Episode 185: Our Light, Our Fight

Chris Dall: Hi everyone! Today on the podcast, as we've been doing over the last several months, we're going to talk about some of the recent steps taken by the current administration to dismantle our public health systems. We hope that this podcast has helped you understand what's going on in Washington and how it might affect you. So, I want to take a moment to thank our listeners who have helped make this podcast possible here at CIDRAP, it's important to us that we can bring you the Osterholm Update without advertisements or a paywall. And we rely on donations from listeners like you to be able to do that and keep this podcast going. A lot of behind-the-scenes staff time goes into the podcast to ensure that you get the most timely, accurate and insightful information possible. And with public health funding so uncertain in the years ahead, we need your support now more than ever before to ensure that we can keep doing what we: love sharing information about infectious diseases and public health with you. If you'd like to make a donation or sign up to become a monthly supporter of CIDRAP, please visit CIDRAP.umn.edu/support. You can find the link in our show notes. Thank you for your trust and partnership. 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.

Chris Dall: 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. In a speech delivered on the Senate floor in February, Louisiana Senator Bill Cassidy spoke about his vote to advance the nomination of Robert F. Kennedy, Jr. to serve as secretary of the Department of Health and Human Services, despite his concerns about Kennedy's anti-vaccine views, Cassidy said he was supporting the nomination after receiving some commitments from Kennedy. Here's one of those commitments: if confirmed, he will maintain the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices without changes, Cassidy said in his speech. But earlier this week, Kennedy reneged on that commitment, announcing in The Wall Street Journal that he was removing all 17 current ACIP members and replacing them with new members. A clean sweep is needed to reestablish public confidence in vaccine science, Kennedy wrote. It was a move that doctors and public health and infectious disease experts have been fearing since Kennedy became the HHS secretary. In the words of one expert, while it wasn't entirely surprising, it was still pretty shocking. On this June 12th episode of the podcast, we're going to discuss Kennedy's remaking of ACIP and what it means for vaccine policy going forward. We'll also discuss the latest viewpoint from CIDRAP's Vaccine Integrity Project, provide an update on the US measles outbreak, COVID, and avian flu. Examine a surge in mpox in Africa and answer an ID query. 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're so glad to be with you again. And to those who might be joining for the first time, I hope we're able to provide you with the kind of information that you're looking for. I will tell you right up front, some have described it as a bit eclectic, but with some science bent to it, but also, hopefully there's a little heart involved with all of this too, as we go through life day after day, wondering what the next day will bring. I also want to acknowledge the podcast team for all their support with this effort. I am very fortunate to be the person whose voice you hear, but not necessarily the person that does all the work behind the scenes. And so, from that perspective, thank you to the podcast team. Now really, I want to start today's episode by shining some light on a story that hasn't gotten as much coverage as other current events, but is certainly relevant to our podcast because of the potential it has to disrupt our health care system and the lives of impacted individuals. You may have heard that the US State Department recently paused all new visa appointments as they develop a new plan for vetting candidates’ social media. This change impacts many people, of course, but there's a particular group of individuals who I'm especially concerned about, the hundreds of foreign born and educated doctors who planned on starting medical residencies in the US this summer. International medical graduates without visas will likely miss the start of their programs. Not only does this affect their positions in educational trajectories, but it also puts a strain on hospital workforces, as they must make do without the individuals they were counting on to provide medical care under the supervision of more experienced doctors.

Dr. Osterholm: This strain will be felt across the country. New York and Florida are the states with the most foreign medical residents, but less populous states like North Dakota and Wyoming rely more on foreign medical residents, with foreign born and educated medical graduates making up 38% and 33%, respectively, of the incoming residents in those states. Long term, any sustained delays in barriers to training will become a larger issue for our physician workforce. Currently, 20% of practicing physicians in the US were born and trained internationally. Our country is known to have some of the highest quality medical facilities, perform cutting edge research, and pay doctors well, which attracts international talents that patients here benefit from when they receive timely medical care by well-trained professionals. Of course, American born medical students will still represent the larger portion of graduates in practicing doctors, but we need this international talent pool to meet the current and future physician workforce needs. Concerningly, the projections show that we'll be short 124,000 physicians by 2027, and that as 30% of doctors currently are 60 or older will retire in the coming decade, that shortage will only grow. Those are the long-term systemic consequences of these delays. But we can't forget the individuals whose lives have been put on pause because of the stalled visa approval process. I'm dedicating this episode to the smart, hardworking, motivated individuals around the world waiting for the green light to travel and continue their pursuit of working in the US medical system. This is a reminder that our government's decisions have far reaching implications for people around the world, in big ways and small ways.

Dr. Osterholm: It's been unfortunate to watch as talented doctors, scientists, researchers, and leaders have their careers and education trajectories derailed over the past several months. We need these experts, and they need us to continue advocating for their ability to work, innovate, and lead at every level, from the hospitals and the clinics, to the health departments and federal research centers. Let's keep fighting for them. Now, moving on to that part of the podcast that some of you want to tune out for a minute and a half, that's just fine. Others have told me you can't wait for it. Today here in Minneapolis, I am very, very happy to report that the last podcast that we have before the summer solstice is, in fact today, June 12^th. In Minneapolis. The sunrise will be at 5:26a.m., sunset at 9 p.m. That's 15 hours, 34 minutes and 16 seconds. Actually, we're still increasing slightly, about 38 seconds a day, but that will soon peak on June 22nd when at that time we will have a total of 15 hours, 36 minutes and 45 seconds of sunlight. Oh, do I love this time of the year. Now moving on. And I'm talking about those dear, dear colleagues at the Occidental Belgian Beer House on Vulcan Lane in Auckland today. Your sunrise was at 7:30a.m., sunset at 5:10p.m., nine hours, 39 minutes and 33 seconds of sunlight. Yep, it's dropping. In fact, soon on June 21st, you'll only have nine hours, 37 minutes and 53 seconds of sunlight. But know that we are really willing to share with you what we have here, so just count on it. We'll give you that boost.

Chris Dall: Mike, you are among the people who've been warning that Kennedy would likely make changes to ACIP. So, what was your reaction when you heard the news?

Dr. Osterholm: Well, Chris, again, let me share my journey with this entire situation. As many of our listeners know, I've had the good fortune to participate in federal government activities dating back to the HIV days with Ronald Reagan and the AIDS Commission, and have worked through every administration since that time, up to, but not including the current one. And notably, I served as a science envoy in the State Department in Trump 1. I felt like I had a pretty good handle on how federal governance occurs and what you might expect to be unusual or different versus that which is actually unheard of. Well, we now have hit the unheard-of button. On the night of the election, I realized that at that time, again in a nonpartizan way, but anticipating the future, in fact, that the document 2025 would likely play a key role in how the new administration unfolded. The next day after the election, I actually wrote an email to our staff indicating that I thought that this was going to be a very difficult and tumultuous time going forward with the new administration, but I didn't fully anticipate what could happen if Robert F. Kennedy, Jr. would be named and confirmed as the Secretary of Health and Human Services. Sure. I was very familiar with his work. I understood how he was one of the key leaders around the world in vaccine myths and disinformation and anti-vaccine movements.

Dr. Osterholm: But again, hoping that the system which, for me seemed, to have a certain number of guardrails and ways in which individuals could only go so far from the median, I had no idea that it could be like this. And so, by the time he was confirmed and started taking actions, I said, wow, this is going to be a lot worse than I even thought. And it was really in the early days of the Vaccine Integrity Project that we came to realize what we thought was surely going to be an eventual remaking of the ACIP, if not the complete destruction of it. Well, that's now happened. We shouldn't be surprised. Let me just point out that this is totally unprecedented territory. What we're watching is a very, very small group of individuals around the secretary who are making unilateral decisions about science, about public policy without any real input from staff, from outside experts, and they are doing this in a way that is, in a sense, almost punishing. And, you know, to me, I look at how they've announced major changes in public policy recently with regard to vaccines. They hold a press briefing about a New England Journal of Medicine article that, in fact, now says that they're going to change who has access to COVID vaccines. And I might note that one of those discussion points at that time was, would pregnant women still be recommended to get the vaccine? And right there in the table that they had in their New England Journal article said, yep, they should be allowed to get the vaccine.

Dr. Osterholm: Well, as we learned a little over a week later, that all changed when the secretary filming a video on X with two of his colleagues next to him, now indicating that that was all changed. A 58 second video with no data. No information. That was all changed. Well, that's the premise upon which the department is now being run. It is that the Secretary can pretty much do whatever he wants, whenever he wants, and that, in fact, science is not really part of that. I know we'll talk more about this in a moment, but I just have to tell you, that is a very, very dark day when we see these 17 members who were dismissed from the ACIP. It does not bode well for science going forward. I think we now have been captured by a public policy world, that one that I find very troubling, versus one that's based on Independent Science Review. So, Chris, we're going to be talking a lot about this over the days ahead, particularly around our work with the Vaccine Integrity Project. But needless to say, it truly is a major challenge to public health going forward.

Chris Dall: Among the claims that Kennedy made in the Wall Street Journal op ed is that ACIP members meet behind closed doors, that most members receive substantial funding from the pharmaceutical industry, and that the body as a whole has become a rubber stamp for vaccines. Now, Mike, as someone who has dealt with ACIP and knows several people who have been involved with it, can you respond to those claims?

Dr. Osterholm: First of all, Chris, let me just be really clear that again, I will attempt to make my comments about the remarks themselves, not about the individual. But I think as we talk through the challenges we have here in this podcast with regard to public policy, how we in fact make recommendations for vaccines or any other public health action, it's hard not to realize that this is really about the personality of an individual who's being allowed by an administration to pretty much run rampant with whatever he or she wants to do. Remember, Mr. Kennedy came into this job with a long history of being anti-vaccine, and he oftentimes would say things in such a way as to make it appear that he wasn't. Such as telling someone, yes, in an outbreak you should get measles vaccine. But we really don't know what's in those vaccines. Casting doubt about his what he has done very, very well with. So, when he needed a reason to dismiss the ACIP, he came up with the idea that they meet behind closed doors or they have substantial funding from pharma. They have all these conflicts of interest. Simply not true. And I find it very hard to believe that someone in a senior position like that could just deny reality. For example, meeting behind closed doors. Every full meeting of the ACIP is absolutely open to everyone. It's also a video link so people can watch it. There is no closed-door sessions that occur during these meetings.

Dr. Osterholm: Now there are working groups that actually review much of the data around the vaccine issues of the day that may meet in a conference room, but it's not such as a closed-door environment. And so, it really is very unfortunate that we give people the sense that these are somehow behind closed doors deals. It's just simply not true. When he talks about substantial funding for pharma, he has stated many times that those individuals who serve on ACIP have major conflicts of interest that are not disclosed, that they are receiving large sums of money from the pharmaceutical industry, or somehow, they're receiving benefit from being a pro-vaccine individual. Again, simply not true. As early as 2000, the issue was raised about keeping track of people's conflicts of interest and how do you record them, and then how do you assure that they are not allowed to participate in any discussions about that particular topic? Now, there was some concern that forms were not filled out correctly, and in 2009 an inspector general report actually supported that and said, there's some sloppy paperwork here, but not one instance was ever found of someone actually acting on a potentially compromised situation, meaning that they were voting for a given piece of action around a vaccine that they somehow benefited from. What's more interesting right now to me, and how you can make these statements that he is, is that literally for the past 20 years, the ACIP members are listed on the website with all potential financial disclosures. They're on the website, meaning that if they have a conflict, it's right there in public view. Now, why would somebody have a conflict of interest might be on this committee because you want the best and brightest minds that are working on vaccines to make the recommendations.

Dr. Osterholm: Well, it turns out that some of these people are doing research on vaccines themselves. And again, they have to recuse themselves if in fact it involved any of their research or the vaccines that they're dealing with. But in many cases, I want to have an expert on vaccine A, who then can look closely at vaccine B and C and make decisions. Are these the vaccines that should be moved forward? How should they be used? What are the concerns? So, the idea that there's this conflict of interest, again, it's just a way to scare people. And as far as a rubber stamp for vaccines, the ACIP has surely done a very, very good job of working with the FDA in responding to vaccine approval and actually removing vaccines from the market, should it indicate that they actually had a potential risk situation that was not detected prior in the licensing process. Remember, most studies today looking at vaccine license approval often have maybe several thousand participants in the study. Well, if something occurs at 1 to 500,000 or 1 to 1 million. You know, it's only going to be with time and the follow up after one has been vaccinated, that you'll pick those things up. That was not a flaw at all in the investigative process of the ACIP. So, Chris, this is a lot to do about nothing. But one of the things that Mr. Kennedy continues to do over and over again is scare people.

Dr. Osterholm: And I must add that, along with one of the comments he made about this issue of dismissing these individuals, he made it very clear that, of course, the public has lost faith in the vaccines. Well, the one way that they lose faith in the vaccines are when people like RFK Jr are out there making the statements they are. I feel sometimes it's almost kind of like, you know, having the arsonist complain about all the houses burning in their neighborhood. You know, this is crazy. It's not at all a function of the fact that the public health community has created these dilemmas about vaccine safety. Its people like him. So, he's actually fulfilling. One of the things that he's done for the past decade is so this doubt, and look how he's been rewarded financially in these litigation issues, very well financially rewarded. You don't see any of the other individuals in the ACIP similarly awarded for that kind of thing. So let me just make it clear we're in a whole new territory with this guy. And what we have to figure out is, how are we going to live in that kind of environment? What are going to be the choices that we all have to make about whether we follow his advice or not? Will payers follow the advice if we have an ACIP that basically is anti-vaccine in nature? We don't know that. But I can tell you right now that what happened this past week will reverberate through public health for many, many decades to come.

Chris Dall: Mike, you and your colleagues on the Vaccine Integrity Project published a viewpoint in response to the ACIP news, and in the piece, you note that it follows a pattern for Kennedy and HHS with little evidence that is provided for policy changes, is selective, and data are retrofitted to support decisions that dovetail with Kennedy's personal views. And a good example of this, and you mentioned it earlier, is this recent decision to remove the recommendation of COVID vaccination for healthy children and healthy pregnant women. Can you explain?

Dr. Osterholm: Well, Chris, let me use my explanation here, hopefully as a model for how we should be talking about these issues, not in an emotionally inflamed comments and accusations and so forth. Show me the data. I'm a scientist. I just want to see the data. And then we can have a discussion about what do those data tell us or not tell us. So first of all, you are absolutely correct, though, that the removal of the COVID vaccine recommendation for healthy children and healthy pregnant women is the perfect example of policies being changed based on Kennedy's personal views rather than the scientific evidence. And sadly, this problem is only going to get worse with the firing of the ACIP current members. As you noted, we explore in more detail in our most recent vaccine integrity project viewpoint, which will be linked to the show notes. After removing COVID vaccine recommendations for children and pregnant women, Kennedy's team released a document titled, quote, COVID Recommendation FAQ, unquote filled with misinformation and disinformation. In one of the most jarring examples, the document states, quote, that a number of studies in pregnant women showed higher rates of fetal loss of vaccinations received before 20 weeks of pregnancy, unquote. But in fact, the study that they cited actually provided data showing just the opposite to be true. Now, you can say, you know, they missed that one. How could you have missed this? This is the kind of sloppiness, the carelessness that is not accepted in science.

Dr. Osterholm: If one of my graduate students made that kind of error, that would be grounds for flunking them for whatever effort they were working on. Now, this is our federal government supposed to be the best and the brightest. And prior to this administration, we actually had at CDC and at the ACIP and at the VRBPAC group at FDA, really the best and the brightest, they were there. So, I think it's fair to say at this point that what we're seeing here is a pattern of misinformation, disinformation. They continue to publish references that are coming from AI because there are references that don't even exist. And if that doesn't give you pause in terms of having confidence in what they're trying to do, and they keep citing this mantra gold standard science. Well, there's no gold standard science here except for fool's gold. Now, let me just further elaborate on some of these numbers. We know that COVID-19 infection during pregnancy is associated with increased risk of severe illness, Hospital admission and preterm delivery. During the last episode, we also covered the devastating impacts of COVID-19 infection in infants under six months of age. For these reasons, the W.H.O. currently recommends COVID-19 boosters for pregnant women. The American College of Obstetricians and Gynecologists, or ACOG, has strongly recommended vaccination for pregnant and lactating women in the United States. In addition to the current COVID-19 vaccines being very effective in reducing severe illness in pregnant women and infants, they also have a strong safety profile.

Dr. Osterholm: Like any medical intervention, there's always a possible risk of side effects such as pain at the injection site, fever or headache. However, there is no evidence of severe adverse maternal or fetal outcomes from vaccinating pregnant women for COVID-19 with currently licensed vaccines. In fact, in a study published last year in the Journal of the American Medical Association on a cohort of nearly 200,000 infants, COVID-19 mRNA vaccination during pregnancy was associated with lower neonatal mortality compared to those not vaccinated during pregnancy. I mentioned this in the last episode, but it's worth repeating. Infants are among the highest risk for severe illness or death due to COVID, and their only method of protection is through antibodies received in utero. The claim by this administration that there isn't enough data to support a universal recommendation for COVID-19 vaccination during pregnancy is categorically false, and I'm scared of the impact that this recommendation will have on both pregnant individuals and infants in the United States going forward. At the very least, they should have followed what, in fact, was the original recommendation that came out from that first New England Journal paper I talked about from several weeks ago, when they at least made vaccine permissive. Yes. We didn't recommend it, but if you wanted to get it and you were in that group, you should be able to get it.

Dr. Osterholm: I'm worried that today payers will say, well, it's not recommended for pregnant women. It's not recommended for younger individuals, i.e., adults. Why pay for it? That's going to be a challenge. The second part of this new recommendation, or lack thereof, Chris, was on COVID-19 vaccination in healthy children. According to the CDC, children and adolescents comprise about 4% of all COVID-19 hospitalizations in the United States. At the recent ACIP meeting in April this year, the CDC presented additional data demonstrating that 59% of children six months to 17 years hospitalized with COVID had at least one underlying medical condition. However, this means that 40% or two out of the five children hospitalized with COVID-19 did not have any underlying medical condition. In other words, those are healthy kids, Chris. The parents, at best, could just have gotten them vaccine out of their intent to minimize illness. There was no warning sign that they should have gotten it. There's also data indicating that fewer than 5% of all children and adolescents hospitalized with COVID in the United States from 2023 to 2024 who were eligible for vaccination, received the most recently recommended vaccine dose. So, yes, children are not getting vaccinated in large numbers, but for parents that want to vaccinate their kids, they should at least have that chance. Not only are healthy kids susceptible to COVID-19, current vaccines are effective in preventing severe illness that could lead to hospitalization.

Dr. Osterholm: And although the risk of severe illness due to COVID in children is much lower than in adults and is similar to, if not greater than what we see for flu. Let me put this into context with mortality data. In 2020, we had 199 pediatric COVID deaths in this country, followed by 612 pediatric COVID deaths in 2021 and 748 in 2022. During the 2023-2024 influenza season, the US had 207 pediatric influenza deaths, and during the most recent 2024-2025 season, we had 216 pediatric flu deaths. If this influenza pediatric mortality warrants the recommendation for influenza vaccines as it does, then certainly shouldn't it be enough to at least allow COVID vaccines for this group if parents want them? Additionally, there is evidence that supports vaccination can lower the risk of long COVID in children. The bottom line is that we have clear evidence supporting the safety and efficacy of COVID vaccines in children and pregnant women, but this did not stop Kennedy's team from releasing a document filled with myths and disinformation, and making policy recommendations based on that misinformation. With the firing of the ACIP, there is truly no telling what this administration will do next to undermine our country's access to vaccines. We will keep you updated as this situation continues to unfold. This is only the beginning, and we are going to be here for the entire time that they are.

Chris Dall: Kennedy says the new ACIP members are going to restore public confidence in vaccines, but if they do include people with anti-vaccine views, and that does seem likely, it seems like it's just going to cause more confusion for parents and providers, and maybe that's the point.

Dr. Osterholm: But as I noted in an earlier answer, Chris, what this administration, at least specifically with regard to what Mr. Kennedy is doing, tends to cover up major, major holes in their professional capacity or integrity by saying we are the best gold standard science, you know, transparency, all these characteristics they keep on mentioning, well, that is all really just a cover up, just the opposite. I personally have never seen an administration that is so unqualified to make the kinds of very critical public health decisions, as is this one. And again, this is not a Partisan statement. I have been involved with every presidential administration back to Ronald Reagan. This is just the honest truth. And so, I think it's very important to understand where is a certain level of this lack of public confidence in vaccines coming from. It's coming from the secretary himself and those he's close to. And we have to just realize that what's happening here is he will continue to say, you know, I'm out there working for you, trying to help you, and this is what I'm doing. And it may sound like, in fact, he is really trying to help you, when in fact just the opposite. He's pursuing his own personal goals. He's pursuing his own personal agenda. And it's a dangerous one. An absolutely dangerous one. And we in the Vaccine Integrity Project are going to continue to work to address this issue. And so that in each and every instance when misinformation comes forward, we will be there to take it on and correct it. And we're looking at how else can we support an ACIP like environment in the community today, when in fact the real ACIP has been captured and is no longer believable. This is a challenge. We're not going to restore the public confidence from having Mr. Kennedy's priorities enacted. In fact, that is what is going to cause a dangerous situation, including the deaths of individuals who otherwise wouldn't have had, had this been at a different time and place.

Chris Dall: One final COVID vaccine note here. The FDA last week approved an updated COVID shot from Moderna that targets a portion of the SARS-CoV-2 spike protein, which allows for a smaller dose than the original Moderna shot. But under the new FDA COVID vaccine framework, it's only approved for people ages 65 and older and younger people with conditions that put them at risk for severe disease. An FDA commissioner, Martin Makary, also said Moderna had agreed to a randomized controlled trial of the shot in healthy, younger people. Your thoughts?

Dr. Osterholm: I'll start by saying I'm glad to see vaccine developers continue investing in research and improve vaccines despite the current landscape. I'm not sure how much longer that kind of investment will continue. Moderna's updated vaccine mRNA 1283, or what you've probably heard called mNEXSPIKE, targets a portion of the SARS-CoV-2 spike protein for virus neutralization, which allows for a dose one fifth of the size of Moderna's original COVID-19 vaccine, mRNA 1273. It was this larger dose that was often associated with some of the side effects experienced in the 24 to 48 hours after vaccination, so this lower dose, which is more effective, is actually welcomed. The new vaccine was tested against the original vaccine in a phase three trial, with 11,400 participants over the age of 12. In this study, participants were given either one dose of mNEXSPIKE or one dose of mRNA 1273. This means every single participant was given a dose of vaccine. Nobody received a placebo. The study results found that the updated new vaccine, mNEXSPIKE, showed a 9.3% higher relative vaccine effectiveness compared to Spikevax in individuals aged 12 and older, and in descriptive subgroup analysis, the new vaccine had a 13.5% higher vaccine effectiveness in adults aged 65 and older. The two vaccines had similar safety profiles, though the updated vaccine had fewer local reactions than the original. These are great results, and I'm glad to see the FDA approved it. The issue here is that the FDA has approved the vaccine only for individuals 65 and older, and in those 12 to 64 years, with at least one of the underlying risk factors acknowledged by the CDC.

Dr. Osterholm: But what about healthy adults? Well, according to the administration's new COVID vaccine framework we discussed in our last episode, it seems that Moderna would need to complete a placebo-controlled trial to be able to receive approval in healthy adults. Not only are these trials expensive and time consuming, but completing a randomized, controlled trial with an inert placebo when we have an effective vaccine available is simply unethical. Moderna has yet said whether they will complete a trial to attempt to gain additional approval, but they have announced that they expect that next spike to be available for those eligible during the 2025-2026 respiratory virus season. Their original vaccine, Spikevax, will also still be available. I also want to add that Spikevax currently remains available for anyone six months or older. So, I'm glad to see a new vaccine option available for all those eligible. I'm really disappointed that we're already seeing the impact of this new illogical vaccine approval framework. That is really just a mask for the fact that they're trying to discourage vaccine uptake. I do not, for the life of me, understand. In a study where they looked at individuals who both had high risk features for disease as well as those not, they found similar results, but they only are going to approve the vaccine for those that may have had, the potential for a more serious illness, makes no sense whatsoever.

Chris Dall: Now on to our infectious disease updates. Let's start with what's going on with the US measles outbreak. And Mike, I'd also like you to address a recent study that showed a further decline in uptake of the MMR vaccine during the COVID pandemic.

Dr. Osterholm: Chris, cases keep accumulating. As of last Friday, US measles cases had jumped by 80, the biggest spike since late April, pushing the total to 1168 in 34 states. I must add that I'm convinced that there are substantially more cases in the communities we're just not picking up. But even with these numbers, it means that the country will likely hit a record number of infections since the disease was officially eliminated from this country 25 years ago. Nearly 90% of cases are linked to one of the country's 17 outbreaks since January. Of cases reported this year, 95% have been in people who are unvaccinated or had unknown vaccination status. Children have borne the brunt, with 38% of infections in 5- to 19-year-olds, followed by 33% in adults and 29% in young children. Most new cases appear to be linked to travel and a proliferation of outbreaks, rather than the original outbreak in West Texas, which is very concerning. Last week, Canada, which is battling an even larger outbreak than the US, reported 225 new confirmed or probable infections, for a total of 2968 cases and 227 hospitalizations. More than 2000 cases have been linked to a main outbreak, which began in New Brunswick in October and spread to Ontario, with related cases in eight other provinces, including more than 700 cases in Alberta. Measles was declared eliminated from Canada in 1998. As in the US outbreak, children have been disproportionately affected, with 5 to 17 year old’s accounting for nearly half of the infections. Over 90% of patients have been exposed in Canada, and 85% have occurred in unvaccinated people. Tragically, measles claimed the life of a premature infant with underlying medical problems born to an unvaccinated mother in Ontario. The first death related to the country's major ongoing outbreak. Earlier this week, the government announced that another six infants have been born with measles, also called congenital measles, and recovered since last fall.

Dr. Osterholm: This shows that in addition to posing a serious threat to unvaccinated pregnant women who can develop pneumonia, lose their pregnancy or die. It can also lead to poor outcomes for the fetus of a newborn. A fetus can be exposed to the measles virus in utero through the placenta, resulting in premature birth or low birth weight. Also, the child may experience fever, rash, encephalitis, and even death. In Europe, the threat of summer travel related measles surges and rising global incidents led the UK's Health Security Agency last week to urge vigilance in England, which has experienced ongoing outbreaks, mainly in unvaccinated children. As I mentioned, a lack of vaccination is also fueling US outbreaks, which coincide with the nearly 3% decline in measles, mumps, rubella and MMR vaccination uptake among US kindergartners since the COVID pandemic began. That figure comes from a Johns Hopkins study published in JAMA and is the one you referred to earlier. Despite being part of the US childhood vaccination program, which averted an estimated 24 million cases of vaccine preventable illness in 2019 alone. The study found that MMR vaccinations declined from 94% before the pandemic to 91% in 2024, and 78% of counties, and in 33 states. Only four states California, Connecticut, Maine and New York, reported an increase in immunization. This is difficult news to process when so much suffering could be prevented by getting vaccinated against this highly infectious disease. If you or your children are unvaccinated, please, please protect yourself, your family and others by seeking immunization now. While the MMR vaccine isn't recommended for pregnant women, if you are planning a pregnancy and weren't vaccinated as a child, protect yourself and your child by getting vaccinated at least one month before pregnancy.

Chris Dall: Let's turn now to the latest COVID variant, NBS 1.8.1. In our last episode, we noted some spikes in Asia related to this variant. Mike, are we seeing any new activity and do we have any new insight into this variant?

Dr. Osterholm: Well, Chris, let me just warn our listeners that we're going to get back into Variant Soup again with regard to numbers and letters. The latest variant is certainly taking up some news coverage. Unfortunately, we really don't have a lot of new insight to the NB1.8.1 since our last episode, the W.H.O. did release a new Global Situation report on COVID activity, but we're not seeing anything new that raises significant alarm bells regarding accelerated transmission. According to this report, as of mid-May, NB.1.8.1 accounted for about 10.7% of global sequences and was increasing, so it's likely that it's higher now. Global test positivity is about 11%, which is the highest it's been since July of 2024. Recent increases in test positivity have been primarily in countries in the Eastern Mediterranean, Southeast Asia and Western Pacific region, with notable surges in cases in Taiwan, China and Hong Kong. As we mentioned in our last episode, as well as in Thailand and India. These increases in COVID activity remain consistent with surges in previous years and don't seem to be a reason to cause severe concern. I'll note that it is still very difficult to paint a complete picture, because data is so very limited, and it's unavailable in many locations at this time. Activity in Taiwan is believed to have peaked as measured by COVID-19 related medical visits. This year's peak of about 70,000 visits the first week of June is about half of the peak experienced during the 2024 surge, when the weekly COVID medical visits reached 132,000.

Dr. Osterholm: During that same week, there were 166 severe cases and 25 deaths, which both marked the highest weekly totals reported in 2025. Unfortunately, there is no data to quantify the surge in China. The data of Hong Kong is limited, but we do know that from the beginning of March to May 10th, cases increased from 33 to over 1000 reported. Test positivity increased from 0.3% to 13.7%. Thailand reported 65,880 new cases between May 25th and 30th, and three deaths. India is currently seeing an increase in cases driven by a combination of variants, including both NB1.8.1 and XFG, another variant that has been gaining attention recently. It was first detected in Canada and like NB1.8.1, it has a significant advantage over previous variants. Although it is immune evasive, it has a lower ACE2 engagement, meaning that it is less likely to increase transmission. This is surely good news. While India has seen an increase in cases, now nearing 7000 active cases, and a test positivity that is 12 times higher than it was in May and the highest it's been all year, they are not experiencing an increase in hospitalizations. This means these variants do not seem to be causing more severe disease, which is a relief and is consistent with what other countries have seen as well.

Dr. Osterholm: All of these countries have seen a rise in cases without significant rise in severe disease, and none of these surgeries have surpassed those of the previous year. All of this is to say that while we're seeing some increases in activity across the globe associated with the new variants, it does not appear like the Omicron level surges we experienced in 2021. I know we didn't provide a national COVID update last episode, and there still isn't much to report on, but I want to provide a quick one before we move on. Reported COVID activity has not changed significantly in the past month. There have been cases of NB1.8.1 across the country, but we're not seeing a substantial surge associated with these cases, at least not yet. The national wastewater level is considered low or very low in every region, which is great news. Although there has been slight increases in concentrations in every region other than the Midwest. Emergency department visits for COVID remain very low and decreasing, and hospitalizations continue to decrease as well. Weekly deaths also continue to decline, the lowest we've seen since the beginning of the pandemic. We can't take our eye off of COVID, but those numbers mean we can breathe a lot easier in the US for the moment.

Chris Dall: While H5N1 avian flu continues to spread in US poultry and cattle, the big news recently was the decision by the Department of Health and Human Services to cancel a $590 million contract with Moderna to develop an mRNA-based vaccine for H5N1 and other pandemic flu viruses. Mike, while this vaccine is still in the early stages of human clinical trials, and we don't know a lot about its efficacy, one of the things we do know about mRNA vaccines is that they can be produced rapidly in the event of a pandemic, and we only have to go back to the COVID-19 pandemic to see that. So how will this decision affect our ability to respond if H5N1 makes that genetic leap and starts spreading more easily in people?

Dr. Osterholm: Well, Chris, first of all, let me just say that this news that you just reported on with regard to the vaccine is extremely disappointing, but again, it's not surprising. The contract with Moderna was initiated during the final days of the Biden administration, and reports earlier this spring indicated that the new HHS leadership was reassessing it, given the anti mRNA sentiments exposed by newly appointed HHS officials. This project had a target on its back from the moment the new administration took office. However, since the contract began, Moderna has collected a considerable amount of data from the 300 healthy adults enrolled in the phase one two clinical trial. Preliminary reports indicate that three weeks after the second dose in a two-dose series, 97.9% of participants showed a 44.5-fold increase in neutralizing antibody titers from baseline. These results suggest that the vaccine formula elicits a rapid, potent, and durable immune response against the H5N1 variant used in the trial. Moderna's CEO stated that the company was pleased with the robust immune response and the safety profile observed, although the cancellation complicates their ability to advance the mRNA platform. As we saw during the COVID-19 pandemic, scientists and manufacturers are uniquely capable of formulating and producing mRNA vaccines on a much shorter timeline than traditional platforms, such as those that are used to make most of the influenza vaccine.

Dr. Osterholm: This is because mRNA technology does not require genetic modification or cultivation of live virus, as is necessary for vaccines targeted at other pathogens. It's important to note that last year, the US built a stockpile of 10 million H5N1 cell-based vaccine doses targeting clade 2.3.4.4b, which includes both viral genomes B3.13 and D1.1, currently circulating in wild birds in captive livestock. While this stockpile is significant, has not been approved by the FDA at this stage. And it's worth remembering that the US population exceeds 340 million. 10 million doses for a two-dose series would be reserved for targeting immunization campaigns, such as for healthcare workers and those with high-risk exposures to affected livestock. It's also possible that the cell-based stockpile vaccine formulation may not adequately match a future viral strain. In contrast, mRNA vaccines can be readily adapted to target specific viral variants and essential capacity given the unpredictable nature of H5N1 as it mutates and spreads to the animal population. The clinical data from Moderna's completed trials would have significantly strengthened our capacity for rapid response if sustained human to human transmission were to occur of H5N1. Canceling this contract represents a major setback in our pandemic preparedness efforts, and unfortunately, I don't see anyone in this administration concerned about what in fact, just happened with this contract.

Chris Dall: Now, an update on something we haven't talked about in a while. And that is the mpox virus, which continues to cause outbreaks in Africa and appears to be spreading rapidly now in Sierra Leone in a way that is alarming some scientists. Mike, what can you tell our listeners?

Dr. Osterholm: As you said, Chris, it's been a while since we covered this issue, but mpox has continued to spread, particularly through sub-Saharan Africa. As we've mentioned in previous episodes, there was a noticeable increase in transmission in the Democratic Republic of Congo throughout all of 2024. Sadly, conflict in the eastern part of the country escalated dramatically this past January because the conflict has drastically reduced the country's testing capacity, we don't really have any kind of understanding of just how many cases and deaths are occurring, but we have every reason to believe that the transmission is ongoing. Six of the seven mpox treatment centers in the area were destroyed, and many mpox patients had to flee without the ability to isolate or be treated for their infections. Vaccination efforts in the region were paused for several months, but fortunately have recently resumed. That said, it is very likely that these efforts will be significantly impacted by US budget cuts to foreign aid. So even if the conflict continues to resolve, it is likely we could see this outbreak worsen without substantial international resources. And as you noted in your question, mpox has also been a challenge in Sierra Leone. The country reported its first mpox cases in January, and since then the outbreak has grown rapidly, now reported an average of over 100 cases per day.

Dr. Osterholm: The cases are of the 2B strain of the virus, which typically causes milder symptoms and is responsible for the global mpox outbreak in 2022. 68% of the cases in the country are in men, most who are 30 to 35 years old. Vaccination efforts are currently underway, with 24,000 people vaccinated so far. 60% of whom are healthcare workers. Though this isn't something we have covered every week due to the lack of new information, this is still a very serious challenge. Mpox was declared a Public Health Emergency of International Concern by the W.H.O. in August 2024 and sadly, if it continues to spread at this rate in sub-Saharan Africa, it may only be a matter of time before we start seeing another global outbreak like we did in 2022. For listeners who are interested in keeping up to date with this issue, I'd encourage you all to follow the mpox coverage at CIDRAP News at CIDRAP.umn.edu/mpox, and we'll continue to keep you updated here on this podcast as more information emerges.

Chris Dall: And now it's time for our ID query. We've received several emails from listeners in the last few weeks that were prompted by your take home message in a recent episode, Mike, in which you said that people should quote, organize, organize, organize. And I think many people are still unsure about what that looks like in their lives. Do we have any resources that we can point people to?

Dr. Osterholm: Well, Chris, as I said a few weeks ago, it's more important now than ever before that we come together as a community and organize. And I understand if people aren't sure quite what that means. So, I want to be really clear today that community organization is really about working with each other for a common cause, a common good. So, what do I mean by organize? Well, it starts with building that community of yours. Be a friend to those in need. In order for us to have community-based advocacy, we need to first have community. Go to your school board meetings, your local political events. Make your voice heard and listen to the voice of others. And one of the things you can do is work towards improving the rates of vaccination in your community. How can you do that? Well, I've enlisted the help of a dear friend and colleague, someone who I have long admired for her work in the area of vaccine preventable diseases. I'm talking about Patsy Stinchfield, who is from Minnesota and has had a 45-year nursing career. Her career has focused on infectious disease prevention. She's a pediatric nurse practitioner specializing in vaccine preventable diseases. She has many, many, many different positions at a state and national level. She is a widely recognized infectious disease specialist, having served as the first nurse voting member of the Advisory Committee on Immunization Practices, and served as a liaison member for the National Association of Pediatric Nurse Practitioners.

Dr. Osterholm: I could go on and talk about item after item in her work with the National Foundation for Infectious Diseases. So many different issues that she's involved with. So, I followed up with Patsy and I said, I know that you'll probably have this at the tip of your tongue, but who are those organizations that you know are wonderful supporters of the use of vaccines in our community, and how can people join them? How can they find them? And the information I'm about to share with you, again will be printed in the podcast notes so that you can get to them yourself. There are a number of immunization focused organizations throughout the country that you can get involved with to help you promote vaccination. I'd like to highlight a few of them today. These all came from Patsy. The first is Voices for Vaccine, an organization working to spark positive, peer to peer conversations about vaccines and diseases they prevent by supporting communities, building networks and developing fact-based content. Voices for Vaccines is looking for volunteers to fill a number of roles, including experts from a variety of fields pediatricians, family medicine, doctors, public health and ID specialists, family law, lawyers, teachers, PR and media experts, fundraising experts and social media influencers. They're also looking for vaccine ambassadors who will attend training sessions on vaccine advocacy, and use their training and toolkits provided by the organization to promote vaccines in their neighborhoods.

Dr. Osterholm: Additionally, they are looking for volunteers to promote, moderate and share Pro-vaccine content on social media, as well as inform the organization about vaccine discussions that are circulating online. They are a phenomenal national organization, but they also happen to be based right here in Minnesota. Another organization doing some very incredible work is Families Fighting Flu. This organization is looking for individuals willing to volunteer as vaccine advocates, as well as those who can host fundraising events. They also have helpful information on their website about how to contact legislators to share your opinions about flu prevention and public health. The organization Vaccinate Your Family is looking for online and community advocates to share their experiences with vaccines and/or vaccine preventable diseases, and also provide some helpful information on contacting your representatives. Looking at more global perspective, the organization Shot at Life has resources on contacting lawmakers about foreign aid for global vaccination efforts and advocating for U.S. involvement in W.H.O., as well as information about how you can promote vaccination on social media. This is certainly not an exhaustive list, but I hope it's a starting point for any of you looking to volunteer in this space. Additionally, I would encourage you to see if your local public health agencies are in need of volunteers for events like pop up immunization clinics. They're often need for both clinical and non-clinical volunteers. So regardless of whether you have a nursing, medical, or other health license, there may be a way for you to get involved.

Dr. Osterholm: I would also recommend joining your community's Medical Reserve Corps. Medical Reserve Corps are groups of clinical and non-clinical volunteers that respond to public health emergencies. They assist with anything from vaccination clinics to natural disaster response to refugee support in their communities. I hope this all provides a bit more clarity to my suggestions to organize, and to give you all some actionable steps towards helping your community. Again, I want to acknowledge that this certainly cannot erase the damage that this administration is doing to public health, especially vaccination efforts, but this is still a chance to make a meaningful difference. I shared this quote from Everett Hale a few episodes ago, but I think it bears repeating in this context. I am only one, but still, I am one. I cannot do everything, but still, I can do something. And because I cannot do everything, I will not refuse to do something that I can do. You all have the opportunity to do something. Again, the information you're looking for is in the show notes for this podcast. And I want to thank Patsy for this information and just to acknowledge her amazing career over the years and all that she has done for the promotion of vaccines in our communities. You have saved so many lives that you'll never know. Thank you.

Chris Dall: Finally, it's time for our favorite segment: This week in Public Health History. Mike, what are we celebrating today?

Dr. Osterholm: Well, we're shining a light on yet another figure in public health that has gone mostly unrecognized. And that's something I really love about this segment. Public health, both now and historically, is made up of people who care deeply about others and who are curious about the world and are willing to spend their lives making it a better place, whether or not they receive recognition. In 1892, an Argentinian medical student, Alejandro Posados, first described a strange illness in a patient who initially presented with a lesion on his face and he believed to be a spider bite. However, the horseman's condition progressed and proved fatal. While the illness was thought to be a parasite at the time, it was determined to be a fungus from the genus Coccidioides. In the same year as the discovery, Myrnie Gifford was born in National City, California. She was an accomplished student, completing her medical degree at Stanford, doctorate at UC Berkeley, and then a certificate in public health at Johns Hopkins. Doctor Gifford became the assistant health officer in Kern County, an area of California that includes the Central Valley and a large amount of agricultural production. She spent the first few years of her job investigating the cause of what was known at that time as Valley Fever, which typically presented with skin nodules and respiratory symptoms. Doctor Gifford eventually identified the cause by inoculating a guinea pig, and was able to deduce that the Valley Fever was in fact the primary stage of the fungal disease Coccidioidomycosis.

Dr. Osterholm: Doctor Gifford began to conduct skin tests on migrant workers throughout the Central Valley, and found that at least 25% of workers were positive for Coccidoides, many without any symptoms. This entirely recharacterized the illness, which was thought to be rare and fatal. Doctor Gifford showed that with proper care, a full clinical recovery was possible. Myrnie was a strong advocate for migrant communities, which bore the burden for over 80% of Valley Fever deaths in the region. Doctor Gifford retired from Kern County Public Health after 20 years of service without ever having received a promotion. However, a library at the health department is now dedicated to her honor. Valley Fever remains a concern in the United States. The fungal spores are found in the soil in the southwestern United States and parts of Washington state. Outbreaks continue to occur in populations who work in agriculture and after weather events that may disturb the soil. A report published in JAMA just last week that analyzed CDC surveillance data, estimates that cases may be 18 times higher than previously thought, causing approximately 23,000 hospitalizations and 1000 deaths each year. This disease is still a major issue in North America, and I'm grateful for both the many scientists and public health experts, including Doctor Myrnie Gifford and Alejandro Posados, for their contributions in understanding, reporting and fighting this particular bug.

Chris Dall: Mike, what are your take home messages for today?

Dr. Osterholm: Well, Chris, I would like to not have the messages I have today, but I got to be honest, just calling balls and strikes here. Without a doubt, these are some of the darkest days of public health policy and practice in my 50-year career. I never thought I would begin to see the kind of situation we see right now with what's occurring with the Department of Health and Human Services and the issue around vaccines, particularly with Mr. Kennedy's leadership. This is a huge challenge, and it's a challenge, honestly, that we as a society have to stand up to. This is not about politics. This is about science and saving lives versus myths and disinformation for whatever personal gain that might be for those who are promoting that. So, my first point is just that these are the darkest days. My second takeaway is that the Vaccine Integrity Project, something we stood up shortly after the election, is growing in not only what it can do and does do, but also the vision for the future. And I'm so excited to be part of this group. We are doing a great deal of work. We'll put a link in the show notes so that you can get to the Vaccine Integrity Project web activity on our website.

Dr. Osterholm: And as time goes on, I think you're going to see much more information coming out from us. If you want to sign up, you can actually receive our viewpoints that are coming out on an as needed basis. As I said, we just published one earlier this week about what happened with the ACIP. I think you may want to read that one. And finally, my third point is getting involved. Now you have a series of options, particularly from a vaccine standpoint, to be able to get involved in your community, to be able to roll up your sleeves and help your children or your grandchildren be part of the solution by being vaccinated. And I think you'll find not only is this an incredibly noble cause, but it's one that brings like, people together who are incredibly enjoyable people to be with. So, I hope that you'll take advantage of this. Again, if you have questions, please get back to us. But the show notes, locations and emails should give you the information you need.

Chris Dall: And, Mike, amid these dark days, do you have a closing song for us that might bring us a little light?

Dr. Osterholm: Well, given that this is the time of light, I must somehow address that issue. Thank you, Chris, for that wonderful lead in. As much as I just commented about the darkness of where we're at, I do want to emphasize that these light days do remind me that there are bright days ahead, and I am confident in that. And whatever is happening right now will not last forever. And it's our job to make certain that whatever we can do to change the course of the challenges, the problems that we do that, but that we also then cherish the moments we will have in the future, where in fact, life will return to a more normal basis on the public health issues. We just will then have to remember the incredible value of public health. So, what I've chosen today is a song by a popular singer, Kacey Musgraves, from her album Star-Crossed, which was released on September 10th of 2021. Her song There Is a light. This is a first time use of this song on the podcast, and we're excited to be able to share it with you. So here it is. There is a light. There is a light at the end of the tunnel. There is a light inside of me. Tried not to show it. To make you feel good. Pretend I couldn't when you knew that I could. I wouldn't cry when the cold wind blows. Gotta let it shine. Because now I know. There is a light at the end of the tunnel. There is a light inside of me. There was a shadow of a doubt. But baby is never going out. There is a light inside of me. There is a light.

Dr. Osterholm: There is a light is so bright. I've been hiding it. There is a light inside of me. There is a light. There is a light inside of me. Aha! There is a light. Oh, there is a light. There is a light inside of me. Well, when you listen to this song, you may hear it repeated over and over again about the light inside of us. I think this really drives home the point that we have to remember. We do have a light inside of us. And as I say so often on this podcast, please, please, as tough as things are right now, challenged on a national level in so many different ways, if we can find kindness, now is the time to do it. It doesn't mean every moment of your waking hours you'll be kind, but in fact, go out of your way. Find someone out there that you can say hello to, or that you can open a door for. Or you can just do something to connect with them in a way that they appreciate that somebody saw them, somebody understood them for that moment. So, thank you very much for joining us again. I hope the information provided was helpful for those, again, who are concerned that this has become a political podcast by describing the issues of what's happening in Washington, DC. I hope you understand that public health policy is all about just what we're talking about. It's not Partisan. It's about, however, doing what we can to make sure or that things like vaccines are never denied to our communities. Be well. Be good. We look forward to talking to you soon. Thank you very much.

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.