prominence as social media serial tweeters that against all evidence were anti-vaccine and anti-COVID vaccine. Persistently posting debunked studies and pushing policy that would have resulted in millions of more deaths as if they were truth and refusing to / unable to (lack of expertise) talk to their audiences about conflicting data reports.

Myself and many social media creators who are highly credentialed in our fields of science and medicine are able to fluently walk our audiences through seemingly conflicting studies and show where/why/how the results are produced, interpret the importance of the results and study design, and describe the direct implications to your health at an individual and population based level. This basic level of scientific fluency is necessary for ACIP decision making, a role that impacts the health of over 340 million people.

Here is how to leave a public comment and below that is the public comment I have submitted for inspiration.

If you would like to speak at the meeting here is a link you can use to sign up to be selected to speak: https://www2.cdc.gov/vaccines/acip/acip_publiccomment.asp

To submit a public comment to ACIP

1. Go to: https://www.cdc.gov/acip/meetings/index.html#cdc_toolkit_main_toolkit_cat_2-public-comment

2. Scroll down until you see the “Public comment” header and click on Federal eRulemaking Portal (or just go there directly by clicking on the link provided here)

3. Search for CDC-2025-0024

4. Write and submit your public comment on the upcoming meeting

One thing of note that I did leave out in my pubic comment was that I would like the ACIP committee to explain the reasoning and provide the supporting data as to why they are revisiting approval of already approved vaccines. The public deserves to see the data that supports them re-reviewing vaccines that have been given for decades.

Here is the comment that I have submitted

I would like the new ACIP committee to ensure that they discuss the following items and/or a timeline of written disclosure for the following items:

1. What is the timeline for disclosure of a complete accounting of all financial conflicts of interest, both past and present, for each newly appointed ACIP member. Please also disclose which independent auditing agency that will be hired to confirm that these are their only financial conflicts of interest.

2. Please explain the plan to publish/outline each newly appointed ACIP members expertise and history of expertise in any of the following fields: Virology, Immunology, Epidemiology, Infectious Disease, and/or their Medical Field of Study and if they are actively practicing or licensed Physicians. If they have no qualifications or active practice in any of these scientific areas please disclose an accounting to the taxpaying public as to why and what their specific areas of expertise is such that they are tasked with making broad-sweeping medical decisions for the United States public.

3. Please discuss in this meeting the ethical considerations of not vaccinating children against potentially deadly and disabling disease to ensure that a "control group" can be used to see how sick and how many of them will die if not vaccinated as has been suggested to be the next goals of the current HHS, FDA and NIH directors.

4. Please discuss if the parents of these children be notified that their children are not receiving the protective vaccines OR does this administration plan to blind these studies such that parents of children in the US will not know if they are vaccinated against measles, mumps, rubella, polio, influenza, tetanus, diphtheria, pertussis etc.?

5. Please discuss parental consent and parental education plans if a study that does not allow childhood vaccination is approved.

6. Please provide a detailed explanation as to why the committees under the HHS have failed to select a variant for the fall SARS-CoV-2 vaccine and how this is expected to impact vulnerable and healthy populations that will, without an updated booster shot, be more prone to development of debilitating long COVID.

7. Please detail the committee's criteria for future vaccine approvals. This is of critical public concern given the rapid appointment of many committee members that do not have a history of direct experience or expertise in any relevant scientific fields beyond initial interest starting ~5 years ago. Typically people tasked with such serious and sweeping power to dictate the health access of a large population (~340 million Americans) have decades of relevant experience and expertise in a relevant field of study.

Many scientists and physicians thought they could reason with RFK Jr and his cronies when he took over as head of HHS. They were wrong.

Since January the destruction of science and medicine in the United States has proceeded at a dizzying pace. Dozens of top officials resigned and fired, billions in already awarded grant funding in areas such as cancer, aging, and autoimmune disease have been clawed back. Pathogen testing for parts of our food supply have been ended at the federal level and our CDC does not have an acting head and can not even respond to reports of lead poisoning. Disease testing and tracking groups have been entirely disbanded, and vaccine development both in the public and private sector are under heavy fire.

Peter Marks’ resignation from the FDA's Center for Biologics Evaluation and Research (CBER) was stunning. Mark’s revelations that he had to block RFK Jr’s team from changing VAERS data while they also demanded evidence of vaccine side effects that simply don’t exist was a window into the disastrous conspiracy theory rabid “leadership” that is now driving decisions that will impact the health and safety of all Americans.

The tipping point for demanding impeachment is now here and it came in the form of the mass firing of the 17 person Advisory Committee on Immunization Practices (ACIP) on June 9th, 2025.

It is now clear that RFK Jr is waging an all-out assault on medicine and science and to maintain otherwise is dangerously naive.

RFK Jr fired the 17 medical professionals and scientists on the ACIP under the guise that it was necessary to restore faith in vaccination and remove conflicts of interest.

This a lie.

RFK Jr, a lawyer, has worked for decades to directly undermine public trust in vaccination and has benefited financially from doing so. He has even published books that spread outright lies. It was not the dedicated medical scientists who were part of ACIP who eroded trust in vaccines.

ACIP has never been a rubber stamp for vaccines. They carefully review studies, data, ask questions, and have paused and denied vaccine approvals in the past. I have personally spent hours listening in to ACIP’s multi-day meetings as a public observer (yes they were all open to the public) and I can unequivocally say that this group proceeds with the utmost caution around any recommendation for OR against recommending vaccination - and they have done both.

ACIP has strict ethical standards around conflict of interest and all positions and advisory roles of each committee member are public information and carefully securitized. On the other hand RFK Jr failed to recuse himself from financially benefiting from a lawsuit against vaccine makers among other sources of income directly tied to his pushing of anti-vaccine propaganda.

So, the line has been crossed. What can you do to help scientists and physicians restore sane leadership to the HHS, FDA, CBER, CDC, and NIH?

Here are 4 simple ways that you can help. I’ll start with the hardest one first.

(1) Contact Your Representative And Demand Impeachment of RFK Jr.

Here are links to find your representative, talking points, and three draft letters (scroll down) that can help get you started.

15 Talking Points on Why RFK Jr. Should Be Impeached

Call your congressional representatives and leave messages or discuss what concerns you most, below is a summary list but there is even more out there. Here is how to find their phone number: Find your representative.

1. Decapitation of Public Health Leadership
   RFK Jr. oversaw or precipitated the resignation or firing of numerous senior public health officials, including the abrupt removal of the entire CDC Advisory Committee on Immunization Practices (ACIP).

2. Failure to Appoint a CDC Director
   Months into his administration, RFK Jr. has yet to appoint a permanent director of the CDC, hobbling the agency’s ability to coordinate national health responses and maintain public trust during disease crises.

3. Promotion of Vaccine Disinformation
   RFK Jr. has a long and well-documented history of spreading misinformation about vaccine safety and efficacy. His position of power dangerously amplifies this pseudoscience, undermining national immunization programs. Loss of herd immunity endangers the safety and well-being of all Americans.

4. Politicization of Public Health Policy
   RFK Jr's replacement of expert-led health bodies with ideologically aligned appointees erodes evidence-based policymaking and creates a dangerous precedent of politicizing health crises for personal or political gain.

5. Conspiracy-Driven Governance
   RFK Jr. routinely promotes conspiracy theories involving COVID-19, government agencies, and pharmaceutical companies. Such views have destroyed his credibility and threaten national stability when translated into policy.

6. Undermining U.S. Scientific Institutions
   His public attacks on institutions like the NIH, CDC, and FDA and their long-standing roles in research, food and drug testing, and disease prevention not only delegitimize decades of scientific progress but have also ended the careers of many of the next generation of scientists, discouraging thousands from engaging in public service.

7. Conflicts of Interest and Unvetted Affiliations
   RFK Jr’s close ties to anti-vaccine organizations and fringe donors—some with extremist or foreign affiliations—raise serious concerns about influence over domestic policy and national security risks.

8. Lack of Executive Experience and Crisis Management
   RFK Jr. entered office without meaningful experience in governance, and it shows. His chaotic handling of health emergencies and policy rollouts reveals a fundamental lack of executive competence.

9. Alienation of Global Health Partners
   His antagonistic views on global health organizations, including the WHO, have damaged diplomatic relationships and U.S. credibility as a global leader in health preparedness.

10. Erosion of Public Trust in Health and Safety
    His rhetoric has sharply decreased trust in public health guidance, leading to increased vaccine refusal, rising preventable disease rates, and public confusion.

11. Alignment with Extremist Movements
    RFK Jr. has appeared alongside far-right, conspiracist, and anti-government activists, legitimizing fringe ideologies that pose long-term threats to democratic norms.

12. Contradictory Civil Liberties Stances
    While claiming to champion civil liberties, his positions often embolden movements that promote disinformation and weaken protections for vulnerable populations under the guise of “medical freedom.”

13. Destabilizing National Policy Through Science Denial
    From climate to infectious disease, his rejection of scientific consensus undermines the ability of government agencies to plan long-term strategies and address urgent challenges.

14. Authoritarian Overreach in Public Health Administration
    By firing entire advisory boards, dismissing credentialed scientists, and centralizing decisions based on ideology rather than evidence, RFK Jr. has exhibited authoritarian tendencies incompatible with democratic public service.

15. Personal Financial Gain and Ethical Conflicts in Vaccine Litigation
    RFK Jr. has profited significantly from his leadership of anti-vaccine organizations such as Children’s Health Defense, which fundraises heavily on fear-based misinformation. Compounding this ethical breach, he has refused to recuse himself from involvement in lawsuits against vaccine manufacturers—despite having a direct financial interest in their outcomes—raising serious concerns about self-dealing, abuse of office, and conflict of interest in public health policymaking.

Three Draft Letters For Congress That Call For The Impeachment Of RFK Jr

Feel free to copy, paste, and adjust the language of these draft letters demanding the impeachment of RFK Jr. Each congressional representative typically has a way to contact them by email listed on their website. Here is a directory of congressional representatives and their websites.

Draft Letter 1: General

[Your Name]
[Your Street Address]
[City, State, ZIP Code]
[Email Address]
[Date]

The Honorable [Representative's Full Name]
[Office Address]
[City, State, ZIP Code]

RE: Demand for the Impeachment of Robert F. Kennedy Jr.

Dear Representative [Last Name],

I am writing to you as a deeply concerned citizen and constituent to formally call for the impeachment of Robert F. Kennedy Jr. His conduct in office has been reckless, dangerous, and fundamentally incompatible with the duties of a public servant entrusted with protecting the health and welfare of the American people.

Since assuming office, Mr. Kennedy has repeatedly undermined public health institutions, gutted scientific advisory boards, and replaced qualified experts with ideologues. Most alarmingly, his mass firing of the CDC’s Advisory Committee on Immunization Practices (ACIP)—amidst a growing measles outbreak—and his failure to appoint a new CDC director demonstrate a catastrophic failure of leadership when clear, evidence-based guidance is urgently needed.

His administration’s disorganized and ideologically driven actions have endangered children and vulnerable populations nationwide. The consequences of his actions are not theoretical—they are already being measured in illness and public confusion.

Equally troubling is his longstanding and well-documented financial entanglement with anti-vaccine organizations, including his continued role in Children’s Health Defense. He has refused to recuse himself from lawsuits against vaccine manufacturers in which he holds a direct financial interest. This is a gross conflict of interest and an ethical violation of the highest order.

RFK Jr. has spread disinformation and conspiracy theories about vaccines, COVID-19, and other public health issues, using his office to amplify pseudoscience while weakening public trust in life-saving interventions. He has promoted figures and movements rooted in extremism and conspiratorial thinking, damaging the integrity of our public discourse and national security.

Additionally, Mr. Kennedy’s and his appointee Marty Makary’s attacks on the FDA and efforts to roll back food and drug safety regulations put all Americans at risk. His push to deregulate food safety oversight and sideline career scientists has already resulted in lowered standards for pathogen testing, and raises grave concerns about the implementation of a non-scientific product approval processes. These moves prioritize ideological interests over the health of American families.

As a constituent, I am outraged by his overreach, science denial, and his persistent efforts to dismantle the very institutions designed to protect us. His behavior is not only a betrayal of the public trust—it is a clear and present danger to the health and safety of our nation.

I urge you to act immediately to begin the process of impeachment proceedings against Robert F. Kennedy Jr. His continued presence in public office is untenable and threatens the well-being of every American.

Thank you for your attention to this urgent matter. I am counting on you to uphold your oath of office and defend the principles of truth, science, and ethical leadership.

Sincerely,
[Your Name]

Draft Letter 2: National Security Focused

[Your Name]
[Your Address]
[City, State, ZIP]
[Date]

The Honorable [Representative’s Full Name]
U.S. House of Representatives
Washington, D.C.

Re: Urgent Call for Impeachment Proceedings Against RFK Jr.

Dear Representative [Last Name],

I am writing to express my deep concern over the misconduct of HHS head Robert F. Kennedy Jr. His recent actions demonstrate a clear pattern of abuse of office, disregard for public health, and ethical misconduct, all of which merit immediate impeachment proceedings.

Since taking office, RFK Jr. has used his position to spread dangerous health disinformation while maintaining financial ties to anti-vaccine organizations and refusing to recuse himself from lawsuits that could personally benefit him. This behavior represents a serious conflict of interest and undermines the trust and integrity expected of public officials.

Even more alarming is the structural damage he has inflicted on the Centers for Disease Control and Prevention. Under his leadership, key disease surveillance and response teams have been dismantled, including groups responsible for monitoring emerging infections, disease outbreaks, and early warning systems. This has severely weakened our national ability to detect and respond to biological threats in real time.

By gutting the agencies and systems designed to warn us about emerging pathogens and epidemics, RFK Jr. has left the nation exposed and vulnerable to crises such as the emerging threat of deadly avian flu (H5N1).

These are not partisan concerns—they are matters of national safety. RFK Jr.'s actions are not just irresponsible; they are dangerous. I urge you to uphold your constitutional duty to protect the American people and support impeachment proceedings before irreversible damage is done.

Sincerely,
[Your Name]

Draft Letter 3: Research Focused

[Your Name]
[Your Address]
[City, State, ZIP Code]
[Date]

The Honorable [Representative’s Full Name]
U.S. House of Representatives
Washington, D.C.

Re: Call for Impeachment of RFK Jr. to Protect U.S. Scientific Leadership

Dear Representative [Last Name],

I am writing as a deeply concerned citizen alarmed by the devastating impact Health Secretary RFK Jr. is having on American scientific research. Recent reporting makes it clear that his policies are not merely misguided—they are dismantling the institutions that have made the U.S. the global leader in innovation and discovery.

Over the last several months, NIH has terminated nearly 800 research projects, including crucial cancer, autoimmune, childhood development, and aging studies—while proposing up to a 40–percent budget cut and laying off thousands of staff  (theguardian.com, wsj.com). These are not political luxuries—they are the foundation of tomorrow’s medical breakthroughs. The effects are immediate: clinical trials are halted midstream, young researchers face career-ending uncertainty, and entire labs are left shuttered.

This isn’t just shortsighted; We risk losing a generation of scientists and innovators. Once that talent is gone, rebuilding it—even with restored funding—could take a generations.

RFK Jr. has also announced plans to censor scientific publishing by blocking government-funded researchers from submitting to top-tier journals such as NEJM, JAMA, and The Lancet. He has even proposed creating government-run journals to replace them  (politico.com). This is not reform—it is the politicization of science at its worst, threatening the free exchange of knowledge and undermining the credibility of US Scientists. It is an embarrassment to the entire research field.

Together, these actions are eroding the global prestige and capacity of U.S. scientific institutions. In the name of politicized agendas, RFK Jr. is sacrificing decades of leadership, innovation, and economic competitiveness. If we do not act now, the long‑term damage to our health, economy, and global standing will be irreversible.

For the sake of America’s future, I urge you to support immediate impeachment proceedings against RFK Jr. We must defend the integrity of our research institutions and ensure that science in the United States remains second to none.

Sincerely,
[Your Name]

(2) Sign this letter of support for NIH Scientists

The Bethesda Declaration (named for Bethesda, Maryland the location of the main campus of the NIH) is legitimate and has been signed by dozens of US Nobel Prize Winners. I have signed it. You do not have to be a scientist to sign it.

Here is the link: The Bethesda Declaration

(3) Donate to Groups Fighting For Science and Medicine

This doesn’t have to be a large donation but groups like CIDRAP and Stand Up For Science are working to make a difference. You can also send donations to your favorite social media creators (not me - find others) who are standing up and fighting back. It takes guts and people are doing this under the threat of career ending actions from our government. They’re doing it because the threat to all of us is very real, buy them a coffee.

(4) Talk To EVERYONE You Can About What is Happening

A very interesting study showed that it only takes about 25% of a group to change a majority group consensus if that 25% is persistent. Do not get discouraged if you feel like people aren’t listening. Be persistent, consider posting on social media (it does feel scary at first).

I have found that even the most adamant Trump supporter pauses long and hard when you tell them that our FDA has stopped testing milk, cheese, and yogurt for deadly pathogens.

Continue to share the information, all of it. Be persistent and be consistent. Know that you may not change the most hardened people, but those on the fence or waiting on the sidelines will join the chorus as it becomes clear to them that RFK Jr is a direct threat to their own personal safety and that of their children. Keep talking to them, the propaganda machine on the other side of this is relentless.

Thank you dear reader for making it this far and thank you for standing up for medicine, science, and all of us.

This last note is for you, there is so much going on that feels dire and immediate, the deluge of negative headlines is crushing and fear inducing. Take some personal time and make sure that you do something that refreshes you, do not let yourself become paralyzed. I took a long hike today with my phone in airplane mode. It was fantastic. I urge you as we are facing down the greatest threat to our democracy and safety in living memory, make sure you still find time for yourself. The news cycle is relentless, but it will still be there in a few hours from now.

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I am a researcher, inventor, and entrepreneur and have been trying to make sense of it all. There is no obvious reason for this level of damage to be done to our research and health institutions. Scientists in general are a hyper-logical group of people, and when repeated assaults to logical reasoning are launched by those meant to be leaders in national science and health initiatives, it can engender a lot of feelings. The first often being disbelief at the blatant stupidity.

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This week I have also been accumulating a tremendous number of stories about the crumbling infrastructure inside Health and Human Services. As someone who is currently independent from federal funding, but connected to many who are impacted, I feel like a rescuer who can hear the tapping of people still alive inside of a capsized ship. Many are fearful of retaliation and career ending sabotage, but still feel desperate to get the message out. Their stories are trickling out slowly.

The people who are speaking publicly must be supported. They are brave and they represent the tip of the iceberg. They are risking their careers so that you and I hear the truth.

The further researchers get away from the disaster and destruction, the more willing some seem to be to talk about it. The link to their stories will be active here when the article is posted.

Despite all of this there have been some bright spots in public health news. Let’s start with the good news.

The Good: Vaccines, Cervical Cancer, and At-Home Screening

Vaccines continue to save lives and prove to be safe and effective.

Late last year it was reported that the HPV vaccine has led to a 62% drop in cervical cancer mortality in women. Last week clinical trial data showed that a single dose of either the bivalent Cervarix or 9-valent Gardasil 9 HPV vaccine had 97% efficacy in participants that were followed over 5 years. Notably Gardasil is approved for prevention of cervical, vaginal, vulvar, anal, oropharyngeal, and other head and neck cancers, not just cervical. The benefit of one shot being effective is improved distribution and prevention.

Currently the US is considering switching to a single dose schedule for this vaccine. Cervical cancer is preventable yet still the leading cause of death from cancer in 37 countries around the world. Cervical cancer rates have continued to drop in the United States and screening (PAP smear) along with HPV vaccination continue to be an important part of prevention and early detection which improves survival rates.

But no one likes PAP smears. I personally prefer long visits to the dentist.

So here is some even better news, today the FDA approved the first at-home Pap smear. This will likely lead to increased screening rates which will improve early detection rates. Early detection of cervical cancer is often lifesaving.

Read more about HPV and Cervical cancer prevention here. It read more about this history of the HPV vaccine (it was first developed in 1991) and the Nobel Prize awarded to Dr. zur Hausen for linking certain HPV strains to development of cervical cancer read more here.

The Bad: Measles

What began as a few cases in west Texas that I reported on in February has spread like wildfire across the United States.

We are now in the midst of the most severe measles outbreak in over 25 years, with cases surpassing 1,000 as of today, May 9th, 2025. In addition to home-grown cases, declines in global vaccine rates have lead to an increase in measles cases among unvaccinated travelers returning home.

Measles is the most infectious disease in circulation, with 9 out of 10 unvaccinated people becoming infected if exposed to the virus. Unlike many other viruses, the measles can remain infectious for hours in a room once the infected person has left. This is why when you see announcements of potential exposure it often spans several hours.

Health officials are urging communities to vaccinate, as measles can lead to severe complications, including pneumonia, encephalitis, and death. Vitamin A does not prevent measles and shows no benefit in studies done in countries where children have sufficient nutrition (the United States). Vitamin A supplementation should only be done under the direction of a physician as children are highly susceptible to vitamin A toxicity which may require hospitalization and can be deadly.

The MMR vaccine remains the most effective method for preventing measles infection. Many are becoming concerned about the potential return of endemic measles in the U.S. (Read more here: Houston Chronicle, Reuters)

As I have said before I do not see this outbreak subsiding anytime soon. Health and Human Services under RFK Jr has failed to take an active role in virus containment, promotion of vaccination, and has pulled funding for measles and other vaccination programs from local health departments. The CDC has indicated that containment is up to local public health departments and that cases are likely underreported.

The majority of states in the United States are under the herd immunity threshold for vaccination (95%) which means this virus will continue to spread. I do believe United States will soon lose it’s measles elimination status, an embarrassing reversal of decades of public health efforts. In the graphic below, only the blue states have an average vaccination rate that will support herd immunity.

Graphic from CDC.gov (https://www.cdc.gov/measles/data-research/index.html) May 9th, 2025.

In addition, other vaccine preventable illnesses have been making a comeback. One these is Pertussis (whooping cough or 100 day cough) which is prevented by the Tdap vaccine. I made the personal choice to update both Tdap and MMR a few years ago. Boosters of these vaccines are often given in adulthood if antibody titers are low or to the mother during pregnancy and after birth (respectively) to help protect the newborn. Tdap is recommended every 10 years and after possible tetanus exposure. If you are high risk or unsure of vaccination status it may be a good idea to discuss vaccination with your physician.

The Ugly: NIH Grant Cuts

The research community has been reeling from the chaos of grant funding claw-backs and grant cancellations that seemingly have no common theme beyond political retaliation.

Yesterday a JAMA report detailed how severe these cuts have been. In summary, a total of $1.8B in unexpected grant cancellations have occurred. This represents a total of 694 grants across 210 US Universities and Institutions.

The cuts covered nearly every research branch of the National Institute of Health with deep cuts to research in Cancer, Autoimmune Disease, Infectious Disease and Childhood Development. The largest dollar amount totally $112 million dollars of awarded grants were cut from The National Institute of Allergy and Infectious Disease, the agency previously headed by Dr. Fauci. The next largest cuts by dollar amount were to Cancer research with $91 million in cuts to grants funded by the National Institute of Cancer. The largest proportional dollar amount ($66 million) was cut from grants awarded under the National Institute of Minority Health and Health Disparities.

The only research areas across the National Institute of Health not cut were grants given to research in Complementary and Integrative Health and Clinical Center grants.

Federal grant spending is a net positive investment of tax payer dollars with an average of $2.5 per every $1 spent being returned to the US economy.

_________________________________________________________________________

Despite the bad news I remain hopeful that the tide will turn and that gold standard science, health, and medical research will prevail. In the meantime I will continue to work to provide in depth coverage of current health topics. Stay safe out there friends.

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I vividly remember Donald Trump in his first term saying something along the lines of: “if we don’t test for COVID there won’t be COVID cases.”

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What I heard as a multi-decade career scientist was: “if you don’t stare directly at the sun, it will disappear”. It was absurd.

Most of us have higher logical reasoning capacities than your average ostrich, sticking their head in the sand. We all know that COVID-19 cases would not have ‘gone away.’ Instead, the viral pandemic would have become deadlier. Without understanding which variants were next and when case waves were starting we could not have updated vaccines, taken spread reduction measures, or prepared hospital staff for incoming waves of sick people.

Without understanding ‘what was killing people’ scientists and physicians would not have had the research support to produce therapeutics and vaccines that could treat, slow, and stop disease spread.

When Trump suggested we stopped testing for COVID-19 there were still guardrails in place. Smart people who had dedicated their lives to public health and worked non-stop during the pandemic response persisted, ignoring the absurd idea to not test for a virus that was killing people so fast that morgues were overwhelmed and refrigerator trucks sat outside of hospitals for weeks at a time.

The first director of the CDC’s injury center was quoted in a recent news report:

"There's nothing partisan about injuries," says Dr. Mark Rosenberg, the first director of the CDC's injury center, which was established in the early '90s.

"These are our kids who are being shot, our kids who are drowning, our kids who are being abused and neglected," he says.

Today, the guardrails and many of the people that preserved public health are gone. Some quit out of sheer exhaustion, not just from the pandemic itself, but continuous harassment of scientists and medical professionals. Others have recently been fired by a team of teens and twenty-year-olds who couldn’t pass a basic college biology course test if given one on the spot.

Agencies within the HHS tasked with protecting the health and safety of Americans, especially the CDC and FDA have suffered significant reductions in operations. In some cases entire branches of these agencies have been eliminated. United States public health is fumbling forward blindly into the unknown.

Accidents and Food and Drug Safety: No Testing, No Tracking, No Guardrails

As of this writing, it appears that the entire injury prevention team at the CDC has been fired. This team tracked motor vehicle crashes, child maltreatment, rape prevention and education, drowning, traumatic brain injury, adverse drug events, firearm injuries and death, drownings, poisoning, dog bites, falls in the elderly, among other accidents.

If no one is tracking adverse drug events through the CDC, and the FDA’s testing branch has been limited that they are unable to do regular routine inspections and testing, we are inviting disaster.

Getting sick and dying from a E. coli coated batch of lettuce, a botulism-heavy batch of local honey, or a bad batch of Tylenol and not knowing the source due to lack of testing means that public health officials won’t be able to stop it. State health departments will have to organize collaborative efforts to track down issues, something they are underfunded and not equipped to do without the assistance of the CDC.

The trends we won’t know about and the data we won’t collect will make it impossible to prepare for and eliminate serious threats to public health.

To paraphrase a comment from a recent video I posted: “we won’t know if something is killing us until the bodies start piling up”.

This is happening very fast.

As I was compiling this article the FDA suspended milk and other dairy product quality testing operations. This is due to workforce cuts. Cuts like this mean that food borne illnesses and potentially deaths will increase, and soon.

Additionally, some people fail to understand that the FDA also safe-guards our food safety as well as the safety of many over the counter products. For example, the FDA forced the recall of many hand sanitizers during the height of the COVID-19 pandemic that had dangerous unlisted cancer-causing chemicals such as benzene. It is murky at best if these operations will continue. This means that suppliers can play it loose with dangerous chemicals that may end up in your baby wipes or child’s hand sanitizer.

Lack of Testing Will Lead to Increases in Disease Spread

Last week, the Florida Department of Public Health issued this warning (April 11th, 2025) urging all patients to seek testing after several years of potential Hepatitis C exposure at: Lily J. Voepel, MD, Interventional Pain Management, located at 4015 N Harbor City Blvd., Melbourne, FL. Patients were possibly exposed the Hepatitis C between June 2023 and March 2025 as a result of unsafe infection control practices. But, it was not Florida Department of Public Health that found the source of this Hepatitis C outbreak, it was the CDC.

But every scientist at the CDC lab who identified the source of the Florida Hepatitis C outbreak has been fired. All news reports indicate that the lab that linked the sudden rise in cases to this one pain management clinic remains shuttered. The CDC team is gone. There is no other lab that is equipped to perform this kind of testing and tracing in the United States.

Hepatitis C which may enter the blood transfusion supply (along with HIV and Hepatitis B) is now a treatable disease and not as much of a death sentence as it once was. However, it can cause years of liver damage before it is detected and the treatment is expensive and may not be fully covered by insurance. It is not fully covered by Medicaid.

Syphilis cases are also on the rise, increasing 80% between 2018 and 2022 and congenital syphilis which can cause life-long health issues for children was 10-times higher in 2022 than 2012. But you’ll see that in this Johns Hopkins report reviewing rising syphilis cases, all links to the CDC data to support these numbers only return blank pages showing 'Page Not Found’ errors.

If you search STI statistics you can find a page with the header: “CDC's website is being modified to comply with President Trump's Executive Orders.”

I am extremely familiar with CDC webpages, data, and organization of the data so I searched to see if I could find the raw data on syphilis cases anywhere. It took me 20 minutes of searching to eventually find that data that shows that both total and congenital syphilis cases are still rising in the United States. The pace of the increase slowed from 2022 to 2023, but it was still increasing.

With the reduction in testing and monitoring, we are likely to not fully capture any significant changes in STI spread that may significantly impact health.

How Many Epidemics or Pandemics Can We Expect With These Cuts?

Currently, we are walking blind into a potential bird flu (H5N1) pandemic. People working on bird flu at both the FDA and USDA were fired. The last reports on this I have been able to find have been about attempts to find and re-hire some of these people. If that has been achieved, if operations are normal, we do not know. Scientists within these agencies are speaking rarely and on condition of anonymity.

I personally can quote one of the many colleagues from my years in research who now works at the NIH. They told me that internally “It’s a shit-show, no one knows what is really going on”. I imagine it is the same inside of the FDA and USDA, and the CDC as we know is no longer testing for many diseases.

With lack of testing, monitoring, treatment, and reduction of disease spread both here in the United States and a withdraw of funding for programs abroad, disease resurgence is eminent. From food-borne illness, to cancer, to viral infection, the safety net is gone.

Many state public health departments may still be doing good work, but the point of the CDC, FDA, and USDA (and many other HHS departments) was to have one cohesive set of data, testing, and regulations across the United States and it’s territories. No other agencies or groups in the United States was equipped to manage this.

Here are just a few examples of what is likely to happen if these agencies are not rapidly back in operation:

• Outbreaks of blood borne pathogens like HIV, Hepatitis B and C can reduce the supply of available blood for transfusion and lack of detection and testing can increase rates of transfusion-based transmission.

• Listeria outbreaks in dairy products can be deadly in children and older adults, who is monitoring the milk on our shelves for safety now?

• The outbreak of MPOX that was controlled in 2022 by CDC teams that no longer exist, may soon re-occur. A more easily spread and deadly Clade 1b MPOX that is spreading in several African countries has already been detected in Europe. There is evidence that the vaccine given for MPOX in 2022 (JYNNEOS) has already worn off and will not be protective if clade 1b arrives in the United States.

The current state of HHS departments is that they are simply not equipped with enough people or enough financial backing to test for diseases, assist in identifying outbreak sources, or help in controlling disease spread.

In summary, it’s not just one epidemic or pandemic we are flirting with, it’s all of them. The guardrails that have prevented high rates of disease spread are gone.

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(image credit: Joshua Sukoff / Shutterstock.com)

Between calling autism a preventable disease (it is a syndrome with a genetic basis, which he refuses to acknowledge) and slashing CDC operations to the point that they are unable to respond to a case of lead poisoning (and much more), RFK Jr. is actively destroying the agencies that serve as the backbone of the United States health, safety, and research systems.

Is it a sort of sick humor or blatant incompetence that RFK Jr called for a search for an environmental cause of a neurological syndrome while his own agency has been stripped so bare of resources it can not respond to lead (a known neurotoxin) poisoning of children that happened within the same week?

The man who eliminated the CDC task force to respond to lead poisoning does not care about the health of your children or the environmental factors involved in childhood disease.

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The experiment has been done. RFK Jr. is a failure. Even the Trump administration complained that they could not get a statement from HHS when needed as measles cases exploded in Texas and the first child died.

Recently in an interview he claimed he didn’t know where cuts were happening inside of US Health and Human Services. He is the head of this agency.

Perhaps if RFK Jr was a real scientist he would understand that unless you are a quantum particle you do not get to claim the status of Schrodinger's cat. RFK Jr. IS in charge of HHS, the dismantling of critical agencies is occurring and his watch as are deaths and destruction of basic health and safety guardrails. This is his responsibility.

If RFK Jr is so incompetent that he is unclear as to what is occurring inside of his own agency, immediate resignation is the answer.

Instead he held a press conference, standing at a podium answering questions from the media as if he has any medical or scientific training. RFK Jr has none. Much like going to space for 11 minutes does not an astronaut make, reading and mis-interpreting fringe research does not make you a scientist.

Medical doctors do not walk into court rooms and start cos-playing lawyers, it would be absurd. RFK Jr. is absurd and it will kill people.

It is with a heavy heart as a life-long scientist that I will continue to share what we know about how disease resurgences that are coming. Death is at our door.

RFK Jr whose foundation, the Children’s Health Defense has promoted unregulated experimentation on autistic children will not suddenly grow a conscience. He is not interested in reasoning with experienced professionals to achieve the best possible outcome. He is interested in lining his pockets regardless of the consequences for you and I. He is interested in proving his half-cocked theories ‘right’ regardless of mountains of evidence proving him wrong. Some of us, maybe some of our children, will pay the price of this with our lives.

His failure to recuse himself of financial benefit from frivolous vaccine maker lawsuits when he assumed the role of head of HHS should have been grounds for non-confirmation.

Our elected leaders put a man who will financially benefit in charge of the scientific data that was the only thing standing between his lies and the health of the American people.

It is clear as the CDC, NIH, FDA, and HHS crumble under unprecedented department cuts, unable in some cases to maintain basic operations, that RFK Jr. is laying the groundwork to use the agencies resources to prove his half-brained deadly theories correct. He has placed a known anti-vaccine grifter who pushed unproven treatments on autistic children in charge of a vaccine safety study.

There is no moral compass at the top and no one left to stop what may come next except a distributed network of local and state health departments, physicians who take pride in their oath and responsibility to patients, and scientists who remain independent and continue to speak to anyone who cares about community health.

The current leadership has indicated they do not care if your children die if they make a career for themselves. They summarily ignore the results of carefully done research studies.

RFK Jr’s army of disinformation spreaders have harassed and threatened people over the years, convinced against all logic and reason to ignore evidence and rather than support thoughtful research they grasp at dangerous experimentation to the point of murdering their own children.

As for the choices parents make, RFK Jr may not be holding the smoking gun, but he loaded it, put it in plain sight and then spent over a decade feeding people lies and getting them drunk off of fake ideals.

He has convinced people that the very scientists and physicians often with autistic children of their own, are hiding something from the public. The unregulated, illegal experimentation on children alone should have these people in jail, but no, now one of them is heading a vaccine and autism study at the behest of RFK Jr.

There is no sane path forward for science, health, and medicine in the United States except for RFK Jr’s resignation and removal of the inexperienced like-minded spineless sycophants now heading FDA (Marty Makary), CBER (Vinay Prasad), and NIH (Jay Bhattacharya).

What is the cause of Autism Spectrum Disorder (ASD)?

I have been asked often: “what is the cause of autism?” as if it were a challenge, as if a scientist couldn’t discuss the current research. This is a ‘gotcha’ attempt often perpetrated by RFK Jr demonstrating how he has worked to keep anyone left listening to him in the dark.

Autism is a spectrum disorder with an up to 90% inherited genetic basis. De novo (new) genetic mutations can be found in some cases. One potential environmental factor not discussed by RFK Jr is congenital (parent to child) CMV (Cytomegalovirus) infection and childhood CMV infection.

CMV is an often symptomless viral illness that is relatively common in the population with significantly more exposure in Hispanic and Black populations (see: seropositivity tables in the study linked above). This 2024 study in the peer reviewed, well respected journal Pediatrics showed that children with congenial CMV infection were 2.5-times more likely to be diagnosed with autism than their peers.

If RFK Jr. admitted that a viral infection is a potential environmental factor, it would naturally follow that that vaccines would be helpful, exactly what RFK Jr. has fought decades to eliminate.

Here are links to reputable research reports indicating a potential link between CMV and autism: Maternal CMV seropositivity and autism symptoms in children (2018), Postnatal Cytomegalovirus Infection May Increase the Susceptibility of Tuberous Sclerosis Complex to Autism Spectrum Disorders (2022), Autism in a child with congenital cytomegalovirus infection (Case Report, 1983), Brief report: autistic disorder in three children with cytomegalovirus infection (Case Report, 2004), Neurodevelopmental outcome in children with congenital cytomegalovirus infection: A prospective multicenter cohort study, (2023).

If you type the words “CMV infection autism” into Pubmed you get a total of 68 reports with increasing frequency over time.

There is more evidence supporting a link between autism and CMV than autism and vaccines, in fact over 200 peer reviewed research papers have shown there is no link between autism and vaccines. Why are RFK Jr and his cohort of anti-vaccine advocates ignoring reports like this in favor of debunked theories?

Because it would mean a vaccine may be helpful and RFK Jr has a vested financial interest in making sure your children can’t get vaccines.

A conference is being held in Minnesota this year to discuss this very topic. For completeness, not every study has turned up a link, though most have. Here is a study that argues that CMV and ASD are not linked. More research should be done here because if a vaccine could reduce severity or rates of ASD that would be an important finding.

Finally, internationally autism rates have gone up (not just in the United States). This rise is correlated with an increased diagnostic criteria in every country where rates have ‘gone up’. For example, Denmark introduced an expanded diagnostic criteria and rates immediately went up. The same occurred in the United States, per a CDC report released nearly in tandem with RFK Jr saying that no one understands the cause of the rising autism rates.

To summarize, there is not necessarily an increase in rates, but more people are being diagnosed due to an expansion in diagnostic criteria.

It seems that RFK Jr might want to spend some time reading the reports that come from the agencies he oversees, perhaps even attempting to understand them or speaking to scientists that don’t trade in half-baked conspiracy theories. Or instead, simply resign.

I can not imagine a less competent leader given the huge number of gaffs, missteps, and false dangerous information he has spewed over the last two months while these agencies fall apart and he admits to being unaware of what cuts have even occurred.

What about RFK Jr’s claims that autism and vaccination are linked?

The first paper attempting to link autism to vaccination in 12 children was retracted and Andrew Wakefield admitted to publishing false data. He also stood to make $43 million by selling test kits, an undisclosed financial conflicts of interest, and lost his medical license for serious professional misconduct which included the mistreatment of autistic children.

Wakefield is not the first person who has abused autistic children and taken advantage of their parents that RFK Jr and his Children’s Health Defense have lionized. The Children’s Health Defense has supported and promoted people that have performed unregulated experimentation on autistic children by pushing their “research” as credible when in reality it lacked ethical and medical oversight and in some cases harmed children. Some of the research they promote to this day was done by doctors that lost their medical licenses for harming their patients.

For that alone RFK Jr should have never been given a seat at the table of any serious health organization. Instead of being ashamed, he is charging ahead with the force of our taxpayer dollars behind him hell-bent on proving himself right while our children, medical credibility, and research organizations pay the price.

Here is a link to a free 234 page Immunization Safety Review with a special focus on Autism and Vaccines.

In case you don’t have time to read it, it summarizes the work of over 200 peer reviewed publications showing there is no link between autism and vaccines. Here is a link to a scientifically accurate and plain-language summary of the current research conclusions.

No ‘alternative’ scientific research findings have countered this mountain of evidence with sufficient findings to warrant destroying cancer research to fund RFK Jr’s frivolous self-serving study on the link between vaccines and autism.

RFK Jr is a disgrace and this period is a dark stain on Medical Science in the United States. The only viable path forward is his resignation and the resignation of his equally disingenuous cohort: Makary, Prasad, and Bhattacharya.

Stay tuned as I try to catch up to the deluge of cuts, changes, and restructuring of US Health and Human Services. As always thank you for your support of this publication and subscription. A huge thank you to those who share these posts and support the work directly, helping me keep it free and easily distributed to everyone.

More to come, (unfortunately).

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To ensure all conflicts of interest are covered I work in an area that is dedicated to bringing lower cost treatments to people and the products could be used to prophylactically to prevent vaccine preventable viruses from infecting people and causing illness, as well as treating those illnesses. Therefore, if vaccines disappeared, I would possibly financially benefit. But I am not a psychopath and prefer to sleep well at night knowing I have done everything I can in my spare time to advocate for scientifically proven preventative health measures that are low cost, safe, and effective. These are the same vaccines I have had, continue to get appropriate boosters of, and recommend to my own friends and family.

For 25 years the United States has maintained its measles elimination status. To maintain this status there must be absence of continuous spread of disease for 12 consecutive months. Cases for 2025 have exceeded 607 reported cases (as of April 9th, 2025) and local health officials in West Texas have indicated it may take a year to control the outbreak meaning loss of measles elimination status is likely.

Amid the backdrop of slashing CDC employee numbers including eliminating the jobs of people who aid in response and containment of disease outbreaks. Another example of how chaotic the mass firings have been inside of Health and Human Services (which oversees the CDC. FDA, and NIH), just today it was reported that the FDA is again allowing telecommuting due to basic operations being threatened by layoffs.

Federal funds that supported vaccine distribution and free vaccine clinics, including measles vaccine distribution in Texas were abruptly shut down on Tuesday March 25th.

The measles outbreak in West Texas is likely underreported. Typical death rates among unvaccinated populations are about 3 in 1000. In West Texas and the associated New Mexico outbreak three people have died but only a combined 561 cases as of April 4th have been reported. To match well established death rates among unvaccinated people, it would mean that there have been nearly 500 unreported cases in the area.

It should be noted that cases of measles have been reported in numerous states in the United States this year, per the CDC:

As of April 3, 2025, a total of 607 confirmed* measles cases were reported by 22 jurisdictions: Alaska, California, Colorado, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York State, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and Washington.

Given the long-standing anti-vaccine stance of the current HHS director as well as numerous recent appointees, it unlikely that federal resources will be directed to controlling the current outbreak. RFK Jr. recently claimed that the infection curve was flattening, but the data doesn’t agree.

It should be expected that this dismantling of public health will lead to more unnecessary deaths from measles and possibly the loss of elimination status in the United States.

Are Vaccine Updates Needed for Adults?

Every health organization around the world recommends the measles vaccine in childhood. Despite this vaccination rates began to fall globally during the SARS-CoV-2 pandemic and have not recovered. Outbreaks around the world have started in earnest with Canada and Mexico both combatting their own outbreaks due to a drop in vaccination rates. The current Ontario, CA outbreak is so large that New York Health officials have begun warning travelers.

Measles vaccination began in the United States in 1963 and both formulations and vaccine recommendations have been updated to ensure the best possible vaccine coverage, which has led to elimination of the disease in the United States being declared in 2000. Measles, until recently, had become so rare in the United States that most new doctors had never seen a case of what was once a common and deadly childhood disease.

Figure from: “154 million lives and counting: 5 charts reveal the power of vaccines”

Erosion of herd immunity will undoubtedly lead to increased measles exposure and it is recommended that people without presumptive immunity get the measles vaccine.

The CDC’s definition of presumptive immunity can be found here.

Additionally, the CDC recommends that adults who were vaccinated between 1963 and 1967 who received the less effective heat-killed virus vaccine get revaccinated.

Once the live-attenuated measles vaccine was introduced, children vaccinated with a single dose. However, this did not provide sufficient coverage as evidenced by several outbreaks and and a two-vaccine schedule was adopted in 1989, leading to measles elimination.

Currently, there is no recommendation for a catch-up program among adults for a second dose of MMR. However, people who are at high risk of exposure or have high-risk people in their lives can have their antibody titers checked and if they are found to be insufficient your physician may recommend a dose of the MMR vaccine.

Summary

• People vaccinated between 1963-67 are recommended to get another measles vaccine

• People vaccinated between 1967-1989 have only received a single dose of the measles vaccine and may want to check their antibody titers or get re-vaccinated especially if they have high risk of exposure and/or may expose someone else who is part of a vulnerable population.

• The CDC and local health departments have begun to recommend accelerated (single shot at 6 months) vaccine schedules for infants in areas where outbreaks are ongoing.

Personally, I hope that we are able to get these outbreaks under control and we do not lose measles elimination status in the United States. But realistically, it is unlikely without federal support for long-standing proven health interventions, which does not seem to be forthcoming.

Infectious respiratory diseases can spread very quickly. In the last five years I have not been on a single plane flight (well over 50 flights) without having at least one person with a persistent, hacking, cough sitting within a few seats of me.

I have not gotten sick from travel since consistently wearing a well-fitting N95 from terminal door to outside the baggage claim. As I wrote the first draft of this post on a flight in February of 2025, a woman next to me asked if I had an extra mask because the person in front of us has been coughing so violently her nose started to bleed and she ran to the restroom holding it and still coughing. The woman next to me wore one of my signature navy blue KN95s, I hoped the best for her. It’s always best to wear one from airport entry to exit.

As I wrote the first draft of this post in early February during the dismantling of USAID which may have had something to do with it’s internal audit of payments made to Starlink. USAID accounts for a small portion (0.3%) of the United States (US) budget, but is arguably a net positive in terms of international relations and stability as well as reduction of life-long debilitating disease both in the United States and abroad.

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This article detailing USAID impact was published in Science on February 28th, 2025 “‘A bloodbath’: HIV field is reeling after billions in U.S. funding are axed”. In summary, millions of people will be directly impacted with a near immediate shift in resources to reduce the spread of HIV/AIDS.

I can hear echoes of push-back regarding ‘put America First’ and ‘why do we support health programs in other countries’?

Simply put, diseases do not respect borders and it is far less expensive to control, treat, and work towards the elimination of a disease overseas than it is to manage an outbreak in the United States.

As I brush-up this draft for final publication the US stock market is set to open at even lower levels than yesterday (April 3rd) which had already wiped close to $3 T of capital out of the market. I will also remind the single issue voters focused on the economy that economic health and population health are tightly linked. In my opinion, the adoption of AI only partially decouples this longstanding fact, though others may quietly believe differently.

To summarize the breakneck speed of public health dismantling both at home and abroad made it impossible as I sat on a plane in early February trying to assess the far-reaching implications of agency dismantling on public health. I waited, and watched the dismembering of long-standing agencies this week as highly experienced world-renown experts were fired or resigned.

I am glad I waited. In February the chaotic operations of this administration had only just begun, and although we are not sure today if they have ended, I believe the trajectory is now clear. For example, grant funding awarded to states to support tracking, prevention and control of infectious disease was canceled April 1st, though the cuts were temporarily blocked by a federal judge the funds may be in limbo while several states move to sue the administration. Chaos is par for the course with the current administration, but unlike version 1.0, version 2.0 seems to have intentionally become more tight-lipped (unless you have the signal app on your phone), far less communicative around activities and intentions.

This approach is the antithesis of how good public health operates, this is how you kill people.

Although the dust still hasn’t settled, I do believe we’re in a place where I can describe a few forward looking scenarios that will help people prepare for what’s to come.

Disease Incidence Will Increase: Dismantling of Public Health Programs at Home and Abroad

The US has drastically altered it’s approach to combating infectious disease, research and development, and promotion of educational resources that improve long-term health and wellness. This will have near-immediate impacts on the health and wellness of both US citizens and health around the world.

Infectious disease outbreaks were rising before reduction in public health measures. Below is a graphic from “Global surge in infectious diseases as over 40 countries report outbreaks 10-fold over pre-pandemic levels” posted in 2024 by the infectious disease tracking company Airfinity that specializes in independent disease forecasting and health intelligence.

In June of 2024 Bloomberg also published “Yes, Everyone Really Is Sick a Lot More Often After Covid” using the same analysis to highlight 13 infectious diseases that are surging above pre-pandemic levels with some cases surging over 30-fold higher in certain areas.

Many of these diseases have begun to increase in the US. For example, measles, which spreads rapidly in unvaccinated populations and has surged in a West Texas community. This outbreak has lead to over 480 cases, more than all US cases combined for 2024 (285). Texas health officials have indicated it will take months, possibly up to a year to get this outbreak under control.

It is unclear how the West Texas outbreak started, but several other cases around the US have been linked to international travel and exposure to the virus overseas. Regardless of how the outbreak started, it wouldn’t have been possible if MMR vaccination rates were at or above the herd immunity threshold.

On average school aged children in the United States are below the vaccination threshold rate of 95% necessary to maintain population based herd immunity with a significant downward trend starting in 2020.

Reference: “Measles Cases Are Surging—These 6 Charts Reveal Why”, Scientific American.

In addition, all 50 states have communities with exceedingly low vaccination rates which can lead to an increased chance of sustained outbreaks.

Without rapid identification, isolation, treatment, or vaccination programs world wide these diseases which already have smaller outbreaks, will rapidly balloon. Diseases we’ve kept at bay through health programs and vaccination are set to rapidly remerge as a result of reduced vaccination, loss of low-cost pharmaceutical distribution, and disease control measures such as educational outreach and condoms. For example, diseases such as HIV and tuberculosis (many people are carriers) can re-emerge quickly without treatment or access to care.

Below are timing estimates for increased disease incidence in the United States:

HIV/AIDS

Rapid re-emergence of AIDS due to elimination of treatment and prevention programs abroad will contribute to increased disease incidence in the United States. This may be delayed if local programs can swiftly fill the gaps left by the dismantling of USAID, though in many regions this is unlikely. Loss of sex education and prevention program funding both abroad and in the US will increase rate of HIV/AIDS spread. Finally, delayed detection and treatment due to reduction in program funding will increase the rate of spread of HIV/AIDS in the US.

I expect that if we maintain surveillance and reporting which is administered through HHS that we will see an uptick in incidence as soon as 6 months from now with significant spread within the United States population within 12-24 months from now.

Hemorrhagic Fevers (Marburg and Ebola Viruses)

Within the next 12 months I expect there to be an increase in cases in endemic regions and increase sporadic cases outside of endemic regions. I believe that larger outbreaks increase the chances of person to person transmission outside of endemic regions for the foreseeable future.

Areas where Ebola and Marburg virus are endemic has seen increased outbreak cadence over the last couple of years. The last time the United States had an Ebola case was in 2014 with four patients having traveled from Libera and Sierra Leone.

The WHO often sends teams of scientists and medical workers to help identify, contain, and treat outbreaks of hemorrhagic fever, and the loss of US support for WHO activities that help reduce the spread of local outbreaks will lead to larger outbreaks in endemic regions and delays in identification that may delay implementation of travel screening.

Tuberculosis

Rates of tuberculosis infection have been increasing globally (except in in the European Region).

(WHO Global Tuberculosis Report, 2024)

Additionally, death rates from Tuberculosis increased in the United States by >5% between 2015 and 2023.

(WHO Global Tuberculosis Report, 2024)

Without continued support of health interventions and testing, I would expect rates of tuberculosis to begin to increase and be detected by health surveillance within the next 1 to 2 years.

Polio

European wastewater surveillance indicates that Polio (though live-attenuated vaccine related) continues to show up in countries that have not recorded a case of Polio for decades. In 2022 the state of New York as well as a few other states embarked on waste water surveillance after a 20 year old Rockland County, (NY) man was paralyzed by the virus.

The United States vaccination rate against polio has continued to decrease in recent years. In some states the polio vaccine coverage was in the 80% range for incoming kindergartners in 2020-21.

This trend has not reversed with the lifting of pandemic measures with an overall increase in requests for vaccine exemptions and a continued decrease in polio vaccination rates among school-aged children. The decrease in polio vaccination from a US average of 95.3% in 2011-12 to 92.6% in 2023-24 follows the overall trend of decreasing childhood vaccination rates.

Link to this interactive tool and more school-aged childhood vaccination facts can be found here: CDC SchoolVaxView

Unvaccinated children are not protected from polio infection and the sudden USAID and CDC halting of support of global Polio eradication efforts in February 2025 are likely to increase global and eventually US incidence of polio infection.

I estimate that we will continue to see sporadic cases of polio in summer months in low vaccination rate communities with large outbreak potential if vaccination rates continue to drop. The oral polio vaccines was phased out in the US in the late 90s and has not been used since 2000. IPV (inactivated polio vaccine) has been used since the year 2000, however there is no data on how long this vaccine remains effective. Given the unknown duration of modern polio vaccines surveillance is critically important to maintain eradication of polio in the United States.

Measles/Mumps/Rubella

The West Texas outbreak is discussed above, however there have already been several smaller outbreaks around the US as of April 4th 2025. Due to an increase in global incidence and continued decline in childhood vaccination in the US, there is likely to be continuation of sustained outbreaks over the next one to two years with increasing frequency unless vaccination rates are increased. Cases of Rubella and Mumps which can be deadly, have also increased in recent years as MMR vaccination rates have declined.

The temperature of social media responses to the current West Texas measles outbreak are wildly polarized. A significant number of people in my audience are horrified at the obvious back-slide of public health in the US. But a few people seem to think that a children dying from a vaccine preventable disease is perfectly acceptable.

The “measles is no big deal” narrative is fueled by groups like “Children’s Health Defense” founded by the current US Director of Health and Human Services, RFK, Jr. The Children’s Health Defense promotes fearmongering and health disinformation that is directly counter to the global communities standard of care and medical practice. It is important to understand that the professionally crafted narrative of “Children’s Health Defense” are not only counter to standard of medical care in the United States, but their recommendations run counter to medical care and decades of scientific research in all developed nations, without exception.

Out of curiosity I went to their scientific evidence page for vaccines. I looked up the first author of the first study of their study collection. The MD practiced homeopathy and had his offices raided by the FDA because he was charged with giving unproven and potentially dangerous therapies to autistic children after telling the parents he could ‘cure’ them. As RFK Jr. took over leadership of HHS he refused to recuse himself of financially benefiting from lawsuits attacking long-standing vaccines give world wide.

Respiratory Viruses

Elevated levels of respiratory virus infection will likely continue for the foreseeable future. Real-world evidence has finally refuted the ill-advised concept of Immunity Debt that was espoused by celebrity doctors and repeated by ill-advised news media in an attempt to explain surging rates of respiratory virus illness among children immediately after the height of the SARS-CoV-2 pandemic.

This was at best blind ignorance as the evidence against ‘Immunity Debt’ was clear from the country of Sweden that did not lockdown (had a several-fold more COVID-19 deaths than neighboring countries) and had an increase in respiratory virus infections that matched the rest of the world.

One potential cause for the surge in respiratory virus infection that is supported by evidence is that SARS-CoV-2 causes significant immunosuppression post-infection. Immunosuppression appears to last for different amounts of time for different people and the severity may be linked to the severity of SARS-CoV-2 infection. This hypothesis remains to be further tested but mechanistically it is sound. I anticipate this research is forthcoming.

In addition, respiratory virus illnesses, including highly pathogenic influenzas (sporadic occurrences globally), are on the verge of mutation that would enable person-to-person spread. Highly pathogenic H5N1 is one amino acid change away from sustaining person-to-person spread. A single amino acid change similar to the one identified by scientists as supporting person-to-person spread was sequenced from a teenager hospitalized for over two months with H5N1 in Vancouver, Canada. Because there were a mix of variants in the teenager it is possible that the H5N1 mutation arose spontaneously as an adaptation during infection. This indicates that this mutation can easily occur in an infected individual that is immunocompetent. In laymen’s terms sustained person-to-person spread of highly pathogenic H5N1 is imminent.

Early detection and isolation through surveillance, and prevention of spread with influenza vaccines are critical interventions for heading off the next influenza pandemic. Few people continue to wear masks post-COVID and practice regular hand hygiene, but those that do will significantly reduce their chances of influenza infection.

While European countries have begun to stockpile H5N1 vaccines, the Trump administration is considering cutting funding to an mRNA based H5N1 vaccine development program, has fired staff working on the H5N1 response, and has not indicated that any new orders of the currently approved H5N1 vaccines are being added to our stockpile that would cover less than 1% of the US population.

While our population may have some pre-existing immunity to the N1 portion of H5N1 that will help minimize the impact of a pandemic. Highly pathogenic H5N9 and H7N9 have recently been reported in domestic bird populations indicating these potentially pandemic causing viruses are spreading well. The global population does not have pre-existing immunity to either of these influenza strains and I am unaware of any approved vaccine or national stockpile that covers them.

Vector-Borne Disease

Finally, a myriad of parasitic and vector-borne (tick and mosquito) illnesses are being reported further north every year. Here are a few examples:

In the United States:

• Alpha-gal syndrome (Lone Star tick).

• Rocky Mountain spotted fever (Rocky Mountain wood tick)

• Dengue fever (Bone break fever, mosquito)

• Eastern Equine Encephalitis (EEE, mosquito)

Without investment in mitigation measures, outbreak tracking, and containment it is expected that these diseases will continue to spread northward and impact new populations.

Why is This Going to Get Worse?

This week HHS underwent a chaotic and poorly-communicated ~25% reduction of it’s workforce. The current cuts to the HHS reduce employee numbers to levels not seen since the Clinton administration, over 30 years ago. The mass attrition also includes several high-level forced resignations or firings of expert scientists and physicians with decades of experience that is difficult to replicate. It is unclear how well the agency will operate going forward even after a period of reorganization.

Rapid dismantling of health program funding both at home and abroad destroys our ‘eyes and ears’ that enable us to identify and try to stop the next pandemic. For example the CDC is a centralized research center for pathogen identification and testing, but has experienced deep cuts firing dozens of people nicknamed ‘disease detectors’ who assisted public health departments with testing and surveillance.

During the prior Trump administration the CDC’s pandemic response team was dismantled mere months before the first report of the SARS-CoV-2 virus. The CDC’s pandemic response team plays an important role in pathogen screening (often at points of entry during global outbreaks), identification, containment, and vaccination. Under the Bush Jr. administration the SARS-CoV virus (the first one) was contained and eliminated by action of the WHO locally in China, and though coordination between the WHO and the US CDC whose actions were streamlined by HHS. Despite the virus having a similar Ro (spreading rate) to the initial SARS-CoV-2 variant. Trump has said he would disband the pandemic response team (again) and it appears that he has made good on that promise in 2025.

The relatively pathogen-free existence of most United States citizens has lulled many of us into forgetting that the fragile bubble of protection we enjoy is directly due to the work of the CDC, WHO, USAID, FDA and many other agencies under the umbrella of HHS.

Funding Cuts That Do Not Significantly Improve US Budgetary Outlook

US agency collaboration with, and support of, the WHO that directs global disease surveillance and programs designed to identify and reduce pathogen spread has ended. Removal of both financial and collaborative support of the WHO will significantly impact these operations. WHO contributions annually, over the last decade were $163 million and $816 million annually, accounting for less than 0.01% of the US federal budget.

Criticism of WHO, especially regarding the early handling of the SARS-CoV-2 pandemic is largely unfounded. The WHO is not a military organization, it relies on cooperation of the nations that it serves and their health care workers and scientists could not enter areas of China that it was not allowed into for treatment and investigation of the SARS-CoV-2 outbreak.

Within the US the narrative that HHS is wasteful organization doesn’t hold up to real-world scrutiny. 70% of HHS spending is mandatory funding programs such as Medicare and Medicaid, while agencies that fund health research and ensure drug safety account for an estimated 11% of the budget. For example, Global Health accounted for 0.1% of federal spending on health programs in 2024, while the FDA tasked with keeping our food and drugs safe accounted for about 0.06% of the total federal budget in 2024.

Figure References: KFF Report What Does the Federal Government Spend on Health Care? (2025)

The total 2024 US budget spend was ~ $6.9 T and the NIH accounted for 0.6% of the spending, and much of it is directly reinvested in the US economy. The NIH redistributes taxpayer dollars to fund research in all 50 United States, at a net economic benefit to the state of $2.5 for every $1 granted. Read more about this in the KFF report: “What Does the Federal Government Spend on Health Care?” (2025).

Summary

The rapid and disorganized upheaval of national health programs combined with catastrophic funding cuts has created the perfect environment of defenselessness to increased spread of potentially deadly pathogens. We are under leadership that has no substantive history or vested interest in disease prevention or meaningful public health measures. In fact, the current administrations appointees within the HHS are entirely unqualified and deeply misguided in their approaches to public health. To exclusion, their resumes boast long-standing public promotion of health disinformation and false as well as wildly if not willfully misinterpreted medical information for personal profit.

What Can We Do?

• On an individual level you can be proactive in taking control regarding personal health and safety. Both personal behaviors and communicating to loved ones that sexually transmitted illness, vector-borne illness (mosquitos and ticks), and respiratory viruses are potentially on the rise can help reduce illness.

• Being prepared can help you and yours stay healthy during these uncertain times. Encourage public representatives to support research as well as health and safety initiatives.

• Continue to share well sourced, accurate health and safety information whenever you can. to stand up to the well-funded incessant machine of medical disinformation.

Note: that I have done my best to cover most immediately concerning infectious diseases though this list is not exhaustive. I have left few out, such as clade 1b MPOX which is more deadly and transmissible and may begin to show up more regularly in the US. In general. the loss of vaccine based herd immunity and the disruption of public health measures in the US and abroad is expected to increase global pathogen spread and has reduced the ability of US public health officials to respond to and contain infectious disease outbreaks of known and novel pathogens.

Thank you for your continued support of this research and reporting.

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As many of you may know I recently got married to Dr. Rubin. We have kept our relationship relatively quiet on social media but have been dating for several years, got engaged last year, and were delighted to finally make it official in a small ceremony with our closest family.

It was a low stress fun event, just what we wanted. Both of us have been incredibly busy.

Dr. Rubin is writing his first book to help people navigate allergies and allergic reactions of all sorts. He has finished his manuscript well ahead of schedule and will be announcing the publication date soon. Be sure to follow him for updates.

I have been busy launching my second company which is developing high-density bioreactor systems for improved therapeutics manufacturing. Our first target product is human IvIg and ScIg, these life-saving medicines are only sourced from human donation leading to high prices and global shortages.

Along with getting married came a big move from San Francisco to Chicago. After packing up my house Zach and I drove cross country with my two dogs enjoying the scenery as we traversed Nevada, Utah, Wyoming, Nebraska, Iowa, and western Illinois.

Once we catch our breaths are looking forward to planning a big celebration with all of our friends in 2026, so stay tuned.

Unfortunately, in the middle of our big celebration and cross country move, our country has been grappling with a large, now multi-state measles outbreak which has led to the measles death in 10 years. Concurrently the US is experiencing the worst Influenza season since the 2009-10 swine flu pandemic. National wastewater levels of RSV and Human Metapneumovirus also remain high while SARS-CoV-2 is at moderate levels on average.

All of this is occurring in a public health environment where scientists have lost their jobs, or their jobs are under threat, research funding has been gutted nationally, and the current leader of Human Health Services which oversees the CDC seems to be uncertain if a measles outbreak that has killed an unvaccinated child should be taken seriously.

Meanwhile multiple ACIP (Advisory Committee on Immunization Practices) meetings have been cancelled. This has set us back in vaccine data review, development, and selection of influenza vaccine strains for the 2025-26 flu season.

HPAI H5N1 (highly pathogenic avian influenza, H5N1) continues to spread in cattle herds and poultry flocks driving up the price of eggs and making occasional leaps to human infection. A second person from Wyoming was hospitalized February 17th with H5N1, but to date no person to person spread has been documented. We are only one mutation away from H5N1 developing person to person spread capabilities and I believe this is eminent.

I do not believe the US is well equipped to handle an outbreak of highly pathogenic avian influenza. To compound our lack of readiness HHS is reviewing an already awarded contract to Moderna, a vaccine maker, that was to support their development of an influenza vaccine. Rapid production and distribution of an H5N1 vaccine will be critical once the virus begins to spread.

There are many more issues including global outbreaks that I will be detailing in future posts.

Overall, I have a heavy heart and am sad to say that we find ourselves in a quickly worsening public health situation and I do not expect next few years to be smooth sailing. Deep cuts to public health programs, services, and research in the United States and abroad will only worsen this situation.

My goal through these times is continue to provide information to help you safely navigate what may come next.

I am nearly settled and looking forward to starting up regular posts again, including my ongoing series on Long COVID. See you soon.