NIH grant delays: Bureaucratic slowdown or more intentional obstruction? Plus, CDC postpones vaccine meeting and cancels a PR campaign—what does it all mean?

That and other catch-up at NIH, CDC, and elsewhere.

Hi everyone,
There's so much happening that I could have written several days' worth of Inside Medicine articles based on today’s stories. But I tried to pack it all in so that we’re up to speed before what could be another Friday Firing Spree™️ by the Trump administration.

As always, I hope this format is useful, and I am grateful for your feedback—especially in response to yesterday’s installment. I appreciated your emails and shared some with “Jamie.”

Today, I chased down updates on a bunch of stories from the NIH and the CDC. There’s a lot that’s clearly bad, and some things that look bad, but I’m honestly not sure what to make of them. I try to be honest about these things rather than always conveying the most alarmist interpretations (which, thankfully, don’t always turn out to be correct). Then, to round out today’s installment, I included a couple of quick hits about Covid-19 tests and, yippee, Dr. Oz.

Let’s get to it!

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Getty Images / Scott Olson

NIH update: The flow of money, delays in new grants, and the effect on graduate school admissions.

Is the money flowing?

The state of NIH funding for biomedical researchers remains opaque. Supposedly, the federal freeze on grant funding is not active. But is the money flowing? It’s actually not easy to know. The NIH doesn’t pay university or hospital-based researchers directly. Instead, the NIH pays external institutions (e.g., Harvard, Yale, Stanford), which in turn pay their scientists. So I can’t ask any of the dozens of grant-funded researchers I know all over the country because they don’t even know. There are stories that despite the end of the federal grant freeze, the flow of money to these institutions never resumed and that, for now, these places are absorbing the costs. That can only go on so long, if that’s the situation. But only the parent institutions (like where I work) know what is happening. And right now, they are spooked and not talking.

The Federal Register is not posting much.

It has been reported (including in MedPage Today) that the Federal Register—the daily journal of the US government—has been temporarily shuttered. That’s being described as an “end around” tactic for the Trump administration’s to stop federal funding of biomedical research. If the Federal Register is not being published as usual, things simply can’t move forward logistically, like the scheduling of “study sections” (committees that review grants and decide what should be funded) and other key steps along the way to announcing new biomedical research grants. Nature reported that the NIH has not posted anything in the Federal Register since Trump took office. I checked and that’s mostly but not entirely true. Instead of the usual stream of communiqués, I only found a couple.

Many new NIH grants are not progressing. It’s not clear why (other than it’s obviously the fault of Musk and Trump).

One researcher I know described some strange logistical happenings at the NIH. They told me that a study section on which they serve was canceled and then the NIH program officer (PO) who wrangles the meetings tried to scramble to reschedule the meeting. But by the time all the members of the committee filled out the required forms, it was already fewer than 30 days from some of the proposed replacement dates, and by the rules, meetings can’t be sprung on people with less than 30 days’ notice. So, an infinite loop has started to occur. What’s unclear is whether this represents some intentional subterfuge. Probably not, given that the POs are dedicated professionals who believe in the NIH mission. It’s more likely that because other NIH staffers were summarily fired from their jobs by Musk and Trump operatives, those who remain have too many balls in the air to manage. Thus, it’s likely that in some cases, the chaos of understaffing might be responsible for the lack of progress in some study sections. Regardless of the intent, this is holding up future grants. Another researcher (who I don’t know) posted about a related issue on LinkedIn:

Nature also reported that some new NIH grants have been announced in recent weeks, but far fewer than usual at this time of year (including during new administrations). The future of NIH funding is so unclear that STAT News reported that graduate schools at major academic institutions are unsure whether to accept incoming students—and so some have paused admissions for now. (Graduate students in the sciences are paid, and the NIH pays the lion’s share of those salaries at most major institutions.) If this were to suddenly change, we’d cease to have a pipeline that trains scientists in the United States of America.

Speaking of the NIH, here’s a post from another dedicated professional who turned to LinkedIn to announce his unexplained firing by Musk and Trump, in their unhinged campaign to destroy our nation’s global dominance in biomedical research.

Radio silence from major universities.

Have you noticed that virtually no universities have specifically come out against the Trump administration’s attacks on public health? (I’m not talking about lone wolves like me who don’t represent their institutions.) The only exception I can think of is Georgetown University, and even at Georgetown, the criticisms have come from just one corner of it—the Center for Children and Families in the McCourt School of Public Policy, and mainly on one issue (not related to the NIH debacles). The CCF press releases have been focused on Medicaid funding, which is a major issue it works on. Why is the CCF so brave? Not surprisingly, it takes no public funding. Still, it’s an interesting exception in a sea of silence from major universities that stand to be throttled by the Trump administration’s attack on research funding. At some point, these institutions are going to realize that silence is more expensive than they think.

CDC update: Vaccine policy, an anticipated MMWR finally sees the light, and possibly good news on our Disease Detectives.

Vaccine advisory group meeting postponed. One flu vaccine campaign canceled.

In the first sign that Senator Bill Cassidy got bamboozled by RFK Jr.’s assurances that vaccine policy would not come under threat if he took over at HHS, the CDC has postponed its planned meeting of the Advisory Committee on Immunization Practices (ACIP). It’s unclear what this means, but many have concerns that this is a step toward the Project 2025 goal of getting the government out of the vaccine recommendation business.

Meanwhile, it was reported that the CDC has canceled one of its PR campaigns designed to increase uptake of seasonal flu shots. Sources in that NPR story took this as a sign that the CDC is embracing the Project 2025 goal of turning away from total support for vaccines. The administration denied that.

Honestly, I’m not sure what to believe here. It’s feasible that this particular campaign called “Wild to Mild” (which basically says that flu vaccines turn the illness from the equivalent of a lion into a little putty-tat) was just deemed to be ineffective. (It’s cute, but I’m not sure it’s the world’s most brilliant campaign ever.) So, the sources who spoke to NPR could simply be people who designed and liked the campaign and were venting and/or expressing disappointment. Alternatively, it really could be the first domino in the Project 2025 effort to undermine federal support for vaccines. It sucks that we live in a timeline in which it’s hard to know. I’m trying to find out more, but so far, I don’t have eyes on this one.

An anticipated CDC Morbidity and Mortality Weekly Report (MMWR) was published yesterday. But where are the other CDC journals?

The CDC’s MMWR was published yesterday. That’s the 3rd week in a row after a creepy-as-hell two-week lapse for the first time in decades. This week, we got four papers, which is the most we’ve seen during the Trump era, and more in line with what we’d normally expect. (There were two papers in each of the two previous issues, which was better than nothing, but still strangely quiet.)

Of note, after weeks of delay, the now infamous H5N1 bird flu paper on household cats was published. There had been speculation that the paper was held up due to politics. My sources at the CDC said otherwise—that everyone is so nervous about anything being wrong that the paper was reassessed and needed a few questions answered before it could be published.

Meanwhile, three other manuscripts in MMWR covered Dengue Virus (which many climate scientists predict may make a big stand in the US as soon as this summer), Hepatitis A, and lead levels in the air after the Los Angeles fires.

Meanwhile, the CDC’s two other big scientific journals are now conspicuously absent this month. Both Preventing Chronic Disease and Emerging Infectious Diseases are monthly journals that were published in January before President Trump took office. With the communications freeze basically being over, these journals’ February issues ought to have been released. I’ll look into it.

Were the Disease Detectives spared?

Last week, it was reported that the Trump administration had decided to summarily terminate the entire first-year class of the Epidemic Intelligence Service (EIS) known as the Disease Detectives. Since then, some have said that this never happened. The question is what really happened?

I’m actually unsure, but I hope that our Disease Detectives were spared after all. The reality is that I don’t know a single person in EIS who received a termination email, but I also can’t account for everyone in the service. Also, if the EIS officers were spared, was that because there was a last-minute policy reversal in response to the widespread outrage that followed the reports of their terminations? Or, had the sacking of EIS officers always been an unconfirmed rumor, despite what multiple sources told CBS News (as well as Inside Medicine and others). Again, I don’t know for sure and I’m working on trying to iron it out. Meanwhile, two other respected CDC training programs are rumored to be in the Musk-Trump crosshairs. Friday is “fire everyone day” in the Trump administration, so we’ll just have to see.

Trump administration flip-flops on at-home Covid-19 test program.

On Wednesday, Reuters reported that the Trump administration reversed a plan that would have shut down the government program that delivers four free Covid-19 tests per household. (For what it’s worth, we discussed that arc here in Inside Medicine eight days ago.) On top of that, The Washington Post reported that the Trump administration even considered solving their little dilemma by up and destroying the government’s stockpile of Covid-19 tests. They didn’t. But they sure thought about it.

Dr. Oz vows to divest from interests where he may have power.

Dr. Mehmet Oz announced that he intends to sell off financial stakes he has in businesses and other investments that may present a conflict of interest if he is confirmed as the Administrator of the Centers for Medicare and Medicaid Services (CMS). (The previous sentence is correct.) If he follows through, it would be a stunning example of someone actually playing by the rules that made our government a beacon of legitimacy and anti-corruption. I hope he does it, and it’s a small thing that shows seriousness of purpose, albeit from a guy who once said that perhaps science has not caught up to psychics. In a related story, here’s a PDF of the organization chart at CMS.

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.

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