Trump Administration suffers first setback in its war on US public health. Federal grants for scientific and medical research must continue for now.
The lawyers did their thing. Chaos temporarily mitigated.
After a horrific day for public health on Monday, Tuesday was, in fact, a better day. Here are updates on several stories I’ve been following
American Public Health Association, others lawyer up and win the first legal battle against Trump’s assault on US public health infrastructure.
Monday, President Trump blocked all federal grants, which could have quickly caused some major medical and research institutions to make substantial layoffs to avoid the brink of financial ruin.
Then the lawyers stepped up. A group of organizations affected by the executive order including the National Council of Nonprofits and the American Public Health Association—the latter of which I am a proud member—sued the Trump Administration today. Here is their complaint.
The outcome was favorable. Within hours, US District Judge Loren L. AliKhan had ordered that the status quo (i.e., a universe in which the US Federal Government actually pays its obligations to established grantees) be maintained through at least February 3rd, and maybe beyond. This was the first real setback to the Trump Administration’s full-on assault on the US public health infrastructure. Lawyers saved a lot of jobs today.
A temporary reprieve from total chaos.
Judge AliKhan pointed out that the government itself didn’t seem to know the scope of its own action. True enough. Prior to the stay, many of us in medicine, science, and public health spent the day trying to sort out just how far-reaching the order was.
Was Medicaid affected? Nobody seemed to know, which caused a great deal of chaos. A press release from Georgetown University pointed out the uncertainty (and “callous indifference”) of the original order. Indeed, Medicare and Social Security had been specifically named as exceptions to the grant freeze, leaving Medicaid and CHIP (the Children’s Health Insurance Program) as potential targets, which would harm millions of Americans immediately.
At a White House Press Conference, the question was dodged. However, later in the day, a memo from the Office of Management and Budget clarified, saying that “mandatory programs like Medicaid and SNAP will continue without pause.” You can view that and answers to other questions here:
Whether Medicaid grants were affected was less clear. A former state health official told me that Medicaid grants would feel the hurt similarly to a government shutdown, which is to say “only a bit.” The real pain would come if Medicaid funds for care reimbursement were suddenly not available.
That suddenly seemed to be a possibility yesterday when Medicaid portals went down in all 50 states for hours. The Trump Administration quickly distanced itself from this part of the fiasco, describing the massive website failure as an “outage.”
Given the timing, it does not seem like a random occurrence, but rather an instance of federal officials not knowing the scope of the President’s order and erring on the side of disruption and destruction. That was walked back.
Grant recipients are feeling the hurt. Real impact on American scientists.
Prior to the stay that halted President Trump’s freeze on the disbursement of grant funding, NIH-funded researchers in major research institutions all over the country desperately attempted to sort out what they could and could not do under the order. For example, one interpretation was that under the edict, no new costs could be incurred. This would quickly tie the hands of a researcher, including an NIH-funded researcher at a major academic institution in the Northeast (not mine) I spoke to yesterday. That scientist told me she was worried that the order meant she could not pay study participants (part of the protocol). So her research had to stop, while she figured it all out with the help of her institution’s legal advice. In addition, she realized that automatic monthly payments her lab makes to license statistical analysis software her team relies on could be construed as violating the order. Pure chaos, and for no good reason.
To understand the stakes, you need to understand how federal grants work. Grantees are under intense scrutiny for how they spend money, and some grants require monthly justifications for all spending. If a future audit of the cash flow from the lab of a grant recipient were to find that a scientist violated an executive order (such as one calling for the temporary halting of all grant-related spending), the grant could be suspended or terminated. So while money continued to come to her lab even before the judicial stay yesterday afternoon (because the Federal grant she won pays her institution which in turn pays her), she had been worried she could not spend it, lest she risk losing the grant on some petty technicality.
Others, including at Stanford University, apparently issued guidance to its scientists reflecting a less draconian interpretation, saying that federally-funded research could continue (with a caveat that DEI work might be too dangerous to conduct).
All of this was of little consolation to my regional colleague. “I will learn more at our meeting with our chair tonight,” she said, “but I believe our institution is interpreting it conservatively. We do a lot of disparities work.” Work studying health disparities is an explicit stated target of Trump’s wrecking ball on public health infrastructure.
Here’s what I told The Boston Globe yesterday: “I mean, what a terrible way to treat scientists,” he said. “These are people who are trying to make the world safer for all of us.
Reversal: HIV drug distribution in poor countries can continue. Whew.
Of President Trump’s actions in the first eight days of his term, the one that stood to have the highest body count was the halting of PEPFAR (the President’s Emergency Plan for AIDS Relief), the United States’ extraordinarily successful program to fight global HIV, which has saved 25 million lives since George W. Bush unveiled it. The cruelty of cutting off these drugs was surpassed only by the stupidity of the move—as doing so would likely cause drug-resistant viruses to emerge, putting people everywhere (including the US) at risk.
Last night, that horrific policy was reversed. The relief in the public health community was palpable. Dr. Craig Spencer described the success of PEPFAR on Twitter/X, calling it “nothing short of miraculous” in turning what was once a death sentence into a manageable chronic disease for people around the globe, just like here in the United States.
Why did this happen?
I’m unclear on why the Trump Administration suddenly changed its tune on this, especially after it went out of its way to clarify that depriving people of HIV antivirals was its explicit intention.
While I do not know the answer, it is possible that for the first time, Trump Administration insiders heard the pleas of reasonable people in their own orbit and turned away from a draconian and cruel policy they had very much wanted to implement.
It’s not far-fetched to believe that such individuals still exist. For example, Secretary of State Marco Rubio spoke and wrote in support of PEPFAR many times during his time in the US Senate, and even cosponsored the bill to renew its funding. Here’s an excerpt from an op-ed then-Senator Rubio wrote for Fox News in 2017:
“Due to large investments by the United States, new infections of HIV have been dramatically reduced. Every American should be proud of this progress and the millions of lives that have been saved.
I was proud that the Senate Appropriations Committee, on which I serve, fought to maintain funding for PEPFAR and other related programs despite the administration’s proposal to reduce it – a proposal that would have negative impacts across the globe.” —Senator Marco Rubio (December 1, 2017)
That’s why it was so jarring that the initial memo that halted PEPFAR had come from the State Department, which Rubio now runs. It implied that Rubio is now completely subservient to the President, rather than a trusted partner.
But something changed. Did Rubio make an impassioned plea? Was it another Trump insider? Whoever it is, we should thank them.
Indeed, Rubio is not alone in his support of PEPFAR within the Trump orbit. In fact, a well-done study from 2012 in the Journal of the American Medical Association assessing PEPFAR’s effect on all-cause mortality in nations receiving aid from the program was co-authored by something of an unexpected Trump insider. That study found that the all-cause mortality benefits of drugs and programs provided under PEPFAR went beyond the HIV-specific mortality gains, likely due to favorable spillover effects (when one person’s viral load is very low, they can’t spread it, leading to second-order impact).
One of the study’s authors? None other than Dr. Jay Bhattacharya himself, President Trump’s nominee to run the NIH! (This would actually surprise few experts who knew some of Dr. Bhattacharya’s work before his adventures in Covid-19.)
Jay, despite all of our past differences, if it was you who managed to reach Trump on reversing the PEPFAR stance, I’ll gladly take you out for coffee next time I’m in town.
Annals of Fake News: ICE did not raid Boston Children’s
An account on Twitter/X reported that ICE had raided Boston Children’s Hospital (BCH) yesterday. The news went viral, but it was false. According to BCH (as reported by The Boston Globe), “The reports that an ICE raid is occurring at BCH are unsubstantiated. The US Immigration and Customs Enforcement (ICE) are not on any Boston Children’s Hospital sites.” BCH also provided its staff with directions on what to do, should that occur, saying “As per current protocols, should a law enforcement official appear on campus or otherwise contact you, you should call Security at 617-355-6121 (5-6121, internally), and Security will connect with the General Counsel’s Office.”
While it’s good that this did not occur, it is worrisome that it was such an easy story for people to believe.
On a lighter note….
Today marks the first confirmation hearing for Robert F. Kennedy, Jr., the nominee for the Secretary of the Department of Health and Human Services. I haven’t said much about this absurd situation because, frankly, I try to use this space to bring you insights that aren’t out there in great abundance already. Everything that must be said about this calamity-in-the-making has been said.
Anywho, last week, while I was at work in the ER, I took a quick break and I procured one of my favorite guilty pleasure snacks from the cafeteria: these bad boys below. They were excellent, as always, and only raised my Hemoglobin A1C level by a small amount.
My friends, I like that simply eating these chemically improbable delicacies is no longer merely a tasty treat, but—thanks to its ingredient list—has now also become an official act of resistance.
Fight the power, y’all! Fight the power.
That’s all for now…Thanks for reading.
Morning,
Caroline Kennedy’s letter in the NY Times and the YouTube reading by her of the letter is an important condemnation of her cousin Bobby Jr. The guy is a predator according to his cousin Caroline. Additionally, the memo from the OMB office has been questioned as having no legal authority to order the termination and phasing of the programs that it did. The MAGAets never do their public pronouncements with any legal underpinnings. It is all for publicity and chaos.
It’s “just peachy” that you’re keeping us all updated. Thank you for the info. We ate some candy this week too, stressful week. Do people think he will be “ impeached “ ( candy pun 🍑🍬) ? I looked up the impeachment process to remember how it works…It’ll be interesting to see what Congress says this week about erratic changes …