Trump's new pandemic czar actually believes in science and research. Yay.
But don't worry, the rest of the news is mostly horrible.
Before we start: I worked in the ER yesterday and am headed over this morning. First, let me say that we are still having a ton of influenza here in the Northeast—and it’s contributing to many hospitalizations. Nationwide, there are actually more influenza-related hospitalizations than Covid ones. In fact, there were at least 38,000 influenza hospitalizations in the US in the most recent week of data, which is more than Covid has hospitalized in any given week nationwide in over two years. If you want to look into that and more, here’s the Inside Medicine data dashboard (which will be refreshed later today; that is if the government permits it.)
Overview: In today’s Inside Medicine, I’m leading with some seemingly good news, which I always like to do whenever that’s remotely possible. In the second section, there’s some more mostly good news regarding the CDC communications freeze and thaw.
But after that, things do head south. I must confess that it’s difficult to keep up with the onslaught of news on US public health infrastructure (especially when I’m working clinically). To document all of that and keep you updated, I’ve written a few compact briefs on some news and developments that occurred in the last day. Much of it is awful (though not all) and we have to keep track so we know where the fight is. I hope it’s useful! Let’s dive right in.
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Trump named new pandemic czar. Experts seem to like him. What does he believe?
It has been reported that veterinarian and biosecurity expert Dr. Gerald Parker has been selected to lead the White House Office of Pandemic Preparedness and Response Policy (OPPR) by President Trump. The position is commonly referred to as the “pandemic czar.” Surprisingly, Dr. Parker worked in the Biden administration on biosecurity and is well-known to insiders.
The announcement was largely seen as a pleasant surprise. “This one is a very good choice,” former OPPR Director under President Biden Dr. Ashish Jha told CBS News. Others who have worked with him (or are familiar with his work) more or less echoed that sentiment to Inside Medicine.
To understand Dr. Parker’s views, I spent some time last night reading a transcript of his testimony at a hearing of the House Select Subcommittee on the Coronavirus Pandemic, a document entitled, “Strengthening Biosafety and Biosecurity Standards: Protecting Against Future Pandemics.”
Here are four key moments that stood out that help us understand his Dr. Parker’s beliefs—or at least what they were in 2023.
Excerpt #1:
“Operation Warp Speed provides lessons learned and is an exceptional bright spot in a sea of many COVID-19 response failures. Response failures demand further, objective investigation to enable new evidence-based preparedness and response policies for the future.”
Interpretation: He’s pro-vaccine and understands that we can do better “next time”in many other ways.
Excerpt #2:
“Unfortunately, the term “gain of function,” a common experimental procedure that is safe when conducted in compliance with the NIH Guidelines and the BMBL [the Biosafety in Microbiological and Biomedical Laboratories handbook], was used to describe “dangerous enhanced pathogen research” in the 2014 moratorium.”
Interpretation: “Gain of function” research, in which scientists study pathogens by changing their genetic codes to alter their functional characteristics, has become a bête noire among conspiracy theorists, including members of Congress, who keep trying to blame the Covid-19 pandemic on Dr. Anthony Fauci. This excerpt is indicative of a larger view advanced by Dr. Parker—that this type of research is actually quite useful and must be carried out with great care and oversight. That’s a much more reasonable position than calls to ban it—especially since the knowledge that can be gleaned might lead to superb new vaccines or treatments in the future.
Excerpt #3:
“Recommendation: Elevate as a Diplomatic Priority Efforts to Establish an International Biorisk Management Framework….Due to the growing scientific curiosity of especially dangerous enhanced pathogen research worldwide, it is imperative that member states enact effective legislation to govern and strictly regulate especially dangerous dual use enhanced pathogen research, including the United States. The recently released guidance from WHO provides guidance for member states to establish biorisk management systems and governance of dangerous dual use research.”
Interpretation: “Dual-use” research refers to science that could either be beneficial or harmful to society, depending on specifics. Dr. Parker’s testimony conveys a reasonable approach to mitigating the risks—specifically by way of international cooperation. The Dr. Parker who delivered these words in 2023 believed in the utility of collaborating with our global partners in order to maximize research safety while reaping the benefits. The question is whether he does now. It’s also notable that he mentioned the WHO’s guidance here. Too bad we just pulled out of the WHO. I wonder what he thinks about that.
Excerpt #4 [emphasis added in bold]:
“I am concerned that COVID-19’s demoralizing experience may trigger malevolent actors to pursue and intentionally use dangerous pathogens for the foreseeable future to achieve their goals, and the increasing probability of laboratory accidents or biocontainment breaches with potentially grave consequences. I am also concerned about wanning public trust in naturally occurring infectious disease and toxin research and our high containment laboratory ecosystem. Our infectious disease high containment research enterprise is essential for public health preparedness, national security, and global health security.”
Interpretation: Unlike the presumed-to-be Secretary of the Department of Health and Human Services (HHS) RFK Jr., Dr. Parker explicitly does not believe we should give infectious diseases research a “break.” That’s good news.
There’s one snag. In January, Dr. Parker’s Twitter/X account posted a 👍 emoji in response to a tweet by then-Vice President-elect J.D. Vance, indicating that RFK Jr. seemingly had enough votes in Congress to be confirmed. So, has Dr. Parker jumped the biosecurity shark? Or is he just playing the game so he can run the OPPR like the esteemed expert that he is—and hope that his boss doesn’t notice?
CDC communications update. The thaw is still thawing.
As hoped, the CDC’s Morbidity and Mortality Weekly Report finally came out yesterday (with articles about the recent Los Angeles and 2023 Maui fires), after an historic two-week lapse, the first in decades. The bad news is that an MMWR article on H5N1 bird flu that was supposed to go live two weeks ago was not included, though it was briefly posted online, The New York Times reported.
So did a CDC Health Action Network Advisory on Ebola in Sudan, also as had been speculated would occur.
While it’s good to see the communications freeze thawing at CDC, it remains deeply concerning that the agency is now selectively publishing some previously approved work. It’s also sad to see partisan scientists shrug off censorship, just because they happen to dislike what is being stifled. I’m seeing a lot of this when I make the mistake of opening Twitter/X (so that you don’t have to).
DOGE. Is it legal? Professor Gostin chimes in…
I am not a legal expert. I’m fortunate to have access to great ones, however. Once again, Georgetown Law’s Larry Gostin answered an email from me and was kind enough to share his expertise with the Inside Medicine audience.
My question this time: Are the brazen actions by DOGE legal? Here’s Larry’s answer:
“DOGE is not a government agency and lacks any power. President Trump believes he can simply slash CDC's budget, which would hollow the agency out and pose a major threat to the public's health.
What CDC functions do Elon Musk or Donald Trump believe are unnecessary or insufficient? The agency conducts surveillance, responds to health emergencies, makes recommendations on childhood and adult immunizations, and so much more. In truth, President Trump cannot unilaterally make drastic cuts in CDC's budget.
Nor can he dismantle the agency. CDC itself is a creation of Congress and it has independent powers. It is Congress that directly funds the agency. Under the Constitution and the Impoundment Control Act, the president must spend all congressionally appropriated funds. If the President believes that CDC's budget should be cut, he would need to convince Congress during the next appropriations process. I would hope that even among Republicans that there would be support for national public health, which only the CDC can ensure.” —Professor Larry O. Gostin.
Will lawfulness prevail? I hope so.
Documenting the DOGE disaster. USAID cuts already decaying progress.
The New York Times reported that the USAID staff is being cut from 10,000 to 800. This is a devastating blow to important projects around the world. The Times also reported that the freezing of most USAID projects has shuttered important clinical trials (including for malaria and tuberculosis) which can’t logistically be paused without causing them to completely fall apart. Years of work is being ruined, and for no compelling reason. For those who believe that randomized clinical trials are essential and are the best way to gain medical knowledge (as I do), this should be cause for vocal outrage. And yet, we’ve gotten silence from transparent Trump apologists within the scientific community.
A PBS Newshour interview with former USAID administrator (under George W. Bush) Andrew Natsios is an extraordinary and eloquent summary of the implications here. In the segment, Natsios delivers a devastating appraisal of Congress’ spinelessness on the USAID/DOGE fiasco in-progress. Please watch it.
Meanwhile, the Wall Street Journal reported that massive cuts are soon coming to agencies within HHS, including the FDA and the CDC.
Will Congress act? Or has it been reduced to a feckless supper club?
Doctors for America sues Trump administration over data.
The non-profit physician group Doctors for America has filed a lawsuit over the Trump administration’s sudden data censorship last week. As reported in MedPage Today, the complaint alleges that "defendants failed to provide required notice of their action to remove these vitally important webpages and datasets, and their actions are arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law….[nor] any rationale for removing any specific webpage or dataset, and any such justification would fly in the face of the longstanding recognition that the webpages and datasets are essential to the government's goal of promoting public health."
I’m very glad to see another group stepping up to defend public health and medicine.
That’s what we know for now. Thanks for reading, sharing, speaking out, and supporting Inside Medicine! Please ask your questions in the comments and if you can’t upgrade due to financial considerations, just email me. If you have details about any of the unfolding stories we are following, please email me or find me on Signal.
Dr. Faust, I deeply appreciate the time and effort you put into these updates. Your ability to synthesize and document these rapidly unfolding developments is invaluable.
That said, while Dr. Parker’s appointment initially seems like a rare bright spot, I can’t shake my concern over that one snag. His apparent approval of RFK Jr.’s confirmation—however subtle—raises serious questions. It reminds me of Schopenhauer’s Law of Entropy: If you put a spoonful of wine in a barrel full of sewage, you get sewage. If you put a spoonful of sewage in a barrel full of wine, you get sewage.
Given the stakes, even a small signal of alignment with RFK Jr.’s brand of anti-science rhetoric is troubling. The question is: was it a calculated move to stay in the room and do the work, or a genuine indicator of where he now stands? Either way, it’s something to watch closely.
It’s frustrating that in this era, we have to spend so much energy deciphering whether an expert is genuinely committed to evidence-based policy or just strategically playing along to survive in a dysfunctional system. Either way, the consequences for public health remain immense.
“Move fast and break a lot of things” apparently worked well in Silicon Valley. It does not seem to translate well to government work, or, to the scientific realm where data rule.