Measles vaccines are the new cool thing in Texas. Plus, the future of USAID may be determined today, updates on H5N1 vaccines, and some good news from the CDC.

Hi everyone, As we head into the end of the week, here’s the catch-up I honestly needed to write for myself just to be able to stay on top of things. It’s a six-topic briefing, covering Measles, USAID, H5N1 vaccines, the latest from the CDC, and more.

A quick reminder: If you are employed by the government (or were recently let go) and you want to speak to me informally, please email me or find me on Signal at "InsideMedicine.88." I promise to maintain your confidentiality.

Let’s get to today’s briefing…

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Getty Images / Majority World

Measles vaccines are the new cool thing in Texas. Sweet.

Measles vaccinations increasing in Texas. According to NBC News, there has been a noticeable increase in new Measles vaccinations since an outbreak of the dangerous disease began there recently.

This is not at all surprising. It is often the case that when a vaccine is so successful that severe cases are rare, some parents get a false sense of security and choose not to have their kids vaccinated. Then, when an outbreak occurs, they realize that this is serious business, and that the wiser move is to get their kids up-to-date on their vaccines. That’s apparently happening now, though we won’t know for a while much interest has increased, nor how long it will last. But for a bad news story like the Measles outbreak in Texas—which just claimed the first life in the US since 2015—this is welcome news.

Yesterday, the CDC released a statement, expressing its condolences to the family of the child who died in the outbreak. It’s notable that RFK Jr. did not make any statement of sorrow or regret during his comments at President Trump’s Cabinet meeting on Wednesday. “We following it,” he said more than once, as he attempted to sell the notion that Measles outbreaks are normal—which they should not be.

The future of USAID: The Supreme Court could weigh in as soon as today.

Today could be an extremely important day in the history of United States foreign policy, public health, and just our overall impact on the world. If the Supreme Court tells the Trump administration that it must honor USAID agreements, it could mean the beginning of an attempt to save that agency from obliteration. This would turn the funding back on for projects that save millions of lives. Some of the plaintiffs’ arguments in favor of requiring the US government to honor its own commitments were published yesterday.

For whatever problems people might find in some nooks and crannies of certain USAID projects, only a profoundly cynical or naive perspective could justify the mayhem that the Musk-Trump attack on this treasured national and global asset has already caused. (Here’s another story in Reuters outlining the cruelty caused by the cuts, affecting programs in Sudan and other places.)

Trump administration considers backing out of bird flu vaccine collaboration.

In the waning days of the Biden administration, the Department of Health and Human Services announced a $590 million investment in Moderna’s promising mRNA H5N1 bird flu vaccine. The hope was that the investment would speed things along—not a far-fetched idea, considering that the funding came in part from the Biomedical Advanced Research and Development Authority (BARDA), the center that successfully stewarded Operation Warp Speed, which brought safe and effective Covid-19 vaccines to the public faster than most experts thought possible. Now, of course, the Trump administration is toying around with canceling that investment. Sadly, the idea of cutting something that might help us seems to be right on brand for the early days of the Trump administration.

A long-standing New York health program now asking about immigration status.

The Floating Hospital, a vaunted New York program with a record of providing medical care to “to all who have needed it, regardless of insurance status, immigration status or ability to pay,” is now asking for proof legal immigration status, Politico reported yesterday. The change comes in response to the Trump administration’s implied directive that recipients of federal funding should only care for (and about) people who have all their papers in order.

I’m not naive enough to believe that everyone on US soil has the right to anything they want, regardless of their legal status. However, when it comes to healthcare, we have a law called EMTALA, which means that if a person’s life, organs, or ability to function is in jeopardy, US hospitals must treat them, regardless of their ability to pay. What that often means is that hospitals absorb those costs and pass them on to people who are paying, either by insurance or out of pocket. It’s far less expensive to keep people out of the hospital through programs like The Floating Hospital than it is to deny care upfront. “An ounce of prevention is worth a pound of cure,” as they say. The Floating Hospital of New York provides behavioral health, dental care, HIV and other infectious disease care, and other services. All of these things are much easier and less expensive to prevent and treat early on than to wait until people get dangerously sick and EMTALA applies.

Republicans continue to eye Medicaid cuts. The misery will not be felt equally.

The House Republicans moved forward with a proposal that seeks to cut $880 billion of federal spending over ten years, which is around 10% of Medicaid’s budget. As discussed in an earlier Inside Medicine, the proposed budget would require the House Committee on Energy and Commerce to find those savings among its projects, of which Medicaid is the biggie. While there are other projects in the committee’s purview, they receive a lot less funding than Medicaid. And the way things are set up, what looks like small cuts in Medicaid could actually cause millions of people to lose their insurance, as described previously in our math deep-dive.

My friend Professor Miranda Yaver at the University of Pittsburgh put together this dashboard showing how much various counties in the US rely on Medicaid. The upshot is that these cuts could really hurt voters, including in Trump strongholds.

The CDC’s Morbidity and Mortality Weekly Report was really normal yesterday. Plus, another CDC journal is finally back.

Thursday is the day we always get a new issue of the CDC’s most-read public journal, Morbidity and Mortality Weekly Report (MMWR). For two shocking weeks after President Trump was inaugurated, there were not MMWR’s. (Sidebar: I’m still not over the fact that the Trump administration’s communications freeze temporarily shuttered such a long-standing reliable scientific publication. That was crazy.) Then, for a few weeks, we had MMWR's that were a little odd—fewer articles than usual, and some delays on expected H5N1 papers (although, I remain thoroughly convinced from insider reports that those delays were due to increased scrutiny/zero margin for error, rather than censorship). I am also pleased to report that, at last, the CDC’s February issues of its journal Preventing Chronic Disease has been published—meaning that all three of the CDC’s public facing scientific periodicals are finally back online.

This week’s MMWR was truly a welcome sight. It contained five articles covering topics that we might have worried could be subject to censorship in the Trump administration. These studies covered this year’s Covid-19 vaccines, this year’s flu shots, some epidemiology about a known, rare, but concerning flu complication (called acute necrotizing encephalopathy), a longer-term evaluation of pre-cancerous cervical cancer lesions (which have decreased due to vaccines), and a paper about H5N1 bird flu in wastewater. I discussed the top-line findings of those papers over on Instagram yesterday. Here’s that video:

That’s all for now! If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.

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