California health officials reported Tuesday that a child in Alameda County tested positive for H5 bird flu last week.

The source of infection is not known — although health officials are looking into possible contact with wild birds — and the child is recovering at home with mild upper respiratory symptoms.

Health officials have confirmed the "H5" part of the virus, not the "N1." There is no human "H5" flu; it is only associated with birds.

The child was treated with antiviral medication, and the sample was sent to the U.S. Centers for Disease Control and Prevention for confirmatory testing.

The initial test showed low levels of the virus and, according to the state health agency, testing four days later showed no virus.

"The more cases we find that have no known exposure make it difficult to prevent additional" infections, said Jennifer Nuzzo, professor of epidemiology and director of the Brown University School of Public Health's Pandemic Center. "It worries me greatly that this virus is popping up in more and more places and that we keep being surprised by infections in people whom we wouldn't think would be at high risk of being exposed to the virus."

Read more: Canadian teenager infected with H5N1 bird flu in critical condition

A statement from the California Department of Public Health said that none of the child's family members have the virus, although they, too, had mild respiratory symptoms. They are also being treated with antiviral medication.

The child attended a day care while displaying symptoms. People the child may have had contact with have been notified and are being offered preventative antiviral medication and testing.

“It’s natural for people to be concerned, and we want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious — and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said CDPH Director and State Public Health Officer Dr. Tomás Aragón.

The case comes days after the state health agency announced the discovery of six new bird flu cases, all in dairy workers. The total number of confirmed human cases in California is 27. This new case will bring it to 28, if confirmed. This is the first human case in California that is not associated with the dairy industry.

The total number of confirmed human cases in the U.S., including the Alameda County child, now stands at 54. Thirty-one are associated with dairy industry, 21 with the poultry industry, and now two with unknown sources.

In Canada, a teenager is in critical condition with the disease. The source of that child's infection is also unknown.

Genetic sequencing of the Canadian teenager's virus shows mutations that may make it more efficient at moving between people. The Canadian virus is also a variant of H5N1 that has been associated with migrating wild birds, not cattle.

Genetic sequencing of the California child's virus has not been released, so it is unclear if it is of wild bird origin, or the one moving through the state's dairy herds.

In addition, WastewaterScan — an infectious disease monitoring network led by researchers from Stanford University and Emory University, with laboratory support from Verily, Alphabet Inc.’s life sciences organization — follows 28 wastewater sites in California. All but six have shown detectable amounts of H5 in the last couple of weeks.

There are no monitoring sites in Alameda Co., but positive hits have been found in several Bay Area wastewater districts, including San Francisco, Redwood City, Sunnyvale, San Jose and Napa.

"This just makes the work of protecting people from this virus and preventing it from mutating to cause a pandemic that much harder," said Nuzzo.

For years, Robert F. Kennedy Jr., has leveraged his famous name, his celebrity connections and his nonprofit, Children’s Health Defense, to spread misinformation about vaccines and call their safety and efficacy into question. Soon, he might have the power to go much further.

If Mr. Kennedy is confirmed by the Senate to be secretary of health and human services, he would be in charge of the nation’s pre-eminent public health and scientific agencies, including those responsible for regulating vaccines and setting national vaccine policy.

Legal and public health experts agree that he would not have the authority to take some of the most severe actions, such as unilaterally banning vaccines, which Mr. Kennedy has said he has no intention of doing.

“I’m not going to take anyone’s vaccines away from them,” he wrote on social media last month. “I just want to be sure every American knows the safety profile, the risk profile, and the efficacy of each vaccine.”

But Mr. Kennedy, who has said that he wants federal researchers to pull back from studying infectious diseases, could exert his influence in many other ways. His actions could reduce vaccination rates, delay the development of new vaccines and undermine public confidence in a critical public health tool.

In the last three decades alone, childhood vaccines have prevented more than 500 million cases of disease, 32 million hospitalizations and more than one million deaths in the United States, according to a recent report from the Centers for Disease Control and Prevention. But vaccination rates have been falling in recently years, and Mr. Kennedy could accelerate the trend, public health experts said.

“A lot of damage is possible,” said Dr. Thomas Frieden, a former director of the C.D.C. who now leads Resolve to Save Lives, a public health nonprofit. “The secretary of health has a life-or-death responsibility. And if unscientific statements and decisions are made, if agencies are damaged, if public confidence is undermined, then you can get spread of disease.”

Here are five things Mr. Kennedy could do.

He could revise the government’s vaccine recommendations.
As the federal health secretary, Mr. Kennedy would oversee the C.D.C., the agency that issues guidance on which immunizations Americans should get and when.

Health insurers look to those recommendations to determine what vaccines to cover and state health departments use them to inform their own vaccine policies.

Mr. Kennedy would have final say over which experts sit on the external committee that advises the C.D.C. on vaccines, and he would be the boss of the C.D.C. director, who decides whether to adopt that guidance. “That’s, in my mind, a recipe for a disaster,” said Lawrence O. Gostin, an expert in public health law at Georgetown University.

A C.D.C. director or advisory committee that is hesitant toward vaccines could usher in changes in the childhood vaccine schedule, such as removing vaccines from the list of recommended immunizations or changing the ages at which they are advised.

“If the question is purely, could the H.H.S. secretary unilaterally remove vaccines from a schedule or alter the schedule, I think the answer to that would ultimately be no,” said Dr. Michael Mina, an epidemiologist and former professor at Harvard University. “But with a little bit of planning, through like-minded appointments and top-down pressure, the answer to that starts to move the needle toward yes.”

One thing he could not do is abolish vaccine mandates, such as requirements that children receive certain immunizations before attending school. Those are set by state and local governments. The federal health secretary does not have the authority to override them.

But some public health experts fear that some state health authorities, particularly in Republican-led states, could follow a C.D.C. that is skeptical of vaccines. One result might be lower vaccination rates — and worse public health outcomes — in red states than in blue ones, Mr. Gostin said, similar to the pattern that played out with the Covid-19 vaccines.

He could slow vaccine development and approval.
Mr. Kennedy would also be in charge of the F.D.A., the agency responsible for approving new vaccines.

He has repeatedly criticized the agency, which fast-tracked the authorization of the Covid-19 vaccines, as well as the shots themselves. As health secretary, he would not be able to remove them or any other already authorized vaccines from the market without strong scientific evidence, Mr. Gostin said. If he tried, vaccine manufacturers could sue over such a decision and courts would most likely rule in their favor, he said.

But he could bring people who share his views into the F.D.A. Together, they could make the process for approving new vaccines more onerous and lengthy, including requiring more data.

“He could say, ‘I don’t think this has been studied in the right way,’” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the F.D.A.

He could also stop or slow vaccine development research conducted at or funded by the National Institutes of Health, the federal government’s top medical research agency, which would also fall under his purview. He has been clear about his plans to empty some divisions that focus on advancing vaccine research and development. He has said he would fight the next pandemic instead by “building people’s immune systems.”

“I’m going to say to N.I.H. scientists, ‘God bless you all,’” Mr. Kennedy said as a presidential candidate last November. “‘Thank you for public service.’ We’re going to give infectious disease a break for about eight years.”

Infectious diseases are still looming, however. And a slowdown in vaccine research, development or approval could have particularly dire consequences in the event of another public health emergency like Covid-19.

Bird flu, for instance, continues to infect American farm workers, and experts have worried that the virus could evolve to spread more easily among humans. If that happened, “we would be in a new pandemic,” said Jennifer Nuzzo, the director of the Pandemic Center at Brown University. “And that pandemic would move very quickly. Any attempt to not act with urgency would be deadly.”

He could emphasize vaccine side effects.
Decades of scientific study confirm that the benefits of vaccines far outweigh the risks, but like all medications, they carry the possibility of side effects, including some rare but serious ones. Mr. Kennedy — who has said he wants more public visibility into safety data — is poised to draw outsize attention to adverse outcomes.

His nonprofit promotes a database of research that includes hundreds of misleading interpretations of vaccine data. In September, the group released “Vaxxed 3: Authorized to Kill,” a film claiming that Covid vaccines led to “tragic outcomes of either death or serious injury.”
Under Mr. Kennedy, federal agencies like the F.D.A. could highlight potential side effects by requiring vaccine makers to list even very rare ones on the packaging label.

Mr. Kennedy could also draw attention to unverified reports of adverse events collected by federal agencies. “What I would worry about is an abuse of the data,” said Dr. Peter Lurie, the president of the Center for Science in the Public Interest and a former associate commissioner at the F.D.A.

Mr. Kennedy could also push federal agencies to conduct more research into vaccine safety. That would not be a bad thing in itself, said Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and an adviser to the F.D.A. “There is more research that can be done, particularly on some of the newer vaccines,” he said.

But, the research must be scientifically rigorous, he added, and build upon decades of scientific evidence related to vaccine safety. “If you signal this to the public as, ‘Well, we have to start from scratch, all of these vaccines are suspect,’ I would disagree with that approach,” Dr. Levy said. “Because many of these vaccines have been very, very well studied, and they’re a huge win for kids.”

He could weaken legal protections for vaccine makers.
Under a longstanding federal law, people who experience serious side effects after receiving certain routine vaccinations are limited in their ability to sue drug companies. Instead, they can seek compensation through a government-run program. The law is intended to encourage drug companies to invest in vaccine development.

Mr. Kennedy could not make major changes to the law without congressional approval, but he could remove specific vaccines from the program. Whether he could take every vaccine off the list is “difficult to say, because it’s uncharted waters, legally speaking,” said Ana Santos Rutschman, an expert on health law and policy at Villanova University.

If vaccines are removed from the program, some companies may decide to stop making them. “And that’s going to have two effects: driving vaccine costs up and reducing availability for those who want the vaccines,” said Dorit Reiss, an expert on vaccine policy and law at the University of California College of the Law, San Francisco.

(And because the program is more favorable to plaintiffs than the courts are, paring down the list could actually make it more difficult for people with vaccine injuries to be compensated, Dr. Reiss added.)

A more recent law also provides liability protections to companies making vaccines for public health emergencies, such as the Covid-19 pandemic. These protections are put in place by a declaration from the secretary of health; in the event of another pandemic, Mr. Kennedy could simply refrain from making one.

Over the longer term, experts said, weakening the liability protections would probably prompt some pharmaceutical companies to abandon vaccine development. “Which, from a public health perspective, may mean fewer vaccines in the future,” Ms. Rutschman said.

He could speak out against vaccines.
Many experts say they worry most about Mr. Kennedy’s bully pulpit. If confirmed, Mr. Kennedy would have a new platform for spreading misinformation about vaccines and amplifying fears about their safety.

“It’s very hard to claw back outrageous ideas when social media algorithms propel them forward,” Dr. Nuzzo said.

Vaccine hesitancy grew during Mr. Trump’s first term as president and persisted after he left office.

Vaccine experts have said that Mr. Kennedy is particularly skilled at taking good, peer-reviewed science and skewing the findings.

Dr. Mina said he expected Mr. Kennedy to “to do exactly what he’s been doing for years: fudging the way that data is meant to be interpreted, using very manipulative tactics to drive a message that makes vaccines look dangerous. He is a master at it — truly a master.”

During a measles outbreak in Samoa in 2019, Mr. Kennedy stoked the skepticism driving the spread. He wrote to the nation’s prime minister on the Children’s Health Defense letterhead, suggesting that the failure of vaccines given to pregnant women and children was the true culprit. More than 50 children died in the outbreak.

RFK Jr. is ‘exactly the wrong pick’ for HHS secretary

Dr. Jennifer Nuzzo, director of Brown University’s Pandemic Center, criticizes President-elect Donald Trump's pick for Health and Human Services secretary.

November 15, 2024