Episode 195: We Can Make a Difference

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. It may be an understatement, but when it comes to infectious diseases and public health, we are living in a time of great uncertainty. 25 years after measles was declared officially eliminated. In the US, we have the highest number of measles cases we've seen since 1992, and a growing outbreak in the southwest is pushing those numbers even higher. And after a few quiet months, we are again seeing a surge in avian flu in bird populations with the ever-present threat of a single mutation that could start another human pandemic. We're also entering respiratory virus season in the midst of a government shutdown that has brought federal surveillance to a halt. On top of all that, our federal health leaders seem to be intent on undermining the vaccine infrastructure that has contributed to dramatic reductions in the numbers of children who become sick or die from preventable infectious diseases. On this October 30th episode of The Osterholm Update, we're going to discuss all of these challenges, as well as some of the steps that we're taking here at CIDRAP to address them. We'll also assess the current picture for COVID-19 and other respiratory viruses, and bring you the latest installment of This Week in Public Health history. But before we get started, as always, we will begin with Doctor Ostrom's opening comments and dedication.

Dr. Osterholm: Thanks, Chris and welcome back to all the podcast family members. It's great to be with you again. I can never tell you enough times how much we appreciate this wonderful relationship we have. And for those of you who might be joining us for the first time, I hope we're able to provide you with the kind of information you're looking for. I promise you it'll be a bit eclectic. It will cover infectious diseases and other things of interest. But I hope most of all, we are able to give you the kind of information that you're looking for. Chris, it's hard to believe, but we're rapidly approaching the end of this year. Where did the year go? The final stretch of November and December often fill up quickly with holiday parties, family traditions, classic recipes, shopping trips, and seasonal decorations. As we enter the season centered on gathering, abundance and sharing, I think it's also important to pause and recognize that for millions of families, the tables look very different this year. Across the country, food insecurity is not just a concerning statistic. It's become a daily reality. Rising costs, shrinking paychecks, and a pause in SNAP benefits due to the government shutdown have left many households facing impossible choices between paying bills and putting food on the table. The latest data we have on food insecurity in America comes from the USDA's 2023 Household Food Security Report, which found that 13.5% of households are approximately 47.4 million people in the US experienced food insecurity. Nearly 14 million of those are children. Notably, the funding for this report, which has shown annual increases in food insecurity for years, has recently been cut by the administration, meaning there will no longer be a national survey to track hunger in our country when it doesn't get counted in the minds of many it doesn’t exist.

Dr. Osterholm: Two things are true. First, without this survey. Individuals experiencing hunger vanish from statistics that are needed to scale social safety nets and food security programing. Second, we don't need statistics to see and feel the food insecurity growing in our communities or homes. Food is more than a fuel to get through a day. It's the foundation of health, of dignity, of hope. Proper nutrition doesn't just fill a stomach. It strengthens the immune system, supports mental health, and allows children to grow, learn, and dream. Without it, every other aspect of well-being begins to unravel. I happen to know about this personally and my own situation growing up and my family in Iowa. As the oldest of six kids and an alcoholic father who drank his paycheck away from week to week. We had more than one day that I remember painfully having not enough food on the table to feed all six kids. Maybe the most painful part of that was seeing the pain in my mother's face, knowing that she couldn't adequately feed her children. Oh boy. I understand this. Today we dedicate this episode to the individuals and families navigating hunger and silence, and to community advocates and food pantry workers who continue to show up even as demand increases and resources wane. For those of us who can consider donating to your local food shelf or community kitchen, volunteer your time, resources or voice support policies that strengthen nutrition programs like SNAP and make healthy food accessible for all.

Dr. Osterholm: Hunger isn't someone else's problem. It is a shared responsibility. When one table is empty, we all feel it. And when we ensure everyone has enough to eat, we build not only healthier bodies, but a stronger, more compassionate society. Well, moving on now to that moment of light and enlightenment. I'm here to report today, October 30th, in Minneapolis. Sunrise was at 7:49 a.m. Sunset will be at 6:03 p.m. That's ten hours, 14 minutes and 15 seconds of sunlight. Now, that doesn't compare nearly as nicely to the sunlight we had back in June, when it was 15 hours and 36 minutes, a drop of almost five hours and 16 minutes since that time. We're losing sunlight at about two minutes and 49 seconds a day, which will soon be leveling off as we hit the December winter solstice, and then we're back to gaining light again. And meanwhile, our dear friends in Auckland, New Zealand, at the Occidental Belgian Beer House in Vulcan Lane, you today saw your sunrise at 618a.m. and your sunset being at 751p.m. tonight. That's 13 hours, 33 minutes and 30s of sunlight. And you're gaining right now at two minutes and nine seconds a day. So, thank you very much for sharing your sunlight with us. We appreciate it very much. We're going to need some of it soon, but meanwhile, we still all can count on the fact we'll have some light.

Chris Dall: Mike, let's start with some of what we're doing here at CIDRAP to address the issues I laid out in the intro, because we have some news on that front in the form of a paper published just yesterday in the New England Journal of Medicine by CIDRAP Vaccine Integrity Project. What can you tell our listeners about this effort?

Dr. Osterholm: Well, Chris, let me just begin by saying I've had the good fortune in my 50-year career to be part of some incredible teams that were able to accomplish some remarkable public health actions. I've also led teams that made a huge difference in the health of our country and even the world with some of our findings. But nothing prepared me for what I'm about to share with you today. I simply cannot say enough about the incredible team of scientists and researchers who have pushed this effort over the finish line. Just yesterday, the finalized article titled Update Evidence Base for 2025 2026 COVID-19, RSV, and Influenza Immunizations was published in the New England Journal of Medicine. This paper, with the full appendices, is over 200 pages, a remarkable document. We heard news from the New England Journal of Medicine about two weeks ago that it would, in fact, be accepted, and it was amazing how quickly that editorial staff were able to turn it around and publish it to the readers. Our frequent listeners have heard me talk about this project before, but as a reminder, the Vaccine Integrity Project initiated this huge systemic review. Shortly after all, 17 members of the ACIP were dismissed by Secretary Kennedy and several new and completely inexperienced members took their place. We were very worried about the integrity of vaccine guidance coming out of the federal government, and believe that we had no choice but to take action. Fast forward to now. The scientific review team of 26 researchers from across the country and one from Canada, pulled off an incredibly detailed review of publicly available data assessing the safety, epidemiology and vaccine effectiveness of the three key fall respiratory viruses Covid, RSV and influenza.

Dr. Osterholm: These were individuals who already had full time jobs but were volunteering their time and expertise because they believed in our mission. I might note that ten of the 26 researchers were CIDRAP team members. I cannot begin to tell you how proud I am of their efforts. I encourage you to read the manuscript on the New England Journal website, or the executive summary on CIDRAP website, both of which we will link in this episode's show notes. The key messages are that these respiratory viruses cause significant illness and death across all ages in the US, and the evidence and the 500 plus studies we reviewed out of over 17,000 that the team screened for inclusion to the study clearly demonstrate that these immunizations are associated with meaningful and positive reductions in severe outcomes, while reassuring safety profiles consistent with prior evaluations. There were no surprises in our analysis. The Vaccine Integrity Project is proud to have been able to provide this resource for medical societies and the public, but we know our work is far from over. While upholders of anti-vaccine and anti-science ideas are in office, we are working to map out our short- and long-term plans for how we can continue to uphold our mission, but for now, know we're not going anywhere. We're in this for the long haul.

Chris Dall: There are some other news about a forthcoming collaboration between CIDRAP and the New England Journal of Medicine that you announced at last week's IDWeek conference in Atlanta. Mike, can you talk about what the purpose of this collaboration is and what its goals are?

Dr. Osterholm: Chris, I'm very honored to report that this past week, I was able to share at the opening session of the ID week activities in Atlanta that, in fact, the New England Journal of Medicine and specifically the journal NEJM Evidence and CIDRAP would collaborate to develop a means of publishing the kind of articles that once were frequently found in the CDC's Morbidity and Mortality Weekly Report. It's really important that we embark upon this new effort, because the MMWR has really become a document that can no longer be trusted for the information included, due to the fact of the editorial oversight occurring from the political appointed leaders at CDC and HHS. So, what we intend to do, working closely with NEJM Evidence and the editor, Chana Sacks, along with our team of Jim Wappes from CIDRAP and two former CDC editors of MMRW, Doctor Sonja Rasmussen and Doctor Rick Goodman, who will be working with CIDRAP to actually collaboratively come together and publish articles simultaneously on both the NEJM Evidence site and the CIDRAP site. Both sites will be open to the public with no paywalls, and we will attempt to do what MMWR has very successfully done for so many decades. We will provide you current, comprehensive and authoritative information coming from the field. And so, this new effort will be known as Public Health Alerts. It is not a new journal. Please don't think that that's the case, but it will be an area on our website where you can check in literally daily to see potentially new and updated information about breaking public health issues. Or in some cases, we'll be publishing data on outbreaks that did occur and what we learned from those outbreaks. So, all I can say is we are very, very honored to be working closely with the editorial team at the New England Journal of Medicine and with CIDRAP. Two outstanding editorial groups who will allow us to be able to share in a timely way the kind of critical information that we need to conduct the business of public health in this country.

Chris Dall: Mike, last week, CIDRAP Vaccine Integrity Project released a video in which you essentially deconstructed a recent video from the Department of Health and Human Services that challenged the role that vaccines have played in reducing illness and death from infectious diseases. You say in that video, quote, to be in the best possible position to evaluate the accuracy of vaccine information coming from the federal government right now, it's worth spending a couple of minutes looking at the how of this video rather than the what. So, Mike, why is focusing on the how so important?

Dr. Osterholm: Well, for many listeners who have not yet seen the video with my response, which is available on the CIDRAP website and YouTube and is also linked in the show notes. Let me just provide a little background. This all really started when Secretary Kennedy put out a video on his own social media, claiming that advances in sanitation and nutrition were essentially what led to the major reductions in deaths from infectious diseases throughout the 20th century, and that vaccines played a very small role. Now, there's absolutely no question that improvements made in the areas of sanitation nutrition have been incredibly important. As someone who has worked in the field of public health for 50 years, I can tell you that all of my colleagues and I recognize and appreciate the impact these measures have had. In fact, public health is actually what drove these achievements. So, if anyone should want to accelerate this, it's us. But to suggest that vaccines were just a minor factor in all of this is simply not true and highly misleading. So that was the main content of his message, and it certainly needed to be addressed, just like the other myths and disinformation that's being put out there. But if we ever really want a chance at pushing back on the flood of incorrect information that's being developed, we also need to address how the message was shaped and delivered, because at face value, these kinds of claims can sound convincing. They include data and figures, and to many it feels credible. But what's really happening is the information is being crafted in a very deliberate way to push a specific narrative. In some cases, the source of the information may actually be legitimate, but data points providing key context are conveniently left out.

Dr. Osterholm: It's kind of like taking a picture, but adjusting the lighting until the shadows tell a different story. The picture itself isn't fake, but what you see isn't really quite real either. And these types of approaches are part of a familiar playbook we've seen before, where selected pieces of information are used to undermine confidence and trust in public health and science. So that's why in the video I wanted to focus on the how. By pointing out these tactics, the goal wasn't necessarily to respond to one misleading video, although that's important, but more so to help people recognize and understand the pattern. So, if you're at all interested in watching the video, I encourage you to do so either on the CIDRAP website or YouTube. But before I close, let me share some examples with you right now of the vaccines that have played a huge role in reducing the risk of serious illness, hospitalizations, and deaths since the times that we've made major gains in health with increased sanitation. Let me start out with one of the first vaccines that was introduced in the 1940s and its impact. Yes, I'm speaking about pertussis. A reduction of about 9000 deaths per year occurred as a result of population-based vaccination. The same can be said of polio. There were 58,000 cases in 1952, the highest total in our history, with 21,000 cases of paralytic polio. It was a fear that every mother and father lived with every day. The Kennedy video also excludes victories delivered by vaccines outside the timeline. Let's look at smallpox.

Dr. Osterholm: It was the leading cause of death in the US in the 1700s and 1800s, killing up to 150,000 people during epidemics. Worldwide, more than 300 million people died from smallpox in the 20th century. Global vaccination and surveillance programs led to its eradication by 1980. If you want to pick a more recent example, one that I actually did a great deal of work on, that's Haemophilus influenzae type b, a bacterial infection. It used to kill up to a thousand children annually, most of them very young, not to mention causing meningitis, pneumonia, and hearing loss. A vaccine was introduced in the late 1980s, and the disease is now mostly a thing of the past. The same is true for pediatric cases of hepatitis B, a dose of vaccine given at birth was introduced in 1991. Prior to that time, upwards of 30,000 US children under ten were infected. Hepatitis transmitted from mother to infant has now been virtually eliminated in the US. In total, there were about 117 million children born in the United States between 1994 and 2023. According to a recent study, routine childhood immunizations averted more than an estimated 1.1 million premature deaths from vaccine preventable illnesses. There is no acceptable number of children dying every year from vaccine preventable diseases. That's why public health advocates are passionate about maintaining vaccine access. We have a tool to save lives and prevent children and parents from having to endure immense suffering. This is why we honor both the era of sanitation. But we also understand the importance of vaccines today in a way that the disinformation shared by the Secretary does a great disservice.

Chris Dall: Let's turn now to measles, which is among the diseases that vaccines have been so effective in preventing. As of last week’s update, from the CDC, there were 1618 confirmed US measles cases this year. But that number is sure to go up with the growing outbreak in Arizona and Utah, which is now the second largest country after the West Texas outbreak that we saw earlier in the year. Mike, do we know what's fueling this outbreak?

Dr. Osterholm: As you know, Chris, this year has been the worst for measles activity since the highly infectious disease was officially eliminated in the United States in 2000. And it could have been averted with an increased uptake of two doses of the highly effective measles, mumps and rubella, or MMR vaccine. In fact, both the US and Canada are now on pace to lose their measles elimination status, which is defined by the lack of local viral spread for at least one year. The undoing of 25 years of progress against the potentially deadly disease is especially shocking in the context of wealthy countries with traditionally strong public health systems untouched by ongoing armed conflicts or civil war. If the US loses its measles elimination status, the government will have to submit a corrective plan of action, highlighting those actions that will allow it to boost MMR vaccine uptake to the Pan American Health Organization. To recap, last week, an outbreak in communities in northwestern Arizona and neighboring southwestern Utah top 20 cases. These communities have historically had low vaccination rates. For example, in the Southwest district of Utah last year, nearly 1 in 5 kindergartners had no documentation of measles, mumps and rubella or MMR vaccination, and in the past few week’s cases have been identified across the Arizona Utah border.

Dr. Osterholm: The southwest outbreak is this year's second largest, behind the one in West Texas, which began in January and reached 762 cases by the time it was declared over on August 18th. In that outbreak, more than two thirds of infections occurred in children. 99 people were hospitalized and two school aged children died. Although it has been declared over, there will likely be more cases showing up in Texas this year because of the other ongoing outbreaks in the US, Mexico, Canada and elsewhere. Earlier this year, Minnesota added another measles case in an unvaccinated child who had traveled internationally for a total of 21 cases. The preschooler was from Olmsted County in the southeastern part of the state, and may have exposed relatives and other patients and staff at the Mayo Clinic in Rochester while seeking treatment. Last year, Minnesota log 70 cases, up from 0 in 2023. And last week, another outbreak, this one in South Carolina, infected 22 people in Spartanburg County in the northwest part of the state, linked to two schools with low student MMR vaccination rates. The outbreaks led to a week’s long quarantine for more than 100 unvaccinated children. The outbreaks in Canada, which began last fall, have sickened more than 5000 people, double the country's tally for the previous 25 years combined.

Dr. Osterholm: Roughly 90% of those infected were unvaccinated. The country had achieved measles elimination status in 1999. Uptake of the MMR vaccine has been declining for years in Canada. In the US. In the US, MMR coverage has been below the federal target of 95% for more than five years, and 92% of those infected in this year's outbreaks were unvaccinated. The MMR vaccine is 97% effective against infection. We only have to look at the years leading up to US measles elimination to see the success of the vaccine after a second dose was recommended in 1989, and a large outbreak the following year led to renewed push for vaccination in 1990. Nearly 28,000 measles cases were reported, a figure that fell to 9619 in 1991 and down to 2200 by 1992. We can't undo this year's infections, hospitalizations or deaths, but we can prevent them in the future. Please get your children vaccinated or grandparents, please help your grandchildren get vaccinated against measles, mumps and rubella. And if you're unvaccinated or unsure if you are immunized, please discuss your options with your healthcare provider. Our nation's health depends on it.

Chris Dall: There was an article last week in the New York Times that was titled simply bird flu is back. Now, this isn't entirely surprising, given that the virus tends to flare up in the fall as birds start migrating south, and we've discussed this in recent episodes of the podcast. So, Mike, does this latest uptick in wild birds and commercial poultry that we're seeing. Does it raise any alarm bells for you, or is this just kind of just the natural progression of things?

Dr. Osterholm: Well, Chris, as I have said on this podcast since its inception, I think I know less about H5N1 today than I did 25 years ago. You may recall that it was a little over a year ago when we first saw the outbreak of H5N1 in dairy cattle throughout the country. And at that time, many were predicting that it would be just a matter of time before that virus would cause the next influenza pandemic. Having tracked H5N1, as I have over the years and have done that literally since 1997, I'm not sure what this virus is going to do or what it can do. I do know that it surely is a challenge in avian species that can spill over into domestic poultry. And I know that it surely can have some impact on other species of animals beyond that of just avian, but will in fact it ever become the next influenza pandemic for humans, I think, is still way up in the air. I say that knowing that there will be another flu pandemic. And as I've said multiple times, the pandemic clock is ticking. We just don't know what time it is, and we don't know what the next agent will be. Could be another coronavirus, could be influenza and not H5N1.

Dr. Osterholm: But to get back to the point of your question, I'm not sure bird flu can really be back when I'm never really sure that it left. It's always been circulating in wild bird populations and making it possible for other animals to get infected. To me, the alarm bells ring louder in the wider context of the outbreak rather than just the increasing number of cases. One major issue is the lack of federal oversight and coordination for the H5N1 response, largely due to decreased funds and the recent government shutdown. With key scientists and public health researchers furloughed, critical work on monitoring H5N1 has stalled. The absence of leadership at the national level has left a huge vacuum in communication and strategy. So, should H5N1 actually have finally obtained that horrible status of a spillover virus into humans that then causes the next pandemic? I'm not sure how soon will be there to pick it up. In addition, we have to understand that we have many exposed farm workers who are essential to early detection and containment efforts and are now hesitant to report symptoms or outbreaks. They fear deportation, especially because of increasingly aggressive immigration enforcement, undermines public health efforts to reach these critical populations. All of this contributes to a fragmented response.

Dr. Osterholm: Without clear up to date guidance from federal agencies, individual states are left to navigate the crisis pretty much on their own. The patchwork approach makes it difficult to get a comprehensive picture of what's happening. Even more difficult to mount an effective outbreak response. The one thing that still brings outbreaks to detection, at least in the domestic poultry side, is the USDA indemnification program, where if in fact you have flocks with H5N1 by basically putting down the rest of that flock, euthanizing them so that the virus will not continue to spread, you get reimbursed for that bird. And so, I think that we're not seeing large outbreaks go unnoticed or for which there is no response, because in fact, from a financial standpoint, it does serve the individual farm owner well to document the outbreak and to get reimbursed for those dead birds. Beyond poultry and wild birds being affected by viruses. Reports from three states Idaho, Nebraska and Texas have now identified positive detections among dairy cattle since September 1st. I'm very interested to see how reports of H5N1 in cattle look again if we'll ever see the massive amount of detections we once did in California and Colorado, or if things remain quiet, either due to inadequate testing immunity or effective preventive strategies.

Chris Dall: Let's take a look now at the latest COVID-19 flu and respiratory syncytial virus data. Again, because we are in the midst of a government shutdown that appears to have no end in sight, we're relying on alternative sources of information, and we'll talk more about that in a moment. Mike, what are those sources telling us right now?

Dr. Osterholm: That's right. Chris, we'll touch on the issue of surveillance during the shutdown shortly, but I just want to add a disclaimer before we dive in here that there is quite a bit of uncertainty with these numbers right now. I know we mentioned this group by name last episode, but I wanted to be sure to give credit to Caitlin Rivers and her team at Force of Infection for the detailed work they're doing providing respiratory illness updates during the government shutdown. Their team is visiting each state public health website to compile and present data available on a weekly basis. This is a tedious task, and I want to be sure they know how much we appreciate it. So again, thank you to Caitlin Rivers and everyone who works on these Force of Infection updates for stepping up and filling this critical surveillance gap for now, four straight weeks. Interestingly, we're having a very slow start to the typical respiratory season. We've yet to see much widespread flu or RSV activity, and COVID-19 activity continues to decline. Looking at the only overall national level data we do have from wastewater scan, COVID-19 concentrations continue to decrease across every region, and both RSV and flu Concentrations seem to be increasing in the south, but relatively steady across other regions. Now, looking at state level data from force of infection, again, the overwhelming message is that respiratory illness activity is low and either flat or only slightly increasing, with levels remaining below what would be expected at this point in the respiratory virus season.

Dr. Osterholm: When I say that activity is increasing, it could be in reference to emergency department visits outpatient visits for influenza like illness. Wastewater activity, test positivity or hospitalizations, depending on the metrics reported by each state. I know this isn't ideal, but we're doing the best we can for the information we have. Only three states and New York City are seeing slight increases in flu and RSV. Hawaii, Louisiana and South Carolina. Seven states are seeing slight increases in just RSV activity. These states are Connecticut, Florida, Minnesota, Oregon, Rhode Island, Texas, and Virginia. Six states Alabama, Mississippi, Nebraska, New Jersey, Ohio, and West Virginia have seen slight increases in flu activity while surveillance data is sparse. The take home message here is that respiratory illness activity is low across the board. I won't be surprised if flu and RSV activity take off at any point, but for now, we can just be thankful that especially during this time of so much uncertainty, we have a slight break from the respiratory viruses. We'll continue to keep you updated to the best of our abilities. And in the meantime, now would be a great time to go and get your vaccines if you have not already done so.

Dr. Osterholm: I do want to add just one other perspective here, and that's what's happening internationally. I mentioned this to you in the last podcast that there's some concern about what's happening in other countries around the world. In the last podcast, I noted the increasing occurrence of influenza in Australia. You are now seeing a record year in terms of influenza cases coupled with low vaccine uptake. As of last week, there are cumulative cases for the season were nearly 20% higher compared to the same time last year. Looking just at October, they've had more than triple the number of cases in October of 2025 compared to October of 2024. I'll note that their season did not get off to a slow start and then take off. These record numbers started on time right at the beginning of when the season would be expected. Looking at Asia, Japan's flu season started earlier and more severe than usual about five weeks earlier. This is the case in several other Asian countries as well, including Singapore, India, Vietnam and Thailand. So, if we look at these countries as any potential predictor of what might happen here, it means we still have to be vigilant. And it's very possible we can still yet see severe flu season emerge out of what has been a very, very quiet fall.

Chris Dall: Now it's time for our ID query. These past few weeks, we've heard from a number of listeners who've been asking about the shutdown and its impact on surveillance for Covid and flu and other infectious diseases. The CDC hasn't updated its Covid or other respiratory viral illness pages since late September, and with all due credit to Caitlin Rivers and her team, who are doing great work, they can't replace the surveillance that the CDC has done. So, are we flying blind at this point, or are state health departments able to pick up some of the slack?

Dr. Osterholm: Well, Chris, it's safe to say that the government shutdown is causing a chaos in many aspects of our lives, and this is no exception. As we just discussed, the government shutdown has put us in a position where relying on computations of state level data to understand what is happening with Covid, flu, and RSV this year. And while I certainly never want to discount the incredible work that Caitlin Rivers and her team are doing, it's essential to note that this does not fully replace what we are getting with national surveillance data. As I mentioned earlier, each state reports different types of metrics, for example, hospitalizations, emergency department visits, ICU admissions, etc. so without access to the federal data, it's much more challenging to make comparisons about what is happening in different states. National data also provides a more clearer variant picture, which can sometimes give us insight on how severe we might expect a respiratory virus season to be, and give us an understanding about whether the flu vaccine is a good match in a particular year. The bottom line is that while the efforts of the team at Force of Infection are incredible, there is simply no replacement for these federal surveillance systems. We rely on this surveillance data to help hospitals and clinics know what to expect each winter season, to make recommendations on the timing of vaccination, and to help guide the public and other disease preventing measures they can take in their lives. This is just one of the many critical government services have been put on pause during the shutdown. And another reason why it's essential that the government reopen soon. Finally, I want to clarify one potential piece of confusion. If surveillance is shut down, then how do we continue to provide measles updates? Actually, due to the state of measles outbreaks in the US, measles surveillance reporting has been deemed essential and are therefore continuing during this shutdown. While it was helpful to have the data available is also a bleak reminder of where we are at public health a significant risk of losing our measles elimination status in the coming months.

Chris Dall: Like I mentioned earlier, you were at ID week last week, and that's the country's largest gathering of infectious disease professionals. It's held every year in October, and this year's location, Atlanta, home to CDC headquarters, seems to hold some symbolism, and it's also the first ID week meeting that's been held since the Trump administration returned. So, I'm wondering if you can talk a little bit about what the mood was like this year compared with past years?

Dr. Osterholm: Chris, it was a meeting that in many ways represented the best of times and the worst of times. I say the best of times in that, bringing the public health community together, the infectious disease experts, we all were there to help support each other, and that type of support cannot be overstated. And so, from that perspective even though many of our CDC colleagues could not attend the meeting if they were still at CDC or if they had been Rift, basically they could attend paying their own way into the meeting. But it's very clear to me how much we need each other at this time and what it is that we can do to support each other. As you know, Chris, I was part of the opening night plenary session for all the individuals who attended the meeting and as I have done on this podcast and have made every effort to do throughout my day to day work, I've tried to give a sense of what we can do to deal with the issues that we've been confronted with, and that, in fact, is not all lost. We can't just sit on our hands and fret. We can do things. And I shared that concept in front of the entire audience in that opening night plenary session. My whole point was, in fact, the VIP is an example of where we saw a challenge and we worked to deal with it.

Dr. Osterholm: And as we also that night had the opportunity to lay out the work we're doing with the NEJM Evidence to create the public health alerts. There are a number of other areas right now that we're working on that really give people the sense that there are things we can do. Will it all be solved overnight? No. We're in this for at least three plus more years and maybe longer after that. But we can't sit back and just assume that there's nothing we can do. And so, one of the most important things I hope I can bring to the table on this issue is hope and optimism. Hope is not a strategy, but it's a really important oil that basically allows the hinges of your professional world to work. And I believe that with all my heart and soul. And I gave people a sense of how they can think about their future. As I have shared with you on this podcast before, on my desk next to my computer, here sits an electronic picture frame that every 30s a new shot comes up with one or more of my grandchildren. I watch that sometimes by the hour, and it just reminds me every one of those shots. Why I do what I do, my efforts and those that I help helped support at CIDRAP are all about what are we doing for our kids and grandkids? It's my love story to them in a sense.

Dr. Osterholm: And finally, I also think we need to have that sense of defiance that we will do everything we can to respond in a professionally competent way to what's happening. And I shared with the audience that night a card that I have on my desk that every morning, one of the first things I do is I read it to myself to remind me of what I do, why I do it. And that card says, the devil whispered in my ear, you're not strong enough to withstand the storm. Today I whisper to the devil’s ear, I am the storm. And I think that's really important that we take that position and that we are out there and effectively are responding to the challenges that we have. We leave no room for doubt about why we do what we do and how we do it, knowing that it will be challenged. So, I hope that my message at ID week surely gave people some positive sense of what we can do in an otherwise very dark world, and the fact that we all must hang together as we move forward in this journey of unfortunate challenges to public health.

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

Dr. Osterholm: This week we are featuring a foundational public health program that continues to support the health of every community in this country. The program's roots began in the early 1900s, amidst the turmoil of two world wars and a Great Depression. The United States faced a paradox a surplus of agricultural products, and a population with many unemployed that cannot afford to purchase them. To meet the needs of both farmers and hungry families, Secretary of Agriculture Henry Wallace and the program administrator Milo Perkins developed a program to purchase and store excess food commodities and provide stamps to families to trade in for both the surplus goods and the items from their regular grocery stores. For four years, what was known as the Food Stamp Program helped to bridge the gap from farmers to families serving approximately 20 million people. After its initial success, the program was Sunsetted. However, it was revived as a pilot program by John F Kennedy in 1961 to great success. In 1964, based on increased pressure to address poverty and hunger across America and stabilize safety net programs, Lyndon Baines Johnson signed the Food Stamp Act. The program was transformed over time to be digitized, rather than using paper stamps through the Electronic Benefit Transfer or EBT cards.

Dr. Osterholm: In 2008, with physical stamps far in the rear-view mirror, the name of the program was changed to the Supplemental Nutrition Assistance Program, or SNAP, and remains a cornerstone of nutrition for close to 42 million Americans every year. Approximately 40% of them are children. Economic analyzes show that every $1 of SNAP funding results in $1.50 of economic activity, supporting local farmers, grocery stores, and other businesses. Additionally, state level data links SNAP benefits to lower risk of deaths of despair like suicide and overdose. Children whose family receives SNAP have a considerable measurable benefit from improved health outcomes to school test scores. This is a critical program for the health and well-being of millions of Americans right now. Due to the government shutdown, SNAP funds are at risk. State and local governments have begun to issue notices that November Snap funds may not be distributed if the shutdown continues. Local food banks and nonprofits are already making preparations to try to fill as much of this gap as possible. Now is as important a time as ever to be kind. I hope everyone who listens can find ways that they can look after their friends, neighbors, and communities when things are so uncertain.

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

Dr. Osterholm: Well Chris, again, there could be any number of them. But let me give you what I think my top three are. The first one is our New England Journal of Medicine publication that came out yesterday shows that we can make a difference. We can have an impact on the public policies of this country, with hard work and a belief in ourselves and a belief in public health. I hope all of you will take an opportunity to go look at the manuscript, to get an understanding of what was done by a remarkable group of individuals who worked 28 hours a day, in some instances, to make this work. The second point is, I'm happy to report that the viral respiratory pathogens that we have vaccines for Covid, RSV and flu all seem to be on the wane here in the United States. We'll keep you posted on that. But for now, at least, we have been spared an early flu season. And finally, we are surely about to experience some very real hardships with regard to food availability. As I just noted in going through the history of the Snap program. We have real challenges here. And who are we as a country if we can't feed our hungry? What does that say about us? Who are we? What are we if we can't vaccinate our kids against the infectious diseases that so many parts of the world would do anything to avoid? Who are we? So, I think this is a wakeup call again about society. It's not about politics. It's not about partisanship. It's about who are we as kind people? And I think this rings loud and true through the events of the current time.

Chris Dall: And what is your closing for today?

Speaker3: Well, Chris, I actually.

Dr. Osterholm: Well Chris, I actually went back to an oldie but goodie. I felt like it really fit the time in the moment. This is something I have used three times before. First of all, in the live episode of August 13th, 2020. Wow. A long time ago. Second time in episode 50. Sitting in limbo on April 8th, 2021. And then I used it again in episode 180 An April Fool's Tragedy, on April 3rd of 2025. Not that long ago, but I thought that it really fit the moment. What I have is a quote from Edward Everett Hale. Some of you may remember if you've listened to previous podcast. Edward Everett Hale was born in April 3rd, 1822 and died on June 10th, 1909. He was an American author, historian, and Unitarian minister. He was famous for writing the piece The Man Without a Country, published The Atlantic Monthly, and he once said, I am only one, but I am one. I cannot do everything, but I can do something. And because I cannot do everything, I will not refuse to do the something that I can do. Edward Everett Hale. If there was ever a time for us to think like that, it's now. I challenge in a most friendly, collaborative way, all of you in the next weeks ahead. Every day, try to do one nice thing for someone that otherwise you might not have expected.

Dr. Osterholm: Go work and volunteer at a food shelf. Donate food if you have the ability to do so. Check on neighbors that in fact may very well not have access to food. Do something that's positive, that takes you out of your comfort zone, but makes it a very different experience for someone else. Also, do things like get involved with public policy. What's happening in your school boards right now with vaccine related policies? What's happening in your local communities? Get involved. Have discussions. Talk to your friends in ways that you might not have ever done before about what can we do together to make this a better place? Go visit a long-term care facility and don't visit the person that has family coming and seeing them every day. They're lucky. Find the person that doesn't have any guests at all for a month at a time. Go say hi. Ask them how they're doing. Don't refuse to do something that you can do. And if there was ever a way, I think, to make the world a better place, it's if we all start thinking in that regard. Remember, you are the storm. Don't ever forget that. Thank you. Be safe. Be kind. Looking forward to talking to you in a couple of weeks. Thank you.

Chris Dall: Thanks for listening to the latest episode of the Osterholm Update. If you enjoyed 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, Meredith Arpey, Leah Moat, Emily Smith, Clare Stoddart, Angela Ulrich, and Mary Van Beusekom.