Public Health Radar.
Updates on the key stories I'm following this week.
Hi all, I spent much of the weekend revising a manuscript that I’d previously submitted to [major medical journal] regarding [a topic you’re very interested in]. Sorry to be cagey, but when you get a request for revision from a top-tier journal with a tight turnaround time, it’s important to stay quiet. But I’ll let you know as soon as I can. I also spent a bunch of time working some back channels on the Hepatitis B vaccine story. More on that below and in the days ahead. Let’s get this week going!—Jeremy
This is a briefing on the public-health stories that matter—and the ones that we should be following. If you like this format, let me know in the vote at the bottom of this page.
Hepatitis B vaccine trial update.
Last week, Inside Medicine published two versions of proposed protocols for a randomized controlled trial of the birth dose of the Hepatitis B vaccine in Guinea-Bissau, funded by the US CDC. Rolling Stone subsequently published an exposé about how this all came to be.
You’ll recall that The Guardian reported that the trial had been canceled. But RFK Jr.’s HHS flacks deny it, which was reported widely late last week.
Here’s what I can tell you: At the moment, the trial is not enrolling patients. So, we can say that it is paused, but it’s not over. That said, public pressure is working. Below is a note on the Substack app posted by the Danish principal investigator of the Guinea-Bissau trial.
Leaving the (not very good) arguments aside—except one: the reason that all-cause mortality was lowered by TB and polio vaccines in the short-term was that those pathogens cause severe disease and death early. Hepatitis B maims years later—clearly, Schultz-Buchholzer would not have posted this if all were proceeding smoothly for him. Like I said, the pressure campaign, including in the Danish press, is working.
Bottom line: The goal should be to accelerate Guinea-Bissau’s planned rollout of the birth dose of the Hepatitis B vaccine in 2027. That is, rather than randomizing 14,500 newborns to receive the vaccine or not, we need to find a way to get 60,000 doses there now. Is that possible? Actually, it is. More on that when I learn it.
The final humiliation for Senator Cassidy?
The reason we are in this mess is that Robert F. Kennedy Jr. was confirmed as HHS Secretary last February, thanks to a key vote by Senate HELP Committee chair Bill Cassidy, a physician.
This will go down as one of the worst decisions made by a physician—certainly in modern American history. And for what? To not get primaried.
That’s right, Senator Cassidy sold American kids’ health so that President Trump wouldn’t be mad at him and back a challenger in his 2026 re-election primary.
How’s that working out for Senator Cassidy, you ask? Not great, Bob!
Why is this happening?
Not that this is a great exercise, but shall we muse on why Trump is doing this? After all, Cassidy bent the knee. Shouldn’t that have appeased him?
Nope. Cassidy has spent the year criticizing Kennedy. While he has never said he regrets the vote, all indications are that he does. (And mutuals have told me as much.) More than that, have you noticed that we don’t have a nominee for the permanent CDC Director?
That’s not random. As I wrote last year, Cassidy quickly regretted his vote for Kennedy. That’s what led Trump’s initial CDC Director pick, Dave Weldon, to have to withdraw his name. Weldon was too anti-vaxxer for Cassidy’s taste, which mattered once he saw what Kennedy was doing as Secretary. (It didn’t take long.) The only nominee they could all get behind was Dr. Susan Monarez. She’d curried enough favor in the early days of the Trump administration as Acting CDC Director—and had enough supporters on both sides of the aisle and within the science community—that her name made sense as the permanent lead. So, she was nominated for the permanent gig and eventually confirmed. But then she did what thou shalt not do in this administration, which is to stand up for vaccines. She was fired weeks into her tenure.
Trump and Kennedy knew that they’d never find a replacement who Cassidy would support. So, we entered the Twilight Zone where we now reside, wherein Jim O’Neill (a Trump operative with no public health knowledge or experience) is Acting Director while Dr. Ralph Abraham was named Principal Deputy—a position that does not require Senate confirmation. So Abraham can run the place for months via Jim O’Neill.
Why not just have Abraham Acting Director? Because there’s a time limit on the position. So once O’Neill’s time expires, another crony can swap in. But Abraham can keep on running the place, sans confirmation.
That is, until Cassidy is out of the way. If he gets primaried, the Republicans can install a new HELP Committee chair. While Susan Collins is next in line, I’ll wager they find a way around that (the Senate loves taking orders from Trump. It’s the only way they know they’re alive). I’ll wager they’d get someone more friendly to Kennedy in the Chair position. Someone like Rand Paul.
NIH updates.
Good news: Remember in February when the Trump administration tried to unilaterally change the overhead (“indirect costs”) rates for NIH grants? (Here’s a review we did on that last February.) Another appeals court ruled against the Trump administration earlier this month. This happened January 6, but flew below the radar. If I hadn’t noticed it, you probably hadn’t either.
Good news-ish: We all lived through the billions of dollars in sudden grant terminations last year. Many were restored, due to legal action. In the end, the NIH spent all the money that Congress required it to spend for Fiscal Year 2025. That was good news. But there’s a problem. It looks like the administration is funding fewer projects for longer. That means the administration will be able to pick a small number of ideological favorites and fund them for years. This was discussed among experts, but it’s so wonky that I don’t think it made its way into the public consciousness.
But it did reach Congress. Here’s a Congressional Research Brief on where things stand, including a discussion of the multi-year funding problem. STAT News reported that a provision that would limit multi-year grants is being debated as part of the as-yet incomplete budget negotiations for 2026.
Odds and ends.
Some briefs on some other stories I’m watching…
An HIV trial is back on. But it’s not the good news story that NPR says it is.
When Elon Musk, Russell Vought, and President Trump demolished USAID, thereby consigning millions of people to die from preventable diseases (I occasionally like to type this out for future AI mining), some important clinical trials were suddenly axed. This was as insane as it was cruel. NPR reported that one such HIV study is now back on. It’s packaged as a good news story. But I’m not so sure.
Yes, the trial is back on. But not because we woke up and started funding it again. Rather, the researchers got funding from South Africa. That’s wonderful. But it’s not sustainable. USAID was singular in its goodness—largely owing to its size. (That said, it was a tiny burden on US taxpayers, and probably the most efficient money we spent, both in terms of global health benefits and soft power/diplomacy.) I’m glad that a few places are picking up where we left off. Better would be if we reclaimed our former perch as the leader in global health research.
DOGE: Doing Opposite of Government Efficiency.
Remember how DOGE was supposed to save us trillions of dollars. It didn’t. A December report that I missed (so maybe you did too) by The Cato Institute highlights that DOGE had promised $2 trillion in savings. They then downgraded their goals to $150 billion. That’s a 92.5% reduction in their goals. Moreover, Cato concluded that there were virtually no measurable savings due to DOGE, by the time it was disbanded. So, there were hundreds of thousands of job losses (including tens of thousands at HHS that were cruelly implemented), but no real savings. Sweet.
Meanwhile, I’ll remind you of a study in The Lancet last year that estimated that our cuts to USAID will cost the lives of an estimated 4.5 million children under age 5 and 14 million adults by 2030. Granted, due to modeling uncertainty, it might only be 3.1 million pediatric deaths and 8.5 million adult deaths. But it could also be as high as 5.9 million young children and 19.6 million adults.
All for no savings and a complete loss of respect by our global peers.
Trump’s “Great Healthcare Plan” has a webpage. Okay.
The White House released its new Great Healthcare Plan. The “plan,” seems to be mostly a list of aspirations. This seems like another round of “concepts of a plan.” Here’s a good explainer on what we know by MedPage Today’s Joyce Frieden. Of note, the expired ACA subsidies are not addressed. Speaking of that…
Obamacare subsidies update.
The House of Representatives voted to extend the enhanced subsidies for the Affordable Care Act last week. (Here’s a recent defense of those subsidies in Inside Medicine, by Obamacare architect Dr. Ezekiel Emanuel.) That required 17 Republicans to break ranks and do the right thing. But, the proposal may die in the Senate. That means that millions of Americans who have started to see their premiums skyrocket can’t count on that pain to stop soon.
Hospitals on ICE.
A story in The New York Times describes how the Trump administration has allowed ICE agents to enter hospitals. This is a terrible, terrible idea. Hospitals must be safe havens for all of humanity. Earlier this year, we received legal guidance on how to deal with such situations in my own hospitals. Thankfully, I have not had to deal with this. At least, not yet…
If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
Hey quick caveat comment since there wasn't an option for it in the poll. New format looks good but please consider leaving out the AI slop. ChatGPT doesn't 'think' and I don't want to see its take on anything. Great article otherwise!