On Monday, I started receiving texts and emails from people sounding the alarm about the executive order that Trump was considering, which would remake the childhood vaccine schedule. Right around 2pm Eastern time, the Washington Post broke the news that they had obtained the draft executive order “that would upend decades of federal guidance on which vaccines are administered to children and call for states to reconsider school vaccine requirements,” and that Trump was expected to sign it as soon as Monday.

Not even 40 minutes later, someone sent another email with the full text of the executive order. I read through it and at first assumed it was just a leaked version of the draft. But within 30 minutes, my phone lit up with a NY Times alert: Trump Signs Executive Order Calling for Fewer Childhood Vaccines. That’s when I realized that “as soon as Monday” meant “as early as today.”

Well. Much panic ensued on social media and in my poor email inbox. I was getting ready to post my finished Substack post about RFK Jr.’s shameful visit to CDC on Friday, and for a moment considered kicking that post down the road and burning another few hours writing this post instead, trying to be timely.

But after I took a breath or two, I came to the conclusion that What in the Health?! has never really been about breaking news, it’s been about helping others understand what’s really happening in public health these swirly, stressful, confusing days. And in many ways, what happened at CDC on Friday is much more important than this executive order. They want us to be running around, chasing every shiny object—and they sit around devising cheap gold shiny objects to toss in the air, just to tire us out. But we have important things to do. I see it as an act of resistance to take a beat and suppress the urge to chase them.

So here we are. Just about a week after the executive order “Delivering Gold-Standard Childhood Vaccine Recommendations for Americans.” Where do we stand?

Basically where we stood before.

The executive order’s own summary of what it is designed to do is this:

“Taking further action to reaffirm that it is the policy of the United States that the core childhood vaccine recommendations should be aligned with scientific evidence and best practices from peer, developed countries while preserving access to vaccines currently available to Americans. Further, it is the policy of my Administration that Federal programs and funding should support maximal parental choice over childhood vaccines, consistent with the Federal Government’s constitutional and statutory obligations and the fundamental principles of personal autonomy and informed consent.”

Translation: We want to make sure Americans can access vaccines aligned with scientific evidence, and parents should have the ability to choose which vaccines their children receive.

Well, this is already true. No change. The only exception is that a few states (California, New York, Connecticut, and Maine) have regulations that say no children can attend public or private kindergarten without having certain vaccines, and only medical reasons (aka allergies to the vaccines themselves) are an allowable exemption. I’ll talk about that more below.

The executive order goes on to say:

“It is hereby declared that the United States recognizes Gold Standard Childhood Vaccine Recommendations informed by the three distinct categories of childhood immunization recommendations identified in the scientific assessment, as specified below:

(i) immunizations recommended for all children: measles, mumps, rubella (MMR), diphtheria, tetanus, pertussis, polio, Hib, pneumococcal disease, HPV, and varicella;

(ii) immunizations recommended for certain high-risk groups or populations: respiratory syncytial virus (RSV) monoclonal antibodies, hepatitis A, hepatitis B, meningococcal B, meningococcal ACWY, and dengue; and

(iii) immunizations based on shared clinical decision-making: hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19.”

Translation: We’re trying to change the vaccine schedule by executive order. We tried to do it another way, and a judge said it wasn’t legal. So we’re trying this way instead.

Except it doesn’t work that way. If you live in California, Connecticut, Maine, or New York, nothing has changed. And if you live somewhere else, nothing has changed. You should still follow the American Academy of Pediatrics recommended schedule, in conversation with your own family’s pediatrician. Do what’s right for you. This executive order has no power over you.

Side note: I am fascinated that the two childhood vaccines that are most controversial in the MAHA space—the MMR and the HPV vaccine—are both on the “recommended for all children” list in this executive order. RFK Jr. cannot be happy about that. (They are both extremely safe and life-saving vaccines according to regular old science, and your kids should definitely get them.) Oh, and the dengue vaccine listed at the end of category 2? It is not currently available in the US outside of Puerto Rico.

It also says:

“The Secretary of HHS, through the HHS Task Force on Safer Childhood Vaccines, shall, within 90 days of the date of this order, present plans to the President through the Assistant to the President for Domestic Policy to, to the extent appropriate and consistent with applicable law:

(a) offer options to administer core childhood vaccines, starting with MMR, as single vaccines rather than combination products/doses, including by working with the private sector and other countries as appropriate, while guaranteeing continued availability of combination vaccines and those vaccines recommended for shared clinical decision-making”

Translation: RFK Jr. has 3 months to present a plan for offering MMR as separate shots.

This will take years of research and development, since right now there ARE no licensed vaccines for measles, mumps and rubella to be administered separately in the US. For vaccines in the US you need to license both the vaccine itself and the factory that produces it. Those don’t exist, and the effort required for vaccine manufacturers to complete clinical trials or license factories for this purpose is extensive. Who is going to rush to do this? No one.

The only other option is to push the FDA to allow individual vaccines from other countries, which would mean American kids going to multiple different doctors appointments to get multiple injections of vaccines made in either China, India, Indonesia, or Japan, instead of a single vaccine made by a US company, offered over two doses (two visits). Trump said outright at the press conference where he signed the executive order, “At 1 year, you should have five separate visits for vaccines rather than getting them all in the same day.” So instead of two doctor’s visits with one shot each, they think it’s better for new parents to bring their babies and toddlers to the doctor five separate times, for five separate shots granting the same protection. Why?? There is no scientific evidence to support this. Trump also said in the press conference: “Together, there could be a possibility they’re quite lethal, and separately, it looks like they are not at all lethal, but just very effective.” This is simply a lie. There is zero evidence to suggest this. Zero. Even those countries with licensed single disease vaccines don’t use them – like India’s monovalent measles vaccine, given at 9 months, which is followed by an MMR or MR vaccine at 12-24 months for full protection. China also uses an MMR vaccine, despite existence of a monovalent mumps vaccine. So….my prediction is this will be much like when there was a big announcement that RFK Jr. was going to find the cause of autism in only 5 months. Five months later they had to do something, so there was a pronouncement that probably it was Tylenol. Except the science didn’t back it up, and all that ensued was unnecessary confusion and fear by pregnant people and their doctors.

And finally, the big threat:

“The Attorney General shall take appropriate measures to further meritorious legal actions challenging State laws that conflict with States’ constitutional and Federal statutory obligations related to parental authority, religious freedom, disability accommodations, and equal protection under the law, including, to the extent applicable under Federal law, States’ obligations to provide religious and medical exemptions from childhood and adolescent immunization requirements.”

Translation: We’re thumping our chests and hoping the DOJ will find some way to address this issue, but honestly there might not be a path forward because we can only address areas where states are violating federal statutes or the Constitution. We’ll see what we can do.

Lots of people are reading this section of the EO and saying “Great! Religious exemptions are back. Too bad California, good try but you were just overruled.” They’re simply wrong. As Dr. Joel Gator—someone who self-describes as “someone who strongly believes parents should have more choice when it comes to vaccines”—says, “The entire legal dispute is over whether states like New York and California are actually violating federal law by refusing to provide religious exemptions. You cannot solve the question by putting the question into an executive order. It is a little like writing, ‘Anyone who legally owes me $10 million should immediately pay me $10 million.’ Great. I strongly support this policy. Now comes the slightly more difficult part of establishing who legally owes me $10 million.”

Closing thoughts

Stephen Miller also piped up at the signing, saying about the childhood vaccination schedule: “Nobody has studied it. Nobody’s looked at it. Nobody’s thought about it.” I don’t know about you, but when Stephen Miller says something I usually assume it’s either a lie or some manipulative way to be terrible to other people. This is certainly a ridiculous lie. The current childhood vaccine schedule has involved decades of research, where people with qualifications substantially better than Stephen Miller, Donald Trump, or RFK Jr. have studied, looked at, and thought about these issues extensively. To say otherwise is frankly absurd.

RFK Jr’s own CDC has a page that provides a lot of details on the safety of the MMR vaccine, demonstrating the years and years of people studying this very thing. And yes, this page talks about the very rare but possible chance of life-threatening reactions to the vaccine. That scares a lot of people, mostly because our human brains aren’t very good at comparing risk levels between two things. There is non-zero risk from the vaccine. But there is a much more than zero risk from the infections you can get if unvaccinated. If you’re interested in understanding this better for yourself, Unbiased Science has just released an outstanding free and interactive tool that allows you to compare the risk of the vaccine to the risk of no vaccine. I strongly encourage you to check it out, here.

In case you are too busy to click the link, I’ll give you just one screenshot:

But seriously, check it out for yourself.

One last thought?

At her confirmation hearing in July, Sen. Bernie Sanders (I-Vt.) said to (now) CDC Director Erica Schwartz, “If confirmed, will you commit that you will report to Congress if you receive directives from Secretary Kennedy or any other individual in the Trump administration to implement policies that are unscientific and could harm the health and well-being of the American people?” And she replied, “Senator, I do not believe that the President or the Secretary would ever do what you just mentioned.”

It was 5 days after she was confirmed as CDC Director that this was dropped in her lap. How will she respond is anyone’s guess – but we’ll learn a lot from this test of Dr. Erica Schwartz’s integrity, and how this will all play out.

At that time, I talked about how embarrassingly poor RFK Jr.’s response was to this horrifying incident. It took him more than 18 hours to condemn the violence. Between that condemnation and the shooting, he instead posted photos of his fishing trip in Alaska. Three full days later, he did visit the building—mostly empty, since traumatized workers had been told they could work from home, especially since many of their office windows had bullet holes in them. He made a few political visits, then left.

But here we are, one year later. On August 7, 2026, the Friday before the one-year anniversary, RFK Jr. finally decided it was time (or was forced?) to return to CDC headquarters and actually talk to some of the people working there. He wanted a photo op: dedicating a portion of the campus road as Officer David Rose Parkway, and making a speech to a room full of CDC staffers while standing next to Officer Rose’s young daughter, his widow, and a plaque on an easel with a photo of him and some text, presumably to be hung in the lobby near where he died.

One might say OK, he’s very late in showing some care for the people whose lives were endangered as a direct result of their commitment to science, helping improve the lives of others, and government service. But at least he finally woke up and did something. I might say that too, except he botched this appearance so terribly it reads like a story in The Onion.

In front of this room of about 200 CDC employees, many of whom were there the day of the shooting, locked down for hours, terrified—and some of whom knew Officer Rose personally, or have gotten to know his family since—he used the word “target” to refer to Officer Rose. Not once did he mention CDC staff who were there that day, highlighting how little the leader of the federal department that encompasses CDC has worked to really engage with the humans involved in this tragedy.

He did say a few nice things: he gave kudos to CDC staff involved in the response to measles in South Carolina, and he called CDC staff “ambassadors for the rest of the world, showing the best of America.” (Quite a departure from the time he called CDC a “cesspool of corruption” or even in his congressional testimony from only four months ago when he said he was bringing in new leadership to help “get [CDC] back on track.”) Of course, he failed to mention that CDC staff are showing the best of America while the US government stands behind them cutting ties with the World Health Organization, destroying USAID, and dismantling key provisions of the President’s Emergency Plan For AIDS Relief (PEPFAR), all of which send a very clear message to the rest of the world about what America thinks of them.

But that was basically the end of the nice things. Instead, he ranted about some of his favorite topics. One gem, to all the scientists in the room: “There are too many incentives to cheat on science,” he said, and complained about relying on drug manufacturers to fund trials (while failing to acknowledge his efforts to slash NIH funding and cut CDC’s budget, making it nearly impossible to do large-scale studies without manufacturer support). He also decried lack of transparency at CDC, calling it “shocking” how inaccessible databases are and going on to claim, “They’re all hoarding their own data.” He went on to lecture people in attendance about how starting in 1989 (unsaid: when ACIP changed the MMR to two doses in the U.S.) he has seen so many more people with autism and autoimmune diseases. Of course, he’s mad he can’t properly prove this link, because CDC staff have thus far resisted sharing sensitive vaccine data with political appointees wishing to twist it for these purposes. Oh and another favorite: “You can’t just trust a scientist, because scientists have biases, too.” Really nice words to commemorate such a painful time.

Here’s another good one: he told them CDC is the “spear tip for public outreach” but that people are scared of infectious diseases so they will “do whatever we say,” meaning “we have to remember this and protect their constitutional rights.” I can’t even. How do trans people feel about all the protection they’re getting? U.S. citizens with brown skin, being nonetheless picked up and detained by ICE? People being shot to death for videoing ICE actions? Holding someone in contempt of Congress for pleading the 5^th? Need I go on? There has never been an administration (or Congress, apparently) less concerned about protecting constitutional rights. Get out of here.

To top it all off, interim CDC Director Jay Bhattacharya—always happy to be in the spotlight—referred to “Doctor Rose” not once but twice in his own remarks. Sure, maybe just a clumsy misspeak (twice) but it gave away how impersonally he’s thought of this murdered police officer. He also joked about being excited to be fired from his job as Acting Assistant Pain in the Ass now that Erica Schwartz has been confirmed as CDC Director, and he no longer has to serve in that capacity while also leading NIH. Really? They made multiple jokes about being fired, in a room full of people who’ve been devastated by RIFs: people who know and love people who have been fired for no reason, and who are trying to keep doing their jobs while they work in teams with multiple vacancies they’ve been prohibited from hiring for, despite their work being fully funded by Congress (at the dismay of the executive branch).

Extra points to whomever thought it was appropriate to give interim director Bhattacharya a proper sendoff by standing up in the hallways grotesque, larger-than-life cutouts of him looking like a WWF wrestler, and thanking him for “stepping into the ring for public health.”

As someone described on social media, “they’re all having one big party,” while memorializing a man who was murdered on the CDC campus for trying to provide safety and security to the scientists inside. If you look closely at the photo, you’ll see that Wrestler Bhattacharya is literally smiling with his big muscles and short shorts in front of a TV screen broadcasting the family of the slain officer, brought there like props.

For a year, RFK Jr. released no official statement about the shooting. He made no effort to actually speak to—or listen to, of course—the dedicated people who spend their days working hard at CDC with their heads down, eyes casting sideways glances at the empty chairs and desks where their beloved colleagues used to sit, wondering if they’ll be next. And now he comes for a photo op, parades the dead man’s daughter around, tells the stricken audience that “you can’t just trust a scientist,” and laughs while his interim lackey Jay Bhattacharya jokes about wanting to be fired.

This is, quite frankly, disgusting behavior. Shameful. Inexcusable.

At CDC, there is a memorial wall with the names of CDC staffers who died while working. At some point, Officer David Rose’s name was quietly added to the wall. There was no announcement, no ceremony for staff to attend. A friend of mine said to me, “I walk by it every day, otherwise I wouldn’t know.”

On Thursday, the day before RFK Jr’s visit, someone tucked a single rose behind his name on the wall. No photo op. No parading of family. Just a moment of silence, and a private acknowledgement of a man whose life was taken by a gunman who believed the exact things RFK consistently promotes.

This is a way to honor someone’s memory.

RIP, Officer Rose. May peace come to your family.

(By the way, I’m Gen Z so this ^^ is the one that really had me falling out of my chair with laughter. I wish I knew who created it so I could give credit where it’s due. It’s already plastered all over the internet. You can get a t-shirt with this image on it already! If you know where it came from, please leave a comment and let me know.)

We shouldn’t laugh. Thousands of people have become terribly ill, more than 100 to the point of needing hospitalization. This kind of diarrhea isn’t just inconvenient, it can be life-threatening. And, well, there’s so much that feels terrible these days;
I think we can be forgiven for laughing about being forced to eat pizza instead of salad because pizza doesn’t put us as risk for diarrhea lettuce. I don’t know about you, but I’m Team Pizza for 2026 so far. Eating healthy is important, but so is comfort food.

By the time I got around to compiling my thoughts about how and why this diarrhea lettuce outbreak became possible, there were others who had done a brilliant job already writing about the complexities, so I decided there’s no need for me to re-invent the wheel.

My colleagues at Defend Public Health, Drs. Judy Stone and Tara Smith, have written great articles that help illustrate:

1. How our big agribusiness structures and deplorable working conditions for migrant farm workers made this possible in the first place, and

2. Why cuts to food safety monitoring programs, sentinel surveillance systems for Cyclospora (and other diseases), and CDC’s infrastructure for outbreak response since January 2025 made it so much harder to quickly identify the source of the outbreak and take the diarrhea lettuce out of service before so many got sick.

Please take a few moments to read Dr. Stone’s great article in Forbes:

It’s The Water, Not Produce, Likely Driving Cyclospora Outbreaks

And then read Dr. Smith’s related op-ed on MS NOW (from before we knew it was the Taylor Farms shredded lettuce):

Cyclospora cases are spreading. Why don’t we know more about it?

Thanks to these public health defenders, and everyone else advocating for continued food safety, worker safety, and data tracking and reporting systems, even when they’re unpopular to big corporations hoping to fly under the radar with their money-saving tactics (and the politicians who enjoy their donations).

Stay safe out there.

The list of tactics the Trump White House has used against its perceived enemies is nasty and brutish but certainly not short. It includes indicting them (James Comey, John Bolton), investigating them (Jerome Powell, Lisa Cook, Gavin Newsom), threatening to investigate them (Chris Christie, Bruce Springsteen), and threatening to prosecute them (top election officials in all fifty states). The Administration has dispatched troops to cities the President doesn’t care for (Chicago, Los Angeles, Portland); sued universities that ticked him off (Harvard, U.C.L.A.); and withheld billions of dollars’ worth of funding from groups and projects that it deems “woke” or wasteful or not in line with Donald Trump’s priorities, whatever those at the moment happen to be.

In What in the Health?! I mostly write about public health-specific things, but as the New Yorker article makes clear, this goes way beyond that. The problem for Trump and his cronies is that what they’ve been trying to do has consistently been found improper and illegal and stopped by the courts.

There was Rhode Island v. Trump, where Judge John McConnell Jr. said the administration’s attempt to pause over $3 trillion in federal spending “fundamentally undermines the distinct constitutional roles of each branch of our government,” issuing a preliminary injunction in Jan 2025, later upheld by an appeals court. There was American Public Health Association v. NIH, where Judge William G. Young ruled that the Trump Administration’s termination of hundreds of NIH grants related to racial disparities, gender equity or transgender health, and COVID vaccines was illegal, calling the government’s directives “arbitrary and capricious” and stating the terminations reflected racial discrimination and discrimination against the LGBTQ community. The Supreme Court later stayed part of that ruling 5-4, allowing NIH to terminate $783 million in grants on jurisdictional grounds, but in December 2025 there was a settlement in which NIH agreed to reconsider frozen, denied, or withdrawn grant applications. In July 2025, 22 Democratic attorneys general and two Democratic governors sued to force the Trump Administration to release $6.8 billion dollars in education funding that had been frozen, and ultimately the administration backed down and released the funds even before a judge forced their hand.

There are plenty more examples. The law is clear, and the executive branch doesn’t have the power to just withdraw funding for things and people they don’t like.

We all know the Trump Administration doesn’t like it when they don’t get their way. So what are they doing about it? As the New Yorker article stated, “Recently, the White House announced plans to codify its campaign of retribution.” In a 400-page document they announced a proposed massive rule change. If implemented in its current form, OMB-2026-0034 would revise 2 Code of Federal Regulations (CFR) Subtitles A and B to make decisions on all federal funding to be made by political appointees, and able to be withdrawn legally at any time, just because the executive branch wants to.

As the New Yorker article goes on to explain, “The rules would affect hundreds of billions of dollars in funding disbursed by agencies ranging from the National Endowment for the Arts to the Transportation Department, to pay for everything from local dance performances to massive infrastructure projects.”

This will affect you deeply and you need to take action. If you’ve already commented, ask three people today to comment, too.

This is your last chance: Comments are due tomorrow, July 13, 2026, at 11:59 pm Eastern (8:59pm Pacific). As of this post there are now 278,884 comments—this is a massive number and it should tell you how serious it is. But no amount of comments is too much, and it’s impossible for there to be too many.

Make comments here. Note that all identical comments will be counted as one, so you can’t just copy someone! But you can be brief, and emphatic. . You don’t have to write a thesis for it to matter.

Read more here to learn more, or if you want some resources for making a comment.

Please share and encourage others to act today!

From their website: “In 1966, three years before Stonewall, the Tenderloin district of San Francisco became the stage for one of the first acts of organized LGBTQ+ resistance in the United States. The queens and transgender women who gathered at Compton’s Cafeteria weren’t just meeting for a meal—they were building community and finding strength in their shared struggles.”

For me, this felt like the right way to mark Pride in 2026. There’s so much to celebrate about being queer (or lesbian, gay, bisexual, transgender, non-binary, two-spirit, intersex, or any other sexual orientation or gender identity). But right now there’s a bit of an extra edge to it. Celebration is resistance. And there’s so much hatred swirling around these days that we absolutely must resist…for ourselves, and for others who are different than we are.

Maybe it’s in part because of my experience in Compton’s Cafeteria last night, but today I’m especially thinking about trans kids, and the importance of protecting them now more than ever.

I’ve already talked in this Substack about our need to protect trans kids, back in December. (If you haven’t already read that one, please take a few minutes to do so. The attacks on trans kids have been incessant and awful since Day 1 of this Administration.) Six months later, it’s worth another post.

Back in March, a federal judge in Oregon ruled Robert F. Kennedy Jr. had overstepped his legal authority when three months earlier he declared that providers of gender affirming care to minors “do not meet professionally recognized standards.” The Trump administration had been sued by 21 states that were seeking to stop them from ending federal funding to hospitals providing gender-affirming care. RFK Jr’s 12-page declaration on this issue (which you have to read here, since they’ve removed it from the HHS website now…all hail the archivists) states that it “supersedes” statewide or national standards of care and that “sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors.” This is how the states sued, since states have the legal right to regulate the practice of medicine within their own borders, and the executive branch of the federal government does not have the authority to unilaterally establish a national medical standard. And at least 21 states, unlike the federal government, want to support the practice of medicine based on science, not ideology. The relief from this federal injunction is temporary, but at least it’s relief.

But then—of course—the assaults continued. Because this is how it goes these days! Last month, NYU Langone Hospital was issued a federal criminal subpoena over the care they’ve provided to trans youth in New York City. A federal grand jury in the Northern District of Texas issued the subpoena, and by doing so demanded information on every minor who received gender-affirming care at NYU Langone since 2020, as well as the names of any providers at the hospital who were involved in offering such care in that timeframe.

Think about this for a moment. Especially if you have kids. Set the trans issue aside for a moment. Really, do this with me. Imagine your kid was dealing with some critical issue that was highly stigmatized. Something you might not want to mention to your colleagues in the lunchroom, or have other kids at school know about, for fear of your kid being treated badly by others. Then imagine you found a place where they could go see medical professionals who really cared about them and wanted to help them feel good again, and you went there feeling confident that HIPAA rules would mean the medical folks couldn’t talk about it, and no one would have to know unless you (or your kid) chose to tell them. So you went and got your kid that care—potentially with a lot of anxiety, and a lot of financial strain. And then imagine that years later, you found out that a grand jury from a state 2,000 miles away had issued a subpoena that was intended to expose your kid for having gone there, along with the medical professionals who helped them. This is what’s happening here. How would you feel?

Just a few weeks ago, a federal judge blocked the Trump administration from similarly obtaining the hospital records of trans minors who’ve undergone medical-affirming treatment in California. I live here, and a lot of the trans kids I know are here, so that’s another big relief…but there are lots of trans kids who are not fortunate enough to live in California. According to Shannon Minter, legal director of the National Center for LGBTQ Rights (formerly NCLR), Trump’s Justice Department initially filed lawsuits trying to compel hospitals nationwide to hand over the records of trans minors receiving care, but “nearly a dozen federal judges rejected their suits.” So what did the Trump administration do? They “quietly opened criminal investigations and threatened to prosecute hospitals that didn’t release their records.” So they tried to do it legally, got repeatedly blocked, and then basically turned to blackmail. (I’m not a lawyer. Maybe it’s not technically blackmail. But it sure feels a lot like it to me.)

These are children. As Bruce Mirken said: “This is not difficult: Gender-affirming care is health care, period, and decisions about that care belong to patients and their health care providers (and families in the case of minors), not politicians on an ideological crusade.”

Whether you celebrate Pride each June—or heck, whether you even like kids or not—it shouldn’t be hard to want to protect trans kids from having politicians meddling in their healthcare decisions. I have lots of pride in trans kids for being brave enough to speak their truth, and in their families and medical providers who are trying to help them live their best lives. I look forward to the days when I can have pride in my federal government again. If we all speak up for the rights and safety of trans kids, maybe we can help bring that future a bit closer.

🏳️‍🌈 Happy Pride! 🏳️‍⚧️

A quick note from me up front: Today’s post is about a proposed change to U.S. Office of Management and Budget (OMB) and regulations. This might sound dry, or boring, or irrelevant to you if you’re not a legislator or a policy wonk. I promise you, this is not boring and it is extremely serious. It is unheard of and would permanently reshape our entire country’s relationship to science. I am not being alarmist. Please read now, and please take action—including sharing widely and encouraging others to act.

In case you missed it, on May 29, 2026, the U.S. Office of Management and Budget (OMB), which sets financial management policies and requirements for federal funding, released a draft regulation that would, if finalized, leave decisions about ALL discretionary federal grants up to the President’s political appointees—and let them cut your funding anytime. (If you’re not a scientist who receives federal funding, this still affects you. You benefit from federal funds that flow to researchers, public health workers, and medical providers every day, whether you know it or not—and this rule goes far beyond the world of public health and medicine, as I detail below.)

Public comments are due July 13.

Q: So much is going off the rails these days—what can we really do?
A: THIS. If you do one thing, DO THIS.

Called the bland-sounding “Regulation for Federal Financial Assistance Docket (OMB-2026-0034),” the nearly 400-page draft rule is truly breathtaking in scope. It has a lot of parts we’ll get into later but in short, it 1) revises 2 Code of Federal Regulations (CFR) Subtitle A to, among other things, require political loyalty tests for all federal grants and assistance, and 2) revises 2 CFR Subtitle B to codify those rules one by one for each of 41 federal departments. The affected departments touch all aspects of our lives, including what we eat, (Department of Agriculture), how we learn (Department of Education), what care we receive (Health and Human Services, Veterans Administration), where we live (Housing and Urban Development), where we play (Department of Interior), how we work (Department of Labor), what we study (National Science Foundation), and where we save (National Credit Union Association) and spend money (Small Business Administration).

As Dr. Megan Ranney, Dean of Yale School of Public Health put it in an apt LinkedIn post: “I was on a call today where a very staid, non-alarmist person said, ‘this proposed uniform guidance is a five-alarm fire.’” The draft rule has a lot to unpack, but here I highlight three key themes to describe how it would cause so much harm. (If you want more, see this googledoc for a summary of sections by theme [look at the multiple tabs]; see regulations.gov for the full text of the proposed rule.)

Theme 1: Rewarding Subservience, Punishing Dissent

The draft rule would create a system of patronage, where only Administration allies get federal funding. It requires political appointees (read: not career scientists) to pre-review organizations and applications for ALL federal funding (not just research) and to make sure both the organization and the application align with federal priorities (read: political beliefs on everything from race and gender to immigration). Once a federal agency awards funds to an organization, it can delay, reduce, or terminate the funding at any time, without explanation. The federal agency could also bar an organization from receiving future federal funding. These rules would apply not just to grantees but also to their subcontractors. For example, grantees would be required to notify their federal funders if subrecipients do anything that could “damage the reputation” of a federal agency or the federal government. This prohibition alone could have far-reaching chilling effects on free speech.

Theme 2: Making the U.S. Stupider and Less Competitive

The draft rule would undermine learning, knowledge-sharing, and innovation. The draft rule attacks expertise in multiple ways: first, it changes our longstanding system to make peer review of federal funding advisory, and not binding. Without peer review (read: review by other scientists who have similar expertise in the work being proposed for funding), federal agencies could be more likely to fund interventions that are ineffective at best and harmful at worst (like the National Cancer Institute studying ivermectin’s “ability to kill cancer cells,” alarming career scientists). The rule prohibits funds from being used for advertising, conferences (unless approved), international collaboration, subscriptions, publications, or memberships. These prohibitions could negatively affect medical journals and trade publications and prevent U.S. and global innovators from being able to share their ideas, collaborate, and innovate.

The draft rule appears written to specifically undermine universities and nonprofits. It requires federal agencies to fund applicants with a) the lowest indirect cost rates (these indirect costs pay for shared infrastructure, like laboratories and libraries), b) a commitment to “Gold Standard Science” (an Executive Order that has some valid critiques of the COVID-19 pandemic response but selectively scrutinizes Biden-era scientific policies), and c) the ability to yield “immediate [study] results” (good science takes time). To make matters worse, the draft rule undermines civic participation by specifically prohibiting nonprofits and institutions of higher education from using federal funds for voter registration drives. It’s unclear how an uninformed public puts America First, unless the point is to stifle voting and dissent.

Theme 3: Creating Uncertainty and Busy Work

The draft rule would it make it harder for federal grantees to know if they will get paid or how much. It prohibits fixed amount awards and subawards, so grantees can no longer apply for, say, $1 million over five years and expect to receive $200,000/year to pay their staff, rent, and expenses. The draft rule discourages cost reimbursement contracts, requires grantees to generate income and spend all of that income before requesting additional funds (which will almost certainly lead to gaps in funding, endangering the ability to pay and retain employees). It also requires grantees to justify every single payment request in writing. In effect, federal grantees could ask for what they needed in their proposals but, because funds can be delayed or terminated at any time, they will be left uncertain if they will ever get paid what they need to sustain the work.

If that wasn’t enough, the draft rule requires all federal grantees and subrecipients to participate in E-Verify (to check job applicants’ eligibility to work in the U.S.) and to report to their federal funding agency if a job applicant is found to be ineligible—i.e. to directly participate in the effort to identify and deport people applying for jobs who do not have green cards or valid work visas. If the organizations do not report this their funding can be terminated, despite the known risk of false negative matches.

The draft rule has a couple provisions that seem reasonable on their face, but it’s hard to trust that they would not somehow be used against federally funded programs. For example, § 200.202(f) encourages federal programs to issue multi-year awards rather than issuing separate annual notices of funding opportunity (NOFOs). That seems good, right? But would it be used to lock in grantees handpicked by federal appointees? Similarly, § 200.204 encourages NOFOs that “reasonably allow for all applicants to compete and succeed against institutions that have historically received consecutive awards in prior years.” This could promote equity, but it could also bias funders against existing grantees who received funding under prior administrations.

A big picture question this raises is what, exactly, is the revenue saved by terminating federal grants going to be used for? Launch more wars? Build more ballrooms? And if not to save money, then what? In her astute analysis, Sarah M. Trimmer observes that the proposed rule goes far beyond OMB’s statutory authority to set financial rules. In a Defend Public Health statement, Harvard’s Nancy Krieger called the draft rule a “power grab.” Perhaps OMB is trying to get around hundreds of court rulings halting its funding cuts?

What can I do?

1. Submit public comments on the proposed Regulation for Federal Financial Assistance by July 13. It’s truly easy! You can type comments into a comment box (5,000 characters max), write a letter and upload it, or do both. When you submit public comments, you can oppose the entire draft rule and/or specific sections; if you do, please list the specific section numbers. § 300.106 would apply this general rule specifically to HHS so please oppose that section! Be sure to personalize your comments because regulations.gov may disregard comments that are identical to those already submitted. Elizabeth Ginexi has posted a great example you can use for inspiration, and Jeremy Berg also has a comment template you could use as a starting place.

2. At your summer barbecues,[1] tell your friends, families, and communities what this policy would do (leave all federal funding decisions up to political appointees and let them legally cut funding whenever they want, with no explanation), what your concerns are, and what they can do if they are concerned, too. (Remember, this rule would stay true for any future presidential administrations, so people on all sides of the aisle, including people who don’t believe in the political aisles at all, may have cause for concern.)

3. Subscribe to What in the Health?! for more opportunities for public comment, and ask others you know to do this, too.

Why bother?

You may be wondering, “Why bother when the Administration is not going to listen anyway?” My response: YES, AND. Yes, the Administration might ignore your comments. AND, it still matters. Public comments can:

A. Signal to the Administration they have gone too far afield and need to backtrack. The law requires federal agencies to consider public comments in their rule-making.[2] This happened when the U.S. Drug Enforcement Agency (DEA) proposed rules restricting access to medications, including buprenorphine for opioid use disorder, via telehealth. After receiving 38,000+ comments, DEA changed course.

B. Create a written record of public sentiment that community groups, lawyers, and judges can reference during lawsuits challenging rules as illegal or unconstitutional.

C. Show the public that they have a voice and that voice matters so they should use it!

As of this posting, the draft federal rule has 22,954 comments—keep ‘em coming!

[1] Thanks to Daniel Raymond for the summer BBQs idea in another context!

[2] The Administrative Procedures Act of 1946, 5 U.S. Code § 553 - Rule making. 2 CFR § 200.202 also encourages federal agencies to “(b) develop Federal programs in consultation with communities benefiting from or impacted by the program.”

You might not be surprised to learn that this week, the entire issue was about Ebola. The Notes from the Field about the current outbreak in the Democratic Republic of the Congo (DRC) and Uganda pointed out that as of June 2, a total of 378 confirmed cases and 63 confirmed deaths have been reported. It also gives more background on this particular strain of Ebola—Bundibugyo virus disease, or BVD—which is rare, and has no vaccine or licensed treatments (unlike the Zaire strain, which is much more common).

But perhaps the most interesting part is the language listed at the top under the heading “What are the implications for public health practice?” That’s where it (rightly) says, “To help reduce the risk for continued spread of Bundibugyo virus, including potential spread beyond DRC and Uganda or importation to the United States, ongoing collaboration between CDC and international partners and coordination among U.S. government agencies are essential.” Remember that – we’ll come back to it.

The MMWR also lays out the assessment of risk to the US population from this outbreak, reminds U.S. clinicians of the CDC guidance about viral hemorrhagic fevers in case they suspect a patient might have it, and provides a series of projections about how big this outbreak might get, modeling a few different scenarios for how well cases are being identified and isolated to prevent spread. The abstract highlights results from one of the best case scenarios (70% of cases entering isolation centers), though the full article notes that if only 20% of patients with BVD are identified and isolated, the likelihood of an outbreak that exceeds 20,000 cases within the next 3 months is 65%, and ≥4000 deaths within 3 months is 69%.

For comparison, the largest Ebola outbreak in history was the 2014–2016 West African epidemic, which resulted in 28,610 reported cases and 11,308 deaths from the Zaire strain, primarily across Guinea, Liberia, and Sierra Leone. This outbreak started in March 2014 and lasted until June 2016 – more than two years. You might recall that during that outbreak, there were 4 confirmed cases in the United States, two of whom were nurses who actually contracted it in Dallas after caring for a man who came from Liberia and fell sick after returning to Texas. (He died; the two nurses recovered.) After that happened, more than a billion (with a B!) taxpayer dollars were spent to establish and sustain a world-class network of biocontainment treatment centers specifically designed for situations like this, so we can prevent nurses from getting sick in the future, and make sure a person with Ebola on U.S. soil has the best possible chance of survival.

Ebola is a disease of movies and nightmares. But the same thing that makes it so scary (that it kills people very quickly)—plus the extremely important fact that it’s not airborne—make Ebola a very poor candidate for a global pandemic like COVID-19. The problem is that it spreads when people show compassion to a loved one who is sick or has just died, and thus come into contact with their highly infectious bodily fluids (which are, tragically, part of the disease’s classic symptoms—the advanced stage of disease is known as the “wet” stage, and only takes 4-5 days to appear). If your child suddenly started showing signs of Ebola, would you stay away and call someone to cart them off to an isolation center, maybe never to be seen alive again? Or would you do your best to care for them, even if it meant risking your own life? That’s exactly why these outbreaks are so hard to contain.

So why am I writing about Ebola in this Substack?

You may have guessed that I’m not just writing this to teach you the basics of Ebola. I’m writing because what’s happening now is exactly what public health professionals have been fearing since January 2025.

It might not surprise you to know that despite the CDC’s assertion that “ongoing collaboration between CDC and international partners and coordination among U.S. government agencies are essential,” our general approach to this outbreak is better characterized as “America First.”

Now, I don’t want to overstate it. There are brave and brilliant people working at CDC and as part of the Public Health Commissioned Corps who are doing their damnedest to help control this outbreak, and protect people in the DRC, Uganda, and elsewhere, not just the US. But the Trump administration is sending these folks there with a new policy: The Wall Street Journal reported last week that the U.S. was planning to construct a makeshift field hospital in Kenya for Americans exposed to or infected with Ebola. Until now, Americans who were infected with Ebola (or any other similar terrible disease) would be brought back to the U.S., so they could receive the best possible medical care. And actually, U.S. citizens have an unqualified constitutional right to enter the United States, per a landmark Supreme Court decision made way back in 1898.

A group from the prestigious O’Neill Institute at Georgetown (many of them members of Defend Public Health, the group I’ve been working with for the last 15 months or so) wrote a letter with profound concern about the plan to relocate Americans to Kenya:

US taxpayers have invested more than a billion dollars to build a network of biocontainment units in major hospitals across the country. These are intensive care units that are engineered to provide maximum biocontainment coupled with the highest standard of care. They require years to design and build and extensively trained staff to safely execute complex clinical interventions without risking self-exposure. The safety record is clear: zero onward transmission to healthcare workers has occurred in these units. Every Ebola patient treated in a US unit survived due to the heroic efforts of the highly trained clinical care teams treating them. In the proposed Kenyan facility, US citizens would be in a makeshift facility that almost certainly cannot provide a level of biocontainment or security comparable to that of a US unit. It would be staffed by personnel with only minimal training, which is insufficient for ensuring robust infection control, adequate biosafety and biosecurity, and high-quality care.

Remember those brave members of the US Public Health Commissioned Corps? They get deployed places, whether they like it or not, similar to the military – they are active duty non-combatant personnel. So some of them are getting sent to Kenya to take care of Americans sent to this new make-shift facility. WaPo reported that in some cases, just three days of training are being offered to them before deployment. Sure, they have public health training. But most of them are not Ebola experts. How would you feel about three days of training before being sent into an Ebola hot zone to provide medical care, if you weren’t already an expert in Ebola??

As the Director of the WHO Center on National and Global Health Law wrote in an editorial on MedPage Today, “Replacing specialized domestic hospitals with a hastily erected facility at a Kenyan air base risks American lives. The Bundibugyo is a rare virus strain for which there are currently no approved vaccines or targeted therapeutic treatments. Managing it relies on high-level supportive care….expecting PHS personnel -- many of whom are being deployed rapidly into a fluid environment -- to maintain rigid Level 4 biocontainment protocols in a temporary field hospital is unrealistic. The risk of occupational exposure for frontline staff is unacceptably high. If an infection control breach occurs, PHS staff could be exposed to a highly pathogenic virus. The administration is compromising patient outcomes and workforce safety to keep the virus physically off U.S. soil.”

Not to mention, remember that MMWR article that said the outbreak will likely remain pretty small, as long as ≥70% of people with Ebola are identified and properly isolated? What do you think happens when you tell people they’ll be forced to go to a hospital in Kenya that was built in a week, if they are exposed to Ebola? Do you think they’re going to speak up the minute they know something’s wrong? If they knew they’d be able to receive the best possible care at one of the biocontainment centers in the U.S. built and maintained specifically for this purpose, they’d speak up right away so they could benefit from that stellar care. In this situation? They’re much more likely to wait and cross their fingers, until they can’t avoid it anymore…or try to get themselves back to the U.S. before anyone realizes what’s happened. This is life or death. Any of us would be inclined to do the same.

I believe that career scientists at the CDC really believe that “ongoing collaboration between CDC and international partners” is “essential,” and are doing their best to act in a collaborative manner. But they’re being undercut by an executive branch that is sending a message that Americans are too important to take on any risk from Ebola—despite our state-of-the-art facilities that have already been proven to be able to treat people with Ebola in them safely—and so we’d prefer to send them to your country instead. Implied (barely): Because you’re less important than we are.

Kenya isn’t taking this lying down. Last week, U.S. officials went on record saying that the facility would only be open to Americans, and any Kenyans (or others) who fell sick with Ebola would be out of luck. The facility was supposed to actually open this week. But a Kenyan court temporary blocked it from opening, pending another hearing that isn’t even going to be scheduled until June 23^rd. The court ordered Kenya’s government to provide details of the agreement it struck with the U.S. over the facility, including financial agreements and whether it would be open to all nationalities, or kept exclusive to Americans.

So at least for now, we’ll have to fly Americans home if they become exposed or sick—or send them to another country willing to take them in, and pretend it’s because of the shorter flight time. Meanwhile, we’re pulling that old “travel ban” out of Trump’s toolkit of favorite harmful and ineffective policies: rolling out new entry restrictions that say that if you’re not a U.S. citizen and have been in the DRC, Uganda, or South Sudan, then you can forget coming to the US. If you’re a U.S. citizen, the new rules say you can only re-enter through Dulles (Washington D.C.), Atlanta, JFK (New York City), or Houston. That sounds reasonable, since presumably people at those 4 airports would be specially trained, and on high alert to make sure Americans stay safe. That’s what all this is about, right? Except this policy was announced on May 21, and on May 24 Laura Kelly arrived to Dulles after having been in Uganda, and no one gave her a second glance. (Spoiler alert: Laura Kelly is white.) So this strategy is going great so far.

The real tragedy?

Here’s the bottom line: We live on an interconnected planet. There are about 50 million airplane seats that fly internationally every single week, and if you’ve flown internationally in the last decade or so, you know that a huge percentage of those have a human sitting in them. Viruses don’t care about international borders, and they don’t care what passport a human body holds when they have the chance to invade. The best way to keep Americans safe from deadly infectious diseases is to invest in international public health infrastructure that keeps people safer everywhere. But despite a long history of the U.S. government doing exactly this, Trump and his cronies have spent the last 18 months doing exactly the opposite.

Let’s start with USAID. Before being dismantled in 2025, USAID used to run the U.S.’s Disaster Assistance Response Team (DART) program, which served to integrate and coordinate the response of USAID, CDC, the State Department, the Department of Defense, WHO, and any other countries’ Ministries of Health during a disaster. In the 2018-2020 Ebola outbreak, USAID managed funding for disease surveillance, lab testing, and investigation of cases and their contacts who may have been exposed, plus oversaw awards to partners in the DRC to help strengthen their systems and bring the outbreak to a close as quickly as possible. Now that there’s no USAID, it’s unclear whether a DART could or would be established and sent to deal with Ebola this time.

Plus, starting in 2009, USAID’s Emerging Pandemic Threats program had been running a project called PREDICT, which strengthened global capacity for early detection of viruses with pandemic potential. The real irony here is that Trump ended PREDICT in…wait for it…March 2020, during his first time in office. MARCH 2020! (On April 1, when half the country was sheltering in place, they got a $2.3 million dollar extension for 6 months as an emergency measure, and then that was it.)

PREDICT actually helped discover an emerging strain of Ebola—Bomboli ebolavirus—in 2018. Might it have been helpful in detecting this current outbreak before it had already gotten so far out of hand? I’ll let you draw your own conclusions.

USAID fell victim to Elon Musk’s chainsaw. Public health professionals were screaming as loudly as possible that the dismantling of USAID and other public health infrastructure at the hands of DOGE was going to spell disaster in the future. And here we are. Defend Public Health’s Tara Smith recently put it very well in an op-ed on MS Now:

In February 2025, Elon Musk admitted the Department of Government Efficiency had accidentally canceled Ebola prevention. He said it was restored “immediately,” but government documents show otherwise…[and] funding from the U.S. Agency for Intentional Development was cut from $1.2 billion to $715 million. In the first three months of fiscal 2026, USAID sent just $67 million. And the Trump administration’s withdrawal from WHO in 2025 reduced the organization’s funding, further hobbling efforts in the area and leaving the U.S. on the sidelines.

It’s not just USAID that’s gone, or the WHO that’s been partially hobbled by our selfish federal policies. In 2024, the U.S. provided $33 million in aid directly to the DRC, to help prop up their health and social sector systems. In 2025, that number fell to less than $10 million. Some people say that the DRC needs to take care of their own country, and shouldn’t be relying on the United States. But here we are back to the point about being an interconnected planet. Withdrawing that much aid that quickly caused a cascade of problems that severely weakened the DRC’s infrastructure.

And now the Ebola outbreak in the DRC in 2026 is everybody’s problem.

If you were one of those people who heard about USAID and thought, “Well, we shouldn’t be putting our hard-earned tax dollars overseas anyway, we should be spending them on Americans at home,” how do you reconcile the fact that the money “saved” by dismantling USAID has been spent bombing schools and endlessly negotiating the opening or closing of the Strait of Hormuz, while the price of gas skyrockets?

Maybe, for whatever reason, the now-defunct impact of USAID on people worldwide isn’t compelling to you. If you need some other comparisons to get a sense of scale here, the NY Times did a pretty great interactive article on this, at the 2-month anniversary of the war. Spoiler alert: this graphic sits at the top of the page:

The Guardian also did some comparisons of the money being spent in Iran, and how that money might instead be spent on social services. They looked only at the $12.7 billion dollars spent in the first six days of the war in Iran:

To me, the size and speed of money spent is mind-boggling. Just this morning, while I was writing this post, the acting comptroller of the Pentagon testified to the House Appropriations Committee that today’s official estimate of money spent is now closer to $29 billion. (Many credible people have claimed repeatedly that this official spending estimate is likely a serious undercount of the real costs.) We’ve also got a White House that submitted a request for $1.5 trillion in military spending for FY2027, the largest request in US history, and a “sizeable increase over last year’s budget,” according to the Pentagon’s own comptroller—a 42% increase over this fiscal year’s budget, to be precise.

Sure, that’s just a budget request. Congress might not approve it. But the $29+ billion spent—and the billions surely about to be spent—on this fight with Iran aren’t a request. That’s money that’s already gone out the door.

But I’m not here to talk about politics in general, I’m here to talk about its effect on health. We all know how money works. Military spending comes at a cost of other things. How is this record-setting military spending being offset? By cutting funds meant to support the health of Americans (including, by the way, American military families.)

The President’s proposed budget has a requested 42% increase in military spending for FY2027, and also called for $73 billion in cuts to domestic programs, including eliminating many of the health, education, and housing programs that millions of Americans rely on to keep their heads above water financially.

7 in 10 Americans say more taxpayer dollars should be spent to advance science and technology in the US. Yet this budget proposes to cut $5 billion from the National Institutes of Health (a 12% reduction in its budget), and the Administration has already cut $150 million from ARPA-H, a 10% cut even before the FY2027 budget is passed. ARPA-H, or the Advanced Research Projects Agency for Health, is a federal funding agency designed to accelerate biomedical and health breakthroughs. Related, thanks to the Trump Administration, China officially surpassed the US in R&D spending this March. These decisions being made to damage science in the US have widespread and long-lasting implications.

OK. Maybe you don’t care if China becomes the most innovative and most powerful research entity in the world, leaving the US in the dust. How do you feel about our life expectancy?

Paul Krugman from the NY Times explained this very well:

Most Americans appear to be unaware of the fact that life expectancy in the United States is substantially lower than in other advanced countries; we’re on a par with poorer nations in Europe like Albania. Surely even fewer people know that this wasn’t always true. In the early 1980s Americans lived about as long as citizens of other rich nations. Now we die substantially earlier:

Maybe you think Paul Krugman cherry-picked France to make us look bad? You can see for yourself. The United States currently ranks #62 in countries for our life expectancy, behind not just France and almost all other European countries but also the United Arab Emirates, Bahrain, Costa Rica, Chile, Panama, Oman…and yes, Albania.

Surprising no one, the budget also proposes (again) to eliminate the National Institute on Minority Health and Health Disparities (NIMHD). Because if you don’t study health disparities, that makes them disappear! (Except no. Unfortunately it just makes them unmeasured. In fact, it will undeniably make them worse.)

These aren’t all future problems. The One Big Beautiful Bill Act was signed almost a year ago, and has already set into motion cuts to federal Medicaid that are projected to be $911 billion by 2035. These cuts were engineered to mostly hit after this year’s midterms, to delay any political fallout, so the biggest pain is still coming. Regardless, many safety net hospitals are already struggling financially. KFF Health News found some hospitals projecting deficits of $80-$100 million just next year; this is the kind of thing that closes hospitals and makes people have to travel dangerous distances for emergency, life-saving care. If you live in a rural area or a low-income part of a city, this could be you—if you suddenly had a heart attack, you would be more likely to die trying to get to a hospital that’s far away.

One of the major problems facing public health is that we are victims of our own success: when public health professionals succeed in their jobs, everyone is healthy and none the wiser. Success equals invisibility, and unfortunately invisibility equals cuts in funding. Then without adequate investment in public health infrastructure, we have a deadly disease outbreak or a natural disaster or teen pregnancy rates skyrocket or people start dying from drug overdoses in devastating numbers, and then suddenly we declare an emergency and the money flows again. This happened during COVID, remember? But our attention spans are short, and that flow of money has already been turned off. Treating public health with this “cycle of panic and neglect,” as pediatrician and California State Senator Richard Pan said to The Guardian last month, is a problem. “We don’t do that to the fire department,” he said. “Public health is part of public safety, and we need to have a baseline of support for that…[it’s] a core function of government”. (Or at least it used to be seen that way.)

So…what?

It’s not enough that we just complain about what the Trump Administration is doing; we need to propose actionable, meaningful alternatives. On April 6, Defend Public Health—a group I volunteer with that is working to protect public health infrastructure from the Trump Administration’s anti-science actions—launched guiding principles for political campaigns that want to prioritize public health, called the People’s Health Platform. This platform highlights the importance of ensuring healthcare for all; restoring scientific integrity; protecting and expanding sexual, reproductive, and gender-affirming healthcare; recognizing the dire threat pollution and climate change pose to life and health; preparing for the next pandemic; and taxing billionaires so we have enough money to build a strong public health infrastructure that keeps us all safe.

Give it a read. Share it with your representatives, or the politicians you hope will represent you after the midterms. Volunteer to help turn the tide. Where our government spends our taxpayer dollars matters a lot. If they’re spending it on bombs to drop abroad instead of improving lives at home, that’s bad for everyone. Public health means the health of all of us. We all need to demand change, before even more damage can be done. Join me in speaking up today!

If you’re not someone who works in public health, then you might find the constant reversals with the Iran negotiations and the Strait of Hormuz to be surprising (though probably not). To those of us in public health, it’s just another day, because this absurdity is part of the professional water we swim in now. That’s actually part of the strategy. And it’s exhausting.

Lest you think I’m being hyperbolic, here are just a few examples of the public health-related news in the last few months that have given many of us professional whiplash:

Jan 13, 2026: The news broke that almost $2 billion of funding to the Substance Abuse and Mental Health Services Administration (SAMHSA) was being immediately rescinded, slashing overnight more than 2,000 programs designed to support Americans struggling with mental health or substance use issues. These programs included:

• 417 programs aimed to prevent suicide,

• 465 programs addressing alcohol use

• 351 programs supporting mental health for Americans living with HIV

• 218 programs for Americans with depression

• 573 grants focused on mental health and substance use services in rural areas

Perhaps you think these cuts are justified because there have been such great improvements in mental health and substance use in this country recently! No. That is incorrect. The U.S. still has the highest rate of overdose deaths of any country in the world, by a lot. Our overdose rate is about 13x that of Germany, and almost 5x that of Australia. We also win the gold medal for having the highest suicide rate of any high-income country, at 14 deaths per 100,000 people—double the rate of the United Kingdom, for example. When the National Bureau of Economic Research compared suicide rates in 16 economically comparable countries, 12 experienced reductions in suicide rates from 2000 to 2020, and of the four that didn’t (the U.S., the U.K., the Netherlands, and Brazil) the U.S. had by far the biggest increase in suicide rate over that time. And by SAMHSA’s own data, among the 4.8 million people with in the U.S. with an opioid use disorder, less than 1 in 4 receive medications designed to help them stop or stabilize use. Seems like a great time to cut $2 billion of funding to address these dismal statistics! With a form letter, no less, that said nothing more than that the funding termination was “effective immediately,” because the services “no longer aligned with the agency’s priorities.”

Jan 14, 2026: After about 36 hours of panicked advocacy from many thousands of public health professionals raising the alarm about these eliminated funds—I cannot express how many emails, text messages, and social media posts flooded into my life during that window—an HHS official told the press that never mind, the money was being restored. No reason given.

“These are cuts he should not have issued in the first place,” Representative Rosa DeLauro (D-CT), the top Democrat on the House Appropriations Committee, told the New York Times. “This episode has only created uncertainty and confusion for families and health care providers.” Ya think? It took a few days for everyone to recover from that whiplash.

Feb 4, 2026: News started to leak that the White House had instructed CDC to rescind $600 million in public health funding from California, Colorado, Illinois, and Minnesota, because of vague concerns about “waste and mismanagement.” Or perhaps less vague concerns about those states being led by Democrats who were speaking out against Trump? Again, panic. These planned cuts, which were confirmed by multiple sources over the subsequent week, were mostly to state and county public health departments. They were funds that were meant to modernize data systems, manage disease outbreaks, and pay for staff who oversee programs meant to keep the most vulnerable citizens safe. Almost immediately, the attorneys general of those four states sued the Trump Administration, claiming the cuts were politically motivated and illegal.

Mar 12, 2026: A federal judge agreed, issuing a preliminary injunction that blocked the cuts until the case could fully be adjudicated, noting that “Plaintiffs are likely to succeed on their claim that OMB’s targeting of them for HHS cuts…is arbitrary, capricious…” He also said “the harm to plaintiffs from OMB’s effort is irreparable and intangible. Plaintiffs are sovereign states, equal to the other states of the Union. To undermine one set of states that are similarly situated to other states inflicts intangible harm to the established system of governance. The loss of capacity to fund and maintain public health infrastructure puts the health of plaintiffs’ residents in jeopardy.” Agreed. More panic averted. At least for now. But these were (are) profound cuts, only temporarily stopped, and it was a very stressful 5 weeks while people in these four states prepared for the dire impacts.

Feb 3, 2026: The FDA issued a letter to Moderna letting them know it was refusing to review their application for a license for their new mRNA influenza vaccine. Why is this such a big deal? As Jonathan Cohn explained well, “This was not a decision to reject the Moderna vaccine. It was a refusal even to think about approving it. The FDA rarely takes such a step, and when it does it’s usually because an application is missing a whole component or includes suspect data. Nobody is suggesting Moderna’s application has those kinds of issues.” So what happened leading up to this letter in February?

Well, in April 2024, Moderna sent the FDA their proposal for testing its new vaccine. They spelled out the clear plan for testing the vaccine. The FDA reviewed the proposal and noted that for people over age 65, the new mRNA vaccine should be compared to the high-dose influenza vaccine (as recommended by CDC for people in that age group), not the standard dose. The problem was that Moderna was testing the vaccine in Europe, where the high-dose influenza vaccine wasn’t readily available. Moderna and the FDA agreed that if they proceeded with comparison to the standard dose in all age groups, then their new vaccine might not be recommended by CDC for people age 65 and older, but that the FDA would still review their submission. This was explicit. In writing. And typical of this kind of process. Moderna invested an estimated $500-$700 million to develop and test this vaccine, with this commitment in place.

In August 2025, the results of the Moderna trial were in: The mRNA vaccine was 27% more effective at preventing symptomatic cases of flu and 49% more effective against hospitalization when compared to the standard-dose vaccine now commonly used. At that time, the FDA said the trial had been properly conducted and encouraged the company to apply for licensure after such promising results. Importantly, Moderna had gone an extra step and performed an additional study in 2,200 people over age 65 comparing the levels of protective antibodies compared to the high-dose vaccine. (The mRNA did, indeed, induce significantly higher levels of antibodies to flu in that age group, even when compared to the high-dose vaccine.) This was great news! Our current flu vaccine isn’t fantastic. It’s better than nothing (and I, for one, get my flu shot every year—as should you!) but it’s slow to make, and we could do better with the antibody protection it offers.

Your Local Epidemiologist summed up the issue very well, so I’ll just quote her:

Flu vaccines help, but they’re far from perfect. In most years, they reduce the risk of hospitalization by roughly 40–60%. (To compare, the measles vaccine is 97% effectiveness against severe disease). Flu changes quickly, which means innovative vaccines are needed.

There are two potential advantages of mRNA technology:

1. Speed: mRNA vaccines can be updated much faster than traditional flu vaccines (3 months vs. 6 months), so they could catch up to flu mutations more quickly.

2. Immune response: Early research suggested stronger immune responses, including T cell and memory B cell responses that were comparable to or stronger than those from enhanced flu vaccines used in older adults.

Feb 11, 2026: The news broke that FDA staff responsible for reviewing these applications had in fact planned to proceed with the review when FDA Center for Biologics Evaluation and Research Director Vinay Prasad overruled them, and unilaterally sent the “refuse-to-file” letter to Moderna. This is not how this is supposed to work. In fact, David Kaslow, the head of the FDA’s vaccine office, wrote a detailed memo explaining why the FDA should review Moderna’s application. But he was not in charge, Vinay Prasad was. That same day, the Wall Street Journal (not exactly known for its progressive takes) published a headline that read: “Vinay Prasad’s Vaccine Kill Shot: Does the White House Know the Harm He’s Doing to Public Health?” Inside the article, the author wrote, “This is arbitrary government at its worst.”

OK, but Prasad was in charge. Why is it such a big deal that he made this decision?

1. Regulators similar to the FDA in Europe, Canada, and Australia have all accepted Moderna’s application for review. This means people who live in Europe, Canada, and Australia are likely going to be able to get a new, faster, and better flu vaccine soon, and in the U.S. we’ll be stuck with the old version.

2. It is well accepted that continuity matters in places like the FDA, despite the change in political leadership in the U.S. every 4-8 years. This is because vaccine and drug development is a slow process. Most vaccines and drugs we benefit from took 5-10 years to develop. Companies invest hundreds of millions of dollars to develop something new, which is why they discuss and negotiate with FDA along the way—if their product ends up to work like they hope, then they want to make sure their application gets reviewed and their product gets FDA approved, so it can be used in the U.S. (and sold in the U.S., helping the company recoup its investment). If a political appointee can just overrule career staff and normal processes without good reason, then companies will no longer have an incentive to invest hundreds of millions of dollars. This hurts medical innovation, which ultimately harms our future health.

Feb 12, 2026: Moderna announced it’s pausing new Phase 3 trials for their other infectious disease vaccines, including vaccines being tested to protect against Epstein-Barr virus, herpes, and shingles. These are viruses you don’t want. But again, if companies think their hundreds of millions will be for naught because someone appointed by Trump doesn’t like vaccines, well, then we’re not going to see newer and better vaccines coming to market. That means we’ll be stuck with older, less effective vaccines—or no vaccine at all (like is currently the case for Epstein-Barr virus and herpes).

Mar 6, 2026: FDA Commissioner Marty Markary announced that Vinay Prasad was out as Director of FDA’s Center for Biologics Evaluation and Research. Again. I am celebrating this. (Again. Talk about whiplash.) But the damage is done. What does it mean for you? In the short term, this fall you’re going to get access to the old version of the flu vaccine. You should still take it. But in the long term, we need a turnaround from FDA or all of our access to newer and better vaccines will suffer.

This nomination comes after a long wait and a lot of leadership swirl.

Under the Federal Vacancies Reform Act of 1998, top federal posts can only be filled by people in “acting” roles for 210 consecutive days, unless there is a nominee pending confirmation. (If a nominee is rejected by the Senate or their name is withdrawn from consideration, the 210-day clock restarts.)

It was August 27, 2025 when Dr. Susan Monarez was ousted, only a few weeks after she was confirmed by the Senate and sworn into office. That started the 210-day clock ticking. But 210 days came and went this past March 25, and the White House missed the deadline to nominate someone new.

Word on the street was that the missed nomination wasn’t for lack of trying—the White House literally could not find a single person who both had the credibility to pass Senate confirmation for such an important role and was willing to serve as director under HHS Secretary RFK Jr., especially after he fired Monarez for refusing to sign off on every recommendation for the Advisory Committee for Immunization Practices (ACIP) “regardless of scientific evidence.”

Dr. Jay Bhattacharya—who is also heading up the NIH, headquartered in Rockville, MD, a 10-hour drive or 90-minute flight from CDC’s Atlanta headquarters—has continued to serve as CDC’s acting director, even after the deadline passed. This wasn’t great, because past courts have struck down the actions of officials who were found to be unlawfully serving due to things like the Vacancies Act. So bottom line, the Trump administration needed to find someone willing to be nominated for that post, or they wouldn’t be able to make public health-related decisions that could survive a court challenge.

Everyone sees the midterms on the horizon.

Some might argue that this administration doesn’t seem to care very much about court challenges, and whether they win or lose them. That might not be enough motivation in itself. But like members of the Senate, the Trump administration is very aware of the upcoming midterm elections, and the danger that could pose.

Increasingly, RFK Jr. appears to be seen as a liability in that fight. While a lot of people like his stances on removing dyes from food, reducing ultraprocessed foods from the average American diet, and limiting our exposure to environmental toxins, there are a lot fewer people on board with Kennedy’s anti-vaccine stance. (Yes, there is a very loud contingent of people who are 100% Team RFK when it comes to vaccines, but when it comes down to it the data show that the majority of Americans understand vaccines save lives, and want their ability to get vaccines to be protected.) Even much of the MAHA movement is starting to turn against RFK Jr., as they realize that RFK is supporting the Trump administration in taking actions that undermine his supposed commitment to making American healthy again.

So what does that mean for a new CDC Director? Were they going to try again with someone who aligned with RFK’s positions on vaccines, like their first nominee in 2025, Dr. Dave Wheldon? Or were they going to find someone willing to serve in the post who would go on record saying that vaccines are an important part of our ability to prevent deadly outbreaks of preventable infectious diseases?

We have an answer, and RFK Jr. probably doesn’t like it.

Yesterday, the news broke that Dr. Erica Schwartz was the new nominee for CDC Director, and would soon be up for Senate confirmation.

Dr. Schwartz is a board-certified preventive medicine physician. She got her medical degree from Brown University. She also has a law degree from University of Maryland, and a Master of Public Health from the Uniformed Services University, or USU. (If you, like me, had never heard of the USU, I’ll help you out—it’s known as the “West Point for Health Professionals” and like West Point, students don’t pay tuition, they pay for their education in military service. The emphasis is on military health care, leadership, and public health readiness.) Dr. Schwartz previously served as chief medical officer of the U.S. Coast Guard, and as deputy surgeon general in the first Trump administration. She’s also a retired admiral in the Commissioned Corps of the U.S. Public Health Service, and during the height of the COVID-19 pandemic she was in charge of the federal government’s program of drive-through testing sites.

She’s clearly, and surprisingly, qualified. Perhaps even more surprising, in her social media posts she has repeatedly praised vaccines as a cornerstone of our strategy to prevent the spread of infectious diseases.

OK, but who knows what will happen. Do you, like me, need a laugh?

Yesterday when Dr. Schwartz was nominated, my phone exploded with news notifications, text messages, Slack DMs, and Signal posts. Had I heard? What did I think? What was I hearing? After a long day, a good friend shared with me some reactions that CDC colleagues had to the NY Times headline about Schwartz’s nomination:

One person, likely soon to be working under Dr. Schwartz, sent to the group, “The headline for this NYT article reads like: “Trump to Nominate Scientist who says Earth is Not Flat as NASA Administrator.”

Someone else responded, “Trump nominates new CDC Director who agrees that health is very important for most folks.”

A third chimed in, “Trump nominates CDC Director who has never consumed aquarium cleaner.”

You have to remember, this is a group of people who’ve had an extremely rough last 15 months. Massive layoffs (an estimated 1 in 3 CDC employees have been RIFed since Jan 2025), a mass shooting by someone mad about COVID vaccines, and an HHS Secretary who posted photos from his fishing trip in Alaska in the aftermath instead of making sure CDC employees knew he cared about their safety. Never mind the incessant assault on science and their commitment to protecting the public’s health by making decisions based on evidence.

I wrote back to my friend, “Honestly, snark like this must be 90% of the way you all get out of bed in the morning these days. 🏆”

His response? “Caffeine and adrenaline caused by anger really - but snark by midday to keep me going😃.”

My hat’s off to everyone still surviving at CDC. Dr. Schwartz may not be perfect, but to me she’s a promising sign. I hope her confirmation sails through the Senate and she provides some stable and science-based leadership to you and your agency.

Now excuse me while I go light a candle and make a fervent wish that yesterday’s announcement is a sign of what’s to come, and who’s soon to be swept out to sea. 🤞🏼

But for me, it’s clear that going to a few big protests—while very important—simply isn’t enough. It’s up to all of us to figure out what we can do every day and how we can be part of the resistance to the maximum extent possible. It’s exhausting, but we’re in this marathon whether we like it or not, and ask any marathon runner: marathons are exhausting. So strap on those running shoes and grab yourself some energy gels.

I’m working on my next series of updates for What in the Health?!—they’re coming soon, I promise. In the meantime, especially if you’re a public health professional, healthcare worker, or academic, please take 3 minutes to read this outstanding call to action by Gregg Gonsalves, fellow member of Defend Public Health, in The Nation:

🗣️A Motto for All Health Workers: Resist, Resist, Resist✊🏼

I can’t say it better than this.

That’s not because there has been nothing to post. I’ve just been SO busy with work that I’ve been struggling to find the time. Since January 5 I’ve been to Atlanta, Tucson, Oceanside (near San Diego) and Calistoga (in the Napa Valley) for work meetings—with a bonus side quest to sleep on the floor in the Dallas airport during a snowstorm. My team and I at Facente Consulting have developed and disseminated two major surveys for a project in 7 different languages. We promoted a website we created and launched a social media campaign about last year’s project on medications for addiction treatment in California. We’ve extracted data from hundreds of published studies about Human T-Lymphotropic Virus 1 (HTLV-1) for the World Health Organization. I’ve given 4 presentations, facilitated 16 meetings, and conducted 21 qualitative interviews. I’ve talked to three different reporters who reached out about various topics. Plus I’m now almost halfway through the public health program planning class I teach to about 40 grad students at UC Berkeley each spring semester, to help make sure the next generation of public health professionals has the skills they need to plan effective interventions in partnership with the communities most neglected and harmed by our current health systems and societal structures.

I’m not saying this to brag—I’m trying to convey that even as the funding and support for public health has been yanked away or made increasingly uncertain, the need for public health has only increased. The people I work with every day have done their best to keep their heads down, stay focused on what matters (the people they’re trying to serve), and figure out how to persevere. Whether the government wants to acknowledge it or not, the public needs us and the work we do. We do this because we care, and we’re going to keep showing up as long as we can.

But it’s incredibly difficult to keep showing up amidst a constant onslaught of terrible news, and daily reminders that the people in power don’t care about our health, and are just fine if all the gains we’ve made in public health in the last few decades are erased, destroyed, and denigrated. Sometimes just getting through the day and then going to bed early after a tall glass of wine and 45 minutes of trashy TV is the best I can muster.

I promise you that the reason I haven’t been posting is NOT because nothing important has been happening. In fact, the intensity of the dystopian public health news has been part of the problem. It’s overwhelming. For example:

• The chair of the country’s Advisory Committee on Immunization Practices (ACIP) said that yes, he had some “concerns” that “some children might die of measles or become paralyzed with polio as a result of a choice not to vaccinate” but explained that these vaccines should be optional because “I am also saddened when people die of alcoholic diseases.” (In case you were wondering, this is a terrible comparison and these situations are not at all the same.) By the way, he also said “I don’t like established science,” going on to claim “science is what I observe.” (I can’t even…no.)

• The CDC announced that they were giving $1.6 million to some Danish researchers to experiment on babies in Guinea-Bissau in Africa by randomly denying some of them the hepatitis B vaccine at birth, despite 1 in 5 people in that country having hepatitis B. Guinea-Bissau has decided that starting next year they’ll begin implementing the birth dose of hepatitis B vaccine that just become optional again in the US, to try to better protect babies there. So our government thought “Well, this is a great opportunity to do a natural experiment. Let’s enroll 14,000 babies in this other country and randomize half of them to get the vaccine and half of them to not, and see who fares better!” Appropriately, there was so much outrage about this—including an official statement from the WHO about how unethical this was—that after about 2 months of back-and-forth chaos the government of Guinea-Bissau put a stop to the study.

• Vinay Prasad, the head of FDA’s Center for Biologics Evaluation and Research (aka our country’s top vaccine regulator), continued his controversial reign by sending a memo claiming that the FDA had concluded 10 children had died from the COVID-19 vaccine even though that was false. He also single-handedly overrode staff scientists at FDA by refusing to even review Moderna’s application for an mRNA flu vaccine in the US, even though they had followed the agreement already made by Moderna and FDA for seeking approval. (What this means for you: you’ll continue to only have access to our mediocre flu vaccines in the near future, instead of a considerably more effective mRNA vaccine.) But then after doing all this damage he apparently got fired (again!) so that was a glimmer of good news in the darkness.

• The Trump administration announced they were cutting $2 billion of funding for mental health and substance use services in the US and mailed out grant termination letters to more than 2,000 addiction and mental health programs around the country, only to reverse themselves one day later because there was so much outrage, including from Congress. (Imagine that! Our Congressional representatives do have power when they choose to use it!)

• HHS also announced they were cutting $600 million in CDC grants to four blue states—Minnesota, Colorado, Illinois, and California—that support local health departments and the vast majority of HIV prevention services in those states. The attorneys general in those states immediately sued over what was seen as an illegal, politically-motivated move, and a federal judge granted a temporary restraining order to prevent cuts while the case is being heard, but meanwhile the termination letters still went out to 66 public health agencies.

• The US officially withdrew from the WHO, then proposed replacing most of the WHO functions with something that will cost us much more than our WHO participation did. (Never mind public health, what a great business move!) This prompted California, New York, Illinois, and New York City to join the WHO themselves via the Global Outbreak Alert & Response Network (states and cities can’t be full members of WHO).

• The Trump administration announced a new rule (or more precisely, an expansion of what’s known as the “Mexico City policy,” which Trump reinstated a year ago) that no federal dollars can be spent on any organization that does anything to “promote DEI” or acknowledge that trans people exist—even if our tax dollars aren’t used for those purposes. A recent analysis by KFF estimates that nearly $40 billion of US foreign aid in 160 countries could be withdrawn over this new rule, on top of the damage that’s already been wreaked by this country on foreign health systems in the last year.

Oh, and perhaps you’ve heard that our country has an increasing number of massive measles outbreaks? This includes outbreaks in multiple ICE facilities, including our largest one two days ago, known as [Concentration] Camp East Montana. Did you know that ICE has a Health Service Corps? Their mission used to be to “Provide the best healthcare delivery system possible, to deliver high-quality healthcare to those in ICE custody.” Now, per their website, they are the entity within ICE responsible for “assessing aliens’ fitness for travel as they prepare for deportation.” Think about that. Measles is the world’s most infectious known pathogen. People with measles are supposed to be immediately isolated to prevent it from spreading like wildfire. But our government is warehousing people and then forcibly relocating them to other countries while they are potentially infectious with a deadly pathogen. (Yes, they are now isolating people who are known to be infected, but the damage has already been done.)

So you can see, it’s a tough time to work in public health. It’s a tough time to be a member of the public, honestly, because all our health will suffer because of these decisions being made by our government, whether or not we’re personally feeling the pain yet. I, for one, am taking a vacation starting tomorrow. I’m burning out, and if I don’t take some time away to recharge then I won’t be able to help anyone else.

Week after next I’ll be back, refreshed and striving to post more often, including deeper dives on most of the things I just touched upon above. I believe communication is power, especially under a regime that is working hard to suppress our free speech and clog our communication channels with distractions and disinformation. So I’ll be back to it soon.

In the meantime, take care of yourselves, and each other. ❤️

I try very hard to stay in my lane when it comes to this Substack. I have experience and expertise in public health. I might have knowledge and opinions about various political issues (oh, I promise you, I do) but there’s a difference between having an educated sense about what’s happening and having expertise about it.

I have mentioned immigration a few times here, in ways that tied directly to public health. And, like many of you, I have been feeling overwhelmed and distraught by the activities of ICE under this Trump/Noem/Miller regime for the last weeks (months…year) and especially since they’ve begun blatantly murdering people in the streets of Minneapolis, with apparent immunity. I haven’t known what to say, and whether it was my place to write about it.

But, in the last day or two it’s really crystallized for me: it IS my place to speak up. Violence is a public health issue, including when it’s state-sanctioned. And that aside, it’s ALL of our place to speak up right now, and we need to do it. Now. In the biggest numbers we can muster, with the loudest voices we can find.

There are epidemiologists and other public health practitioners who specialize in gun violence, intimate partner violence, and police brutality. There are those who study torture and war and the violence of dictators in countries outside the US…and now there are people studying ICE and the damage their activities are doing to our neighbors and communities.

The videos of the senseless and completely avoidable murders of Renee Good and Alex Pretti in Minneapolis have been shocking, and—appropriately—have caused an uproar around the country (and the world). Almost as revolting are the bald faced lies being told by this administration, showing no remorse at all for the death sentences that their ICE agents have unilaterally chosen to impose upon Americans not committing any crime. (If you think either Renee Good or Alex Pretti were committing a crime, I must believe you haven’t watched the videos with your own eyes and ears, and have only listened to the talking points of Trump and his goons.)

But it’s not just Renee Good and Alex Pretti we need to be talking about. A person who’s here without documents allowing them to be here legally doesn’t deserve to die by the hands of the government either. That’s a civil offense, and punishment is never the death penalty. Yet since Trump’s inauguration day on January 20, 2025, there have been 27 reported shootings by ICE agents resulting in 8 deaths. At least 32 people died in ICE custody in 2025. And of course, this is only the people being killed by this masked gestapo of untrained people being told they have absolute immunity. Once we talk about families being torn apart, small children being detained, the trauma of watching your preschool teacher be dragged out of school or a disabled woman being dragged out of her car screaming…it just gets worse and worse. In the last day or so there’s been much news about Greg Bovino being removed from his role after the disasters in Minneapolis (though let’s be real, it’s the optics they’re concerned about, not the killing). Sure, this feels like a win, except when you realize it’s a shell game and he’s being replaced with someone who’s known to be at least as bad. There’s no regret here. No desire to change.

People who work in public health are toiling to gather data, design interventions, and change structures to prevent future victims (and perpetrators) of violence. When it comes to something this big, this brutal, and this encouraged by the government that’s supposed to protect us, well, it’s hard to know what to do. For me—not a violence prevention expert—it feels like a time to take my cues from others, connect with my community, and speak out loudly against this.

Yesterday I came across a post on Substack that stopped me in my tracks. If you’re feeling a bit overwhelmed and helpless like me, I hope you find inspiration and power in this like I did. Teri Leigh wrote:

I’m writing this from Minnesota.

These are just a few things that may not be making the national or international news.

• a beloved local donut shop Glam Doll Donuts across the street from where Alex Pretti died turned into a warming house and medic center for protestors building and maintaining the memorial site.

• a 70yo independent bookstore owner DreamHaven Books down the street expressed his pain on camera, walked through a tear gas cloud, and his website crashed less than 24 hours later from too much business and donations.

• the day after tear gas bombs destroyed a N-Mpls neighborhood sending a 6mo old baby to the hospital, at daybreak, a small church community cleaned up the mess of pepper balls, tear gas containers and trash so the neighbors didn’t have to wake up to the memories.

• a local independent journalist Mercado Media pounding the streets everyday reporting things from the ground had a testicle removed and showed up two days later to walk with 75,000+ community members to walk the streets in -20 degree weather.

• a local sex-positive adult-store The Smitten Kitten has completely transformed into a donation and distribution center.

• a local pizza place Wrecktangle Pizza raised over $83K in less than a few days to support families that are sheltering in place.

• tow-truck companies are donating their services to clean up the accidents and abandoned vehicles left by ICE and the city is waiving impound fees.

• local multi-faith spiritual leaders are spearheading sit-ins at corporate headquarters such as Target and USBank to have deeper conversations with CEOs and boards of directors about community relief.

• social workers are taking in children who came home from school with both their parents “disappeared.”

• animal shelters and pet-fostering agencies are rescuing pets left alone for days or weeks after their humans were detained.

• every restaurant, church, karate dojo, dance studio, school, barber shop, and other small business has created their own underground grassroots supportive network to protect their neighbors, get people to and from work, and raise funds to pay everyday bills.

• women who are moms and work full-time jobs are donning reflective vests in shifts to stand watch at bus stops, city parks, and grocery store parking lots in sub-zero temps to bear witness before going home to tuck their babies in at night.

• the MN National Guard offered donuts, coffee, and hot cocoa to peaceful protesters the day after Alex Pretti died, reminding community that we are all in this together and they are here to keep the peace.

These are just a few examples. Stories like this are happening in the hundreds here, every single day!

Community is EVERYTHING!

We can do this. We can come together, and care for each other. We can undermine the government by not playing into their goal to divide us and beat us down. I, for one, have joined a neighborhood Signal group, and been trained by a local organization to recognize and respond to ICE in my community. I’ve hung some ACLU red cards in the Little Free Library in front of my house, and have been so pleased to see that neighbors have been replenishing the envelope every time it empties.

Community is everything, but just showing love for each other won’t be enough. Here are some other things we all can do:

1. Follow this important advice from Katelyn Jetelina (Your Local Epidemiologist) who is an honest-to-goodness gun violence epidemiologist: “Take care of your mental health. Do not keep watching the videos of the victims…we have so much literature in gun violence research showing that media exposure results in numbness, nightmares, anxiety, and all the symptoms of PTSD.”

2. Do watch this video from L.A. Taco (an independent media organization) with tips about recording ICE if you see them, and keeping yourself safe when you do it.

3. Watch this video, too, from Witness Media Lab, to learn how you can use videos to protect the people you film (not ICE, of course, but the people they’re going after).

4. Call your senators immediately and urge them to block funding for DHS and ICE until there are measures put in place to ensure they are held accountable for unlawful behavior—and that they’re unmasked, and trained to avoid this unlawful behavior in the first place. I’m not going to pretend that our police and military are people who always do the right thing and never break the rules to harm others. Rules and training aren’t everything. But these ICE agents are vigilante squads being supported to trounce civil liberties and blatantly violate human rights. It must stop, and we need Congress to stop it. As the coalition Defend Public Health (of which I’m a member) has said: “This is a public health emergency, traumatizing entire communities and making residents afraid to seek medical care for fear of being kidnapped or killed. With FY26 funding on the line this week, it is time for the U.S. Senate and Congress as a whole to take aggressive action to stop the assault on Black and brown people in our communities.” Call the congressional switchboard at (202) 224-3121 to be connected to your Senators’ offices. If you need help figuring out what to say, here are some great statements from Nurses for America, the American Association of University Professors, National Nurses United, and AFSCME (the American Federation of State, County and Municipal Employees).

Hang in there. Stick together. Use your voice. Use whatever privilege you have. Care for your neighbors. Let them care for you, too. We must persevere.

What other suggestions do you all have of other actions we can take?

We are not Denmark.

Children in the United States need all the vaccines that were on the prior schedule, because that’s what actual science says keeps them safe.

It’s anti-vaccine ideology that says we need to get rid of vaccines from the childhood vaccine schedule, which the US government unilaterally did this week, stepping over the vaccine scientists at the CDC who are supposed to oversee this.

If you believe this will make children safer because they receive too many vaccines today, you have been misled.

Unfortunately an anti-vaccine activist was nominated to be Trump’s Secretary of Health and Human Services, and Congress confirmed him to the post.

What’s happened now is exactly what people predicted would happen.

Children in this country will die unnecessarily as a result of these actions.

There’s just not much else to say.

P.S.: If you are a parent (or planning to become one) and are worried about the implications of this vaccine schedule change for you or your family, there’s a great FAQ from Your Local Epidemiologist here that will hopefully assuage some fears about vaccine access.

What are the latest battles in the war against trans people?

• On Wednesday, the House passed HR 3492, sponsored by outgoing GOP Rep Marjorie Taylor Greene, which if passed in the Senate and signed into law would (1) subject healthcare providers to up to 10 years in prison for providing gender-affirming care to minors, and (2) would criminalize parents who help their children access gender-affirming care, even if determined to be medically necessary in discussion with their child’s doctor.

Before I continue, let’s get something clear. Gender-affirming care for young people mostly consists of mental health supports and hormone blocking medications to prevent usual body changes experienced during puberty. Major medical associations, including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry have supported such care. They universally agree that gender-affirming care is clinically appropriate and can be lifesaving treatment for both children and adults. Professional medical organizations do not recommend surgery for children as a part of care, and research shows that it’s rare among transgender or gender-diverse teens. If you thought otherwise, that’s because the Republican talking points on this issue are meant to mislead you.

You don’t have to like this idea of gender-affirming care for young people. You don’t even have to understand it, to get on the right side of the fence. If like me you’re a parent, you most likely want whatever’s best for your kid(s). Parenting is really hard. It’s often very difficult to know what to do when complicated situations arise with your kids. Very often there’s no clear answer, though there is no shortage of overconfident people who are happy to tell you that they know what’s best, and that you’re not doing it right. The parents I know who have trans or non-binary kids spend a lot of time talking with them and thinking about what’s best—usually involving talking together with their pediatrician to discuss options and next steps to take (or not). But these moves by the feds—the very people who talk about needing smaller government and more parental choice when it comes to things like vaccines—are designed to prevent parents from having choice. HR 3492 literally tries to criminalize both doctors and parents who try to make choices the government doesn’t like. Imagine if the government tried to criminalize doctors and parents in the US who chose non-medically necessary circumcision of their children at birth? How would that go over? I have news for you: that’s elective surgery on a child who’s too young to make the decision for themselves. Sound familiar?

• OK, but maybe MTG’s criminalization bill seems an obvious step too far to you, and you’re confident it won’t pass the Senate (probably true), so it doesn’t matter. On Thursday, RFK Jr’s Department of Health and Human Services issued a proposed rule that would prohibit hospitals and health systems that accept Medicare or Medicaid from providing gender-affirming care to young people—regardless of how that care is paid for. If this rule is finalized and allowed to stand, it will effectively end most gender-affirming care for youth nationwide, regardless of what laws Congress passes. Put in simple terms, this proposed rule says that if any hospital prescribes puberty blockers to any trans patient under the age of 18, that hospital can no longer receive Medicare or Medicaid reimbursements for any care they provide. Since in the US, Medicare and Medicaid are the primary financial drivers for hospitals—together covering nearly half of all hospital spending and more than 60% of patient volume—this is a major dealbreaker. HHS is trying to force the hands of hospital administrators. Not to mention, “Allowing the government to determine which patient groups deserve care sets a dangerous precedent,” said Dr. Susan Kressly, president of the American Academy of Pediatrics.

• Oh, and the same day the HHS rule was proposed by RFK Jr. and Dr. Oz, the House passed HR 498, which doubles down by barring Medicaid from covering gender-affirming care for trans youth. Medicaid covers about 40% of children nationwide, so this bill means that families who can afford private alternatives might be able to figure out ways to get their trans kids the care they need, but families with more limited means will be left without options to support their kids. If the Senate also passes this (unlikely), it would only serve to deepen health disparities among rich and poor in this country.

• But there’s more! Back on October 30, a federal rule was finalized that will bar nonprofits from qualifying for Public Service Loan Forgiveness if they “engage in chemical castration” of minors—intentionally inflammatory phrasing for what the administration later defines in the rule as, yes, puberty blockers and hormone therapy, which as I’ve said above is clinically appropriate and supported by all the major medical associations. This change means that as of July 1, 2026, doctors, nurses, and staff at any hospital, university, or nonprofit that provides gender-affirming care to minors will lose access to loan forgiveness. (By the way, it also applies to hospitals that provide care to undocumented immigrants, or don’t actively cooperate with ICE.) You might be asking yourself, “Wait, loan forgiveness? I’m still paying off student debt from decades ago…who cares if their loans aren’t forgiven?” Here’s the deal. The Public Service Loan Forgiveness (PSLF) program says that healthcare providers who work in nonprofit and safety-net settings for 10 years and make qualifying payments on their student loans for that whole time can then have the remainder of the federal student loan debt forgiven, in acknowledgement of their public service. The average medical student in the US graduates with more than $200,000 in debt, and most then complete residencies where they work extraordinarily long hours for extraordinarily poor pay. Given that, you can imagine that after residency many doctors seek employment in fancy private practices where they can quickly pay off that debt and start buying nice things for themselves as a reward for all that hard work. The problem is, a heck of a lot of people in this country need medical care and only can access it through public hospitals in rural or underserved areas, where the pay for healthcare providers isn’t good. (Traditionally these settings have relied heavily on foreign doctors, who now largely aren’t able to provide care here due to the Trump administration’s new rules making H1 visas cost prohibitive.) Since there’s a projected nationwide shortage of up to 86,000 physicians by 2036, we desperately need people willing to become doctors who will work in these regions of the US. The PSLF is the key to that. So, this rule is yet one more effort to effectively ensure that trans youth who rely on hospitals in rural or poor areas for their medical care won’t be able to access gender-affirming care. There’s lots of redundancy built in here.

• It’s not all about the youth, though. The Trump administration is working hard to erase trans people entirely, and deny they ever existed. How? I’ll give you three ways, though there are many more:

  • Starting in 2026, the Trump administration will require U.S. cancer registries that receive federal funding (which is most of them) to classify patients’ sex as male, female, or unknown. The new policy says that trans and non-binary patients should be categorized according to their sex assigned at birth, and when that information is not available, they must be counted as “unknown” gender. As I’ve said before, when you don’t collect data on health disparities, that doesn’t make them go away. It makes them invisible, and therefore makes them worse. As in, more trans people will die of cancer. This is avoidable, but this administration doesn’t want to avoid that outcome.

  • It doesn’t just stop with cancer registries: the Trump administration is trying to prevent all federal surveys from collecting data related to sexual orientation and gender identity, except in their prescribed, ideologically (aka not scientifically) based ways. These federal surveys are hugely important to our understanding of the health of various groups of people in the US, on everything from sleep quality to crime victimization. And—say it with me now—if you don’t collect data on trans people, it makes health disparities worse. More trans people will be sick, injured, or killed by these moves. That’s the point.

  • I’ll end on one that’s especially petty and heinous: earlier this month the Trump administration changed the name on the official portrait of Admiral Rachel Levine, Biden’s assistant secretary of health, and the first trans person ever to win Senate confirmation. Admiral Levine is a four-star admiral and under Biden led the Commissioned Corps of the U.S. Public Health Service. Trump’s HHS removed her name and replaced it with her deadname. That’s a disgusting move. It’s literal erasure.
    

OK, but aren’t minors too young to know whether they need gender-affirming care, anyway?

No.

I’m guessing that when you were 17, 15, 12, and even 10 years old, you had a pretty good sense of your own gender, the genders of those around you, and where you felt like you fit in and where you didn’t. Gender shapes so much of our experiences, and we are all keenly aware of that from a very, very young age. Think back to your childhood—you know that’s true. Journalist Erin Reed (Erin in the Morning) already reported this so well I’m just going to share her words: “Gender-affirming care saves lives. A Cornell review of more than 51 studies found that such care significantly improves the mental health of transgender people. One major study reported a 73 percent drop in suicidality among trans youth who began treatment; another found a 40 percent reduction in actual suicide attempts in the previous year. Research published in the Journal of Adolescent Health in April 2024 showed puberty blockers sharply reduced depression and anxiety. Abroad, a German review backed by 27 medical organizations endorsed gender-affirming care for youth, and a recent French medical consensus did the same. The evidence has driven a historic resolution from the American Psychological Association—representing 157,000 members—formally condemning bans on trans care.”

But what about safety for women in bathrooms? Protecting women in sports?

Once again, I can’t say it better than some who’ve already written about this, so I’m going to share some excerpts from a great piece by Ryan Cooper at The American Prospect:

For many years now, conservatives, along with an influential group of centrists and liberals, have presented a certain narrative regarding trans people in this country: They are Concerned. They’re worried, they say, about trans women in bathrooms—what if a male predator leverages trans rights systems to pretend to be a woman and ambushes victims in the bathroom? They’re worried, they say, about people getting transition care too easily—what if gender clinics and endocrinologists start bum-rushing children into transition surgery? Above all, they say, they are outraged about trans women in sports—what if a man pretends to be a woman so he can win first place easily?

This narrative is and always has been a lie. What these people actually have is a seething, obsessive hatred of trans people. They want them either back in the closet or dead.

Trans rights don’t have anything to do with the possibility of men invading women’s bathrooms. A man could already do that by dressing up regardless of what rights trans people have, and in any case, toilets are a pretty unusual and risky location to try to harass or assault someone. Studies show allowing trans people to use the correct bathroom doesn’t have any effect on safety.

On the sports question, if an adult man were to claim to be a woman solely so he could compete in a women’s competition, that at least would theoretically be unfair. The problem is that this does not happen. Sports leagues that still allow trans competitors require some proof of having undergone hormone therapy, and studies demonstrate this largely erodes any physical advantage from undergoing male puberty.

In any case, the numbers involved here are microscopic. Precisely one (1) trans person has ever competed in the Olympics, and they did not win a medal. As of a year ago, there were fewer than ten trans athletes in all of American college sports, and their record isn’t that great either. Notable transphobe Riley Gaines somehow parlayed a career out of tying a trans woman for fifth place in a college swim meet.

Bottom line: Don’t get sucked in by the fear-mongering talking points. They’re intentionally playing on your emotions to get you to climb over to their side of the fence. There’s no data to support what they’re saying. Don’t fall for it. You’re better than that.

So, what can I do?

1. Contact your U.S. Senators.

Tell them to oppose H.R. 498 and H.R. 3492 if they reach the Senate floor, and to defend access to gender-affirming care for youth in any way they can.

2. Contact your health care system and providers.

Make it clear that the HHS rule to withhold Medicare and Medicaid funds from hospitals providing gender-affirming care is still a proposed rule, not a requirement. Gender affirming care remains protected under the laws of California (where I live) and many other states. Tell your healthcare system that you will not stand for pre-compliance with the Trump administration’s efforts to roll back gender-affirming care. Find flyers, messages, and contact info here. (By the way, there’s evidence that this works! Your words do matter!)

3. Stand up for trans kids.

Share this post, or one of the articles cited here, with friends or family who have fallen for the fear-mongering talking points. Keep in mind that any parents you know who have trans or non-binary kids are probably having an extremely hard time right now; ask if there’s any way you can support them, or at the very least make a little effort during this holiday season to show them you’re thinking of them, and you care. And no matter how hard it is for you, make sure you’re using the right pronouns for the trans people in your lives, whether they’re adults or children. Not sure what pronouns are the right ones? You can just ask.

It’s time for yet another installment of what the WaPo editorial board referred to as “the CDC’s next anti-vaccine clown show.” Publishing the opinion right before last week’s meetings of the Advisory Committee on Immunization Practices, or ACIP, on December 4 and 5, the editorial board wrote:

“There is little hope Kennedy and his fellow travelers will acknowledge such facts [about hepatitis B vaccination]. Not when President Donald Trump pronounces from the White House podium that vaccines cause autism, contrary to dozens of studies. And not when the government’s top vaccine regulator casually uses an internal memo to announce that coronavirus vaccines have killed at least 10 children, without any data to back it up. It’s dogma, without scientific scrutiny.

This is probably why Kennedy’s appointees are not releasing much information ahead of their meeting. Or they simply don’t know what they’re doing. During their last meeting, in September — when they first attempted to delay the hepatitis B shot before ultimately tabling the issue — many seemed bewildered by simple matters of process.”

A lot happened at that meeting, besides the >60 “falsehoods, distortions, and outright lies being megaphoned from one of the nation’s highest committees.” I’ll give you the highlights. You probably heard about the change re hepatitis B vaccine for babies, and that’s a big one, so I’ll save it for last.

1. The ACIP chair was new (again).

3 days before the meeting, RFK Jr. appointed former ACIP chair Martin Kulldorff to a new influential role at HHS--chief science officer for the Office of the Assistant Secretary for Planning and Evaluation (ASPE). Kulldorff was no friend of the vaccine, but he had shown himself willing to limit some of the most anti-science agenda pushing during the committee. He wasn’t a great leader of the committee but he did try grounding conversations at least somewhat in data.

By moving him into HHS and thus off of ACIP, RFK Jr. was able to install Kirk Milhoan as ACIP chair, instead. The wreckage RFK Jr. has created of the system thus far has clearly not gone far or fast enough for him. Milhoan is a senior fellow to the Independent Medical Alliance, an organization created early in COVID, known for promoting unproven COVID treatments such as ivermectin. He’s also gone on record tying COVID-19 vaccines to increases in miscarriages and cancer, things that simply aren’t supported by data.

No matter what, as UC Law professor Dorit Reiss posted on Bluesky, “Dr. Kulldorff had done a pretty poor job running ACIP…[but] appointing someone without experience three days before a meeting is not likely to make the meeting run more smoothly or better.”

2. The presentations were not made by expert scientists.

There was no vote last week on the childhood vaccine schedule, beyond hepatitis B. But the groundwork was clearly being laid for more major changes.

No CDC scientist presented at the meeting, which was highly unusual, as this used to literally be the main job of numerous scientists. To be fair, on Friday morning ACIP member Robert Malone noted that two high-profile vaccine proponents—Dr. Paul Offit, director of the Children’s Hospital of Philadelphia’s Vaccine Education Center, and Dr. Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development—had been invited to speak, and both declined. Offit explained, “I don’t want to legitimize what I think is an illegitimate process. I don’t want to be part of a process that gives bad advice, that’s putting children in harm’s way.” Hotez said something similar.

Instead, on Friday Aaron Siri—an attorney with ties to RFK Jr.—led the committee through an excruciatingly (and unusually) long 76-slide presentation about the childhood vaccine schedule. His presentation was so filled with falsehoods and misrepresentations about vaccines that when he finished ACIP member Cody Meissner—an actual pediatrician—said into the microphone, “What you have said is a terrible, terrible distortion of all the facts,” and “I don’t think you should have been invited.”

US Senator Bill Cassidy—a physician who had the power to stop RFK Jr.’s confirmation but was swayed by lies and false promises—posted on X:

Gee, too bad we couldn’t have seen this coming, Senator Cassidy.

I’m sure many of you reading have heard the same talking points that Siri and others repeat over and over as if they’re true. They often claim that children receive “72 shots” or “96 doses” from the childhood vaccine schedule, but this is intentionally misleading.

Children whose parents follow the current vaccination schedule receive about 54 doses of immunizations by age 18. About a third of those are yearly flu vaccines. To get to 72 or 96 doses, one has to count not only a yearly flu vaccine (18 doses) but also a yearly COVID-19 shot (another 18 doses), plus count combination vaccines (like the MMR) as separate vaccines—or count vaccines that pregnant people receive, since those also benefit the child before they are born.

The reality is this (figure from Your Local Epidemiologist):

This is what science has done for us. We should be thrilled. I, for one, am thrilled that my child (now 17) was able to be so much more protected from debilitating infectious diseases than I was, born in 1980. Kids born today will be even better off than my kid is…if we’re able to limit the further destruction of this administration.

3. The committee—as expected—changed the recommendations about the birth dose of the hepatitis B vaccine.

I gave a detailed explanation of this issue and why it’s a problem in a previous post. Dr. Paul Offit also wrote on his own Substack about how infuriating this is, because earlier attempts to recommend hepatitis B birth doses only for babies of mothers known to have hepatitis B, or babies born to people at highest risk of hepatitis B infection, simply didn’t work. The only real changes in the numbers of babies infected with hepatitis B (and subsequently dying) came once the universal birth dose was recommended in 1992. So the ACIP has now voted to recommend we return to a strategy that didn’t work the first time, over a decade when we tried it. Awesome. If you want even more details, you can read The Vaccine Integrity Project’s new Hep B Evidence Brief here.

At this point, I’ll be honest. I’m feeling pretty exasperated about all this, and pretty salty. Maybe it’s because this once-scientific, highly respected committee has been gutted, with members replaced by RFK Jr cronies who have said absurdly false and incredibly stigmatizing things. ACIP member Vicky Pebsworth blamed gay men, promiscuous women, and immigrants for spreading hepatitis B. Evelyn Griffin declared that “illegal immigrants” are to blame. Michael Belkin said—on the record, mind you—that hepatitis B is a disease of “junkies, gays, and promiscuous heterosexuals.” These are the people who have been appointed to lead the nation’s scientific committee that largely controls our access to vaccines, and whether we have to pay for vaccines out of pocket or not. They said these things into microphones. With thousands of people watching. In 2025. Are you kidding me?!

Maybe I’m salty because the celebrations happening on social media are just gross. Trump posted a long and characteristically inaccurate and unprofessional message on Truth Social, which RFK Jr. reposted with the response: “Thank you, Mr. President. We’re on it.”

Then Dr. Robert Malone, an ACIP member known for his anti-vaccine views, reposted that, with “Mission Accomplished.” Very scientific approach, for sure. Love this professional committee.

Maybe I’m salty simply because people are going to die because of this decision. Actual people, actual deaths. Sort of like when George W. Bush proudly claimed “Mission Accomplished” for the Iraq War being over and won, before another 4,292 US soldiers and 100,000+ Iraqis died violent deaths in said war.

For these reasons, I’ve decided that instead of all the scientific, objective, and professionally written reports of this ACIP decision, I’m going to share with you the (still scientifically accurate) one that is really speaking to me most:

ACIP Decides More Newborns Do Need To Catch Hepatitis B

CDC staff and outside experts tried. They really did. They explained what this disease is, what is does, how infectious it is, and how the mass immunization program starting in the early 90s saved thousands of children from infection, from long term complications, and an ultimately early death for some. Here is one simple chart that CDC staff presented to ACIP earlier this year on the matter.

How in the actual hell do you look at that chart and decide vaccinations have to go?

Let’s talk about the actual decisions that were made.

Vote 1> The ACIP recommended the birth dose of the hepatitis B vaccine no longer be given at birth in the hospital by default, but delayed if desired, at least until the pediatrician’s visit at 2 months of age.

This matters for reasons I’ve already laid out. The implications of this vote are that hundreds of people will contract deadly chronic liver disease in the next decade, because they were infected with hepatitis B unnecessarily at birth. Totally avoidable—and we know this, because we have data proving the vaccine is safe and prevents this type of death, from 1992-2025—the years the prior birth dose recommendation was in place.

IMPORTANT: if you have a baby now and you do want them to get vaccinated at birth, you still can (and should) get that vaccine in the hospital, and have it covered by insurance. You can opt in. It just isn’t the default anymore.

Vote 2> Parents should ask their kid’s pediatrician to test their baby’s blood for hepatitis B antibodies after the first dose, to see if they’re already immune and don’t need the subsequent doses.

This one was really bananas. There is zero science to back up this recommendation. Yes, there is an established titer threshold for antibodies to hepatitis B, thought to be protective. But this applies to adults who have been fully vaccinated (or already naturally infected with hepatitis B—which, by the way, is lifelong and incurable). In clinical trials, scientists have conclusively determined that three doses of the hepatitis B vaccine are enough to reach that immunity threshold and give someone protection. That’s why the hepatitis B vaccine is three doses. We have no science that demonstrates whether a baby who reaches that established titer threshold after one dose will retain antibody levels above that threshold, and stay protected without the subsequent doses. Antibodies can wane. (This is why you need to keep getting COVID boosters.) We don’t know if this strategy of testing antibody levels after one shot is safe and effective. But the ACIP just voted to recommend that be a practice that parents and their health care providers adopt for their newborn babies.

Plus, the ACIP recommended that insurance cover the cost of that lab testing. But ACIP has no authority over that. They only have authority over immunization policy, and whether insurers have to cover immunizations. So that part of the vote holds no weight. It also means that—even if insurance were to pay—infants would have another blood draw (with risk of infection) plus another doctor’s visit to get results and be immunized if indicated. It costs our health care system more, even if it doesn’t cost individual families more. And again, we have no science at all to back this up. Cool, cool. “Gold standard science” we have here. Thanks, Trump and RFK, Jr. Making us all healthier. Maybe. Or actually not.

I’m not the only one who thinks this is bananas. Three different ACIP members asked repeatedly about the scientific basis for these decisions, and ultimately voted against both changes. Remember, these are RFK’s hand-picked people, so this much disagreement should be a big red flag for all of us.

Dr. Cory Meissner (a pediatric infectious disease specialist) responded to a presentation at one point with, “There were so many statements that I disagree with, it’s hard to be succinct.” When he voted no, he said, “Do no harm is a moral imperative. We are doing harm by changing this wording.”

Dr. Kirk Milhoan, the new ACIP chair, said that the two month timepoint was chosen because it was a point at which infants had matured beyond the neonatal stage. ACIP member Dr. Joseph Hibbeln then said there was no data presented to back up a claim that two months is an appropriate cut-off. “This is unconscionable,” he proclaimed. Dr. Raymond Pollack, a transplant surgeon who has likely transplanted a lot of livers for people dying from their hepatitis B infection, also voiced strenuous objections throughout the meeting, and voted no on the first vote along with Drs. Meissner and Hibbeln.

When it came to the second vote (about the antibody testing before the 2^nd or 3^rd doses), even Dr. Milhoan had concerns. Adam Langer, a CDC subject matter expert who wasn’t asked to present but was called in to comment on the proposal before the committee, said that the committee “would be making a real huge assumption” to conclude that a baby having achieved the titer threshold after one dose would have durable protection against hepatitis B without further doses. Milhoan then said he would be most comfortable voting instead to recommend further study on the issue of whether three doses are really needed. But in the end, he didn’t propose a change to the voting language, and voted with the majority to recommend testing after one dose, which passed by a vote of 6-4 (with one member abstaining). Cool.

OK, so what does all of this have to do with Denmark??

No one at the ACIP meeting ever suggested there was new scientific information about effectiveness of the US childhood vaccine schedule, nor that there were new safety concerns about any vaccines. Panelists blatantly pointed out the ACIP review of the hepatitis B recommendations was prompted by parents concerned about the vaccine, and the fact that most European counties give the hepatitis B vaccine a few months after birth, not right away.

Tracy Beth Høeg, a longtime critic of broad COVID vaccination for children (and new acting director of the FDA’s Center for Drug Evaluation and Research), was brought in to brief the committee on the difference between the US and Danish vaccine schedules. She’s a dual Danish/US citizen, so naturally she was the best choice for presenting this critical information on vaccine schedules. The White House also named Denmark as a “peer nation” in a fact sheet about Trump’s Friday directive to review international approaches to childhood vaccination in “peer, developed countries.”

It’s cute that we want to compare ourselves to Denmark, and use them as a model. But the US is not Denmark. In 2023, Denmark reported only 99 cases of chronic hepatitis B in the whole country. In the US, that number was 17,650, and a report from the Vaccine Integrity Project at the University of Minnesota estimates that more than 17,000 infants are born to women with hepatitis B in the United States every year.

In case you’re saying to yourself, “Yeah, but Denmark is tiny and the US is huge, you’re comparing apples to oranges,” scientists have done the math for you. The rate of newly diagnosed chronic hepatitis B infections in the US in 2023 was 6.1 per 100,000 people, and in Denmark it was only 1.7 per 100,000 people.

But there’s a bigger difference between our two countries: people in Denmark have free, universal healthcare. That means they don’t hesitate to go to the doctor for testing or treatment. Denmark also has one of the best disease surveillance systems in the world. They know when people have infections, and they take steps to get them treated and healthy. In the United States, only 1 in 3 women living with hepatitis B receive care for their infection, and 1 in 5 pregnant women in the US are not tested for hepatitis B. In Denmark, virtually 100% of pregnant women receive hepatitis B testing, and virtually 100% of people who have been diagnosed with hepatitis B receive ongoing care for it.

If we want to use Denmark as a model, then let’s use Denmark as a model! I for one would love to pay more taxes and have a social system that actually cares for its citizens, making them happier and healthier as a result. (Gasp, I know. I just said one of the worst possible things for an American to say. Pay more taxes?!) Here are some examples of how our countries compare:

^The U.S. is the only wealthy nation with no federally mandated paid parental leave. The Family Medical Leave Act will protect someone’s job for 12 weeks under certain circumstances, but it can be unpaid.

†The U.S. Fair Labor Standards Act (FLSA) does not require employers to provide payment for time not worked, including vacations or holidays. Under the Danish Holiday Act, all employees are entitled to 5 weeks of paid vacation every year.

‡This is actually the average annual income (all I could find), not the median, but since Denmark has one of the lowest income inequality coefficients in the world, the average is pretty close to the median (unlike the US, where a small number of extremely wealthy people skew the average).

This comparison isn’t just for fun. Our health isn’t just shaped by the medical care we receive. It’s shaped by all sorts of socioeconomic and environmental factors, including stress, happiness, and the very things in this table above. As Jessica Malaty Rivera from Defend Public Health recently said, “The exposure rate, the disease status rate in the U.S. is terrible, and that’s why we have the policy that we have to protect children. We shouldn’t be asking what another country is doing. We should be asking, ‘What should we be doing based on the exposures and risks and concerns that we have for our population?’” The Danes don’t need to vaccinate their babies for hepatitis B in the hospital, before they leave. In the United States, we absolutely do. We are not the same as Denmark.

In closing: Stick with the science.

The science around hepatitis B vaccination hasn’t changed—the politics in our government have changed. You can get the most up-to-date version of the childhood immunization schedule from the American Academy of Pediatrics here. Screenshot it, download it, print it if you want, and bring it to your next pediatrician’s appointment. This is the gold-standard science. The ACIP cannot be trusted, and should be ignored.

The American Academy of Pediatrics isn’t the only science-driven institution that acted quickly to protect children’s lives, and speak out about best practices for hepatitis B vaccination after last week’s meeting.

The West Coast Health Alliance, including the Washington State Department of Health, the California Department of Public Health, the Oregon Health Authority, and the Hawaii Department of Health all came out strongly in favor of the birth dose still being given by default in hospitals in those states. The Maryland Department of Health issued a standing order for hepatitis B vaccination to help maintain access for all newborns. The Northeast Public Health Collaborative (which includes CT, DE, ME, MD, MA, NJ, NY, PA, RI, VT & NYC) released a statement that they continue to recommend that all newborns receive a hepatitis B vaccine birth dose within 24 hours of delivery.

Our states are stepping up and sticking with the science. They shouldn’t have to fill the void left by the feds, but that’s where we are. You can—and definitely should—stick with the science, too.

Unless you’re part of the Trump administration, of course.

It’s ironic, because it was February 5, 2019, when President Donald Trump surprised a lot of people by announcing his administration’s new initiative, called Ending the HIV Epidemic: A Plan for America, during his State of the Union address. In his speech, he said, “My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.” And indeed, a huge amount of federal dollars flowed for this purpose, and great strides have been made in HIV prevention and care in the last 5 years as a result. It was one of his best legacies.

Unfortunately, halfway through his own 10-year plan, President Donald Trump v2.0 seems to have forgotten his own pronouncement. Just shy of 6 years from the date he announced his plan to end the HIV epidemic within a decade, Trump (with Elon Musk on his shoulder of course) announced a pause on U.S. foreign aid, including HIV work made possible through USAID and PEPFAR.

The AIDS Vaccine Alliance estimates that as of October 15 of this year, 2.5 million people who used HIV pre-exposure prophylaxis (PrEP) in 2024 to prevent HIV transmission in 2024 lost access to their medicines in 2025 due to this change. In a report released last week, UNAIDS projected that as a result of these cuts there will be an additional 3.9 million people who newly acquire HIV between 2025 and 2030. This is the opposite of ending the HIV epidemic by 2030. It’s making it much worse.

(And just in case you hear anyone around you saying “Well, Trump said he’d end the HIV epidemic in the United States; it’s not our responsibility to end it around the world,” let’s be clear that we live in a global society. You simply cannot end HIV in one country—especially one as big and internationally connected as the United States—without ending it everywhere. Period.)

This year’s World AIDS Day theme, selected as usual by the World AIDS Campaign’s Global Steering Committee, was “Overcoming disruption, transforming the AIDS response.” Huh. I wonder how they came up with that theme?

On the Tuesday before Thanksgiving, someone at CDC posted a screenshot of their computer screen to the AltCDC account on BlueSky, sharing with the world the guidance they had just received from the administration:

It’s hard to believe that after 11 months of this crap I can still be surprised by anything this administration does, but this one got me. Like many people who’ve devoted the last 20, 30, or 40 years of their careers to HIV prevention and care, this felt like not just a slap in the face, but a bizarre 180° position for the Trump administration to take.

You can’t just wish AIDS away. Pretending it doesn’t exist makes it worse, not better. And for an administration that claims to care so much about government waste, you’d think they’d realize that you can’t decide on November 25 to withdraw from activities planned for December 1 without a huge amount of waste. Money has already been spent. Muzzling civil servants from talking about it doesn’t help anybody.

So here it is. This World AIDS Day, we should have been celebrating some incredible advances in HIV prevention. This year, especially, there was a huge game-changer: clinical trials were completed for a new drug, lenacapavir, which is incredibly effective at preventing HIV transmission with a single injection every 6 months. This is the closest we’ve ever been to an HIV vaccine, by a lot. Twice a year, people need to go to a clinic and get an injection, and they’re very likely to stay HIV free. This could be the thing that finally turns the tide. Recognizing this, in July the WHO recommended widespread use of lenacapavir as soon as possible.

Except, the Trump administration’s overnight withdrawal of foreign aid funds to support HIV work worldwide has broken much of the very infrastructure that could make this happen. In most cases, lenacapavir sits as unfilled potential. Even if countries can access the drug (which isn’t a sure thing), in so many cases the staff who would have helped administer it have been laid off amidst massive funding cuts.

So instead of celebrating a turning point in the HIV epidemic—which has killed almost ¾ of a million people in the United States and more than 44 million people worldwide since 1980—the U.S. government asked federal workers to spend nothing, and say nothing during World AIDS Day this year. It’s despicable. You know who else acted like that as president? Ronald Reagan. He might be revered by a lot of Republicans for his economic policies, but it’s hard for anyone to paint a rosy picture of his handling of the HIV epidemic. It’s widely acknowledged that his failure to act in the 1980s is one of the key reasons the epidemic was able to take hold, killing so many around the world.

It’s fitting then that ACT UP (the famous activist group AIDS Coalition to Unleash Power) launched a new media campaign on World AIDS Day this year. If you were around in the 80s, you might remember that ACT UP created a green poster with Ronald Reagan’s face, hot pink eyes, and the matching hot pink caption “AIDSGate,” to raise awareness of how Reagan’s mishandling of HIV and AIDS was leading to thousands (now millions) of unnecessary deaths. That poster was everywhere, and it did have an impact.

Well I’ve talked a lot about Trump in this post, but of course RFK Jr. is the man at the helm of the Department of Health and Human Services. Yes, the guy who infamously has said that HIV does not cause AIDS—like, he said that in 2023, not 1987—and has recently blamed the early days of HIV transmission on the “gay lifestyle” and drug use (addiction to poppers, to be specific), which was debunked as a scientific theory more than 30 years ago.

“AIDSGate” is an outdated term, plus it’s already been used. More importantly, RFK Jr. isn’t just terrible on HIV and AIDS like Reagan was, he’s terrible on all sorts of health issues that will lead to unnecessary death. ACT UP is paying attention, and you should be, too:

Dismantling Healthcare = Death. Spread the word. ACT UP, FIGHT AIDS!

For my part, I’m grateful that despite how panicked I felt earlier this year, my consulting company is still intact. My family is healthy and we’re still on pretty solid ground.

I’m also very aware that this isn’t true for everyone, and a lot of people are especially experiencing hard times during the holidays. While I try to do what I can to donate to important causes or take other steps to care for my neighbors year-round, I always try to step it up a little during the holiday season.

In case you’re looking for some ideas for new ideas for places where your donation could go a long way toward making a real difference, I thought I’d share a few of the places I’m donating to this year. (All these options are tax-deductible, if that’s important to you.) I invite you to join me, or donate what you can afford to another place of your choosing!

• Support, recognize, and amplify the contributions of LGBTQ+ students, activists, educators, and community leaders in the field of public health through the Kevin Roe Legacy Fund. This has been a very tough year to be LGBTQ+, and especially trans or non-binary—this is one way to help. This fund is especially important to me because Kevin Roe was my friend, and he died unexpectedly in May of this year from a massive heart attack. He was a public health professor at San Jose State University and a tireless champion of the health and empowerment of queer people. It had been his dream to create a scholarship fund to support LGBTQ+ students studying public health or related fields at SJSU, demonstrating leadership potential and commitment to the values Kevin lived by. None of us expected to support that dream without him, but his family, friends, and colleagues have been determined to launch this fund to honor his memory. If this cause speaks to you, we’d love to have you as an inaugural donor to help get it off the ground.

• Assist a hard-working Haitian family in Connecticut in their efforts to open a small health clinic in Haiti, through a donation to the Diabetes and Hypertension Relief Center, or DHRC. In a year when U.S. foreign aid has been decimated, it’s a tough time to be fundraising for health relief in a foreign country. This one is meaningful to me because my mom is a retired nurse, and in 2019 went with this family to Haiti with other nurses, doctors, pharmacists, and students to provide free healthcare as volunteers. In one week, they served over 1,500 men, women, children, and infants, most of whom had walked miles to attend the pop-up clinic. After 4 years of organizing this pop-up clinic each summer, the Dufort family knew they needed to find a more sustainable solution. Their family donated the land and is working to build a permanent clinic in the town, and your donation would make a huge difference to help make this dream a reality.

• Give back to local Indigenous tribes in acknowledgement of the ways you benefit from living on stolen land, by paying a voluntary land tax. Indigenous people continue to face some of the worst health inequities of any group in the U.S., thanks to a long legacy of genocide and oppression. If you live in the San Francisco Bay Area like I do, there are a few options. Those of us in the East Bay can pay Shuumi Land Tax. Shuumi means “gift” in Chochenyo, the native language of the Lisjan Ohlone people from this region. Your Shuumi land tax benefits the Sogorea Te’ Land Trust and their rematriation work, facilitating the return of Indigenous land to Indigenous people. This includes caring for land, cultivating urban gardens, cultural regeneration work, urban emergency response strategies, engaging in public education and advocacy, and nurturing Indigenous resilience. If you live in San Francisco or the peninsula, you can pay Yunakin Land Tax (Yunakin means “village” in Ramaytush, the native language of that region). If you’re outside the Bay Area, there may be other land tax options, or you can reach out to a local tribe and ask what kinds of support would be most beneficial to them.

• Contribute to an organization looking to advance health equity by fostering bold, cutting-edge ideas by donating to Springboard HealthLab. I think it goes without saying to anyone reading this Substack that this has been a very tough year for organizations focused on improving health equity. Springboard HealthLab is a non-profit close to my heart because I co-founded it in 2021 with the current executive director Jen Hecht, and I’m still the Board Chair. Springboard HealthLab is an incubator for big ideas that aim to improve health equity across communities. It supports cutting-edge public health projects that need help to get off the ground or to grow, and then helps them find a permanent home. If you want to support an organization that isn’t afraid to take risks in a time when the government is trying to suppress innovative equity-focused projects, then here’s a great way to do it.

• Show your support to the former employees of the CDC who were fired as part of the government’s efforts dismantle this federal public health agency by donating to the mutual aid program of Fired But Fighting. I wrote about this one earlier—there are lots of ways this organization is helping the civil servants who were tossed aside by Trump and RFK Jr. and are now struggling to make ends meet through the holidays.

Donating money isn’t the only way you can help this holiday season. In a time when kindness feels hard to come by, a little kindness can go a long way to showing our neighbors we care. Here are just a few options:

• Check in on people who may be isolated. A simple visit, phone call, or text to an elderly neighbor, someone living alone, or a new parent can make a huge difference. Social connection is a health intervention.

• Practice “micro-kindness” in public spaces. Things like holding a door, letting someone go ahead in line, complimenting someone’s clothing or hairstyle—these tiny interactions take almost no effort and can really put a smile on someone’s face. This adds up in terms of community health.

• Walk with someone for exercise or company. Walking is free, improves mental and physical health, and helps friends or neighbors feel cared for.

• Share skills or offer help instead of money. There’s so much you might be able to offer, from helping someone carry groceries to shoveling snow, raking leaves, or offering someone a ride to an appointment. You might know how to fix a leaky faucet and save someone the expense of a high water bill, or a plumber. Maybe you know how to repair someone’s clothing, or can help a student with their math homework so their parent doesn’t have to stress about it. If someone you know is sick or working long hours, you could offer to walk their dog, or cook a little extra when you make dinner, and bring some by.

• Let someone know you’re thinking about them. A card slipped under a door or a handwritten note arriving in the mailbox can bring surprising warmth. It’s inexpensive but deeply personal. Or sometimes it’s as simple as saying “How are you doing, really?” instead of blowing past a greeting. You never know whether your genuine expression of caring might open a door for someone who needs it.

It doesn’t matter what you do this holiday season—in a time when empathy and caring appears to be in short supply, any action you take will matter. Public health isn’t just about vaccines and education campaigns. All of us will be better off if we stick together and do what we can to help the others in our community.

What other ideas do you have that I didn’t mention? Please add comments with your suggestions, so others can take advantage of those options, too!

That changed this last week.

On Wednesday, I started receiving messages from friends and colleagues asking me if I had seen the CDC website on vaccines and autism. Until Wednesday, that webpage said “studies have shown no link between receiving vaccines and developing autism spectrum disorder.” It cited a National Academy of Medicine review of scientific papers from 2012, and a separate CDC study on this issue from 2013. But now, the website has changed:

Shortly after the change was made, Paul Offit, a pediatrician and virologist who directs the Vaccine Education Center at Children’s Hospital of Philadelphia (the world-renowned CHOP), wrote a post on his Substack entitled “CDC 1946-2025: R.I.P.”. Katelyn Jetelina (Your Local Epidemiologist) updated her Substack with a new post called One of CDC’s final blows. And what it means for you. One of her subheaders declares, “Now, part of CDC [has] flatlined.” Both of these experts are incredible communicators, and they’re not prone to hyperbole. Many people are wondering now whether it’s possible for CDC to survive this.

The Centers for Disease Control and Prevention. The place where Kate Winslet’s character worked in Contagion (and yes, in real life is the place that deploys “disease detectives” and coordinates containment strategies during deadly outbreaks in the US and abroad). It’s also the place that:

• Runs our national disease surveillance systems, which track infectious and chronic diseases across the country so we understand where our biggest risks are,

• Operates some of the world’s most advanced public health labs, providing diagnostic confirmation for rare or emerging pathogens, and tracking variants of new viruses through genomic sequencing,

• Oversees our national stockpiles of medications to protect us in the event of bioterrorism or a chemical or radiological exposure, and funds and trains state and local health departments on public health emergency preparedness,

• Coordinates our access to vaccines that keep us healthy, through development of vaccine recommendations, funding of immunization programs, and tracking of vaccine safety signals,

• Monitors and responds to hazards in the workplace, including workplace injuries, dangers of asbestos and silica exposure, and other toxic exposures,

• Funds the vast majority of public health efforts to prevent infectious and chronic diseases at the state and local level, including HIV, hepatitis B and C, mpox, heart disease, cancer, and diabetes, and

• Gathers data, funds research, and designs interventions to reduce deaths from motor vehicle accidents, firearm injuries, drug overdoses, child abuse, intimate partner violence, and suicide—including providing technical assistance to states for their work on these issues.

People are now wondering aloud whether the CDC can survive concerted efforts by the Trump administration and RFK Jr. to dismantle and undermine it as a scientific agency. If the CDC collapses and goes the way of USAID, all of these things that CDC does for all of us in the United States will be debilitated. This is not a drill.

Why is this website change such a big deal?

In case you didn’t know, the false claim that vaccines cause autism can be traced to a research article published in 1998 that was retracted way back in 2010. Now, scientific articles aren’t easily retracted. This only tends to happen when there are major errors in the methods, or a comprehensive investigation finds evidence of ethical violations and fraud. In this case it was the latter. Yet the impacts of this improper, unscientific paper have persisted for decades in anti-vaccine messaging, including that of RFK Jr, our current Secretary of Health and Human Services.

The actual scientific evidence is extremely clear that vaccines do not cause autism, and the CDC webpage now obviously suggests otherwise. This is horrifying, and it is intentional. How do I know?

1. In an interview with a reporter from the New York Times, RFK Jr. said so. He took credit for it, bragging that he “personally instructed” the CDC communications office to make the change. Just in case I need to say it again, RFK Jr. is not a scientist. He’s an environmental lawyer who has made millions of dollars by suing vaccine manufacturers for causing harm. He is personally, financially invested in creating the appearance of a real link between vaccines and injury or death.

2. It’s technically correct that “studies have not ruled out the possibility that infant vaccines cause autism,” as the website now claims. But this is because it’s literally impossible to rule out a possibility of something. That’s not how science works. Perhaps Paul Offit explained it best (bold emphasis mine): “Currently, 24 studies performed in 7 countries on 3 continents involving thousands of children and costing tens of millions of dollars have all found the same thing. Children who have received the MMR vaccine were not at greater risk of developing autism than those who didn’t receive it. Researchers could have done a hundred studies, or a thousand studies, or a million studies but that still wouldn’t have proven that it couldn’t happen. You can never prove never…If RFK Jr. wanted to be honest with the American public, he would make it clear on the CDC’s website that chicken nuggets also might cause autism, which has never been and will never be disproven.” (Think about it. The logic is exactly the same here. Don’t fall for what RFK Jr. is doing.)

3. Dr. Demetre Daskalakis, the former Director of the CDC’s National Center for Immunizations and Respiratory Diseases (e.g. the guy who oversaw our access to vaccines until he resigned in protest when Susan Monarez was ousted as CDC director), told Dr. Jeremy Faust of the Inside Medicine Substack that people at CDC “were completely blindsided by this [website] update.” There is a team of CDC scientists who’ve dedicated their careers to understanding the data and protecting the public’s health related to these issues—if they’re blindsided by a change like this on the website, it can only be politically motivated and not science-based. Taking it a step further, Dr. Daskalakis made it very clear: “The CDC cannot [any longer] be trusted as a source. It is a weapon.”

4. If you go to the actual CDC webpage, you might notice that the first header below the title still reads “Vaccines do not cause autism,” with an asterisk. Weird, right? The asterisk leads you to a footnote explaining that this language was not removed from the site due to an agreement with Senator Bill Cassidy (R-LA) that it remain on the CDC website. This was an explicit condition of him being the deciding vote that enabled RFK Jr. to become confirmed as HHS Secretary. It’s a shocker, I tell you, that they technically adhered to their agreement while giving Cassidy the middle finger with the entire rest of the webpage. He was hoodwinked. Which apparently everyone in the United States except Senator Cassidy saw coming. (Cassidy posted on X on Thursday that “What parents need to hear right now is vaccines for measles, polio, hepatitis B and other childhood diseases are safe and effective and will not cause autism. Any statement to the contrary is wrong, irresponsible, and actively makes Americans sicker.” With all due respect, sir, too little too late. I hope you are having a lot of trouble sleeping at night.)

As Your Local Epidemiologist wrote late last week, “This was political actors overriding science in a place where accuracy, integrity, credibility, transparency, and honesty literally saves lives.” In case this speaks to you differently, Dr. Marc Veldhoen—a well-known Dutch immunologist—wrote on Threads three days ago (again, bolding is mine), “The CDC pages have now been hijacked for state-sponsored disinformation. It is terrible to see this happening. This is ideology, unscientific, over facts, data and the scientific method.” This is language we use in the US to speak ill of countries like North Korea, Russia, or China. This is language people outside of the US are now using about our government. Why can’t most people seem to see this—see the severity of what’s happening here? What are we going to do about it?

Now who can we trust?

Perhaps the most important question at the moment is what the average American without a PhD in vaccinology or epidemiology or a medical degree should do to gather information and make the best possible decision about health-related issues. We all want to keep ourselves and our family members safe, and we can’t rely on the CDC to help us with that, at least for now. Forget RFK Jr. just for a second: CDC is now being directed by a person with no medical or public health training, who has still, two months after his appointment following Monarez’s firing, has never met with the leadership team at CDC. He’s also not sent a single email to staff since his first email to them on September 16. (I happened to be there at CDC then, and I can tell you that it did not go over well. At least one person described the main thrust of the email to the people still standing at CDC to be “You are terrible humans.” So maybe it’s good that he hasn’t tried to communicate further.) If you really want to ruin your day, you could look at extremely distressing X feed, which includes an odd focus on anti-aging research and worse, a hashtag he appears to have coined (#MorningMedicaidMugshot) where he posts “mugshots” of real people he labels as “illegal aliens” and claims have been stealing Americans’ health care. This is Jim O’Neill, the acting director of the United States Centers for Disease Control and Prevention, posting on his official social media account, @HHS_Jim. Are you proud? This is making America great again?

So we can’t trust the CDC anymore. There are madmen at the helm. What to do?

• You can read this brief from Canada that provides the real data demonstrating that vaccines do not cause autism, in an accessible way. This document was created for doctors and public health professionals to be able to talk to patients about this issue, but you don’t need a PhD to be able to read the summaries of the studies that tell us vaccines don’t cause autism. This is a good choice if you want to dive deep and “do your own research” on the research.

• You can read this really good report that Defend Public Health released in December about what the science does say about the risk factors for autism. Defend Public Health is a volunteer group of public health experts who have formed a coalition to resist and counter the dangerous health actions from the current administration. (I’m a part of the group and have been impressed with their commitment to vetting real scientific information and effectively communicating it to the public.)

• You can look to other scientific organizations not under the control of the federal government. A lot of them—including the American Academy of Pediatrics and the Infectious Diseases Society of America—have been doing a great job stepping into the void left by CDC since January, releasing guidance that’s actually based in science. Despite what RFK Jr. might be trying to tell you in a bit of absurd irony, these are not organizations that are bought by Big Pharma or otherwise stand to benefit from lying to you about scientific evidence that can keep you and your family healthy. The President of the American Academy of Pediatrics responded to the recent changes on the CDC website with a bold statement:

• You can find other health and science communicators you trust. Besides me, you can follow Your Local Epidemiologist (one of my faves) or any of the other people vetted by The Evidence Collective and recommended for this purpose.

The ramifications of a change like this on the CDC website are serious. They may argue that it’s technically correct, and that’s true, but it’s what Robin Cogan—who runs a great weekly blog called The Relentless School Nurse—calls “pretzel logic,” which is designed to create doubt where none belongs. As Cogan says, nurses “know the stakes. Even small drops in vaccination rates invite outbreaks of measles, whooping cough, and other preventable diseases.”

Last week I attended a webinar by the Association of Healthcare Journalists, where Dr. Dan Jernigan (formerly the head of the National Center for Emerging and Zoonotic Infectious Diseases, until he resigned after Susan Monarez’s firing along with Dr. Daskalakis), said that RFK Jr. was trying to undermine the CDC by “going from evidence-based decision-making to decision-based evidence making.” That’s exactly right, and it’s not what we should want from our health leaders or our scientists. (By the way, the webinar was outstanding, if you want to know more about what’s really gone down at CDC under RFK Jr. It’s engaging and worth a watch.)

Take a deep breath. Be cautious about anything the government-run agencies are saying about health, especially about vaccines, gender health, reproductive health, or environmental science. Look for other sources you can actually trust. Call your representatives in Congress, and continue insisting that they stand up and protect their constituents from this state-sponsored disinformation, which endangers all of our health.

A last note for my readers who are public health professionals:

We need to focus on rebuilding trust. We need people to know that we are not synonymous with these political shills who have co-opted our CDC (even if you are one of the fierce scientists still working there and doing your best to conduct actual science). We need to not be dismissive, and treat people who are ignorant of the scientific facts as if they are stupid. They are not stupid, and they need us to provide good information in ways they can hear it. Taking our frustrations out on them isn’t going to help.

If you haven’t already, I highly recommend reading this exceptional article by Jess Steir, modeling how we can talk to others and have a real impact.

And how? 8 moderate Democrats in the Senate decided to vote with the Republicans to advance a short-term funding measure, the first step in re-opening the government. The Senate will need to debate and then pass a final bill, and that bill will still need the approval of the House, and then signature by the president. House Speaker Mike Johnson has summoned everyone to return immediately so they can vote on it, post-haste.

The short-term funding measure extends government funding through January 30, and passes a series of longer-term spending bills, including funding SNAP through the end of this fiscal year. (Unless another continuing resolution is passed by Jan 30, the government will shut down again.)

The good: If passed, this deal will reverse all the firings of federal workers who were RIFd during the shutdown, and it will ensure all federal workers who still had to work during the shutdown (like air traffic controllers, TSA, and more) get paid what they were owed for working during the shutdown. (Well I should HOPE so!) It also offers protections so that no other federal workers can be laid off through the end of the fiscal year.

The bad: With very limited exceptions (basically what’s above), this is the same exact bill Democrats have been rejecting all along. There are no extended health insurance subsidies, no changes to prevent the president from continuing to withhold congressionally appropriated funds like he’s being doing, nothing. If Democrats didn’t get any wins, then the 41 days of pain from the shutdown were for naught. We might as well have skipped it.

Yes, as part of the deal, Senate Republicans have promised to hold a vote in early December on extending health insurance subsidies. That’s not actually written into the bill that’s about to pass, it’s just a handshake agreement. And they haven’t said they’ll vote to pass any extension to the subsidies, just that they’ll vote on it.

Mark my words: Average Americans are all about to be hosed. If I’m wrong I will come back here and apologize, loud and clear. But I think we all know how this is going to go. The Democrats are like Charlie Brown trying to kick the football.

Notably, not one of the 8 Democrats who crossed the aisle for this vote are up for re-election in 2026, leading many to suggest that despite the outrage some in Democratic leadership might be displaying for the cameras, this was probably orchestrated behind the scenes. They worked to protect the most vulnerable among them during the midterms. They’re hoping by the time it matters, we’ll forget those who agreed to vote for this bill.

Let’s not forget.

Here are the 8 names to remember:

• Sen. Dick Durbin of Illinois

• Sen. Jacky Rosen of Nevada

• Sen. John Fetterman of Pennsylvania

• Sen. Catherine Cortez Masto of Nevada

• Sen. Jeanne Shaheen of New Hampshire

• Sen. Maggie Hassan of New Hampshire

• Sen. Tim Kaine of Virginia

• Sen. Angus King of Maine (he’s an independent who caucuses with Democrats)

Here are their faces.

Remember this when Lucy pulls the football, again.