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.

Word count: 884
Copyright WP Company LLC d/b/a The Washington Post Jan 6, 2025

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."
Keep up with the latest medical breakthroughs and healthcare trends with the Reuters Health Rounds newsletter. Sign up here.
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

Most human cases of bird flu in North America have been mild, a fact that’s underscored by a new study of the first 46 confirmed human H5N1 infections in the United States this year. But the case of an ill Canadian teen stands out because of its severity and because the source of exposure remains a mystery.

With the number of cases continuing to grow, leaders from the National Institutes of Health are calling for more action to tackle the bird flu outbreak.

The teenager, who was hospitalized with H5N1 infection in November, became critically ill and spent almost two weeks hooked up to machines that took over for her failing heart, lungs and kidneys, according to a report published Tuesday in the New England Journal of Medicine.


The 13-year-old had asthma and obesity but was otherwise in good health before catching H5N1. She recovered after aggressive treatment with a combination of three antiviral drugs, according to the report.

“She had multiorgan failure and was horribly ill,” said Dr. Megan Ranney, an emergency medicine physician and dean of the Yale School of Public Health, who was not involved with the girl’s care.

The teen was treated with extracorporeal membrane oxygenation, or ECMO, in which machines take over the work of the heart and lungs to give the body a chance to recover. She also had continuous dialysis to help remove toxins from her blood because her kidneys weren’t working, as well as plasma exchange, in which machines separate the clear part of the blood from blood cells so harmful substances can be removed.

“Were those extraordinary treatment modalities not available, she likely would not have lived,” Ranney said.

Health officials in British Columbia closed their investigation into the case late last month after being unable to find the virus in any of the household pets, nearby animals, or soil or water samples. Close monitoring of people who were around the teen determined that no one else caught the virus from her. At the time, it wasn’t clear whether she had recovered.

The new report on the teen’s case “clearly shows that a child who was otherwise generally healthy became sick and then got very, very ill in a matter of days. This is a very worrisome outcome that we should be much more concerned about happening with other infections,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University. She was not involved in the case.

The teen was infected with a newer variant of the H5N1 virus, D1.1, which is carried by wild birds. This variant has played a role in some infections of poultry workers in Washington, which were mild, and a recent human infection in Louisiana, which was severe.

In both severe infections – the teen’s and the case in Louisiana – the virus has shown changes that mean it might be adapting to humans, a finding that has put infectious disease experts on high alert since it increases the possibility of human-to-human spread.

“For this reason, we should be much more aggressive in conducting environmental surveillance for H5N1 to track the virus and to prevent people from becoming infected,” Nuzzo said.

The report of the first 46 human cases, also published Tuesday in the New England Journal of Medicine by researchers at the US Centers for Disease Control and Prevention, shows that most were exposed to infected animals or to raw milk.

Eye redness, or conjunctivitis, was the most common symptom in these farmworker infections, showing up in 42 of 46 cases (93%). Almost half of the workers had fevers, and more than a third reported respiratory symptoms. The average duration of illness was about four days.

The article also acknowledges that the official number of cases is an undercount. Although the CDC says there have been 66 confirmed cases in the US this year, recent testing on dairy farms found that 7% of workers had evidence of recent H5N1 infection in their blood.

In a commentary that accompanied the two studies, Dr. Jeanne Marrazzo, who directs the National Institute of Allergy and Infectious Diseases, says the mutations found in the virus isolated from the Canadian teen highlight an “urgent need for vigilant surveillance and assessment of the threat of human-to-human transmission.”

Surveillance has been hampered because of incomplete reporting of animal infections, she wrote. The US Department of Agriculture hasn’t been submitting critical details like the exact dates when animals have gotten sick or precise locations that help scientists track the evolution of a virus over time.

Taken together, she writes, the new reports of human cases show that the pace of human H5N1 infections has been accelerating. There have also been an increasing number of people with respiratory symptoms, like breathing problems or coughing, linked to their infections.

Although the overall number of human infections related to H5N1 has been low, the continued drip, drip, drip of human and animal detections is not a good sign.

“This kind of repetitive, persistent opportunity for passage from one species to another, from one anatomic space to another, that’s what that’s what influenza thrives on to mutate,” Marrazzo told CNN. “This virus doesn’t miss a beat.”

She and co-author Dr. Michael Ison, who is chief of the Respiratory Diseases Branch at NIAID, call for better cooperation between human and animal disease investigators, complete reporting of data from animal infections so scientists can better track how the virus is spreading, development of countermeasures like vaccines and antiviral medication, and more precautions to prevent infection, such as increased use of recommended personal protective equipment and education about the risks of being around sick animals.

“The risk is really going to come when this gets better at obviously infecting humans, and then we are faced with potential for human-to-human transmission,” Marrazzo said.

The fate of a Canadian teenager who was infected with H5N1 bird flu in early November, and subsequently admitted to an intensive care unit, has finally been revealed: She has fully recovered.

But genetic analysis of the virus that infected her body showed ominous mutations that researchers suggest potentially allowed it to target human cells more easily and cause severe disease — a development the study authors called “worrisome.”

The case was published Tuesday in a special edition of the New England Journal of Medicine that explored H5N1 cases from 2024 in North America. In one study, doctors and researchers who worked with the Canadian teenager published their findings. In the other, public health officials from across the U.S. — from the Centers for Disease Control and Prevention, as well as state and local health departments — chronicled the 46 human cases that occurred between March and October.

There have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024.

In the case of the 13-year-old Canadian child, the girl was admitted to a local emergency room on Nov. 4 having suffered from two days of conjunctivitis (pink eye) in both eyes and one day of fever. The child, who had a history of asthma, an elevated body-mass index and Class 2 obesity, was discharged that day with no treatment.

Over the next three days, she developed a cough and diarrhea and began vomiting. She was taken back to the ER on Nov. 7 in respiratory distress and with a condition called hemodynamic instability, in which her body was unable to maintain consistent blood flow and pressure. She was admitted to the hospital.

On Nov. 8, she was transferred to a pediatric intensive care unit at another hospital with respiratory failure, pneumonia in her left lower lung, acute kidney injury, thrombocytopenia (low platelet numbers) and leukopenia (low white blood cell count).

She tested negative for the predominant human seasonal influenza viruses — but had a high viral loads of influenza A, which includes the major human seasonal flu viruses, as well as H5N1 bird flu. This finding prompted her caregivers to test for bird flu; she tested positive.

As the disease progressed over the next few days, she was intubated and put on extracorporeal membrane oxygenation (ECMO) — a life support technique that temporarily takes over the function of the heart and lungs for patients with severe heart or lung conditions.

She was also treated with three antiviral medications, including oseltamivir (brand name Tamiflu), amantadine (Gocovri) and baloxavir (Xofluza).

Because of concerns about the potential for a cytokine storm — a potentially lethal condition in which the body releases too many inflammatory molecules — she was put on a daily regimen of plasma exchange therapy, in which the patient’s plasma is removed in exchange for donated, health plasma.

As the days went by, her viral load began to decrease; on Nov. 16, eight days after she’d been admitted, she tested negative for the virus.

The authors of the report noted, however, that the viral load remained consistently higher in her lower lungs than in her upper respiratory tract — suggesting that the disease may manifest in places not currently tested for it (like the lower lungs) even as it disappears from those that are tested (like the mouth and nose).

She fully recovered and was discharged sometime after Nov. 28, when her intubation tube was removed.

Genetic sequencing of the virus circulating in the teenager showed it was similar to the one circulating in wild birds, the D1.1 version. It’s a type of H5N1 bird flu that is related, but distinct, from the type circulating in dairy cows and is responsible for the vast majority of human cases reported in the U.S. — most of which were acquired via dairy cows or commercial poultry. This is also the same version of the virus found in a Louisiana patient who experienced severe disease, and it showed a few mutations that researchers say increases the virus’ ability to replicate in human cells.

In the Louisiana case, researchers from the CDC suggested the mutations arose as it replicated in the patient and were were not likely present in the wild.

Irrespective of where and when they occurred, said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I., “it is worrisome because it indicates that the virus can change in a person and possibly cause a greater severity of symptoms than initial infection.”

In addition, said Nuzzo — who was not involved in the research — while there’s evidence these mutations occurred after the patients were infected, and therefore not circulating in the environment “it increases worries that some people may experience more severe infection than other people. Bottom line is that this is not a good virus to get.”

(This article originally appeared in Harvard Public Health magazine. Subscribe to their newsletter.)

Can we predict the ebb and flow of infectious disease the way meteorologists predict the weather?

The federal government has bet big on the concept with a new nationwide network called Insight Net, which links academic disease modelers with public health practitioners. The network comprises 13 research consortia with participants in 24 states and is funded with up to $262 million from the Centers for Disease Control and Prevention. Insight Net members are piloting analytical techniques that combine novel data sources to guide surveillance and inform decision-making during outbreaks. The end goal is to create something akin to a National Weather Service for disease.

Such capacity would be a game-changer for state and local health authorities and for hospitals. At the height of the Covid-19 pandemic, “we were not good at forecasting the demand,” says Douglas Sawyer, chief academic officer of MaineHealth, that state’s biggest hospital system. “We didn’t steer the ship, so to speak, with high fidelity as we wish we could have. We couldn’t prepare and shift resources in thoughtful ways.”

Many hospitals struggled with the crush of patients who needed intensive, isolated care. Because hospitals could not accurately predict the size of impending infection waves, many delayed or canceled routine health care such as physicals or cancer screenings. Meanwhile, Covid care sites built or converted by federal and state authorities ended up being largely unneeded.

These forecasting issues had serious financial consequences for hospitals—and serious health consequences for the public. Insight Net’s progress toward closing that information gap has been steady and marked by small but important victories—as well as plenty of reminders that even the best forecasts are only as good as the data that feed them.

By linking people working in public health directly with disease modelers, the CDC aims to fix the ad hoc approach it used for pandemic forecasting, which was panned from almost the start. In the summer of 2020, a critique in Foreign Affairs labeled the CDC’s approach “an arbitrary assortment of academics” reacting on the fly and asserted no one today would handle hurricane response in that fashion. In 2021, the CDC tapped Caitlin Rivers, one of the article’s coauthors and an epidemiologist at Johns Hopkins Bloomberg School of Public Health, as the first associate director of its new Center for Forecasting and Outbreak Analytics, or CFA. In 2023 the CFA established Insight Net, and Rivers, who had returned to Johns Hopkins, became director of its node in the network (Dylan George, her Foreign Affairs coauthor, is the CFA’s current director). Their core message, then and now: Disease forecasting shouldn’t be improvised.

Policymakers and the public put their trust in major storm alerts, according to George, because the weather service is “applying the best models in an operational context on a day in and day out basis, cranking out results,” George says. “And then you have local meteorologists interpret those results for people to actually make decisions.” That process establishes a track record of monitoring and communicating forecasts, including their uncertainty, even when the weather is calm, sunny, and mild. “We’ve tried to pattern after that,” George adds.

At the height of the Covid-19 pandemic, “we were not good at forecasting the demand.”

That has meant investing in a dedicated program for disease forecasting, with formal working relationships between modelers and federal, state, and local health officials. It also means the CFA has been keen to demonstrate how modeling can help public health practice and communication. For instance, it has tapped data from the National Wastewater Surveillance System, launched by the CDC in 2020, to improve localized forecasts of Covid hospital admissions. It also helped the Chicago Department of Public Health confront a March 2024 measles outbreak at a temporary migrant shelter housing more than 1,400 people. As public health workers began vaccinating and screening shelter residents to identify and isolate the sick, department leaders reached out to the CFA, which rapidly refined a model of measles to mimic the outbreak’s timeline of infection, symptom onset, and recovery, which Chicago health officials could then use to predict its future course.

The model didn’t influence the department’s interventions, which were already underway. But it did reassure officials they’d correctly identified their patient zero: Outbreak simulations that assumed earlier, undetected infections generated far different case data from what was observed. The forecasts also helped set expectations for the outbreak’s severity by providing a range of potential case numbers and dates when infections would peak and subside. After a couple weeks of continuous updating with data on new measles cases, the model predicted there would be between 57 and 65 cases and the final rash would appear on April 16. In the end, the outbreak lasted about two months and infected 57 people.

“It really helped our own planning, and our thinking about staffing,” says Stephanie Gretsch, an epidemiologist at the Chicago Department of Public Health. “It was also incredibly helpful for communicating with our city agency partners responsible for housing and schooling; and the hospitals we asked to help isolate infected residents, to give them a sense of how long we thought this was going to last.”

After the outbreak, Chicago public health officials used the modeling to quantify the value of its interventions. Outbreak simulations where responses did not include mass vaccination or active case-finding efforts suggested it would have lasted seven weeks longer and more than quadrupled the number of infections. This finding suggests that modeling hypothetical scenarios might offer a tool for easing heightened skepticism of public health interventions and investments, say several Insight Net partners.

Syphilis is one target of the Insight Net consortium at the University of Utah. The disease, resurgent in the U.S., can infect a fetus during pregnancy and cause serious medical complications, including miscarriage, stillbirth, and infant death. The goal is to “address the issues and show how bad this problem could get if trends continue,” says principal investigator Matthew Samore, a professor of medicine and the division chief of epidemiology at the University of Utah. “We also want to get a deeper understanding of how STIs like this are spreading through different populations…and to calculate how much benefit do we get by investing in more intensive screening and contact tracing.” By helping establish the extent of the risk, the models could bolster requests to fund more screening and treatment of groups with high infection rates, such as people in prison.

Modeling hypothetical scenarios might offer a tool for easing heightened skepticism of public health interventions and investments, say several Insight Net partners.

The modeling could also improve disease forecasting dashboards used by the public to assess health threats. The Massachusetts Department of Public Health, or MDPH, has dashboards that track severe respiratory illnesses statewide, but delays in data reporting from local hospitals limit their usefulness. In 2024, MDPH worked with the Insight Net researchers at the University of Massachusetts Amherst and the University of Texas at Austin to build models filling in those gaps, allowing it to add recent emergency room visits and hospital admissions due to Covid, RSV, and influenza broken down by demographics. Such small-scale adoptions are needed both to validate disease forecasting and to build trust in the models, says Meagan Burns, a senior informatics epidemiologist at MDPH. “These tools are very cool, but they’re also very new,” she says.

People in Massachusetts also are getting a look at disease forecasts as part of their weather news. Last February, meteorologists at Boston’s CBS affiliate, WBZ-TV, began adding localized disease data visualizations to their weather reports. These are put together by the Insight Net team based at Johns Hopkins and arranged through a collaboration with the American Meteorological Society. The first one featured a colorful chart showing that emergency room visits due to Covid-19 were declining steadily from their post-Christmas peak. The original plan was to do weekly check-ins on infectious respiratory illnesses, but as the weather warmed, infection numbers plummeted and stayed low.

“There were several weeks where there wasn’t a whole lot to talk about with Covid or the flu,” says meteorologist Terry Eliasen, executive producer of WBZ’s weather team. While viewers might find sunny weather forecasts useful, there didn’t seem to be much news value in “sunny” public health numbers. So WBZ skipped a few weeks. Then Eliasen asked the Johns Hopkins team what else it could do. Over the summer, researchers responded with data visualizations related to outbreaks of norovirus and eastern equine encephalitis, as well as the risk of heat-related illnesses.

This quick shift in focus drew praise as a sign that the university-based modelers at Insight Net are serious about partnering with public health practitioners and communicators. The CFA worked with the Council of State and Territorial Epidemiologists, or CTSE, on the legal and logistical issues of data-sharing, and to see what forecasting tools might be useful to its members. The two organizations convened a series of meetings with state and local health officials to ask what uses they might have for forecasting tools and whether there were specialized techniques they’d like. That was especially useful, says Janet Hamilton, the CSTE’s executive director. “We need to have enough time to talk to the modelers to say, ‘That’s a great model but it doesn’t help me. It doesn’t answer my questions.’”

Disease threats do not yet have the color-coded, real-time tracking maps the National Weather Service uses for potential hurricanes. Of course, there are no satellite images of developing disease threats, which not only are propelled by unique (and often mutating) biology, but also have to account for something that’s even harder to predict—human behavior. Several Insight Net forecasters are trying to meet this massive data challenge by mixing traditional data sources such as infection rates with the digital breadcrumbs of human activity like searches for symptoms, social media posts, and trends in medication purchases.

People spread diseases when they travel and gather, notes Alessandro “Alex” Vespignani, a physicist and computational scientist at Northeastern University whose lab models large-scale complex systems. He and his team are part of an Insight Net research consortium with Maine’s major hospital systems, MaineHealth and Northern Light Health, which are working on a pilot project to weave human mobility data into disease models. They draw on aggregated and anonymized mobile device location data, databases of global flight schedules, and traces of pathogens found in wastewater sampled from municipal sources and from international flights for analysis by the Boston biotech company Ginkgo Bioworks.


For all of Undark’s coverage of the global Covid-19 pandemic, please visit our extensive coronavirus archive.

“Our models are like a layer cake,” Vespignani says, with each layer creating a virtual “business as usual world” the modelers use for outbreak simulations. Layers are only added if they significantly improve the model’s predictions or extend the timeline for an accurate forecast. For instance, the lab found that it could accurately forecast greater Boston hospital admission rates three weeks ahead of time by adding mobility and proximity data derived from about 82,000 mobile phones, compared to just two weeks using conventional public health data such as statewide Covid test results. That extra week for planning is “a big deal for hospitals” for scheduling staff and procedures, says Samuel Scarpino, director of Northeastern University’s Institute for Experiential AI and a member of the Insight Net team. Since hospitals aim for 90 percent capacity, even a slight uptick in the need for beds can complicate care.

This fall, the lab will tap retrospective data from Maine’s Covid hospitalization numbers to try to replicate that forecasting capability. It’s also planning to use the mobility-enhanced models to forecast hospitalizations for flu, RSV, and Covid at individual Maine hospitals this winter. If these efforts are successful, Scarpino hopes to scale the models for use nationwide.

The Insight Net initiative also faces the labyrinthine way the U.S. gathers and shares core public health data such as test results and hospital records. Reducing those obstacles is a key target of the CDC’s Data Modernization Initiative, launched in 2019 to promote things like electronic case reporting, interoperability among different data collection systems, and standardized data use agreements between state, tribal, local and territorial, and federal health authorities. But the data pipeline’s bottlenecks aren’t simply technical and legal, according to infectious disease experts such as Jennifer Nuzzo, an epidemiologist who directs Brown University’s Pandemic Center. They also involve whether we’re asking the right questions about disease threats to get the data we need. “It’s great for us to invest in analytic approaches that can help us tell what could happen in the future,” says Nuzzo. “But what I want to see is a better utilization, analysis, and visualization of the data that we have to tell us what’s happening today.”

For instance, the fragmented efforts to track the H5N1 bird flu virus in the U.S. have drawn a chorus of concern from public health leaders and researchers. Last year, the virus leapt from wild birds to more than 100 million poultry in 49 states as well as other domesticated species, including dairy cows and, more recently, pigs. A small but growing number of people have also been infected (mostly farm workers, but not all). Tracking the virus requires coordination among multiple federal agencies, including the Department of Agriculture, the Food and Drug Administration, and the CDC, as well as states that vary widely in the ways they test animals, people, and bulk milk tanks.

Thus far, most humans with bird flu have had minor symptoms, and there’s no evidence of the virus spreading from person to person, which could trigger a pandemic. But the risk increases with flu season, because different viruses infecting the same host can swap genes (known as genetic reassortment) and evolve into something new and more dangerous. If pandemics were hurricanes, having the avian flu virus circulating in cows along with regular flu infections in humans would be akin to a low pressure system in the Caribbean — it could dissipate, but it could also develop into huge trouble for the mainland United States. Nuzzo says we could better predict the outcome if we focused more on targeted surveillance about emerging health threats.

Fragmented efforts to track the H5N1 bird flu virus in the U.S. have drawn a chorus of concern from public health leaders and researchers.

“An awareness of what’s happening this week, and last week, is the starting point for trying to figure out what’s going to happen in the next few weeks and beyond,” says Roni Rosenfeld, a professor of machine learning, language technologies, computer science, and computational biology in the School of Computer Science at Carnegie Mellon University and a cofounder of the Delphi Research Group, a global network of disease modelers working with Insight Net. “So, already before the pandemic, we shifted much of our effort to what I call situational awareness — being aware of what’s happening right now at as fine a geographic, pathogenic, syndromic, and demographic granularity as possible.”

Dylan George, director of the CFA, agrees that disease forecasts will require better raw data and more proactive surveillance. He argues now is the time to strengthen partnerships between researchers and public health practitioners, to build trust and a shared language, and to smooth frictions that can cripple effective collaboration during a crisis. The ultimate test of success for Insight Net, he says, will be seeing them in action:

“If a bunch of state and local health department folks are saying, ‘These forecasting tools are helping me do my job better,’ then I know that we deserve to live another day.”

Chris Berdik is a Boston-based science journalist.

In April 2017, three months after Donald Trump was inaugurated president, tens of thousands of scientists and their supporters gathered on Boston Common in the damp, chilly air to protest the new administration’s proposed steep budget cuts to medical research.

The March for Science, echoed in similar rallies across the country, pushed back on Trump’s statements denying climate change and his administration’s plan to slash billions of dollars from the National Institutes of Health, the federal government’s largest funder of medical research.

The simmering threat of bird flu may be inching closer to boiling over.

This year has been marked by a series of concerning developments in the virus’ spread. Since April, at least 65 people have tested positive for the virus — the first U.S. cases other than a single infection in 2022. Dairy cow herds in 16 states have been infected this year. The Centers for Disease Control and Prevention confirmed the country’s first severe bird flu infection on Wednesday, a critically ill patient in Louisiana. And California Gov. Gavin Newsom declared a state of emergency last week in response to rampant outbreaks in cows and poultry.

“The traffic light is changing from green to amber,” said Dr. Peter Chin-Hong, a professor of medicine at the University of California, San Francisco, who studies infectious diseases. “So many signs are going in the wrong direction.”

No bird flu transmission between humans has been documented, and the CDC maintains that the immediate risk to public health is low. But scientists are increasingly worried, based on four key signals.

For one, the bird flu virus — known as H5N1 — has spread uncontrolled in animals, including cows frequently in contact with people. Additionally, detections in wastewater show the virus is leaving a wide-ranging imprint, and not just in farm animals.

Then there are several cases in humans where no source of infection has been identified, as well as research about the pathogen’s evolution, which has shown that the virus is evolving to better fit human receptors and that it will take fewer mutations to spread among people.

Together, experts say, these indicators suggest the virus has taken steps toward becoming the next pandemic.

“We’re in a very precarious situation right now,” said Scott Hensley, a professor of microbiology at the University of Pennsylvania.

Widespread circulation creates new pathways to people
Since this avian flu outbreak began in 2022, the virus has become widespread in wild birds, commercial poultry and wild mammals like sea lions, foxes and black bears. More than 125 million poultry birds have died of infections or been culled in the U.S., according to the U.S. Agriculture Department.

An unwelcome surprise arrived in March, when dairy cows began to fall ill, eat less feed and produce discolored milk.

Research showed the virus was spreading rapidly and efficiently between cows, likely through raw milk, since infected cows shed large amounts of the virus through their mammary glands. Raccoons and farm cats appeared to get sick by drinking raw milk, too.

The more animals get infected, the higher the chances of exposure for the humans who interact with them.

“The more people infected, the more possibility mutations could occur,” said Jennifer Nuzzo, a professor of epidemiology and the director of the Brown University School of Public Health’s Pandemic Center. “I don’t like giving the virus a runway to a pandemic.”

Until this year, cows hadn’t been a focus of influenza prevention efforts.

“We didn’t think dairy cattle were a host for flu, at least a meaningful host,” Andrew Bowman, a professor of veterinary preventive medicine at Ohio State University, told NBC News this summer.

But now, the virus has been detected in at least 875 herds of cows across at least 16 states, as well as in raw (unpasteurized) milk sold in California and in domestic cats who drank raw milk.

“The ways in which a community and consumers are directly at risk now is in raw milk and cheese products,” Chin-Hong said. “A year ago, or even a few months ago, that risk was lower.”

Cases with no known source of exposure
The majority of the human H5N1 infections have been among poultry and dairy farmworkers. But in several puzzling cases, no source of infection has been identified.

The first was a hospitalized patient in Missouri who tested positive in August and recovered. Another was a California child whose infection was reported in November.

Additionally, Delaware health officials reported a case of H5N1 this week in a person without known exposure to poultry or cattle. But CDC testing could not confirm the virus was bird flu, so the agency considers it a “probable” case.

In Canada, a British Columbia teenager was hospitalized in early November after contracting H5N1 without any known exposure to farm or wild animals. The virus’ genetic material suggested it was similar to a strain circulating in waterfowl and poultry.

Such unexplained cases are giving some experts pause.

“That suggests this virus may be far more out there and more people might be exposed to it than we previously thought,” Nuzzo said.

Rising levels of bird flu in wastewater
To better understand the geography of bird flu’s spread, scientists are monitoring wastewater for fragments of the virus.

“We’ve seen detections in a lot more places, and we’ve seen a lot more frequent detections” in recent months, said Amy Lockwood, the public health partnerships lead at Verily, a company that provides wastewater testing services to the CDC and a program called WastewaterSCAN.

Earlier this month, about 19% of the sites in the CDC’s National Wastewater Surveillance System — across at least 10 states — reported positive detections.

It’s not possible to know if the virus fragments found came from animal or human sources. Some could have come from wild bird excrement that enters storm drains, for example.

“We don’t think any of this is an indication of human-to-human transmission now, but there is a lot of H5 virus out there,” said Peggy Honein, the director of the Division of Infectious Disease Readiness & Innovation at the CDC.

Lockwood and Honein said the wastewater detections have mostly been in places where dairy is processed or near poultry operations, but in recent months, mysterious hot spots have popped up in areas without such agricultural facilities.

“We are starting to see it in more and more places where we don’t know what the source might be automatically,” Lockwood said, adding: “We are in the throes of a very big numbers game.”

One mutation away?
Until recently, scientists who study viral evolution thought H5N1 would need a handful of mutations to spread readily between humans.

But research published in the journal Science this month found that the version of the virus circulating in cows could bind to human receptors after a single mutation. (The researchers were only studying proteins in the virus, not the full, infectious virus.)

“We don’t want to assume that because of this finding that a pandemic is likely to happen. We only want to make the point that the risk is increased as a result of this,” said paper co-author Jim Paulson, the chair of molecular medicine at Scripps Research.

Separately, scientists in recent months have identified concerning elements in another version of the virus, which was found in the Canadian teenager who got seriously ill. Virus samples showed evidence of mutations that could make it more amenable to spreading between people, Hensley said.

A CDC spokesperson said it’s unlikely the virus had those mutations when the teen was exposed.

“It is most likely that the mixture of changes in this virus occurred after prolonged infection of the patient,” the spokesperson said.

The agency’s investigations do not suggest that “the virus is adapting to readily transmit between humans,” the spokesperson added.

The viral strain in the United States’ first severe bird flu case, announced on Wednesday, was from the same lineage as the Canadian teen’s infection.

Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, said the CDC is assessing a sample from that patient to determine if it has any concerning mutations.

Hensley, meanwhile, said he’s concerned that flu season could offer the virus a shortcut to evolution. If someone gets co-infected with a seasonal flu virus and bird flu, the two can exchange chunks of genetic code.

“There’s no need for mutation — the genes just swap,” Hensley said, adding that he hopes farmworkers get flu shots to limit such opportunities.

Future testing and vaccines
Experts said plenty can be done to better track bird flu’s spread and prepare for a potential pandemic. Some of that work has already begun.

The USDA on Tuesday expanded bulk testing of milk to a total of 13 states, representing about 50% of the nation’s supply.

Nuzzo said that effort can’t ramp up soon enough.

“We have taken way too long to implement widespread bulk milk testing. That’s the way we’re finding most outbreaks on farms,” she said.

At the same time, Andrew Trister, chief medical and scientific officer at Verily, said the company is working to improve its wastewater analysis in the hope of identifying concerning mutations.

The USDA has also authorized field trials to vaccinate cows against H5N1. Hensley said his laboratory has tested a new mRNA vaccine in calves.


...

Keith Poulsen’s jaw dropped when farmers showed him images on their cellphones at the World Dairy Expo in Wisconsin in October. A livestock veterinarian at the University of Wisconsin, Poulsen had seen sick cows before, with their noses dripping and udders slack.

But the scale of the farmers’ efforts to treat the sick cows stunned him. They showed videos of systems they built to hydrate hundreds of cattle at once. In 14-hour shifts, dairy workers pumped gallons of electrolyte-rich fluids into ailing cows through metal tubes inserted into the esophagus.

“It was like watching a field hospital on an active battlefront treating hundreds of wounded soldiers,” he said.

Nearly a year into the first outbreak of the bird flu among cattle, the virus shows no sign of slowing. The U.S. government failed to eliminate the virus on dairy farms when it was confined to a handful of states, by quickly identifying infected cows and taking measures to keep their infections from spreading. Now at least 875 herds across 16 states have tested positive.

Experts say they have lost faith in the government’s ability to contain the outbreak.

“We are in a terrible situation and going into a worse situation,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “I don’t know if the bird flu will become a pandemic, but if it does, we are screwed.”

To understand how the bird flu got out of hand, KFF Health News interviewed nearly 70 government officials, farmers and farmworkers, and researchers with expertise in virology, pandemics, veterinary medicine, and more.

Together with emails obtained from local health departments through public records requests, this investigation revealed key problems, including deference to the farm industry, eroded public health budgets, neglect for the safety of agriculture workers, and the sluggish pace of federal interventions.

Case in point: The U.S. Department of Agriculture this month announced a federal order to test milk nationwide. Researchers welcomed the news but said it should have happened months ago — before the virus was so entrenched.

“It’s disheartening to see so many of the same failures that emerged during the covid-19 crisis reemerge,” said Tom Bollyky, director of the Global Health Program at the Council on Foreign Relations.

Far more bird flu damage is inevitable, but the extent of it will be left to the Trump administration and Mother Nature. Already, the USDA has funneled more than $1.7 billion into tamping down the bird flu on poultry farms since 2022, which includes reimbursing farmers who’ve had to cull their flocks, and more than $430 million into combating the bird flu on dairy farms. In coming years, the bird flu may cost billions of dollars more in expenses and losses. Dairy industry experts say the virus kills roughly 2% to 5% of infected dairy cows and reduces a herd’s milk production by about 20%.

Worse, the outbreak poses the threat of a pandemic. More than 60 people in the U.S. have been infected, mainly by cows or poultry, but cases could skyrocket if the virus evolves to spread efficiently from person to person. And the recent news of a person critically ill in Louisiana with the bird flu shows that the virus can be dangerous.

Just a few mutations could allow the bird flu to spread between people. Because viruses mutate within human and animal bodies, each infection is like a pull of a slot machine lever.

“Even if there’s only a 5% chance of a bird flu pandemic happening, we’re talking about a pandemic that probably looks like 2020 or worse,” said Tom Peacock, a bird flu researcher at the Pirbright Institute in the United Kingdom, referring to covid. “The U.S. knows the risk but hasn’t done anything to slow this down,” he added.

Beyond the bird flu, the federal government’s handling of the outbreak reveals cracks in the U.S. health security system that would allow other risky new pathogens to take root. “This virus may not be the one that takes off,” said Maria Van Kerkhove, director of the emerging diseases group at the World Health Organization. “But this is a real fire exercise right now, and it demonstrates what needs to be improved.”

A Slow Start

It may have been a grackle, a goose, or some other wild bird that infected a cow in northern Texas. In February, the state’s dairy farmers took note when cows stopped making milk. They worked alongside veterinarians to figure out why. In less than two months, veterinary researchers identified the highly pathogenic H5N1 bird flu virus as the culprit.

Long listed among pathogens with pandemic potential, the bird flu’s unprecedented spread among cows marked a worrying shift. It had evolved to thrive in animals that are more like people biologically than birds.

After the USDA announced the dairy outbreak on March 25, control shifted from farmers, veterinarians, and local officials to state and federal agencies. Collaboration disintegrated almost immediately.

Farmers worried the government might block their milk sales or even demand sick cows be killed, as poultry are, said Kay Russo, a livestock veterinarian in Fort Collins, Colorado.

Instead, Russo and other veterinarians said, they were dismayed by inaction. The USDA didn’t respond to their urgent requests to support studies on dairy farms — and for money and confidentiality policies to protect farmers from financial loss if they agreed to test animals.

The USDA announced that it would conduct studies itself. But researchers grew anxious as weeks passed without results. “Probably the biggest mistake from the USDA was not involving the boots-on-the-ground veterinarians,” Russo said.

Will Clement, a USDA senior adviser for communications, said in an email: “Since first learning of H5N1 in dairy cattle in late March 2024, USDA has worked swiftly and diligently to assess the prevalence of the virus in U.S. dairy herds.” The agency provided research funds to state and national animal health labs beginning in April, he added.

The USDA didn’t require lactating cows to be tested before interstate travel until April 29. By then, the outbreak had spread to eight other states. Farmers often move cattle across great distances, for calving in one place, raising in warm, dry climates, and milking in cooler ones. Analyses of the virus’s genes implied that it spread between cows rather than repeatedly jumping from birds into herds.

Milking equipment was a likely source of infection, and there were hints of other possibilities, such as through the air as cows coughed or in droplets on objects, like work boots. But not enough data had been collected to know how exactly it was happening. Many farmers declined to test their herds, despite an announcement of funds to compensate them for lost milk production in May.

“There is a fear within the dairy farmer community that if they become officially listed as an affected farm, they may lose their milk market,” said Jamie Jonker, chief science officer at the National Milk Producers Federation, an organization that represents dairy farmers. To his knowledge, he added, this hasn’t happened.

Speculation filled knowledge gaps. Zach Riley, head of the Colorado Livestock Association, said he suspected that wild birds may be spreading the virus to herds across the country, despite scientific data suggesting otherwise. Riley said farmers were considering whether to install “floppy inflatable men you see outside of car dealerships” to ward off the birds.

Advisories from agriculture departments to farmers were somewhat speculative, too. Officials recommended biosecurity measures such as disinfecting equipment and limiting visitors. As the virus kept spreading throughout the summer, USDA senior official Eric Deeble said at a press briefing, “The response is adequate.”

The USDA, the Centers for Disease Control and Prevention, and the Food and Drug Administration presented a united front at these briefings, calling it a “One Health” approach. In reality, agriculture agencies took the lead.

This was explicit in an email from a local health department in Colorado to the county’s commissioners. “The State is treating this primarily as an agriculture issue (rightly so) and the public health part is secondary,” wrote Jason Chessher, public health director in Weld County, Colorado. The state’s leading agriculture county, Weld’s livestock and poultry industry produces about $1.9 billion in sales each year.

Patchy Surveillance

In July, the bird flu spread from dairies in Colorado to poultry farms. To contain it, two poultry operations employed about 650 temporary workers — Spanish-speaking immigrants as young as 15 — to cull flocks. Inside hot barns, they caught infected birds, gassed them with carbon dioxide, and disposed of the carcasses. Many did the hazardous job without goggles, face masks, and gloves.

By the time Colorado’s health department asked if workers felt sick, five women and four men had been infected. They all had red, swollen eyes — conjunctivitis — and several had such symptoms as fevers, body aches, and nausea.

State health departments posted online notices offering farms protective gear, but dairy workers in several states told KFF Health News that they had none. They also hadn’t heard about the bird flu, never mind tests for it.

Studies in Colorado, Michigan, and Texas would later show that bird flu cases had gone under the radar. In one analysis, eight dairy workers who hadn’t been tested — 7% of those studied — had antibodies against the virus, a sign that they had been infected.

Missed cases made it impossible to determine how the virus jumped into people and whether it was growing more infectious or dangerous. “I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, an executive director at the international organization the Coalition for Epidemic Preparedness Innovations, who served as assistant secretary for preparedness and response in the Obama administration.

Citing “insufficient data,” the British government raised its assessment of the risk posed by the U.S. dairy outbreak in July from three to four on a six-tier scale.

Virologists around the world said they were flabbergasted by how poorly the United States was tracking the situation. “You are surrounded by highly pathogenic viruses in the wild and in farm animals,” said Marion Koopmans, head of virology at Erasmus Medical Center in the Netherlands. “If three months from now we are at the start of the pandemic, it is nobody’s surprise.”

Although the bird flu is not yet spreading swiftly between people, a shift in that direction could cause immense suffering. The CDC has repeatedly described the cases among farmworkers this year as mild — they weren’t hospitalized. But that doesn’t mean symptoms are a breeze, or that the virus can’t cause worse.

“It does not look pleasant,” wrote Sean Roberts, an emergency services specialist at the Tulare County, California, health department in an email to colleagues in May. He described photographs of an infected dairy worker in another state: “Apparently, the conjunctivitis that this is causing is not a mild one, but rather ruptured blood vessels and bleeding conjunctiva.”

Over the past 30 years, half of around 900 people diagnosed with bird flu around the world have died. Even if the case fatality rate is much lower for this strain of the bird flu, covid showed how devastating a 1% death rate can be when a virus spreads easily.

Like other cases around the world, the person now hospitalized with the bird flu in Louisiana appears to have gotten the virus directly from birds. After the case was announced, the CDC released a statement saying, “A sporadic case of severe H5N1 bird flu illness in a person is not unexpected.”

‘The Cows Are More Valuable Than Us’

Local health officials were trying hard to track infections, according to hundreds of emails from county health departments in five states. But their efforts were stymied. Even if farmers reported infected herds to the USDA and agriculture agencies told health departments where the infected cows were, health officials had to rely on farm owners for access.

“The agriculture community has dictated the rules of engagement from the start,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “That was a big mistake.”

Some farmers told health officials not to visit and declined to monitor their employees for signs of sickness. Sending workers to clinics for testing could leave them shorthanded when cattle needed care. “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too,” said an email from the Weld, Colorado, health department.

“We know of 386 persons exposed — but we know this is far from the total,” said an email from a public health specialist to officials at Tulare’s health department recounting a call with state health officials. “Employers do not want to run this through worker’s compensation. Workers are hesitant to get tested due to cost,” she wrote.

Jennifer Morse, medical director of the Mid-Michigan District Health Department, said local health officials have been hesitant to apply pressure after the backlash many faced at the peak of covid. Describing the 19 rural counties she serves as “very minimal-government-minded,” she said, “if you try to work against them, it will not go well.”

Rural health departments are also stretched thin. Organizations that specialize in outreach to farmworkers offered to assist health officials early in the outbreak, but months passed without contracts or funding. During the first years of covid, lagging government funds for outreach to farmworkers and other historically marginalized groups led to a disproportionate toll of the disease among people of color.

Kevin Griffis, director of communications at the CDC, said the agency worked with the National Center for Farmworker Health throughout the summer “to reach every farmworker impacted by H5N1.” But Bethany Boggess Alcauter, the center’s director of public health programs, said it didn’t receive a CDC grant for bird flu outreach until October, to the tune of $4 million. Before then, she said, the group had very limited funds for the task. “We are certainly not reaching ‘every farmworker,’” she added.

Farmworker advocates also pressed the CDC for money to offset workers’ financial concerns about testing, including paying for medical care, sick leave, and the risk of being fired. This amounted to an offer of $75 each. “Outreach is clearly not a huge priority,” Boggess said. “I hear over and over from workers, ‘The cows are more valuable than us.’”

The USDA has so far put more than $2.1 billion into reimbursing poultry and dairy farmers for losses due to the bird flu and other measures to control the spread on farms. Federal agencies have also put $292 million into developing and stockpiling bird flu vaccines for animals and people. In a controversial decision, the CDC has advised against offering the ones on hand to farmworkers.

“If you want to keep this from becoming a human pandemic, you focus on protecting farmworkers, since that’s the most likely way that this will enter the human population,” said Peg Seminario, an occupational health researcher in Bethesda, Maryland. “The fact that this isn’t happening drives me crazy.”

Nirav Shah, principal deputy director of the CDC, said the agency aims to keep workers safe. “Widespread awareness does take time,” he said. “And that’s the work we’re committed to doing.”

As President-elect Donald Trump comes into office in January, farmworkers may be even less protected. Trump’s pledge of mass deportations will have repercussions whether they happen or not, said Tania Pacheco-Werner, director of the Central Valley Health Policy Institute in California.

Many dairy and poultry workers are living in the U.S. without authorization or on temporary visas linked to their employers. Such precarity made people less willing to see doctors about covid symptoms or complain about unsafe working conditions in 2020. Pacheco-Werner said, “Mass deportation is an astronomical challenge for public health.”

Not ‘Immaculate Conception’

A switch flipped in September among experts who study pandemics as national security threats. A patient in Missouri had the bird flu, and no one knew why. “Evidence points to this being a one-off case,” Shah said at a briefing with journalists. About a month later, the agency revealed it was not.

Antibody tests found that a person who lived with the patient had been infected, too. The CDC didn’t know how the two had gotten the virus, and the possibility of human transmission couldn’t be ruled out.

Nonetheless, at an October briefing, Shah said the public risk remained low and the USDA’s Deeble said he was optimistic that the dairy outbreak could be eliminated.

Experts were perturbed by such confident statements in the face of uncertainty, especially as California’s outbreak spiked and a child was mysteriously infected by the same strain of virus found on dairy farms.

“This wasn’t just immaculate conception,” said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. “It came from somewhere and we don’t know where, but that hasn’t triggered any kind of reset in approach — just the same kind of complacency and low energy.”

Sam Scarpino, a disease surveillance specialist in the Boston area, wondered how many other mysterious infections had gone undetected. Surveillance outside of farms was even patchier than on them, and bird flu tests have been hard to get.

Although pandemic experts had identified the CDC’s singular hold on testing for new viruses as a key explanation for why America was hit so hard by covid in 2020, the system remained the same. Bird flu tests could be run only by the CDC and public health labs until this month, even though commercial and academic diagnostic laboratories had inquired about running tests since April. The CDC and FDA should have tried to help them along months ago, said Ali Khan, a former top CDC official who now leads the University of Nebraska Medical Center College of Public Health.

As winter sets in, the bird flu becomes harder to spot because patient symptoms may be mistaken for the seasonal flu. Flu season also raises a risk that the two flu viruses could swap genes if they infect a person simultaneously. That could form a hybrid bird flu that spreads swiftly through coughs and sneezes.

A sluggish response to emerging outbreaks may simply be a new, unfortunate norm for America, said Bollyky, at the Council on Foreign Relations. If so, the nation has gotten lucky that the bird flu still can’t spread easily between people. Controlling the virus will be much harder and costlier than it would have been when the outbreak was small. But it’s possible.

Agriculture officials could start testing every silo of bulk milk, in every state, monthly, said Poulsen, the livestock veterinarian. “Not one and done,” he added. If they detect the virus, they’d need to determine the affected farm in time to stop sick cows from spreading infections to the rest of the herd — or at least to other farms. Cows can spread the bird flu before they’re sick, he said, so speed is crucial.

Curtailing the virus on farms is the best way to prevent human infections, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, but human surveillance must be stepped up, too. Every clinic serving communities where farmworkers live should have easy access to bird flu tests — and be encouraged to use them. Funds for farmworker outreach must be boosted. And, she added, the CDC should change its position and offer farmworkers bird flu vaccines to protect them and ward off the chance of a hybrid bird flu that spreads quickly.

The rising number of cases not linked to farms signals a need for more testing in general. When patients are positive on a general flu test — a common diagnostic that indicates human, swine, or bird flu — clinics should probe more deeply, Nuzzo said.

The alternative is a wait-and-see approach in which the nation responds only after enormous damage to lives or businesses. This tack tends to rely on mass vaccination. But an effort analogous to Trump’s Operation Warp Speed is not assured, and neither is rollout like that for the first covid shots, given a rise in vaccine skepticism among Republican lawmakers.

Change may instead need to start from the bottom up — on dairy farms, still the most common source of human infections, said Poulsen. He noticed a shift in attitudes among farmers at the Dairy Expo: “They’re starting to say, ‘How do I save my dairy for the next generation?’ They recognize how severe this is, and that it’s not just going away.”

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Our phones buzz with the same question every time an unusual outbreak makes the news: “What’s happening?” As physicians and frequent responders to infectious threats around the world, people assume we have immediate answers. But in the chaotic early days of an outbreak, even seasoned experts are navigating through more questions than certainties. This was recently the case with reports of a “mystery illness” in the Democratic Republic of Congo (DRC).

Recently, the World Health Organization reported 406 cases and 31 deaths from an unknown disease in the Panzi health zone, a remote area more than 400 miles from the capital Kinshasa. While investigations initially explored multiple possibilities, the DRC’s health ministry is attributing the outbreak to severe malaria — a devastating disease, especially for children under 5, whose vulnerability is heightened by food insecurity and malnutrition in the region. The World Health Organization is running further testing.

This time, the culprit may be a known disease. But the initial uncertainty underscores a critical truth: In a world where pathogens are constantly emerging and evolving, we must have systems in place to rapidly detect, investigate, and respond — especially when it’s not a familiar foe.

It’s a global health cliché to say that what circulates in Congo today could be in Colorado tomorrow. But it’s also true. And in these situations, time to detection and response matters because it can translate to lives saved. As political shifts fuel calls to pull back our global presence, the United States must strengthen its partnerships and its commitments to outbreak surveillance, response, and research worldwide. Failure to do so amplifies health threats abroad and increases risks here at home. When a disease can traverse distant shores in a single airplane flight, maintaining and strengthening these investments and relationships is not only an act of global leadership, but also an essential investment in America’s own security.

The U.S. has long played a central role in building surveillance systems to detect emerging infectious threats. In 1951, just five years after its founding, the Centers for Disease Control and Prevention launched the Epidemic Intelligence Service (EIS), training “disease detectives” to identify and contain outbreaks both domestically and globally. U.S. funding and expertise have since driven key initiatives like the Global Polio Eradication Initiative (GPEI) and the Integrated Disease Surveillance and Response (IDSR) systems. More recently, in 2016, the U.S. supported the creation of the Africa CDC to bolster public health capacity and response across the continent.

The President’s Emergency Plan for AIDS Relief (PEPFAR), while designed to combat the HIV pandemic, has arguably been the most impactful initiative for building global detection capacity. Launched 21 years ago, PEPFAR remains the largest single-disease global health investment ever made by any country, saving more than 26 million lives. From the start, it has funded laboratories, procured diagnostic equipment, trained local lab technicians, and built robust health information systems for monitoring and reporting reliable health data worldwide.

These investments have been critical not only for HIV surveillance but also for detecting and responding to other health threats like tuberculosis, malaria, and emerging pathogens. During the Covid-19 pandemic, those investments helped increase diagnostic and surveillance capacity for SARS-CoV-2 globally. Despite its undeniable impact and long-standing bipartisan support, recent partisan gridlock threatens PEPFAR’s future. Without it, vital systems for disease detection could collapse, and millions of HIV patients may lose access to lifesaving medication — jeopardizing their health and risking a resurgence of the global HIV pandemic.

Programs to detect when outbreaks emerge are vital, but so is responding swiftly and effectively the moment a threat is detected. This is why the U.S. has also established an extensive overseas network of public health partnerships and field offices. The CDC operates in more than 60 countries, including in the Democratic Republic of the Congo, where the current “mystery illness” emerged. The CDC’s presence there since 2002 has provided essential access and trust, empowering American experts to work side-by-side on responding to outbreaks with local health authorities from the start.

These relationships are not forged overnight and require trust. Without deep, pre-existing ties built on years of cooperation, training, and shared surveillance, the U.S. would be just another outsider scrambling to negotiate entry and information at the outset of a crisis. Take the global effort to monitor and contain emerging influenza strains: U.S. support underpins a network of international labs that track new flu variants, giving health officials a head start on vaccine development and public health measures. Or consider the 2016 Zika outbreak, when close collaboration with Latin American partners, supported by U.S. funding and expertise, helped rapidly identify transmission hotspots and target mosquito control interventions.

The U.S. is heavily involved in developing and deploying medical countermeasures that stop outbreaks in their tracks. During a recent Marburg virus outbreak in Rwanda, U.S. funding enabled the rapid deployment of tests, vaccines, and treatments — protecting health care workers, saving lives, and likely preventing the outbreak from spreading beyond the region, including to the U.S.

This reflects a long-standing U.S. commitment to medical countermeasure research and development. During the 2014-2016 West African Ebola outbreak, there were no vaccines or treatments to protect health care workers or care for patients. As providers working in Ebola Treatment Units in West Africa — and one of us later as a patient after contracting the disease — we saw firsthand the devastating consequences of this absence. Since then, U.S.-funded research has led to the development of effective Ebola vaccines and treatments, tools that have been critical in subsequent outbreaks and could one day be essential in a domestic crisis.

Each year, numerous U.S. agencies — including the National Institutes of Health, Biomedical Advanced Research and Development Authority, Department of Defense, and Administration for Strategic Preparedness and Response, and others — invest hundreds of millions of dollars into research and development of medical countermeasures. Without this funding, the global ability to respond to emerging health threats would erode, making it harder to protect frontline health care workers, provide lifesaving care to patients, and contain outbreaks before they spread — potentially to U.S. shores.

This is not to say these agencies are perfect. The CDC’s domestic outbreak responses, particularly during the Covid-19 pandemic, exposed areas in need of improvement. The NIH, too, has faced criticism for bureaucratic inefficiencies and redundancies. But these institutions have built immense scientific and operational capacities over decades.

Reforms that streamline processes, improve responsiveness, and enhance transparency are essential. But punishing these agencies for perceived overreach during Covid-19 is not. Discarding the expertise and infrastructure they have cultivated would be dangerously shortsighted. Instead, we must refine — not reject — the global health apparatus that has protected Americans and millions of others worldwide.

Equally concerning are misguided proposals like the “eight-year pause on infectious disease research” floated by Robert F. Kennedy Jr., whom President-elect Trump intends to nominate for Health and Human Services secretary. Infectious threats are unlikely to get the message that they are supposed to take such a pause. And stepping back from investing in critical areas — such as tools to combat antimicrobial resistance and climate change-driven vector-borne diseases, or harnessing synthetic biology and artificial intelligence to help us combat infectious diseases threats — will make the U.S. fall behind the rest of the world in our readiness. Microbes remain impervious to electoral cycles; parasites and pathogens are not swayed by partisan slogans.

The United States is the largest funder and implementer of global health programs, and it must remain so — regardless of which people or party are in positions of political power. There is no wall tall enough to shield us from the panoply of global pathogens.

Craig Spencer is a public-health professor and emergency-medicine physician at Brown University. Nahid Bhadelia is an associate professor of infectious diseases and the founding director of Boston University’s Center on Emerging Infectious Diseases. She was previously the senior policy adviser for global Covid-19 response on the White House COVID-19 Response Team.

All known life is homochiral. DNA and RNA are made from “right-handed” nucleotides, and proteins are made from “left-handed” amino acids. Driven by curiosity and plausible applications, some researchers had begun work toward creating lifeforms composed entirely of mirror-image biological molecules. Such mirror organisms would constitute a radical departure from known life, and their creation warrants careful consideration. The capability to create mirror life is likely at least a decade away and would require large investments and major technical advances; we thus have an opportunity to consider and preempt risks before they are realized. Here, we draw on an in-depth analysis of current technical barriers, how they might be eroded by technological progress, and what we deem to be unprecedented and largely overlooked risks (1). We call for broader discussion among the global research community, policy-makers, research funders, industry, civil society, and the public to chart an appropriate path forward.

A new threat now looms. In a recent publication in Science, we joined an esteemed list of researchers in raising the alarm about risks of ongoing efforts to create ‘mirror life’. If created, mirror life could lead to the destruction of life, the environment and food systems across the globe, including exacerbating inequities that already exist in low- and middle-income countries.

Every year, more than one million people die from antimicrobial resistance. It is one of the most important global health threats, according to the World Health Organization. This sentiment was echoed at the recent Jeddah Conference, where representatives from more than 57 countries pledged to move towards decisive multilateral action on antimicrobial resistance.

Antimicrobial resistance is also fundamentally a matter of health equity. It disproportionately affects low- and middle-income countries: diseases caused by bacteria that are resistant to antibiotics spread more quickly, and are more lethal, in developing countries. At the same time, high-income countries disproportionately contribute to the overconsumption and overproduction of antimicrobial drugs that can cause and exacerbate antimicrobial resistance in the first place.

This pattern of global inequity extends beyond antimicrobial resistance, with the Global South (countries of the developing world) often suffering the consequences of problems predominantly created by the Global North.

A new threat now looms. In a recent publication in Science, we joined an esteemed list of researchers in raising the alarm about risks of ongoing efforts to create “mirror life”. If created, mirror life could lead to the destruction of life, the environment and food systems across the globe, including exacerbating inequities that already exist in low- and middle-income countries. We must ensure that scientists and policymakers from developing countries are included as part of the discussions and leadership about governing mirror life.

Mirror life refers to organisms created with “mirror molecules”. Mirror molecules have the same structure as natural molecules, except they are flipped, like how one’s left hand is a mirrored version of one’s right hand. Proteins are made up of amino acids that are normally found in a “left-handed” form, and DNA is made up of nucleic acids that are normally found in a “right-handed” form. Mirror forms of these molecules, such as right-handed amino acids and left-handed nucleic acids, are rarely used in nature, but can be artificially created in laboratory settings. By putting together mirror proteins, DNA, and other mirror molecules, scientists may be able to create entire mirror lifeforms.

Spread unchecked
We argue in our paper that mirror bacteria (the form of mirror life most likely to be created first) could evade human, plant, and animal immune systems, which have evolved to protect against microbes found in nature. Beyond getting past our immune systems, mirror bacteria also could evade natural predators like viruses that target bacteria (bacteriophages), which would enable mirror bacteria to spread relatively unchecked throughout nature, with potentially devastating effects on the environment and the world’s food systems. A pandemic caused by mirror bacteria would have catastrophic effects worldwide. For these reasons, in our paper, we argue that mirror life should not be created. We call, as well, for broader governance around mirror molecules.

Mirror life may create unprecedented, worldwide risks, and its effects would be felt by all countries. The severity and scope of its impact could be quite unlike anything that has been seen before. Luckily, few laboratories are actively interested in the development of mirror life — and none of them are in developing countries. However, it would be a grave injustice if the discussion of governance around mirror life included only stakeholders in high-income countries, as it is the low- and middle-income countries that could be the most affected if mirror life were ever to be created. Hard as it is to imagine, the proliferation of mirror life, and its devastating consequences on human and animal immune systems, might require isolating bunkers to house humans and their life support systems — an expensive enterprise.

Covid-19 has demonstrated that the effects of novel biological threats hit hardest in the Global South. These countries are less able to provide emergency healthcare to those affected, and if we were to succeed in developing new drugs to counter mirror life, they would probably be amassed and stockpiled by high-income nations. This is the same pattern we’ve seen in practically every pandemic. The 1918 Influenza — which killed up to 50 million people — began spreading in Europe, yet South Africa and India were two of the worst affected countries. A pandemic due to mirror life could be much more disastrous.

It is imperative that those driving the threat from mirror bacteria recognise their responsibilities and actively engage leaders from low- and middle-income countries in the discussions around governance. Ensuring representation of the Global South will enable transparency and accountability. Engaging appropriate global entities to provide oversight and accountability over research into mirror life would be essential to facilitate the protection of all countries.

Countries and organisations in the Global North should work with regulators in developing countries to create governance for any laboratory that develops an interest in working on mirror life in the future. This would also prevent laboratories from dodging regulations by moving their research to developing countries.

Fortunately, scientists who are engaged in the research that would serve as a precursor to the creation of mirror life are cognisant of the risks. The development of mirror life is something that can still be halted. While an entire mirror bacterium could pose a significant threat, the synthesis of specific mirror biomolecules on their own do not pose similar risks — and, in fact, could lead to new medicines.

Oversight
For instance, mirror proteins have been touted as an option for creating drugs to fight HIV, still an ongoing pandemic disproportionately affecting regions such as southern Africa. Innovation in this space needs to be diffused worldwide, so that low- and middle-income countries can benefit just as much as high-income nations. The peaceful and beneficial uses of such precursor research underscore the need to engage experts everywhere in discussions about oversight and to instill a hyper-awareness as to when to stop the research before it becomes dangerous.

With mirror life, the world has the invaluable opportunity to avoid repeating the mistakes of the past. Practices that have led to antimicrobial resistance are key examples where actions taken by high-income countries can have negative effects in low- and middle-income countries. Similarly, (industrial) practices that have led to climate change have been largely led by countries of the Global North, with disproportionate impacts on the Global South. Air pollution has largely been caused by industrial corporations and high-income nations burning fossil fuels, yet it disproportionately affects low-income communities and causes diseases like lung cancer to become more prevalent in vulnerable populations.

Global action wasn’t taken rapidly enough to prevent the devastating consequences of antimicrobial resistance, climate change, and air pollution. The risks posed by the potential to create mirror life are unparalleled and fall in a class of their own. However, when it comes to mirror life, we have the chance to act wisely — now — and prevent a damaging worldwide impact. Incorporating global perspectives into the governance of mirror life is the only way to ensure we are all safe. DM

Wilmot G. James is a Professor in the Department of Health Services, Policy and Practice and Senior Advisor to the Pandemic Center in the School of Public Health, Brown University, Providence, Rhode Island. Vaughn S. Cooper is Professor in the Department of Microbiology and Molecular Genetics and a founder of the Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Biden administration officials said Wednesday they have no current plans to authorize a stockpiled bird flu vaccine, despite an escalating outbreak among livestock in the U.S. and at least 58 human infections across seven states.

The move means any decisions about a bird flu vaccine will likely be left to health officials in the incoming Trump administration, who may be led by anti-vaccine activist Robert F. Kennedy Jr., whom Trump has picked to lead the Department of Health and Human Services.

The virus has been spreading in dairy cows since the spring and had infected at least 774 herds in 16 states as of Wednesday, according to the Centers for Disease Control and Prevention. Last Friday, the Agriculture Department stepped up its response to the outbreak, issuing a federal order mandating testing of the national milk supply.

The USDA said the testing, set to begin next week in six states, will give farmworkers better confidence in the safety of their animals and their ability to protect themselves from infection, as well as give officials a better sense of where herds are infected.

The virus’s spread in mammals that have close contact with humans is concerning for public health experts, because it gives the bird flu many opportunities to jump to people and potentially mutate to spread effectively from person to person.

Almost all bird flu cases in the U.S. have been in farmworkers who have had contact with infected animals — either dairy cows or poultry — aside from a patient in Missouri and a child in California. A teen in Canada who got very sick and was hospitalized also had no clear contact with infected animals.

The federal government has two bird flu vaccine candidates available in limited quantities in the nation’s stockpile, though they need to be authorized by the Food and Drug Administration before they can be used.

In May, health officials said the government would begin looking at vaccination if the virus mutated in ways that would make existing antivirals like Tamiflu less effective, or if it appeared it was causing serious illness in people.

Dr. Nirav Shah, the CDC’s principal deputy director, said Wednesday that the criteria for deploying a vaccine remains the same.

“When we think about respiratory vaccines, their sweet spot is really in preventing severe disease and death,” Shah said. “When we look at what is currently unfolding with H5, even in the human cases, thankfully what we’ve seen thus far is mild disease,” he said, using a shorthand for the strain of the influenza virus causing the bird flu outbreak.

“That is not a guarantee, and that could change, but that is one of the things that we are on the lookout for because the vaccine would be maximally effective against reducing severity of disease,” Shah said. While the administration isn’t considering a vaccine today, that could change if the outbreak changes, he said.

Still, some public health experts believe the time for vaccination is now, particularly for farmworkers.

“I do not think we should gamble with farmworkers’ lives by waiting for them to be hospitalized or die before using the tools we have to protect them,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

A balancing act
Whether to authorize or deploy a vaccine is a constant balancing act for public health agencies, Shah said, noting that even the safest vaccine can come with side effects.

In 1976, at the first signs of an H1N1 swine flu outbreak in the U.S., public health officials quickly initiated a nationwide vaccine campaign. The shot, however, caused a small increased risk of Guillain-Barre syndrome, a rare condition that causes the immune system to attack healthy nerve cells.

The outbreak never spread widely, but it set public trust in the flu shot back decades.

“It led to an analysis and introspection about whether the response to those 13 cases of swine flu had been an overreaction,” Shah said. “And, indeed, there was a high degree of vaccine skepticism that emerged.”

Still, the public health agencies are prepared to authorize a vaccine for bird flu if needed, Shah said, adding officials are consistently testing strains against the vaccine candidates.

A spokesperson at the Administration for Strategic Preparedness and Response, an agency within HHS that manages the nation's stockpile, said the agency has worked to “fill and finish” vaccine doses of a candidate vaccine that’s well-matched to the virus circulating in dairy cows.

There will be up to 10 million doses available by the end of the first quarter of next year, enough to vaccinate 5 million people, the spokesperson said.

A spokesperson for the FDA said the agency is “actively engaged with federal partners in the U.S., as well as industry,” including evaluating potential vaccine candidates, should the need arise for use in people.

When is the right time?
Dr. William Schaffner, an infectious diseases expert at Vanderbilt University Medical Center, said there isn’t a need to authorize a vaccine at this time, given the lack of evidence of human-to-human spread nor signs that the virus is causing severe disease in people. Existing tools, such as antivirals and personal protective equipment, are sufficient enough right now, he said.

There are a higher number of cases, but Schaffner attributed that to public health officials looking harder for the virus through testing and surveillance.

Schaffner said the incoming Trump administration’s anti-vaccine rhetoric doesn’t change his stance.

“I think we should be very careful about anticipating what the new administration will do,” he said. “The administration will be getting a lot of good, solid scientific evidence, not only from people at the CDC and the Food and Drug Administration, but they will hear from industry and lots of public health officials and experts across the country.”

The Trump transition team didn’t respond to a request for comment.

Dr. Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory, also said it’s not necessary to authorize a vaccine at this time.

“We need to keep advocating based on the science and data to make informed decisions, or do the best we can at the intersection of science, economics and political science,” Poulsen said.

Nuzzo, of the Brown University School of Public Health, said that while antivirals are important for anyone exposed to or infected with the virus, their effectiveness is limited by a very small window of time in which they must be given. She also said the country’s testing strategy is not timely enough to adequately protect farmworkers.

A vaccine, she said, could protect farmworkers from the possibility of severe illness.

Poulsen said one issue officials could run into, however, is finding farmworkers who are willing to get the vaccine, noting that some may be distrustful of the shot.

“I would start with seasonal flu and only go to the H5N1 strains if they find that people are propagating virus or getting severely sick,” Poulsen said. “That has not happened.”

It’s hard to turn on the news or look online without seeing something related to bird flu. Also known as H5N1, the virus is spreading in a few states across the country and sickening animals and farm workers.

Additionally, bird flu bacteria was recently found in raw milk; last week, the U.S. Department of Agriculture ordered that both raw and unpasteurized milk must be tested for bird flu.

Given the circumstances, it’s only natural to worry about the virus, so we asked experts to share their thoughts. Below are the societal and health-based concerns they have about bird flu right now:

They’re worried about farm workers who make up most bird flu cases.
Experts told HuffPost the average person doesn’t need to panic at this point in time.

“Today, the greatest fear I have is for people that we know are being exposed to this virus directly ― so that’s the farm workers,” said Dr. Jennifer Nuzzo, a professor of epidemiology and the director of the Pandemic Center at Brown University School of Public Health in Rhode Island.

Farm workers who are in close contact with poultry and cows are currently at risk and are largely becoming infected; 56 of the 58 reported bird flu cases in the U.S. this year can be traced back to cattle or poultry exposure, according to the Centers for Disease Control and Prevention.

“We already know that they’re getting infected, and we know that they’re getting sick, and fortunately, they haven’t gotten very sick,” Nuzzo said. “They haven’t gotten severely ill, they haven’t died, but we literally don’t know why that’s happening.”

They are paying attention to non-farm worker cases as well.
A Canadian teenager with no underlying health conditions was also infected with bird flu and ended up in the hospital.

“That just shows you how much of a gamble the whole thing is, because you literally can’t predict it. Are you going to be like the farm worker who gets a frankly hideous case of conjunctivitis and some respiratory symptoms, or are you going to be like the teenager in British Columbia? You don’t know,” Nuzzo said.

“I want to be clear. I’m not talking about the general public. I am talking about people that we know are being exposed to this virus,” she added. “This virus is not yet capable of spreading between people, and although we’re also seeing increasing cases occurring with an unknown exposure — meaning we don’t know where they got it from ― that also is concerning to me, but those events are still quite rare.”

They’re concerned that it could swap genes with the seasonal flu, making it able to spread more easily.
“The concern is that H5N1 is an avian influenza. Influenza viruses are notorious for changing. They can shift over time, they can reassort with each other and make much bigger shifts quite quickly,” said Meghan Davis, an associate professor in the department of environmental health and engineering at the Johns Hopkins Bloomberg School of Public Health in Maryland.

“The reason this is important is that if you would have a person who is infected with both H5N1 and a seasonal flu, you now could have one of those bigger reassortment events,” Davis continued. “So, some swapping of the genes ... you might be able to give the H5N1 virus genes that make it more virulent in people or that make it possible to transmit more easily from person to person, and that’s definitely something we want to prevent.”

They’re worried about infections in household pets.
“For me, as an animal health specialist, I’m very worried about the amount of disease we’re seeing in animals, which is extraordinary,” Davis said. “We’re talking about millions of birds lost. We’ve got many dairy cows affected — I think we’re now up to over 700 herds in the country that have been impacted by it. It’s also a virus that can be lethal in some species, not just the marine mammals we heard about in prior years, but also cats.”

This goes for cats on farms that drink raw milk in addition to domestic cats, where the contamination source is unclear, she said. Cats could have had contact with a dead bird that’s infected with the virus, raw milk, or other infected animals, with Davis noting that “we’ve been finding that the virus can infect mice, and so that’s a huge concern as well.”

“I’m really trying to get it out there about the cats, because I think that it’s just so possible for an infection to occur,” she said. “And I worry ... because if you have a pet infected in a home, that’s a very different kind of exposure than even drinking the raw milk or having occupational contact as a worker on a farm.”

These infections could happen in folks who avoid potential contamination sources like raw milk and farms because they’re immunosuppressed or pregnant, Davis explained.

“We just don’t know what we might see in terms of the kind of infection that could come out of that kind of exposure,” she said.

Davis also noted that the same concerns extend to other household pets like dogs, who could also come in contact with birds, mice or other infection sources.

They’re worried about the consumption of raw milk.
In recent months, raw milk has grown in popularity as people like Robert F. Kennedy Jr. and Gwyneth Paltrow promote drinking it. However, raw milk is known to carry harmful bacteria and does not have proven health benefits when compared to pasteurized milk. Moreover, raw milk is directly tied to bird flu.

“If you’re someone who is drinking raw milk ... here’s what I’m worried about: The virus is spreading to more and more dairy farms. We know that when cows are infected, the amount of virus that’s in their milk is very high. We also know from animal studies that consuming H5N1-infected milk can make these animals that consume it very sick, including hideous neurologic symptoms,” Nuzzo said. “So when I connect those dots, that tells me I don’t think I would drink raw milk.”

However, you don’t need to be concerned if you drink pasteurized milk.

“Commercial pasteurization, which brings milk to a certain temperature for a certain duration of time, sometimes under pressure, is effective at inactivating the virus,” Davis said.

She also noted the importance of the USDA ordering raw and unpasteurized to be tested for bird flu, explaining that testing will help officials determine infected farms.

They’re concerned that the conditions that cause pandemics are only getting worse.
“I think it is really important for people to understand that the conditions that give rise to pandemics are only getting more pronounced,” Nuzzo said. “There are going to be more pandemics in the future. We should try to prevent them ... sounding the alarms right now with H5N1 is an attempt to just do that.”

She also explained how climate and environmental change plays a major role in the spread of new pathogens.

“The new pathogens that have the ability to infect people and then spread between people, they have to be things that we don’t have immunity to, and the majority of those come from wildlife,” Nuzzo said. “So, anything that shakes up our interaction with wildlife is what potentially creates risk.”

This includes things like deforestation, reforestation and land use changes, she said, in addition to “wild animals having more contact with humans, either directly or through domesticated animals, like cows and pigs.”

“Ultimately, it’s about creating more opportunities for people to become exposed to wildlife pathogens [and] allowing those wildlife pathogens to become adapted for infecting and spreading between humans,” Nuzzo said.

They’re worried that society isn’t doing enough to prepare for future pandemics.
Plenty of people are talking about bird flu right now for good reason.

“We’re trying to get government to do more to get ahead of this virus so that it doesn’t become a problem for general members of the public. Nobody wants to go through another pandemic, nobody wants a farm worker to lose his or her life just for putting milk in our fridges,” Nuzzo said. “So, we are kind of sounding the alarm for the purposes of policy and practice changes that could make everyone safer.”

Nuzzo noted that, because of how horrible COVID-19 was, people have a hard time grasping the idea that more pandemics will happen, hoping that they never have to go through something like that again. And it doesn’t help that society is often quick to say disease emergencies are over — a problem that Nuzzo argued stops us from planning more effectively against pandemics.

“And I think that is getting in the way of our doing the kinds of things that would just make us more ready for these events. ... It may come, it may not. But if we’re generally ready for it, then we don’t have to sit there and work ourselves up about it,” she said.

Shutting down everything, as was the case with the COVID pandemic, is not how society should have to respond to a pandemic, with Nuzzo saying, “That is not what responding to a pandemic is supposed to be.”

Instead, she explained that, to curtail a potential bird flu pandemic — or any pandemic, for that matter — the government should focus on preventing the virus from infecting more farm workers and killing people, getting ahead of it so it can’t mutate and become more contagious, developing medications, and improving indoor air quality.

“So that when these things happen, they don’t just wash over us and upend our lives,” Nuzzo said.

Health officials in Marin County are investigating a possible H5N1 bird flu case in a child.

Officials have been investigating since last week and are working with the California Department of Public Health and the Centers for Disease Control and Prevention to determine how the child was exposed.

The information was provided in a Friday “health status update” newsletter, and buried at the end of a paragraph about the county and state’s monitoring of the virus, raw milk and a note about a new USDA program designed to test milk nationwide.

If confirmed, this would be the second case of an infected child in California.

“It’s deeply concerning that another child may have H5N1. We need to know much more about this case, including some hypotheses for how she or he may have contracted the virus,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I. “Given the proximity of this case to the last case of H5N1 diagnosed in a child without known exposure to animals, it may be prudent to conduct a broader investigation, including a serologic study, to see if there is evidence of other infections in the area.”

Last month, state health officials announced a child in Alameda County was positive for the disease. Investigators have not been able to determine the source of exposure. The child suffered from mild respiratory symptoms, and no one else in the child’s family or day care was infected.

Neither the state nor county public health officials have responded to queries from The Times, and no further information was provided in the newsletter.

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The U.S. Department of Agriculture will begin testing the nation’s milk supply for the bird flu virus known as H5N1, nearly a year after the virus began circulating through dairy cattle, the department announced on Friday.

Under the new strategy, officials will test samples of unpasteurized milk from large storage tanks at dairy processing facilities across the country.

Farmers and dairy processors will be required to provide samples of raw milk on request from the government. And farm owners with infected herds will be required to provide details that would help officials identify more cases and contacts.

The rules were first floated in October and were supposed to be implemented in November. The first round of testing is now scheduled to begin the week of Dec. 16, according to the announcement on Friday.

The new strategy is a departure from the voluntary guidance that the department had issued during the outbreak. Many dairy farms have not complied with voluntary testing of milk or of dairy workers, leaving federal officials in the dark about how widely the virus might have spread.

“I have been absolutely frustrated that we do not know the extent of the outbreak in cattle,” Seema Lakdawala, a virologist at Emory University, said.

Many experts in the United States and elsewhere, including with the World Health Organization, have sharply criticized the lack of testing of cattle and of people who may be infected with the virus. The virus does not yet spread easily among people, but every untreated infection is an opportunity for it to gain the ability to do so, experts have said.

The virus replicates easily in the udders of cows, and raw milk from infected animals contains very high levels of the virus. At least some farm workers are thought to have become infected from droplets of milk, perhaps through their eyes.

Robert F. Kennedy, Jr., President-elect Donald J. Trump’s pick to lead the health department, has been a proponent of raw milk. California, the nation’s biggest dairy producer, recently recalled some raw milk products and halted their production after the virus was detected in some samples.

“The positive H5N1 samples from raw milk sitting on the shelves in California highlights the potential risk for milk processors who interact with milk before it’s pasteurized, and also to members of the public who consume raw milk,” said Samuel Scarpino, director of A.I. and life sciences at Northeastern University.

No one has yet been known to become ill from drinking raw milk, although farm animals, including cats, are thought to have died after consuming contaminated milk. Pasteurized milk sold to consumers has already been shown to be free of the virus.

The new rules are an attempt to gain control over the outbreak, Agriculture Secretary Tom Vilsack said in a statement.

The strategy “will give farmers and farmworkers better confidence in the safety of their animals and ability to protect themselves, and it will put us on a path to quickly controlling and stopping the virus’s spread nationwide,” he said.

It is unclear whether the incoming Trump administration will continue the program.

“Come Jan. 21, things could change again,” said Dr. Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory.

The virus has now been detected in 720 herds in 15 states, although experts believe that figure is a significant underestimate, given the lack of mandatory testing. At least 58 people, most of them farm workers, have also been infected.

The agency’s last major mandate on testing came in April, when it issued a federal order requiring that lactating dairy cows be tested for flu before being moved across state lines.

Under the new strategy, the Agriculture Department will monitor bulk milk samples from farms nationwide, and work with state officials to identify infected herds.
....

Avian flu is storming through California, with more than 250 new cases detected among dairy herds in the past 30 days, according to the US Department of Agriculture. Since the flu was first detected in cattle in March, the USDA has confirmed more than 700 cases in 15 states. New England cattle have been spared so far, but there’s little reason to think that will last indefinitely.

To its credit, Massachusetts is testing all of its 95 licensed dairy farms, with inspectors collecting milk samples from farms’ bulk tanks. So far, Massachusetts has had no positive samples. Since avian flu was detected in Massachusetts birds, state officials imposed testing and health certification requirements for imported poultry and conduct routine surveillance testing for Massachusetts flock owners that sell birds or participate in shows.

But birds, cows, and diseases cross state lines. “To eliminate the virus on a national scale, we have to be able to do national surveillance,” said Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory.

The USDA announced Oct. 30 that it planned to enhance testing and monitoring for avian flu. But since the election, there’s been silence on any concrete plans. Obviously, implementing federal policy in the lame-duck days of a presidential administration is tricky. But cattle — and more importantly, the farmworkers who work with them — are getting sick. The Biden administration should implement a national policy requiring the bulk testing of milk as a means of surveillance that will make it easier to detect and contain the virus. That should be paired with efforts to protect farms and their workers as much as possible from financial repercussions when the virus is detected and to ensure farms have the tools they need to prevent the spread, including access to testing and personal protective equipment.

The highly pathogenic avian influenza, H5N1, has been circulating among birds for years but is now spreading among cows. The virus sickens cows, but symptoms can be treated and cows usually recover. More concerning, the US Centers for Disease Control and Prevention has confirmed 58 human cases, mostly among farmworkers. Those cases have generally been mild, with symptoms like pink eye. There are a few cases without known animal exposure, including a teenager from British Columbia who became seriously ill.

Epidemiologists say the bigger threat is that the virus, if left unchecked, could mutate into a form that causes more severe illness or spreads more rapidly among people. “I can’t tell you it is the next big thing,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. “But I also can’t tell you it’s not.”

Part of containing the spread is identifying where the virus is, and so far that’s not happening as efficiently as it could. Colorado implemented mandatory bulk milk testing in July amid a spate of avian flu cases in dairy herds, and its last confirmed case was mid-August. But many states simply aren’t testing cows or people. After all, there’s an economic cost to the testing itself and to quarantining those infected.

The USDA only requires testing of lactating dairy cows when they move across state lines.

Poulsen said testing can most easily be done in bulk. For example, in a state without known cases, testing milk at a central processing facility can rule out the presence of the virus. He said any rules should protect the confidentiality of farm records, so regulators know where virus is present but farmers are not stigmatized. The testing also needs to be paired with evidence-based regulations for controlling the movement of cattle — like requiring negative tests before a previously infected herd can move off a farm.

Federal and state governments can also play a role working with farms to figure out what they need to prevent and deal with an outbreak. This could involve bulk buying googles and gloves or offering education, testing services, and medication to farmworkers. This can be particularly challenging with farmworkers who lack legal immigration status or health insurance or who don’t speak English. Shira Doron, hospital epidemiologist at Tufts Medical Center, suggested the government needs to create financial incentives for farms to do the right thing for public health — which could include policies like compensating farmers for the money they lose after a positive test.

The United Kingdom has been stockpiling H5N1 vaccines, and the United States has vaccines in development, although they are not yet commercially available. Federal officials should continue to prepare in case vaccination becomes necessary.

Avian flu may now pose only a limited threat, but increased testing, containment, and preparedness will ensure it doesn’t become a bigger one.

Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.

Can we predict the ebb and flow of infectious disease the way meteorologists predict the weather?

The federal government has bet big on the concept with a new nationwide network called Insight Net, which links academic disease modelers with public health practitioners. The network comprises 13 research consortia with participants in 24 states and is funded with up to $262 million from the Centers for Disease Control and Prevention (CDC). Insight Net members are piloting analytical techniques that combine novel data sources to guide surveillance and inform decision-making during outbreaks. The end goal is to create something akin to a National Weather Service for disease.

Such capacity would be a game-changer for state and local health authorities and for hospitals. At the height of the COVID-19 pandemic, “we were not good at forecasting the demand,” says Douglas Sawyer, chief academic officer of MaineHealth, that state’s biggest hospital system. “We didn’t steer the ship, so to speak, with high fidelity as we wish we could have. We couldn’t prepare and shift resources in thoughtful ways.”

Many hospitals struggled with the crush of patients who needed intensive, isolated care. Because hospitals could not accurately predict the size of impending infection waves, many delayed or canceled routine health care such as physicals or cancer screenings. Meanwhile, Covid care sites built or converted by federal and state authorities ended up being largely unneeded.

These forecasting issues had serious financial consequences for hospitals—and serious health consequences for the public. Insight Net’s progress toward closing that information gap has been steady and marked by small but important victories—as well as plenty of reminders that even the best forecasts are only as good as the data that feed them.

Forecasting more than the next crisis
By linking people working in public health directly with disease modelers, the CDC aims to fix the ad hoc approach it used for pandemic forecasting, which was panned from almost the start. In the summer of 2020, a critique in Foreign Affairs labeled the CDC’s approach “an arbitrary assortment of academics” reacting on the fly and asserted no one today would handle hurricane response in that fashion. In 2021, the CDC tapped Caitlin Rivers, one of the article’s coauthors and an epidemiologist at Johns Hopkins Bloomberg School of Public Health, as the first associate director of its new Center for Forecasting and Outbreak Analytics (CFA). In 2023 the CFA established Insight Net, and Rivers, who had returned to Johns Hopkins, became director of its node in the network (Dylan George, her Foreign Affairs coauthor, is the CFA’s current director). Their core message, then and now: Disease forecasting shouldn’t be improvised.

Policymakers and the public put their trust in major storm alerts, according to George, because the weather service is “applying the best models in an operational context on a day in and day out basis, cranking out results,” George says. “And then you have local meteorologists interpret those results for people to actually make decisions.” That process establishes a track record of monitoring and communicating forecasts, including their uncertainty, even when the weather is calm, sunny, and mild. “We’ve tried to pattern after that,” George adds.

That has meant investing in a dedicated program for disease forecasting, with formal working relationships between modelers and federal, state, and local health officials. It also means the CFA has been keen to demonstrate how modeling can help public health practice and communication. For instance, it has tapped data from the National Wastewater Surveillance System, launched by the CDC in 2020, to improve localized forecasts of Covid hospital admissions. It also helped the Chicago Department of Public Health confront a March 2024 measles outbreak at a temporary migrant shelter housing more than 1,400 people. As public health workers began vaccinating and screening shelter residents to identify and isolate the sick, department leaders reached out to the CFA, which rapidly refined a model of measles to mimic the outbreak’s timeline of infection, symptom onset, and recovery, which Chicago health officials could then use to predict its future course.

The model didn’t influence the department’s interventions, which were already underway. But it did reassure officials they’d correctly identified their patient zero: Outbreak simulations that assumed earlier, undetected infections generated far different case data from what was observed. The forecasts also helped set expectations for the outbreak’s severity by providing a range of potential case numbers and dates when infections would peak and subside. After a couple weeks of continuous updating with data on new measles cases, the model predicted there would be between 57 and 65 cases and the final rash would appear on April 16. In the end, the outbreak lasted about two months and infected 57 people.

“It really helped our own planning, and our thinking about staffing,” says Stephanie Gretsch, an epidemiologist at the Chicago Department of Public Health. “It was also incredibly helpful for communicating with our city agency partners responsible for housing and schooling; and the hospitals we asked to help isolate infected residents, to give them a sense of how long we thought this was going to last.”

After the outbreak, Chicago public health officials used the modeling to quantify the value of its interventions. Outbreak simulations where responses did not include mass vaccination or active case-finding efforts suggested it would have lasted seven weeks longer and more than quadrupled the number of infections. This finding suggests that modeling hypothetical scenarios might offer a tool for easing heightened skepticism of public health interventions and investments, say several Insight Net partners.

Syphilis is one target of the Insight Net consortium at the University of Utah. The disease, resurgent in the U.S., can infect a fetus during pregnancy and cause serious medical complications, including miscarriage, stillbirth, and infant death. The goal is to “address the issues and show how bad this problem could get if trends continue,” says principal investigator Matthew Samore, a professor of medicine and the division chief of epidemiology at the University of Utah. “We also want to get a deeper understanding of how STIs like this are spreading through different populations…and to calculate how much benefit do we get by investing in more intensive screening and contact tracing.” By helping establish the extent of the risk, the models could bolster requests to fund more screening and treatment of groups with high infection rates, such as people in prison.

The modeling could also improve disease forecasting dashboards used by the public to assess health threats. The Massachusetts Department of Public Health (MDPH) has dashboards that track severe respiratory illnesses statewide, but delays in data reporting from local hospitals limit their usefulness. In 2024, MDPH worked with the Insight Net researchers at the University of Massachusetts Amherst and the University of Texas at Austin to build models filling in those gaps, allowing it to add recent emergency room visits and hospital admissions due to Covid, RSV, and influenza broken down by demographics. Such small-scale adoptions are needed both to validate disease forecasting and to build trust in the models, says Meagan Burns, a senior informatics epidemiologist at MDPH. “These tools are very cool, but they’re also very new,” she says.

People in Massachusetts also are getting a look at disease forecasts as part of their weather news. In February, meteorologists at Boston’s CBS affiliate, WBZ-TV, began adding localized disease data visualizations to their weather reports. These are put together by the Insight Net team based at Johns Hopkins and arranged through a collaboration with the American Meteorological Society. The first one featured a colorful chart showing that emergency room visits due to COVID-19 were declining steadily from their post-Christmas peak. The original plan was to do weekly check-ins on infectious respiratory illnesses, but as the weather warmed, infection numbers plummeted and stayed low.

“There were several weeks where there wasn’t a whole lot to talk about with Covid or the flu,” says meteorologist Terry Eliasen, executive producer of WBZ’s weather team. While viewers might find sunny weather forecasts useful, there didn’t seem to be much news value in “sunny” public health numbers. So WBZ skipped a few weeks. Then Eliasen asked the Johns Hopkins team what else it could do. Over the summer, researchers responded with data visualizations related to outbreaks of norovirus and eastern equine encephalitis, as well as the risk of heat-related illnesses.

This quick shift in focus drew praise as a sign that the university-based modelers at Insight Net are serious about partnering with public health practitioners and communicators. The CFA worked with the Council of State and Territorial Epidemiologists (CTSE) on the legal and logistical issues of data-sharing, and to see what forecasting tools might be useful to its members. The two organizations convened a series of meetings with state and local health officials to ask what uses they might have for forecasting tools and whether there were specialized techniques they’d like. That was especially useful, says Janet Hamilton, the CSTE’s executive director. “We need to have enough time to talk to the modelers to say, ‘That’s a great model but it doesn’t help me. It doesn’t answer my questions.’”

Fixing public health data: everything, everywhere, all at once
Disease threats do not yet have the color-coded, real-time tracking maps the National Weather Service uses for potential hurricanes. Of course, there are no satellite images of developing disease threats, which not only are propelled by unique (and often mutating) biology, but also have to account for something that’s even harder to predict—human behavior. Several Insight Net forecasters are trying to meet this massive data challenge by mixing traditional data sources such as infection rates with the digital breadcrumbs of human activity like searches for symptoms, social media posts, and trends in medication purchases.

People spread diseases when they travel and gather, notes Alessandro “Alex” Vespignani, a physicist and computational scientist at Northeastern University whose lab models large-scale complex systems. He and his team are part of an Insight Net research consortium with Maine’s major hospital systems, MaineHealth and Northern Light Health, which are working on a pilot project to weave human mobility data into disease models. They draw on aggregated and anonymized mobile device location data, databases of global flight schedules, and traces of pathogens found in wastewater sampled from municipal sources and from international flights for analysis by the Boston biotech company Ginkgo Bioworks.

“Our models are like a layer cake,” Vespignani says, with each layer creating a virtual “business as usual world” the modelers use for outbreak simulations. Layers are only added if they significantly improve the model’s predictions or extend the timeline for an accurate forecast. For instance, the lab found that it could accurately forecast greater Boston hospital admission rates three weeks ahead of time by adding mobility and proximity data derived from about 82,000 mobile phones, compared to just two weeks using conventional public health data such as statewide Covid test results. That extra week for planning is “a big deal for hospitals” for scheduling staff and procedures, says Samuel Scarpino, director of Northeastern University’s Institute for Experiential AI and a member of the Insight Net team. Since hospitals aim for 90 percent capacity, even a slight uptick in the need for beds can complicate care.

This fall, the lab will tap retrospective data from Maine’s Covid hospitalization numbers to try to replicate that forecasting capability. It’s also planning to use the mobility-enhanced models to forecast hospitalizations for flu, RSV, and Covid at individual Maine hospitals for the winter of 2024-25. If these efforts are successful, Scarpino hopes to scale the models for use nationwide.

The Insight Net initiative also faces the labyrinthine way the U.S. gathers and shares core public health data such as test results and hospital records. Reducing those obstacles is a key target of the CDC’s Data Modernization Initiative, launched in 2019 to promote things like electronic case reporting, interoperability among different data collection systems, and standardized data use agreements between state, tribal, local and territorial, and federal health authorities. But the data pipeline’s bottlenecks aren’t simply technical and legal, according to infectious disease experts such as Jennifer Nuzzo, an epidemiologist who directs Brown University’s Pandemic Center. They also involve whether we’re asking the right questions about disease threats to get the data we need. “It’s great for us to invest in analytic approaches that can help us tell what could happen in the future,” says Nuzzo. “But what I want to see is a better utilization, analysis, and visualization of the data that we have to tell us what’s happening today.”

For instance, the fragmented efforts to track the H5N1 bird flu virus in the U.S. have drawn a chorus of concern from public health leaders and researchers. Earlier this year, the virus leapt from wild birds to more than 100 million poultry in 49 states as well as other domesticated species, including dairy cows and, more recently, pigs. A small but growing number of people have also been infected (mostly farm workers, but not all). Tracking the virus requires coordination among multiple federal agencies, including the Department of Agriculture, the Food and Drug Administration, and the CDC, as well as states that vary widely in the ways they test animals, people, and bulk milk tanks. The only federally mandated H5N1 screening is for lactating dairy cows being moved across state lines.

Thus far, most humans with bird flu have had minor symptoms, and there’s no evidence of the virus spreading from person to person, which could trigger a pandemic. But the risk increases with flu season, because different viruses infecting the same host can swap genes (known as genetic reassortment) and evolve into something new and more dangerous. If pandemics were hurricanes, having the avian flu virus circulating in cows along with regular flu infections in humans would be akin to a low pressure system in the Caribbean—it could dissipate, but it could also develop into huge trouble for the mainland United States. Nuzzo says we could better predict the outcome if we focused more on targeted surveillance about emerging health threats.

“An awareness of what’s happening this week, and last week, is the starting point for trying to figure out what’s going to happen in the next few weeks and beyond,” says Roni Rosenfeld, a professor of machine learning, language technologies, computer science, and computational biology in the School of Computer Science at Carnegie Mellon University and a cofounder of the Delphi Research Group, a global network of disease modelers working with Insight Net. “So, already before the pandemic, we shifted much of our effort to what I call situational awareness—being aware of what’s happening right now at as fine a geographic, pathogenic, syndromic, and demographic granularity as possible.”

Dylan George, director of the CFA, agrees that disease forecasts will require better raw data and more proactive surveillance. He argues now is the time to strengthen partnerships between researchers and public health practitioners, to build trust and a shared language, and to smooth frictions that can cripple effective collaboration during a crisis. The ultimate test of success for Insight Net, he says, will be seeing them in action:

“If a bunch of state and local health department folks are saying, ‘These forecasting tools are helping me do my job better,’ then I know that we deserve to live another day.”

Illustration: Mary Delaware / Source images: Adobe Stock