Episode 181: Public Health Policy Is Political

Chris Dall: Hello and welcome to the Osterholm Update, a podcast on COVID-19 and other infectious diseases with Doctor Michael Osterholm. Doctor Osterholm is an internationally recognized medical detective and director of the Center for Infectious Disease Research and Policy, or CIDRAP, at the University of Minnesota. In this podcast, Doctor Osterholm draws on nearly 50 years of experience investigating infectious disease outbreaks to provide straight talk on the latest infectious disease and public health threats. I'm Chris Dall, reporter for CIDRAP news. And I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. On April 6th, health officials in Texas announced the death of a second child in the state's ongoing measles outbreak, which has now surpassed more than 550 cases. Both of the children who died were unvaccinated. The Texas measles outbreak is the largest in the country right now, but it's not the only one. And at the current rate, the United States appears to be on pace to surpass the 1274 measles cases reported in 2019. Meanwhile, Department of Health and Human Services Secretary Robert F. Kennedy Jr. continues to make contradictory statements about the outbreak and about the measles, mumps and rubella vaccine. On April 6th, he said in a post on the social media site ‘X’ that the most effective way to prevent the spread of measles is the MMR vaccine.

Chris Dall: And in a later interview with CBS news said people should get the vaccine. But in that same interview, he suggested the death of the eight-year-old girl may not have been caused by measles and continued to question the safety of vaccines. In an interview with Fox News, he said there should be more focus on finding better treatments for measles and, quote, not just saying the only answer is vaccination. The ongoing measles outbreak is just one of the topics we'll be covering on this April 17th episode of the Osterholm Update. We'll also assess the potential impacts from the latest round of federal health agency job cuts, discuss the stalled approval of the Novavax COVID vaccine, and some confusing comments RFK Jr. has made about that vaccine. Bring you updates on H5N1, avian flu, COVID and long COVID and answer an ID query about next season's flu vaccine. We'll also bring you the latest installment of This Week in Public health history. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.

Dr. Osterholm: Thanks, Chris, and welcome back to all the podcast family members. We also welcome those who may be listening for the first time. We hope we're able to provide you with the information you're looking for. Let me just begin by saying that this particular podcast could have taken five hours of recording time, given all the issues we have to cover. So, we've made some choices about what we're going to cover today and hopefully catch up on other issues in future podcasts. All I can say is it's so good to have you back. You know, we talk about this podcast family and it is true. It really is that if you could see the kinds of comments, the letters, the emails that we get every week, helping us understand what it is we're trying to do and how we can do it better, and I can't say that enough times. Thank you for that. Thank you. And we just always hope that we're here for you in a way that's helpful, useful, and most of all, one that gives you some comfort. These are not comfortable times. Not at all. In fact, these are the most difficult times that I've ever experienced in my 50 years in the business. But as I've said time and time again, now is not the time to give up or give in. We can bend, but we will not break. And throughout this podcast today, I think you'll understand just exactly what that means.

Dr. Osterholm: So again, welcome back to all of you who are routine listeners and to our guests. And get ready. We hope that you find what you're looking for today. Chris, as you mentioned during your introduction, the measles outbreak in Texas is growing by the day. And let me be very clear, I don't think we really understand just how big it's gotten. In fact, two days ago at the Advisory Committee on Immunization Practices meeting, a CDC epidemiologist actually made that point that there is likely a major undercount of cases that are occurring in Texas because many of the people are cases are part of a community that don't want the information out about what's happening with measles. And again, we're beginning to see measles cases show up in locations around the country. We'll talk a bit about what that means, but for this dedication segment, I'd like to take a minute to shed some light on people who are perhaps most vulnerable in these measles outbreaks. Infants under 12 months of age and individuals who are severely immune compromised. I want to focus especially on babies under 12 months of age. This situation, frankly, is complicated. Inference under a year are not routinely vaccinated against measles because in fact, maternal antibody does carry over from the mom, who is hopefully previously vaccinated and may interfere with how well the vaccine takes for up to six or more months. So, we typically wait until 12 months of age to begin to vaccinate these kids.

Dr. Osterholm: However, as you know, we sometimes recommend that kids as young as six months of age get vaccinated if they're going to a location where measles cases are commonly found, such as international travel. And now, unfortunately, even in this country, now, those vaccines may offer some protection, maybe even some good protection, but we don't know how well they work given this potential maternal antibody blocking of the vaccine take. And so, we will always tell the parents do not count that early vaccine dose as in fact one counting towards the two doses that your child should receive. So just remember, a dose as early as six months is meant to extend the protection for a baby who for about the first six months has protection from maternal antibodies. The key, though, has the mom been vaccinated or has she too actually had measles in the past? If neither of those occurred and were seen more and more individuals 25 years of age and younger who have not been vaccinated but are now having babies, that means that that child has no protection against measles right at birth. And this is a big quandary we have right now. How do we handle that? And how many people, not just in that preschool age group, but also young adults. How many do have protection from previous vaccination or in rare instances, the having measles themselves? So, this is really a confusing situation right now. I am worried about all the new moms who have not been vaccinated, meaning their newborns won't have protection during those early months.

Dr. Osterholm: This is a trend I can see getting worse year by year. Just as childhood vaccination rates have unfortunately been decreasing over time, even small declines in national vaccination coverage can result in dramatic increases in the number of cases and outbreaks. For so long, the early vaccination of infants 6 to 11 months was a precaution for international travel. It's scary, and it's sad to see us losing ground on measles prevention here in the US. We actually now have to consider do we need to vaccinate some of our kids 6 to 11 months of age, just because of the extensive measles activity in this country. And so, in that regard that I think about what's coming up next week, April 21st through the 28th is National Infant Immunization Week, highlighting the importance of protecting children two years and younger from vaccine preventable diseases. It's not just measles vaccine that's so important. There's diphtheria, mumps, rubella, polio, varicella, rotavirus and other diseases that we shouldn't have to see become common again. We all have a role here by getting vaccinated ourselves to protect those who aren't eligible. And if you have children, making sure you're on track with their well-child appointments and routine vaccinations. And so, I say to parents, caregivers and loved ones of people living in the areas where we're seeing active transmission of measles. My heart goes out to you.

Dr. Osterholm: It's a scary time, and I'm sure you're worried about the health and safety of your family. You want to get your child vaccinated, but in fact, they may not yet be eligible. Please take care of each other, demonstrate empathy and care for our community by encouraging vaccination. And remember, it's not just for measles, it's all those other vaccine preventable diseases that I also just mentioned. And now, of course, the podcast Family knows what's next. April 17th, the Minneapolis-Saint Paul. I am happy to report sunrise at 6:24 in the morning, sunset at 8:01 in the evening for 13 hours, 37 minutes and seven seconds of sunlight. Wow. It's great. The daily increase in sunlight has actually peaked, and we're now dropping, meaning that we're still seeing more sunlight each day. But the rate of increase has dropped. Now we're getting about two minutes and 58 seconds of additional sunlight each day. Yes, summer is coming here. We can't wait. To our dear friends and colleagues in Auckland, New Zealand. I can tell you right now that your days are still fairly long, but yes, they're getting darker. Your sunrise today is at 6:48 a.m., your sun set at 5:52 p.m., 11 hours, four minutes and 34 seconds of sunlight. You're losing sunlight at about two minutes and 11 seconds a day. But as I've said time and time again, you are there for us through our dark season. We'll be here for you through your dark season.

Chris Dall: Mike, we're going to start today with the ongoing measles outbreak. The Texas outbreak is by far the largest in the US and is getting the most attention. But we've had cases reported now from 25 US jurisdictions. Where do you think this is headed?

Dr. Osterholm: Chris, My bottom line conclusion is, I don't know, but I can surely tell you that I'm very concerned about this. I think we are at as high a risk period for seeing major increases in measles activity in this country as we've been in 20 to 30 years. And I say that for several reasons, but most importantly is just the sheer number of people who are in our communities who do not have protection against measles. Another factor that is often not considered is the fact that despite having a vaccine that has 97% protective effectiveness, which is remarkable. That means about 3% of our population each year that's born into our communities will not have protection even if they were fully vaccinated. So, if you vaccinated, 100% of the kids, 3% would likely still not have protection. Well, in a state like Minnesota, which has 68,000 live births every year, 3% of that is about 2000 individuals every year actually may be vaccinated and still not have adequate protection. Now you say, well, that's not a lot. Think what happens over ten, 15 years. Think what happens at 20 years. That's 40,000 individuals theoretically living in our community who think they're protected, but they're not. You add that up with those who did not get vaccinated, including those now in their 20s and 30s who avoided measles infection because we did such a good job of controlling it through the 1990s, 2000, 2010 decades. Now we have a growing pool of individuals who are ripe for the virus to be introduced.

Dr. Osterholm: Think of this like a forest fire, where basically the ones that really burn hot and burn fast are where there's much more wood in the forest to burn. If you've had a fire in the last ten years and most of that wood has already been burnt out, you don't have anywhere near the same kind of fire. And now we have a situation where we have a growing number of susceptible people that will make any one of the previous introductions of the measles virus in the community that was relatively easily controlled with vaccination, even more complicated now, even more difficult to do just by the sheer size of the population. So, Chris, this is a growing challenge. Let me go back to the Texas outbreak and just share some perspective. As of this past Friday, April 12th, which is the most recent national update provided by the CDC, there were a total of 712 measles cases confirmed across the country this year, across 25 jurisdictions. 93% of these cases are outbreak associated. This compares to just 69% of cases in 2024. Again, speaking to the point that I made earlier about a growing susceptibility for outbreaks to happen because of a critical mass of unprotected individuals living in our community, only 70% of the cases are in children and adolescents. Now, I say only, that means that, in fact, this point that I raised earlier about the number of young adults in particular who are susceptible now to measles at this age is really important.

Dr. Osterholm: Remember, measles actually increases in severity among those who are older, even though it is surely a huge challenge in young children. So far, 11% of all cases have been hospitalized, which surely is an undercount of all the cases out there. And tragically, three deaths in the US have now occurred, two confirmed and one under investigation. Two of these deaths were in school aged children, both of whom were unvaccinated and had no underlying health conditions, and one was an unvaccinated adult. While these deaths have received a lot of media attention and for good reason, I also want to remind listeners that in addition to the risk of death, there are serious long-term complications that can result from infections, including subacute sclerosing panencephalitis. The condition I noted in an earlier podcast, where the virus resides in the nervous system and eventually causes a fatal encephalitis several years down the road. We also know that infection during pregnancy can result in preterm birth and low birth weight infants. So, in fact, we do have real concerns beyond that of children under age five. A majority of measles cases and most of the deaths in children have occurred in Texas, which was confirmed 561 cases since last January. As I noted a moment ago, the CDC themselves believe that that is a real undercount, that we're missing a number of cases in that community. Almost all the cases we're talking about have been in West Texas, and nearly two thirds of the cases have been in Gaines County.

Dr. Osterholm: As we mentioned before, this is a highly under-vaccinated part of the state. During the 2023 to 2024 school year, the percentage of kindergartners in Gaines County that received conscientious exemptions for vaccination requirements was nearly 18%, the third highest in the state. Less than 82% of kindergartners were up to date on their MMR that year. Far below the herd immunity threshold of 95 to 97%. Measles cases in New Mexico, Kansas and Oklahoma have been linked to the outbreak as well. A total of 63 cases have been reported in New Mexico, 32 in Kansas and nine in Oklahoma. Think of these outbreaks occurring as the sparks flying off that big forest fire. We are going to continue to see more and more of these examples. It's likely that the number of states with cases linked to the Texas outbreak will rise as the outbreak continues to grow. There have also been 225 measles cases and one death in an outbreak in Mexico, which is linked to an unvaccinated child who recently traveled to Texas. Not the other way around, not Mexico to the United States, but the United States to Mexico. Measles cases in New Mexico, Kansas and Oklahoma have been linked to the outbreak as well. A total of 63 cases have been reported in New Mexico and 32 in Kansas and nine in Oklahoma. In addition to the cases in Texas, New Mexico, Kansas and Oklahoma, measles cases have also been reported in 21 other US jurisdictions. There have been a total of seven measles outbreaks so far this year, which is defined as three or more related cases, meaning that the Texas outbreak is far from the only transmission we're seeing in this country.

Dr. Osterholm: We're seeing more and more little outbreaks show up, which very quickly could grow into large Texas outbreaks. These additional outbreaks were seen includes 20 cases in Ohio, 16 of which are believed to resulted from transmission occurring within the state, as well as an outbreak in Indiana with six cases. Time will tell whether these outbreaks remain relatively small, or whether they will grow to the level that we're seeing in Texas, but I wouldn't count on these outbreaks staying small. And this brings me back to your question, Chris. Where are we headed? For starters, the US is on track to have its worst measles ever since the 1990s. In fact, we've already had more measles cases this year than we had in any year since 1995, with the sole exception of 2019, when we had a total of 1274 measles cases with the rate at which this outbreak is growing. I would be very surprised if we don't surpass that number by the end of the year, and maybe even sooner. I want to put these numbers into context, particularly in light of a recent comment made by Secretary Kennedy in regard to the measles outbreak here in the United States, he said, and I quote, I would compare it to what's happening in Europe. They had 127,000 cases and 37 deaths.

Dr. Osterholm: And so, what we're doing here in the United States is a model for the rest of the world, unquote. No, that's simply not true. I want to clarify some of the things about his comment, because it's lacking a lot of important context. The number that Kennedy cited were the 2024 cases from the W.H.O. European region. This region not only includes Europe, but also much of Central Asia as well, including many countries that are not considered high income. These countries lack most of the public health infrastructure that we have. So, comparing our measles numbers to theirs really doesn't make sense. A few of these middle-income countries account for a great deal of these cases in the region, including Romania, which has 30,692 cases, and Kazakhstan, which has 28,147 cases. While I don't agree that we should be comparing our measles numbers with the W.H.O. Eastern region as evidence, we're doing well with measles. I do think it's worth discussing some of the trends observed there in measles cases over the past few decades, because I think we could be headed in a very similar direction. Prior to 2017, measles cases in the W.H.O. European region, which again includes much of Central Asia, had been declining for nearly 20 years, reaching a low of 4400 cases in 2016. Cases then began increasing dramatically, and by 2019, more than 106,000 cases were reported. Remember, just three years earlier it was 4400 and now it's 106,000. Cases declined during the pandemic before increasing again to the over 127,000 cases reported in 2024.

Dr. Osterholm: But what I really want to zoom in on is what's happening in England. I think this gives us a really important window into our possible future. In England, for example, more than 2900 measles cases have been reported in 2024, the highest reported in the country since 2012. Just 84% of the children in England had received both doses of the MMR vaccine by their fifth birthday, much lower than the 93% MMR vaccine coverage seen in the United States. But our vaccine uptake is dropping in a very similar way that we saw in England over the course of the past 5 to 7 years. And let me just give you some sense of why the numbers we're seeing in England today are a possible harbinger of things to come. Think about this. In 2000, England had 79 cases reported. In 2017, they had 284 cases reported. And in 2024, now they have 2900. Remember, the US is about six times larger than England, so that if we were to even have the same rate of cases as they would have, that would mean that we would actually see up to 20,000 to 30,000 cases compared to them. What's happening here is we're beginning to see these countries take off with prolonged, extended outbreaks of measles occurring because of the large number of accumulated unvaccinated, unprotected individuals. So, the fact that England now is talking about 2900 cases last year, and this year, it looks to be even much higher.

Dr. Osterholm: This should not be a surprise given the large number of unvaccinated people, and it gives us a warning. This is why the mixed messaging from this administration is so concerning. It is true that Kennedy has made some pro-vaccine statements in recent weeks, including a statement in which he said the most effective way to prevent the spread of measles is the MMR vaccine. However, he has also said it's very hard to tell whether the deaths that have occurred in this outbreak could have been prevented with vaccination. And as we've discussed many times before in this podcast, he continues his long history of spreading disinformation about vaccines, especially the MMR vaccine. It was noted that when he attended the funeral of the young girl, the second case of measles that died in Texas, he actually said to the father of that case, when asked by the father about vaccine, he said, and I quote, you don't know what's in these vaccines, unquote. Now, does that give anybody confidence at all that these vaccines are safe and effective? He continues to promote the idea that these vaccines are unsafe, ineffective and even that they can cause autism. He never comes right out and says they absolutely are causing autism as such. But he keeps saying, are they safe? You know, look at how autism has increased over time. He's also promoted dangerous and ineffective alternative treatments to measles. And one of the doctors he has promoted has reportedly continued to treat patients in Texas despite being actively infected with measles themselves.

Dr. Osterholm: Additionally, some of the recent actions taken by the administration are now threatening the response to the outbreak. Local public health officials in Texas, as well as those in other states with measles cases and particular outbreaks, have been working tirelessly to fight these outbreaks. But sadly, due to the federal funding cuts to local public health departments, dozens of free vaccination clinics have been canceled. This is not wasteful government spending. This is critical public health work and it is happening all around our country. The bottom line is we're on track to have our worst season of measles since the 1990s, and things are showing no signs of getting better. This is not going to be a short term hit. I think this is a trend that we're going to see really causing us great concern for the next several years. I just hope that we can turn things around before we accept a new normal of measles, similar to what is now being seen in the UK. These cases and deaths are preventable, and the fact that we're moving backwards is tragic. Also, remember that we're now talking about a slightly different epidemiology of this infection than we did pre-vaccine, when in fact very few older children and young adults got infected because they'd been infected as young children. We're seeing children who should be fully protected with their vaccine schedule, and we're seeing literally adolescents into young adults now becoming cases. Measles is a measure of the breakdown of public health in this country.

Chris Dall: It should be noted that measles is not the only vaccine preventable illness that's on the rise. We're also seeing a dramatic increase in pertussis cases here in the US. And in a recent opinion piece in the Philadelphia Inquirer, the inventor of the rubella vaccine said he's worried about the return of that disease. Mike, when you combine declining uptake of routine childhood vaccines with the public health job cuts that we're seeing at the federal and state level, are you concerned that we're going to see a return of these illnesses?

Dr. Osterholm: Chris, the short answer is yes on steroids. I'm very concerned. But more than that, I'm extremely frustrated. The key word you mentioned, Chris, is preventable. There are a number of diseases we don't have an effective prevention or treatment for genetic conditions, certain cancers, neurodegenerative diseases. But pertussis, rubella, mumps these are mostly preventable because we have good vaccines. Yes. They're not perfect. And we've addressed that before on this podcast. But they are very, very good. And they save lives and they prevent diseases with debilitating consequences. We've been speaking about measles due to the expanding outbreak in Texas and rising cases around the globe. But let me review the other parts of the MMR vaccine that are being affected by drops in vaccination rates, mumps and rubella. Mumps is a viral illness that can cause a telltale swell in jaw and face due to the infection of the parotid glands. Mumps is mild for many, but can result in chronic complications, including deafness and decreased fertility in men. Before a vaccination was available, the US experienced around 162,000 cases of mumps per year. Globally before vaccination, Mumps was responsible for about 10% of all meningitis cases and one third of all encephalitis cases. The implementation of the mumps vaccine has dropped mumps cases by 99% in the US. We still experience some outbreaks in populations that are highly concentrated, such as in colleges, prisons and communities with overcrowded housing. But the widespread adoption of this vaccine has been highly effective in reducing the disease's impact. But let me remind you, while we're talking about children not being vaccinated for measles, if you're not vaccinated for measles, you're not vaccinated for mumps, as we're talking about this vaccine, in all three of these different infections being included in that single vaccine.

Dr. Osterholm: Rubella, sometimes called German measles, is another viral illness that is mild for many but can have a very significant complication in others. At highest risk are pregnant individuals. Infections with rubella in the first trimester have an 80 to 90% chance of miscarriage or stillbirth. If a fetus survives, a child can be born with congenital rubella syndrome, which can cause deafness, blindness, and other life-threatening organ issues. Before vaccines were available, 12.5 million people in the US were infected with rubella. Approximately 11,000 lost their pregnancies, 2100 newborns died, and 20,000 babies were born with congenital rubella syndrome. With vaccinations available and uptake significant, rubella was considered eliminated in the US in 2004, meaning the ongoing transmission of the country was no longer occurring. For the last 20 years, the US has seen between 2 to 10 cases per year that now can be promptly identified and contained by our public health teams. But as we begin to see the erosion of childhood vaccines, the MMR in specific. We are going to see the return of German measles rubella. We're going to see the return of mumps and the complications that I just talked about. Now let me add one additional disease that is not part of MMR, but is still nonetheless very important. We're talking about pertussis or whooping cough. In 2024, the United States suffered well over 35,000 cases of whooping cough and ten deaths, the highest numbers in more than a decade.

Dr. Osterholm: Yet for this year, the CDC has already reported 6600 cases of pertussis, a number four times greater than last year. These increases are due in part to the declining immunization rates among kindergartners. Recently, two infants in Louisiana died from whooping cough. The first deaths from the disease in the state since 2018. Cuts to CDC funding for disease surveillance immunization clinics will only make this problem much worse. Again, part of the childhood vaccination programs that we're talking about. So, I think we can all agree measles, mumps, rubella, pertussis are usually mild for many people, but there is reason why vaccines were developed to prevent them due to the potential for devastating consequences. The more that the US and other countries reduce their MMR vaccine coverage, as well as tetanus and pertussis, we are going to see more and more small pockets of susceptible people grow into very large pockets. We will see this disease bounce back and we will see many of the horrible consequences I just shared with you. Cuts in funding for public health only increase this problem. Our state and local public health agencies play an absolutely critical role in improving vaccine coverage, facilitating laboratory testing and responding to outbreaks. The results of public health cuts isn't going to make America wealthy again. It will take us back to a time and make America diseased again. That is a very, very scary proposition for an old man like me who's been around far too long and has seen too many advances, too many victories to realize. Now we're actually seeing a major reversal of that trend.

Chris Dall: I want to turn now to the job cuts at federal health agencies. This is a topic we've covered a lot in recent episodes, but we thought for this episode and future episodes, we would try to drill down on the potential impacts that may soon be visible to the public. Today, we're going to discuss the cuts at FDA and how they might affect drug reviews and food safety.

Dr. Osterholm: Chris, this is an absolutely major concern. The cuts to federal, state, and local public health funding will have devastating consequences around the world that we will feel for years to come. And as will the termination of critical research grants. As of Monday, a total of 1295 Health and Human Services research grants have been terminated by the administration, with over $7 billion of funding that was then left unpaid. This is simply monumental. Let me just repeat that again. Over $7 billion of public health funding that was being counted on to be used today has been left unpaid and will stay that way. It is impossible to cover all the consequences of these cuts in a single episode, so we'll be taking on just a few topics today. But I have to start out by, first of all, saying this has been a very difficult and very personal experience for me over the course of the past several weeks. As many of you know, I have enjoyed, appreciated, and felt incredibly honored to serve as a mentor to hundreds and hundreds of graduate students over my 50 years in the business. I love nothing more than teaching my class with 40 of the best and the brightest in that class, all waiting to find jobs in the public health world where they can make a difference, where they can do good, where they can understand what it means to give. Today I looked them in the eye and it's often eyes with tears, as they don't have a prospect for a future job anytime soon, and they're watching their mentors, or at least their supervisors, also lose their jobs.

Dr. Osterholm: This is a challenging time and it won't come back overnight. If, in fact, we started to restore the kind of funding that we're talking about a few years from now, it will take potentially a decade or more to regrow that type of expertise, those individuals who have provided such critical service. So, Chris, let me just say it's impossible to cover all the consequences of these cuts in a single episode. So, we've taken on just a few topics today. We've already discussed the cancellation of MMR vaccination clinics in Texas that were a critical part of their measles outbreak response. This could result in an increase in severe illness, lifelong complications, or even death, particularly for children who are uninsured and do not have access to affordable vaccinations through primary care clinics or other settings. It's unfathomable to me that we could even consider cutting back on this type of spending in the midst of these outbreaks, and these cuts aren't unique to Texas. As I just noted, states around the country are experiencing these cuts. Our own Minnesota Department of Health has been in the news for what these major cuts represent. Some of my graduate students have been the ones who are the first to lose their jobs. I understand this in a very painful and personal way.

Dr. Osterholm: So, as we watch other state and local departments making similar cuts, making them equally vulnerable to the expansion of this outbreak and future outbreaks, just remember this was all preventable. I'd like to focus today on two other critical areas where we will see impacts on these funding cuts, which you mentioned in your question, Chris. Drug reviews and food safety. As a reminder, 3500 FDA employees were laid off on April 1st, not including the additional employees who took buyout offers. A total of 28 senior leaders have left the organization since the administration took office. One of the ways that many of you will see the impacts of losing these employees is through delays in drug review. The Office of New Drugs has lost a significant amount of their expertise and staff support needed to review applications and studies in a timely manner, which will delay their decision-making process. This means we could have safe and effective drugs that are being developed and have the ability to save lives, but won't be used because of the regulatory delays. Imagine if your loved one was sick and there was a drug that could save them, but wasn't available simply because the FDA didn't have enough staff or staff with correct expertise to review the data and process the application. In a similar manner, with the elimination of a policy division at the Office of Generic Drugs, we will see a significant slowing in the development of generic products that make life saving treatment more affordable.

Dr. Osterholm: We are already facing a crisis of prescription medication affordability in this country, and now it's almost certain that things will get worse. Perhaps more concerningly the drug review program itself is at risk of shutting down. This is because it is funded through fees from drug companies that the FDA is required to refund if the organization does not use a certain amount of appropriated funding because of workforce reductions resulting from recent layoffs, it is likely the FDA will use significantly less of its appropriated funding, therefore putting them at risk of being legally required to refund drug companies and then being left with even less funding for the program. This is incredibly concerning, and it seems as if it's a devolving black hole. Moving on to food safety, this is another area that I'm highly concerned about. This is one issue that, in theory, should unite the country because we all eat and we all want our food to be safe. While I'm going to focus on the FDA, the cuts also to the CDC, as well as state and local health departments around the country, all are compounding issues. They all feed into a much less prepared system to respond to food safety concerns. Just to remind everyone, major cuts were made to the processes that ensure the safety of our food. Last month, a joint committee across the FDA and Department of Agriculture that aimed to improve detection of food borne diseases and limit cases and deaths was shut down.

Dr. Osterholm: The committee was particularly focused on improving the safety of infant formula following the deadly outbreak in 2022 that resulted in a nationwide formula shortage. Funding for state level inspections, which accounted for half of inspections of food processing facilities, 90% of produce safety inspections, and all retail store inspections, was also significantly reduced last month. The recent FDA employee cuts have added yet another layer to this crisis. Many scientists at food safety labs around the country were laid off. Nearly all of the Office of Policy and International Engagement staff were laid off. These were the individuals who shared data internationally to prevent foodborne outbreaks in other countries from reaching the United States. Finally, the bottom line is that the public health system in this country were doing a lot of incredible and important work. Still not nearly enough, but surely a lot. It is very likely that we will see increased cases of foodborne disease that could have been prevented if our old systems were still in place and worked effectively. People will die or suffer from worse and quality of life while they wait for safe and effective medications to be approved for use. It breaks my heart to see these systems that keep us safe be dismantled in such a reckless way. No accountability for what's been done. And these are just a few examples, so stay tuned. We'll continue to cover this in the weeks ahead.

Chris Dall: On the topic of drug reviews, there seems to be a lot of confusion regarding the Novavax COVID vaccine, which has been sold under emergency use authorization since 2022. The FDA missed an April 2nd deadline for deciding on the traditional approval of the vaccine. When asked about that delay in the CBS news interview, Secretary Kennedy said it had to do with the vaccine's composition, saying that the single antigen approach, quote, has never worked for respiratory illnesses. Mike, do you have any idea what's going on with the Novavax vaccine or what Kennedy is talking about?

Dr. Osterholm: Well, Chris, as I will comment in a moment, I have always approached my job, my life's work to calling balls and strikes. And again, it doesn't matter to me about Partisan politics in terms of a position. You know, as I've said many, many times from a public health perspective, right is right, even if nobody's right and wrong is wrong. And if everybody's wrong. And so please again, take my comments in this vein. I don't have a clue what the secretary was talking about when he said that a single antigen approach has never worked for respiratory illness. We have a number of vaccines that work like that, and it's his comments like this without basis are simply dangerous. There will be people who will hear this and say, well, wait a minute, what are the single antigen vaccines? Should I, in fact get them or not? He says they don't work. I really wish I had a better answer to your question, Chris, but the truth is, there is no good reason for what is going on right now or for Kennedy's comment. As you mentioned in your question, the FDA missed their deadline for the approval of the Novavax vaccine. In response to this, Kennedy claimed that the vaccines like Novavax that target a single part of the pathogen known as a single antigen vaccine, have never worked against respiratory illnesses. Like so many of Kennedy's vaccine claims, this is simply not true, as all the COVID vaccines on the market are single antigen. Our most flu vaccines, which target the hemagglutinin protein and the RSV vaccines. These vaccines aren't perfect, but to say that they don't work is simply absolutely wrong. Kennedy's statements are concerning not just because of what they could mean for Novavax vaccine, but for all other single antigen vaccines as well.

Dr. Osterholm: That said, I do want to reassure listeners that the Novavax vaccine is still currently available. It just remains available under emergency use authorization rather than a full license. But the future is uncertain, and it points to a greater issue. The Secretary of HHS, who is supposed to be the leader for public health in this country, is repeatedly spreading baseless anti-vaccine claims and forcing agencies like the FDA to act on misinformation. How can we even begin to repair the lost trust in public health in this country, when public health leaders are spreading misinformation and organizations are acting on it. We're just a few weeks out from the meeting in which the FDA will advise COVID vaccine manufacturers on the composition of their 2025-2026 vaccines. And I am deeply concerned about how this meeting will go. If it happens at all, I know that staying up to date on COVID vaccinations is very important to most members of the podcast family, so please know that we'll keep you updated as this progresses. And let me just add one last piece of good news I've shared with you in the past, my sense that the Novavax vaccine actually had less immediate reactions after its receipt than did the mRNA vaccines. Even fever, chills, sore arms, etc., and a study released this past week confirmed that there was a significant improvement in the overall reaction rates people got taking the Novavax vaccine versus the mRNA vaccines. So again, both vaccines are good, but I have preferred Novavax, and I think the data support that it will be truly, truly a major mistake if the FDA does not help provide for approval of this vaccine.

Chris Dall: While we're on the topic of COVID, what are you seeing in the latest COVID data?

Dr. Osterholm: You know, Chris, I love the fact that we're not leading with COVID right now. That tells you something about where we're at. And it's a wonderful comment in and of itself. COVID-19 activity remains low and decreasing. The national wastewater level is considered low and decreasing in every region, with the South being the only region with moderate wastewater concentrations. Emergency department visits for COVID are very low and decreasing. Unfortunately, hospitalization data has not been updated since April 4th, so I can't speak to those numbers. Weekly deaths also continue to decline, with 466 COVID deaths the week of March 15th, which is the most recent week with complete data. My overall sense, however, is that the death numbers have continued to decrease weekly, and by the time we do get the data for mid-April, they'll be substantially lower than the 466 deaths I just reported. In fact, I hope that we will see days throughout the spring and summer where we're well below the 300-death mark per week. While we're on the topic of COVID, I want to add a quick flu update as well. Outpatient visits for flu are at 2.5%, which is finally below the national baseline of 3% for the first time in 18 weeks.

Dr. Osterholm: This means we can declare the end of the official flu season, although there is still some influenza circulating. Four states and the District of Columbia are considered to have moderate flu activity. 12 are low and 34 are minimal. Influenza diagnoses and emergency department visits are down to 1.1%. New hospital admissions are down 31% compared to last week, and about 6500 new admissions last week. So far this season, there have been an estimated 590,000 flu hospitalizations and 26,000 deaths. Truly a real tragedy. 188 of these deaths have occurred in children. 29 of these pediatric deaths occurred in the two weeks just since our last episode. Even though we're seeing influenza activity wind down, these residual pediatric cases are truly tragic. While our flu season is coming to an end, our friends in Australia are at the beginning of their flu season and are experiencing earlier than usual spike in activity. Laboratory confirmed cases from January to March were 59% higher compared to the same time last year. If you're listening from Australia, now would be a good time to seek out a flu shot and we'll continue to provide updates on the situation in the Southern Hemisphere as we are able.

Chris Dall: There were two interesting studies published last week on how many people and which particular demographic groups are being affected by long COVID symptoms. Mike, what can you tell our listeners about those studies?

Dr. Osterholm: Chris, I know this issue is one that is very important to our listeners, as so many of them are personally affected by long COVID. Though we have covered the results of some long COVID studies in recent episodes, it has been a while since we've taken a step back to really look at what do we know and don't know about long COVID. So, I'd like to take a moment to do that today. Before we get into the results of the studies you mentioned, I want to highlight a New York Times article by Danny Blum, Nina Agrawal and Alice Callahan titled A Clearer Picture of COVID's Lasting Effects on the body. The authors do a great job of explaining what we know about how long COVID impacts the lungs, the gut, the brain, heart and circulatory system. And I'll try to summarize some of their findings for you, especially for newer members of the podcast family who may not be familiar with long COVID. I wish I could refer you to the article itself, but it's behind a paywall. And so, if you do have access to the New York Times, I urge you to read it. If you don't, I'll try to give you what in fact was shared in this article. Let's start with the lungs. The SARS-CoV-2 virus causes inflammation in the airway, which can destroy lung tissue, impairing our body's ability to deliver oxygen.

Dr. Osterholm: In some cases, as people recover from their acute infections, scar tissue can form, which can reduce lung capacity. This can cause permanent lung COVID symptoms of shortness of breath and coughing. Moving on to the heart, we know that COVID-19 infections can increase the risk of cardiac events, including heart attacks, and there are a few potential reasons for this. In acute cases, particularly in individuals who already have significant plaque buildup, the stress caused by fever and inflammation can lead to an irregular heartbeat known as arrhythmia, or, in severe cases, a heart attack. For individuals with cardiac symptoms from long COVID, it is likely that the inflammation caused by the virus can injure the heart and damage the cells that line the blood vessels, compounding the inflammation. This can then create further damage to the heart and other tissue, which can lead to heart failure and arrhythmia, or even a blockage that can cause a heart attack. The mechanisms behind long COVID symptoms and other organ systems are not as well understood. We know that COVID can cause long term gastrointestinal symptoms such as diarrhea, constipation, reflux and abdominal pain, but it's unclear exactly why this is the case. There is evidence that suggests the virus could disrupt the gut microbiome, which may explain some of these symptoms. It's also possible that the inflammation from SARS-CoV-2 infection and microbiome disruption could damage the lining of the intestines, or damage the nerves that signal gut pain and control the contractions that keep food moving through the GI system at the appropriate pace.

Dr. Osterholm: All of this can contribute to stomach pain, diarrhea, and constipation. Similarly, we don't know exactly what causes the neurologic long COVID symptoms. We've discussed the cognitive symptoms associated with long COVID, often referred to as brain fog, many times in this podcast. And as some of you may remember, I myself temporarily experienced these symptoms after my own COVID infection in 2023. Other common neurological long COVID symptoms include headache, dizziness, and new or worsening mental health issues. There are several theories behind why this occurs. It could be caused, at least in part, by inflammation that damages neurons and prevents the formation of connections between synapses, which are the places in our brains that allow neurons to communicate with each other. It's also possible that brain fog could be the result of a virus disrupting the blood brain barrier, which is the membrane that operates as a filter to protect our brains. Finally, some researchers believe that neurological long COVID symptoms could result from fragments of this virus that can linger in the brain long term. It's also worth noting that more than one of these hypotheses could be correct, and there may be multiple potentially interacting causes of neurologic long COVID symptoms.

Dr. Osterholm: We also have more to learn about the cause of circulatory long COVID symptoms, which include fatigue, shortness of breath, and exercise intolerance. Just as with other long COVID symptoms, researchers believe that the inflammation is a key factor potentially damaging the nerve fibers in our body that control the squeezing ability of blood vessels, ultimately resulting in reduced blood flow. Other research suggests that muscles of long COVID patients aren't able to extract the proper amount of oxygen from the blood, and that the mitochondria, often referred to as the powerhouse of the cell, may not work at full capacity in long COVID patients, also hindering muscle tissue. All of this is why we have so often described long COVID as a complex puzzle, an understatement, with many, many missing pieces. But each study uncovers another piece, helping us get closer to seeing the full picture and ultimately finding treatments for this condition that have impacted so many lives. As you mentioned, Chris, the two studies I want to talk about today are giving us a better understanding of who has been affected by COVID. The first one was conducted by researchers at Northeastern University, who analyzed data from the US Census Bureau's Pulse Survey from the fall of 2022 and 2023. The pulse survey results include data on 375,000 US adults, nearly 50,000 of whom self-reported having long COVID.

Dr. Osterholm: The researchers used the data to assess three main variables social, demographic, and economic factors. The risk of unemployment, financial difficulties and anxiety and depression, and economic impacts of lost wages. They found that approximately 1 in 7 working adults in the US reported experiencing long COVID in late 2022 and 2023. Again, one out of seven working adults. Lower household income female sex, Hispanic Latino ethnicity and being gay, lesbian or bisexual were associated with an increased risk of developing long COVID. Unsurprisingly, long COVID was associated with an increased risk of unemployment, financial difficulties, and anxiety and depression. Lost wages due to long COVID cost the US an estimated $211 billion in 2022 and $218 billion in 2023. Think about that. Almost a half $1 trillion. These numbers surely would give anyone reason to believe we should be investing in studies on long COVID and how to address them, as opposed to cutting. And yet, right now, over the course of the past two months, we have cut, cut and cut at everything about COVID and long COVID. The second study I want to cover used data from 2022 and 2023 national health interview surveys in the United States. The researchers used 18 different social determinants of health to categorize survey participants into quartiles, indicating their level of social disadvantages. Those in the highest quartile of social disadvantage were 152% more likely to report long COVID than those in the lowest quartile.

Dr. Osterholm: When the researchers looked at the subgroup level analysis, they found the effects of social disadvantage were greater for women and black participants. These researchers interpreted these findings to mean that the increase in long COVID risk found in women and black Americans is a result of more than disparities in socioeconomic status alone. The researchers wrote: Black communities are often concentrated in areas with limited health care access, environmental pollution, and food insecurity factors, all linked to chronic inflammation and to impaired recovery. This is exactly why research into these disparities is so important. But tragically, as we've covered in recent weeks, the NIH has recently defunded all research related to both long COVID and socioeconomic, gender, and racial disparities in health outcomes. Although these two studies that I just detailed helped uncover a few more pieces to the long COVID puzzle, most of the picture is still quite unclear. And sadly, because of these funding cuts, it may stay unclear for quite some time. As always, we will keep you updated as research progresses in this area. Finally, I want to say to all our listeners who are struggling with long COVID, we see you. We read all the impactful messages you share with us, and now more than ever, we are continuing to advocate for you.

Chris Dall: Let's turn now to H5N1 avian flu. Last week, H5N1 detections in dairy cattle hit 1000 while outbreak in poultry flocks continued. But there's some interesting new research on a potential H5N1 vaccine for animals. Mike, what can you tell us about that?

Dr. Osterholm: Thanks, Chris. As you mentioned, the national total for H5N1 detections in dairy cattle has surpassed 1000 now totaling 1020 positive herds as of this past Monday. The most recent detections have spanned three states eight in Idaho, two in California and one in Arizona. On the poultry side, a commercial table egg layer in Ohio plus two captive bird flocks in Wisconsin and South Dakota are the latest high volume poultry facilities to be hit, affecting over 364,000 birds combined. Week after week, we see these numbers keep tallying up. I'm sure many listeners are wondering about the latest activity to alleviate the ongoing outbreak in attempting to safeguard our farms. I want to use this week's H5N1 segment to talk a little bit about vaccines past, present, and future. As we've discussed in previous episodes, part of the new USDA plan in addressing H5N1 is to dedicate funds to vaccine and therapeutics research to protect egg laying chickens. US regulatory bodies have historically resisted using vaccines among domestic poultry farms due to the global trade concerns, instead relying on culling to eliminate the virus from a flock. However, there is an international precedent for mass immunization in poultry as a high pathogen avian influenza disease mitigation strategy. Following several waves of outbreaks among poultry in China beginning in 2013, H5/H7 bivalent inactivated vaccine for chickens was introduced in 2017, and the H7N9 virus isolation rate in poultry dropped by 93.3% after vaccination. Mexico, Egypt and France also vaccinate their poultry against avian influenza. Fast forwarding to February 2025, the USDA granted conditional approval for an updated H5N1 vaccine from Zoetis, an animal health company based in the US which contained inactivated H2N2 virus and is labeled for use in chicken.

Dr. Osterholm: But before it can fill the national veterinary stockpile, the USDA must do its own verification of the vaccine to ensure safety and efficacy. A viable vaccine candidate is good news for the future outlook of reducing harm from H5N1 outbreaks in US poultry, but may yet have unforeseen limitations. Finally, I just want to briefly cover a new study from researchers in China that represents a building block towards H5N1 pandemic preparedness. Although it is not a silver bullet on its own, the study demonstrated an intranasal vaccine using a weakened influenza virus. In tests on mice and hamsters, a single dose of this nasal spray vaccine provided strong protection against H5 infection, preventing both sickness and death. The vaccine triggered a broad immune response, including antibodies, mucosal immunity and memory T cells that can help fight future infections, even in animals that had poor immunity to regular flu viruses. The vaccine still worked well. I'm very interested to see how these results and others will be translated in the future, and potentially contribute to the H5N1 vaccine landscape. We have long sought a mucosal vaccine like this as a holy grail response to protecting individuals, as well as animal species, to influenza. Will this really materialize into something significant? We don't know. We've seen a lot of false starts in the past, but nonetheless, it's another start.

Chris Dall: Now it's time for our ID query. This week we received an email from Patty about next season's human flu vaccine. She wrote, I am an IP nurse and coordinate our clinics for flu shots. Do you have words of encouragement that the flu shot will be manufactured for distribution, regardless of whether HHS cancels planning committees this year?

Dr. Osterholm: First of all, I want to say thank you to Patty for both the question and for your efforts coordinating these flu shot clinics. Secondly, I do, in fact, have words of encouragement that the shot will be manufactured for distribution this year. Despite that, the Vaccine related Biological Products Advisory Committee of the FDA was canceled on March 13^th, a group of experts from the FDA, CDC and Department of Defense met to discuss the upcoming flu season and agree on a vaccine recommendation. They came to the same conclusion as the W.H.O., which is that the 2025-2026 flu vaccine should be a trivalent vaccine protecting against two A strains, H1N1 and H3N2 and one B strain. The H3N2 strains will be updated from the 2024-2025 vaccine, but the influenza A, H1N1, and influenza B strains from the 2024-2025 vaccine will remain the same. Following this meeting, the FDA informed their approved manufacturers of the recommendations and has said that they believe they will have an adequate supply of vaccine for the upcoming season, and they do not anticipate any impact on the timing of availability. Now, of course, we're still waiting to hear what's going to happen with COVID vaccines.

Chris Dall: Finally, we received an email last week from a listener who said, in essence, that the podcast has become too political and that our focus on federal job and funding cuts and Secretary Kennedy's messaging is cutting into our focus on infectious disease. Mike, what's your response?

Dr. Osterholm: Chris, before I respond to this comment, I want to first acknowledge how thankful we are for all the feedback we've received, both the positive and the constructive criticism. We've received so much support from the podcast family for the way that we've covered politics in our recent episodes, and I can't say enough how much we appreciate all of you who have taken the time to reach out via email or on social media to share such kind words and feedback. Although we may not have time to respond to many of these messages, please know that we read every single one and consider it in preparing our following podcast episodes. We also appreciate the constructive criticism we receive, as we are always striving for ways to make this podcast better and more helpful for you. But that doesn't mean we'll always agree with your suggestions, and I think that is the case here. We've received a few emails from members of the podcast family who, as you mentioned, Chris, feel this podcast has become too political. The last thing we ever want to do is alienate any members of the podcast family, and we understand that this type of news can be a lot to take in. However, I, along with the rest of the podcast team, believe that we would be doing our listeners a disservice if we stopped covering these quote unquote political issues. Remember, first of all, that we are from the Center for Infectious Disease Research and Policy: Policy. and that what our job is, is to see public health practice carried out in the most effective and comprehensive way it can.

Dr. Osterholm: And oftentimes policy getting something done actually bumps in head on with politics. But we're nonpartizan. As many of you know, I have made it a really top priority for CIDRAP to always just call balls and strikes. Sometimes calling those balls and strikes necessarily involves some aspect of what's happened in the political system. The second thing is, is that, as you know, I've served a role in every presidential administration since Ronald Reagan dating back to the HIV/AIDS Commission, in the Trump one administration I was a science envoy for the State Department. And so, I have had experience working in that nonpartisan manner of trying to basically just do what we can to effectively impact on the public's health. And that's what I'll continue to do, is try to call balls and strikes and lead what we're trying to accomplish, not because it's a political issue, but because it's a policy issue. How do we turn vaccines into vaccinations? How do we make decisions about how we reach out to individuals in our community for their own safety and security? There are fair reasons for taking this position. Let me just say that the reason why we can't simply stop covering politics is because it would be irresponsible to cover infectious diseases without acknowledging the political components of outbreaks. For example, how can we responsibly cover the measles outbreaks in the United States without acknowledging Robert F. Kennedy's role in spreading anti-vaccination rhetoric and refusing to take a strong and consistent stance in support of MMR vaccine.

Dr. Osterholm: How can we have covered the rise in vitamin A toxicity in children? In our last episode, without first explaining that Kennedy recommended dangerous cod liver oil supplements? How will we ever be able to cover infectious disease issues happening in low- and middle-income countries without discussing the impacts of the total dismantling of USAID and PEPFAR? Yes, these issues are political in their very nature, and we can't remove the narrative from our podcast. I also want to point out, though, that this isn't the first time that we've talked about policy or government actions. We were critical of the H5N1 response during the Biden administration and continue to be during this administration. We're also critical of a lot of the messaging surrounding mpox from the government health agencies during the 2022 global outbreak which occurred during the Biden administration. We've also haven't hesitated to give presidential administrations the credit they deserve for public health successes. We talked several times in recent episodes about PEPFAR, the United States President's Emergency Plan for AIDS relief, which was started during the George W. Bush administration and up until the current administration received widespread bipartisan support. We're not blindly critical of Republicans, and we're not blindly supportive of Democrats. This is all about the science. And how do you apply it to protecting the public's health? The reason we're covering politics in an unprecedented way is because things are happening in an unprecedented way.

Dr. Osterholm: Never before in my 50 years in public health have I seen anything like this. Never before we've seen an HHS secretary refuse to clearly and consistently support the importance of childhood vaccinations. Never before have we seen such a massive dismantling of the federal, state, and local public health systems that keep us safe. I hope there comes a day when we can spend less time covering the politics policy interface. But with the recent actions of the administration, I unfortunately don't see that happening any time soon. We will still continue to cover other infectious disease issues, just as we have been doing over the past few months. Your COVID update, H5N1 updates, long COVID updates aren't going to go anywhere, but they may be impacted as public health surveillance capabilities rapidly diminish and as funding for research for things like long COVID is no longer available. And we're going to be honest with you about that, even though it is inherently political. I hope that this clarifies why we have had this shift in our context. And again, I truly hope that hearing this doesn't make any of our listeners feel alienated. But from the very beginning of this podcast, I've promised to provide straight talk on infectious disease issues. And that is exactly what we're doing here. We're just calling balls and strikes.

Chris Dall: Now it's time for this week in public health history. Mike, what are we celebrating today?

Dr. Osterholm: Today we're talking about the Indian Health Service, or IHS. The Indian Health Service is an agency within the Department of Health and Human Services that provides federal health services to American Indians and Alaska Natives. You may have heard the name of this agency recently. A number of HHS health leaders affected by reduction in force or reorganizing efforts were given letters proposing their reassignment to IHS. The response to these reassignments has been strong, with senior health officials calling the moves disrespectful to both federal workers who are being forced out of their jobs, and the IHS, which has become known as a political pawn. But this isn't necessarily the first time that the IHS has been politicized. The relationship between tribal governments and the federal government is explicitly outlined in the US Constitution, which recognizes Native American tribes as sovereign nations with certain inherent rights. Before the IHS was established, the Schneider Act of 1921 listed the federal government as responsible for providing health services to the tribes. For many decades, however, these services were wholly inadequate. The health status of Native Americans remained poor as they battled high infant mortality and excessive deaths due to infectious disease. In 1955, the Indian Health Service was established. One of the first acts was to conduct a comprehensive survey of the Indian health and needs. They concluded that there should be more substantial federal Indian health programs, and that all programs should be affordable, free from discrimination, and developed in cooperation with tribal communities. Today, the IHS provides comprehensive health services for approximately 2.8 million of the nation's estimated 3.7 million American Indians and Alaska Natives. Indian life expectancy has increased by about ten years since 1973, and the way the agency consults with tribes has become a model for the entire federal government. Challenges persist, however. Indian life expectancy is still nearly 11 years less than that of the US general population, and chronic disease, violence and mental health disease continues to negatively impact the community. The IHS is a critical and respected institution. It needs more resources to serve its population adequately. Being used as a pawn in the current dismantling of our federal health agencies is helping no one.

Chris Dall: Mike, we've covered a lot today, but what are your take home messages for our audience?

Dr. Osterholm: Chris, again, it's always a difficult task to narrow down to just a couple of main points. But first of all is we are truly in a period of crisis in terms of public health, not only in this country but around the world. This crisis is in part due to the messaging and the ability to articulate what our public health approach is to infectious diseases, chronic diseases, etc. we may talk about a healthier population, but what does that really mean when you're making major cuts to the kinds of programs that have had such an important role in improving health? So, I think the bottom-line message is stay tuned. We're all still dealing with this. And as I've said in the past, get involved, whether it be statewide, regionally, in your local community, whether it be at the state legislature, county commissioners, whether it be in school districts and school board meetings or city council meetings. There are still over 300 pieces of legislation that have been proposed that would be very, very harmful to public health. And now is the time for local communities to stand up and help deal with those very issues. The second thing is, as I've pointed out in the past, we do have some major new initiatives coming from CIDRAP. I thought we'd have maybe an announcement this week, but we surely will have an announcement at the next podcast.

Dr. Osterholm: We can take on the challenges of the current day with programs and with efforts that, in fact, will make a difference. And finally, I just want to say that my heart goes out to so many in the public health profession, and particularly those who are just entering the profession, as to what your future holds. It is a huge challenge. I don't have any words to adequately express the pain that I'm watching happen with so many people being let go from positions. And again, as I pointed out time and time again, I am the first to say if we can streamline something, if we can improve its quality of its service, if we can do anything to make it more efficient, I'm all for that. That requires planning. It requires in-depth understanding of what the challenges are in that particular profession, and it also means that you use a surgical instrument. You don't use a machete, and that's not what's happened. We are using machetes. And so, at this point, all I can say is stay tuned and someday there will be a reversal. I'm convinced of many of these decisions, as in fact, we witnessed the absolute pain and suffering that this is going to cause so many in our community.

Chris Dall: And what is your closing song for today?

Dr. Osterholm: I do have a closing song today that we've used twice before in the podcast on August 26th, 2021, in episode 66, thank you Doctor Jenna and we use it also in May 12th, 2022, in episode 103 Words Matter. And I picked a song from the Beatles today, a song that I happen to be very fond of, and I think the words surely match up with the time. Help is a song by The Beatles that served as the title song for their 1965 film and the band's accompanying soundtrack album. It was released as a single in July of 1965, and was number one for three weeks in the United States and the United Kingdom. Credited to the Lennon-McCartney Help! was written by John Lennon with some assistance from Paul McCartney. During an interview with Playboy in 1980, Lennon recounted, the whole Beatles thing was just beyond comprehensive. I was subconsciously crying out for help. This song is one that right now we're all looking for what we can do to receive and give help. Here it is, the Beatles. Help, help! I need somebody! Help! Not just anybody! Help! You know I need someone. Help! When I was younger, so much younger than today, I never needed anyone's help in any way. But now these days are gone. And I'm not so self-assured now I find I've changed my mind. I've opened up the doors. Help me if you can. I'm feeling down. And I do appreciate you being round. Help me get my feet back on the ground. Won't you please, please help me. And now my life has changed. In oh so many ways. My independence seems to vanish in the haze. But every now and then and then I feel so insecure I know that I just need you like I've never done before.

Dr. Osterholm: Help me if you can. I'm feeling down and I do appreciate you being round. Help me get my feet back on the ground. Won't you please, please help me? When I was younger, so much younger than today, I never needed anybody's help in any way. But now these days are gone. And I'm not so self-assured now I find I've changed my mind. I've opened up the doors. Help me if you can. I'm feeling down. And I do appreciate you being round. Help me get my feet back on the ground. Won't you please, please help me. Help me. The Beatles help! Thank you all so very much for joining us for another podcast. A lot of material today, we realize that. But this is a big week in terms of lots of information out there. We'll keep you posted on changes that continue to occur almost on a daily basis. And all I can say is, is that we'll get through this. As I've said last time, we will bend, we will bend, we will bend, but we will not break. And this is such an important point right now and all that happens out there, it's all about taking care of each other. This next week. Be kind. Boy, it's hard sometimes right now. It's a very energized and in some cases, dark situation. But an act of kindness, particularly to someone who's a stranger, can result in some wonderful, wonderful moments. Moment. So, thank you for joining. We look forward to talking to you again in two weeks. And stay well, stay safe. And thank you.

Chris Dall: Thanks for listening to the latest episode of the Osterholm Update. If you enjoy the podcast, please subscribe, rate, and review wherever you get your podcasts, and be sure to keep up with the latest infectious disease news by visiting our website, cidrap.umn.edu. This podcast is supported in part by you, our listeners. If you would like to donate, please go to cidrap.umn.edu/support. The Osterholm Update is produced by Sydney Redepenning and Elise Holmes. Our researchers are Cory Anderson, Angela Ulrich, Meredith Arpey, Clare Stoddart, and Leah Moat.