If you work in healthcare or public health and believe in the science of vaccines, the spectacle that unfolded in the White House yesterday likely triggered some very strong emotions. For me, they came in waves; first profound sadness and a sense of defeat, then rage, and finally resolve to continue to stand up for what I know is true and to do my best to keep protecting my community and the patients I care for every day.

To recap briefly, the President of the United States signed an executive order seeking major changes to the childhood vaccination schedule in the US. A major focus of the announcement was the MMR vaccine, which protects children against measles, mumps and rubella and is usually given as a multivalent vaccine in two doses. Disinformation was a prevailing theme, with long-debunked claims about vaccines causing autism and assertions about children receiving harmful volumes of vaccines repeated from the highest office in the country.

All of this is happening while the US is experiencing a resurgence of measles, a disease that was declared eliminated from sustained transmission in this country more than two decades ago and that caused deaths during the large outbreaks of 2025.

It is tempting to be dismissive when discussing the impact of this kind of vaccine disinformation. Parents can always discuss their decisions with their pediatrician or another healthcare provider. There is no practical way for an executive order to dictate every conversation happening in physician offices across the country. Doctors will continue to practice evidence-based medicine.

I think this stance is wrong, and potentially dangerous, because it ignores a very basic reality: what leaders say carries weight.

Spreading disinformation and dangerous rumors about safe vaccines is an extremely effective way to attack the trust people have in public health interventions. We saw this repeatedly during the COVID pandemic. At a White House briefing in 2020, President Trump publicly speculated about whether disinfectants could somehow be used inside the body as a treatment for COVID, prompting public health agencies and manufacturers to warn people not to ingest or inject disinfectants.

The misinformation from that period has not disappeared. To this day, I encounter people who refuse lifesaving blood transfusions because they do not want blood products they believe have been “tainted” by mRNA vaccines. We continue to see people refuse vaccines and treatments because of claims that have little or no basis in science. The examples are too many to list in this brief reflection, but the harm is not theoretical. It is reflected in vaccine-preventable diseases returning, outbreaks growing larger, and people experiencing complications and deaths from infections we know how to prevent.

It will probably take me a long time to fully process my emotions about what is happening to public health and how the spread of disinformation is shaping the way people engage with healthcare. So for now, I am choosing to take a more practical approach. As healthcare professionals, I believe we have to reimagine our practice to meet this moment.

I cannot control which executive order comes out of the White House. I cannot control the latest unfounded claim about the safety of a proven vaccine, treatment or drug being amplified by a powerful politician. I cannot control what someone has watched online before they walk into my clinic. But I can control what happens in my daily interactions with people and with my patients, whether in the clinic or the hospital. And I increasingly believe that this is what matters most right now.

I want to share the story of a patient I first met several years ago.

At the time of our first meeting, this person was at probably the lowest point in their life, weathering homelessness, several personal tragedies, job loss and a complete loss of confidence in a healthcare system they felt had abandoned them. They were also in the final stages of advanced HIV and had essentially resigned themselves to dying because, at that point, death felt preferable to continuing to live the life they were living.

I was consulted to help treat an opportunistic infection. From the moment I walked into the room and introduced myself, I immediately sensed that leading with the medical issue at hand would probably be met with frustration and tuning out yet another voice there to tell this person what to do, how to act and how to be well.

So I did something else. I asked for permission to sit next to their bed, and then I asked them to tell me their story.

Their first reaction was surprise, followed by a question.

“Why do you care?”

I responded that I could not help them the best I could if I did not know their story.

Initially, slowly and with a weak voice, they began to speak. Then it was as though I had opened a floodgate. I listened without interrupting, probably spending more time in that encounter than I could reasonably afford to. We did not talk very much about the reason for my consult. I felt that the moment deserved the respect of not being tainted by my own agenda of getting the work done. I promised that I would talk to their medical team about the infection I had been asked to help treat and that I would return the next day.

And I did. The days and encounters that followed allowed me to get to know this person more, to learn about the failings of the healthcare system that had contributed to bringing them to this point and to understand a little better where their mistrust came from. At discharge, I offered to become their HIV primary care physician, with very little confidence that they would actually keep the appointment. Their history of being lost to follow-up preceded them.

To my surprise, they showed up. What followed has now become a patient-physician relationship spanning many years. I have watched this person navigate profound hesitancy about lifesaving antiretroviral therapy to becoming virologically suppressed and living a fully restored, healthy life. Today, they receive long-acting injectable HIV treatment, which sits at the cutting edge of HIV medicine. Last year, they also received their first influenza vaccine under my care.

None of these changes happened overnight. They required time, patience, continued support, non-judgment and, perhaps most importantly, seeing the person in front of me.

I did not get there by winning an argument.

My relationship with this patient is just one tiny illustration of the power healthcare providers still have. We occupy an extraordinary position of privilege in which we meet people while they are navigating illness, information, doubt and fear, often within a healthcare system that has itself failed them in very real ways.

We have the incredible privilege of providing a steady and constant voice in the chaos, anchoring our guidance in science while also pausing long enough to see the person in front of us. I think that distinction matters enormously right now.

The response to vaccine disinformation cannot simply be to repeat the facts more loudly. We have to continue to be rigorous about the science, correct false claims when we hear them and defend evidence-based public health policy. But we also have to understand why the person sitting across from us may be skeptical in the first place.

Sometimes that skepticism comes from misinformation. Sometimes it comes from fear. Sometimes it comes from experiences with healthcare that have given people very legitimate reasons not to trust us. Usually it is more complicated than any one of these things.

And this is where I think healthcare professionals have an enormous opportunity in this moment. Executive orders may dominate the news of the hour, but they do not change what happens in that first interaction when I walk into a patient’s room, shake their hand, look them in the eyes and introduce myself.

They do not change what happens when I sit down and listen.

They do not take away my ability to explain what I know, acknowledge what I do not know, correct misinformation without humiliating someone for believing it, and earn enough trust that perhaps they will come back tomorrow and continue the conversation.

That space still belongs to us.

We have an opportunity as health professionals to do something really special in this season. Yes, our responsibility is to stand up publicly for science when it is being distorted. But perhaps just as importantly, it is to keep showing up in the quiet, ordinary encounters where trust is actually built.

I started yesterday feeling profoundly sad and defeated by what I was watching. I am still angry.

But wallowing in defeat is simply not an option.

Our roles matter.

There is too much at stake.

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I am an infectious diseases physician and scientist writing at the intersection of medicine, global public health, society and justice. If this piece resonated with you consider sharing it and subscribing.

I had hoped that the next time I wrote about the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC), it would be to reflect on encouraging news. Unfortunately, the trajectory of the outbreak remains deeply concerning.

As of July 30, 2026, the outbreak has caused more than 3,600 confirmed cases and nearly 1,600 deaths, making it the largest Ebola outbreak ever recorded in the DRC and the second largest in history, surpassed only by the 2014–2016 West African epidemic. Even more striking than the numbers is the speed. In just over two months, this outbreak has already surpassed the total number of cases recorded during the DRC’s previous largest outbreak, which unfolded over nearly two years.

New anthropological research shared just a week ago offers an important clue as to how this happened. Although the findings have not yet undergone peer review, investigators who spent weeks interviewing nearly 100 healthcare workers, survivors, community leaders, bereaved families, coffin makers, and cemetery caretakers in Mongbwalu concluded that Ebola was likely spreading silently for roughly four months before it was formally recognized. By the time health authorities in Kinshasa confirmed Ebola, widespread community transmission was already underway.

Like Ebola is wont to do, it exploited silent chains of transmission, was amplified by traditional funeral gatherings, and took advantage of the social and demographic conditions that created the perfect storm for the outbreak to accelerate. From the moment the outbreak was formally recognized and a public health emergency declared, the response has largely been playing catch-up.

The outbreak is unfolding in an especially challenging setting. Its epicenter lies in Ituri Province, a region scarred by conflict, mass population displacement, and a well-founded mistrust of both government institutions and outside actors. It also comes just five months after the DRC declared the end of its previous Ebola outbreak, underscoring how relentless these epidemics can be.

All of this has unfolded against the backdrop of profound changes in global health financing. The DRC had previously relied on the United States for roughly 70% of its humanitarian response funding, and the funding cuts that followed the dismantling of USAID likely contributed to delays in outbreak detection and response capacity, according to humanitarian organizations and global health experts. While it is impossible to quantify exactly how much these cuts influenced the current epidemic, it is difficult to imagine that reductions in surveillance, laboratory capacity, and emergency preparedness had no effect.

Much of what is unfolding today carries a profound sense of déjà vu.

The deadliest Ebola epidemic in history, which swept through Guinea, Liberia, and Sierra Leone between 2014 and 2016, caused more than 28,600 cases and over 11,300 deaths. Although those countries had never previously experienced Ebola, two of them were still recovering from years of civil war that had devastated their healthcare systems and public health infrastructure. The outbreak expanded for months before the international response reached the scale necessary to contain it.

One of the enduring lessons from West Africa is that Ebola is rarely defeated by sophisticated technology alone. Unlike respiratory viruses such as SARS-CoV-2, Ebola is not especially well suited to causing a global pandemic. People who become infected are often too sick to travel long distances, transmission requires close contact with the bodily fluids of someone who is ill, and asymptomatic transmission is not thought to play a major role. Yet Ebola possesses another dangerous characteristic, it can smolder undetected for weeks or months before exploding into view.

Containing an Ebola outbreak still depends on the same public health fundamentals that have worked for decades: rapidly identifying cases, diagnosing infection, tracing and monitoring contacts throughout the incubation period, providing safe isolation and treatment for those infected, and ensuring that those who die are buried safely and with dignity. None of these interventions are technologically complicated but all of them are resource intensive.

They require trained burial teams, diagnostic laboratories, treatment centers, personal protective equipment, surveillance systems, and enough frontline healthcare workers to sustain a response over many months. Perhaps most importantly, they require trust. Communities must believe that seeking care is safer than hiding illness, and that public health authorities are working with them rather than against them.

The response is now unfolding in earnest, led by the Congolese government with support from the World Health Organization, Africa CDC, and numerous international partners. There have already been important scientific milestones worth celebrating. Clinical trials evaluating therapeutic agents for infected patients are underway. A post-exposure prophylaxis trial has begun enrolling close contacts of confirmed cases. Meanwhile, a Phase 1 study in the United Kingdom is evaluating one of several candidate Bundibugyo Ebola virus vaccines, an important step toward developing a vaccine specifically targeting the virus responsible for this outbreak.

These accomplishments should give us reason for cautious optimism. Yet optimism is difficult to sustain when each epidemiological update shows that the outbreak continues to outpace the response and the case fatality rate remains approximately between 30-44% among confirmed cases.

So what has to change?

In speaking with colleagues working across agencies on the frontlines of this outbreak, one message comes through consistently; the need for resources remains enormous. There are simply not enough treatment centers to meet demand. Protective equipment remains limited in some settings. The logistics of working in conflict zones remain extraordinarily difficult. Some colleagues have also described how travel restrictions imposed by certain countries have complicated efforts to recruit experienced international responders.

The funding gap is equally sobering. In July, WHO Director-General Tedros Adhanom Ghebreyesus warned that the joint WHO–Africa CDC response plan faced a funding shortfall of more than $400 million even as the outbreak continued to accelerate.

The absence of a licensed vaccine targeting Bundibugyo ebolavirus presents another major challenge. An active scientific debate has emerged over whether the existing stockpiles of the licensed Zaire ebolavirus vaccine (Ervebo) should be deployed in carefully selected high-risk populations. Current WHO guidance concludes that the available evidence is insufficient to recommend its use outside controlled research settings because data supporting cross-protection against Bundibugyo virus remain limited and inconsistent. Others argue that findings from nonhuman primate studies and emerging immunologic data justify evaluating its use prospectively in carefully selected populations while measuring effectiveness. At present, neither position is supported by definitive clinical evidence, illustrating both the urgency of the situation and the limits of our current tools.

Perhaps most importantly, this outbreak must remain in the global conversation. In a world filled with competing humanitarian crises, attention is a finite resource. The longer an outbreak persists, the easier it becomes for those far removed from its immediate consequences to look away. But epidemics do not disappear simply because the headlines move on.

During the West African Ebola epidemic, one of the moments that crystallized the crisis for many Americans came when Thomas Eric Duncan, a Liberian national visiting family in Dallas, was diagnosed with Ebola after initially being sent home from an emergency department. He later died from the disease, and two nurses who cared for him became infected before ultimately recovering. One of those nurses, was transferred to Emory University Hospital for specialized care. Those events served as an important reminder that an outbreak anywhere is ultimately an outbreak everywhere.

But tragedies should not matter only when they reach our own doorstep. The Bundibugyo Ebola outbreak will not simply fade into the background. It will continue its relentless course until the response catches up with the virus. That requires more than passing headlines or expressions of concern. It requires sustained political commitment, adequate financing, scientific collaboration, and partnership with the communities at the center of this epidemic.

Ebola remains a formidable virus. But history has repeatedly shown that when the world commits the necessary resources and attention, outbreaks can be brought under control. Whether that happens this time depends less on the biology of the virus than on the choices we make in responding to it.

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I am an infectious diseases physician and scientist writing at the intersection of medicine, global public health, society and justice. If this piece resonated with you consider sharing it and subscribing.

Summer this year brings warm weather, sunburn, and one of the most anticipated sporting spectacles on the planet. The FIFA 2026 World Cup kicks off on June 11, spread across three host nations (the United States, Mexico, and Canada) with 48 countries competing in 104 matches over 39 days. As a Cameroonian, football is more than a hobby. It’s something woven into national pride and core memories. The legend of Roger Milla and the 1990 Indomitable Lions, who stunned the world by knocking out Diego Maradona’s Argentina, is still one of the first things people bring up when I tell them where I’m from. Milla’s dance at the corner flag is iconic. For a country our size, football gave us a language through which we were seen around the world. Our glory days now live mostly in nostalgic YouTube clips and heated family debates about whether today’s players could ever measure up, but the emotional investment is eternal. This year Cameroon didn’t qualify, a sentence that physically pains me to type but I still get to soak up some of the excitement from Atlanta, one of the host cities.

Unfortunately, years of infectious disease training mean that I do not experience mass gatherings like a normal person. Millions of travelers, packed transit systems, summer heat, stadium food, sleep deprivation, and emotionally volatile football fans set my brain running outbreak risk assessments against my will. And the timing is impeccable, because emerging viruses appear determined to make themselves part of the conversation. First came an Andes hantavirus outbreak linked to a cruise ship, words I did not expect to type in this lifetime and now an unfolding outbreak of Bundibugyo ebolavirus serious enough for the WHO to declare a Public Health Emergency of International Concern. With outbreaks dominating headlines and post-COVID anxiety still humming in the background, it’s fair to wonder whether mass gatherings like the World Cup are an infectious disease risk.

The reassuring answer is yes, but probably not in the catastrophic ways people imagine. Fortunately, the health risks most fans are likely to encounter are not exotic hemorrhagic fevers but the same familiar infections that accompany almost every large gathering of people. Historically, major outbreaks linked directly to sporting events have been uncommon. Better surveillance, faster outbreak response, and international coordination mean the realistic risks are smaller and far more boring. Respiratory and gastrointestinal infections like influenza, COVID-19, norovirus, and salmonella are the most common. These are the pathogens that thrive wherever exhausted humans gather in close quarters and collectively decide that hydration and sleep are optional. So instead of panicking, be prepared.

Before You Travel, Vaccines Are Still Your Best Idea

Before boarding a plane in your team’s jersey, emotionally bracing for the inevitable penalty-shootout heartbreak, it’s worth checking your vaccination history. Measles is the big one this tournament. Measles cases and outbreaks have been reported across all three host nations, and dense international travel creates ideal conditions for it to spread. Measles is one of the most contagious pathogens we know of. Fever, rash, red eyes, cough; if those show up during or after travel, seek medical care. COVID, meanwhile, remains very much with us, despite the widespread decision to simply stop thinking about it. Older adults, immunocompromised people, and frequent travelers should still take booster recommendations seriously.

Travel medicine gets more interesting once you remember the World Cup is often only one leg of the trip. A match in Mexico City turns into beach time, family visits, eco-tourism, and a few questionable layovers. Mosquitoes, unfortunately, remain unimpressed by sporting events. If you’re heading beyond the host cities, think about destination-specific risks like dengue, malaria, typhoid and whether preventive medication or vaccines make sense. And because humans are relentlessly optimistic about their own stamina, a brief word on heat; June and July temperatures in parts of Mexico and the southern United States can be genuinely punishing. Heat exhaustion, dehydration, and alcohol are an under-appreciated combination. I know hydration sounds boring, but emergency departments in summer beg to differ.

Hand Hygiene Is King

Hand hygiene remains one of the most effective defenses against respiratory and gastrointestinal infections. This sounds so unglamorous that it is promptly ignored by almost everyone. So I would say it again, wash your hands after using the restroom, before eating and use sanitizer after public transit. Thousands of equally sweaty supporters have touched every surface before you, and they were not thinking about you when they did it.

Food safety counts too. If something has been sitting outdoors in the summer heat for a questionable length of time, trust your instincts and let it go. Open-air stadiums are generally lower risk than crowded bars, fan zones, clubs, and transit systems, so the riskiest part of your day may not be the match at all. Ventilation matters, and if you’re immunocompromised or otherwise medically vulnerable, masking in crowded indoor settings is still entirely reasonable.

If You Get Sick, Please Do Not Heroically Push Through

Fever with a rash, severe diarrhea, relentless vomiting, significant respiratory symptoms; these are not cues to crack another beer and soldier on to the next match. Seek medical care, and tell whoever treats you where you’ve been. Travel history is one of the most useful things you can hand a clinician, and one of the most commonly forgotten. The overwhelming majority of World Cup illnesses will, thankfully, be mild and self-limited. Early recognition is the most powerful tool we have in outbreak control, and it costs you nothing but a little ego divulging the many questionable choices you may have made while traveling, to a clinician.

There’s also the small matter of medications, which become critically important the instant you forget them. If you rely on daily prescriptions, pack more than you think you’ll need and keep them on you, not in checked luggage. Airlines are unpredictable, chronic conditions like hypertension, asthma and diabetes, reliably, are not.

And because infectious disease physicians become unavoidably parental on the subject of travel please practice safer sex. That may mean HIV PrEP, DoxyPEP for bacterial STI prevention if you qualify, or simply packing condoms you actually intend to use. Large international gatherings create new connections between people, and celebration plus alcohol has never once in recorded history been a solid foundation for sound risk assessment.

Football, Public Health, and the World We Live In

Part of what makes the World Cup extraordinary is that for a few weeks every four years, the world collectively agrees to care deeply about something joyful and gloriously irrational. A last-minute goal can dissolve borders, politics, and language barriers in ways diplomats spend entire careers failing to achieve. But it is impossible to talk about this tournament honestly without naming the backdrop it unfolds against.

Immigration enforcement in the United States means some fans who might otherwise travel will quietly decide not to. Others already living in host cities may avoid public gatherings out of fear. A tournament built on celebrating global movement sits uneasily beside an increasingly restrictive conversation about migration and belonging. And then there’s the simple fact that FIFA has through the years turned attendance into a luxury product. Ticket prices, accommodation, and travel costs now place the tournament out of reach for many of the ordinary supporters who give it meaning in the first place.

Football has always belonged most truly to ordinary people. Modern international football, increasingly, does not.

All of this unfolds while public health infrastructure across parts of North America, the United States in particular is being eroded and defunded. Surveillance systems, vaccination programs, laboratory networks, epidemiologists and the machinery that protects entire populations from outbreaks is invisible right up until the moment it fails.

COVID taught us that weakening public health systems doesn’t make infectious disease threats disappear. It just leaves us more exposed to them. For a few weeks this summer, football will deliver joy, spectacle, heartbreak, unity, and refereeing decisions capable of ending lifelong friendships. Perhaps we need some of that right now.

But when the final whistle blows and the champions lift the trophy, infectious diseases will still be here. Measles will still not care about borders and mosquitoes will remain annoying and resolutely nonpartisan. Public health infrastructure will still matter, and we’ll still have to grapple with all of it. For a month, football will convince us that borders matter less than goals, flags, and last-minute miracles. Then the tournament will end, the crowds will disperse, and the work of protecting public health will continue. Viruses won't know the difference.

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I am an infectious diseases physician and scientist writing at the intersection of medicine, global public health, society and justice. If this piece resonated with you consider sharing it and subscribing.

A Familiar Crisis in Unfamiliar Territory

Ebola is back and so are travel bans, fear-mongering, anxiety-ridden messaging, and the particular chaos that descends when a disease most of the world has decided belongs to someone else crosses into the news cycle.

Almost a week ago, the world learned of a new Ebola outbreak unfolding in the Democratic Republic of the Congo and Uganda. The outbreak is caused by a rare species of orthoebolavirus known as Bundibugyo virus, which has caused only two previously recorded outbreaks in history: the first in Bundibugyo, Uganda in 2007, and the second in Isiro, DRC in 2012. This is the third. The large number of suspected cases and deaths at the time the outbreak was formally identified, and the location of the epicenter in Ituri province (a conflict-torn region with nearly a million displaced people) rightly raises alarm. The WHO moved rapidly to declare a Public Health Emergency of International Concern, mobilizing international partners for the response.

While the DRC is no stranger to Ebola, this is the country’s 17th recorded outbreak, this crisis could not have come at a worse time. The shockwaves of funding cuts accompanying the dismantling of USAID are not yet fully absorbed. Logistical, collaborative, and technical support structures between US public health leadership and the rest of the global health infrastructure are at their most fragile in a generation. Cross-border spread into neighboring Uganda, and the potential for the outbreak to extend into South Sudan another country fractured by ongoing conflict is already drawing comparisons to the West Africa outbreak of 2014–2016.

That outbreak was the deadliest in recorded Ebola history. It resulted in more than 11,000 deaths and nearly 29,000 infections across Sierra Leone, Liberia, and Guinea, three West African countries that share many of the structural vulnerabilities of northeastern DRC: under-resourced health systems, histories of conflict, and communities with hard-earned reasons to distrust outside intervention.

What We Built and What We Are Dismantling

Despite the devastation of that outbreak, the world was supposed to emerge better prepared. And in meaningful ways, it did.

We now have a licensed vaccine for Zaire ebolavirus, the species responsible for most historical outbreaks approved by both the FDA and the European Commission. Candidate vaccines for Sudan ebolavirus are in advanced phases of clinical development. Critically, no licensed vaccine or approved treatment currently exists for Bundibugyo virus, the species responsible for this outbreak. That gap is critical and is shaping every decision being made on the ground in Ituri right now.

Local capacity for viral sequencing across the African continent has also grown tremendously. Genomic centers of excellence have taken root in countries that a decade ago had to send samples abroad and wait weeks for results. In this outbreak, scientists at the Institut National de Recherche Biomédicale in Kinshasa and the Central Public Health Laboratory in Kampala produced near-complete Bundibugyo genomes in under 16 hours from sample receipt, confirming a new spillover event and placing it in evolutionary context against all prior outbreaks. That is a scientific achievement that should be celebrated loudly and specifically.

These investments were doing exactly what they were designed to do before the seismic disruption of funding cuts and the withdrawal of US leadership from the global public health stage. In 2025, countries across Africa responded effectively to outbreaks of Ebola Zaire, Ebola Sudan, and Marburg virus in Uganda, Rwanda, Tanzania, and the DRC, each contained within a relatively short period. A genomics laboratory in South Africa sequenced Andes hantavirus from a passenger aboard the Hondius cruise ship who received care there, rapidly sharing the sequence with the world.

What this tells us is investment in building local capacity and strengthening health systems yields benefits for the entire global community, not only the countries that receive the aid. The question is whether we are willing to sustain that investment when there is no active crisis demanding our attention. Recent answers to that question have not been encouraging.

The Theater of Travel Bans

What has been most disheartening to observe in these early days of the response has been the resurfacing of travel bans.

The United States government rapidly moved to impose a 30-day travel restriction on all non-US citizens who had been in South Sudan, the DRC, or Uganda within the previous 21 days. Decades of public health evidence tell us that such bans especially imposed in the midst of an active outbreak are largely ineffective and reliably generate stigma, xenophobia, and racist rhetoric. In the specific context of this outbreak, the theater of these restrictions is even more transparent than usual.

The people at the epicenter of this crisis in Ituri province could not board a plane and fly to the United States even if they wanted to. The US issues so few visas for travel from DRC that the current administration did not even see fit to impose the visa bonds it introduced for countries with high overstay rates because Congolese nationals are denied visas at such high rates in the first place. The same dynamic applies to South Sudan. As for Uganda, visa bonds ranging from $5,000 to $15,000 are in place, figures that are effectively prohibitive for most citizens of a country where average wages make such sums unimaginable. A travel ban on populations that were already largely excluded from travel is not a public health measure, it is performance.

The consequences of that performance unfolded in real time just two days ago. An Air France flight from Paris bound for Detroit was diverted to Montreal after US authorities identified a passenger who had recently been in DRC. What followed was widespread panic online including viral claims that Bundibugyo virus is airborne. It is not. Like all ebolaviruses, Bundibugyo spreads only through direct contact with the bodily fluids of a symptomatic individual. The diverted passenger was assessed by Canadian public health authorities upon landing, determined to be asymptomatic, and routed back to Paris. They were not infectious and not a threat, yet sent home anyway.

This is what travel bans do. They other. They create panic. They spread disinformation. They erect barriers to the movement of resources, aid workers, and expertise toward the places that need them most. And they obscure a fundamental epidemiological reality, any meaningful risk of Bundibugyo virus reaching Europe or North America is far more likely to arrive via returning foreign nationals with the financial resources and passport privilege that affords them freedom of movement or via humanitarian workers evacuated abroad to receive care.

In the current outbreak, an American missionary physician working at Nyankunde Hospital in eastern DRC contracted Bundibugyo virus while caring for patients and was evacuated to Berlin’s Charité hospital for treatment, along with his wife and four young children. Six additional high-risk American contacts are also in the process of being evacuated. During the 2014–2016 West Africa outbreak, 27 foreign nationals the vast majority of them aid workers were medically evacuated for treatment in Europe and the United States. Not one was Liberian, Sierra Leonean, or Guinean. Those who received care in high-resource settings had survival rates of approximately 80%, substantially higher than those who did not have that choice or that privilege.

The travel ban targets Congolese nationals and the evacuations serve Americans and Europeans. The asymmetry is not incidental. It is the point.

Dignified Goodbyes in times of Outbreak

Beyond travel bans, the news that a treatment center had been set on fire in Ituri after a grieving family demanded the return of their young son’s body, was met online with swift and heavy condemnation. I have seen posts calling those family members savages. I have watched people who have never set foot in eastern DRC render confident verdicts about the irrationality and danger of communities they know nothing about. What is entirely missing from those reactions is context and history.

Ituri province has been battered. Conflict has torn through this region since the mid-1990s. Fighting has intensified significantly since late 2025, displacing over 100,000 people in just the past two months, with nearly a million people internally displaced across the province overall. Just days before the treatment center was set on fire, militants linked to the Islamic State killed at least 17 people in a village in Ituri with machetes and firearms, burned homes, and took hostages. This is the environment in which health workers are asking families to surrender their dead.

In many parts of the world, a dignified burial is the final act of love a family can offer someone they have lost. The rituals that accompany death are intimately connected to beliefs about the afterlife, about the relationship between the living and the dead, about what it means to honor a life fully lived. Ebola does not dissolve these beliefs. It collides with them. And when health systems respond to that collision with rules rather than relationship, with enforcement rather than explanation, with the language of compliance rather than the language of care, they lose the trust that makes any response possible. That is not a failure of the community but a failure of the response and, it is also not new. During the 2018–2019 Ebola outbreak in North Kivu and Ituri, over 300 attacks on Ebola health workers were recorded in a single year, leaving six dead and 70 wounded. Violence in these situations is rarely random. It is almost always downstream of grief that has nowhere to go, of mistrust that has been earned over generations, of communities that have learned, correctly that outside actors do not always have their interests at heart.

I lived through COVID in the United States. I remember sitting with families who could not enter the ICU to say goodbye to a dying parent, a spouse, a child. Some of them grew angry. Some of them became frightening in their grief. I had enormous compassion for all of them because I understood that their anger was not really about me, or the rules, or even the hospital. It was about the unbearable fact of losing someone they loved without being able to hold them. If that parallel does not open a window into our shared humanity, I am not sure what will.

The communities in Ituri are not a problem to be managed. They are people to be met with transparency, with humility, with the recognition that trust is built slowly and destroyed quickly, and that no outbreak response has ever succeeded without it.

What We Owe Each Other

As we continue to watch this outbreak unfold in eastern DRC and Uganda, I find myself returning to a simple truth that the science consistently affirms and that politics consistently forgets: outbreak response works when it is grounded in equity, trust, and the recognition of shared humanity. It fails when it is organized around fear, exclusion, and the fiction that some people’s safety matters more than others’.

The scientists at INRB in Kinshasa who sequenced a novel virus genome in under 16 hours deserve our admiration and our investment. The contact tracers working in a conflict zone under the threat of violence deserve our solidarity and our protection. The nurses staffing treatment centers in Ituri deserve the supplies, the training, and the international support that would have been far more robust had the last several years unfolded differently. The families grieving their dead under impossible circumstances deserve our compassion not our condemnation.

Where one is born and the passport one carries are simply the luck of the draw. The people in the DRC and Uganda weathering the onslaught of a deadly disease; with no licensed vaccine, in a conflict zone, with their treatment centers on fire and their borders effectively sealed, did not choose this. They are playing the cards they were dealt. They are doing it with remarkable resilience and skill. And they are doing it while keeping the rest of us safer than our current policies deserve.

The least we can do in return is to see them as human and then to act accordingly.

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I am an infectious disease physician and global health researcher who writes at the intersection of medicine, science, and justice. If you enjoyed reading this piece please consider subscribing or sharing it with others

It has been a busy week for me.

I have been on the infectious diseases consult service while also following every update of the unfolding Hantavirus outbreak linked to the Hondius. In many ways, it has felt like reliving the early days of the COVID-19 pandemic, except this time, it is not a novel pathogen, but a well-described virus appearing in an entirely new epidemiologic context: transmission aboard a cruise ship.

As I sat down to write this entry, I found myself wondering what exactly I wanted the focus to be.

So much has already been written about the outbreak itself; the ongoing investigation, contact tracing efforts, debates about airborne spread, arguments over what constitutes “close contact,” and the inevitable re-litigation of every success and failure of the COVID-19 pandemic response. Once again, the WHO and CDC are being placed on trial in the court of public opinion by people who still hold those institutions singularly responsible for everything that went wrong during the hardest years of the pandemic.

The truth is that many of these debates will never be fully settled in our lifetimes.

When you survive a global pandemic, you are never quite the same afterward. Those of us who lived through COVID-19 will probably spend years continuing to metabolize what happened scientifically, psychologically, politically, and personally.

So rather than rehashing familiar arguments, I want to focus on something else entirely, how we respond emotionally to the next infectious threat, and how not to let the trauma of COVID distort our judgment and overwhelm common sense.

What much of the public does not fully appreciate is how frequently those of us working in infectious diseases and public health confront potential outbreak scenarios. Most simply never become visible outside hospital walls.

The needle-stick injury from a patient with hepatitis B in a chaotic emergency room.

The patient with measles who sat unmasked in a crowded hallway for hours before the diagnosis was recognized.

The patient with active pulmonary tuberculosis who was not placed on airborne precautions because nobody initially suspected MTB.

These situations happen all the time.

Most never escalate into anything that reaches even local news because well-established infection prevention systems rapidly activate. Identify the index case. Isolate. Trace contacts. Secure specimens. Notify the appropriate authorities. Provide prophylaxis or treatment when necessary. Repeat.

It is unglamorous work. Mostly invisible work. But it is the work that prevents outbreaks from becoming catastrophes.

One particular experience from several years ago crystallized this reality for me.

At the end of a long clinical day, I received a page from a colleague in the ICU requesting approval for a respiratory viral panel for a critically ill patient who had been admitted overnight and was now mechanically ventilated. At the time, these tests were expensive and restricted through Infectious Diseases approval.

I asked for more clinical context.

“Well,” my colleague replied, “this is a young man who arrived from the Democratic Republic of Congo two days ago. He was found unconscious in the field and intubated by EMS.”

Immediately, every alarm bell in my head went off. Not simply because the patient was critically ill, but because I was aware of an ongoing Ebola outbreak in the DRC at that exact time.

I told my colleague immediately: “Isolate the patient. I am coming to evaluate him now.”

I quickly reviewed the chart. Fever. Thrombocytopenia. Altered mental status. Very limited collateral history. No clarity about exactly where in the DRC he had traveled from, what exposures he might have had, or how long he had been symptomatic before arrival.

I rushed to the ICU, donned PPE, and entered the room.

After examining the patient, I had an internal conversation that I hope never to repeat:

“What if this is Ebola?”

“And if I even remotely suspect it, how can I justify not acting?”

I made the decision immediately.

I spoke with the ICU attending and recommended sealing off the room, limiting care teams, and implementing strict isolation protocols pending further evaluation.

Within an hour, hospital leadership had been activated. Infection prevention teams mobilized. The cascade began.

Which emergency room bay had he initially occupied?

Who had entered the room?

Where were his laboratory specimens?

Which lab personnel had handled them?

Should those samples now be considered potential biosafety level-4 material until proven otherwise?

The CDC was notified. Discussions began regarding possible transfer to a specialized biocontainment unit. Emergency diagnostic testing was arranged.

For six hours, my world narrowed to a single terrifying question.

And somewhere in the middle of all this, another realization quietly surfaced, I myself was now potentially exposed.

Even though I had worn airborne and contact PPE, pathogens like Ebola demand an entirely different level of precaution and psychological reckoning.

Those six hours remain among the most intense of my professional career.

Then the results came back.

Negative.

Not Ebola. Not another deadly hemorrhagic fever virus. The patient ultimately recovered fully.

This story never made the news because it did not need to. When I reflect on moments like that and on the countless near-misses that occur daily around the world, I actually find reassurance in what modern infectious disease systems are capable of. We understand disease transmission extraordinarily well. We know how to contain outbreaks. We know how to interrupt chains of spread. We know how to implement infection prevention measures rapidly under uncertainty.

COVID altered many things, including the amount of grace the public is willing to extend toward institutions responding to outbreaks in real time. Some criticism of the pandemic response was absolutely warranted. Public health agencies made mistakes. Messaging sometimes changed in confusing ways. Scientific uncertainty was not always communicated clearly.

But there is a difference between demanding accountability and abandoning trust altogether.

Does endlessly placing the WHO or CDC on trial over every evolving recommendation from 2020 actually improve our ability to respond to the next outbreak?

Does convincing the public that every changing recommendation is evidence of deception rather than scientific adaptation make anyone safer?

I do not think it does.

None of this means public health institutions are beyond criticism. Institutions are made up of human beings, and human systems are inevitably shaped by politics, bureaucracy, competing interests, and at times genuine mistakes. COVID exposed many of those fractures in painful and very public ways.

But I also think something important gets lost in these conversations.

The people who actually do this work; infectious diseases physicians, epidemiologists, infection prevention teams, laboratorians, field investigators, nurses, and public health responders remain deeply committed to the mission that brought many of us into these professions in the first place. We trained for this work because we believe outbreaks matter, containment matters, and because protecting the public matters.

When the outbreak aboard the Hondius was recognized, the response team deployed to the ship included infectious diseases physicians and epidemiologists. That detail may sound unremarkable to most people, but to me it says everything.

This is who we are.

When outbreaks happen, people like us go toward them.

Not because it is glamorous or politically convenient. But because it is the job we trained to do.

In infectious diseases, there is often an unspoken understanding that when everyone else is trying to determine how dangerous something may be, someone still has to be willing to walk into the room first.

As I have watched public anxiety, chaotic messaging, and reflexive blame re-emerge during the Hantavirus outbreak, I find myself leaning less into outrage and more into humility. Those of us in infectious diseases and public health respond to threats constantly. We make decisions quickly, often with incomplete information. Sometimes we make mistakes because we are human beings operating under pressure and uncertainty.

But the core principles of outbreak management have not fundamentally changed. Identify. Isolate. Trace. Contain. Communicate. And despite all the anger and distrust left behind by COVID, those systems still work far more often than most people realize.

Perhaps the lesson here is not that public health institutions are infallible. They are not. It is that a world without functioning public health systems, outbreak investigators, infection prevention teams, laboratorians, epidemiologists, and frontline clinicians would be immeasurably more dangerous. The people doing this work have always been there, before COVID, during COVID, and now again during the next outbreak.

Most of the time, you simply never hear about the disasters that never happened.

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For context, influenza vaccination has been mandatory for U.S. military personnel since the 1950s, with the Department of Defense historically targeting over 90% annual coverage.

As an infectious diseases physician, I find this decision baffling, not because I am reflexively pro-vaccine, but because history has already answered the question of what happens when militaries lose control of infectious disease.

Before bullets, there was disease

For the first 145 years of U.S. military history, far more personnel died from infection than from combat. Historians have formalized this into two periods: the Disease Era (1775–1918) and the Trauma Era (1941–present). During the Civil War, roughly two-thirds of the 660,000 military deaths were caused by pneumonia, typhoid, dysentery, and malaria. In the Mexican-American War, disease accounted for an estimated 88% of U.S. deaths. During the Napoleonic Wars, British soldiers were eight times more likely to die of disease than of a battle wound.

The turning point came with World War II, which coincided with two of the most transformative advances in medical history: antibiotics and mass vaccination. By the 1940s, militaries were systematically deploying vaccines against yellow fever, tetanus, typhoid, and influenza. Penicillin was available to treat wounded soldiers. Sanitation and vector control were no longer afterthoughts. World War II was the first major American war in which combat killed more soldiers than disease and military vaccination policy is a large part of why that was true.

The first mandate: Washington and smallpox

In February 1777, George Washington ordered the mandatory variolation of the Continental Army against smallpox. It was the first mass immunization policy in U.S. history, and it came after a devastating outbreak had already crippled American forces during the Quebec campaign. British troops, largely immune from childhood exposure, held a decisive biological advantage. Washington described smallpox as “more destructive than the sword.” Many historians credit his decision with preserving the Continental Army long enough to win the war. It is worth pausing on that. The founding act of American military medicine was a vaccine mandate.

Barracks epidemiology hasn’t changed

The Civil War offers the second lesson. Measles killed at least 4,246 Union soldiers, with case fatality rates of 6% in white soldiers and 11% in Black soldiers. Immunologically naïve recruits from rural communities were packed into crowded camps, placed under intense physical stress, and shipped around the country. Outbreaks were so predictable that they were treated as a phase of training , a rite of passage called “seasoning.” Modern recruits face the same conditions. Young adults, from different regions, in close quarters, under physiologic stress, are the ideal marinade for an outbreak. What has changed is not the epidemiology of infectious diseases but the availability of vaccines to blunt their effects and offer reliable protection.

1918: the military as a global amplifier

The 1918 influenza pandemic remains the clearest example of what happens when infectious disease intersects with military logistics. The outbreak is conventionally traced to Camp Funston, Kansas in March 1918. Within weeks, ~1,100 of 56,000 troops there were sick, and outbreaks had reached 24 of 36 major U.S. training camps. At Camp Devens in Massachusetts, 14,000 soldiers a quarter of the camp were infected by September. From there, troop movements seeded outbreaks across the United States and the world. Rail networks, ports, and troopships turned military logistics into a transmission network. In India, the virus traveled inland on trains carrying returning soldiers. African ports receiving demobilizing troops saw case numbers explode within weeks South Africa and Kenya each lost an estimated 4–6% of their populations. The U.S. numbers alone estimate approximately 26% of the U.S. Army infected, more than a million soldiers, roughly 45,000 military deaths, and 675,000 civilian deaths more than the United States lost in WWI, WWII, Korea, and Vietnam combined. The military was not just affected by the 1918 pandemic it amplified it well beyond the borders of the U.S.

Adenovirus: the modern warning

If WWII shows us what happens when you control infectious disease in a military population, adenovirus shows what happens when you stop. For decades, U.S. recruits received an oral vaccine against adenovirus types 4 and 7. In 1996, the sole manufacturer stopped production. By 1999, the stockpile was depleted and vaccination ceased. Between 1999 and 2010, the military recorded roughly 110,000 febrile respiratory illnesses among recruits, 73,000 confirmed adenovirus cases, and 8 deaths. Each year without the vaccine produced resulted in on average, one death, 1,100 to 2,700 hospitalizations, and about 13,000 infections. When a replacement vaccine was licensed in 2011, case rates dropped dramatically and have stayed low since. This is as close to a controlled experiment as public health ever gets. Same population, same bases, same pathogen. Vaccine off, cases up. Vaccine back on, cases down. It is also the closest historical analog we have to the decision made this week.

Why this never stays “in the military”

Militaries are not closed systems. The health of a military population directly shapes the health of the communities around it. Service members live with families. They share base schools, base clinics, and base commissaries. They travel home on leave, eat in local restaurants, use local hospitals, and work alongside civilian contractors. In the coastal towns around Norfolk, outside Fort Liberty, around Camp Pendleton, in the communities encircling U.S. bases in Germany, Japan, and Korea, the epidemiology of the base is the epidemiology of the surrounding county. When you drop a base’s vaccination coverage below the threshold required for herd immunity, the county becomes more vulnerable to whatever that base is currently incubating.

The amplification problem also runs in the other direction. U.S. service members deploy to regions with pathogens their home populations have not encountered in generations. For example yellow fever in West Africa and South America, Japanese encephalitis in parts of Asia, typhoid and cholera in low-sanitation environments. When they come home, they come with their microbiome and their exposures. The 1918 pattern clearly demonstrated the ability of troops to carry a virus from port to port, from camp to home, from military depot to civilian rail line. It is not a historical artifact but rather a template that modern logistics would make more efficient.

A personal aside

A few weeks ago, while on clinical service, I got a call from one of the teams with a new consult: “Young active duty military service member, presenting with unexplained seizures — we are concerned for rabies.”

After a good chuckle at an overly enthusiastic intern (rabies is exceedingly rare in the U.S. and the exposure history did not fit), I told the team, very confidently: If this individual is an active duty service member in the U.S. Army, they are vaccinated against rabies. You can be sure of that.

That certainty came from the U.S. military’s long, disciplined, boring, expensive history of protecting its own people from preventable infection , the same history that made rabies a footnote to an intern’s case presentation rather than a real possibility in a young American soldier with seizures.

The flu vaccine reversal is, on its face, limited. One vaccine. One population. Exemption windows for branches that choose to keep it. But vaccine policy rarely retreats in a single step, and rarely retreats in isolation.

The open question is not only what this means for the U.S. military. It is what it means for the populations that military is stationed within, deploys to, and ultimately comes home to. What we can say with certainty is this: lower influenza vaccination coverage in the military will mean more sick soldiers next season, and more preventable complications in otherwise young, healthy individuals. History has already shown us how this story ends when vaccines are withdrawn. Ignoring it does not change the outcome. It only ensures that when it happens again, it will not be a surprise it will be a choice.

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I am writing this from Cameroon, where I spent four days participating in a free cancer screening campaign in the Southwest region, an initiative organized by the Association of Cameroonian Physicians in the Americas, in partnership with the Faculty of Health Sciences of the University of Buea and the Buea Regional Hospital. Over four days, the team offered screening for breast, cervical, prostate, and colorectal cancers. On paper, this is what progress looks like bringing together multi-disciplinary international and local teams for access, outreach, early detection. But what I encountered forces a more difficult question. What happens when the frameworks we use for prevention are fundamentally mismatched to the realities on the ground?

A Disease That Doesn't Fit the Template

Breast cancer is the leading cancer among women in Cameroon, with over 4,200 new cases diagnosed every year. That alone is not surprising. What is striking and deeply concerning is the age distribution. We are not primarily seeing post-menopausal disease, as is classically described in other settings. We are seeing young women. Women between 30 and 50 account for the majority of cases, and in some instances, diagnoses have occurred in girls as young as 17.

This is not the epidemiologic pattern we expect from data generated in high-income settings, where breast cancer incidence rises with age and peaks after menopause. When a disease behaves differently, the response should not be to force it into existing models. It should be to ask why.

What Is Done to Girls' Bodies

Part of the answer may lie in something we have collectively failed to confront with sufficient urgency.

When I was in primary school what would be called middle school in the United States, almost every girl in my class had undergone breast ironing. At the time, it was spoken of in terms of pain. That was the frame through which we understood it, a painful but normalized part of growing up for many girls. What none of us grasped was that this repeated trauma to developing breast tissue might carry consequences far beyond that moment. Decades later, it is becoming increasingly difficult to ignore the possibility that the damage inflicted during those formative years may be contributing to a pattern of early-onset, and often aggressive, breast cancers in very young women.

Breast ironing targets girls between the ages of 8 and 13, particularly those who begin developing breasts early. It involves applying repeated pressure and heat using heated stones or other implements to flatten breast tissue. The stated goal is protection from the predatory male gaze; to reduce visibility, to delay sexualization, to shield girls from harassment, sexual assault, and early pregnancy. But the biology does not negotiate with intent, in reality what this practice causes is direct and repeated tissue injury including chronic inflammation, fibrosis, and disruption of normal breast development. It leaves lasting psychological scars, and plausibly creates a microenvironment that may predispose to malignancy through cycles of injury and abnormal repair. Studies have shown it does little to protect young girls from sexual predation or prevent teenage pregnancies.

One in four Cameroonian women are estimated to have undergone this practice and in some parts of the country this estimate approaches 50% of women. The practice is not a marginal exposure but rather it is widespread, normalized, and almost entirely invisible within formal risk models. It is also not a Cameroonian problem alone. Breast ironing has been documented across West and Central Africa in Nigeria, Chad, Togo, Benin, Côte d'Ivoire, and Guinea-Bissau as well as in East and Southern Africa, including Kenya, Zimbabwe, and South Africa. Estimates suggest that approximately 3.8 million girls across sub-Saharan Africa are affected ( and this is likely an underestimate). The practice has also been reported among African diaspora communities in Europe, including the United Kingdom, where cases have been documented and prosecuted. This is a regional phenomenon that demands a regional research agenda and a global health response that does not treat it as an obscure footnote from a single country.

What Statistics Cannot Capture

In a setting like Cameroon, where health systems are constrained and access to care is profoundly uneven, a cancer diagnosis is often experienced as a death sentence. Screening is not routinely performed, and most cases present at advanced stages where curative treatment is no longer possible. There are more than 21,000 new cancer diagnoses in the country each year, and the mortality-to-incidence ratio sits at approximately 63 percent. That number alone reflects a system where detection comes too late. But statistics do not capture what this looks like in practice.

During the campaign, I met a 23-year-old woman who had traveled nearly 300 kilometers with her eight-month-old child in search of care. What she revealed was not something screening could help with. She had a fungating breast mass and clear evidence of metastatic disease. She was, in every clinical sense, actively dying. This was not a case that had been missed by screening. This was a case that had never had a chance.

The Problem With Imported Guidelines

Against this backdrop, the limitations of imported screening guidelines become impossible to ignore. Most global recommendations advise starting routine breast cancer screening at age 40. These guidelines are grounded in populations where breast cancer incidence increases with age, and early-onset disease is relatively uncommon. But in Cameroon, the risk landscape is fundamentally different.

If a large proportion of women have been exposed to repeated breast trauma in childhood, and are presenting with cancer in their 30s or earlier, then applying a starting age of 40 is structurally misaligned with the disease we are trying to detect. It ensures that a significant number of cancers will be missed until they are no longer treatable. The guideline, as written, does not protect these women. It fails them by design.

The Evidence Gap Is Not Permission to Look Away

There is still no robust epidemiologic data definitively linking breast ironing to breast cancer risk. I want to be clear about that. But the absence of definitive data should not be misinterpreted as the absence of risk. What we have is a highly prevalent exposure, a biologically plausible mechanism, and a population-level signal of early-onset disease. From a scientific standpoint, this should be more than enough to trigger urgent investigation. We need rigorous studies that examine this exposure, integrate it into clinical and surgical histories, and characterize its potential contribution to carcinogenesis. Until that work is done, we are operating with a blind spot one that disproportionately affects young women who are already at the margins of global health attention. The failure to generate this evidence is a choice with significant consequences.

This Is Gender-Based Violence Which Must Be Named

Breast ironing is often framed as a harmful cultural practice, something to be educated away through awareness campaigns. That framing is incomplete, and in some ways, it is a distraction.

Breast ironing is gender-based violence. It is an act performed on girls’ bodies without their consent, causing lasting physical harm, because those girls’ bodies were considered dangerous. Because their developing breasts were read as invitations to assault, to stigma, to early pregnancy and, no one with authority was willing or able to remove those actual threats. So female family members ( mothers, grand mothers , aunts) intervened in the only way they believed was available to them. They modified the child, because they did not trust the system to protect her.

That context does not excuse the harm. But it does determine what an adequate response looks like. If we are serious about ending this practice, the response cannot be limited to awareness campaigns targeting women and families. It must also directly confront the conditions that make the practice seem necessary: the normalization of sexual violence against girls, the absence of accountability for predatory behavior, and the structural failure to protect female bodies in public and private spaces. Without addressing those drivers, we are asking families to abandon what they perceive as protection without offering anything in its place. That is not a public health strategy.

What Context-Sensitive Global Health Actually Requires

What this experience makes undeniable, for me, is a broader failure in how global health operates. We have a persistent tendency to universalize recommendations without adequately interrogating local context. We export frameworks built on data from high-income populations, apply them to settings with fundamentally different risk profiles, and call it evidence-based medicine.

In Cameroon, a more rational and ethical approach would include:

Earlier risk assessment for women with a documented history of breast ironing, beginning in their 20s. Consideration of earlier or targeted screening protocols, calibrated to local epidemiology rather than imported age cutoffs. Investment in locally generated data, so that policy is informed by the population it is meant to serve. And a willingness to hold the discomfort of not yet having all the answers, while still acting with urgency in the face of a plausible and prevalent risk.

Because if we continue applying one-size-fits-all frameworks in contexts where they do not fit, we will continue to miss disease, particularly in populations that are already at the highest risk of being overlooked.

What We Owe The Next Generation

The 23-year-old woman I met had traveled 300 kilometers to be seen. She deserved to be seen long before that at 17, or 20, or 23, in a system designed around what her life actually looked like. She deserved screening guidelines written with her in mind. She deserved a public health apparatus willing to ask the uncomfortable questions about what had happened to her body long before any tumor appeared.

We cannot give her that now. But we can decide what we owe the next generation of girls.

We can name breast ironing as gender-based violence and insist on structural responses to the conditions that sustain it. We can demand research that centers populations too long treated as footnotes. We can build screening protocols that reflect local realities, not imported assumptions. And we can stop treating the absence of certainty as justification for inaction.

The girls societal norms ironed flat are growing up. Some of them are getting sick. The least we can do is pay attention.

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I am an infectious disease physician and global health researcher who writes at the intersection of medicine, science, and justice.

A Public Health Giant, and a Singular Achievement

This past weekend, we lost William Foege, a giant of public health whose work shaped an entire generation of thinking about what collective action can achieve. Dr. Foege is best remembered for his pivotal role in the eradication of Smallpox, a singular public-health triumph that remains unmatched more than four decades later.

I never met Dr. Foege, but his legacy has been present in nearly every lecture I have ever attended on disease eradication. Smallpox eradication was not simply a technical success; it was also a moral and political one. Anchored in the strategy of ring vaccination an approach Dr. Foege helped conceptualize and operationalize, the campaign abandoned the fantasy of blanket vaccination coverage and instead targeted outbreaks with precision, surrounding cases with rings of protection and deploying scarce vaccine resources where they mattered most.

Eradication Was Never Just Technical

When smallpox was declared eradicated in 1980, it demonstrated something profound: that public health, when understood as a collective project, could achieve outcomes that no individual action ever could. That success inspired generations of researchers and policymakers to imagine the elimination and even eradication of other infectious diseases such as polio and measles. But nearly half a century later, it is worth asking whether such a feat would be achievable today.

Smallpox was, by any measure, a uniquely eradicable pathogen. It had no animal reservoir. Infection and vaccination conferred long-lasting immunity. There was little asymptomatic transmission. And we had a highly effective, durable vaccine. These biological features were essential but biology alone does not explain why eradication succeeded then and remains elusive now.

Could We Do This Again?

What has changed most dramatically is not our science; it is our social contract. At the time of smallpox eradication, vaccination was widely understood as a public good. It was not framed primarily as a personal consumer choice or an individualized risk–benefit calculation, but as a shared obligation to protect communities especially the most vulnerable. Dr. Foege articulated this ethos plainly when he said, “Public health might be the greatest measure of kindness, the greatest measure of how to treat each other.” That understanding of public health as an expression of collective responsibility has steadily eroded, replaced by a discourse that elevates individual preference above communal protection.

Public health continues to pursue eradication and elimination goals, but only a small number of human pathogens are even theoretically amenable to eradication. Disease elimination; defined as the interruption of transmission within defined geographic regions, has been achieved for several vaccine-preventable infections. Yet even these hard-won gains are now slipping away as vaccination is increasingly justified, defended, or rejected on the basis of individual preference rather than collective responsibility.

Disinformation, Politicization, and Reversal of Progress

Poliomyelitis illustrates this tension clearly. Before vaccines, poliomyelitis was a devastating disease that paralyzed and disabled children worldwide. Biologically, polio remains a plausible eradication target: humans are the only reservoir, and effective vaccines exist. But unlike smallpox, polio is often transmitted silently through asymptomatic shedding, and vaccine-derived poliovirus strains complicate eradication efforts. Add to this the realities of conflict, fragile health systems, and deepening mistrust of vaccination campaigns, and the challenge becomes not just technical but political. The erosion of commitment to individual action for collective benefit has materially slowed progress. Recent suggestions by senior policy figures in the United States that polio vaccination could be made “optional” triggered predictable alarm and underscored how deeply individualism has polluted vaccine discourse.

Measles offers an even starker warning. Measles is a human-only pathogen with an excellent vaccine. Yet it is also among the most contagious viruses known: one infected person can transmit measles to 12–18 others. Preventing outbreaks requires sustained vaccination coverage above 95%. For measles, perhaps more than for any other vaccine-preventable disease, community protection is the intervention. Individual protection alone is insufficient. And yet, measles has returned rapidly and predictably in settings where it had previously been eliminated. The reasons are not mysterious. Decades of disinformation falsely linking vaccines to autism, combined with the ongoing politicization of vaccine policy and the reframing of vaccination as a matter of personal choice, have undone elimination gains that took years to achieve.

Science Cannot Eradicate Disease Alone

As we reflect on the legacy of William Foege and the thousands who made smallpox eradication possible, we should resist the temptation to treat that achievement as a relic of a simpler time. The lesson is not that eradication is no longer possible because science has failed us. It is that eradication depends on a vision of public health that we have steadily abandoned. Yes, we vaccinate to protect ourselves and our children from disease. But in doing so, we also protect our communities and, in the case of smallpox, eliminated an entire human pathogen from existence.

If we wish to eliminate or even control infectious diseases in the modern era, we must reckon honestly with the shift from community good to personal choice alone. Public health cannot succeed when collective protection is optional, solidarity is negotiable, and community benefit is subordinated to individual preference. Science can take us only so far. What ultimately determines whether we eliminate or eradicate disease is how we treat one another and whether we are willing to accept that the choices we make about vaccination shape not just our own risk, but the health of our communities.

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The last 48 hours have been a veritable roller coaster regarding the study I first wrote about in December 2025. This is a study funded by the CDC through HHS, designed to examine the so-called non-specific effects of childhood vaccines in Guinea-Bissau, using a trial design that plans to randomize 7,000 newborns to not receive the hepatitis B birth dose. For a few hours yesterday, myself and researchers around the world who have been following and speaking out about this planned unethical clinical trial breathed a sigh of relief when The Guardian (US) reported that the trial may not proceed as planned.

That sense of reprieve was short-lived. Very quickly, a revised protocol surfaced online, the study’s backers (HHS) made it clear that they intend to proceed on schedule. These contrasting reports murky the water on what the actual status of the trial is. After reviewing the amended protocol, one conclusion is unavoidable, this revision is little more than lipstick on a pig. The core ethical violations that prompted global concern remain intact, and in some respects the investigators have doubled down.

At the heart of the study, nothing fundamental has changed. The investigators still plan to randomize approximately 7,000 newborns to not receive the hepatitis B birth dose a vaccine that is globally recommended and known to prevent perinatal transmission of a lifelong, potentially fatal infection. That single fact alone should give any clinician, ethicist, or public health professional pause. Hepatitis B acquired at birth is not a benign exposure. In high-prevalence settings like Guinea Bissau, perinatal infection carries a 70–90% risk of chronic infection, with downstream risks of cirrhosis, hepatocellular carcinoma, and premature death. In Guinea-Bissau, where up to 18% of the population is hepatitis B surface antigen positive, these are not speculative harms for babies exposed at birth. Randomizing infants to forego a proven preventive intervention at the moment of highest risk is deliberately exposing children to preventable harm.

The Amended Protocol Changes Process, Not Ethics

The revised protocol makes procedural clarifications, but it does not address the ethical fault line at the center of the trial. The investigators continue to argue that there is “equipoise”( the core ethical idea that a clinical trial can only proceed if there's genuine, balanced uncertainty within the expert medical community about the relative merits of the interventions being compared) because hepatitis B birth-dose vaccination is not yet universally implemented in Guinea-Bissau and because many mothers are not screened for hepatitis B. That argument fails scientifically and ethically.

Absence of implementation is not absence of obligation. The fact that a health system has not yet achieved universal coverage does not create moral permission to randomize children away from a WHO-recommended standard of prevention especially when that standard exists precisely because the consequences of perinatal infection are so severe. The amended protocol itself acknowledges both the high prevalence of hepatitis B among women in Guinea-Bissau and the effectiveness of the birth dose in preventing vertical transmission, while still choosing a design that withholds that protection from half of enrolled infants.

Ethical alternatives are available and were deliberately not chosen

A question that continues to arise is whether there is any way this trial could be conducted ethically. The answer is yes but with important caveats.

A stepped-wedge or phased rollout design is a possible ethical alternative. In theory, such a design can be defensible, but only under very specific conditions. The key distinction is whether delayed access is unavoidable, or whether it is being manufactured by the research design.

A phased rollout can be ethically justifiable if a government and its partners genuinely cannot vaccinate all newborns immediately because of binding constraints e.g. limited vaccine supply, cold-chain capacity, staffing shortages, or transport barriers and the rollout would look essentially the same whether or not a study existed. In that case, the research is observing scarcity, not creating it. But those constraints must be real, documented, and not solvable with resources already in hand. That is not what is happening here.

This trial is well-resourced, externally funded, and operationally capable of delivering vaccines yet it chooses not to deliver the hepatitis B birth dose to all newborns in order to preserve a control group. That is not unavoidable scarcity rather it is engineered scarcity, and that distinction matters ethically. There are additional guardrails that any ethical phased rollout would require and this study meets none of them.

First, the study must not determine who gets vaccinated first. Rollout order should be driven by public health logic facility readiness, geography, disease burden and not by what produces the cleanest statistical comparison. Randomization is only ethically acceptable if it occurs between rollout sequences the Ministry of Health in Guinea Bissau would plausibly adopt anyway, not sequences invented to optimize study power.

Second, the standard-of-care floor must always be respected. Infants in later phases should receive everything they ordinarily would: maternal screening where feasible, counseling, linkage to care, and vaccination as soon as capacity allows. Vaccination should never be delayed simply because “the study isn’t finished.”

Third, the research question itself must justify the risk. Using phased rollout to study implementation challenges or confirm well-established benefits such as reductions in perinatal transmission is one thing. Using scarcity to chase poorly defined “non-specific effects” in newborns is far harder to justify, particularly given how sensitive such outcomes are to confounding, secular trends, and care-seeking behavior. These are precisely the weaknesses stepped-wedge designs are most vulnerable to.

Finally, strong local governance and transparency must anchor the entire process. Any phased rollout must be clearly ministry-led, shaped by local priorities, and communicated honestly to communities. Families must understand that some sites start later because of rollout capacity not because their children were randomized to receive less care.

None of these conditions are met by the current study.

The Foreign Gaze at Work

Many scholars have pointed out that this study and the global reaction to it reflects a familiar and deeply troubling pattern in global health research: what Seyi Abimbola has described as the foreign gaze.

The foreign gaze is not about bad intentions. It is about who gets to define the problem, whose uncertainty counts, and whose lives absorb the risk when evidence is deemed incomplete. It is about research agendas shaped primarily by external institutions and priorities, while affected communities are positioned as sites of data collection rather than as equal moral stakeholders.

That pattern is unmistakable here.

The principal investigators are Danish. The sponsor is a Danish institution. The funding includes support from the U.S. government through HHS and the CDC. Yet the only ethical approval explicitly cited is from Guinea-Bissau’s national ethics committee. There is no indication of parallel ethical scrutiny by institutions in the countries where the study was designed, funded, and justified.

At a press conference this week, Dr. Yap Boum of Africa CDC indicated that Africa CDC is ready and willing to support redesigning the study in a manner that aligns with ethical standards. That involvement from regional public health leadership is welcome and important. It makes clear that concerns about this trial are not coming from outsiders alone but are shared by African public health leaders themselves.

An important voice still missing from this discourse, however, is that of public health authorities in Guinea-Bissau. Their perspectives are the most important ones here, and I hope they will weigh in soon. The country is currently navigating a difficult political moment, having recently faced an attempted coup, and that context matters.

Some may argue that criticism of this study from voices outside Guinea-Bissau particularly those from outside the African continent risks reinforcing the very dynamics of the foreign gaze it seeks to critique. To that I would say this: ethical concerns anywhere in the world must be open to scrutiny, especially when powerful institutions are involved. The responsibility is not to remain silent, but to call out harm while actively amplifying local expertise and leadership.

Abimbola’s work helps clarify the deeper issue. In global health, uncertainty is often treated as a reason to delay interventions in African settings, while the same level of uncertainty would rarely be tolerated to justify withholding protection in Europe or North America. The evidentiary bar quietly shifts depending on who bears the risk. This is how the foreign gaze operates: uncertainty becomes a virtue when it slows delivery of care to marginalized populations; scarcity becomes a justification rather than a failure to be corrected. Procedural ethics are satisfied, while structural inequities persist.

Seen through that lens, the problem with this trial is not only about hepatitis B vaccination. It is about whether African newborns are once again being positioned as acceptable sites of uncertainty for questions that would never be answered this way elsewhere.

On the Investigators’ Defense

After my initial substack in December, the lead author of the trial protocol reached out with a detailed defense of the study’s ethical basis. I responded directly and point by point. I will link that full exchange here so readers can review it in its entirety here. If nothing else, the widespread critique clearly did not fall on deaf ears. But it was deeply disappointing that the response ultimately refused to grapple with the study’s ethical blind spots and instead doubled down on defending what remains indefensible.

A Question of Priorities

If the investigators truly care about the health of children in Guinea-Bissau, there is a far more ethical, impactful, and immediate use for the $1.6 million allocated to this study. That funding would save more lives if it were used now to ensure that as many newborns as possible receive the hepatitis B birth dose rather than to fund a trial that withholds it from thousands of infants while the government plans to roll out the intervention nationally in 2027 anyway.

The question is not whether hepatitis B birth-dose vaccination will be implemented in Guinea-Bissau. That decision has already been made. The question is what we choose to do in the meantime. Do we protect children when we know how or do we study them while leaving them exposed?

History will not judge this trial by its statistical power, its composite endpoints, or its theoretical contributions to the literature on vaccine interactions. It will judge it by a far simpler standard: When we had the resources to prevent harm, did we choose to do so?

For now, the fact that this study is paused, under close scrutiny and, that further revisions may yet come feels like a battle won. But the war is far from over. We will continue to watch closely, to speak plainly, and to insist that the protection of study participants comes first.

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Here We Are Again

Here we are again, at the end of another year.

One that brought more challenges than there is ink to write about, but also moments that forced me to pause, to think about what lies ahead and how I might contribute, in my own small way, to a better 2026.

In this final Substack of 2025, I considered doing a rundown of the highs and lows of the year for infectious diseases, public health, and global health. I decided against it. There are many gifted writers and publications that will do a better job of that than I ever could.

Instead, I settled on sharing how I experienced this year in the many roles I occupy, and the lessons I drew from those experiences. I hope these reflections give you something to think about as you take stock of your own year and, perhaps, spark a bit of hope along the way.

The Physician

If you read this Substack with any regularity, you probably know that I am an infectious disease physician practicing in the United States. This year has been one of the hardest for my field and of my career since the peak of the COVID-19 pandemic.

Watching organized and deliberate efforts to undermine vaccines and public health agencies and grappling with what that means for disease prevention and outbreak control, has made our work of keeping patients safe far more difficult. Planned cuts to HIV funding, and what they could mean for the epidemic in the U.S., have kept me up at night, particularly when I think about my own patients’ ability to access care and treatment. Compounding these challenges, another poor recruitment year for infectious diseases trainees has underscored a long-standing problem of a shrinking workforce and a pipeline that has been narrowing for over a decade.

And yet, through all of this, I have seen an infectious diseases community that remains deeply committed to showing up and doing what is right. Leaning on one another. Supporting each other. Locking elbows and holding the line, much like we did in the eye of the storm during the pandemic. The prevailing sentiment has been: we’ve been here before and this, too, will pass.

What I have had to recognize this year is that the fear and uncertainty I feel are not unique to me as a physician. My patients feel them too. The undocumented immigrant afraid to come to clinic for the care they need because of the threat of ICE raids. The person living with HIV who depends on the AIDS drug assistance program or the Ryan-White program to access lifesaving medications.
The patient on chemotherapy who is now afraid to leave home even to buy groceries because measles, pertussis, and other vaccine-preventable diseases are re-surging.

My role has been to be there for them and to use my training not only to provide care, but also reassurance, clarity, and a sense of safety amid so much chaos.

The Scientist

When I am not caring for patients, my other job is being a scientist conducting clinical and translational research. I once thought that when the clinical world felt overwhelming, I could find refuge in science.

That has not been the case. The research landscape this year has been just as uncertain. It began with devastating cuts to research funding across sectors, with biomedical and clinical research particularly hard hit. In another time, I felt I had my dream job combining clinical care with translational research to find better solutions for my patients. This year, many of us saw that dream profoundly challenged.

While I worry about whether my own young lab can sustain itself in a climate where funding is more limited and increasingly unpredictable, my deeper concern is what this moment is doing to the scientific ecosystem more broadly. Research questions that took years to build toward are being abandoned. Several labs I know have already been forced to downsize or close. University PhD admissions are shrinking. Trainees who once planned academic careers are quietly choosing other paths not because the science matters less to them, but because the ground beneath them no longer feels stable enough to stand on. These losses represent ideas that will never be tested, discoveries that will arrive later or not at all. They represent a generation of scientists being asked to build a future on uncertainty.

I stay on (for now), because I still believe deeply in the importance of the work we do to advance human health and serve the greater good. In response, I have leaned more heavily into my role of mentor. The mentorship meetings may have run longer. The conversations about balance, uncertainty, and life outside the lab may have gone deeper. Perhaps I needed that connection as much as my mentees did, to remind myself that the work still matters, that it is still worth doing, and that we will find ways to adapt. Maybe that means thinking more creatively about funding, or leaning more fully into collaborative science. Whatever it takes to keep our spark and our sense of purpose alive.

The Advocate

I have never met an infectious diseases physician who wasn’t also an advocate. The nature of the work demands it because pathogens do not exist in a vacuum, and neither do the people they affect. This year required that hat more often than most.

From sustained attacks on science and vaccines to policy decisions that quietly but profoundly shape who gets sick, who gets care, and who is left behind, it became impossible to sit on the sidelines and remain silent. Advocacy, for me, took many forms. Some of it was public and visible; running an Ask an ID Doc Q&A series online once a month, or writing this Substack to help make sense of complex infectious disease and global health issues and what they mean locally and globally. Some of it was quieter, ongoing conversations with friends, colleagues, and acquaintances trying to understand what they were worried about and why.

One of the most important parts of this work has been listening. Listening to people I disagree with. Listening to vaccine-hesitant parents and patients. Listening to those who question the value of funding global health efforts and science more broadly. Not to validate misinformation or harm, but to understand the fears, experiences, and gaps in trust that shape those views and to have honest, constructive conversations grounded in evidence and respect.

Some advocacy moments came from places I did not anticipate: speaking at my local church on Good Friday about cuts to healthcare research funding, or talking with a rabbi who reached out seeking thoughtful ways to address vaccine hesitancy within his community. They were ordinary moments of human connection but they add up, and they matter.

The Human

As I go into 2026, I am not carrying resolutions so much as renewed commitments. I will keep wearing these hats to the best of my ability. I will keep my oath to patients to do no harm, to tell the truth, and to care for their health with clarity and compassion, even as the systems around us falter.

I will remain curious in my scientific work, even when the path forward feels uncertain. I will continue to support my trainees and mentees as they navigate a landscape far more precarious than the one I entered, and I will do what I can to help them see that their work still matters.

I will continue to defend science and advocate for what is right, even when doing so is uncomfortable or inconvenient. And I will keep looking for ways, small and tangible, to support and contribute positively to the communities I belong to.

Thank you for reading this Substack over the past year and for trusting me with your time and attention. Whatever hats you wear in your own life, I hope this offered a moment of recognition or simply the reminder that continuing to show up still matters.

Especially on the hardest days.

Happy New Year.
Here is hoping 2026 is a better year for us all.

I write about infectious diseases, public health, and global health often through reflection and lived experience. If these reflections resonate, I hope you’ll consider subscribing.

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The recent announcement of a $1.6 million research grant funded by the U.S. Centers for Disease Control and Prevention (CDC) alongside the Pershing Square Foundation and the Bluebell Foundation to a Danish research group affiliated with the Bandim Health Project should set off alarm bells for anyone familiar with both the science and the ethics of vaccine research.

According to the study’s own description, the investigators plan to initiate a randomized controlled trial of the hepatitis B vaccine at birth in Guinea-Bissau beginning in early 2026. The rationale hinges on what they describe as a “unique window of opportunity.” Guinea-Bissau’s Ministry of Health has decided to implement a universal hepatitis B birth-dose policy starting in 2027. Until then, newborns will be randomized to receive the hepatitis B vaccine at birth, the future policy or to receive no hepatitis B vaccine at birth, reflecting the current policy. All infants, regardless of allocation, will receive BCG and oral polio vaccine. Children will then be followed for “overall health outcomes.”

Guinea-Bissau is a small West African country with exceptionally high maternal and infant mortality and an extraordinarily high burden of hepatitis B infection nearly one in five people are infected. In that context, the core ethical problem is already clear: there is no clinical equipoise for the research question being proposed.

What the Trial Is Actually Testing

The evidence supporting the hepatitis B birth dose is robust and unequivocal. Administered within 24 hours of birth, it prevents perinatal transmission, reduces progression to chronic infection, and lowers the lifetime risk of cirrhosis and hepatocellular carcinoma. It is a cornerstone of the World Health Organization’s global hepatitis B elimination strategy. This is not a hypothesis in need of testing.

Yet this trial is explicitly not designed to evaluate whether the birth dose prevents hepatitis B that question has been answered repeatedly through randomized trials, decades of post-licensure surveillance, and real-world implementation across multiple regions. Instead, the investigators seem to argue that the hepatitis B vaccine at birth has “never been tested on a large scale for its overall health effects,” and that it is therefore unknown whether the vaccine has so-called non-specific effects on all-cause morbidity or mortality.

On that basis, newborns in a high-burden setting will be deliberately randomized to forgo a proven, life-saving intervention not because of supply shortages or parental refusal, but by design to explore speculative population-level effects that are tangential to the vaccine’s known and established purpose.

The Ethical Sleight of Hand: “Current Policy” vs. Known Benefit

In high-burden settings like Guinea-Bissau, the hepatitis B birth dose is among the most powerful and cost-effective public health interventions available. The reason it is not universally administered today is not scientific uncertainty, but structural, logistical, and financial barriers which make it challenging for resource-constrained settings to fund this intervention. Those barriers should be the focus of investment. The trial’s ethical justification rests heavily on the claim that infants randomized to no birth dose are merely receiving the “current policy.” That framing is doing substantial ethical work because the absence of a birth-dose policy reflects implementation failure and not uncertainty about benefit. The investigators themselves acknowledge this by noting that Guinea-Bissau has already committed to adopting universal birth-dose vaccination in 2027. That decision alone eliminates any claim of equipoise.

When Research Becomes Premeditated Harm

Ethical research depends on genuine uncertainty about whether an intervention is beneficial. That condition is plainly absent here. Randomizing newborns to no hepatitis B vaccine at birth in order to evaluate “overall health effects” of an intervention whose primary benefit is already known is indefensible. When benefit is established, withholding an intervention is no longer neutral experimentation it becomes premeditated harm. This is not a theoretical concern for this trial, the control arm will include infants who remain susceptible to perinatal hepatitis B infection during the highest-risk period of their lives, in a country with limited access to downstream diagnostic and treatment infrastructure. There is no indication that the investigators will assume responsibility for providing lifelong care to children who develop chronic hepatitis B or its downstream complications as a result of being randomized to the control arm. The ethical breach is compounded by where and in whom this study is being conducted.

A randomized trial withholding a proven, life-saving intervention from newborns would not be approved by an institutional review board in the United States or Europe. Ethical standards do not become optional because the participants are African. African children deserve the same protections as children anywhere else. The investigators emphasize that the trial was approved by the Guinean National Ethics Committee in November 2025 and describe it as “the first and likely the only one of its kind.” That doesn't reassure me. Being the only trial of its kind is not a virtue when the reason such trials do not exist elsewhere is because they are considered unethical.

Why This Will Fuel Mistrust Far Beyond the Trial

But the danger of this study does not end with the children enrolled. As someone who studies vaccine hesitancy and health misinformation in Africa, I know that mistrust is shaped by history, memory, and lived experience. Narratives about “Africans being used for medical experimentation” or “vaccines being designed to harm African children” are not fringe beliefs. They are persistent, powerful drivers of vaccine refusal impacting the uptake of life-saving vaccines across the continent. These narratives are reinforced every time researchers behave as though ethical shortcuts are acceptable in low-income settings.

We have seen this before. In 1996, Nigeria faced one of the worst meningitis epidemics in its history. While Doctors Without Borders treated children with a WHO-endorsed antibiotic, Pfizer used the crisis as an opportunity to test an experimental drug, Trovan, in children despite limited pediatric safety data and unresolved concerns from adult trials. Parents later reported they had not been informed that their children were receiving an experimental drug. Children died. Others were left with permanent disabilities. Subsequent investigations found that the trial violated fundamental ethical standards, including informed consent. Pfizer eventually settled lawsuits years later, but the damage was already done. The episode became embedded in collective memory as proof that Western medical institutions were willing to experiment on African children during moments of crisis.

That memory had long-lasting consequences. In 2003, polio vaccination campaigns were boycotted across several northern Nigerian states. Religious leaders explicitly cited the Pfizer trial as justification for distrust. Polio cases surged, Nigeria became a reservoir for poliovirus, and global eradication efforts were set back by more than a decade. Rigorous analyses later showed declines not only in polio vaccination but also in routine childhood immunizations particularly among educated mothers who were most aware of the trial.

The Cost of Repeating Old Mistakes

The proposed hepatitis B birth-dose trial risks repeating this exact pattern. It will not advance science, the scientific question has already been answered. What it will do is provide fresh evidence for long-standing fears of exploitation, hand misinformation a credible narrative, and undermine confidence in vaccines that are already saving millions of lives. Unethical research does not remain confined to academic journals. It reverberates through communities, erodes trust, and produces public health harms that routinely exceed any supposed scientific gain.

If global health institutions and researchers are serious about improving child health in Africa, they must stop repeating the same mistakes under the banner of research. The researchers planning this trial still have an opportunity to do the right thing. Reconsidering a study design that withholds a proven, life-saving intervention from newborns is an ethical obligation. Science advances when we ask hard questions responsibly. It falters when we pursue them especially at the expense of the very children we claim to protect.

African children deserve better.

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The potato salad left out since noon? Staphylococcus aureus waiting to strike. The rice that cooled on the counter overnight? A playground for Bacillus cereus. The creamy dip by the chips station? Possibly harboring Norovirus, the king of winter outbreaks and the reason “stomach flu” can take down entire departments in 48 hours. If you don’t believe me, read this story from last year where a noodle dish brought to an office potluck in Maryland resulted in 46 people who ate the dish being taken to hospital for food poisoning.

No one brings food to a potluck intending to spark an outbreak that lives in workplace legend, but the combination of homemade dishes, questionable refrigeration, and the occasional cat sous-chef makes for a microbial minefield. So, in the interest of keeping both your holiday spirit and your intestinal tract intact, here’s my guide to navigating the season’s potlucks and office parties food-poisoning free.

The Danger Zone

Most foodborne bacteria thrive between 41°F and 140°F (5–60°C), the aptly named “danger zone.” Food that sits too long at these temperatures becomes a rich culture medium. The two-hour rule is non-negotiable: after that, bacterial counts can double every twenty minutes. Common offenders include Clostridium perfringens (the “cafeteria germ”), Salmonella, and E. coli O157:H7. All can cause severe gastrointestinal illness, and all love a warm buffet. Keep hot foods hot, above 140°F (60°C), using slow cookers or chafing dishes, and cold foods cold, below 40°F (5C), preferably nestled in ice. When in doubt, throw it out, I know grocery prices are high but there is no glory in being stoic about spoiled shrimp cocktail or sushi.

Preparation: Where the Outbreaks Begin

Failure to cool food properly is one of the leading causes of foodborne illness. Large pots of stew or chili need to be cooled in shallow containers no more than two inches deep to allow heat to escape quickly. Never partially cook food to “finish later”; bacteria such as Clostridium perfringens flourish in half-cooked environments. Plan ahead. Prepare dishes close to serving time whenever possible. And remember that some foods like cooked rice and potatoes can be deceptively risky because they provide ideal moisture and nutrients for bacterial growth once cooked.

Hygiene and Cross-Contamination

Good hygiene remains the simplest and most effective infection-control measure we have, whether you’re in an ICU, an operating theater or your kitchen. Wash hands with soap and water before, during, and after food preparation. Use separate cutting boards for raw meats and ready-to-eat foods. Wash knives and utensils thoroughly after contact with raw poultry or seafood. Cross-contamination is how your “fresh” salad ends up contaminated with Campylobacter from the cutting board that previously hosted the chicken. One careless step can undo even the most perfect cooking.

Cooking: Data-Driven Doneness

Undercooked meat can be hazardous:

1. Cook beef, lamb, and pork to at least 145°F(63°C) (medium rare, after a three-minute rest).

2. Ground meats and egg dishes should reach 160°F (71°C).

3. Poultry and stuffing require 165°F (74°C).

Viruses and parasites like Giardia, Toxoplasma gondii and Trichinella are killed at these temperatures. A cooking thermometer costs less than a co-pay in an emergency room or a visit to my office; use one.

The Human Factor

Roughly one in five food-borne illness outbreaks in the U.S. each year is linked to an infected food handler (who may be symptomatic or asymptomatic). A single asymptomatic norovirus carrier can contaminate hundreds of servings. If that sounds dramatic, meet the original celebrity culinary super-spreader: Typhoid Mary. Mary Mallon was an early-1900s cook who managed to infect at least 51 people (possibly more than 100) with typhoid fever all while looking perfectly healthy. After public health officials tracked her down, she was quarantined… twice! The first time didn’t stick; she simply changed her name and went back to cooking. The second time lasted the rest of her life. If you are sick or recovering from a “24-hour bug” please sit this one out. Bringing sealed store-bought cookies is a completely acceptable act of public health heroism strongly endorsed by your friendly neighborhood ID doc.

Transport and Service

If you’re bringing food to share, think like an epidemiologist. Hot foods belong in insulated containers packed right before you leave; cold foods ride in a cooler with ice packs. Transport food separately from pets or groceries. Once at the event, use clean serving utensils. Don’t top up half-empty platters replace them with freshly filled ones. Keep serving portions small so food isn’t left at room temperature for long. After two hours, unserved dishes should be refrigerated or discarded. The bacteria don’t care how expensive the ingredients were.

How to Handle Leftovers

Immediately refrigerate or freeze food that wasn’t served. Divide it into shallow containers to speed cooling. For thick foods like stew, aim for no more than two inches of depth; for soups, three inches. Keep your refrigerator below 40°F (4 degrees centigrade). Any food that sat out on the buffet? Thank it for its service and let it go. No amount of microwave reheating can undo four hours in the danger zone.

Final Thoughts

Foodborne illnesses send an estimated 128,000 Americans to the hospital and kill about 3,000 each year numbers that rise every holiday season. Most are preventable with simple precautions: clean hands, separate cutting boards, adequate cooking, and prompt refrigeration.

So, this year, may your potluck plate bring you joy, not Giardia. Celebrate, connect, and remember that a little microbiologic awareness is the secret ingredient to a truly safe holiday feast. Keep hot food hot and cold food cold. And if it’s been sitting out long enough to require a risk-benefit analysis just skip it. Nothing grows in alcohol so if you would rather not risk it, indulge safely in the festive booze.

Happy Holidays, whichever ones you celebrate!

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This October, Moderna announced that its mRNA vaccine candidate against congenital cytomegalovirus (CMV) didn’t meet its protective efficacy endpoint. This news is disappointing, but not surprising. CMV is a formidable adversary and one of the most complex viruses we’ve ever tried to outsmart. Despite the challenges of developing a vaccine, the need remains critical.

The Hidden Epidemic

Although CMV is ubiquitous, it rarely makes headlines but it should. It is the leading infectious cause of birth defects worldwide. In the United States, about 1 in 200 babies are born with CMV, and globally the annual prevalence ranges from 1 in 70 to 1 in 208 births. Of these, up to one in four will suffer lasting consequences of infection in utero, including hearing loss, developmental delays, seizures, or vision problems. In the U.S. alone, CMV causes around 20,000 congenital infections and thousands of permanent disabilities every year. In 2018, the associated annual healthcare cost of these infections was 6–7 billion dollars in the U.S.

Unlike Zika virus, which grabbed global attention, CMV spreads quietly through saliva, urine, and other body fluids. Most adults acquire it in their lifetime, often from toddlers who shed the virus for months after infection. For pregnant people, exposure can mean transmitting the virus to the fetus (congenital CMV), even if they’ve been infected before.

“But Don’t Most People Already Have CMV?”

Yes, and that’s a big part of the problem. Natural infection doesn’t confer sterilizing immunity. People can be re-infected with different CMV strains or experience reactivation from latency, leading to fetal transmission even in seropositive mothers. So, the idea that “natural immunity is best” simply doesn’t hold water in this instance. We still need a vaccine that performs better than nature’s version and provides durable protection from infection with new virus strains and prevents reactivation of latent virus.

Why Developing a CMV Vaccine Is So Challenging

CMV belongs to the herpesvirus family, the same group as HSV, VZV, and EBV and is an absolute master of immune evasion. Once inside the body, it establishes lifelong infection (latency), reawakening when immunity dips. The virus expresses proteins that block antigen presentation, hijack key innate immune receptors (including natural killer cell receptors), and mimic cytokines to dampen immune responses. It even encodes its own fake IL-10 and important cytokine that counters inflammation.

Designing a vaccine that overcomes these tricks is like trying to train the immune system against a shapeshifter. Protection likely requires not one, but several arms of the immune response working together:

1. First, it has to generate antibodies that block infection - proteins that recognize and neutralize the virus before it can enter our cells. These antibodies target viral “entry tools” like the gB and pentamer proteins, which CMV uses as keys to slip into human cells.

2. Second, we need antibodies that do more than just block infection: Some antibodies act like flags, tagging infected cells so the immune system’s cleanup crews can find and destroy them.

3. Finally, we need T cells: the immune system’s long-term sentinels that can recognize and kill cells already infected with CMV and help keep the virus in check when it tries to reactivate later.

The challenge is that we still don’t know which combination or level of these responses actually prevents congenital infection. Even the correlates of protection remain elusive.

Lessons from Past Attempts

The first CMV vaccines date back to the 1970s, when live-attenuated strains showed partial success in transplant recipients. Later, a subunit vaccine based on the viral envelope protein gB achieved about 50% efficacy in seronegative women. That’s good by vaccine standards for a herpesvirus but not enough for licensure.

More recently, Moderna’s mRNA-1647 vaccine encoded both gB and the pentamer complex to target multiple routes of infection. Despite strong antibody and T-cell responses in early phase studies, its efficacy fell short in its phase 3 study. These results are disappointing but every trial refines our understanding of what protection looks like and helps define the next generation of design.

A Matter of Endpoints and Expectations

Another issue: what counts as “success”? Many CMV trials measure whether vaccinated people become infected at all which is often based on detecting the viral DNA in saliva or urine. But not every transient detection equates to disease or fetal transmission. The real clinical goal is preventing congenital infection and its consequences, not necessarily eliminating every trace of the virus. A vaccine that is able to cut transmission to fetuses by even 40–50% would prevent thousands of children from being born with lifelong disabilities. That’s worth pursuing, even if it doesn’t achieve sterilizing immunity.

Where the Field Is Heading

New vaccine designs are focusing on teaching the immune system to recognize the virus more precisely. Some vaccines use improved versions of CMV key surface proteins reshaped to look exactly like the ones the virus uses to enter our cells. Others combine multiple viral targets in a single shot, aiming to trigger broader protection.

Researchers are also finding ways to make antibodies work harder not just blocking infection, but helping the immune system clean up infected cells more efficiently. And some teams are going after the stealth tactics used by the virus to evade the immune system directly, by designing vaccines that target the very proteins CMV uses to hide from our defenses or to stay dormant in the body.

Importantly, the effort isn’t limited to protecting pregnancies. CMV is also a serious threat for transplant patients, where reactivation of the virus can be deadly or cause organ rejection. A vaccine that reduces how much virus reappears during reactivation or how sick it makes people could save lives, even if it doesn’t prevent infection completely.

Why This Still Matters

CMV may not make the nightly news, but its burden falls heavily and unfairly on families who least hear about it. Globally, congenital CMV is more common in low- and middle-income countries, and in communities where early infection is nearly universal and screening during pregnancy is inaccessible. Like is the case with other infectious diseases those at highest risk often have the least access to screening, early intervention, or care. Even a partially effective CMV vaccine would be a public-health milestone. It would protect babies, reduce disability, and ease suffering for families worldwide. Every incremental improvement brings us closer to that goal.

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This Thursday, the Advisory Committee on Immunization Practices (ACIP) will meet to review vaccine policy. On the agenda is a question that, by all logic, should be settled science: the need for a perinatal dose of the hepatitis B vaccine within 24 hours of birth.

One would think that a vaccine that has, since its introduction in 1982, demonstrably saved lives, prevented cancer, and nearly eliminated a major pediatric infection in the United States would be beyond controversy. Yet in today’s climate of relentless anti-vaccine rhetoric, the hepatitis B vaccine has become the latest target. The stakes are high: restricting access to the newborn dose would place children’s lives in grave danger.

A Brief History of Hepatitis B and Its Vaccine

Hepatitis B virus (HBV) is one of the most consequential viruses of the modern era. It was discovered in 1966 when Dr. Baruch Blumberg, working at the NIH, identified what he first called the “Australia antigen” in blood samples. This breakthrough not only revealed the virus but also enabled the development of diagnostic tests. For this discovery, Blumberg received the 1976 Nobel Prize in Medicine.

By 1980, HBV had become one of the first human viruses to be fully sequenced, laying the foundation for vaccine development. The first hepatitis B vaccine, licensed in 1981, was derived from purified plasma of individuals with chronic HBV infection. It was remarkably effective, but in the context of the emerging HIV epidemic, reliance on plasma-derived products raised concerns. That spurred a scientific revolution: in 1986, the plasma vaccine was replaced by a recombinant DNA vaccine manufactured in yeast cells. This was the world’s first recombinant vaccine a breakthrough that has since shaped modern vaccinology.

In 1991, the U.S. adopted universal childhood hepatitis B vaccination, with a special emphasis on the birth dose. At the time, an estimated 200,000 new HBV infections occurred in the U.S. each year, including about 20,000 infants infected perinatally. Within a generation, those numbers plummeted. Today, fewer than 20 U.S. infants are infected annually, and pediatric HBV has been nearly eliminated.

The impact extended far beyond infection rates. Infants infected at birth face up to a 90% chance of developing chronic HBV infection, which can progress to cirrhosis, liver failure, or liver cancer decades later. The hepatitis B vaccine became the first vaccine proven to prevent cancer, making it one of the greatest achievements in preventive medicine.

For decades, U.S. vaccine policy has set the tone for other nations, serving as a scientifically sound standard. The World Health Organization (WHO) also recommends the perinatal hepatitis B vaccine as a critical tool to prevent mother-to-child transmission. In recent years, WHO has worked with low- and middle-income countries to expand access to the birth dose, often with fragile but steady progress. A retreat from this policy in the United States would reverberate globally, emboldening detractors, undermining the elimination agenda, and threatening to stall lifesaving progress in countries still struggling to introduce and sustain the vaccine.

What the Detractors Say and Why They’re Wrong

Anti-vaccine activists recycle a handful of misleading arguments. Here’s how the science stacks up:

1. “Newborns aren’t at risk unless their mother is infected.”

The myth: If the mother tests negative, the vaccine isn’t needed.

The reality: Testing can be delayed or inaccurate. Many mothers don’t know their status, and HBV can spread in households through small cuts or shared objects. The birth dose ensures no baby slips through the cracks.

2. “Hepatitis B is only a sexually transmitted disease.”

The myth: Babies don’t need protection from a virus spread through sex or drug use.

The reality: HBV spreads through blood and body fluids, including exposure during birth. Infants are especially vulnerable and the consequences of infection at birth are lifelong.

3. “The vaccine is unsafe in newborns.”

The myth: Giving vaccines at birth is harmful.

The reality: Decades of data show the vaccine is safe. Side effects are mild, serious reactions are extremely rare. The risk of HBV disease is infinitely greater.

4. “The immune system is too immature.”

The myth: Vaccinating too early stresses the immune system.

The reality: Newborns’ immune systems handle thousands of antigens daily. A single HBV antigen is trivial in comparison.

5. “Parents can decide later.”

The myth: Waiting until adolescence is fine.

The reality: The greatest vulnerability is at birth. Delay means lost protection when it matters most. Studies show children who miss the birth dose are also more likely to miss other vaccines.

6. “Natural immunity is better.”

The myth: Fighting HBV naturally builds stronger protection.

The reality: “Natural immunity” to HBV often means chronic infection and a 25% chance of early death from liver disease. The vaccine protects without the devastation.

7. “HBV isn’t common anymore, so why vaccinate?”

The myth: The disease is gone; the vaccine isn’t needed.

The reality: HBV isn’t common because of vaccination. Before 1991, thousands of children were infected every year. Stopping universal vaccination would invite resurgence.

Why the Birth Dose Must Be Defended

The hepatitis B birth dose is one of the quiet triumphs of modern medicine. It has slashed perinatal transmission, prevented thousands of cases of liver cancer, and saved untold lives. To undermine it now based on fear, misinformation, or bad-faith arguments would deliberately endanger newborns. Delaying vaccination until age 4, as rumored under RFK Jr.’s “Make America Healthy Again” agenda, would mean families who want to protect their babies could face out-of-pocket costs if insurers stop covering the birth dose. That is not “gold standard science.” It is political interference that puts ideology over evidence.

The hepatitis B vaccine proves what science can achieve: a safe, effective tool to eliminate a deadly virus and prevent cancer. Rolling back the birth dose could reverse decades of progress and while betraying the next generation. This is a moment to defend science, not dismantle it. To protect children, not place them in harm’s way. The hepatitis B birth dose saves lives, for this reason it must remain non-negotiable.

📢 Protecting health starts with facts.
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The events of the last 48 hours have left the U.S. public health community shaken to its core. The shockwaves from the resignations at the top of the CDC, once regarded as the world’s leading public health agency, will reverberate far beyond America’s borders. Even more sobering are the words in resignation letters and media interviews: an institution that once stood firmly on science and evidence, now hollowed out and steadily replaced by misinformed ideological stances on vaccines and other essential interventions.

Like so many in public and global health, I have my own CDC story. Mine is not decades of service on the frontlines of outbreaks or a long career as an epidemiologist. My connection began in 2006, the very first time I visited the United States. As a final-year medical student in Cameroon, I was awarded a three-month fellowship at CDC’s Global AIDS Program (GAP). The project was a collaboration between my medical school and scientists at the CDC. I had collected specimens from pregnant women with HIV who were receiving antiretroviral therapy to prevent mother-to-child transmission. Those samples were shipped to Atlanta, where I joined CDC’s antiretroviral drug resistance team to study how HIV prevention programs might contribute to HIV drug resistance, and to generate evidence to guide local HIV prevention and treatment.

I remember that first day at the CDC vividly. Bright-eyed and filled with awe at finally standing inside the institution I had only read about from afar, I was welcomed by Dr. John Nkengasong, then director of GAP, and introduced to my supervising team. For 12 weeks, I trained with dedicated scientists who taught me how to run genotyping assays on the samples I had brought from Cameroon. That work became my first-ever peer-reviewed scientific publication, and more importantly, provided insights that helped inform HIV policy in my home country at a critical time.

Such was the power of the CDC. My story is just one drop in the vast ocean of the agency’s impact in training scientists and shaping global health policy. That is why this week’s unraveling feels so personal. The CDC shaped not only careers like mine but also the health of millions worldwide. From Ebola to Marburg, Mpox to Nipah, the CDC has always been there tracking disease, developing diagnostics, and supporting frontline response teams during some of the deadliest outbreaks. During the 2014–2016 Ebola epidemic alone, nearly 1,900 CDC staff members were deployed to West Africa (primarily Guinea, Liberia, and Sierra Leone), in what became the largest emergency response in the agency’s history. Beyond such crises, the CDC has been equally critical in the long fight against older foes: poliomyelitis, malaria, tuberculosis, and HIV.

My career has since come full circle. Today I work in an institution across the street from the CDC. As an infectious diseases physician in the U.S., my reliance on the CDC and my respect for the colleagues who keep its mission alive has only deepened. Every clinician knows the CDC as the hotline you call when faced with a pathogen you’ve never seen before. Someone is always on the other end ready to guide isolation precautions, advise on treatment, or arrange shipment of samples for testing that only the CDC can perform.

I’ve experienced this firsthand many times. On one such occasion a patient under my care developed a brain abscess caused by a very rare mold. With CDC’s help, we identified the organism, chose the right therapy, and saved a life. That kind of quiet, behind-the-scenes expertise happens every day across health systems in America. Most people never notice, because the system works. Outbreaks are tracked, food borne infections contained, environmental hazards investigated, long before headlines appear.

Of course, the CDC has not been flawless. The Tuskegee syphilis study remains an indelible stain, and some aspects of the COVID-19 response have drawn justified criticism. Yet through its 80-year history, across multiple administrations, the consensus remained: the CDC was a force for the common good trusted to uphold science above politics or personal beliefs

Which brings us back to today. What becomes of the CDC now? One thing is certain, the agency as we once knew it is gone. RFK Jr. has signaled every intention of replacing its leadership with non-scientists or pseudo-scientists aligned with his anti-vaccine beliefs, with the aim of making it harder to access vaccines or to find information grounded in science on a wide range of health issues. Whether it is pushing unfounded claims about vaccines and autism, undermining the use of SSRIs for depression, or promoting a myriad of other falsehoods, the result is the same, the public can no longer confidently rely on the CDC as the trusted source for safeguarding their health. The consequences of this erosion are not abstract. Barely two weeks ago, the agency came under attack when a domestic terrorist fired 500 rounds into CDC buildings, blaming the institution for mental health challenges he falsely attributed to the COVID vaccine. A police officer was killed defending the public that day, and CDC employees now carry the trauma of an assault that will haunt them for years.

It is hard not to feel defeated in the face of such a coordinated attack. But the stakes are too high for public health professionals, scientists, and clinicians to simply throw up our hands. Public health is the branch of medicine that keeps patients out of hospitals; it is preventive medicine at its best. And in this moment, it needs its strongest defenders.

I remind myself that stars shine brightest in the darkest nights. Public health in America is in one of its darkest hours. Which means all of us in the medical community must become its brightest defenders. How? By stepping up in our communities. By recommending vaccines. By sharing accurate information about foodborne outbreaks or environmental hazards. By pointing people to credible sources of health information when the CDC falters. By advocating for a return to science in public health. And, most importantly, by standing in solidarity with our colleagues still at their duty posts within the CDC holding the fort, being the voice of reason, and doing their best to keep the ship from sinking. Call your representatives. Write to them. Remind them that these decisions carry life-or-death consequences for the people they serve.

We must treat this moment like the existential threat that it is. The CDC was more than just another federal agency it was a global beacon of science in service to humanity. Its legacy of impact deserves not only to be remembered, but to be defended, so that it can live on.

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The Dismantling of Public Health from the Top Down

It is a challenging time to be a practicing clinician in the United States, especially if you believe in public health policy that is grounded in science and centered on the well-being of the population.

This week brought yet another seismic shift: the dismissal of all 17 expert members of the Advisory Committee on Immunization Practices (ACIP), the independent body that has long guided national vaccine recommendations. Today new appointees to the ACIP advisory were announced. Alarmingly many of the individuals on the incoming list lack the expertise to advise on vaccines and are also notorious anti-vaccine campaigners and individuals who promoted unproven therapies during the COVID-19 pandemic. This is only the latest in a disturbing series of decisions announced by the new leadership at the Department of Health and Human Services.

Among them:

• A large, federally funded study to investigate discredited links between vaccines and autism

• New federal guidance that drops recommendations for COVID-19 vaccination in pregnant people and children despite their high risk for severe outcomes

• The promotion of unproven treatments like steroids and antibiotics during measles outbreaks, while downplaying vaccines

The consequences are already tragic: the United States is now experiencing its worst measles outbreak in 30 years, with three confirmed deaths, including two children. Just this year, two unvaccinated children in Kentucky died from pertussis another vaccine-preventable disease. These assaults on evidence-based medicine, particularly vaccines, the most impactful biomedical innovation of the past century, are not isolated incidents. They are being legitimized and enacted at the highest levels of government. And the consequences won’t stop at our borders. The United States has long served as a leader in global medical standards. When our public institutions undermine science, that skepticism doesn’t stay contained. It spreads eroding trust in vaccines worldwide, emboldening disinformation networks, and jeopardizing the hard-fought progress we've made toward global immunization equity.

What This Moment Demands from Us

So where does that leave those of us who still believe in science, truth, and the moral imperative to protect the most vulnerable? As medical practitioners, we take an oath to do no harm and to act in the best interests of our patients, guided by integrity, evidence, and ethics. In this moment, that means showing up even harder. In every patient encounter whether in the hospital, the exam room, or the urgent care center, we must meet fear with facts and confusion with clarity. These are still sacred spaces, where trust can be built, where lives can be protected, and where we can help our patients navigate a disorienting information landscape with empathy and truth.

In my own clinical practice, I’ve shifted how I work because the stakes are simply too high. In the clinic, I don’t wait for the topic of vaccines to come up I raise it, every time. I ask questions. I listen. I provide answers grounded in data and delivered with compassion. In the hospital, when I see a consult, I now routinely check immunization status and offer vaccines before discharge if a patient is eligible. Every point of contact is an opportunity to protect someone from preventable illness.

Here’s what that looks like in action:

– I offer vaccines at every visit, not just during flu season or back-to-school checkups.
– I open conversations proactively, because I know the silence is being filled by misinformation.
– I share trusted, accessible resources that help patients make informed choices.
– I leverage social media to amplify accurate vaccine information and remind people of what’s at stake.
– I speak to my community, especially the most vulnerable, those most likely to bear the brunt of this anti-science tide.

Despite the noise, the fear, and the politics, here’s what I know: most people still want vaccines. They understand the value. They just need reassurance, clarity, and guidance. We owe it to them to engage, especially now.

A Call to Clinicians

We all know that the ongoing erosion of public health infrastructure won’t stop at immunization guidelines. It threatens to destabilize our entire healthcare system one falsehood, one policy, one press conference at a time. But clinicians still hold tremendous power: the power of trust, of relationship, of truth-telling in the room where fear speaks the loudest.

If you’re a clinician feeling discouraged, I see you and I urge you: please don’t disengage. Double down. Speak up. Be that trusted voice in your patient’s life and in your community. Reclaim your role as a science communicator, a public health advocate, and a source of truth. Rising to meet this moment may be the greatest test of the oath we all took: to do no harm and to protect those we serve. We may not be able to stop every dangerous policy, but we can build resilience at the ground level with our words, our presence, and our refusal to be silent.

A Reminder for the General Public

It pains me to say this but right now, many of the official messages on vaccines coming from the U.S. Department of Health and Human Services (HHS) can no longer be trusted. That’s not a statement I make lightly.

In this moment, it’s more important than ever to lean on healthcare providers you trust. Ask questions. Start conversations. And importantly, familiarize yourself with credible, science-based sources for vaccine guidance because your health decisions should be grounded in truth, not politics.

Here are trusted international sources you can rely on for up-to-date vaccine information:

• 🌍 World Health Organization (WHO)
  Routine Immunization Summary Tables

• 🇨🇦 Canada’s Immunization Guide
  Canadian Immunization Guide

• 🇪🇺 European Centre for Disease Prevention and Control (ECDC)
  EU Vaccination Schedules

• 🇬🇧 United Kingdom NHS Immunization Schedule
  UK Routine Immunisation Schedule

Until sanity returns to U.S. public health leadership, these are some of the most reliable, transparent, and globally respected sources of vaccine guidance available. You deserve the truth. You deserve protection. And you deserve to be empowered with real information.

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Although I’m not Catholic, I must admit I got caught up in the excitement over the announcement of a new leader for the world’s two billion Catholics. The sheer exuberance of the faithful around the globe and here in the U.S., where the new pontiff hails from was infectious. As I chuckled my way while scrolling through the memes and hot takes online, reading speculation about where Pope Leo XIV might land on various hot-button issues, one question bubbled up for me.

What’s his take on condoms, contraception, and STIs?

Let’s call it a professional quirk. As an infectious diseases doctor, my mind lives permanently in the proverbial gutter.

You see, the Vatican has always had thoughts about sex. So many thoughts. The kind wrapped in dense moral theology and sealed with a wax stamp of “no, thank you.”
And I’ve lived through three popes now (I’m not that old, I promise). So come with me on a little rewind let’s take a stroll through papal history and see where the last three stood on sexual health.

Pope John Paul II: The Condom Cold Shoulder

Charismatic. Revered. Globally influential. And unwaveringly opposed to condoms.
Pope John Paul II rejected artificial contraception in all its forms. During his long papacy (1978-2005), as HIV tore through communities in Africa and beyond, the Church’s official stance clung tightly to abstinence (which, let’s be honest, has never stopped anyone from having sex) and marital fidelity (noble in theory, but hardly the only relationship model out there). Harm reduction tools like condoms were brushed aside as morally dubious. And that had real-world consequences. In many regions, Catholic hospitals were the only healthcare providers available. You could get antiretrovirals and a prayer but asking for condoms was like pitching Sex Ed at a chastity convention.

Pope Benedict XVI: Condoms? Maybe. Sometimes. Sort of.

Benedict XVI (2005-2013), the traditionalist theologian, wasn’t exactly known for his modern takes. In fact, he seemed determined to drag the Church back to the 17th century with Latin masses and strict adherence to old-school doctrine. But then, in 2010, he surprised everyone by suggesting that condom use might be justified in certain situations like a male sex worker trying to prevent HIV transmission.
Oooh la la Pope Uptight giving a side-eye green light to condoms? It wasn’t a doctrinal overhaul, but it cracked open the door. Cue weeks of Vatican gymnastics as spokespeople tried to explain how this wasn’t really an endorsement of condoms. It was progress but of the tiptoe-don’t-scare-the-bishops variety but still, a win for Team Prevention.

Pope Francis: Pastoral Over Papal Pronouncements

Pope Francis (2013-2025) , widely seen as one of the most compassionate pontiffs, brought warmth and ambiguity in equal measure. While Church doctrine on contraception remained unchanged (spoiler: still a “NO”), he prioritized care over condemnation. His papacy saw Catholic health programs quietly expand HIV prevention services even if they didn’t exactly lead with a bowl of condoms at the clinic door. His vibe? Less “hellfire and brimstone,” more “let’s care for people where they are”. He signaled a gentler, more inclusive tone toward LGBTQ+ Catholics, showing that pastoral care didn’t always have to come with a finger wag. And honestly, that was a breath of fresh air.

Enter Pope Leo: The Meme-Worthy Mystery

And now we have Pope Leo XIV: the first American-Peruvian pope, with Italian, and Black Louisiana Creole roots. An Augustinian. A meme generator. An all-around enigmatic figure who has captured the world’s imagination this week and remains entirely TBD on sexual health messaging. Will he carry Francis’s torch of pastoral compassion, or swing the pendulum back toward firmer doctrine? We don’t know yet. But as someone who has spent years in the trenches fighting preventable infections, I can’t help but hope that he will embrace a science-informed, pragmatic approach to sexual health. It matters that the religious leader of 2 billion catholics should be someone who believes that preventing HIV, reducing STIs, and upholding human dignity are not mutually exclusive goals. Condoms may be theologically complicated, but from a public health perspective when used consistently and correctly? They are as close to a miracle in STI and pregnancy prevention as latex gets.

Final Thoughts (From the ID Corner)

It might seem like a small thing in the vast universe of Catholic doctrine. But the Church’s positions on these issues shape health policies, influence foreign aid, and affect millions of lives especially in places like sub-Saharan Africa and Latin America where Catholic healthcare providers are the backbone of care. So yes, I’ll be watching to see whether Pope Leo brings intellectual flexibility to matters of the bedroom. And maybe just maybe the next time we hear “Habemus Papam,” it might also come with a quiet “Habemus Condom.”

P.S

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Uganda Contained Sudan Virus — And the World Should Pay Attention

This past week, Uganda officially declared the end of its latest outbreak of Ebola Sudan virus, one of four Ebola virus species known to infect humans and cause deadly disease. This milestone is significant not only because Sudan virus outbreaks have historically been devastating, but because Uganda achieved containment amid a rapidly shifting and often hostile global health funding landscape.

Since the United States' withdrawal from the World Health Organization and cuts to foreign aid, a dominant narrative has warned that countries across Africa would be unable to respond to emerging infectious threats without foreign intervention. Uganda's response and those of its regional neighbors powerfully proves otherwise.

A Rapid, Coordinated Response

The outbreak was declared on January 30, 2025. By April 25, Uganda had reported just 12 confirmed and two probable cases, including four deaths (case fatality ratio[CFR] of 29%). Through rapid contact tracing, quarantine, and effective clinical care, Uganda swiftly contained the outbreak. Even more striking: within four days of the outbreak being declared, Uganda launched a clinical trial of an experimental Sudan virus vaccine, a virus for which there is currently no licensed vaccine. This response marks a significant improvement over previous Sudan virus outbreaks in the country, including the 2000–2001 outbreak (425 cases, 224 deaths; CFR 53%) and the 2022–2023 outbreak (164 cases, 74 deaths; CFR 47%).

Preparedness Pays Off

These successes are not accidents. They are the result of sustained investments in outbreak and pandemic preparedness across the African continent. Following the devastating 2014–2016 West Africa Ebola outbreak and more recently COVID-19, countries have had to strengthen their health systems, build rapid response capacity, and developed research infrastructures capable of launching clinical trials under emergency conditions. Filovirus outbreaks like Ebola and Marburg have historically had case fatality rates reaching 70%. Yet today, the dividends of prior investment are clear: improved containment, licensed Ebola Zaire vaccines, and the growing prospect of licensed vaccines for Marburg virus disease and Sudan virus.

A Regional Success Story

In the past six months, three separate viral hemorrhagic fever outbreaks across East Africa have been contained with extraordinary speed and coordination:

• Rwanda, from September to December 2024, managed its first-ever Marburg virus disease outbreak. Sixty-six cases were confirmed, including 15 deaths (23% CFR). Rwanda also achieved the first successful intensive care management of critically ill Marburg patients in Africa and embedded vaccine trials into its response.

• Tanzania, in January 2025, contained a smaller Marburg outbreak — just two confirmed and eight probable cases — within a month.

These outcomes stand in sharp contrast to predictions of collapse and uncontrolled spread following reductions in foreign support.

The Problem with “Collapse” Narratives

Despite these real-world successes, a persistent narrative warns of the total collapse of healthcare systems across Africa following cuts to U.S. foreign aid. A recent modeling study predicted that without the approximately US$12 billion the United States spent on global health in 2024, up to 25 million additional deaths could occur over the next 15 years, largely due to disruptions in programs targeting tuberculosis, HIV, family planning, and maternal and child health.

These warnings are important for underscoring the urgency of the situation. However, while the sudden loss of funding creates a serious vacuum, such projections can easily slip into stereotypical portrayals of African nations as wholly dependent on foreign aid. They often overlook a critical reality: foreign aid is rarely without conditions, and its benefits are far from one-sided.

For example, the United States stands to incur substantial financial and strategic losses from cutting aid to Africa, including negative impacts on American businesses, diminished geopolitical influence, and heightened national security risks. U.S. industries that supply goods and services for aid programs such as agriculture and healthcare, are likely to suffer, while opportunities for market expansion and resource access may be ceded to global competitors like China. Moreover, foreign aid has historically contributed to political stability in regions critical to U.S. security interests, making the potential fallout from these cuts far more costly than the $12 billion annual investment currently made.

Fragile Systems at Home, Strong Systems Abroad

Ironically, while global health investments are shrinking abroad, the U.S. is contending with its own unraveling public health infrastructure. Under the leadership of RFK Jr., a known purveyor of medical disinformation, funding for local health departments and the CDC has reached historic lows.

Imagine what would happen if a case of Marburg or Ebola were imported into this weakened environment. The only reason that scenario hasn’t materialized is because African countries stopped outbreaks at the source.

Colonial Echoes in Global Health

Image source

A deeper examination of global health’s history and its colonial origins reveals that these narrative flaws are not new. Colonial-era campaigns to control tropical diseases were rarely motivated by altruism; rather, they aimed to protect colonial settlers and ensure the continued exploitation of lands and peoples. These efforts also routinely dismissed or suppressed local medical knowledge, branding it as primitive or irrelevant. Although today’s global health frameworks have evolved, they still risk replicating these dynamics unless equity, genuine partnership, and local leadership are intentionally centered.

While foreign support has helped strengthen healthcare systems and advance research, the products of collaborative studies involving African populations have not always been equitably accessible to those communities, nor have the contributions of local leaders been adequately recognized. For global health partnerships to be truly transformative, their benefits must be mutual rather than extractive and built with sustainability in mind. Equally important, we must shift how global health is framed: who benefits, who is labeled "dependent," and who is positioned as the "savior" must all be critically re-examined.

Rewriting the Narrative

Illustration by Yifan Wu

As we grapple with the fallout from funding losses, it is crucial not only to amplify Africa’s recent successes but also to reframe the narrative. We must confront the historical roots of dependency, dismantle the systems that perpetuate inequity, and focus on breaking the cycle not reinforcing it through negative portrayals that risk infantilizing an entire continent and its people.

A total reimagining is needed: one that inspires hope, acknowledges resilience and growth, and builds new narratives that finally uproot the damaging legacies of the past. The recent successes in Uganda, Rwanda, and Tanzania challenge entrenched ideas of “white saviorism” and dependency. They remind us that when investment builds sustainable capacity and when local leadership is centered, African countries are not only capable of protecting their own populations, but of setting global standards for outbreak response. The world benefits from this, not just Africans.

We should not simply lament the loss of foreign aid. We must champion these victories as proof that investment in African-led systems works and that the return on that investment is global safety. Collapse and despair should never be accepted as the inevitable outcome of one foreign country’s withdrawal of support. Dependency is a narrative, not a destiny. It’s time we stopped mistaking one for the other.

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The FDA just paused a quiet but critical program. Here’s why that should worry all of us

I wasn’t planning to write today. But the news that the FDA has quietly suspended its milk quality control testing program gave me pause, and then sent me digging. As an infectious diseases physician, part of my job is detective work. I ask patients what they’ve eaten, where they’ve traveled, and what they’ve been exposed to. Sometimes, the answer is in the fine details: a piece of fresh cheese brought home from travels, a glass of raw milk, a dairy product that slipped through the cracks. So when I hear that a cornerstone of the dairy safety infrastructure has been put on hold, it grabs my attention. What exactly is milk quality testing? And why should anyone outside of food regulation or medicine care that the FDA has stepped back from it? Let me explain what’s at stake.

What Just Happened?

The FDA confirmed it has suspended its Milk Laboratory Proficiency Testing Program a cornerstone of how we ensure that milk sold in the U.S. is safe, properly tested, and uniformly regulated. The reason? Budget and staffing cuts. The agency’s Moffett Center Proficiency Testing Laboratory, which ran the program, has been closed. And with it, the FDA’s ability to run the quality-control checks that keep milk safety consistent across the country has been paused possibly until 2026. Most people will never hear about this. There’s so much in the news already, it’s hard to keep up.

Why This Matters

Milk safety depends on layered safeguards that catch problems before they reach consumers. Under the Pasteurized Milk Ordinance (PMO) which is adopted by almost every state milk is routinely tested for:

• Harmful bacteria like Listeria, Salmonella, and E. coli

• Somatic cell counts, which reflect cow health and milking hygiene

• Antibiotic residues, which can slip into milk if drug withdrawal times aren’t followed

• Any adulteration or contamination from handling or storage

These tests rely on labs doing the work and on the FDA verifying that labs are doing it right. The FDA ensures that results are accurate, reliable, and comparable across states and systems.

What’s at Stake Now?

Without the FDA’s oversight, state labs have no unified system to benchmark their testing, and inconsistencies are likely to creep in. False negatives will become more likely, and contaminated milk could make it into the food supply undetected. Smaller or under-resourced jurisdictions will be hardest hit, widening existing inequities in food safety. Accountability will weaken. And if testing falters, there will be no federal backstop to identify where and how. The FDA has said the program likely won’t resume until at least FY2026. That’s a long time to fly without instruments.

This Isn’t Empty Fear-Mongering

The last case of listeriosis I managed was a few years ago. The patient was a pregnant woman in her twenties who came in with fever and confusion. The only revealing part of her history? She had eaten fresh cheese (queso fresco) brought to her as a gift by family visiting from Central America. Listeria monocytogenes is one of several pathogens that can be transmitted through contaminated dairy products. She made a full recovery with prompt diagnosis and antibiotics, though she spent several days in the ICU. Tragically, she lost the pregnancy. Fortunately, we don’t see these cases very often but not because these pathogens have disappeared. We don’t see them because the systems designed to detect and prevent them have worked quietly and reliably for decades.

The Bigger Picture

Besides Listeria, pathogens like Salmonella, E. coli, Brucella, and Mycobacterium tuberculosis can all be transmitted through contaminated milk. The reason we don’t worry about that risk when we pour milk into cereal or hand a yogurt cup to a child is because we trust the regulatory process. As if this weren’t enough, we’re currently in the middle of an outbreak of highly pathogenic avian influenza (H5N1) in U.S. dairy cattle across multiple states. Viral fragments have already been found in commercial milk samples. This adds a new layer of concern especially for unpasteurized milk. The idea of a zoonotic virus making its way into the food supply isn’t hypothetical. That risk increases when quality checks are suspended.

A Crisis of Public Health Infrastructure

This news is part of a larger evolving story: the steady disinvestment in public health infrastructure, which is eroding the backbone of the programs that keep our food, water, and medications safe. Most Americans don’t realize how many of these systems exist or that they’re quietly being hollowed out. But when something goes wrong, we all feel it. If milk, one of the most closely monitored foods in the U.S., can lose federal oversight without widespread notice, what else are we not watching closely enough?

Consider Dairy Alternatives (If You’re Concerned)

If the suspension of milk safety testing leaves you feeling uneasy, you're not alone. This isn’t a call to panic, but it is a moment to reflect on your personal risk and how we collectively uphold public health protections. In the absence of strong federal oversight, switching to non-dairy alternatives may be a more prudent option for individuals who are immunocompromised, pregnant, or simply more risk-averse. Plant-based milk options like oat, soy, almond, and rice are not immune to safety concerns, but they’re not subject to the same risks as animal-derived dairy products (Listeria, Salmonella, Brucella, E. coli, Mycobacterium bovis). This isn’t a blanket recommendation just a a reminder to make informed choices, especially for those with underlying vulnerabilities.

What You Can Do

I hope this crucial program for public health food safety is quickly restored. In the meantime, there are actions you can take:

📞 Call your representatives and urge them to fund the FDA’s milk testing program and reverse the cuts to the workforce which have resulted in its suspension.
🛡️ Support food safety advocacy groups working to protect these systems.
📤 Share this post to help others understand what’s at stake.
🥛 Choose wisely, especially if you or your loved ones are vulnerable.

The safety of our food shouldn’t be up for debate. Let’s keep it that way.

The Rise and Fall of Trust in Infectious Diseases

At the start of the COVID-19 pandemic, infectious diseases doctors were suddenly front and center. We were seen as heroes people turned to us for answers, leaned on our expertise, and genuinely valued our role in helping the broader medical community navigate an emerging and unfamiliar threat.

That moment didn’t last.

As the pandemic dragged on and people grew weary, that early gratitude gave way to frustration and, in many cases, outright hostility. The measures meant to protect lives became politicized. Misinformation exploded. Vaccine mistrust surged. And the very same physicians who had been praised for their bravery and insight were now being vilified. Called fearmongers. Accused of having an agenda. Treated as if science itself were optional. That shift has been painful and dangerous. And the ripple effects are still being felt.

A New Era of Challenges

We’re now in a climate where anti-vaccine rhetoric is louder and more organized than ever. We’re seeing cuts to funding for essential public health tools, disease surveillance systems, research infrastructure, community health programs. And with the new U.S. administration, we’re facing leadership at the highest levels of health policy that is openly hostile to vaccines and rooted in pseudoscientific beliefs. For those of us in infectious diseases, it feels like the goalposts have moved. We’re expected to keep showing up for our patients while also pushing back against a political tide that undermines our very work. It’s exhausting. And yet, I’m still here.

What Keeps Me Going

So how am I continuing to show up in this moment? How do I keep doing this work especially when it feels like the world around me is becoming more hostile to the truth?

I’ve gone back to my roots.

I’ve doubled down on the communities I serve. I’ve focused on the sacred trust that exists between doctor and patient. And I’ve tried to stay grounded in the reasons I went into medicine in the first place: to care for people, to help them make informed decisions, and to stand firm in science even when it’s unpopular. Like many of my colleagues I am choosing to keep showing up with persistence and humility.

Small Wins That Matter

This Friday in clinic, I had one of those moments that reminded me why I keep going.

Two of my patients who’ve almost always refused vaccines agreed to get booster shots. TDAP and Pneumonia. No delay. No conditions. Just, “Yes.”

It didn’t happen overnight. It’s taken years of consistent, nonjudgmental conversation. Years of offering vaccines even when I expected a no. Years of listening, answering questions, and respecting their right to decide while gently reminding them why I ask every single time.

This time, one of them paused after I said I could defer the order and he could come back next week if he needed more time. Then he looked at me and said:

“You know what, doc—I trust you. Let’s get it done today.”

That trust didn’t come from a headline or a policy memo. It came from five years of relationship-building. These are the kinds of victories that don’t make the news but they make all the difference. They’re a reminder that vaccine hesitancy isn’t always permanent. That conversations matter. That trust, once earned, can lead to life-saving decisions.

Speaking Outside the Clinic

This weekend, I’m taking that same message beyond the clinic walls. I’ve accepted an invitation to speak at a local church about the attacks on public health—as part of a Good Friday service, no less.

It’s not an academic talk. It’s not a professional panel. It’s me, speaking to members of my own community people who may not be plugged into the world of science or policy, but who live in the world that’s being shaped by these decisions.

And I jumped at the chance.

Because people deserve to know what’s at stake when we see cuts to the CDC, the FDA, disease surveillance programs, environmental protections, and the scientific research that gives us the tools to fight infectious diseases, cancer, and more. These aren’t abstract concepts - they affect the air we breathe, the water we drink, the safety of the vaccines in our kids’ arms.

This is my opportunity to speak plainly and honestly and I plan to take it.

Mentorship Is Resistance, Too

The last way I’m choosing to show up right now is by supporting the next generation.

I’ve redoubled my efforts as a mentor. I’m more intentional about being present for my mentees. About encouraging their curiosity, cheering on their wins, and reminding them that even in the midst of uncertainty, science is still full of wonder. Full of purpose. And full of promise. This is important work. It’s not always glamorous, and it’s rarely easy but it matters. And I want them to know that. I want them to believe it. And I want them to see it modeled in real time.

The Defiance of Persistence

I’m not under any illusion that any of this is easy and maybe, at times, it’s not even sustainable. These are not simple times, and doing this work—showing up—comes at a cost. But I can’t afford to be silent. None of us can.

Even when we’re cast as villains, we still have a vital role to play.

Persistence in the face of adversity is an act of defiance. And that defiance, the decision to keep advocating for patients, to keep speaking to our communities, to keep mentoring with intention IS my way of holding the line.

Because this moment will pass. And when the next chapter is written, we will need the voices, the vision, and the leadership of the generation we’re nurturing today.

P.S:

If this resonates with you whether you're in medicine, public health, or simply someone trying to make sense of it all I’d love to hear how you keep showing up. Feel free to reply, share, or send this to someone who needs a little encouragement to keep going.