Updates on Trump's public health choke hold. A scorched Earth approach ensues.
Seven major stories we are following, January 28, 2025.
Yesterday was very bad for public health in our nation and the world. Here are seven stories I’ve been following closely in the last day.
Trump suddenly halts all federal grants, panic looms.
Last night President Trump issued an executive order immediately halting all federal grants. The order goes into effect today. This action goes well beyond the earlier order halting new grant funding applications at the NIH. It means that money that pays the salaries of grant-funded researchers will literally not show up this week. The scope of this move was seen by the experts I spoke to (both on the scientific and legal ends) as unprecedented and probably illegal.
Nevertheless, for large research institutions like Johns Hopkins University and the University of California, San Francisco—which get sizable percentages of their income from federal grants—the effects of even a short-term stranglehold could be immediate. (That appears to be the point.) It’s unclear how much cash these institutions have on hand, but if money stops coming in, layoffs would quickly become necessary, affecting scientists and other staff. For systems with more diverse revenue streams (including where I work) and financial models more reliant on clinical operations, a longer chokehold could be endured. Some experts are especially concerned that institutions serving rural areas could be the first to feel the hurt, which would be all the more disastrous because these hospitals are safety nets without a backup.
The reaction of one former Department of Justice lawyer who had not yet seen the executive order when I shared it with him during a phone call this evening encapsulated the sentiments of many: “Jesus f*&king Christ.”
Why are they doing this? Per the memo from the Office of Management and Budget:
“Financial assistance should be dedicated to advancing Administration priorities, focusing taxpayer dollars to advance a stronger and safer America, eliminating the financial burden of inflation for citizens, unleashing American energy and manufacturing, ending “wokeness” and the weaponization of government, promoting efficiency in government, and Making America Healthy Again….In the interim, to the extent permissible under applicable law, Federal agencies must temporarily pause all activities related to obligation or disbursement of all Federal financial assistance, and other relevant agency activities that may be implicated by the executive orders, including, but not limited to, financial assistance for foreign aid, nongovernmental organizations, DEI, woke gender ideology, and the green new deal.” —Matthew J. Vaeth, Acting Director, Office of Management and Budget.
Putting aside the pettiness of this statement, it again just does not make sense. As I wrote yesterday, you need not halt all flights to study the aviation industry.
What next? Certainly someone is going to sue over this. The question is who has standing and who will be willing to do it? The former is easy: anyone who receives federal grants. The latter remains to be seen. But with billions and eventually trillions of dollars at stake, expect the outrage in the scientific community to quickly translate into a legal counterattack, whether by way of litigation, or eventually by Congress.
Trump issues CDC—WHO stop work order. Here is what that immediately means.
Last week, the Trump Administration announced its intent to withdraw the US from the WHO. Now things have suddenly become much worse, much sooner. A stop-work order was delivered to the CDC yesterday, meaning that CDC officials cannot continue to collaborate or even communicate with WHO colleagues. They can’t even go to a meeting.
To understand the immediate impact, I spoke to a former WHO consultant (who did not want to be named, citing career concerns). My goal was to understand specific examples of this order. Here’s a summary of our conversation (I’m using ‘marks’ to indicate extensive paraphrasing):
‘One immediate impact is CDC’s contributions to WHO operations—particularly in vaccine and infectious disease divisions. Around 50 CDC employees are typically assigned to six-year rotations at WHO headquarters in Geneva. The WHO vaccine and infectious disease divisions lean on the CDC folks. Their absence (starting now) immediately diminishes the WHO’s work. So while US funding to the WHO has not run out, the instant problem is a “brain drain” caused by US federal employees being barred from any interaction with the organization.’
‘An example of how we might feel this is the composition of next year’s flu vaccine. Not only is CDC expertise important in that work, even if the US officials sit it out, the stop work order and communications ban means that even if the WHO were able to do its usual work of developing its yearly flu vaccine—which relies on expert analysis of the latest circulating flu viruses—there would be no official mechanism for US vaccine makers to receive that information. Yes, it could be leaked, but that’s not how things work. The US flu vaccine can’t just be thrown together under the radar. Without official channels, the information cannot be used. So, we might not have a flu vaccine, or else we may have to buy it from overseas.’
USAID top brass and other civilian officials placed on leave.
President Trump ordered around 60 USAID (the US Agency for International Development) officials placed on administrative leave yesterday. This adds to the ongoing crisis at the agency. On Friday, a stop-work order was issues, leaving US global aid efforts in shambles. USAID programs like PEPFAR—which fights HIV/AIDS globally and has saved >20 million lives—are now without leadership and funding. Even if the funding is restored, much of the administrative capacity to execute these programs has now been gutted, and rebuilding that infrastructure will take time.
Again, my conversation with the former WHO consultant was informative. Here is a summary of his talking points during our chat (I’m again using ‘marks’ to indicate extensive paraphrasing):
‘The effect of this draconian move is difficult to envision, but it is massive. And it’s not just money going overseas. US-based NGOs that depend on USAID grants are affected. For example, US-based NGOs are funded by USAID to do work for other nations with fewer resources. The stop-work order means that this work must cease now. These US workers might be able to be reassigned to some other project, but eventually the funding will run dry and people will start losing their jobs. And it may not take long. Many NGOs (here and abroad) operate week-to-week with minimal financial reserves. So, a sudden halt in funding could quickly force layoffs and, for some, permanent closure.’
How soon will these cuts be felt? How “real” is this?
‘These aren’t abstract impacts; they’re immediate and devastating. Even US-based researchers and staff working on USAID-funded projects are seeing their work grind to a halt, as organizations scramble to comply with federal auditing requirements that prevent them from using funds during a stop-work order.’
‘There’s no way around this. All of these organizations are subject to intense auditing.’
What’s impact will this move will have?
‘This isn’t just a disruption—it’s a demolition. USAID is more than an aid agency; it’s a cornerstone of US national security, a projection of our soft power and stability globally. If the goal was really to cut waste, there would be ways to streamline operations without decimating the infrastructure. A temporary pause on new proposals, for example, would allow organizations to adjust. But a blanket stop-work order, paired with the firing of key personnel, leaves no room for recovery. It doesn’t just pause aid—it shuts it down, potentially for good. The result is widespread harm, not only to the world’s most vulnerable populations but also to the reputation and strategic interests of the United States. This is not just poor policy, it is outright cruel.’
HIV drug distribution stops. It’s real.
In case the intent of halting PEPFAR—the United States’ highly successful effort in combating global HIV—was not completely clear, the Trump Administration clarified things yesterday.
“The Trump administration has instructed organizations in other countries to stop disbursing H.I.V. medications purchased with U.S. aid, even if the drugs have already been obtained and are sitting in local clinics,” The New York Times’ Apoorva Mandavilli reported. “On Monday afternoon, officials worldwide were alerted that PEPFAR’s data systems would shut down at 6 p.m. Eastern — roughly three hours after the email was received — immediately closing off access to all data sets, reports and analytical tools.”
People who do not receive their life-saving HIV medications may start dying soon—and for no reason that I can determine other than President Trump and his aides just sort of feel like it. (Again, if they wanted to improve the program, they could do so without shuttering things down.)
National Science Foundation grant reviews stopped by Trump.
Funding applications to the National Science Foundation are now on hold. The NSF is an independent federal agency, entirely funded by the US government. So this pause—which appears to be temporary—is another example of the consequence of the gag order on all federal public health agencies that President Trump issued last week.
While an NSF spokesperson told The Washington Post the move only applies to review panels scheduled to meet this week, there’s no good reason why it couldn’t be extended. (There’s no good reason why it was instituted.)
If you’re curious what kind of research the NSF funds, it is everything. Here’s a link to some of its recent grants studying cancer, tuberculosis, and heart disease.
NIH researchers can do “mission critical work.” A glimmer of good news.
Researchers at the NIH can in fact do “mission critical work” during a temporary communications pause ordered by President Trump, STAT reported yesterday. The clarification was needed after workers at the agency were told that communications included day-to-day activities such as food and supplies that keep precious living organisms (from cell lines to animals) alive. It’s a small win, given the other chaos here, but we’ll take it.
Data blackout update. Some hope here as well.
Yesterday’s Inside Medicine looked at which CDC data websites had and had not been updated in light of the Trump Administration’s gag rule on public communications.
Here’s a quick update on the three resources that had not been updated as of the weekend. (Thanks again to Dr. Carter Mecher for help on this.)
CDC COVID Data Tracker (usually updated on Mondays and Fridays): Partially updated yesterday (1/27) after having not been updated on time. Some of the data on the website remains out of date, though.
CDC FluView (usually updated every Friday at noon): Updated yesterday (1/27)
CDC RespVaxView [added by Faust] (updated on Wednesdays): Still not updated. Last update remains 1/15. (This site provides access to Covid-19, flu, and RSV vaccination dashboards, including data by age).
Two non-government data repositories to know about.
With the government’s public health data websites consistency in question, some non-government dashboards may become increasingly important resources. Here are three to know about:
WastewaterSCAN. This site has wastewater data on Covid, RSV, and flu plus a number of other pathogens. It’s really impressive.
Verily. This site is actually made from data on WastewaterSCAN, but is a little easier to use.
Biobot. Another wastewater dataset with Covid, RSV, and flu. However, since this company lost its contract with CDC (to Verily), their updates have been less frequent. I’m worried they’re running out of money.
That’s all for now…Thanks for reading.
Dear readers, As you can imagine, I’ve basically stopped most of my non-clinical work to report, dig, and write these recent Inside Medicine newsletters. Your support—both through feedback and upgrades—during this time has been truly spectacular. Please share this work widely and call your representatives. We’re in this together and we won’t give up!
It’s taken only one week for this administration to reveal just how toxic and feckless it is.
Thank you for this very sobering update. Other than financial support, what actions can we take to fight these efforts? It feels like we are all standing here looking into the headlights and hearing the roar of an oncoming train yet we can't seem to get out of the way. Please know that I I am not criticizing and efforts to inform us of these changes, such as your writing, are key. But what else can we do?