SCOTUS issues its first ruling on USAID funding, granting Trump admin a temporary stay until Friday. That's when things may get real...

Also: Texas reports first Measles death in the US since 2015. RFK Jr. describes outbreak as "not unusual."

Hi everyone,
We are headed for our first real ruling from the US Supreme Court. At stake is the future not just of USAID-funded projects but possibly the Trump administration’s approach to demolishing decades of good work we’ve done in public health and biomedicine.

In addition, misinformation flew during President Trump’s Cabinet meeting yesterday regarding Ebola and Measles. We’re here to correct the record.

A quick reminder: If you are employed by the government (or were recently let go), and you want to speak to me informally, please email me or find me on Signal at "InsideMedicine.88." I promise to maintain your confidentiality.

Let’s get to today’s briefing…

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Chief Justice Roberts issues first ruling on the fight for USAID funding. It means nothing, but Friday just got interesting.

Chief Justice Roberts granted the Trump administration an administrative stay that effectively paused a lower judge’s prior order to resume USAID funding by last night. Roberts’ stay just kicks the can down the road for a couple of days, according to Georgetown Law’s Professor Steve Vladeck. “It’s a temporary play for time, nothing more,” Steve told me last night. Here’s how Steve described it on Bluesky:

For anyone keeping score at home, here’s where we are:

1. Earlier this month, a group of plaintiffs (AIDS Vaccine Advocacy Coalition, Global Health Council, and others) brought a complaint saying that the government could not just randomly stop USAID-administered foreign aid.

2. A judge agreed, and ruled that the funding must continue.

3. However, the plaintiffs eventually brought another complaint, saying that the government had not complied with the judge.

4. The judge agreed, and gave the Trump administration until Wednesday evening to turn the funding back on—and reminded them that they could not try to achieve the same outcome by other sneaky means.

5. The State Department asked the D.C. Circuit to intervene today. It said no thanks.

6. The State Department then asked the United States Supreme Court to intervene. Within hours, Chief Justice Roberts ruled that the status quo (i.e., nothing happening, no aid flowing), would remain until Friday, at which point the Supreme Court would actually rule on the merits.

(If I have any of this wrong, please correct me. I’m not a lawyer. I’m just a doctor trying to figure this all out with you!)

All of this means that Friday may be the first time that the US Supreme Court genuinely puts its thumb on the scale of the future of public health and biomedical research in this country. How the Court handles this case could be an indicator of its willingness to stand up to other draconian moves that Musk, Trump, and Project 2025 architects have taken to obliterate our status as the undisputed leader in public health and medical progress—and to decimate our federal government overall.

Trump Cabinet Meeting Misinformation Exhibit 1: Elon Musk makes false claim on federal employee firings and Ebola prevention.

Yesterday, President Trump’s cabinet meeting featured false statements by Elon Musk. Musk said, "We will make mistakes. We won't be perfect. So, for example, with USAID, one of the things we accidentally canceled very briefly was Ebola prevention."

Our friend Dr. Craig Spencer took to Twitter/X to debunk that. Here’s the text of Craig’s thread:

“On January 29, Uganda reported an Ebola outbreak. Normally the US. would've very quickly sent one of our Ebola experts to help the response. But this time, we didn't. Because we couldn't. Because this administration wouldn't let them go right when this outbreak was declared.

And normally the US would've helped set up border screening and other measures on the ground. But this time, we didn't. Normally, we would've spoke with the WHO about helping end the outbreak. But this time, we didn't. Because CDC staff weren't even allowed to talk to them.

I've been told by a colleague that Uganda tried calling the White House to notify them of the outbreak for two days, but no one answered the phone.

Two months ago we had amazing experts working on global health security there. Now there appears to be no one to pick up a phone.

You know who does 'Ebola prevention' here in the US? The CDC. Hundreds of these frontline experts lost their jobs last week as part of indiscriminate 'cost saving' firings. More cuts are expected. USAID has long supported Ebola response efforts overseas. Not anymore.

So, it's not true to say 'one of things we accidentally canceled very briefly was Ebola prevention' and that it was quickly restored. Because [Musk and Trump] have hobbled or directly dismantled the response structures needed to end Ebola outbreaks abroad and protect us here in the US.” —Dr. Craig Spencer.

Elon Musk, I believe, is deserving of the title of “The Crown Prince of Dunning-Kruger.” The Dunning-Kruger effect describes the phenomenon wherein people who know a little about a topic think they know a lot—they don’t yet know what they don’t know. From there, a predictable path ensues…

The Dunning-Kruger effect.

It’s not a good thing when your country’s public health and biomedical future are at the mercy of someone who has just summited “Mount Stupid.”

Trump Cabinet Meeting Misinformation Exhibit 2: RFK Jr. glosses over Measles severity, gets basic facts wrong. First US death shrugged off.

Not to be outdone by the Crown Prince of Dunning-Kruger, Elon Musk, the newly-confirmed Secretary of the Department of Health and Human Services, Robert F. Kennedy Jr., spoke during the Cabinet meeting, providing less of an update about the Measles outbreak in Texas than a word salad replete with staggering inaccuracies. TL;DR: For the first time since 2015, a Measles death has been reported in the US. RFK Jr. downplayed the whole thing. Let’s break it down:

• RFK Jr. statement: “We are following the Measles epidemic.”

  • Response: We should not be merely following it. We should be doing something about it. There should be a massive response, ideally led by the CDC, to increase vaccination rates in kids.

• RFK Jr. statement: “I think there are 124 people who have contracted Measles at this point in Gaines County, Texas, mainly, we are told in the Mennonite community. There are two people who have died, but we’re watching it, there are about 20 people hospitalized, mainly for quarantine. We’re watching it. We put out a post on it yesterday, and we’re going to continue to follow it.

  • Error #1: While there are many cases in Gaines it is misleading to omit that there are also cases in eight other counties, including Terry, where there are at least 21 cases.

  • Error #2: Thankfully, only one person has died, not two, as Secretary Kennedy said. I’m glad he's wrong, but I’d like the Secretary of the Department of Health and Human Services to get the facts right.

  • Error #3: No mention of vaccines. For its part, the Texas Department of State Health Services provided vaccination status information and advised that vaccination is the best way to prevent getting sick from Measles.

  • Error #4: The 18 hospitalized people are not being hospitalized for “quarantine.” Some have been hospitalized for the severity of illness and others for isolation. Look, I know it’s a semantic thing, but he’s the Secretary of the Department of Health and Human Services. Quarantine is separation from others when an exposed person does not yet know if they’ve been infected and must be kept from others until the disease has been ruled out. Isolation is separating from others when a person is known to be infected, and must last until the contagious period ends.

  • Error #5: Again, he doubled down on this concept of “watching it.” That simply won’t do it.

• RFK Jr. statement: “Incidentally, there have been four Measles outbreaks this year in this country. Last year there were sixteen. So, it’s not unusual. We have Measles outbreaks every year.

  • Reply: This is a nauseating normalization of terrible. In 2000, the United States had zero Measles cases and was declared eradicated from this country. The increasing number of Measles outbreaks in recent years does not reflect anything “normal.” It reflects inadequate vaccination coverage, thanks to those who have undermined the safety and efficacy record of those vaccines.

Meanwhile, the American Academy of Pediatrics released a statement marking the pediatric death. Unfortunately, the AAP did not openly oppose RFK Jr.’s confirmation to his position as our nation’s top health official.

More good people the Trump administration has lost.

Over on LinkedIn, I see many posts from dedicated federal workers who have been fired or resigned due to the unfolding Musk-Trump attack on US public health. Take a look at this one below. Wouldn’t we rather have people like Itir Cole doing work to protect us? I sure would. 2

I resigned from my job at the US Digital Service. My team and I—senior technologists—were assigned to the CDC, working across software systems, most notably CDC’s Disease Surveillance System. If we were ever going to learn the lessons we missed during Covid-19, this program was essential. This system tracks over 100 nationally notifiable conditions—from Anthrax to Zika.

Why does this matter?

Say you unknowingly eat contaminated food and get severely ill. You go to the ER, where medical staff send a sample for testing. The lab confirms a foodborne pathogen—one that can kill. Now, it’s not just about you; it’s a threat to the community. Public health experts use the system we built to investigate. They contact you, track what you ate, and look for similar cases—a potential outbreak. It’s not always food. Severe illness can come from petting baby chicks, for example.

*The software is where the puzzle pieces come together.* Investigators trace the contamination source—was it improper handling at a restaurant or a tainted ingredient somewhere along the supply chain? Partners like restaurant inspectors and the USDA help confirm sources.

Public health works when it’s invisible—you only hear about it when things go wrong.

On the day I resigned, nearly all of my team was fired, locked out of their computers without time to transition responsibilities. No real cause was given. No one in my chain of command was consulted.

When the Bubonic plague wiped out half of medieval Europe, they hadn’t figured out organisms yet. Some blamed the stars, others turned to self-flagellation, or worse, sealed families in their homes to die in isolation. Without public health, people resort to grotesque methods to control what they don’t understand.

We had a real chance to learn from the pandemic and propel forward. We lost it.

I worry for my colleagues—highly skilled, intelligent, and deeply committed people who chose public service. They deserved better. A single engineer on my team had more experience than the entire reported expertise of those on the DOGE team—at least of those willing to share their names.

When talent is squandered and programs are gutted, we don’t get them back. It took decades to build both, and we’re losing them together—a sacrifice in the name of efficiency, made possible by indifference.

I’m writing this to ask you to care. Get engaged. Take back our collective power.

—Itir Cole.

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 at InsideMedicine.88.

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