Public health under attack from within.

Day 3 of the new Trump Administration was an "own goal" against our shared interests.

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Getty Images/ damircudic

The first three days of the Trump Administration have been a long year. Many of you emailed, called, texted, or messaged me on social media with important questions about what is happening. Long story short, rather than strengthening government capabilities—ranging from keeping the public informed on emerging safety threats to cutting-edge research that is the envy of the world—the new administration took moves that will (at least temporarily) diminish our resources and readiness. Many of the actions making headlines are “own goal” mistakes that hurt all Americans, including those who voted for President Trump.

Here’s what we know, as of Wednesday evening:

Public health agency gag order.

Background:

On Tuesday, the Trump Administration ordered all federal public health officials to refrain from external communications. Per Reuters, the gag order apparently includes:

• Scientific reports. Example: The CDC’s Morbidity and Mortality Weekly Report (where I myself have published data in collaboration with the CDC). The MMWR often brings up-to-date information on outbreaks, like H5N1 bird flu.

• Health advisories. Example: If there were a salmonella outbreak or food recall, the FDA would not be permitted to communicate that (albeit, there may be exceptions. See below).

• Updates to websites, including public-facing data.

• Updates and messaging on social media.

What is effected?

Does the order affect the CDC’s MMWR? It’s pretty clear that MMWR will not be published tomorrow, which is highly unusual (if not unprecedented )in the publication’s 60-plus years of existence. To not have a new MMWR tomorrow will be very, very weird for a lot of us.

Does the order affect FDA food recalls and warnings? We don’t know. There were not any today, but they don’t happen every day, so it’s hard to know if there would have been. Personally, when there’s a salmonella outbreak in some vegetables at major supermarkets, I like to know that.

Does the order affect FDA drug-related warnings? One piece of good news is that the FDA did release at least one emergency notification about new black box warning for a multiple sclerosis drug today. This implies that at least some communications are being permitted. What’s chilling to consider is who is making the call, if not the FDA itself?

Does the order affect public-facing realtime data dashboards? There are a number of resources the federal government updates on an ongoing basis. Some of these reports and dashboards are updated on a certain day of the week. Today, we would have expected an update on Covid and influenza vaccine uptake. The update did not occur, which is highly concerning. While the vaccination rates are not absolutely essential information, I took it as a bad sign that the CDC had interpreted the gag order to include this kind of data. The looming question is whether data that is essential will be updated this week, including data on Covid, influenza, and RSV hospitalizations that powers the Inside Medicine virus dashboard, for example. The data we use for our dashboard are always updated on Fridays. So, we don’t yet know if there will be an update on Friday. If there is not, we’ll be flying blind in the peak of respiratory virus season. One of the CDC officials I spoke to today told me, "I’m unclear on why this happened, but I was told they are working on it.” I hope we get our data. We need it.

States may step up. A California Department of Health official I spoke to wrote “California will continue to work collaboratively with our federal partners to ensure that families in our state are healthy and our communities are vibrant places to live and work. While we don’t typically speculate on the potential impacts of a new federal administration, we remain committed to protecting Californians’ access to the critical services and programs they need.”

New NIH research applications and other key activities halted.

This evening, we learned that the NIH has been instructed to halt the process that approves funding for new scientific and medical research. Other important activities were also stopped, including training sessions that were literally interrupted and canceled in the middle of the day today.

Below is an email I was shown from an NIH official to a group tasked with vetting federal grant applications for scientific research—the very research that makes US innovation and leadership in medicine the envy of the world. (I reformatted and redacted it to protect the source).

Who is in charge at the CDC?

It’s not exactly clear who is running the CDC at the moment, as no interim director was named during the Presidential transition. The “org chart” of the CDC would suggest that Dr. Nirav Shah might be filling the role, but if I had to guess, I’d wager that Dr. Deb Houry (who has served in a lateral position to Shah one rung below the Director) is actually in charge at the moment. Both Shah and Houry are practical and respected experts who can work with any administration (whether Democrat or Republican), but Houry has far more experience within the agency. So just as a practical matter, I think Houry is at the helm—at least on most issues. For now, that means the CDC retains its capabilities and there is less chaos than there could be.

Is there anyone keeping the lights on in our health security infrastructure?

The AP reported that 160 officials at the National Security Council were abruptly fired today. Some of these individuals could be career officials and experts who worked under the Directors for:

• Global Health Security and Biodefense.

• Medical and Biodefense Preparedness.

• Emerging Biological Threats.

It’s unclear who is keeping the lights on in these areas at the moment, but in a moment in which an H5N1 bird flu outbreak could erupt at any time and a Marburg virus outbreak is underway in Tanzania (just to name two problems), we could use expertise in DC right now.

Meanwhile, there had been a rumor that the Office of Pandemic Preparedness and Response Policy in the White House had been suddenly gutted today, but apparently that is not true. That said, an expected mass exodus of talented experts from that office occurred last week, which is a loss for us all.

That’s enough news for one day. Stay safe, everyone!