This week in the Trump administration’s "adventures" in public health.

From uncertain vaccine recommendations to defunding oversight of group homes for the disabled—and some sudden policy reversals in the face of pushback—it was a busy week.

I’ve been working clinically all week so I just wanted to drop in, say hello, and share a few brief items I’ve been following to round out the week.

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Getty Images / Alex Wong

Updates on vaccine policies.

The CDC’s Advisory Committee on Immunization Practices met last week. The votes went as expected, although participation by a new non-voting FDA participant who asked some oddball questions raised a few eyebrows. Of note, the committee signaled that it may limit its recommendation for annual Covid-19 vaccinations to high-risk persons. This would align with policies in many other peer nations and, in fact, is not too far off my own longstanding read of the data. Honestly, if it weren’t for the fact that HHS is currently being run by RFK Jr., this change would not actually bother me, so long as the vaccines remain available to those who (in consultation with their doctors) have reasonable reasons for wanting to receive them. So, fortunately, I don’t think this potential ACIP-recommended change reflects pressure from HHS. In fact, if the CDC were to put all of its efforts toward keeping high-risk persons up-to-date (instead of shoring up rates among all comers), population outcomes might actually improve. The problem is, I doubt this HHS will fund such a campaign.

Meanwhile, there are rumors that the CDC’s recommendation that children receive a Covid-19 vaccine as part of the routine childhood immunization schedule may be reversed, Politico has reported. Whether this refers to the primary series or annual shots is unknown, but it almost certainly applies to the primary series—otherwise, the topic would have been lumped in with the CDC’s apparent plan to turn away from yearly Covid-19 shots for people without increased risks, as above. In my view, denying children the primary Covid-19 vaccine series would carry far more danger than a retreat from recommendations on annual boosters would. We need more information on this, but, without a doubt, any person should have vaccine-conferred immunity to Covid-19 prior to becoming infected with it. At this point, infants and young children are about the only people in this category. They deserve to have immune systems that have been safely primed to fight off the virus. Covid-19 vaccines have been shown to safely provide exactly that. Turning away from that would be unwise and even tragic in some cases. ACIP next meets in June, but HHS Secretary RFK Jr. could technically intervene before then because, unlike for adults, Covid-19 shots for children under age 12 remain available only under emergency use authorization.

Meanwhile, whether the FDA will finally grant full approval to Novavax’s Covid-19 vaccine remains uncertain. Will they? Won’t they? The story keeps changing—and, alarmingly, in the absence of any changes in the regulatory requirements. So, this is palace intrigue nobody asked for, and possibly a bellwether for the future of vaccine policy in the United States. I’ll have more on the FDA soon.

A brief measles update.

Speaking of diseases that vaccines protect people against, the measles outbreak in the United States is now the largest since the disease was declared eliminated here in 2000. There are now north of 900 cases, and likely more than that given inadequate testing. The New York Times has a relatively new resource tracking the outbreak. One former CDC official told me that the Times’ webpage is more user-friendly than the one offered by the CDC (albeit the CDC’s page isn’t bad). Regardless, experts are now concerned that the present outbreak will take months to control, at a minimum. For any parents who have not yet done so, vaccinating children against measles now could work in time to save lives and/or prevent a local outbreak. Here’s how to find one.

The FDA suspends milk testing.

The FDA has suspended its program to test milk for various pathogens. Some see this as a sign that the effects of 20,000 terminations in HHS are already apparent, while others, including one non-government expert quoted in The Washington Post, say this will not compromise public safety due to other safety mechanisms in place. Still, I hardly found it reassuring, given the extent of H5N1 spread in animals, a growing problem. If and when this disease mutates such that it routinely causes severe disease in humans, gains the ability to spread from person to person, or, worse, both, we’ll regret moves like this.

Another potential consequence of the proposed HHS budget cuts: Safety in group homes.

Last week, Inside Medicine published the first look at the Trump administration’s draft for massive budget cuts to HHS. This week, Mother Jones published a follow-up story that highlighted just one of the proposed cuts: the elimination of the Administration for Community Living, an HHS asset which among other things, helps prevent abuse in so-called “group homes.” Group homes are valuable resources for people with various disabilities, and they vastly range in quality. Any decrease in oversight could have horrific effects on people who rely on group homes for housing and care.

Trump administration plans to Make America Healthy Again by turning away from grants that protect kids from toxic chemicals.

Despite the slogan to Make America Healthy Again, it has been reported that the Trump administration has instructed the Environmental Protection Agency to cancel tens of millions of dollars in grants that track chemicals toxic to children and that fund innovative research by early-career scientists.

An autism registry will won’t be created. Women’s Health Initiative will won’t be axed.

Recently, it was announced that the United States government would create a registry of patients with autism. Now, after massive pushback over privacy concerns, that plan has been walked back. Meanwhile, RFK Jr. previously promised that the cause of autism would be all sorted out by September. But his newly confirmed Director of the NIH, Dr. Jay Bhattacharya, pushed back on the timeline this week. In defense of RFK Jr., when you think you already know the answers to a scientific question, September seems like a long ways off.

Elsewhere, a plan to axe The Women’s Health Initiative was apparently reversed, after widespread outcry. The WHI itself says it had been informed a couple of weeks ago that its longstanding funding was to vanish. But it also updated its website on Friday to say that it had not received any formal notification of the policy reversal reported in the media, leaving it in a place of “uncertainty.”

These were, in my view, two examples of public outcry leading the administration to quickly change course—and a reminder that our voices still matter.

An attempted government takeover of medical education.

The Trump administration announced on its website that it wants to effectively take over accreditation of medical schools and other disciplines in higher education. It claimed that the move is to ensure that medical schools focus on what it calls quality education. The administration implied that medical schools are too focused on the “recruitment and retention of individuals underrepresented in medicine.” Left unsaid is that these efforts are necessary to create a healthcare workforce that meets the needs of the American people. The executive order also said that medical schools should provide “high-quality academic programs at a reasonable price.” I agree. But I worry that this administration may believe that “high-quality” excludes essential medical education, whether that be reproductive care or teaching students that resolving disparities stands to save millions of lives more than, say, another generation of designer drugs.

Speaking of the White House’s website, last week, Covid.gov went from being a source of information about the pandemic to being what several commentators called “fan fiction.” I’ve now read through a bunch of it, including a 2024 report by the US House of Representatives Select Subcommittee on the Coronavirus Pandemic and, whoaboy, there’s a lot wrong here. The main problem is that the website replaces science with vitriol, a big finger-pointing blame game. I’ll chime in on this another time.

An update on the Trump administration’s attack on Harvard and other major research universities.

Earlier this month, the Trump administration tried to bully Harvard University into surrendering its First Amendment rights. Since then, there has been the expected half-hearted walk-backs on one hand, and escalations on the other, including attempts to freeze grants here and at other major research universities (ironically, as Science pointed out, another comms freeze meant that the administration could not actually inform anyone at the universities about this.)

Harvard has done exemplary work in fighting back, including filing a forceful and unflinching lawsuit against the Trump administration this week. It has also done yeoman’s work in taking back the narrative. While the Trump administration has advanced largely baseless (or else irrelevant) accusations, the university has in turn used the moment to educate people on why the American people can and should be proud of the research carried out both here and by our competitors. The university’s landing webpage is now a well-designed infomercial highlighting the benefits of research itself, and is now entitled “Research Powers Progress.”

Meanwhile, my friend and colleague Dr. Atul Gawande published an essay in The New Yorker, entitled “The Cost of Defunding Harvard,” in which he compellingly lays out both the scientific and human tolls stemming from the Trump administration’s attacks on these endeavors. Among other shockingly unwise moves, the administration has cut funding to tuberculosis research, which remains the world’s leading cause of death among infectious diseases.

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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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