As avian flu drives egg prices to record levels and increasingly poses a risk to humans, moves by the White House to cut spending and restrict communications have hobbled public health officials’ response, with the new administration yet to outline a clear strategy on how it plans to stem the spread of the virus.

State and local public health officials have gone weeks without regular updates on avian flu from the Centers for Disease Control and Prevention after President Donald Trump froze nearly all external communications from the agency, said a person familiar with the situation. It wasn’t until this week that some of those communications began to resume, the person said.

Widespread funding cuts across the government and new restrictions on funding for National Institutes of Health grants have also created uncertainty among infectious disease researchers and local health officials, who are unsure about what resources they will have to work with going forward. Meanwhile, cuts to the U.S. Agency for International Development have limited monitoring of the virus overseas.

“When you add that uncertainty, it plays into what health departments can do when their entire funding situation is at risk,” said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials. “It makes it even harder to do more when you don’t think you’ll have the resources or they might get pulled out from under you.”

At the same time, key positions in the Trump administration central to responding to the threat of a pandemic have remained unfilled. And the secretaries running the Health and Human Services and Agriculture departments weren’t confirmed until this week, though bird flu was one of the first items on Agriculture Secretary Brooke Rollins' agenda after her confirmation.

The disruptions come at a potentially perilous time. The virus has been decimating poultry flocks, causing egg prices to more than double. It has been showing signs it can evolve to more easily thrive in a variety of species, including a new strain detected among dairy cattle this month. While there are no indications the virus can be transmitted among humans, at least 68 people in the U.S. have contracted avian flu and one person has died, according to the CDC. Researchers worry that the more the virus replicates, the more opportunities it will have to develop a mutation that would enable it to spread easily from human to human.

“This is getting more and more dangerous and urgent, and the scientific community is setting off alarm flares,” said Stephen Morrison, who directs the global health policy center at the Center for Strategic and International Studies. “But are they translating into the government moving at a faster pace or with a different resolve? No. Instead, we’re in a period of confused transition that’s been made worse by the disruptions in government function and the normal slowness of getting the new team in.”

The White House didn’t respond to a request for comment on its strategy for addressing avian flu and what additional steps it planned to take to address the spread of the virus.

Rollins, who was confirmed by the Senate Thursday, told reporters that she had a briefing in the Oval Office Thursday night and would be announcing more on the department’s plan to address egg prices “in the coming days.”

“We are looking at every possible scenario to ensure that we are doing everything we can in a safe, secure manner, but also to ensure that Americans have the food that they need,” Rollins said when asked about the price of eggs. “And as a mom of four teenagers, actually, I fully understand and feel the pain of the cost of these eggs.”

White House National Economic Council Director Kevin Hassett said in an interview on MSNBC Thursday that the Trump administration would soon have a strategy now that Rollins has been confirmed.

“It turns out, President Biden’s team didn’t have an avian flu strategy, and now we’re about to have one, as soon as Brooke Rollins is at the Department of Agriculture,” said Hassett.

In a statement on egg prices earlier this week, the White House said Rollins would take “bold, decisive action to address the crisis” by refocusing the agency tasked with stopping the spread of the virus among animals “on its core mission: protecting the health of the United States’ plants, animals, and natural resources while simultaneously lowering costs.”

So far, though, public health officials say the White House has created more confusion than clarity.

In West Virginia, Michael Kilkenny, head of the Huntington Health Department, said he hasn’t been getting regular updates from the CDC for the past several weeks.

“We just don’t know what’s happening right now. We don’t know if this is expanding into our area if we aren’t getting that communication from the CDC,” said Kilkenny. “In more rural areas, there are small health departments that, without the information they need coming from the CDC, they’re not going to be able to inform their small-flock farmers, poultry farmers or higher-risk agricultural workers that depend on the local health department for information or services.”

The prospect of potential federal funding cuts have also caused his and other health departments he works with to begin contingency planning and put hiring and new projects on hold.

“We are holding on hiring and we are holding on planning while we are waiting to see that there is clear evidence that things are going to be funded before we can spend our work time planning or even submitting for a project,” said Kilkenny. “That is how this disrupts us.”

Along with limiting CDC communications with local health officials, the World Health Organization has also been receiving limited information on the spread of avian flu in the U.S. since Trump signed an executive order to withdraw from the global health organization, WHO director-general Tedros Adhanom Ghebreyesus said during a Feb. 12 press conference.

The “near-total communication freeze” at public health agencies “is deeply unprecedented, and that alone scares me more than anything else,” said Jennifer Nuzzo, director of the pandemic center at the Brown University School of Public Health.

Nearly a month in, Trump has yet to name an official to head the White House Office of Pandemic Preparedness and Response Policy, which was created in 2022 by Congress to coordinate pandemic response across agencies. During the campaign, Trump said he would likely get rid of the office and criticized President Joe Biden’s efforts to prepare for another pandemic.

“He wants to spend a lot of money on something that you don’t know if it’s gonna be 100 years or 50 years or 25 years,” Trump said of Biden in a July interview with Time magazine. “And it’s just a way of giving out pork.”

“It doesn’t mean that we’re not watching out for it all the time,” Trump said. “But it’s very hard to predict what’s coming because there are a lot of variations of these pandemics.”

Trump’s key Cabinet officials who will be overseeing the federal response have given little insight into their strategy.

Rollins said during her Senate confirmation hearing last month that one of her top four priorities would be to put a team in place to stem the spread of avian flu, though she didn’t say what changes she would like to see the Agriculture Department make.

“There is a lot that I have to learn on this, and if confirmed, this will be, as I mentioned in my opening statement, one of the very top priorities,” Rollins said when asked about her response to avian flu. “We are hyperfocused on finding the team right now. I’m sure they’re already working. I have, obviously, respected the process and not gotten too involved. I know that the current team and the future team will be working hand in hand to do everything we can on animal disease.”

Health and Human Services Secretary Robert F. Kennedy Jr., who was confirmed by the Senate on Thursday, said during his confirmation hearing that he would focus more on tackling chronic disease, like heart disease and diabetes, and less on infectious diseases. When asked about devoting resources to avian flu during his confirmation hearing, Kennedy said he “intends to devote the appropriate resources to preventing pandemics. That’s essential for my job.”

Previously, Kennedy has said the currently available vaccines for avian flu that the U.S. has stockpiled may be dangerous and ineffective. Researchers are working on developing a new generation of avian flu vaccines based on the same mRNA technology used to develop the Covid vaccines, which Kennedy called the “the deadliest vaccine ever made,” though studies have shown it to be safe.

Kennedy has also been a proponent of drinking raw milk, which can put people at risk of foodborne illness, including avian flu. The CDC has warned that it might be possible to contract bird flu from drinking raw milk and urged Americans to drink only pasteurized milk.

Agriculture industry officials and infectious disease researchers have been calling on the federal government to significantly ramp up its response with greatly expanded testing, funding for research to better understand the virus and develop new treatments, and more assistance for dairy farmers to encourage them to test their cattle.

The United Egg Producers, an advocacy group for the egg industry, is urging the federal government and Congress to devote more resources to researching how the virus is spreading and evolving and to develop more effective and widespread vaccinations for animals. The industry group has also been calling for more rules and enforcement around the testing and movement of animals, and additional funding for local laboratories to provide quick and accurate test results.

“Our industry needs more from our state and federal government animal health partners — and we need it fast,” the United Egg Producers said in a statement.

The organization says its industry has lost more than 100 million egg-laying hens since 2022, including more than 29 million over the past four months. Once a flock of birds is infected with the highly pathogenic strain of the avian flu, the virus quickly spreads and is fatal in the vast majority of birds. When a flock becomes infected, farmers and veterinarians are supposed to notify the USDA, which will kill the entire flock and decontaminate the facilities. The federal government reimburses the farmers for the live birds that are culled in the process.

Public health researchers have said the Biden administration didn’t react quickly enough to stop the spread of the virus among dairy cattle after it was first detected in herds in March. It wasn’t until December that the Agriculture Department rolled out a national milk testing program, and three of the country’s top milk-producing states still aren’t a part of that federal surveillance effort.

The Trump administration will have to work with officials in states that still aren’t regularly testing their milk to try to get them on board, said Morrison. Texas’ state agriculture commissioner, Sid Miller, told NBC News that surveillance milk testing was unnecessary in Texas since there weren’t any active cases of bird flu in the state’s commercial cattle or poultry.

“From April until the end of the Biden administration, the response was slow and sluggish,” said Morrison. “We are still not testing animals and humans at the level that is needed, we still don’t have a coherent strategy and a system of accountability, and we still don’t have in place the kind of compensation mechanisms needed for those dairy farmers who suffer losses because of infections in their herds.”

Researchers worry the U.S. is running out of time to strengthen its response.

“If we don’t act now, we’re only giving the virus more opportunity to continue to adapt and potentially evolve into something more dangerous in a human population,” said Erin Sorrell, a senior scholar at the Johns Hopkins Center for Health Security. “Now is the time to act.”


Shannon Pettypiece

Sonya Stokes, an emergency room physician in the San Francisco Bay Area, braces herself for a daily deluge of patients sick with coughs, soreness, fevers, vomiting, and other flu-like symptoms.

She’s desperate for information, but the Centers for Disease Control and Prevention, a critical source of urgent analyses of the flu and other public health threats, has gone quiet in the weeks since President Donald Trump took office.

“Without more information, we are blind,” she said.

Flu has been brutal this season. The CDC estimates at least 24 million illnesses, 310,000 hospitalizations, and 13,000 deaths from the flu since the start of October. At the same time, the bird flu outbreak continues to infect cattle and farmworkers. But CDC analyses that would inform people about these situations are delayed, and the CDC has cut off communication with doctors, researchers, and the World Health Organization, say doctors and public health experts.

“CDC right now is not reporting influenza data through the WHO global platforms, FluNet [and] FluID, that they’ve been providing information [on] for many, many years,” Maria Van Kerkhove, interim director of epidemic and pandemic preparedness at the WHO, said at a Feb. 12 press briefing.

“We are communicating with them,” she added, “but we haven’t heard anything back.”

On his first day in office, President Donald Trump announced the U.S. would withdraw from the WHO.

A critical analysis of the seasonal flu selected for distribution through the CDC’s Health Alert Network has stalled, according to people close to the CDC. They asked not to be identified because of fears of retaliation. The network, abbreviated as HAN, is the CDC’s main method of sharing urgent public health information with health officials, doctors, and, sometimes, the public.

A chart from that analysis, reviewed by KFF Health News, suggests that flu may be at a record high. About 7.7% of patients who visited clinics and hospitals without being admitted had flu-like symptoms in early February, a ratio higher than in four other flu seasons depicted in the graph. That includes 2003-04, when an atypical strain of flu fueled a particularly treacherous season that killed at least 153 children.

Without a complete analysis, however, it’s unclear whether this tidal wave of sickness foreshadows a spike in hospitalizations and deaths that hospitals, pharmacies, and schools must prepare for. Specifically, other data could relay how many of the flu-like illnesses are caused by flu viruses — or which flu strain is infecting people. A deeper report might also reveal whether the flu is more severe or contagious than usual.

“I need to know if we are dealing with a more virulent strain or a coinfection with another virus that is making my patients sicker, and what to look for so that I know if my patients are in danger,” Stokes said. “Delays in data create dangerous situations on the front line.”

Although the CDC’s flu dashboard shows a surge of influenza, it doesn’t include all data needed to interpret the situation. Nor does it offer the tailored advice found in HAN alerts that tells health care workers how to protect patients and the public. In 2023, for example, a report urged clinics to test patients with respiratory symptoms rather than assume cases are the flu, since other viruses were causing similar issues that year.

“This is incredibly disturbing,” said Rachel Hardeman, a member of the Advisory Committee to the Director of the CDC. On Feb. 10, Hardeman and other committee members wrote to acting CDC Director Susan Monarez asking the agency to explain missing data, delayed studies, and potentially severe staff cuts. “The CDC is vital to our nation’s security,” the letter said.

Several studies have also been delayed or remain missing from the CDC’s preeminent scientific publication, the Morbidity and Mortality Weekly Report. Anne Schuchat, a former principal deputy director at the CDC, said she would be concerned if there was political oversight of scientific material: “Suppressing information is potentially confusing, possibly dangerous, and it can backfire.”

CDC spokesperson Melissa Dibble declined to comment on delayed or missing analyses. “It is not unexpected to see flu activity elevated and increasing at this time of the year,” she said.

A draft of one unpublished study, reviewed by KFF Health News, that has been withheld from the MMWR for three weeks describes how a milk hauler and a dairy worker in Michigan may have spread bird flu to their pet cats. The indoor cats became severely sick and died. Although the workers weren’t tested, the study says that one of them had irritated eyes before the cat fell ill — a common bird flu symptom. That person told researchers that the pet “would roll in their work clothes.”

After one cat became sick, the investigation reports, an adolescent in the household developed a cough. But the report says this young person tested negative for the flu, and positive for a cold-causing virus.

Corresponding CDC documents summarizing the cat study and another as-yet unpublished bird flu analysis said the reports were scheduled to be published Jan. 23. These were reviewed by KFF Health News. The briefing on cats advises dairy farmworkers to “remove clothing and footwear, and rinse off any animal biproduct residue before entering the household to protect others in the household, including potentially indoor-only cats.”

The second summary refers to “the most comprehensive” analysis of bird flu virus detected in wastewater in the United States.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, said delays of bird flu reports are upsetting because they’re needed to inform the public about a worsening situation with many unknown elements. Citing “insufficient data” and “high uncertainty,” the United Kingdom raised its assessment of the risk posed by the U.S. outbreak on dairies.

“Missing and delayed data causes uncertainty,” Nuzzo said. “It also potentially makes us react in ways that are counterproductive.”

Another bird flu study slated for January publication showed up in the MMWR on Feb. 13, three weeks after it was expected. It revealed that three cattle veterinarians had been unknowingly infected last year, based on the discovery of antibodies against the bird flu virus in their blood. One of the veterinarians worked in Georgia and South Carolina, states that haven’t reported outbreaks on dairy farms.

The study provides further evidence that the United States is not adequately detecting cases in cows and people. Nuzzo said it also highlights how data can supply reassuring news. Only three of 150 cattle veterinarians had signs of prior infections, suggesting that the virus doesn’t easily spread from the animals into people. More than 40 dairy workers have been infected, but they generally have had more sustained contact with sick cattle and their virus-laden milk than veterinarians.

Instead, recently released reports have been about wildfires in California and Hawaii.

“Interesting but not urgent,” Nuzzo said, considering the acute fire emergencies have ended. The bird flu outbreak, she said, is an ongoing “urgent health threat for which we need up-to-the-minute information to know how to protect people.”

“The American public is at greater risk when we don’t have information on a timely basis,” Schuchat said.

This week, a federal judge ordered the CDC and other health agencies to “restore” datasets and websites that the organization Doctors for America had identified in a lawsuit as having been altered. Further, the judge ordered the agencies to “identify any other resources that DFA members rely on to provide medical care” and restore them by Feb. 14.

In their letter, CDC advisory committee members requested an investigation into missing data and delayed reports. Hardeman, an adviser who is a health policy expert at the University of Minnesota, said the group didn’t know why data and scientific findings were being withheld or removed. Still, she added, “I hold accountable the acting director of the CDC, the head of HHS, and the White House.”

Hardeman said the Trump administration has the power to disband the advisory committee. She said the group expects that to happen but proceeded with its demands regardless.

“We want to safeguard the rigor of the work at the CDC because we care deeply about public health,” she said. “We aren’t here to be silent.”

Amy Maxmen: amaxmen@kff.org

CNN
—
Blood testing of large-animal veterinarians suggests that H5N1 bird flu has spread more widely than US surveillance of the virus is capturing, according to a new study by federal and state disease detectives.

The study comes as Ohio announced its first human case of H5N1 in a poultry worker who was hospitalized with respiratory symptoms but has since recovered.

The new study of vets found that three of the 150 who signed up to be tested – or 2% – had antibodies against bird flu in their blood. Antibodies indicate that the vets were infected with bird flu, although they didn’t have symptoms.

It is one of three studies on bird flu that were delayed after the Trump administration issued a pause on outside communications from federal health agencies last month.

The study on blood testing of vets who treat cows was released Thursday in the Morbidity and Mortality Weekly Report, which is published by the US Centers for Disease Control and Prevention.

The other studies, which still have not been released, reportedly detail transmission between cats infected with bird flu and people in the same household, and discuss H5N1 detections in wastewater.

Blood tests in veterinarians
For the research, called a seroprevalence study because it looks for evidence of infections in the blood to try to determine a population’s exposure to disease, researchers from the CDC and the Ohio Department of Health went to the annual meeting of the American Association of Bovine Practitioners, which was held in September in Columbus.

Before the meeting, the CDC emailed members to ask whether they’d like to participate. It enrolled 150 veterinarians from 46 states and Canada who had their blood drawn at the conference. Just over half were from states known to have positive dairy herds, and 1 in 4 said they’d worked with infected cattle.

Three vets’ blood tests came back positive for antibodies to the H5N1 virus, even though none of them had experienced any memorable symptoms or worked with cows that had tested positive for H5N1. One vet who had antibodies had worked with infected poultry, however, according to the study.

One veterinarian who tested positive said they’d treated cattle in Georgia and South Carolina, two states with no reported infections in cows.

The report’s authors write that their findings suggest there may be H5N1 infections in cows in states that haven’t reported any, and they highlight the need for faster and more comprehensive testing of animals and milk to identify infected herds.

Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University, said the study had good news and bad news.

The bad news, she said, is that bird flu is spreading where we don’t have eyes on it.

“I think the bottom line here is that there are vets who may have been infected in states that hadn’t reported outbreaks, which is bad,” Nuzzo said. “It speaks to the need to improve our surveillance so that we can better detect when outbreaks are occurring on farm so we can protect people.”

The good news is that the researchers didn’t see evidence of a large number of under-the-radar infections.

“We’re not missing some huge submerged iceberg of mild infections that would possibly make us think that this virus could be much milder than what it has historically been,” Nuzzo said.

Other experts said the study spoke to some of the challenges veterinarians face in protecting themselves from the virus.

“This report tells us is that this virus can infect and present without symptoms in animals and that enough virus is shed either directly from animal to veterinarian or via touching surfaces to infect the vet,” said Dr. Erin Sorrell, a senior scholar at the Johns Hopkins Center for Health Security. Nuzzo and Sorrell did not work on the new study.

Bird flu infections in humans remain rare
There is no evidence that H5N1 is spreading from person to person. The CDC says the risk to the public remains low, although people who work on farms and with infected animals, or who have backyard poultry flocks, are at higher risk of an H5N1 infection.

Since March 2024, there have been 68 confirmed H5N1 infections in people in the US. All but three have had known exposures to animals.

Two of those cases have been severe, including an older person in Louisiana who died last year.

The most recent serious infection was a farm worker in Ohio who had contact with infected birds. Ohio announced its first bird flu case in a human on Wednesday.

That person was hospitalized with respiratory symptoms but has since recovered, according to a health official familiar with the details of the case who was not authorized to speak to the media.

The subtype of the virus has not been confirmed, but it is probably the newer strain, D1.1, the official said.

A new study published by the U.S. Centers for Disease Control and Prevention shows that the H5N1 bird flu virus is probably circulating undetected in livestock in many parts of the country and may be infecting unaware veterinarians.

In the health agency’s Morbidity and Mortality Weekly Report, a group of researchers from the CDC, the Ohio Department of Health and the American Assn. of Bovine Practitioners, reported the results of an analysis they conducted on 150 bovine, or cow, veterinarians from 46 states and Canada.

They found that three of them had antibodies for the H5N1 bird flu virus in their blood. However, none of the infected vets recalled having any symptoms — including conjunctivitis, or pink eye, the most commonly reported symptom in human cases.

The three vets also reported to investigators that they had not worked with cattle or poultry known to be infected with the virus. In one case, a vet reported having practiced only in Georgia (on dairy cows) and South Carolina (on poultry) — two states that have not reported H5N1 infections in dairy cows.

Seema Lakdawala, a microbiologist at Emory University in Atlanta — who was not involved in the research — said she was surprised that only 2% of the veterinarians surveyed tested positive for the antibodies, considering another CDC study showed that 17% of dairy workers sampled had been infected. But she said she was even more surprised that none of them had known they were infected or that they had worked with infected animals.

“These surprising results indicate that serum surveillance studies are important to inform risk of infections that are going undiagnosed,” she said. “Veterinarians are on the front line of the outbreak, and increased biosafety practices like respiratory and eye protection should reduce their exposure risk.”

Jennifer Nuzzo, director of the Pandemic Center at Brown University, described the study as a “good and bad news story.”

“On one hand, we see concerning evidence that there may be more H5N1 outbreaks on farms than are being reported,” she said. “On the other hand, I’m reassured that there isn’t evidence that infections among vets have been widespread. This means there’s more work that can and should be done to prevent the virus from spreading to more farms and sickening workers.”

The analysis was conducted in September 2024. At that time, there had been only four human cases reported, and the infection was believed to be restricted to dairy cattle in 14 states. Since then, 68 people have been infected — 40 working with infected dairy cows — and the virus is reported have infected herds in 16 states.

John Korslund, a retired U.S. Department of Agriculture scientist, said in an email that finding H5N1 antibodies in the blood of veterinarians was an interesting “but very imprecise way to measure state cattle incidence.” But it underscored “that humans ARE susceptible to subclinical infections and possible reassortment risks, which we already knew, I guess.”

Reassortment occurs when a person or animal is infected with more than one influenza virus, allowing the two to mingle and exchange “hardware,” potentially creating a new, more virulent strain.

More important, he said, the D1.1 version of the strain — which has been detected in Nevada dairy cattle and one person living in the state — is “changing the landscape. ... [P]eople may be more more susceptible (or not) with a greater potential for severeness (or not).”

“I’m confident that we’ll find it in other states. Its behavior and transmissibility within and between cattle herds is still pretty much a black box,” he said.

Copyright Los Angeles Times Communications LLC 2025

In October, Stanford University professor Jay Bhattacharya hosted a conference on the lessons of COVID-19 in order “to do better in the next pandemic.” He invited scholars, journalists, and policy wonks who, like him, have criticized the U.S. management of the crisis as overly draconian.

Bhattacharya also invited public health authorities who had considered his alternative approach reckless. None of them showed up.

Now, the “contrarians” are seizing the reins: President Donald Trump has nominated Bhattacharya to lead the National Institutes of Health and Johns Hopkins University surgeon Marty Makary to run the Food and Drug Administration. Yet the polarized disagreements about what worked and what didn’t in the fight against the biggest public health disaster in modern times have yet to be aired in a nonpartisan setting — and it seems unlikely they ever will be.

“The whole COVID discussion turned into culture war dialogue, with one side saying, ‘I believe in the economy and liberty,’ and the other saying, ‘I believe in science and saving people’s lives,’” said Philip Zelikow, a scholar and former diplomat based at Stanford’s Hoover Institution.

Frances Lee, a Princeton University political scientist, has a book coming out that calls for a national inquiry to determine the lockdown and mandate approaches that were most effective.

“This is an open question that needs to be confronted,” she said. “Why not look back?”

For now, even with the threat of an H5N1 bird flu pandemic on the horizon, and some other plague waiting in the wings of a bat or goose in a far-flung corner of the world, U.S. public health officials face ebbing public trust as well as a disruptive new health administration led by skeptics of established medicine.

Zelikow led the 34-member COVID Crisis Group, funded by four private foundations in 2021, whose work was intended to inform an independent inquiry along the lines of the 9/11 Commission, which Zelikow headed.

The COVID group published a book detailing its findings, after Congress and the Biden administration abandoned initiatives to create a commission.

That was a shame, said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, because “while there are some real ideological battles over COVID, there’s also lots of stuff that potentially could be fixed related to government efficiency and policy.”

...

Channel 9 is the Educational Access Channel. All public, parochial or other non-profit schools recognized by the State Department of Education are eligible for programming on Channel 9. Also eligible; U-Mass Dartmouth and Bristol Community College. Types of programs that are aired on Channel 9 include school graduations, concerts & plays, School Committee meetings, reading programs, educational forums and school athletic events. Education Access Programming – Channel 9 918 S. Rodney French Blvd. – New Bedford, MA 02744 Tel: 508-979-1775 – Fax: 508-979-1764

Dr Wilmot James is a Professor in the School of Public Health, Brown University. He served as a Member of Parliament in South Africa between 2009 and 2017, and Federal Chairperson of the Democratic Alliance (DA) between 2010 and 2016.

For the likes of Trump and Musk, human misfortune appears as if it is mere collateral damage in the longer-term effort to engineer their version of sustainable Western civilisation, on Earth as it will be on Mars.

Nelson Mandela spent 27 years in prison for his beliefs. He emerged with an enduring desire to establish a democratic and free society for all and not just some. He believed that South Africa could only succeed if the assets and talents of everyone including all minority populations were included in a forward-looking historical project for South Africa he called nation-building.

It is with the greatest regret that US President Donald Trump and his helper Elon Musk today seek to undo and shatter the peacemaking efforts of one of the greatest leaders of the 20th century.

Today the world’s most powerful man has struck a bargain with the world’s wealthiest man to bully South Africa into change by energising a small group of disgruntled extremists, destabilising the country’s politics and punishing its people.

South Africa’s Expropriation Act 13 of 2024 is merely a hook by which they launched their efforts, by twisting a law that is not race-based into one that supposedly is, thereby igniting the energies of a South African domestic constituency to join their global cause. In this effort, they join Steve Bannon, widely regarded as the Lenin of the Right.

...

CNN reports a Nevada dairy worker may have been infected by deadly D1.1 version of H5N1 bird flu
Worker shows only mild symptoms
Genetic analyses of this version show changes that could make it pass more easily between people
A dairy worker in Nevada may have tested positive for a strain of H5N1 bird flu known to have killed one person and severely sickened another.

CNN reported Saturday night that a worker tested positive for the D1.1 version of the H5N1 bird flu virus. Confirmation testing by the Centers for Disease Control and Prevention is underway.

The report has not been confirmed by the CDC or Nevada’s Department of Health and Human Services.

According to CNN, the person’s symptoms include conjunctivitis, or pink eye — a common symptom that has been seen in people who have been exposed to the virus in North America since March 2024, when the virus was first reported in Texas dairy herds.

Since that time, 67 people have been infected with H5N1 bird flu. In 63 of those cases, workers picked up the virus while working with infected animals; 40 got it working with dairy cattle, 23 with infected poultry. In three cases, the source of exposure was not determined. And in one case, a person got it from handling sick and or dead birds in a backyard flock. That person died.

Last week, federal health officials announced that at least four dairy herds in Nevada had been infected by a strain of the H5N1 bird flu that is circulating in wild birds and that led to the death of one person in Louisiana and several sickened a teenager in Canada. That strain is called D1.1, and it is slightly different than the one that had been circulating widely in the nation’s dairy herds, which is called B3.13.

The news comes on the heels of a U.S. Department of Agriculture report that examined the D1.1 strain found in the Nevada dairy cows and found changes in the genetic code thought to help the virus copy itself more easily in mammals, including humans.

Researchers have not been able to determine how the wild bird version of the virus spilled into Nevada herds, although there were reports of massive bird die-offs in the area during that period.

Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, said if confirmed, it’s a relief this latest dairy worker is reported to have only shown mild symptoms, but she underscored how little we actually know about who gets sick and why when it comes to H5N1 bird flu.

She said there are several hypotheses floating around about why most dairy workers have, thus far, only shown mild symptoms after infection when compared to the severe cases reported in two people who had been exposed to D1.1. (Several poultry workers in Washington were also exposed to D1.1 while depopulating an infected poultry operation. While many had respiratory symptoms, they were considered mild cases by public health officials.)

One of those theories is that the H5N1 B3.13 version is less dangerous than D1.1, she said.

“I’ve not been convinced of that,” she said.

Now seeing someone having milder infection with D 1.1, “I think, just raises more questions about why some people have severe illness and why some people don’t,” she said. “I would argue that at this point, we have no idea ... and we shouldn’t assume that just because someone was exposed to one variant or another means they’re going to have mild or severe illness. ... We shouldn’t assume that H5N1 is in any way destined to be a mild virus. And for that reason, we need to treat each infection with caution and work to prevent future infections.”

Asked if she was surprised that roughly one year into the outbreak of H5N1 bird flu in dairy cattle people are still getting sick and infected, she said “no.”

Little has been done to increase the protection of dairy workers against this virus, she said, and health officials have not “done much to try to stay ahead of how this virus is transmitting and where.”

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Here & Now's Scott Tong speaks with epidemiologist Jennifer Nuzzo about the rising cases and different strains of the bird flu popping up all over the country.

On this edition of Your Call, we discuss Trump administration's attack on public health.

We also look the consequences for public health and vaccines should RFK Jr. – who is now headed to the Senate for a confirmation vote and bird flu’s unprecedented spread in livestock and other mammals – including human cases – amid concerns it could become the next pandemic to hit the U.S. if these outbreaks are not properly addressed.

Guests:

Dr. Jenner Nuzzo, Professor of Epidemiology and Director of the Pandemic Center at Brown University School of Public Health

Dr. Paul Offit, Professor at the Perelman School of Medicine at the University of Pennsylvania and the Director of the Vaccine Education Center at Children’s Hospital of Philadelphia

The data, which appeared fleetingly online on Wednesday, confirmed transmission in two households. Scientists called on the agency to release the full report.

Cats that became infected with bird flu might have spread the virus to humans in the same household and vice versa, according to data that briefly appeared online in a report from the Centers for Disease Control and Prevention but then abruptly vanished. The data appear to have been mistakenly posted but includes crucial information about the risks of bird flu to people and pets.

In one household, an infected cat might have spread the virus to another cat and to a human adolescent, according to a copy of the data table obtained by The New York Times. The cat died four days after symptoms began. In a second household, an infected dairy farmworker appears to have been the first to show symptoms, and a cat then became ill two days later and died on the third day.

The table was the lone mention of bird flu in a scientific report published on Wednesday that was otherwise devoted to air quality and the Los Angeles County wildfires. The table was not present in an embargoed copy of the paper shared with news media on Tuesday, and is not included in the versions currently available online. The table appeared briefly at around 1 p.m., when the paper was first posted, but it is unclear how or why the error might have occurred.

The virus, called H5N1, is primarily adapted to birds, but it has been circulating in dairy cattle since early last year. H5N1 has also infected at least 67 Americans but does not yet have the ability to spread readily among people. Only one American, in Louisiana, has died of an H5N1 infection so far.

The report was part of the C.D.C.’s prestigious Morbidity and Mortality Weekly Report, which, until two weeks ago, had regularly published every week since the first installment decades ago. But a communications ban on the agency had held the reports back, until the wildfire report was published on Wednesday.

Experts said that the finding that cats might have passed the virus to people was not entirely unexpected. But they were alarmed that the finding had not yet been released to the public.

“If there is new evidence about H5N1 that is been held up for political purposes, that is just completely at odds with what government’s responsibility is, which is to protect the American people,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health.

It was important that the C.D.C. immediately publish the full data and the context in which they were collected for other scientists to review, she said.

Scientists have long known that cats are highly susceptible to the virus. At least 85 domestic cats have been infected since late 2022, according to the U.S. Department of Agriculture. But there had not previously been any documented cases of cats passing the virus to people.

Although cats may be infected when they prey on infected wild birds, cases among domestic cats in the United States began rising last year as the virus spread through dairy farms. On many farms, dead cats were the first signal that cows had been infected. Several recent cases in pet cats have also been linked to contaminated raw pet food or raw milk.

H5N1 is often fatal in cats, which may develop severe neurological symptoms.

Historically, H5N1 has primarily affected birds. But over the last several years, new versions of the virus have proved capable of infecting a wide range of mammals, including wild and domestic cats, seals and dairy cows. Infections in mammals give the virus more opportunities to evolve in ways that could allow it to infect humans more easily.

Copyright 2025 The New York Times Company

If it seems like almost everyone you know is getting sick with influenza or some other virus right now, it’s not your imagination. The Northern Hemisphere’s respiratory illness season, which typically runs from October to May, is in full swing. Flu hospitalizations appear to have declined from an initial peak in January, but they remain high, and cases may be rebounding. Levels of the virus that causes COVID detected in wastewater are also high and may be rebounding. And respiratory syncytial virus (RSV) is still putting people in the hospital, albeit at lower levels than flu or COVID. Yet despite all the sniffles, it’s shaping up to be a fairly typical year for respiratory viruses.

Flu
So far, this year’s flu season looks pretty similar to that of previous years—with the exception of 2020–2021, when flu all but disappeared because of COVID-related masking and social distancing measures. This season’s weekly hospitalization rate reached a peak around January 4 and then appeared to decline, though the Centers for Disease Control and Prevention indicated there may be possible delays in reporting. The latest positive test rate data (some of which were released several days late under the new presidential administration) show a slight rebound in infections, so we may not be out of the woods. There have been some reports that this year’s flu vaccine might be less effective than in previous years, which could explain the apparent high levels of sickness that are currently around. But this season doesn’t seem to be particularly more severe than others.

This year’s flu season started a bit late, says Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health. But we’re still in the thick of it, she says. “I don’t know how it’s going to play out,” Nuzzo adds.

To prevent becoming seriously ill with flu, health officials still recommend getting the flu vaccine if you haven’t already, especially if you are age 65 or older or have underlying health conditions. Masking, avoiding crowds and being in well-ventilated spaces are always helpful at reducing the chance of getting infected. And if you should test positive for flu, antiviral drugs such as Tamiflu are available by prescription.

The fact that this year’s season started slightly later than last year’s is a relief, Nuzzo says, in light of the ongoing H5N1 avian influenza outbreaks in cows and poultry that have caused 67 human infections and one death in the U.S. Nuzzo is worried about people getting infected with both H5N1 and seasonal flu—a situation that could increase the risk of bird flu adapting to humans and becoming a pandemic. “I’m a bit relieved because I was fretting about the co-occurrence of H5N1 and seasonal influenza,” she says. “I’m worried about humans getting infected with both viruses.”

...

Bird flu is spreading fast. The virus is infecting chickens, ducks, turkeys and cows across the U.S. and Ohio is leading the nation in cases. Nearly 9 million birds have been affected, mainly in Western counties like Darke and Mercer.

Ohio is the second-largest producer of eggs in the country, so officials believe this outbreak will have devastating impacts on the poultry industry nationwide.

Tuesday on the "Sound of Ideas," we'll talk about H5N1 virus that is continuing to adapt and has started infecting humans.

As of January, 67 people were infected by a strain of the virus called H5N1, according to the Centers for Disease Control. The first death occurred on Jan. 6.

While no human cases have been reported in the state, officials are working to contain the outbreak by euthanizing infected flocks and composting the carcasses.

For now, humans are at low risk for contracting the virus, but experts say this may change as cases continue to rise.

Later in the hour, we'll talk about an exciting opportunity for commercial astronauts in Northeast Ohio. They'll have the chance to study and experience extreme levels of gravity thanks to a new agreement between NASA Glenn's Research Center and Blue Abyss, a U.K. based commercial aeronautics company.

Blue Abyss plans to study human spaceflight, training and simulations of extreme environments- preparing for challenges in low-Earth orbit, on the moon and on Mars.

The company purchased 12 acres of land from the city of Brook Park to build its first American campus, which is still in the early stages. The project is estimated to cost upwards of $253 million when construction is completed.

Guests:
-Dr. Amy Edwards, M.D., Pediatric Infectious Diseases, University Hospitals
-Dr. Jennifer Nuzzo, Dr. P.H., Director of the Pandemic Center, Professor of Epidemiology, Brown University
-Brian Baldridge, Director, Ohio Department of Agriculture
-Josh Freeh, Manager, Human Exploration and Space Operations Project Office, NASA Glenn Research Center
-Edward Orcutt, Mayor, City of Brook Park
-John Vickers, CEO, Blue Abyss

When Rwanda announced an outbreak of the highly infectious Marburg disease in September, partners from around the world, including the U.S. Agency for International Development (USAID), provided emergency funding to help curb it. Marburg kills 88% of the people who catch it, but this funding, in conjunction with efforts from the Rwandan ministry of health, rapidly contained and treated 51 of 66 cases in what was thought to have largely been a public health victory.

On the day of President Donald Trump’s inauguration, another Marburg outbreak was announced in Tanzania, where the virus has thus far killed at least eight people. Meanwhile, Ebola (a virus similar to Marburg, also with a high fatality rate) was recently detected in Uganda; public health officials are struggling to contain mpox in Africa; and H5N1, the virus commonly referred to as bird flu continues to infect an unprecedented number of people and species around the globe.

Many are concerned that the Trump Administration’s actions in the first two weeks of operation, including signaling that he would withdraw from the World Health Organization (WHO) and issuing a freeze on public health communications, are hampering the nation’s potential to respond to these various infectious disease threats at a time when protective measures need to be ramped up most.

“It’s just a sucker punch in your gut,” said Dr. Syra Madad, an infectious disease epidemiologist at NYC Health and Hospitals. “These threats are not going away — in fact, it’s the opposite. They are increasing.”

Since the U.S. helped found the WHO in 1948, its partnership with the global health agency and its member countries has helped curb countless outbreaks, including ending smallpox and bringing polio to the brink of eradication. The U.S. is the largest donor to the agency in the world.

The partnership with the WHO facilitates U.S. participation in various global surveillance systems for infectious disease threats that could touch down in the country. It allows the U.S. and participating countries to share vaccine stockpiles, pool international data about infectious disease risks, and even send public health workers to countries with outbreaks to help with contract tracing and other surveillance efforts.

Withdrawing from the WHO would mean forgoing these existing networks and destroy trust that has been built up over decades of international collaborations.

“They’re not looking at the damage this is going to cause the United States’ credibility," Madad told Salon in a phone interview. "When the next administration comes around, it’s going to undermine the United States’ leadership in public health."

In the Democratic Republic of the Congo, where another suspected Ebola outbreak was recently reported, unrelated violence erupted in the capital city of Kinshasa, motivating the U.S. to close its embassy there and remove staff, said Dr. Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.

“You have a possible Ebola outbreak happening in the country at the same time you are trying to repatriate Americans,” Nuzzo told Salon in a phone interview. “To not be able to talk to the partners that may know what is going on to help assess risks and what it means for people returning … you start to see what we lose by not being able to engage.”

...

By Elizabeth Hlavinka
Elizabeth Hlavinka is a staff writer at Salon covering health and drugs. She specializes in exploring taboo topics and complex questions that help humans understand their place in the world.

MORE FROM Elizabeth Hlavinka

Days after President Donald Trump took office, the Department of Health and Human Services imposed an indefinite "pause" on communications, silencing the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR) for the first time in it 60 years of existence. The journal, which once documented the first AIDS cases, has missed two editions with no return date.

MMWR "is really important for states to read to have a more in-depth understanding of what might be going on and what to do about it," Jennifer Nuzzo, director of the Pandemic Center at Brown University, told AFP, calling the pause a "radical departure" from norms.

The overall communications freeze has also prevented federal officials from updating the public or even state and local officials on bird flu, which has so far killed one person and sickened dozens, said Nuzzo.

Meanwhile, CDC scientists have been instructed to retract or revise all papers submitted to external journals to remove language deemed offensive -- including the word "gender," Jeremy Faust, a physician and Harvard instructor who runs the Inside Medicine Substack, was the first to report.

Nuzzo stressed that gender identity, not just biological sex, is crucial in targeting interventions, as seen with mpox, which disproportionately affects men who have sex with men and transgender women.

- Critical resources for doctors scrubbed -

Doctors were blindsided by the sudden removal of a CDC app that assessed contraceptive suitability based on medical history -- for example, progestin-only pills are advised for patients with liver disease.

Also deleted: CDC pages containing clinical guidance for PrEP (a critical HIV-prevention tool), resources on intimate partner violence, guidelines on LGBTQ behavioral health, and more.

"I'm really not sure what is so radically leftist about treating gonorrhea," Natalie DiCenzo, an obstetrician-gynecologist and member of Physicians for Reproductive Health, told AFP, on the removal of STI guidelines.

Some pages have since been restored but now carry an ominous disclaimer: "CDC's website is being modified to comply with President Trump's Executive Orders."

Jessica Valenti, a feminist author and founder of the Abortion, Every Day Substack, has been archiving deleted materials on CDCguidelines.com to preserve their original, inclusive versions.

"The hope is to have it be a resource for the people who need it," she told AFP, adding that even if documents are later restored, words like "trans" may be scrubbed from them.

"Deleting data of groups of people who are clearly not prioritized by this administration is essentially erasing them," Angela Rasmussen, a prominent US virologist told AFP. "It's going to cause people to suffer, and die."

- Infectious outbreaks unreported -

As medical associations sound the alarm over the lack of federal health communication, outbreaks are slipping under the radar.

In Kansas City, Kansas, what is reportedly the largest tuberculosis outbreak in modern US history is unfolding -- with 67 active cases since 2024. Yet no national health authority has reported on it.

"The National Medical Association (NMA) is calling for a swift resolution to the federal health communications freeze, which has the potential to exacerbate this outbreak and other public health threats," wrote the group, which represents African American physicians.

Caitlin Rivers, senior scholar at the Center for Health Security at Johns Hopkins University, writes a weekly newsletter updating readers on disease outbreaks in her free time, relying on CDC data for influenza tracking.

"The last two weekends, I have had to compile data by hand because key data sources have been unavailable," she told AFP.

© 2025 AFP

Several US Centers for Disease Control and Prevention websites and datasets related to HIV, LGBTQ people, youth health behaviors and more have been removed after the agency was directed to comply with executive orders from President Donald Trump. Epidemiologist Dr. Jennifer Nuzzo explains the consequences.

Just as Massachusetts is experiencing a large outbreak of avian flu, the flow of scientific information from the federal government that state officials need to combat the outbreak has become unreliable.

It’s a lot more than just birds that could be affected if updates do not resume on a consistent basis: Aggressively responding to the disease when it’s mostly affecting birds and livestock is the best way to ensure it doesn’t spread further to humans.

In a call with reporters Wednesday, state ornithologist Andrew Vitz said between 500 and 1,000 suspected cases of avian flu have been reported in wild birds in Massachusetts (there may be multiple reports about each bird). The actual number of infected wild birds is likely much higher.

Some domestic birds have also been affected. One 30-bird flock of domestic chickens in Plymouth had to be euthanized because of infections.

Highly Pathogenic Avian Influenza, or H5N1, can be fatal to birds. Waterfowl and aquatic birds are most at risk, along with raptors that eat bird carcasses. Avian flu has also spread to dairy cows, with around 950 infected herds reported nationwide, although none so far in Massachusetts. Most worryingly, there have been 67 reported human cases and one death, according to the US Centers for Disease Control and Prevention, almost all of them among people exposed to infected birds or cattle. The biggest fear about avian flu is that it will mutate to a form that’s more dangerous to people.

Soon after he took office, President Trump imposed a freeze on federal health agencies’ meetings and public communications. Despite that, the US Department of Agriculture is updating its public website about the number of bird flocks affected by flu and the CDC is updating its tally of infected dairy cow herds.

But researchers say there has been less communication over the last two weeks than before from the federal government.

Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, said the CDC canceled all of the regular informational calls and briefings it typically holds with state and local public health partners.

Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory, said in an email that in addition to the lack of updates to stakeholders, groups at the CDC and National Institutes of Health that do work related to the avian flu were put on hold. “The confusion over messaging and who can say what or anything is complicating matters at a bad time,” Poulsen said.

Kaiser Health News reported that the Trump administration stopped the publication of new studies related to whether veterinarians who treat cattle have been infected by bird flu and whether infected people have spread the virus to pet cats. The studies had been scheduled to be released in the CDC’s Morbidity and Mortality Weekly Report, a weekly publication that, as of Thursday, has not published since Jan. 16.

Massachusetts state epidemiologist Catherine Brown said the communications freeze is a “disappointment,” but if the pause is only two weeks, it is unlikely to result in a significant impact on the state’s ability to track or respond to avian flu. The Trump administration has called the pause short-term, but it is unclear when communications might fully resume. Massachusetts is continuing to communicate with officials in other Northeast states and national professional organizations of epidemiologists and public health labs.

For now, state recommendations are to follow basic precautions: Stay away from sick or dead birds; report sick poultry to state wildlife officials; keep cats indoors and pets away from wildlife; eliminate standing water; isolate new birds before adding them to a flock; and take biosecurity measures around domestic birds, like disinfecting equipment.

Going forward, it will be important for scientists and health officials to track the disease’s spread and continue learning about how it is transmitted, who is at risk, and what preventative measures and treatments are recommended. Federal government agencies like the CDC, USDA, and NIH are well-poised to do this research and communicate their findings nationwide. Trump shouldn’t just let them do that; he should insist that they do.

Vague federal directives have led to frantic action, and perhaps overreaction, before a Friday deadline.

Federal and state health officials and staff members scrambled on Friday to comply with a 5 p.m. deadline by the Trump administration to terminate any programs that promote “gender ideology,” and to withdraw documents and any other media that may do so.

Federal workers had already been ordered to halt diversity, equity and inclusion initiatives, to scrub public references to those efforts and to place employees involved in them on administrative leave.

At federal health agencies, veterans hospitals, and local and state health departments, compliance took a variety of forms. At the Centers for Disease Control and Prevention, employees hurried to remove terms like “transgender,” “immigrant,” “L.G.B.T.” and “pregnant people” from the website.

Employees at some VA Hospitals were told that L.G.B.T.Q. flags and other displays were no longer acceptable, according to an administrative email reviewed by The New York Times.

Bathrooms at health agencies were to be set aside for use by a single “biological sex,” according to federal directives, and the word “gender” was to be removed from agency forms.

The instructions are a 180-degree pivot for health scientists and clinicians, who have worked for years to integrate diversity and equity into research and clinical services, including those for gay, lesbian and transgender individuals.

The directives “risk dismantling programs that have been built up over decades to serve the needs of Americans,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

“What I’m worried about here is that in this attempt to make headlines, we’re issuing very bold and broad statements,” she said of the administration.

The upheaval followed two executive orders that President Trump issued on Jan. 20. The one entitled “Ending Radical and Wasteful Government DEI Programs and Preferencing” terminated the federal government’s D.E.I. efforts.

The other, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” shut down governmental efforts to be more inclusive of a variety of gender expressions, including in scientific research.

In both instances, the federal Office of Personnel Management followed up with memos explaining how to carry out the changes and issuing deadlines. The memos affected a broad swath of programs at all levels of government, but details were sparse.

Some employees at the C.D.C. were befuddled by an order, for example, to delete mentions of gender from research databases, some dating back decades, as other government rules prohibit manipulation of scientific data.

Agency web pages that have been deleted as part of President Trump’s “Defending Women” initiative include ones about ending gender-based violence and supporting L.G.B.T.Q. youths, and another about racism in health.

C.D.C.’s AtlasPlus, which holds 20 years of surveillance data for H.I.V., tuberculosis, hepatitis B and other diseases, is missing.

Also removed were the pages of the C.D.C.’s Youth Risk Behavior Surveillance System, which surveys youngsters about dangerous activities like drinking and drug use, smoking and risky sexual behaviors that can lead to unintended pregnancies and sexually transmitted diseases.

The survey reported recently on the high rates of depression among teenage girls and lesbian, gay and bisexual youth.

Some directives from agency administrators, including one emailed to Veterans Affairs hospitals and reviewed by The Times, ordered the termination of “accessibility” programs, as well as other diversity and inclusion initiatives.

The hospitals treat military veterans, many of whom are disabled.

The C.D.C. itself told funding recipients on Wednesday that “any vestige, remnant, or renamed piece” of diversity programs funded by the federal government “are immediately, completely, and permanently terminated,” according to an unsigned memo obtained by The Times.

Diversity and inclusion programs at federal agencies have also been disbanded, and scientific work groups have been ordered to halt their activities, according to an email reviewed by The Times.

Public health experts warned that the D.E.I. prohibitions affect not only diversity in staffing, but health equity programs aimed at disadvantaged populations.

For example, some programs help seniors with low incomes gain access to vaccines and provide assistance to communities of color who are at increased risk of conditions like diabetes.

Including gender as a research factor in studies helps identify groups at risk of sexually transmitted infections like syphilis, which has reached its highest levels in 50 years.

“Health equity is basically all of public health,” Dr. Nuzzo said.

“This work and these data and these studies are really important for us to answer the essential question of public health, which is, Who is being affected and how do we best target our limited resources?” she said.

None of this would seem to align with the goals of Robert F. Kennedy Jr., President Trump’s nominee for health and human services secretary, who has made chronic diseases a main talking point. Most chronic conditions disproportionately affect people who are socially disadvantaged, including rural Americans and people of color.

Some state health administrators have interpreted the D.E.I. directives as applying only to hiring and promotion. Health programs that do outreach to disadvantaged populations, including ethnic and racial minority groups, will not be affected, they have told staff members.

But one employee at a state H.I.V. prevention program said the new edicts about gender may hamper the program.

“We are still not sure how this will affect our work if we are not allowed to talk about individuals who are transgender, as that is a lot of the population we work with in H.I.V.,” said the employee, who asked not to be identified for fear of retribution.

Some V.A. hospitals have warned employees that prohibited D.E.I. activities include “displaying of pride symbols, e.g. flags, lanyards, signature blocks, etc.,” prompting employees at New York hospitals to remove wall hangings that indicated they were welcoming to lesbian, gay and transgender patients.

Some asked their supervisors whether they also needed to remove books from their offices. The ambiguity of the federal directives, coupled with employees’ heightened anxiety, “may lead them to take a sledgehammer when they really need a scalpel,” Dr. Nuzzo said.

At one V.A. facility, administrators deleted all computer folders and files with the term “D.E.I.” in the name. “We gave them access to files and they disappeared from our folders,” said one employee speaking on condition of anonymity.

“I think no one knows what to say,” the employee said. “Everyone’s walking on eggshells.”

Agencies were instructed to turn off software features that prompted users to enter their pronouns in their signatures. The C.D.C. also deleted personal pronouns from its internal directory.

The administration has also threatened employees who don’t inform on colleagues who defy the orders or who try to “disguise these programs by using coded or imprecise language.”

Already, contractors working on health equity issues are being let go. At least one worker on a longtime contract was fired because of his role supporting such a project a year ago.

Some C.D.C. officials began preemptively censoring material that discussed health equity even before Mr. Trump took office.

Fearing that their programs would be shut down, they began deleting content from websites and holding back research findings, including those from a project that cost about $400,000.

But for other projects, merely snipping out mentions of equity or gender is impossible, because they are aimed specifically at reducing health disparities in chronic conditions.

“I don’t think that there’s anything that our division works on that wouldn’t have to stop,” said one C.D.C. employee who wished to remain anonymous for fear of retaliation.

Anticipating that the Trump administration may take aim at certain issues, some scientific groups have archived data related to H.I.V. and other sexually transmitted infections, as well as births and deaths, education, environment and housing.

On Friday, hundreds of scientists gathered for a “datathon,” in an attempt to preserve websites related to health equity.

“There’s been a history in this country recently of trying to make data disappear, as if that makes problems disappear,” said Nancy Krieger, a social epidemiologist at Harvard University and a co-leader of the effort.

“But the problems don’t disappear, and the suffering gets worse,” she said.

Ellen Barry contributed reporting.
Copyright 2025 The New York Times Company

A potential Ebola outbreak has been reported in a western part of the Democratic Republic of the Congo, in what would be the second viral hemorrhagic fever outbreak in the region at a time when the Trump administration has paused communication with the World Health Organization.

In addition to the possible Ebola outbreak, there is an outbreak of Marburg fever, caused by a related virus, in Tanzania, which shares a border with eastern DRC.

Global health experts said Tuesday that the news underscored how unwise it is for the United States to sever ties with the WHO. On Monday, staff of the Centers for Disease Control and Prevention — which typically coordinates closely with the WHO and provides expertise — were instructed not to interact with the Geneva-based global health agency following President Trump’s executive order saying that the United States would withdraw its membership.

“The agencies that are statutorily responsible for protecting our health are unable to do that job because they are not able to pick up the phone and talk to people who might have information that could protect U.S. health and security,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University’s School of Public Health.

“This is just one of the examples about how the United States loses access, loses the ability to protect American lives.”

A WHO official told STAT that 12 suspected cases of Ebola, including eight deaths, have been recorded in the Boyenge health area, in DRC’s Equateur province. The deaths occurred between Jan. 10 and 22.

Samples have been sent for testing to DRC’s National Institute of Biomedical Research, which is based in the Congolese capital of Kinshasa, the official said. If confirmed, this will be the fourth outbreak in Equateur province since 2018.

A new strain of avian influenza has been identified for the first time in the United States, raising concerns that the virus is transforming in a way that could eventually cause wider outbreaks among humans.

U.S. officials disclosed the discovery of the virulent H5N9 strain at a California duck farm in a report in recent days to the World Organization for Animal Health, which maintains a database of animal disease threats.

That disclosure comes as the United States confronts a growing outbreak of another bird flu strain, H5N1, that is spreading in poultry farms across the nation and has infected dairy cows for the first time. Human cases have been sporadic and confined mostly to dairy workers exposed to sick animals.

The H5N9 strain itself does not pose a grave threat to humans, officials and experts said.

But scientists are worried that the continuing spread of H5N1, alongside seasonal flu and other strains, could produce new versions of the virus that spread more easily among humans. That scenario is caused by "reassortment," the exchange of genetic material when hosts are infected with multiple versions of a virus.

The U.S. Agriculture Department's Animal and Plant Health Inspection Service, which is investigating the California outbreak, confirmed that the duck farm case does stem from reassortment of the H5N1 virus circulating in U.S. birds. But the agency said the finding was not unexpected.

Public health experts warn that previous bird flu pandemics have started because of reassortment.

"It does suggest there's enough virus around that reassortment might become more frequent," said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. "With enough H5 in these animals and enough seasonal flu in humans, you get them together, and you have a recipe for a potential pandemic virus."

Both H5N1 and H5N9 cases were discovered in a Merced County commercial duck meat farm in late November. State officials quarantined the facility, and nearly 120,000 birds were killed. Genetic sequencing in January confirmed the new strain, the first of its kind in the United States, triggering the report.

Steve Lyle, a spokesperson for the California Department of Food and Agriculture, another agency investigating the outbreak, said the agency is taking no additional action because the strain was not unexpected, the flock has been euthanized, and the farm would be cleaned and tested for viable virus before birds return.

The H5N9 strain is not completely unfamiliar. Less virulent versions have been discovered in birds in the United States previously, and highly virulent versions similar to that found in Merced County have been detected in other countries. Highly virulent versions are more likely to kill birds but are not necessarily a greater threat to humans.

Either way, health experts said the discovery underscores the urgency of containing H5N1. Even if there is no surge of humans killed or hospitalized, epidemiologist Jennifer Nuzzo said, an uncontained outbreak can be expensive.

"The fact that these [agricultural] operations are having to cull their flocks is costly. We see that when we look at the cost of eggs in the store," said Nuzzo, director of the Pandemic Center at Brown University's School of Public Health. "The fact that cows can continue to get infected is ultimately going to prove costly."

Copyright WP Company LLC d/b/a The Washington Post Jan 28, 2025

H5N1 avian influenza was detected in a flock of around 40 birds in Washington County, the Rhode Island Department of Environmental Management announced Friday.

RIDEM’s Animal Health Unit has since euthanized the noncommercial farm flock, according to the department’s press release. The local food supply remains safe, RIDEM added.

Deputy Chief of the Division of Agriculture and State Veterinarian Scott Marshall, who leads Rhode Island’s H5N1 response, explained that the state has a “proactive response plan” that involves “responding quickly to reports of sick or dying domestic birds, obtaining samples and submitting these samples to nationally accredited labs for a diagnosis,” Marshall said in the press release.

Rhode Island is located along a major flight path for migratory birds known as the Atlantic flyway, according to the press release. The virus is expected to be more prevalent in wild birds.

The Ocean State reported its first H5N1 infection in October 2022, detecting the strain in a noncommercial backyard flock. A year later, the virus was reported in a fox kit, the state’s first and only mammalian case of H5N1.

Since an emergence in the United States in 2022, H5N1 has been detected in every U.S. state.

Initially limited to poultry and wild birds, the virus has since gone on to infect mammals, including humans. Since 2024, the United States has seen 67 total confirmed cases of H5N1, and one human death from the virus, according to the Centers for Disease Control and Prevention.

But risk of bird-to-human H5N1 infection is low, according to the CDC. Rhode Island has yet to report a human case of avian flu.

“My biggest concern is for Rhode Islanders who may have contact with sick animals,” wrote Jennifer Nuzzo, a professor of epidemiology and the director of the Pandemic Center at the Brown University School of Public Health, in an email to The Herald.

Though there have been no human-to-human transmissions of the virus, Nuzzo worries that the flu strain could eventually “gain the ability to spread between people.”

“This is why we are urging government officials to do more to track and slow the spread of this virus so that it can't evolve to be a bigger harm to humans,” Nuzzo added.

RIDEM advised the public to avoid “direct contact with birds or other animals infected with or suspected to be infected with avian influenza,” and to wear protective gear if necessary.

Megan Chan
Megan is a metro editor covering health and environment. Born and raised in Hong Kong, she spends her free time drinking coffee and wishing she was Meg Ryan in a Nora Ephron movie.

Ever since the novel coronavirus reached the United States five years ago, it has unleashed punishing winter waves of illness.

But the usual covid uptick is much more muted this winter and appears to have peaked. The virus is less rampant in wastewater compared with winters past. Hospitalization rates have gone down.

Instead an unusual medley of ailments emerged this season — walking pneumonia, RSV, norovirus and bird flu — along with the more familiar foe: influenza, which is garnering more attention than covid this time around because the hospitalization rate is three times as high.

Winter offers ripe conditions for airborne viruses to spread as people travel and gather for the holidays and spend more time indoors. But covid is not a seasonal bug, even though public health officials have rolled out vaccinations and free test kits ahead of cold weather months.

"Right now, flu is the driver," Demetre Daskalakis, who directs the Centers for Disease Control and Prevention's response to respiratory infectious-disease threats, said last week. "We obviously have a healthy respect for covid-19 given things can change, but right now, it's not as dominant of a player."

What does the data show?
It's not easy to directly compare winter covid waves because data availability and collection has changed. For example, hospitals no longer test every patient for covid, and official case tallies are no longer available as people take tests at home or not at all. That said, this winter appears to be better by multiple metrics released before and after President Donald Trump took office.

Wastewater offers the best window into the prevalence of coronavirus since most people with covid don't get tested or seek medical care but do expel the virus when they go to the bathroom.

Marlene Wolfe, co-principal investigator for WastewaterSCAN, a private initiative that tracks municipal wastewater data, said viral levels in sewage are lower than during the peak of earlier winter waves and the peak of the recent summer wave.

"That's a bit of an unusual pattern compared to the last several years," said Wolfe, also an assistant professor of environmental health at Emory University's Rollins School of Public Health.

The change is also apparent in hospitals.

Relying on a sample of hospitals, the CDC reports that 38 out of every 100,000 people were hospitalized for covid this season as of Jan. 11, less than half the rate at the same point last year.

Similarly, about 1 percent of emergency department visits in mid-January involved covid diagnoses, compared with about 2 percent the previous year.

So what changed this winter?

The summer wave offered protection
Unlike flu and respiratory syncytial virus (RSV), covid hangs around in the spring and summer. And the covid wave in the summer of 2024 was worse than the one in the summer of 2023.

That's why this weaker winter covid season came as no surprise to Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at the Brown University School of Public Health.

"We had such a huge summer wave of infection, and that left in its wake a lot of immunity," Nuzzo said.

This means people who got covid in the summer and were exposed to it again in recent weeks were less likely to become infected and spread the virus.

Nuzzo and other experts say this illustrates the downsides of a public health strategy that lumps covid with seasonal respiratory viruses. The updated coronavirus vaccines did not become available until late August when the summer wave was already receding. The free coronavirus test by mail program did not restart until late September.

Coronavirus hasn't evolved as drastically
Now that practically everyone has some degree of immunity to the coronavirus from vaccination or prior infection, the virus has to evolve to bypass the antibodies trained to block it to keep infecting people. Some mutations are more significant than others.

Variants that fueled previous winter waves marked significant evolutionary leaps that made Americans more vulnerable for infection. But the XEC variant, which now accounts for nearly half of new cases, is not substantially different than the KP and FLiRT variants that drove the summer uptick, experts say.

"We are definitely moving in a very similar axis of viruses where there's not been like a sudden shift or a change that evades immunity," Daskalakis said.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, has long been critical of calling covid a seasonal virus, noting that waves often coincide with the rise of a new variant. He cautioned against assuming future covid winter waves will keep getting weaker because more threatening variants could emerge, similar to how some strains of influenza are worse than others.

"From season to season, we have bad flu years, we have less bad flu years," Osterholm said. "It's really dependent on the combination of virus that is circulating and the level of immunity in the population."

Vaccine coverage improved
While most Americans got their first covid shots, they were much less willing to get booster doses and the updated formulas for new variants.

But the sluggish vaccination rate is rebounding, and people were more willing to get new covid shots headed into this winter.

In early January, nearly half of seniors were up to date on their covid shots, compared with a third at the same point last year, according to CDC survey data. That's the age group most likely to be hospitalized if they get covid.

The increase in vaccination rate for adults overall was smaller but still statistically significant: 19 percent to 23 percent.

The updated vaccine formula targeted the KP.2 lineage, which is similar to the currently circulating variants.

Still, covid shouldn't be viewed in a vacuum
Raynard Washington, who chairs the Big Cities Health Coalition, an organization representing major health departments, cautioned against celebrating lower covid activity this winter.

It's still killing vulnerable people (more than 3,000 since December) and placing stress on hospitals and public health officials as they also confront influenza, RSV and norovirus, the gastrointestinal bug experiencing an unusual surge this winter, which some media outlets and medical commentators have dubbed "a quad-demic."

"I don't want to offer a false sense of security," said Washington, director of the public health department in Mecklenburg County, North Carolina. "We have four messy viruses circulating that we are trying to respond to."

Public health experts are especially concerned about flu this year because of growing concerns about the H5N1 strain of bird flu. Most influenza tests cannot distinguish between it and seasonal flu, meaning bird flu cases could go missed. And if a person is simultaneously infected with seasonal flu and H5N1, the viruses can exchange genetic material to create a new virus that can spread more easily between humans.

The public health advice is the same as in earlier winters: It's not too late to get a flu or covid shot if you haven't already gotten one. It's important to stay home when sick. And wash your hands thoroughly this year since norovirus spreads through fecal matter.

US health agency employees are now banned from nearly all travel and certain agencies and programs have been ordered to stop issuing new contracts and grants until further notice.

The limits on travel and spending, announced internally on Wednesday, add to previous indefinite halts on external communications, including publishing new reports or even posting to social media, and on reviewing and approving new medical research, a nearly $50bn industry in the US.

Employees of the 13 agencies overseen by US Health and Human Services (HHS) may only travel to return from assignments or to escape life-threatening situations. That means regular meetings with state and local health officials, training sessions and grant reviews are now on hold.

All federal agencies have been ordered to stop funding for foreign projects, including global health, and to stop work immediately on any programs involving the World Health Organization. Some agencies have also been ordered to stop cutting checks for projects and programs.

The mood at health agencies has been “nothing short of morose and somber”, said one CDC employee who requested anonymity because of the ban on communications.

Most staff members have experienced administration transitions under Democratic and Republican presidents before, but this transition has signaled “a dramatic shift” in the second Trump administration’s approach to federal agencies, especially those working on health and science, the employee said.

Agencies are still grappling with the outpouring of executive orders and how to interpret them, the employee said. The uncertainty amid these changes has left federal employees with “an overwhelming sense of dread and hopelessness”.

Halting vital response efforts and research, even temporarily, could take years to undo, the employee added.

Outbreak response will suffer from the bans on travel and communications, which is particularly dangerous given the evolving outbreak of highly pathogenic bird flu among animals and people, experts said.

“The US is in a critical period in responding to H5N1,” said Jennifer Nuzzo, director of the Pandemic Center and professor of epidemiology at the Brown University School of Public Health. “Any actions that slow or prevent the ability of US scientists to collect, analyze and disseminate data will weaken our abilities to track and protect ourselves from this virus.”

If, for example, a state detects a new pattern of transmission or a new cluster of cases in people, officials from the US Centers for Disease Control and Prevention (CDC) or the US Food and Drug Administration (FDA) might not receive clearance for a “mission critical” exception for travel to that state to aid in outbreak response or even to communicate with the state or the public.

Read further at the link for the article

The United States is ground zero for the H5N1 bird flu.

Since March 2024, when the virus was first reported in a Texas dairy herd, the virus has killed one person, sickened scores more, contaminated the nation’s food supply, felled dozens of house pets, infected more than 900 dairy herds across 16 states, and caused the deaths of millions of wild animals and commercially raised chickens, ducks and turkeys.

So how President Trump and his administration will deal with this widespread, potentially deadly virus, which scientists say is just a mutation or two away from becoming a full-blown human pandemic, is a question many health officials and infectious disease experts are now asking.

And so far — say the few who will go on the record about their concerns — things are not looking promising.

On Monday, Trump issued an executive order that will remove the U.S. from the World Health Organization — a 76-year old international agency created, in part, to share data and information about global pandemics.

He has also shuttered the Biden-era White House Office of Pandemic Preparedness, which was directed by Congress to streamline and coordinate the nation’s response to burgeoning pandemics, such as avian flu. Since the office’s formation in 2023, it has initiated multiagency coordinated efforts to “test” the nation’s preparedness for novel disease outbreaks, and has provided advice and coordination regarding vaccine development and availability among various health agencies, such as the Centers for Disease Control and Prevention and the Food and Drug Administration. A visit to the office’s website Wednesday morning showed a “404 Page Not Found” error message.

And on Tuesday evening, news broke that the Trump administration delivered instructions to a number of agencies within the department of Health and Human Services to put a “pause” on all health communications. The department did not respond to questions about the issue.

However, a note from a Human Services spokesman to a Times reporter on a different topic noted that the agency “issued a pause on mass communications and public appearances that are not directly related to emergencies or critical to preserving health.”

The spokesman said the pause was temporary and set up to allow the new administration’s appointees “to set up a process for review and prioritization.”

Experts say while we’re still in just the first week of the new administration, and things could change, these developments don’t bode well for a transparent and timely response to the growing avian flu crisis.

“More cases of H5N1 are occurring in the United States than in any other country,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I. “Pausing our health communications at a time when states are scrambling to contain this virus is dangerously misguided. This will make America less healthy and will worsen the virus’s economic tolls.”

Experts also say the new administration’s moves could lead to economic and social isolation for many Americans. Other nations may begin to question the health and safety of exported agricultural products, such as dairy, livestock, poultry and meat, as well the health of Americans who want to travel internationally.

“I can foresee countries slapping travel and trade restrictions on the U.S. It’ll affect millions of Americans,” said Lawrence Gostin, a legal scholar at Georgetown University.

Although the WHO does not typically support travel restrictions or trade bans, independent nations can call for such measures. In January 2020, Trump temporarily suspended entry to all non-U.S. citizens coming in from China.

Other nations, said Gostin, could take similar measures if they feel the U.S. is not being transparent or openly communicating information about the H5N1 outbreak. And without a seat at the WHO’s negotiating table, where new pandemic guidelines are currently being drawn, the U.S. may find itself on the outside looking in.

“With our withdrawal, we’d be ceding influence leadership” to China and other U.S. adversaries, said Gostin — the exact opposite of what we should be doing during such a precarious moment for a potentially emerging pandemic. “When the next [WHO] director general is elected, it’ll be China that will be pulling the strings — not the United States,” he said. “Our adversaries will be setting the global rules that we’re going to have to live by.”

Trump’s decision to remove the U.S. from the WHO rests on two of his convictions: First, that the organization mishandled the COVID-19 pandemic and second, that it charges the U.S. too much money — “far out of proportion with other countries’ assessed payments,” Trump said in his executive order.

Between 2015 and 2024, the WHO charged the U.S. between $109 million and $122 million per year. That accounts for 22% of all member contributions, making the U.S. the largest contributor to the organization.

However, “in the case of H5N1, the new administration has indicated less support for formal pandemic preparedness activities,” he said, as evidenced by Trump’s withdrawal from the WHO and the shuttering of the White House pandemic office. The moves, he added, “may indicate less Trump administration support for extended federal surveillance and response efforts for H5N1 infections in humans and animals.”

He said the virus will likely have to pose a more imminent threat before this new administration decides to provide “significant federal activities or dollars.”

Nuzzo, the Brown University researcher, agreed.

“The Trump administration will have no choice about acting on H5N1 — the virus is continuing to sicken people and livestock and is driving up our grocery bills,” she said. “The question is not whether the Trump administration will act to combat H5N1, but when and how many lives and livelihoods will be harmed before they act.”

Times staff writer Emily Alpert Reyes contributed to this report.

But it’s not just the isolationist moves and the potential loss of diplomatic strength and influence that worries experts and health officials.

Moves to eradicate offices designed to streamline the nation’s response to bird flu, and directives to “pause” communications about it, suggest either ignorance or a willful blindness to the way H5N1 — and all zoonotic diseases — move through the environment and potentially harm people, said Matthew Hayek, assistant professor of environmental studies at New York University.

The Trump administration “has a real opportunity to come in and and think about this virus and change the way we manage these kinds issues,” he said — noting the Biden administration’s bungled and flat-footed response, which allowed the virus to spread virtually unchecked across the nation’s dairy herds for months. Instead, “from the looks of it, that’s not going to happen. It seems that these first worrying steps with respect to muzzling public health agencies is moving in the opposite direction. And doubling down on the Hear No Evil, See No Evil, Speak No Evil strategy of the Biden administration” is just going to make it worse.

The U.S. Department of Agriculture intends to continue updating its H5N1 website as samples are tested and confirmed, according to Lyndsay Cole, an agency spokesperson. On Thursday, two new dairy herds in which there were positive tests for bird flu were added to the agency’s “Situational Update” website for H5N1.

John Korslund, a retired USDA scientist, said he wasn’t too worried, yet. He said it usually takes a few days or weeks when a new administration comes online for things to settle.

This Pandemic Center-authored brief explores the current landscape of wastewater surveillance in the US and the importance of developing it further.

As bird flu cases in the United States have begun to surface over the past year, public health officials continue to raise concern over the potential rapid spread of the virus among humans.

The circulating H5N1 strain of the bird flu has resulted in 67 total confirmed cases and one death in the United States since the outbreak in 2024, according to the Centers for Disease Control.

While the presence of the H5N1 virus isn’t new — there have been 970 confirmed human cases across the globe since 1997, the CDC reports — there has yet to be human-to-human transmission of the virus. But mutations in the H5N1 strain over the past two years have concerned public health experts as the virus could potentially be more contagious between humans.

“What has changed in the last two years is that first, it has become way more widespread among birds, but second, we are seeing large-scale infection of mammals,” said Ashish Jha, the dean of the Brown University School of Public Health and former White House COVID-19 response coordinator.

Historically, H5N1 primarily caused outbreaks in wild birds and occasionally in poultry. But as of March 2024, the bird flu has spread to over 900 herds of dairy cows across 16 states.

The more H5N1 is transmitted around humans, the higher the risk of human-to-human transmission, which can end up being “very, very deadly,” Jha said.

Experts have studied this virus for more than 25 years, but it remains difficult to predict if viral evolution will occur, let alone when the virus might mutate, said Jennifer Nuzzo, an epidemiologist and the director of the Pandemic Center at the Brown University School of Public Health.

“Just because it hasn't happened doesn’t mean it won’t,” Nuzzo said, adding that mutations in the disease indicate that infection in humans is “increasingly possible.”

A majority of the contracted cases in the United States come from farm workers exposed to cattle. While most of these cases result in mild symptoms such as eye redness and fever, this may be because the virus has primarily infected young, healthy farm workers and not that the virus itself has become less lethal, according to a Science News article. Historically, H5N1 has had a mortality rate of approximately 50%.

The U.S. healthcare sector was already bracing for turbulence when Donald Trump assumed the presidency on Monday. The president's order, in his first hours in the White House, to pull out of the World Health Organization is a sign of the uncertainty.

Drugmakers, public-health officials, and the rest of the health sector face a Trump era in which U.S. healthcare agencies are run by vaccine skeptics, and dramatic policy shifts on healthcare issues seem all but guaranteed.

While it wasn't unexpected, the decision to drop out of the WHO represents another significant disruption. The move will deprive the organization of roughly a fifth of its funding and cut U.S. experts out of its work and its decision-making processes.

"There is no replacement for what the WHO does," said Jennifer Nuzzo, professor of epidemiology at Brown University and director of the school's Pandemic Center. She called the order, one of Trump's first official acts, "deeply troubling."

The U.S. "still needs all of the work that WHO does, but what it will lose is the ability to shape how WHO does that work," Nuzzo said.

Take the twice-yearly meetings when World Health Organization experts gather to decide which strains of influenza the world needs to be protected against in the coming flu season.

It is the national health agencies and the vaccine makers that pick up the WHO's recommendations and run the immunization campaigns that inoculate nearly a billion people against flu each year . But it all starts with the WHO, the United Nations agency that serves as the backbone of the global health system.

Founded in 1948, the WHO is a specialized U.N. agency with its own leadership, budget, and bureaucracy. The group responds to health emergencies, supports national health systems, and does all sorts of background work that makes the global health system function.

Trump has been a critic of the WHO, and also attempted to withdraw the U.S. from the organization during his first term. In his executive order on Monday, he cited the WHO's alleged "mishandling of the COVID-19 pandemic," and said that the U.S. pays more than its fair share of the group's budget.

The WHO plans to spend a total of $6.8 billion in 2024 and 2025. The U.S. has paid between $163 million and $816 million to the WHO each year since 2015, according to the healthcare policy group KFF, between its dues and voluntary contributions, or nearly a fifth of the WHO's total budget.

Public-health experts acknowledged to Barron's that the WHO has problems, but said it is effectively irreplaceable. "While the WHO is hardly a perfect agency, it has continued to serve an absolutely critical role in the global response to public-health issues," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "You need someone to, in a sense, be air-traffic control for these infectious disease issues."

The same day that Trump signed the executive order, the WHO announced it was helping authorities in Tanzania respond to a new outbreak of the Marburg virus disease, a rare illness with a fatality rate of roughly 50%. The WHO said it was working with local Tanzanian health authorities on disease surveillance, testing, treatment, infection control, and other measures.

The WHO regularly jumps in to assist in similar outbreaks, in part to keep them from spreading geographically.

"We as a country remain vulnerable to a number of infectious disease issues that right now don't exist in our country, because we're able to stop them in a distant border somewhere around the world," said Osterholm. "That all occurs because of WHO. There are a lot of places in the world we have U.S. experts stopping disease transmission that would never be allowed there if they weren't part of the WHO team."

The WHO also reviews the safety and efficacy of many categories of new medicines, a process that stands in for drug approvals for countries without their own regulatory agencies like the Food and Drug Administration. That is useful for drugmakers looking to sell their medicines in smaller markets.

In addition to its work responding to public-health emergencies, the WHO also sets global health policies in annual meetings of a representative decision-making body called the World Health Assembly. Last year, that body updated the international agreements that govern how the WHO and national governments respond to pandemics and other emergencies.

The WHO is also in the process of negotiating a separate pandemic agreement, though the Trump executive order explicitly orders the secretary of state to stop work on those negotiations.

The withdrawal of the U.S. from the WHO won't stop the work of the WHO. But it could hobble the organization.

"If it's losing somewhere between 15 and 20% of its budget, you can imagine that it has some serious consequences for its operations," says Josh Michaud, associate director for global health policy at KFF. "If there is an Ebola outbreak or Marburg outbreak, or whatever it is, they're not going to all of a sudden not be able to respond or do the work that they do. It just would compromise the comprehensiveness, the timeliness, perhaps the effectiveness of that."

The order comes amid persistent concerns that the continuing outbreak of H5N1 avian influenza could set off a new pandemic. Michaud says that the WHO coordinated the global response to the Covid-19 pandemic, and that U.S. contributions during that time were vital.

Asked for a response to the order withdrawing from WHO, the pharmaceutical industry trade group PhRMA, which has taken a distinctly nonconfrontational approach to the Trump administration, said its members "remain committed to working with the U.S. government and other partners to enhance global health and access to the medicines patients need."

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

By Josh Nathan-Kazis

Soon after being sworn in as the 47th President of the United States on Monday, Donald Trump signed a slew of executive orders that could reshape science at home and abroad. The orders — which direct the actions of the federal government but cannot change existing laws — are designed to shift policies and priorities on several scientific issues, including climate and public health. They also aim to cut the government workforce, which includes scientists, and potentially reduce its authority.

It remains unclear how much weight many of the orders will carry, but policy specialists who spoke to Nature say that they clearly mark the direction Trump intends to steer the United States during his second term in the White House.

“A lot of the power of executive orders is in the messaging,” says Gretchen Goldman, president of the Union of Concerned Scientists, an advocacy group based in Cambridge, Massachusetts. And the message thus far is clear, she says: “The administration is trying to undermine the government experts themselves, as well as the processes by which we make science-based decisions in government.”

Here Nature examines some of the executive orders that are most relevant to science.

Changing climate
Trump signalled in one order that — similar to his first presidency from 2017 to 2021 — he would pull the United States out of the 2015 Paris climate agreement. Citing both national security concerns and the impact of high energy prices that “devastate” American citizens, Trump also declared a ‘national energy emergency’ at home, an action that could enable his government to greenlight fossil-fuel-based energy projects.

Trump’s emergency order, one of many focusing on energy issues, would allow US agencies to identify energy projects where federal regulations and laws protecting, for instance endangered species, are holding up progress, according to the president. Agencies would then be authorized to move more quickly to approve projects, including through the use of “any lawful emergency authorities”.

But there are limits to what Trump can accomplish, because in many ways, “the economy trumps Trump”, says Mark Maslin, an Earth-system scientist at University College London. For instance, Maslin says, it’s now much cheaper to invest in renewable energy sources such as solar and wind than it used to be, and that means that investments in those technologies will continue.

Comparatively, Trump will have an easy time withdrawing the United States from the Paris accord, which commits nearly 200 countries to limiting Earth’s warming to 1.5–2 °C above pre-industrial levels. During Trump’s first presidency, his administration had to wait more than three years before formally withdrawing from the pact because of the rules of the agreement. Joe Biden, who succeeded Trump as US president, quickly rejoined. This time, the exit process will require only one year.

Although the Paris agreement will continue to function without the United States — the world’s second-largest emitter of greenhouse gases — many scholars worry that a US exit will inevitably reduce pressure on other countries to act. This follows Earth reaching its highest temperature on record last year, and scientists say that countries must increase efforts to curb emissions if they are to achieve the global goal.

“Anything delaying or halting that effort will lead to lives lost on the ground,” Goldman says.

In withdrawal
As expected, Trump also signed an order to withdraw the United States from the World Health Organization (WHO), a United Nations agency responsible for global health that the new president alleges mishandled the COVID-19 pandemic. He has also said that the United States pays a disproportionate amount of dues to the agency compared with other member nations.

Trump announced that the United States would leave the WHO in May 2020, during his first presidency, but because the process takes one year, Biden blocked it on his first day in office in 2021.

Public-health researchers say that leaving the WHO will cripple the country’s ability to respond nimbly to emerging health threats and curtail the country’s reputation as a global-health leader. Because its annual contribution makes up more than one-tenth of the organization’s budget of billions of dollars, the United States withdrawing from the WHO could also kneecap the agency’s mission. “It is a very worrisome signal to the global community about our seriousness as a partner in protecting health,” says Jennifer Nuzzo, an epidemiologist who directs the Pandemic Center at Brown University, in Providence, Rhode Island.

The WHO’s member countries share information and expertise on infectious-disease outbreaks and other threats, and without this key knowledge and data — for instance, the DNA sequence of an emerging virus — the United States will be slower to respond to crises, Nuzzo says. In addition, the withdrawal creates “opportunities for other countries to step in and assert themselves in ways that might not be compatible with US interests”, she says. For example, the United States has been a leading voice calling for stringent biosecurity measures in the construction of new pathogen-research centres around the world, she adds.

A US pullout from the WHO could also imperil collaboration with the US Centers for Disease Control and Prevention (CDC), says David Heymann, an infectious-disease epidemiologist at the London School of Hygiene and Tropical Medicine and a former assistant-director general at the WHO. The flagship US public-health agency runs more than a dozen WHO collaborating centres in areas ranging from influenza surveillance to antimicrobial resistance. “It would be a loss for CDC, but it would be a loss for WHO,” he says.

It is unclear if Trump can withdraw from the WHO using an executive order, because the United States accepted membership in the agency in 1948 through a law passed by the US Congress. It might, therefore, require Congress's approval to leave. Lawrence Gostin, a specialist in health law and policy at Georgetown University in Washington DC who directs a WHO collaborating centre, said on the social-media platform X that he is considering challenging the order in court.

Deep cuts
Several of the orders Trump issued on 20 January focus on the federal workforce, which includes roughly 280,000 scientists and engineers. The Trump administration is seeking to reduce its size and regulatory power.

In one, Trump says there will be a 90-day hiring freeze for the federal government, with the directive to reduce the size of the federal workforce when the order expires. Other orders might coax federal employees to leave their jobs themselves: for example, Trump is seeking to mandate that federal employees return to the office full time, and requiring agencies to recognize only two sexes, male and female, which would, for example, prevent employees from listing their preferred gender on official documents.

All of this is part of a broader effort to slash spending and the size of government. For many observers, the message for science is clear. “This is the world we’re going to be in,” says Robert Atkinson, the president of the Information Technology and Innovation Foundation, a non-profit think tank based in Washington DC. “We’re not going to be expanding science. We’re actually going to be cutting it.”

Yet another executive order focuses on a change to the rules governing civil servants — those hired on the basis of their expertise rather than as political appointees. Stating that all federal employees who work on “policy-influencing positions” must be accountable to the president, the order reinstates a policy formerly known as 'schedule F' that the Trump administration attempted to put in place during his first term in office. It would have made it easier for the administration to fire tens of thousands of workers, including many government scientists, and replace them with political loyalists. The Biden administration revoked that order and also put in place a new rule designed to enhance civil-service protections. The Trump administration is nonetheless moving forwards with its schedule F changes — which are already being challenged in court by a union representing public employees.

“It represents an unprecedented politicization of the civil service,” says Don Moynihan, a political scientist at the University of Michigan in Ann Arbor. “Traditionally, we have this clear dividing line between political appointees and the career civil service. Schedule F seeks to blur, if not completely erase, that dividing line.”

While some areas of science and technology, such as AI and quantum computing, are expected to benefit under the second Trump administration, the barrage of Day 1 executive orders did not inspire confidence in researchers or policy specialists. “I actually am more worried now than I ever have been,” Atkinson says. “I think the stars are aligning in a way that could really hurt the science community at the federal level.”

President Donald J. Trump signed an executive order withdrawing the United States from WHO, complaining that the agency has unfairly demanded too much in funding.

“Ooh, that’s a big one,” Trump said in the Oval Office as an aide handed him the executive order — one of a handful he signed Monday after being inaugurated for his second term.

The order revoked a letter that Joe Biden sent WHO at the start of his presidency in 2021 reversing Trump’s announcement in July 2020 that the U.S. would withdraw its support.

‘Onerous payments’
The U.S. helped found WHO in 1948 and has been one of the global health agency’s largest funders. The relationship has been heavily criticized by Trump and his allies for years.

When Trump first announced plans to pull funding from WHO during the COVID-19 pandemic, he cited concerns about the agency’s relationship with China and its response to the COVID-19 pandemic.

Although the new order signed by Trump on Monday also referenced those and other reasons, the document mostly focused on the proportion of WHO’s funding that is paid by the U.S., especially in relation to China.

WHO had asked the U.S. to contribute around $130 million per year in 2024 and 2025, according to documents posted online. That represents 22% of the approximately $578 million the agency requested annually from member states, according to a breakdown by WHO’s executive board.

By comparison, China was asked to contribute around 15%. No other country was asked to contribute more than 8%.

“WHO continues to demand unfairly onerous payments from the United States, far out of proportion with other countries’ assessed payments,” Trump’s executive order says. “China, with a population of 1.4 billion, has 300 percent of the population of the United States, yet contributes nearly 90 percent less to the WHO.”

‘Endangering health everywhere’
As it did last time, the administration’s decision to withdraw from WHO elicited rebukes from public health experts who worry that it imperils global public health and makes the U.S. less safe.

In a statement, the co-faculty directors of the O’Neill Institute for National and Global Health Law at Georgetown University said the decision “risks undermining decades of progress.”

“U.S. funding has been instrumental in supporting the WHO’s pandemic response. Without it, the organization’s ability to address global health emergencies will be significantly weakened, endangering health everywhere,” said Michele Bratcher Goodwin, SJD, LLM, and Lawrence O. Gostin, JD.

The announcement was “unsurprising, but deeply disappointing,” said Jennifer B. Nuzzo, DrPH, director of the Pandemic Center at Brown University School of Public Health.

“It means the U.S. will lose the ability to shape and define priorities for the organization’s critical work,” Nuzzo told Healio.

Although Trump has criticized WHO’s relationship with China, the U.S.’s withdrawal will likely allow China to increase its influence over the agency, Nuzzo and Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, both said.

Additionally, Adalja said the decision “will put the U.S. in a position where it will be without full situational awareness of infectious disease outbreaks that are occurring globally, [and] will hamper the ability of the CDC to be most effective in global health.”

“I can't think of one way that this makes America safer and more secure, and I can't think of one way that it advances our national interests,” Gostin told Healio.

“Trump can shut down the southern border against immigrants, but you can't shut the border against a pathogen,” he said. “We rely on a vast network of WHO laboratories and government agencies to provide us with surveillance data and pathogen samples to allow us to detect outbreaks early, respond to them, and also to develop vaccines and treatments. We used to be first in line to get vaccines and treatments, but we might find we’re near the end of the line.”

What’s next?
The executive order “starts a process that will take 1 year for withdrawal to occur,” Adalja noted. Gostin said the order could be blocked in the courts and he has threatened to file a lawsuit to stop the withdrawal.

“I believe that he shouldn't be able to unilaterally withdraw, that he needs congressional approval, and that something this monumental shouldn’t be made on the president's whim or the president's grudge against WHO,” Gostin said.

“It wouldn’t make America stronger. It would make America alone and fragile,” he said. “It’s a win-win if the United States stays in and WHO becomes stronger and more resilient and more accountable.”

In a statement, WHO cited its longtime collaboration with the U.S. as instrumental in eradicating smallpox and nearly eradicating polio and suggested there may be a way to repair the relationship.

“With the participation of the United States and other member states, WHO has over the past 7 years implemented the largest set of reforms in its history, to transform our accountability, cost-effectiveness, and impact in countries. This work continues,” WHO said. “We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe.”

References:
Statement from the O’Neill Institute for National and Global Health Law on the United States’ withdrawal from the World Health Organization. https://oneill.law.georgetown.edu/press/statement-from-the-oneill-institute-for-national-and-global-health-law-on-the-united-states-withdrawal-from-the-world-health-organization/. Published Jan. 21, 2025. Accessed Jan. 21, 2025.
White House. Withdrawing the United States from the World Health Organization. https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the-united-states-from-the-worldhealth-organization/. Issued Jan. 20, 2025. Accessed Jan. 21, 2025.
WHO. Assessed contributions payable by members states and associate members 2024-2025. https://cdn.who.int/media/docs/default-source/ac-docs-2024-2025/assessed-contributions-payable-by-member-states-and-associate-members-in-2024-25.pdf. Published May 9, 2024. Accessed Jan. 21, 2025.
WHO comments on United States’ announcement of intent to withdraw. https://www.who.int/news/item/21-01-2025-who-comments-on-united-states--announcement-of-intent-to-withdraw. Published Jan. 21, 2025. Accessed Jan. 21, 2025.
WHO. Scale of assessments for 2024/2025 (EB152.R3). https://cdn.who.int/media/docs/default-source/ac-docs-2024-2025/scale-of-assessment-2024-25.pdf. Published May 9, 2024. Accessed Jan. 21, 2025.

Cambridge Forum takes an incisive look at America’s public health system in the light of another potential pandemic, and the prospect of an incoming president who is set to dismantle our current public health care science regarded by many, as the best in the world. Alarm bells were sounded early last December when The Lancet, the world’s top medical journal, published an issue dedicated to U.S. public health lauding its remarkable global record and worrying for its future, under a second Trump administration.

Undoubtedly, America’s health achievements have changed world history in terms of the lives saved. Victories against polio and yellow fever, HIV-AIDS and malaria, infant mortality and TB are often taken for granted, along with the virtual eradication of smallpox. But all this may soon change dramatically, if Trump follows through on his disastrous choices for top government healthcare appointments.

According to an analysis by Canadian health and science writer, Crawford Kilian, the breakdown in America’s public health system is just getting started – The Tyee December 20, 2024. Future health care spending at home and abroad is slated for drastic cuts, says Killian, and “Trump’s impending return seems likely to collapse American health science with consequences as disastrous for the rest of the world, as for the 346 million Americans.”

Defense against dangerous epidemic outbreaks requires constant vigilance, and public support for public health safety measures, like vaccinations. No one can afford a repeat of Covid-19, the worst global pandemic in a century, which ended up costing the lives of over 1.2 M. Americans. Our speakers include Dr. Krutika Kuppalli, infectious disease specialist and global health physician, who advises the W.H.O on emerging diseases and Crawford Kilian, science and health reporter, who has blogged about H5N1 avian flu and other potential hazards to global health since 2005. Our discussion will address the looming public health crisis and discuss the best ways forward.

Also joining the Forum is Jennifer Nuzzo, an epidemiologist and a nationally and globally recognized leader on global health security, public health preparedness and response, and health systems resilience.

In addition, Nuzzo regularly advises national governments and for-profit and non-profit organizations on pandemic preparedness and response, including during the COVID-19 pandemic. She is a pandemic advisor for Impact Assets’ Stop the Spread Campaign and a member of the National Academies of Sciences, Engineering and Medicine’s (NASEM) Standing Committee for the Centers for Disease Control and Prevention (CDC) Center for Preparedness and Response. Her articles have appeared in NYT, The Washington Post, USA Today, Politico, The Hill, and The Boston Globe.

Audio from this event presented at the link provided

Ten years ago, I was in the hospital battling Ebola. My fever rarely relented. I felt so weak that getting up was a herculean task, attempted only a few times a day. Having treated patients with Ebola in Guinea, I knew these symptoms well. I also knew that the worst of my illness was yet to come — if I even survived.
Those 19 days in the hospital were the hardest of my life. Yet my experience was easier than that of my Guinean patients. They waited days for test results to confirm their diagnosis; mine were available within hours at the New York hospital where I was treated. In Guinea, I had too many patients and too little time to spend with them, which forced tough decisions about whose care to prioritize; during my hospitalization, dozens of clinicians were constantly available. The profound injustice weighed heavily on my mind, even as my body was failing.
During the 2014–2016 West African Ebola outbreak, which was concentrated in Guinea, Liberia, and Sierra Leone, nearly half of patients died. Nine of the 11 patients treated for Ebola virus disease (EVD) in the United States survived. The 2 who died weren’t American citizens. Delayed access to critical care probably contributed to their deaths, reflecting a global health truism: life-and-death questions are often decided by the color of your passport.
When Sheik Umar Khan, a preeminent Sierra Leonean physician, had EVD in 2014, experts decided not to offer him the monoclonal antibody cocktail ZMapp, one of the most promising treatments at the time. Reportedly, he died without knowing it was available at the hospital where he was treated. Months later, the U.S. Food and Drug Administration (FDA) facilitated the delivery of a similar treatment from Canada to my hospital, even though the global supply was said to be exhausted. Together, my treating clinician and I decided not to use the dose. In many ways, Dr. Khan and I were similar — both physicians battling the same virus, for which a potentially lifesaving treatment was available. Access wasn’t the issue; agency and autonomy were: only one of us was given a choice about treatment.
In the decade since, there have been numerous proposals and promises to reform global health infrastructure. Yet inequity remains deeply entrenched. To prevent another decade of halting progress, action is needed to improve access to current medical countermeasures, leverage research consortia and trial agreements to support access to new tools, and bolster manufacturing capacity in often-overlooked countries.
Expanding access to existing products could have immediate effects. Despite the FDA’s approval of new treatments for Orthoebolavirus zairense (also known as Ebola virus [EBOV]), the species responsible for the 2014–2016 outbreak, survival hasn’t dramatically improved in subsequent outbreaks. Two monoclonal antibody treatments — Inmazeb (atoltivimab, maftivimab, and odesivimab) and Ebanga (ansuvimab) — have been shown to reduce mortality,1 but patients lack reliable access to them. The manufacturers have licenses and patents giving them exclusive control over these drugs, and nearly the entire supply is in the U.S. Strategic National Stockpile.2 When EBOV outbreaks occur, communities must depend on the goodwill of foreign governments and corporations to send doses. During the four EBOV outbreaks that have occurred since the FDA approved these medications, only 41% of patients with confirmed or probable disease received either treatment.3
An allocation program could promote access to treatments earlier in outbreaks. The International Coordinating Group on Vaccine Provision’s emergency Ebola vaccine stockpile offers a model. The United States contributed more than $750 million to the development of EVD treatments and could have conditioned funding on guarantees of greater access, such as their inclusion in a global stockpile.
Additional avenues exist for leveraging influence earlier in research-and-development processes to promote increased downstream access to medical countermeasures. There are no approved treatments for Sudan virus or Marburg virus, which cause symptoms similar to those of EBOV. To promote future access to new therapies, countries at risk for outbreaks could establish a research consortium to expedite clinical trials when cases are first reported and incorporate post-trial access agreements as a condition of hosting studies of potential countermeasures.
The development of lenacapavir underscores both the potential for and the importance of leveraging such opportunities to improve access. The PURPOSE 1 trial, conducted in South Africa and Uganda, and the PURPOSE 2 trial, conducted in seven countries, showed that the drug prevents HIV infection. Lenacapavir is priced at about $44,000 per patient per year in the United States; the manufacturer’s licensing agreements with six generics manufacturers to produce the drug and sell it to 120 countries at a lower cost is therefore important. But this arrangement doesn’t ensure comprehensive access: some countries with high HIV rates — including many in South America, where the drug was studied in PURPOSE 2 — aren’t included. Moreover, none of the manufacturers are based in sub-Saharan Africa — a missed opportunity to support emerging manufacturers in that region.4
The Covid-19 pandemic demonstrated that bolstering local manufacturing capacity is crucial for supporting global health equity. During the pandemic, there was a sharp division in access to personal protective equipment, diagnostics, and vaccines between high-income countries and low- and middle-income countries (LMICs). When vaccines were developed, LMICs often paid higher prices and still found themselves at the back of the distribution line. Despite efforts in the Covid-19 Vaccines Global Access (COVAX) initiative to ensure equitable access, inequities persisted. A 2023 analysis of access to Covid-19 medical products summarized the biggest hurdle: “The political economy is structured to improve and lengthen the lives of those in the Global North while neglecting and shortening the lives of those in the Global South.”5
Mpox responses highlighted similar challenges but also showed what can be achieved with sufficient political will. In 2022, when cases surged in cities such as New York, Montreal, and Berlin, immunization campaigns were promptly rolled out. Meanwhile, as outbreaks intensified in Central and East Africa, diplomatic delays and sluggish vaccine-donation efforts hampered the global response. Of the 5.3 million mpox vaccine doses pledged globally, only a fraction have been delivered.
Recently, investments in vaccine research, development, and production in many middle-income countries — including China, India, and Brazil — have shown that emerging powers can challenge long-standing inequalities. Similarly, Partnerships for African Vaccine Manufacturing is supporting manufacturers across Africa to produce 60% of the vaccines needed on the continent by 2040, up from the 1% they produce now. BioNTech opened an mRNA vaccine facility in Rwanda in 2023, with support from the Coalition for Epidemic Preparedness Innovations. The mRNA vaccine technology transfer hub in South Africa, established by the World Health Organization (WHO), is facilitating mRNA-vaccine production capacity in 15 LMICs in Africa, Asia, and South America.
Global support is needed to launch these initiatives, but long-term sustainability hinges on governments stepping up. Countries will need to allocate increased resources to building robust regulatory frameworks, develop and sustain technical expertise, and commit to purchasing locally produced vaccines, even if they are initially costlier than alternatives.
By strengthening their own capacity, countries could address local challenges while also boosting global resilience against health threats. For example, Rwanda, with one of the region’s strongest health systems, swiftly detected, contained, and managed a recent Marburg virus outbreak, deploying investigational vaccines and treatments. This capacity prevented regional spread and saved lives.
Global health inequities persist because the systems intended to address them don’t always deliver. In December 2021, the WHO established an intergovernmental negotiating body to develop a global pandemic agreement aimed at rectifying problems revealed during the Covid-19 pandemic. Negotiators have reportedly reached a consensus on important proposals and report making progress on previous sticking points, including strengthening regulatory systems and geographically diversified production of health products. But discussions regarding equitable vaccine access and the transfer of technology and information for countermeasure production have reached a stalemate. Strong commitments and compliance mechanisms are essential for addressing entrenched inequities.
In the face of current and looming global health threats — including antimicrobial resistance, climate change, and new pandemics — action is urgently needed. Governments and multilateral global health organizations must improve access to existing countermeasures, leverage conditions on public funding and trial agreements to enhance access to new tools, and support local manufacturing in LMICs. The world has the tools to prevent suffering and death in places made vulnerable by a long history of global health inequity. The question is whether we will take the necessary steps to ensure that everyone has access to them.

Robert F. Kennedy Jr., President-elect Donald Trump’s choice to lead the nation’s health agencies, formally asked the Food and Drug Administration to revoke the authorization of all COVID-19 vaccines during a deadly phase of the pandemic when thousands of Americans were still dying every week.

Kennedy filed a petition with the FDA in May 2021 demanding that officials rescind authorization for the shots and refrain from approving any COVID vaccine in the future.

Just six months earlier, Trump had declared the COVID vaccines a miracle. At the time that Kennedy filed the petition, half of American adults were receiving their shots. Schools were reopening and churches were filling.

Estimates had begun to show that the rapid rollout of COVID vaccines had already saved about 140,000 lives in the United States.

The petition was filed on behalf of the nonprofit that Kennedy founded and led, Children’s Health Defense. It claimed that the risks of the vaccines outweighed the benefits and that the vaccines weren’t necessary because good treatments were available, including ivermectin and hydroxychloroquine, which had already been deemed ineffective against the virus.

The petition received little notice when it was filed. Kennedy was then on the fringes of the public health establishment, and the agency denied it within months. Public health experts told about the filing said it was shocking.

John Moore, a professor of immunology at Weill Cornell Medical College, called Kennedy’s request to the FDA “an appalling error of judgment.” Gregg Gonsalves, an epidemiologist at the Yale School of Public Health, likened having Kennedy lead the federal health agencies to “putting a flat earther in charge of NASA.”

Dr. Robert Califf, commissioner of the FDA, described Kennedy’s effort to halt the use of COVID vaccines as a “massive error.”

Kennedy’s transition spokesperson did not respond to requests for comment, but has said recently that he does not want to take vaccines away.

Asked in November by an NBC reporter about his general opposition to COVID vaccines — and whether he would have stopped authorization — Kennedy said he was concerned that the vaccines did not prevent transmission of the virus.

“I wouldn’t have directly blocked it,” he said. “I would have made sure that we had the best science, and there was no effort to do that at that time.”

Kennedy’s early opposition to COVID vaccines has alarmed public health experts, many of whom contend that it should disqualify him from overseeing health agencies with the power to authorize, monitor and allocate funding for millions of vaccines each year.

They are also concerned about how he might handle a possible bird flu pandemic, which could necessitate a rapid deployment of vaccines.

As Kennedy prepares for his confirmation hearings before two Senate committees, he and his allies have insisted that he is not anti-vaccine.

In fact, in mid-2023, he told a House panel that he had taken all recommended vaccines — except for the COVID immunization.

At his confirmation hearings, he’ll most likely face scrutiny of his broader statements on vaccines, including that the polio vaccine cost more lives than it saved.

Trump has stepped forward in recent weeks to defend Kennedy after The New York Times reported that one of Kennedy’s lawyers had previously petitioned the FDA to revoke approval or pause distribution of several polio vaccines over safety concerns.

“I think he’s going to be much less radical than you would think,” Trump said last month.

After the Times report, Trump and Kennedy expressed their support for the polio vaccine.

If confirmed by the Senate as secretary of the Health and Human Services Department, Kennedy would assume oversight of $8 billion in funding for the Vaccines for Children program and would have the authority to appoint new members to a panel that makes influential vaccine recommendations to states.

At the time that Kennedy challenged the COVID vaccines, some of his objections touched on wider concerns about their rapid development. Emergency-use authorization — a preliminary form of approval — for immunizations was unusual. Others argued that a public health emergency dictated a speedier rollout.

Dr. Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health, said it would be reasonable to debate whether COVID vaccines should have been subject to additional study.

But she profoundly disagreed with Kennedy’s views, saying that “the idea that in early 2021 that you could be saying that people over the age of 65 don’t need COVID vaccines — that’s just nuts.”

Vaccines have rare side effects, and there have been cases of injury from the COVID shots. Government officials weigh the harms against the potential to save lives. An estimate released in early 2024 found that the COVID vaccines and mitigation measures saved about 800,000 lives in the United States.

Another study found that in late 2021 and 2022, COVID death rates among unvaccinated people were 14 times the rates of those who had received a COVID booster shot. Researchers also estimated that from May 2021 through September 2022, more than 230,000 deaths could have been prevented among people who declined initial COVID inoculations.

From the start of the COVID vaccine campaign, Kennedy’s view that the COVID vaccines were dangerous put him at odds with Trump, whose Operation Warp Speed to develop the vaccines was one of his policy triumphs. And Kennedy went on a concerted campaign against the vaccine.

Kennedy told Louisiana lawmakers in late 2021 that the COVID vaccine was the “deadliest vaccine ever made.”

He has remained a plaintiff in a lawsuit against President Joe Biden and others, contesting efforts by government officials to limit his ability to suggest on social media that COVID vaccines were not safe.

Bird flu's unprecedented spread among livestock and other mammals in the U.S. has raised fears that another pandemic could be in store.

The incoming Trump administration will have to prepare for this risk. As H5N1 spills into more people and animals, scientists warn it could evolve to better infect humans and become more dangerous.

Trump and his picks to helm federal health agencies have largely been silent on bird flu. The messaging so far — and the track record of those Trump has chosen to oversee a potential bird flu crisis — is "worrisome," says Dr. Andrew Pavia, professor of medicine at the University of Utah who's worked on influenza pandemic preparedness for more than two decades.

The transition team did not respond to NPR's request for comment on its plans.

Trump's choice to lead the Department of Health and Human Services, Robert F Kennedy Jr., has an extensive history of making inaccurate and misleading statements on vaccines and infectious diseases. He's a lawyer who for years led an advocacy group that is a major player in the anti-vaccine movement, promoting the long-debunked idea that vaccines lead to autism, among other false claims.

Kennedy denies spreading misinformation, though his criticism of vaccines is well known.

He's also made specific comments undermining trust in the bird flu vaccines. In an online post last summer, he claimed there's "no evidence" the licensed shots for the national stockpile will work and that they "appear dangerous."

And he suggested in another post that "someone" might bioengineer a dangerous form of the virus to profit off the vaccine.

Scientists who study the vaccines are deeply troubled by these statements.

"They are false, baseless and inaccurate," says Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia.

Kennedy has also discussed having the National Institutes of Health take a break from infectious disease research for eight years, and replacing hundreds of employees there.

Trump himself suggested last spring that he'd like to disband an office in the executive branch that handles pandemics.

If confirmed as health secretary, Kennedy would have broad powers. He could declare a public health emergency, control and direct funding, and influence key decisions at the Centers for Disease Control and Prevention, the Food and Drug Administration, and NIH, all of which are overseen by HHS.

"At every step, he can certainly play a role in hampering or being a barrier," says Syra Madad, director of the special pathogens program at NYC Health + Hospitals.

This could be of huge consequence for how prepared the country is to face an escalating crisis. Still, some scientists point to the first Trump administration's speedy work on a COVID-19 vaccine with Operation Warp Speed, and say they think that ultimately Kennedy would need to listen to Trump if he called for a similar effort.

"If the president tells him to do something, I would hope that would be the case," says Dr. Carlos del Rio, a professor of medicine at Emory University. "And let's be honest, there has been a lot of failure in the current response."

An urgent need to prepare
Bird flu currently doesn't pose an imminent threat to the American public — most of the 67 human cases since last April have only led to mild illness and were caused by direct exposure to infected animals.

But, scientists caution, things could change quickly.

"This is like some brush burning around your house," says Dr. Jesse Goodman, an infectious disease physician at Georgetown University and a former FDA official.

"You better pay attention because it could turn into something else."

To prepare for this threat, the U.S. must strengthen the pipeline of vaccines and treatments for bird flu, says Pavia. The Trump administration will need to help bolster supplies of the existing shots and support development of new ones.

"We are fooling ourselves that we have enough vaccine capacity and the ability to respond quickly," he warns.

Already under the Biden administration, scientists have criticized the federal government for the slow pace of its response.

"There's a lot of work that still needs to be done," says Jennifer Nuzzo, who directs the Pandemic Center at Brown University School of Public Health, adding that it's not like "handing over the keys to the car with the engine running."

Two weeks ago — more than nine months after the outbreak was first detected in cattle — health officials announced an investment of more than $300 million into pandemic readiness for bird flu. It wasn't until December that the federal government took key steps to track the spread in dairy cattle.

"We're flying blind just like we did during COVID-19," says Madad.

Alongside vaccines, public health experts have outlined a list of urgent tasks to battle bird flu, including: working with the industry to improve biosecurity measures and testing on farms; coordinating with state and local authorities on the ground; and planning for contingencies.

There are gaps in disease surveillance efforts on farms. And ultimately public health agencies have limited authority in this area, says Dr. Luciana Borio who served as the FDA's chief acting scientist from 2015 to 2017 and is now a fellow at the Council on Foreign Relations.

"That means we have to put even more effort into developing new vaccines and therapeutics more quickly," she says. "We can't just hope that this is going to go away."

Casting doubt on vaccines
Kennedy has grabbed headlines for promoting raw milk despite the public health warnings that it can harbor the bird flu virus. His views on vaccines could be even more consequential.

The Health Secretary could influence the rollout of a vaccine campaign and communication with the public. While it's rare to do so, he could even override FDA decisions on vaccine approvals and authorizations, and how the CDC comes up with recommendations, notes James Hodge, a law professor at Arizona State University.

"There's much he could do to disrupt vaccine programs in this country," says Offit. "I have little doubt that were he to pass his confirmation hearing, that's exactly what he'll do."

Last year, Kennedy took direct aim at bird flu vaccines in several posts on X.

He cited the pharmaceutical industry's financial interest in developing bird flu vaccines and he raised a conspiracy theory, suggesting that the government's work on bird flu vaccines may be in anticipation of a "lab-derived pandemic."

In June, he wrote: "With so much money on the table, is it conceivable that someone might deliberately release a bioengineered bird flu?"

Dr. Andrew Pekosz calls the idea "preposterous," and points out that developing vaccines ahead of time is exactly what needs to be done, in case a crisis emerges in the future.

"This is the planning and preparedness that public health officials and scientists do to be ready to respond," says Pekosz, a professor of microbiology at Johns Hopkins Bloomberg School of Public Health. "Those vaccines could be the primary way we protect our population from a potential H5N1 pandemic."

And contrary to Kennedy's statement raising a safety concern, the existing bird flu vaccines, as with the seasonal influenza shots, "have shown a safety record," he says. "They're not dangerous."

Those vaccines were developed to target older strains of bird flu and approved based on clinical data that looked at their safety and the immune response the vaccines elicited in participants.

The federal government is now having manufacturers update these shots to more closely target the strain of bird flu in circulation — similar to what's done with seasonal influenza every year — and is gathering more data based on new studies, which aren't yet published.

It's expected there will be about 10 million doses stockpiled by the spring.

Kennedy's claim there's "no evidence" the vaccines will work is misleading because their effectiveness can only be determined in human trials once a bird flu virus is actually spreading between people, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy.

"There's no way we could know because we don't have the virus that's going to cause the next pandemic yet," he says.

However, health officials have noted that the newer vaccines, ordered by the federal government for the national stockpile, appear well-matched against the virus circulating in animals, according to lab research on the immune response they generate.


There is also separate data published last July showing the originally licensed vaccines induce antibodies "that likely would be protective" against the current strain, says Offit, though you can't know for sure without vaccine effectiveness studies.

If the virus changes significantly and begins spreading among people, it's entirely possible the vaccine will need to be updated further. That's why the federal government is not preemptively manufacturing hundreds of millions of doses right now, according to David Boucher, a senior official with the Administration for Strategic Preparedness and Response.

'A swift response'
In the event of a bird flu pandemic, Nuzzo says she expects Americans will "demand" vaccines, given just how deadly this virus might be.

"What I am worried about is whether any ideological opposition, or perhaps lack of understanding of science, gets in the way of a swift response," she says.

If the virus started spreading among humans, the country would not be able to manufacture all the needed shots in a rapid timeframe.

It would take about six months to churn out 150 million doses, and even longer if the virus had changed enough to warrant another update, says Boucher. And that's still not nearly enough to protect the entire U.S. population of more than 330 million people.

These concerns have prompted the federal government to invest in mRNA vaccine technology for bird flu as was done for COVID-19. These shots could be manufactured in a much faster timeframe.

Borio believes the government's work to accelerate development on new bird flu vaccines will continue under Trump, based on her experience working under the first Trump administration.

"No president or Congress wants to see people dying needlessly of an influenza pandemic," she says.

For his part, Trump's pick to lead the FDA, Dr. Marty Makary, has pushed back on concerns that Kennedy's stance on vaccines should disqualify him from being secretary.

But this transition period is a delicate moment, when the country could be caught off guard if the situation suddenly changes, says Goodman, who recommends the Biden administration share its pandemic playbook so incoming officials can game out different pandemic scenarios and assess readiness. He also cautions that Trump's team needs to preserve the federal workforce, including the career scientists, who have the knowledge on bird flu and pandemics.

"You want to keep the best people, not scare them away," with "extreme rhetoric," he says.

As Trump brings in new people, Pavia hopes he taps those with bird flu expertise, saying there are plenty of "conservative choices," with backgrounds in biodefense and the military. After all, it was President George W. Bush who emphasized the threat of bird flu 20 years ago.

"What you can't do is bring in novices. You can't bring in people who don't have any experience with the diseases or with the complexities of a response," he says. "Mother Nature doesn't care what your politics or your policies are."

The Biden administration, in its waning days, is allocating $306m to respond to public health threats from bird flu, a move applauded by public health experts as the H5N1 outbreak continues to expand among people and animals in the US.

As the outbreak intensifies, the US should continue investing in pandemic response like wastewater monitoring, vaccine manufacturing and distribution, rapid test development and other pressing needs to curtail the outbreak, experts say.

But it’s not clear whether the incoming Trump administration will continue such work.

About $183m of the new funding will go toward pandemic preparedness writ large, especially treatment, at the regional, state and local level, while $103m will be spent monitoring people who have been exposed to the bird flu virus. Another $8m will go to test manufacturing and distribution, and $11m is set aside for research on how to combat H5N1.

“These investments are critical to continuing our disease surveillance, laboratory testing and monitoring efforts alongside our partners at USDA,” Xavier Becerra, secretary of the US Department of Health and Human Services (HHS), said in a statement.

The new funding will be distributed within weeks and because the money has already been appropriated, it cannot legally be reversed if the incoming Trump administration lays out diverging priorities.

While the Biden administration has spent about $1.8bn responding to bird flu so far, the majority of those funds have gone to the US Department of Agriculture (USDA) to address the outbreak among animals.

About $360m of those funds have gone toward human health in this outbreak, which means the new allocation nearly doubles the total amount committed to curtailing bird flu in people.

“I’m thrilled to see this funding made available and I hope that the new administration leans into it to strengthen our ongoing monitoring of the spread of the disease and our ability to stay alert for human cases,” said Megan Ranney, emergency physician and dean of the Yale School of Public Health.

Steps like monitoring the virus in milk and producing more antiviral medication could have been more effective earlier to curtail the outbreak, she said.

“I worry that the virus is already widespread amongst animal reservoirs in the US, so there’s a little bit of luck now in whether or not it turns into a pandemic,” Ranney said. “It could have potentially been averted had we acted more aggressively six or nine months ago.”

Awarding funding to regional, state and local health departments is particularly important because “that seems to be an important catalyst to take action”, said Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health.

“It’s often federal action of some sort, usually in the form of money, that gets states activated,” Nuzzo added.

Improving communication and data-sharing between local entities like healthcare professionals, businesses and school leaders is key for understanding patterns of disease in communities, Ranney said: “Who’s getting sick from what, when and why?”

There was a “long list” of actions needed to respond to this outbreak and to prepare for potential worsening scenarios, with initiatives like monitoring wastewater for pandemic-potential pathogens “top of mind”, Nuzzo said.

Nuzzo noted that “there’s some question about the funding and whether that will be continued” and “wastewater surveillance not only needs to be continued but needs to be expanded”.

Other forms of monitoring for the virus also needed to be supercharged, Nuzzo said. “We are in flu season now, so our strategy for finding cases has to shift, and that will require more H5N1-specific testing, not just testing for flu A.”

While some at-home flu tests exist in the US, they are prohibitively expensive and not widely available. Creating affordable, accessible rapid tests for H5N1 could help ascertain and prevent spread, Ranney and Nuzzo pointed out – especially if the virus mutates for sustained transmission between people.

“If it could spread easily between people, we would be in a pandemic, and it would be around the globe in a matter of weeks,” Nuzzo said.

In the meantime, she said, “we need to do more to protect farm workers”. That includes offering H5N1 vaccines, whether through an emergency use program or a clinical trial, to people at risk of getting sick.

“This is a nasty virus that nobody wants to get. It is a great blessing that the farm workers have not gotten sicker,” Nuzzo said. “But we have seen that this virus retains the potential to make people severely ill.”

The first death in the US from the highly pathogenic avian influenza occurred in Louisiana earlier this month.

Samples of the virus showed a worrying set of mutations that probably occurred over the patient’s course of illness, similar to mutations seen in the 13-year-old girl who has been hospitalized because of bird flu for the past two months in British Columbia, Canada.

“It’s another reminder of how important it is for us to be planning ahead in case of the worst-case scenario and also to try to avert the worst-case scenario,” Ranney said. “We shouldn’t be waiting until the worst happens to act.”

Trump’s pick to lead the HHS, Robert F Kennedy Jr, has for decades staked out anti-science positions, particularly against lifesaving vaccines. Kennedy has also encouraged raw milk consumption during this outbreak.

“We’re going to give infectious disease a break for about eight years,” Kennedy said of infectious disease research last November.

But pandemics are happening with increasing regularity, especially in a changing climate. And a major part of responding to them goes beyond science or funding.

“We need public leaders, health officials and community groups to work together to create trust,” Ranney said.

NEW YORK (AP) — The Biden administration on Tuesday released a “roadmap” for maintaining government defenses against infectious diseases, just as President-elect Donald Trump pledges to dismantle some of them.

The 16-page report recaps steps taken in the last four years against COVID-19, mpox and other diseases, including vaccination efforts and the use of wastewater and other measures to spot signs of erupting disease outbreaks. It’s a public version of a roughly 300-page pandemic-prevention playbook that Biden officials say they are providing to the incoming administration.

Biden officials touted the steps they took to halt or prevent disease threats, but some public heath researchers offer a more mixed assessment of the administration’s efforts. Several experts, for example, said not nearly enough has been done to make sure an expanding bird flu pandemic in animals doesn’t turn into a global health catastrophe for people.

“Overwhelmingly you’ve heard a lot of frustration by outside experts that we’ve been under-reacting to what we see as really serious threat,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health.

Public health experts worry the next administration could do less
Trump and his team plan to slash government spending, and Trump has endorsed prominent vaccine detractors for top government health posts. During the campaign last year, Trump told Time magazine that he would disband the White House office focused on pandemic preparedness, calling it “a very expensive solution to something that won’t work.”

Public health researchers also point to Trump’s first administration, when the White House in 2018 dismantled a National Security Council pandemic unit. When COVID-19 hit two years later, the government’s disjointed response prompted some experts to argue that the unit could have helped a faster and more uniform response.

In 2020, during the pandemic, Trump officials moved to pull the U.S. out of the World Health Organization. President Joe Biden reversed the decision, but Trump’s team is expected to do it again. Experts say such a move would, among other things, hurt the ability to gain information about emerging new outbreaks before they comes to U.S. shores.

Officials with the Trump transition team did not respond to emails requesting information about its pandemic planning.

Many public health experts praise Trump for “ Operation Warp Speed, ” which helped spur the rapid development of COVID-19 vaccines. But several also noted that decades of planning and research under previous administrations laid the groundwork for it.

What do Biden officials say they accomplished?
COVID-19 vaccines did not start to trickle out to the public until after Biden defeated Trump in the 2020 election, and it was the Biden administration that stood up what it describes as the largest free vaccination program in U.S. history.

“President Biden came to office amidst the worst public health crisis in more than a century,” said Dr. Paul Friedrichs, director of the White House Office of Pandemic Preparedness and Response Policy, in a statement. “He partnered with stakeholders across the nation and turned it around, ending the pandemic and saving countless lives.”

Friedrichs’s office was established by Congress in 2022. He said the administration has “laid the foundation for faster and more effective responses to save lives now and in the future.”

What has been done to prepare for bird flu and other threats?
The pandemic office, which released the report Tuesday, said it has taken steps to fight bird flu, which has been spreading among animal species in scores of countries in the last few years.

The virus was detected in U.S. dairy herds in March. At least 66 people in the U.S. have been diagnosed with infections, the vast majority of them dairy or poultry workers who had mild infections. But that count includes an elderly Louisiana man who died.

Among other steps, the administration is stockpiling 10 million doses of vaccine that is considered effective against the strain that’s been circulating in U.S. cattle, and spent $176 million to develop mRNA vaccines that could quickly be adapted to mutations in the virus, with late stage trials “beginning shortly,” the document says.

READ MORE: Louisiana patient is the first to die of bird flu in the U.S., health officials say

Having measures in place to quickly develop and mass produce new vaccines is crucial, said Michael Osterholm, a University of Minnesota expert on infectious diseases.

“We don’t really have any understanding of what influenza virus will emerge one day to cause the next pandemic,” Osterholm said. “It sure isn’t this (bird flu strain), or it would be causing it (a pandemic) right now.”

The U.S. should maintain collaborations that train disease investigators in other countries to detect emerging infections, public health experts say.

“We have to continue to invest in surveillance in areas where we think these infectious agents are likely to emerge,” said Ian Lipkin, an infectious diseases researcher at New York’s Columbia University.

“I’m hoping that the Trump administration — as they are concerned about people coming across the border who may be infected with this or that or the other thing — will see the wisdom in trying to make sure that we do surveillance in areas where we think there’s a large risk,” he said.

The Biden administration has been pumping money out the door to fund bird flu preparedness programs before the Trump team takes over, leaving public health officials grateful even as they insist the incoming president will need to do more once he’s in office.

“This is a good down payment on funding for what is currently a limited number of human cases acquired directly from infected animals. It is not adequate funding for preparing for a potential pandemic,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

The Department of Health and Human Services announced in early January it would be awarding over $300 million in funding for bird flu response efforts, including $186 million through the Administration for Strategic Preparedness and Response for preparedness efforts like training for hospital staff, special units for infectious diseases and personal protective equipment stockpiles.

David Boucher, ASPR’s director of infectious disease preparedness and response, told NOTUS that the incoming Trump administration’s potential views on H5N1 were not considered when deciding which programs to allocate funds to and when. But he said that almost all of the recently announced funding has already been obligated to specific contracts and grants.

“Where we are focusing on the transition is to make sure that it’s smooth, so that our response to H5N1 carries through and we don’t have any disruptions,” he said. “We want a seamless transition to make sure that we’re giving the best response possible to the American public.”

The current H5N1 outbreak began in early 2024. Cases have been detected in wild birds, poultry and cattle — along with over 60 confirmed human cases, mostly in agricultural workers. One person with severe H5N1 died in early January.

A health care lobbyist, who asked to remain anonymous in order to remain on good terms with the incoming Trump administration, said public health advocacy groups involved in the bird flu response are waiting to see how HHS secretary nominee Robert F. Kennedy Jr. may influence public health policy. Kennedy has repeatedly implied that bird flu was created in a lab, potentially with the knowledge of the government, a theory that is not supported by evidence.

Kennedy and the Trump transition team did not respond to requests for comment.

“I think there’s a lot of question marks about the stance that the administration is going to take. [Trump’s first administration] obviously presided over a wildly successful program in Operation Warp Speed, but that has caused some friction within the Republican caucus and the Republican Party,” the lobbyist said. “It’s hard to know who will be calling the shots on the response and what they will want to do. So I think there’s definitely concern, but certainly hope that they will continue preparing in the same way that the Biden administration has.”

But New York State Health Commissioner James McDonald told NOTUS that the every-other-week phone calls he’s had with HHS throughout the current bird flu outbreaks aren’t currently scheduled to continue past Jan. 20.

“They’re waiting for the new administration to see what they want to do,” McDonald said.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a former member of HHS’ COVID-19 advisory committee, said that while the Biden funding was “a start,” it wasn’t enough. What the U.S. really needs to be prepared for a future pandemic, Osterholm said, is sustained investment in vaccine development and manufacturing — because once a serious outbreak actually starts, it’s already too late.

“When you have a pandemic begin, it’ll happen real fast, and it’s like falling off a cliff,” Osterholm said. “Imagine you’ve just walked miles and miles on a perfectly flat piece of ground, and then you take one more step and you’re 24 inches off the edge of the cliff, and it’s five miles straight down. That’s where we’re at. We don’t know how close we are to the edge of that cliff.”

But the U.S.’s vaccine manufacturing capacity is far below what would be needed to adequately protect the population should H5N1 become a widespread pandemic, Osterholm said — and the 60 million doses of antiviral drug Tamiflu the U.S. has stockpiled won’t be enough if H5N1 becomes widely transmitted between humans.

“That won’t stop transmission. At best, it will reduce serious illness and deaths, but it won’t stop the pandemic, and of course, it won’t even begin to address what’s happening globally,” Osterholm said.

The chances of the incoming administration making a large investment in vaccines may be slim. Kennedy, a longtime vaccine skeptic, has said he would give infectious disease research a “break.” And Trump has said he would support efforts by Kennedy to investigate if vaccines cause autism, a claim that has been debunked.

“I worry about the fact that a lot of people who will be in health decision making positions will be new to the job,” Nuzzo said. “We lost a lot of experienced people due to political attacks and general attrition during COVID-19.”

But regardless of staffing challenges, Nuzzo said she believes the incoming administration will be forced to act on H5N1 — if not because of the public health risk, then because of the threat it poses to the economy. Nuzzo pointed to egg shortages and the loss of income to dairy farmers as examples of H5N1’s economic impacts.

“For an administration that was elected in part because of the cost of grocery bills, I don’t see a scenario in which they can ignore H5N1 and still answer the political mill that is hoping for a safe, healthy and inexpensive food supply,” Nuzzo said.

—
Margaret Manto is a NOTUS reporter and an Allbritton Journalism Institute fellow.

Yesterday, health officials in Louisiana announced that a patient who was hospitalized with severe bird flu in December has died. The individual contracted bird flu after exposure to a backyard flock and wild birds. It is the first death recorded in the United States attributed to H5N1, or avian influenza.

The person was over the age of 65 and reportedly had underlying medical conditions. The Louisiana Health Department has not released any more details about the patient.

A total of 66 people in the US tested positive for bird flu in 2024, according to the Centers for Disease Control and Prevention. In all of the other cases, people developed mild symptoms and made a full recovery. But the Louisiana case is a stark reminder that avian flu can be dangerous. And as the number of human infections rises, health experts worry about more cases of severe illness—and potentially more deaths.

“This is an ongoing game of Russian roulette,” says physician Nahid Bhadelia, founding director of the Center on Emerging Infectious Diseases at Boston University. “The more virus there is in our environ
ment, the more chances there are for it to come into contact with humans.” It was only a matter of time before bird flu turned deadly, she says.

The US is in the middle of an H5N1 outbreak that shows no signs of stopping. The virus has infected more than 130 million birds, including commercial poultry, since January 2022. In April 2024 it spilled into dairy cows for the first time. Though not fatal for cows, the virus has sickened more than 900 dairy herds in 16 states.

Most people who come down with bird flu are farm workers or others who have direct contact with sick animals. Of the 66 confirmed infections in the US last year, 40 had exposure to dairy cows, while 23 had exposure to poultry and culling operations. In the three other cases, the exact source of exposure is unknown.

Since 2003, more than 850 human cases of H5N1 bird flu have been reported outside the United States, and about half of those have resulted in death. In a statement released Monday, the CDC said a death from H5N1 bird flu “is not unexpected because of the known potential for infection with these viruses to cause severe illness and death.” Federal health officials say the risk of getting bird flu remains low for the general public, and there is no evidence that the virus is spreading from person to person anywhere in the country.

One of the puzzling aspects of the current US outbreak is why all the human infections until now have resulted in mild illness. “It could be that they're young, healthy people,” says Jennifer Nuzzo, director of the Pandemic Center and a professor of epidemiology at Brown University. “It could be that the way they're being exposed is different from how we've historically seen people get infected. There are a number of hypotheses, but at this point they're all just guesses.”

Nuzzo says it’s very possible that the Louisiana patient’s preexisting health conditions contributed to the severity of their illness, but also points to the case of a teenager in Canada who was hospitalized with bird flu in November.

The 13-year-old girl was initially seen at an emergency department in British Columbia for a fever and conjunctivitis in both eyes. She was discharged home without treatment and later developed a cough, vomiting, and diarrhea. She wound up back in the emergency department in respiratory distress a few days later. She was admitted to the pediatric intensive care unit and went into respiratory failure but eventually recovered after treatment. According to a case report published in the New England Journal of Medicine, the girl had a history of mild asthma and an elevated body-mass index. It’s unknown how she caught the virus.

“What that tells us is that we have no idea who is going to develop mild illness and who is going to develop severe illness, and because of that we have to take these infections very seriously,” Nuzzo says. “We should not assume that all future infections will be mild.”

There’s another clue that could explain the severity of the Louisiana and British Columbia cases. Virus samples from both patients showed some similarities. For one, both were infected with the same subtype of H5N1 called D1.1, which is the same kind of virus found in wild birds and poultry. It’s different from the B3.13 subtype, which is dominant in dairy cows.

“Right now, the question is, is this a more severe strain than the dairy cattle strain?” says Benjamin Anderson, assistant professor of environmental and global health at the University of Florida. So far, scientists don’t have enough data to know for sure. A handful of poultry farm workers in Washington have tested positive for the D1.1 subtype, but those individuals had mild symptoms and did not require hospitalization.

“In the case of the Louisiana infection, we know that person had comorbidities. We know that person was an older individual. These are factors that contribute to more severe outcomes already when it comes to respiratory infections,” Anderson says.

In the Louisiana and British Columbia cases, there’s evidence that the virus may have evolved in both patients to produce more severe illness.

A CDC report from late December found genetic mutations in the virus taken from the Louisiana patient that may have allowed it to enhance its ability to infect the upper airways of humans. The report says the changes observed were likely generated by replication of the virus throughout the patient’s illness rather than transmitted at the time of infection, meaning that the mutations weren’t present in the birds the person was exposed to.

Writing in the New England Journal of Medicine, the team that cared for the Canadian teen also described “worrisome” mutations found in her viral samples. These changes could have allowed the virus to more easily bind to and enter cells in the human respiratory tract.

In the past, bird flu has rarely been transmitted from person to person, but scientists worry about a scenario where the virus would acquire mutations that would make human transmission more likely.

For now, people who work with birds, poultry, or cows, or have recreational exposure to them, are at higher risk of getting bird flu. To prevent illness, health officials recommend avoiding direct contact with wild birds and other animals infected with or suspected to be infected with bird flu viruses.

Emily Mullin is a staff writer at WIRED, covering biotechnology. Previously, she was an MIT Knight Science Journalism project fellow and a staff writer covering biotechnology at Medium's OneZero. Before that, she served as an associate editor at MIT Technology Review, where she wrote about biomedicine. Her stories have also... Read more

Bird flu continues to spread widely in cattle and wild birds. What challenges does the incoming Trump administration face in tackling the outbreak and preparing for a possible pandemic?

The first confirmed death from the H5N1 bird flu in the U.S., reported Monday by officials in Louisiana, comes amid growing concerns that the world could be stumbling into another pandemic.

The bad news around the H5N1 outbreak has been mounting: Nearly a thousand U.S. dairy herds infected since last March, nearly 20 million domestic poultry destroyed due to infections in December, 66 human infections in the U.S., and now one death.

The...

ADDS Louisiana and UK researcher quotes, details

The first human death from bird flu in the United States has intensified calls for the government to ramp up efforts to stave off the threat of another pandemic -- particularly ahead of Donald Trump's return to the White House.

Health experts around the world have for months been urging US authorities to increase surveillance and share more information about its bird flu outbreak after the virus started spreading among dairy cows for the first time.

On Monday, Louisiana health authorities reported that a patient aged over 60 was the country's first person to die from bird flu.

The patient, who contracted avian influenza after being exposed to infected birds, had underlying medical conditions, US health authorities said.

The World Health Organization has maintained that bird flu's risk to the general population is low, and there is no evidence that it has been transmitted between people.

However health experts have been sounding the alarm about the potential pandemic threat of bird flu, particularly as it has shown signs of mutating in mammals into a form that could spread more easily among humans.

The avian influenza variant H5N1 was first detected in 1996, but a record global outbreak since 2020 has resulted in hundreds of millions of poultry birds being culled -- and killed an unknown but massive number of wild birds.

In March, the virus started transmitting between dairy cows in the United States.

Since the start of last year, 66 bird flu cases have been recorded in humans in the United States, many of them among farm workers, according to the Centers for Disease Control and Prevention.

The US cases had been relatively mild until the Louisiana patient, though a Canadian teenager become severely ill. Nearly half of the 954 human cases of H5N1 recorded since 2003 have been fatal, according to the WHO.

Marion Koopmans, a virologist at the Erasmus University Medical Center in the Netherlands, emphasised that the public should not be unduly worried about another pandemic.

"The problem is that this is how it could start," she added.

Koopmans criticised that "there is not really an effort to contain" the bird flu outbreak among cattle in the United States.

Tom Peacock, a virologist at the Imperial College London, said he thought "the biggest error the US has made is its slow and weak response to the cattle outbreak".

The reason bird flu was affecting US cattle seemed to be a combination of this weak early response, poor biosecurity, "and the intensification of US dairy farming (which involves far more movement of animals than any European system)," he told AFP.

Peacock was a co-author of a preprint study released on Monday, which has not been peer-reviewed, describing how the mutations of H5N1 in cattle enhance its ability to infect other mammals -- including humans.

Rebecca Christofferson, a scientist at Louisiana State University, said there were signs that the deceased patient's virus mutated while they were infected -- but it was not transmitted to anyone else.

"The worry is, the more you let this sort of run wild... the more chances you have for this sort of mutation to not only occur, but to then get out and infect someone else, then you start a chain reaction," she told AFP.

WHO spokeswoman Margaret Harris said the United States "are doing a lot of surveillance" on bird flu. "That's why we're hearing about it," she added.

Last week, the US government awarded an additional $306 million to bolster H5N1 surveillance programs and research.

Peacock said that monitoring has increased for US cattle but warned "big gaps" remain.

Rick Bright, a former top US health official, has been among those calling for the department of agriculture to release more information about bird flu infections among animals.

"There are still just reams of data from this current administration that haven't been released," he told the Washington Post on Monday.

The United States has a stockpile of millions of H5N1 vaccine doses, which Bright said should be offered to at-risk people such as farm workers.

The Biden government has also been urged to encourage companies to develop rapid home tests as well as monitor wastewater for bird flu.

Several of the experts called on Biden to act quickly, before president-elect Trump replaces him in less than two weeks.

There are particular concerns about Trump's pick for health secretary, Robert F. Kennedy Jr.

Kennedy is a sceptic of vaccines, which would be among the most powerful weapons to fend off a potential new pandemic. He is also a known fan of raw milk, which has repeatedly been found to be contaminated with bird flu from infected dairy cows.

People at home have been advised to avoid infected animals -- and raw milk -- and to get a seasonal flu vaccine.

Christofferson said her "biggest worry" was that if someone was infected with both seasonal flu and H5N1, they could mix to become "something that's either more transmissible and or more dangerous to people".

The Barron's news department was not involved in the creation of the content above. This article was produced by AFP. For more information go to AFP.com.
© Agence France-Presse

NEW YORK (AP) — The first U.S. bird flu death has been reported — a person in Louisiana who had been hospitalized with severe respiratory symptoms.

State health officials announced the death on Monday, and the Centers for Disease Control and Prevention confirmed it was the nation’s first due to bird flu.

Health officials have said the person was older than 65, had underlying medical problems and had been in contact with sick and dead birds in a backyard flock. They also said a genetic analysis had suggested the bird flu virus had mutated inside the patient, which could have led to the more severe illness.

Few other details about the person have been disclosed.

Since March, 66 confirmed bird flu infections have been reported in the U.S., but previous illnesses have been mild and most have been detected among farmworkers exposed to sick poultry or dairy cows.

A bird flu death was not unexpected, virus experts said. There have been more than 950 confirmed bird flu infections globally since 2003, and more than 460 of those people died, according to the World Health Organization.

The bird flu virus “is a serious threat and it has historically been a deadly virus,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. “This is just a tragic reminder of that.”

Nuzzo noted a Canadian teen became severely ill after being infected recently. Researchers are still trying to gauge the dangers of the current version of the virus and determine what causes it to hit some people harder than others, she said.


“Just because we have seen mild cases does not mean future cases will continue to be mild,” she added.

In a statement, CDC officials described the Louisiana death as tragic but also said “there are no concerning virologic changes actively spreading in wild birds, poultry or cows that would raise the risk to human health.”

In two of the recent U.S. cases — an adult in Missouri and a child in California — health officials have not determined how they caught the virus. The origin of the Louisiana person’s infection was not considered a mystery. But it was the first human case in the U.S. linked to exposure to backyard birds, according to the CDC.

Louisiana officials say they are not aware of any other cases in their state, and U.S. officials have said they do not have any evidence that the virus is spreading from person to person.

The H5N1 bird flu has been spreading widely among wild birds, poultry, cows and other animals. Its growing presence in the environment increases the chances that people will be exposed, and potentially catch it, officials have said.

Officials continue to urge people who have contact with sick or dead birds to take precautions, including wearing respiratory and eye protection and gloves when handling poultry.

___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The patient, aged over 65, had been hospitalized in the southern state since at least mid-December, when the US Centers for Disease Control and Prevention (CDC) announced it as the country's first serious case of human infection from the H5N1 virus.

"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk," the Louisiana Department of Health said in a statement announcing the death.

It said the patient had "contracted H5N1 after exposure to a combination of a non-commercial backyard flock and wild birds," but had detected no further H5N1 infections nor evidence of person-to-person transmission in the state.

The news comes just days after the federal government awarded an additional $306 million to bolster H5N1 surveillance programs and research, amid some criticism for President Joe Biden's administration over its response to the simmering issue.

The amount of bird flu circulating among animals and humans has alarmed scientists over concerns it could mutate into a more transmissible form -- potentially triggering a deadly pandemic.

Since the beginning the 2024, the CDC has recorded 66 cases of bird flu in humans in the United States.

"We have a lot of data that shows that this virus can be lethal, more lethal than many viruses we worry about," Jennifer Nuzzo, a professor of epidemiology at Brown University, told AFP.

"For that reason, people have been quite alarmed about these outbreaks that have been occurring on farms and other places in the US and have really been shouting for the US government to do more," she said.

Death 'not unexpected'
The CDC said in December that genetic sequencing of the H5N1 virus from the Louisiana patient was different from the version detected in many dairy herds around the country.

And a small part of the virus in the patient had genetic modifications that suggested it could have mutated inside the body to adapt to the human respiratory tract.

However, such mutations are not the only thing that could make the virus more contagious or transmissible between humans, according to researchers interviewed by AFP.

H5N1 was first detected in 1996, but since 2020, the number of outbreaks among bird flocks has exploded, while a growing number of mammal species have been affected.

"While tragic, a death from H5N1 bird flu in the United States is not unexpected because of the known potential for infection with these viruses to cause severe illness and death," the CDC said in a statement.

The World Health Organization has recorded over 950 bird flu cases in humans since 2003 in 24 countries, including a large number in China and Vietnam.

Nuzzo said the announcement of the US death did not change her perspective, but underscored her "big worry about the relatively unchecked spread of this virus and the urgency of doing more to prevent people from being infected."

"This is a nasty virus that no one wants to get," she said.

The U.S. has recorded its first death of a person infected with bird flu.

The patient was a resident of southwest Louisiana who was hospitalized last month with the first known severe case of bird flu in the country.

On Monday, the Louisiana Department of Health said the person had died from the illness but shared few other details because of patient privacy rules.

The patient was over 65 and had underlying medical conditions.

The patient contracted the illness after being exposed to "a combination of a non-commercial backyard flock and wild birds," according to a news release. An "extensive public health investigation" did not turn up any other cases of H5N1 in a person or evidence of human-to-human spread.

More than 65 people have caught bird flu during the current outbreak, primarily from close contact while working with infected dairy cattle or poultry.

While these cases have largely led to mild illness, historically other strains of bird flu have proved quite deadly in humans. Of the more than 950 cases reported to the World Health Organization, about 50% have resulted in death.

"We have 20-plus years of data showing that it's a pretty nasty virus," said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. "I am not counting on future infections all being mild."

In November, a 13-year-old girl in British Columbia, Canada, was hospitalized with bird flu. How she caught the virus isn't clear. But her illness was so serious she required extracorporeal membrane oxygenation (ECMO) to keep her alive.

That case underscores that it's "very difficult to predict who will become severely ill after an infection," said Nuzzo. "We should not discount this latest death in Louisiana because the patient had underlying health conditions."

Genetic sequencing from the Centers for Disease Control and Prevention indicates the H5N1 virus responsible for both of these severe illnesses belongs to the D1.1 genotype. While this is a different genetic lineage from the virus infecting dairy cattle, it's still part of the same strain circulating globally in wild birds and U.S. dairy herds — technically known as clade 2.3.4.4b.

The virus appears to have picked up some worrisome mutations during the course of the Louisiana patient's illness.

The same may have happened in Canada. In both cases, there's no indication others were infected, though.

In a statement on the Louisiana death, the CDC reiterated that the risk to the general public is still considered low, saying there are no "concerning virologic changes actively spreading in wild birds, poultry, or cows that would raise the risk to human health."

The outbreak in dairy cattle recently led California to declare a state of emergency and kept public health officials on edge because of the increased potential for the virus to spill over into humans.

Their advice is to avoid contact with wild birds, poultry and rodents and to wash your hands after touching feces or objects that could be contaminated with saliva or mucus, such as bird feeders.

Pets can also catch the virus, particularly by consuming raw meat or raw milk, which can also harbor high loads of the virus.

Edited by Jane Greenhalgh

An uptick of a routine virus in China ignited dire headlines and social media posts, but public health experts caution that the human metapneumovirus cases are part of the typical ebb and flow of respiratory virus seasons and are no reason to be alarmed.

Chinese authorities in late December reported a rising rate of children ages 14 and under testing positive for human metapneumovirus, or HMPV, as part of a broader update on the respiratory virus season. Videos posted on social media of crowded hospitals prompted speculation about the start of another global outbreak.

But respiratory diseases in China this season appear less severe and are spreading at a smaller scale compared with last year, Foreign Ministry spokeswoman Mao Ning said Friday. Public health experts and officials in the United States shared similar assessments that the situation in China does not appear unusual.

The discourse surrounding HMPV illustrates how perceptions of infectious-disease threats have become skewed in the aftermath of covid — particularly when images of sick people emerge from China. Viruses well known among infectious-disease experts but obscure to the public now attract outsize attention.

The HMPV worries are reminiscent of panic last winter over childhood pneumonia cases in China caused by the common Mycoplasma pneumoniae bacterium that periodically spike in countries. Public health experts said those concerns, including a call for a travel ban, were also overblown.

"There's just this tendency post-covid to treat every infectious-disease anything as an emergency when it's not," said Amesh Adalja, an infectious-diseases physician and senior scholar at the Johns Hopkins Center for Health Security. "You wouldn't probably be calling me in 2018 about this."

What is HMPV?
HMPV is nowhere close to SARS-CoV-2 (the virus that causes covid-19) or pandemic material. It's among the long-standing, usually anonymous viruses that cause cold- or flu-like symptoms in the winter.

"How many times do you get sick in the winter and you have no idea what you've got?" said Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health. "It's a virus you'll get. You'll probably get it multiple times in your life."

HMPV has zoonotic origins spilling over from an avian species centuries ago before it was discovered in the Netherlands in 2001. It is part of the same pneumoviridae family as respiratory syncytial virus (RSV), which often infects young children and sparks outbreaks at day cares.

Andrew Pavia, chief of the division of pediatric infectious diseases at University of Utah Health, said HMPV behaves similarly to RSV, with caseloads more severe some years than others. It can put strain on hospitals, especially when coinciding with upticks of covid, flu and RSV.

Why are health experts not too worried about HMPV in China?
Kevin Griffis, a spokesman for the U.S. Centers for Disease Control and Prevention, said the agency is monitoring the outbreak in China but does not think it is novel, and that most respiratory virus hospitalizations are caused by influenza A.

In the United States, less than 2 percent of patients tested for respiratory viruses in late December had HMPV, which ranked last among the usual culprits, according to CDC data.

China underwent one of the world's most restrictive and prolonged lockdowns in response to covid, reducing people's exposure to other viruses such as HMPV. That created a situation where people became more susceptible during a surge, experts said, leading to unusual cases even in young and middle-aged adults.

"Even though you say it's typically affecting the very young and very old, it doesn't mean exclusively," Nuzzo said. "When you have a lot of people getting sick at once, you see things you may not see when it's spread out over time."

Nuzzo said she has not heard reports of unusually large numbers of hospitalizations and deaths in otherwise healthy young and middle-aged adults that would raise alarms, as clinicians in China did during the early days of covid.

Improved testing and disease surveillance have also made it easier to spot upticks in HMPV that would have gone unnoticed years ago.

"People don't realize that metapneumovirus virus is just one of those cadre of viruses that causes upper respiratory infections and has been doing so for a very long time. We're just getting better about testing it and naming it," said Adalja, the infectious-diseases physician. "That can sometimes lead to stories that can be sensationalistic."

What are the symptoms and treatment?
Just because a virus is routine doesn't mean it's mundane. Like other respiratory viruses, HMPV can progress to more serious symptoms, including pneumonia, and poses elevated risk to young children, older adults and immunocompromised people.

But most cases remain mild, with symptoms such as cough, fever and nasal congestion.

There is no vaccine or antiviral treatment for HMPV. Doctors and public health authorities offer no special advice for preventing HMPV: It's the usual mix of washing your hands, covering your mouth when sneezing, and avoiding sick people.

"This is typically less severe than flu or covid. It's basically like the common cold," said Katelyn Jetelina, a California epidemiologist who writes a weekly newsletter on infectious diseases. "There's very little people can do about it. There's no drugs, there's no vaccine. Masking probably works like it does with the other viruses. But that's about it."

Lena H. Sun contributed to this report.

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The victim was older than 65 years and had preexisting health conditions, according to Louisiana authorities, and was believed to have handled wild birds.
There is no evidence yet that the virus has acquired the ability to transmit between people.
A Louisiana resident infected by H5N1 bird flu has died, state authorities there reported Monday, marking the first U.S. death from the disease.

The patient, a person older than 65 years with preexisting conditions, is believed to have handled infected noncommercial and wild birds with the virus, according to the Louisiana Department of Public Health. The person’s name and gender were not disclosed.

The news has confirmed what many experts fear: That if left to spread unabated, the disease has the potential to cause severe illness and death.

“This is an unfortunate reminder that H5N1 retains the ability to cause severe illness and death. It would be wrong to be reassured by the fact that the patient had underlying health conditions,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I.

Nuzzo noted that a child in Canada was also critically sickened by the virus but ultimately survived. However, the lengths doctors took to keep the child alive — daily blood transfusions, intubation and extracorporeal membrane oxygenation, a life support technique that temporarily takes over the function of the heart and lungs for patients with severe heart or lung condition — highlight the extraordinary severity of disease the virus is capable of delivering.

“For this reason, we must treat all infections seriously, and work harder to prevent them,” Nuzzo said.

Before H5N1 bird flu virus arrived in North America in 2021, the disease had been recognized as having potential to cause severe disease and death.

...

Jan 6 (Reuters) - A U.S. patient who had been hospitalized with H5N1 bird flu has died, the Louisiana Department of Health said on Monday, marking the country's first reported human death from the virus.
The patient, who has not been identified, was hospitalized with the virus on Dec. 18 after exposure to a combination of backyard chickens and wild birds, Louisiana health officials had said.
The patient was over age 65 and had underlying medical conditions, officials said, putting the patient at higher risk for serious disease.

Nearly 70 people in the U.S. have contracted bird flu since April, most of them farmworkers, as the virus has circulated among poultry flocks and dairy herds, according to the U.S. Centers for Disease Control and Prevention.
Federal and state officials have said the risk to the general public remains low.
The ongoing bird flu outbreak, which began in poultry in 2022, has killed nearly 130 million wild and domestic poultry and has sickened 917 dairy herds, according to the CDC and the U.S. Department of Agriculture.

An analysis of the virus taken from the Louisiana patient showed it belongs to the D1.1 genotype - the same type that has recently been detected in wild birds and poultry in Washington State, as well as a recent severe case in a teen in British Columbia, Canada, according to the CDC.
It is different from the B3.13 genotype currently circulating in U.S. dairy cows, which has mostly been associated with mild symptoms in human cases including conjunctivitis, or pink eye.

The CDC said the risk to the general public remains low. Experts have been looking for signs that the virus is acquiring the ability to spread easily from person to person, but the CDC said there is no evidence of that.
People who work with birds, poultry, cows, or have recreational exposure to them, are at higher risk, Louisiana health officials said in a statement.
Worldwide, more than 950 human cases of bird flu have been reported to the World Health Organization, and about half have resulted in death.

"Though H5N1 cases in the U.S. have been uniformly mild, the virus does have the capacity to cause severe disease and death in certain cases," said Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.
Several experts said the death was concerning, but not surprising.
"This is a tragic reminder of what experts have been screaming for months, H5N1 is a deadly virus," said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University's School of Public Health.
"I hate to have the death of somebody be a wake-up call," said Gail Hansen, a veterinary and public health consultant.
"But if that's what it takes, hopefully that will make people look at bird flu a little more carefully and say this really is a public health issue we need to be looking at more closely."
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Reporting by Jasper Ward, Katharine Jackson, and Leah Douglas in Washington and Tom Polansek and Julie Steenhuysen in Chicago; editing by Timothy Gardner and Bill Berkrot

As concern grows over the bird flu outbreak in the U.S., the Biden administration is accelerating its efforts to watch and prepare for a potential pandemic.

The Department of Health and Human Services on Friday announced $306 million in new funding for avian flu preparedness, a third of it earmarked for increased monitoring and testing of farmworkers. Most of the rest will go to regional, state, and local programs aimed at preparing for a bird flu pandemic.

Public-health experts have been highly critical of the federal and state response to the bird flu, which was first identified in cows in the U.S. early in 2024. They say the government should have been far more aggressive in monitoring and trying to control the spread of the virus.

"I'm glad to see they're taking more effort," said Jennifer Nuzzo, a professor of epidemiology at Brown University and director of the school's Pandemic Center. "Inasmuch as it signals that this is a serious threat and we need to treat it seriously, I think that's important."

The announcement comes just over two weeks before the Trump administration arrives in Washington. It is the latest in a series of 11th-hour efforts by Biden officials to quickly ramp up their response to the outbreak, which has sickened cattle, poultry, and an increasing number of people across the U.S.

Two weeks ago, the Department of Agriculture said it would begin nationwide testing of unprocessed milk to track the H5N1 avian flu virus. Experts had called for them to do that at least since April.

Though the Centers for Disease Control and Prevention continues to say that the threat the virus poses to the general public is low, there have been a number of worrying developments in recent weeks.

In mid-December, the CDC said that a person had been hospitalized in Louisiana with the first serious case of bird flu in the U.S., a month after officials in Canada reported a serious case there . Later, the CDC said that an analysis of swabs from the Louisiana patient found changes in the virus that could help it bind to human cells .

Those changes likely happened as the virus replicated in the Louisiana patient, according to the CDC. That patient hasn't passed the virus to anyone else, the agency has said.

But the identification of the mutated virus serves as a reminder of how quickly influenza viruses can change, and how avian flu could eventually pose a serious challenge to human health.

The newly-announced HHS awards include $90 million to the Hospital Preparedness Program, an initiative within HHS's Administration for Strategic Preparedness and Response that provides funding to help hospitals respond to major emergencies and disasters. ASPR's Regional Emerging Special Pathogen Treatment Centers, which are hospitals designated to care for patients with very infectious diseases, will get $26 million.

The funds also include $10 million for the National Disaster Medical System, an ASPR program that sends medical personnel and supplies to states in an emergency. The largest individual award is $103 million for CDC to give to local jurisdictions for increased monitoring of people exposed to infected animals.

The funding announced Friday comes after earlier allocations by HHS and the USDA, including $101 million in funding HHS announced in May. HHS said in June that it committed $176 million in funding to Moderna to develop an mRNA-based pandemic flu vaccine .

So far, the government efforts have done little to stop the spread of the virus. The USDA has confirmed cases of H5N1 in 915 dairy herds across the U.S., nearly 200 in California in the last 30 days alone. The virus has ripped through more than two-thirds of California dairy farms since August , and experts say the government's explanation for how it has spread is unconvincing.

The CDC, meanwhile, has confirmed 66 human infections, half of them in California.

"While the risk to humans remains low, we are always preparing for any possible scenario that could arise," HHS Secretary Xavier Becerra said in a statement on Friday. "Preparedness is the key to keeping Americans healthy and our country safe."

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

By Josh Nathan-Kazis