One year ago, President Trump was inaugurated. Today, Dr. Angela Rasmussen (Rasmussen Retorts) and I gathered four experts to discuss the major currents of the year. That is: what happened, what’s next.
We welcomed:
Dr. Gigi Gronvall, a biosecurity expert from the Johns Hopkins Center for Health Security.
Dr. Noam Ross, who co-founded Grant Witness, which has been tracking NIH, NSF, and other grant cuts (and reinstatements). He caught us up on NIH grants—what has happened, and what’s coming.
Dr. Paul Offit, a co-inventor of the rotavirus vaccine. (His Substack is essential reading.) He helped us cover RFK Jr.’s attack on vaccines.
Dr. Demetre Daskalakis, who was the Director of the CDC’s National Center for Immunizations and Respiratory Diseases (until he had to resign in protest). He chimed in on RFK Jr. as well, but took us inside the CDC, as only he can.
An in-depth summary with timecodes can be found below. I hope you find this session informative, and please join me in thanking our panelists! Closed captions (㏄) for the above video and a transcript option (📄) can be found beneath the video playback control bar above.
Also: We tried something new! Instead of two to four guests having one continuous conversation, we had four guests, but each was only on for 10–20 minutes (i.e., shorter, more focused segments), each covering a specific area of expertise.
Quick reminder that this is all entirely free for everyone, thanks to the subset of people who upgrade to premium. If you’d like to support this work, here’s how👇
Summary & Highlights.
Aided by ChatGPT.
One Year In: How the Trump Administration Eroded Public Health.
Setting the table (00:00:32)
We went live to mark the one-year “helliversary” of the Trump administration’s impact on public health—an hour built around crisp, rotating segments with experts who’ve been watching the damage up close: Angela Rasmussen, Gigi Gronvall, Noam Ross, Paul Offit, and Demetre Daskalakis. We framed the goal plainly: name what’s been broken, explain why it matters, and look for early signals that pushback is (or isn’t) working.
Where virology is now (00:01:09)
We started with a blunt status report from the virology front: lab science and public health capacity have both taken direct hits. We talked about NIH-funded researchers losing grants, federal virologists losing jobs, and a new “safety and security” executive order that effectively narrows what virology research can be done—creating a chilling effect that doesn’t just slow papers, but weakens preparedness.
Measles and the meaning of “elimination” (00:02:05)
We zeroed in on measles as the crisis the public can actually feel. Angela walked through what sequencing does and doesn’t do: you don’t need every sample to understand a single, continuing chain of transmission. Viral genomes, time, and location let epidemiologists infer whether outbreaks are linked—exactly the kind of technical competency that becomes impossible to replace once you hollow out agencies. We connected the dots between vaccine denialism, silence/chaos from public health leadership, and the plausibility that the US is drifting toward losing measles elimination status.
Gigi Gronvall on biosecurity: public health is national security (00:05:00)
Gigi laid out the overlap: if you “hack at” public health, you sabotage biosecurity. Surveillance, research capacity, workforce stability—these are the same muscles you need for deliberate threats and naturally emerging ones.
She cited a key pre-year marker: the bipartisan National Security Commission on Emerging Biotechnologies (NSCEB) report, which warned the US is losing its edge in biotech and risking strategic disadvantages—especially around supply chains. We emphasized the whiplash: the commission’s recommendations included investing in public health and research, but the year delivered the opposite—instability, fear, and scientists considering leaving.
The talent pipeline is already cracking (00:08:34)
We talked about the early warning sign that doesn’t require waiting years: recruitment. Gigi described how the US no longer feels like the default destination for scientific talent—and how safety, politics, and instability now shape choices. The cost isn’t abstract: it’s the next generation of labs that never get built here.
Allies are recalibrating: “America is unreliable” (00:09:54)
Gigi also described what it feels like internationally: treaties and global coordination rely on good faith or predictable self-interest. This year signaled neither. She pointed to the destruction of USAID infrastructure and State Department shifts as undermining diplomacy and, downstream, preparedness.
Denmark, vaccines, and geopolitical weirdness (00:11:00)
We had a darkly surreal exchange about Denmark being invoked constantly by those trying to undo vaccination policy—while, geopolitically, Denmark/Greenland/NATO rhetoric spirals. The point wasn’t to claim a neat causal story; it was to capture how chaotic governance breeds bizarre feedback loops.
We also pulled the thread back to what we can document: the administration’s willingness to platform flawed “Denmark” narratives while sidelining rigorous Danish science—and the broader moral geometry of who gets harmed when ideology drives public health.
“Leaving the WHO happens Thursday” (00:13:53)
We flagged the immediate security implication: withdrawing from WHO harms both public health and national security—especially for information-sharing, coordination, and technical participation.
Noam Ross: what happened at NIH (00:14:15)
Noam gave the year’s most concrete accounting. We discussed:
NIH losing roughly 20–25% of staff.
More than 5,800 grants terminated or suspended.
The cuts spanning ideological targeting (transgender health, equity, mRNA, preparedness), personnel targeting (researchers associated with workforce-broadening programs), and institutional “blackmail” (whole-university funding pauses).
We framed it as a breach of the basic promise science requires: long-term investment. Pulling grants “on a whim” doesn’t just end projects—it destabilizes the idea that research commitments mean anything.
The “neurotransmitter” problem, and how the purge worked (00:17:20)
We revisited the early reports that some terminations appeared driven by crude word searches (“trans” etc.). Noam clarified that while there were sloppy, error-prone examples, the pattern looked more targeted than purely random—still executed by non-experts, still ideologically driven, still reckless enough to create collateral damage and clerical chaos.
DGOF and the shotgun approach (00:20:47)
Angela pushed on dangerous gain-of-function enforcement: why were some groups terminated outright while others were told to revise? The takeaway: the tool isn’t fine-grained science; it’s a blunt instrument wielded by people with an agenda and limited technical competence. Gigi reinforced this: grants clearly outside DGOF got swept up anyway.
Pivot to vaccines, CDC, and ACIP (00:26:10)
We moved to the vaccine universe and set the timeline:
RFK Jr. promised not to “tinker” with vaccines and implied ACIP was sacrosanct.
Then he fired all 17 ACIP members and replaced them with mostly aligned appointees.
The result wasn’t merely controversial policy—it was a collapse of process: credibility, conflict vetting, evidence frameworks, and predictable decision-making.
Paul Offit: “It’s been awful” (00:27:31)
Paul described the emotional and institutional experience: scientific truth is being replaced by declared truth, and expertise is treated as optional.
He pinpointed the moment the ceiling disappeared:
Early 2025, measles reappeared.
After a child died—the first measles death in years—RFK Jr. went on national TV and repeated false claims about the measles vaccine and romanticized natural measles.
“Nothing happened.” No accountability, no real constraint. That’s when Paul concluded RFK Jr. could do whatever he wanted.
Cassidy, confirmation, and the cost of “tricky” (00:29:31)
We talked about Senator Bill Cassidy’s role in confirmation and how the political bargain backfired. We also connected it to why CDC leadership remains unstable: once the confirmation fight burned Cassidy, the administration couldn’t easily route a consensus CDC director through the process—especially after vaccine-aligned candidates became liabilities.
Demetre Daskalakis: CDC as a hijacked plane (00:31:08)
Demetre described CDC as an agency in hostage mode: scientists produce high-quality work; leadership uses it as a checkbox and proceeds with predetermined decisions. He painted CDC as increasingly performative—“theater” around ACIP—while RIFs and constant reorganizations keep the institution suspended in place.
Morale at NCIRD and the “cost of doing business” moment (00:34:24)
Demetre emphasized morale is grim, especially in immunization programs: staff are asked to do the same work, then told it won’t matter. We described the cognitive dissonance of labs racing to sequence and document measles transmission while leadership minimizes the stakes.
How “strategic incompetence” becomes strategy (00:36:04)
We argued that the process failures aren’t random:
When evidence presentations (like vaccine safety data) created friction, the solution wasn’t to debate the evidence—it was to stop presenting it.
If the goal is to move outcomes regardless of data, you remove the parts of the process that could slow you down.
Offit: three categories of physician response (00:38:18)
Paul laid out how clinicians are reacting:
Ignore CDC/ACIP and follow AAP/ACOG and other professional societies.
Keep practicing normally but spend more time fielding vaccine confusion.
See patients decline vaccines because policy language (“shared clinical decision-making”) signals optionality.
We tied that to what’s already visible: falling coverage and outbreaks that reflect erosion, not a single day’s decision.
The conversations we should have been having (00:40:40)
We stressed something that often gets lost: we’re not arguing for maximalism; we’re arguing for process and proportionality.
COVID boosters for certain low-risk groups might reasonably be framed differently.
HPV policy could evolve with new data.
But none of that can happen on vibes, leaks, or agency coercion. Without credible methods (GRADE/EtR), even “right-sizing” becomes indistinguishable from sabotage.
Joseph Hibbeln and the evidence-framework rebellion (00:43:39)
Angela highlighted a surprising bright spot: Joseph Hibbeln repeatedly insisted on proper methods—GRADE, EtR, trained evidence analysis—and clashed with Robert Malone. It was absurd theater at times, but the core mattered: someone inside the wreckage still trying to force evidence-based procedure back onto the track.
The trust debate: what went wrong, and who’s lying now (00:46:00)
Paul acknowledged retrospect: some COVID-era policies could have been communicated differently; other countries moved faster to risk-based framing. But Angela drew a hard line: the collapse in trust wasn’t mainly because of imperfect messaging—it was driven by sustained, intentional lying about science and vaccines, now with official branding.
We also argued that critics who demanded perfection from public health leaders often offered worse alternatives (including strategies that would have produced far more death before vaccines).
What we’re watching next (00:58:36)
We ended with near-term indicators that reveal whether resistance is working:
Paul Offit
FDA slow-walking vaccines in ways that make seasonal vaccination impractical.
VICP (Vaccine Injury Compensation Program): if undermined, manufacturers could exit—replaying the 1980s collapse in vaccine production.
Hope: litigation (including AAP’s suit) and broad parental support that could become organized political pressure.
Demetre Daskalakis
Same two alarms: VICP destabilization and deeper weaponization of FDA (“all teeth”).
Hope: the judiciary—clear legal violations, accumulating damages, and courts as the most realistic brake.
Angela Rasmussen
We underscored the asymmetry: the “kitchen sink” strategy of disruption works by exhausting attention and making consequences feel delayed.
Our counter-strategy has to be equally multi-channel: litigation, mobilization, media, education—anything that documents, explains, and raises the cost of continued destruction.
Closing: why this format matters (01:06:29)
We ended with the meta-point: this kind of panel—domain expertise, long-form, unglamorous policy mechanics—rarely makes it onto TV. That’s why these Substack Lives matter and why we’re doing them. We committed to a Part 2 and to doing these often, because the administration’s contempt for expertise makes public visibility of expertise a civic act.
If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
