Public Health Blitzkrieg Day 5: Trump pauses global HIV funding. Fauci stripped of security. Oddly normal interim directors named at FDA and NIH.

Updates on another frantic day in the Second Trump Administration's public health adventures for January 24-25, 2025.

Getty Images / Jim Watson.

Trump pulls lifesaving HIV funding for now. PEPFAR halt threatens two decades of progress and American leadership.

There are few US global initiatives more successful than PEPFAR, the President’s Emergency Plan for AIDS Relief. Started by President George W. Bush, the program was so well-funded (and so successful), that prominent liberal advocates and activists who were among the harshest critics of Republican politics have hailed it as a massive American success story. PEPFAR has saved 25 million lives, according to the State Department. It has provided treatment for >20 million people including successful treatment so that 5.5 million babies that would have been born with HIV were born HIV-free.

President Trump pulled the funding today, at least temporarily, the New York Times reported this evening. Final decisions on the status of programs like PEPFAR may take 6 months. That is too long to wait and so the race against the clock is on. HIV drugs are highly effective and work quickly. When funding for drugs runs out, people will just start dying. Also, resistant strains will emerge, posing a risk to everyone, including Americans.

There are many other programs affected by President Trump’s pause of foreign aid, but PEPFAR is a supremely unusual one; it has saved so many lives and enhanced the reputation of the United States as a true friend of the world. Not many US-backed initiatives achieve such lofty goals.

Pausing PEPFAR is a disgusting act. It’s unclear if this pause will harm very few or millions of people. But one way to make the pause hurt nobody would be to reverse the decision immediately. I would advocate strongly for that, for the good of the American people and the world. And, I hope that when the program resumes that the world blames a few selfish zealots for any harm done, rather than the rest of us who simply want to live in a world that is free of HIV for good.

Trump removes Fauci’s security detail.

Dr. Anthony Fauci needs a security detail. Think about what that even means. The fact itself is such a problem, reflecting the toxic nature of things in our country. Dr. Fauci served our nation admirably for decades, in both Republican and Democratic administrations. Sadly, he has become demonized and public health has become politicized (Fauci is staunchly poltically independent who probably voted for both Democrats and Republicans, but that’s just me speculating). Things are so bad that, Former President Biden preemptively pardoned Dr. Fauci on his last day in the Oval Office. Fauci, for his part, acknowledged the action while maintaining that he had done nothing wrong to even warrant the pardon.

Today, it was reported that the Trump Administration has pulled the government-paid security detail protecting Dr. Fauci in recent years. I’d heard rumors of this, so it was not a surprise to many. But it’s still just depressing. Fauci will now pay for his own security, reports say. I hope he doesn’t need it, but I worry that this move might be interpreted by the recently pardoned violent felons of January 6th as an invitation to cause trouble. Look, the reality is that a security detail can only do so much to keep someone safe. But the presence of a government-provided security at least meant that if someone ever attempted to harm Dr. Fauci, the attacker would either not succeed or at a minimum would be very unikely to leave the scene unhurt themselves. These are important deterrents.

I asked Dr. Fauci about this in my 47-minute interview with him last summer for MedPage Today and Inside Medicine. Here’s our exchange on that:

Faust: So knowing now that, going into public health, someone who wants to be the next Anthony Fauci or even along the spectrum of that, why would they do that? Aren't they going to be dissuaded from that? Because they see that what it leads to is threats against you and your family. It leads to someone in Congress yelling and saying, "You're not a doctor." What would you say to someone who is thinking about going into public health and public health research?

Fauci: You know, Jeremy, I would encourage them strongly to do it if they're thinking about it, because the gratification and the feeling of accomplishment that you can have in the arena of public health in general and public service, which is intimately connected to public health, is worth the difficulties that we face.

It would be nice if we didn't have that, but it would not discourage me from strongly encouraging younger people, even though they see some of the slings and arrows that we get subjected to by people who should know better. I still think the end game, the end of the day of what you can get out for yourself and for others, and the feeling of gratification you get about helping others in public health totally... all of life, Jeremy -- I don't want to get too philosophical -- is a risk-benefit ratio. You take risks, and what's the benefit? What's the risk? And the benefit of pursuing your career in public health far outweighs, in my mind, the risks.

I am glad that despite everything, Dr. Fauci still believes in public service. But I think the headlines around the revoking of his government-paid security serves as another subtle disincentive for bright minds to follow in his footsteps.

Dr. Sara Brenner named FDA interim Director. Experts react.

Dr. Sara Brenner was identified as the interim Director of the FDA. (This may have already been in place, but it was reported today. Ironically, the FDA could not comment because of the President’s gag order on communications from federal public health agencies.

Here’s what we know: Brenner served as the FDA’s Chief Medical Officer and Associate Director for Medical Affairs and seems to be well-liked and respected by former colleagues, including officials who have served both Democratic and Republican administrations. Brenner has a long record that includes work on “diagnostic data quality, harmonization, reporting, diagnostic device performance, and leveraging emerging technologies for public health, medical, and policy decision-making during the pandemic.”

Insider reactions: “She is great,” said Dr. Luciano Borio, the former acting chief scientist at the FDA. Borio worked with Brenner at the Office of Science and Technology Policy during the first Trump Administration and later served on then-President-elect Biden’s highly selective Covid-19 Advisory Board. Borio described Brenner as “highly capable and hard working.”

“Yes! She is good,” a former Biden White House official told me today. “Sara was instrumental in FDA’s role around diagnostics and diagnostic data for the Covid-19 response.”

Immunologist and diagnostics expert Dr. Michael Mina was also enthusiastic. “I have called on Sara when I was hitting up against roadblocks. Sara is a level-headed very clear thinker and cares deeply about advancing the mission of the FDA rather than seeing it rest upon what it has been doing in the past. Sara is a terrific leader, and is forward looking. From my perspective, she saw the current approaches at FDA especially in diagnostics as limiting and recognizes that many of the approaches that the FDA currently takes are not fully appreciating where [the field is] on digital health and diagnostics. She is rigorous but not dogmatic. I feel she is superbly qualified.”

Dr. Mathew Memoli named NIH interim Director. Experts react.

STAT reported that Dr. Matthew Memoli has been named as the acting Director of the NIH. Memoli is an NIH insider who worked on Covid-19 policy. On the plus side, he has the benefit of NIH experience (including extensive research on respiratory viruses).

Interestingly, Memoli was described by STAT as a critic of Dr. Anthony Fauci, though all I can find on this is a difference of opinion over vaccine mandates during the Covid-19 pandemic. The disagreement seems to be that Memoli felt that low-risk adults should not be required to receive the primary Covid-19 vaccines. A Wall Street Journal article about an internal debate over Covid-19 vaccine mandates in 2021 reported that Memoli supported the vaccines for the elderly and others with high risks, but not a requirement for all-comers. (This, I should mention, is where I came down on Covid-19 booster mandates later that year.)

Technically, Fauci was Memoli’s boss at the National Institute for Allergy, Immunology, and Infectious Diseases. Naturally, I was curious. So, I asked Memoli himself about it this afternoon. He declined to make any comment and referred me to NIH communications.

This evening, I spoke to a scientist who has collaborated with Memoli (but does not know him well). “He’s a good man….He’s one of us,” the scientist said. He described some of Memoli’s contributions in helping influenza vaccine challenge studies move forward, which could lead to a universal flu vaccine.

But the choice was a surprise, the scientist told me. “We were all surprised to see his name today,” he said. The implication is that there were many people in the NIH hierarchy who were senior to him (and higher-profile than Memoli). That was cause for speculation. Either more logical picks were passed over, they declined to serve in the role, or that Memoli’s choice reflected something else, like a political preference from the Administration. Perhaps publicly criticizing any aspect of a Covid-19 vaccine mandate from within the NIH was enough to curry the favor needed. As to whether there was bad blood between Memoli and Fauci? “I am unaware of that,” my source said.

Dr. Rick Bright, a former senior HHS official, said “I have known Matt for many years through our mutual work on development of improved influenza vaccines, including efforts to develop a universal flu vaccine. Matt established a human influenza virus challenge model, whereby he studied vaccine effectiveness by intentionally infecting people with live viruses to see how sick they would get after exposure. He also worked very closely with Dr. Jeff Taubenberger, who was instrumental in using molecular methods of creating viable viruses, using their sequence data. With this approach, they were able to reconstruct the highly lethal flu virus that mimicked the 1918 pandemic strain. Matt used this reconstructed virus to study influenza pathogenesis in various models. Matt is a good guy, and has a lot of basic science experience, working primarily as an internal NIH scientist.” Whether that makes Memoli a good administrator is another matter. “I am not aware of his managerial or policy expertise. However, as with each of these interim roles, these could be very temporary.”

While Dr. Bright didn’t explicitly point this out, I couldn’t help noticing the reference to invovlement in making a possibly very dangerous stain of flu in a laboratory. With all of the obsession that Trump world has given gain-of-function research in recent years, you’d think they’d be a little gunshy on tapping a scientist who was doing reserach that involved creating a 1918-like flu virus in a lab. I personally trust scientstis like Dr. Memoli to do this work. But do the people in Trump world?

Meanwhile, infectious diseases physician and former member of the Biden Covid-19 Advisory Board (and good friend of mine) Dr. Céline Gounder interviewed Memoli on the Epidemic podcast a few years ago. According to Gounder, “I think what Memoli had right is that antibodies to Covid-19 might prevent severe disease, but not necessarily infection. There’s no question that vaccination is a lower risk way to gain that protection. But what many got wrong is that vaccination would get us to herd immunity against Covid-19. Neither vaccination nor infection, the latter of which Memoli thought might induce better protection, got us to herd immunity. But we all gained immunity somehow, some taking the riskier route of infection, and most of us now have good enough immunity that we won’t get severely sick from Covid-19.”

Finally, it appears that Memoli’s selection was meant to be announced on Wednesday. But, again, the broad gag order may have prevented the NIH from sharing that news with the public initially. But the announcement is now live on the NIH site. So, obviously somebody higher up thinks that this is important enough news that it is worthy of an exception to the reign of censorship that the NIH and other agencies are currently under.

Overall outlook on interim leadership at the federal public health agencies.

Something weird is happening. The interim directors of CDC, FDA, and NIH—news of which broke in the last 24 hours—are better known and have established relationships within federal public health circles than the would-be permanent nominees. And, almost by design, these interims seem to have deep ties on both sides of the political divide. It’s shockingly normal.

So, while there’s chaos related to the typical functioning of these agencies (vis-a-vis President Trump’s disruptive executive orders this week that caused some data blackouts, the silencing of public service announcements, and interrupted the evaluation of new scientific research), starting now there likely will be stability and steadiness from these agencies’ leadership. For now, at least.

Some data still live, despite gag order.

A quick update on the data gag order. When we found out that Trump’s gag order on public health agency communications included updates to websites, we worried that the data powering the Inside Medicine Respiratory Virus dashboard might be affected. Fortunately, the source data were updated today, as usual.

We do not know whether that was always going to happen, or if intense lobbying by patriotic Americans who have served both Republican and Democratic administrations achieved that. Either way, we’re relieved. That said, as I anticipated, flu season continues to rage. After a dip last week, national rates again increased, with new peaks in some parts of the country, including here in Massachusetts. To see how things are going your state, you can explore the data. Thanks as always to Benjy Renton for keeping the dashboard curated.

More tomorrow…