Episode 200: A Moment Among Moments

Chris: Hello and welcome to the Osterholm Update, a podcast about infectious diseases and public health featuring 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 over 50 years of experience in infectious disease epidemiology to provide straight talk on the latest infectious disease outbreaks, counter misinformation and disinformation about vaccines, and distill the complex and ever-evolving public health threats facing our world. 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. Looking back over the past two months of my podcast scripts, I realized just how heavily we've focused on the efforts by Health and Human Services Secretary Robert F Kennedy Jr to undermine the US vaccine infrastructure. And I would truly like to be able to focus on something different, like the current flu season. But because the federal assault on US immunization policy continues, that's where the focus needs to remain. By now, you've probably heard that on January 5th, acting Centers for Disease Control and Prevention Director Jim O'Neill signed a memorandum that reduced the number of CDC-recommended childhood immunizations from 17 to 11 to align the country more closely with Denmark, which recommends ten vaccines for children.

Chris: It was a move that, while not entirely unexpected, was still shocking, both in the way it was announced and the lack of any underlying scientific data to justify such a decision. And experts fear that it will likely create confusion for many parents making these changes amid ongoing outbreaks of vaccine-preventable diseases shows a disregard for the real confusion famILIes already face. The president of the Infectious Diseases Society of America said in a statement. The changes to the US childhood immunization schedule and all of the implications of those changes will be the focus of this January 15th, 2026, episode of the Osterholm Update. We'll also discuss some recent comments by Secretary Kennedy on kids and flu vaccines. Bring you the latest on this winter's severe flu season. Answer an ID query on respiratory syncytial virus vaccine guidance and share an update from the Vaccine Integrity Project. And because this is our 200th episode, two Osterholm Update, producers are going to join us to share some noteworthy data on the podcast. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.

Dr. Osterholm: Thanks, Chris, and welcome back to the podcast family again. It's a real honor to be able to be with you today. We appreciate you very much. And for those of you who may be listening for the first time, I hope we're able to provide you with the kind of information you're looking for today. I will acknowledge up front that this is going to be a challenging podcast for me, at least based on the topics we're going to cover. And some of the scientific and personal emotion overlaps that you will soon experience. Before we begin today's episode, though, I want to take a few minutes to acknowledge the situation here in Minnesota, where CIDRAP is based and where I, and the rest of the podcast team, all live and work. This is where ten of my family members live, including five of my grandchildren. Minneapolis has had its fair share of news coverage lately, with all the eyes on the large ICE presence that has moved into our city. There are daily stories emerging on what this has looked like for our community. They often take on an international news coverage. On January 7th here in Minneapolis, one ICE operation ended in the lethal violence resulting in the death of a community member, Renee Nicole. Good. We've certainly all heard the conflicting accounts of the events from the authorities. What is not in dispute is that the event has caused real harm. People are grieving. People are angry. People are scared. And many people, especially immigrants and people of color, are feeling highly vulnerable and unsafe. We've always said that here at CIDRAP and on the podcast, our role is to call balls and strikes about what we know something about.

Dr. Osterholm: We've done that for the past 200 episodes, and we take that role and the boundaries of that role very seriously. Usually, we're calling balls and strikes on issues of health policy, research methods, or public health program interpretation. We do this with our education and experience in public health using statistics, research, and data. But this moment requires us to lean in to call balls and strikes with our heart. And this is where our hearts are right now. This is a public health podcast, and it's reasonable to ask, why are you talking about this here? The answer is rooted in the values that define public health. Public health is grounded in health equity. Safety, dignity, and freedom from violence should not depend on race, immigration status, or neighborhood. Public health is grounded in social justice and collective responsibility. Violence does not affect only one person or one family. It ripples through the communities shaping mental health, stress, trust in institutions, and willingness to seek care or engage with systems meant to protect public health. Public health depends on honesty, transparency and evidence based practice. Whether we are responding to an outbreak or a death caused during a government operation, accountability and truthful communication are foundational to community well-being. I believe we have lost our way in finding the critical perspective needed to get to a path forward, a path that brings us through this horrible crisis that we are experiencing throughout this country and specifically right here in Minnesota. Can we acknowledge that we all want safe communities free from crime and violence? Can we also acknowledge that there are many undocumented immigrants living here and who have been living here for decades? These include many people who have been willing to do the jobs most of us would never do, particularly at or below minimum wage.

Dr. Osterholm: They have raised families that contribute every day to the well-being of our communities. And can we also acknowledge that immigrants, regardless of their legal status, contribute to the fabric of such communities, contributing financially, culturally, and socially? Arresting teachers, retail staff, cooks, students, small business owners, construction workers, daycare staff, and healthcare workers--especially when such arrests break apart families who have lived together in this country for decades--doesn't get us closer to those safer communities we all dream of. As an epidemiologist who has spent his entire 51 year your career, trying to understand the difference between what kills us versus what hurts us, versus what makes our lives safer, I can't help but apply the same type of logic to this situation. I encourage us to think critically about what is actually making our communities less safe, and how can we show up as community members to build the world we want to see? We are not here to debate politics or assume we're legal experts. We are not. We are here to say that having compassion for the family of Renee Good and the thousands of Minnesotans who currently feel unsafe leaving their homes to go to school, work, the grocery store or the hospital is core to who we are and all we care about as practitioners and advocates of public health. Public health is scientific and moral work. Rather than dedicating this episode to a person or a group. I want to ask something of you, the listeners. I ask that in the coming days and weeks, you think about how to dedicate your time, resources, or skills to showing up in your own community, wherever you are in this country or, for that matter, in the world. What local action can you take to make your neighborhood, your workplace, or your town a more peaceful, welcoming, and supportive community? Support organizations doing positive local work. Speak up for dignity, transparency, and safety. If public health stands for anything, it stands for showing up when it's uncomfortable and necessary. We hope you'll join us in that mission. 

Dr. Osterholm: Well, that was tough. That was real tough. But let me make the transition now to that moment in the podcast that brings a great smile to my face and to my heart and to some of you today in Minneapolis. Sunrise is at 4:57, sunset at 7:57. That's nine hours, ten minutes and 23 seconds of sunlight. We're actually gaining today one minute and 47 seconds of sunlight by the end of January, just a few days away, will be at nine hours and 46 minutes of sunlight. Growing rapidly. Now to our dear colleagues in Auckland at the accidental Belgian Beer House on Vulcan Lane. Today your sun rises at 617 a.m., your sun set at 8:42 p.m. that's 14 hours, 24 minutes and 28 seconds. But you are, in fact, losing sunlight at about one minute and 19 seconds per day. It won't be long until we'll be catching up to you with our sunlight.

Chris: Mike, we're going to start with the changes to the US childhood immunization schedule. Can you walk our audience through the vaccines that are no longer routinely recommended by the CDC, and what the implications of removing these recommendations could be?

Dr. Osterholm: Well, Chris, again, this could take hours to peel back the vaccine onion here. But let me try to summarize what has happened in just a few short weeks. The new US childhood vaccination policy announced early last week without going through the usual scientific and review channels, recommends all children receive vaccines against 11 infectious diseases. This is down from 17. Those diseases include measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type b, pneumococcal disease, human papillomavirus or HPV, and varicella or the chickenpox virus. Vaccines against six other diseases are now advised for only high-risk children, including RSV, hepatitis A, hepatitis B, dengue, and two vaccines targeting bacterial meningitis. Dengue vaccines have always been reserved for relatively small number of children in specific circumstances, and some vaccines are now recommended for what we call shared clinical decision making, including those against rotavirus, COVID-19, influenza, meningococcal disease, and hepatitis A and B, and let me just spend one moment on what this shared clinical decision making is all about. This means that a parent should talk to their healthcare provider to see if, in fact, they should get the vaccine. Now, the challenge with this is many people don't have a healthcare provider. Over a third of kids in this country do not have a physician. So, to actually solicit that kind of information and have a discussion with a healthcare provider is a challenge. That right there is a barrier. Another barrier we're adding to the overall vaccine program. Then on top of that, to now downgrade these vaccines to a status of shared clinical decision making makes it sound as if somehow this vaccine really isn't all that important.

Dr. Osterholm: Shared clinical decision making literally is all about confusion. Now, don't get me wrong, I believe that parents should have informed consent. They should know about what vaccines that they're needing to get and what the issues are around the protection from that vaccine and other any risks. But now, to go to what we call shared clinical decision making makes it sound like, well, they're no longer recommended, but talk to your physician or healthcare provider about it. And this is going to be one more reason why parents will say, well, if it's no longer routinely recommended, why should I get it? In another important change announced last month, the CDC now recommends only one dose of HPV vaccine rather than 2 or 3 doses. It also dropped the recommendation for the newborn dosing of hepatitis B in December. I am absolutely certain that we will see a major increase of hepatitis B in newborn children who are born to mothers who are infected with hepatitis B, and for which only getting the vaccine in the first hours after delivery is able to stop the infection from taking hold following the delivery of the child and the exposure to blood and body fluids during delivery. This will ultimately turn out to mean thousands of children in this country will eventually die from cirrhosis of the liver or from hepatocellular carcinoma, because we did not administer that dose of vaccine immediately.

Dr. Osterholm: Vaccinating a child a month later, when in fact they were exposed to the virus at birth, does very little to protect them from hepatitis B infection. So this recommendation, I think, is simply dangerous. Public health experts, including me, immediately pounced on these radical and what I believe is even dangerous changes, saying there is no reason to change a system that works. As I have said, eliminating the US childhood vaccine recommendations without public discussion or transparent scientific review of the data is simply a wildly irresponsible decision. Even if only some Americans follow the revised vaccine schedule, it will lead to more cases of life-threatening infectious diseases, hospitalizations, and deaths, particularly amid the already declining rate of vaccination in this country. So while Secretary Kennedy has the ultimate discretion to issue vaccine recommendations, legal experts have also commented that Kennedy and the Trump administration may be on shaky ground by holding a news conference with selected news outlets to announce the new policy, rather than following the usual transparent channel of the Advisory Committee on Immunization Practices, or ACIP. For example, in July, the American Academy of Pediatrics filed a lawsuit against Kennedy, claiming that he violated the law when he directed the removal of COVID-19 vaccine from the CDC immunization schedule for children and pregnant women, both groups that are at increased risk for serious illness, hospitalizations and deaths, and for both groups, which we have ample data to show that COVID vaccine substantially reduces the risk of serious outcomes among these two groups. In addition, a growing number of medical organizations such as the AAP and at least 17 states have publicly opposed the changes and said they won't adopt the current childhood vaccine recommendations from the ACIP.

Dr. Osterholm: Many pediatricians and family doctors also say they will continue to follow AAP's guidance, rather than that of the CDC. And late last week, the AAP and more than 200 health groups sent a letter to Congress urging lawmakers to conduct swift and robust oversight regarding the abrupt changes to the US childhood vaccine schedule. This would include investigating why the schedule was changed, why credible scientific evidence was disregarded, and why the committee charged with advising Kennedy and immunizations didn't discuss the proposed changes as part of the public meeting process. The administration has said that all childhood vaccines, regardless of category, remain covered by insurance, although it's not clear whether this remains true in the future. I believe it won't. If coverage is dropped for certain vaccines, there may be less incentive for vaccine makers to keep them on the market, endangering their access. One of the saddest things for me right now is that all of these changes have only sowing more confusion and anxiety among parents who just want to make the best decisions for their kids. The most important thing to know is that all of these vaccines are still recommended by public health experts, and are available to parents who want them for their children. Just talk with a healthcare provider. The life of your child could be saved by taking that very action.

Chris: We've discussed this on the podcast before, but one of Secretary Kennedy's arguments is that the US was an outlier in terms of its childhood immunization schedule, but that's not really the case, is it?

Dr. Osterholm: In fact, it's not the case at all. And this is where we run into this problem of statements made that appear to be factual. And there are nothing more than illusions at best. In fact, if you look at the number of vaccines that a child is administered in the United States, it was very similar to what we see throughout most of Europe, not Denmark or for that matter, throughout the rest of the world, including Asia. We have actually published stories on that in the CIDRAP news. We've laid out the countries, and so for anyone to suggest we need to back off and be like Denmark is simply just not true. Denmark, a country of little over 6 million people, have an incredibly healthy population due to single-payer health care. The fact that they actually offer a wide range of preventive services to their famILIes, that's not what we have here. If we had the Denmark health care system in the United States, I'd be willing to have a different discussion with you. But we don't. And therefore we have to just understand that this statement from Secretary Kennedy just has no basis whatsoever.

Chris: Before the announcement about the childhood vaccine schedule, there was another federal policy change regarding vaccines that might have gone unnoticed but caught the attention of CIDRAP news reporter Liz Szabo. On December 30th, the center for Medicare and Medicaid Services sent a letter to state health officials informing them that states will no longer be required to report to CMS how many children they vaccinate. Mike, what are some of the potential implications of this decision?

Dr. Osterholm: Well, Chris, I do think this is probably going to fly largely under the radar. These kinds of administrative decisions don't always make headlines, though it did here at CIDRAP. And I think our news reporter, Liz Szabo, for picking that up and running with it. But I can tell you that these kinds of decisions can have far reaching consequences that people should be aware of. It goes without saying that we need to know how many children are being vaccinated in this country. That information is essential for public health and schools to identify where there are pockets that are vulnerable to outbreaks, and where much more outreach, education and access are needed to make sure that children and communities are adequately protected. There are some states, Minnesota being one of them, that have incredibly robust infrastructure at the state and local level that track these rates and are able to respond to gaps accordingly. Now, that doesn't always translate to improved rates of vaccination, and I'll touch on that in a moment. But with the current federal administration, there have been massive cuts to the infrastructure and the abILIty to respond to very low vaccine rates. Now, imagine what is happening in states that already have bare bones systems of vaccination monitoring in response. The CMS data set on childhood vaccinations provides an important safety net for states that don't have the detailed tracking.

Dr. Osterholm: Approximately 40% of all children in this country are covered by Medicaid. So it gives a very meaningful snapshot of what is happening on the ground, even for the states that have stronger public health systems. It offers an important standardized data set. When reporting is voluntary from states, it's very difficult to track national trends over time with such a patchwork of different methods, timelines, and populations being sampled. I want to call out some truly outstanding recent reporting by The Washington Post that highlights just how powerful data on vaccination rates can be, and what we lose when that data isn't available. We'll link this article in the show notes. While it's free to read, you do need to create an account with an email and password to access it. The project brought together reporters, data analysts and a graphic designer who reached out to all 50 states for school and county level vaccination data on kindergartners and with a focus on the MMR vaccine. They were able to obtain county level data from 44 states and the school level data from 34 states, using some really striking visuals. The post shows that the share of US counties with heard level of vaccination rates for measles, meaning 95% or higher, has fallen from 50% to 28% since 2018. Let me repeat that the share of US counties with herd level vaccination rates 95% or higher has fallen from 50% to 28% since 2018.

Dr. Osterholm: The article highlighted Minnesota, a state with a relatively strong surveillance infrastructure. Yet some of the steepest declines in vaccination rates. Out of Minnesota's 87 counties, only four reported herd immunity protection for measles in kindergarten students. That's less than 5%. And even those counties with the higher level of protection Pennington, Traverse, Yellow Medicine, and Cottonwood represent a relatively small population base compared to the rest of the state. I really encourage listeners to take a look at this article to see the power of having information about local vaccination rates in the case of Minnesota. The data is invaluable, but also make clear that surveillance is only step one. Data alone doesn't raise vaccination rates, it just shows where the work urgently needs to happen. Rounding out the consequences of this decision from CMS, the announcement looks a lot like the previous ones we've seen from the current leadership. It was made unilaterally, lacking transparency, no real scientific justification, and designed to erode trust in public health, particularly in vaccines. It leaves us always asking when the next shoe will drop. These are the kinds of decisions that don't make much noise at first, but over time can quietly reshape how prepared or unprepared we are to manage the next outbreak.

Chris: We'll talk more about flu in a moment, but in an interview with CBS news last week, Secretary Kennedy said it might be better if fewer children received the flu vaccine, which is now one of the vaccines under the shared clinical decision making category. And he cited a study by the Cochrane Collaboration that he said found there's no evidence that the flu vaccine prevents serious illness, hospitalization or death in children. Mike, your response?

Dr. Osterholm: Well, Chris, this interview was very revealing and I want to give a lot of credit to the reporter, Nancy Cordes. In her initial questioning, she asked Secretary Kennedy about the abrupt changes to the vaccine schedule. He repeatedly dodges questions and insists that the federal government isn't taking vaccines away. They will still be covered by insurance, but Nancy presses further. She points out the obvious implication that these actions will clearly result in fewer children receiving vaccinations. This is when Kennedy actually admits he does think it would be a good thing if fewer children received flu vaccine. Now let's talk about the evidence he cites, and I'm using large quotation marks here. Kennedy mentions a Cochrane review that primarily assessed randomized controlled trials of influenza vaccine for a single season. To be clear, the review did in fact show a benefit of both the live and inactivated vaccines for reducing infections with flu in children. However, there was insufficient evidence to address the impact on hospitalization. But let me explain why this particular document only looked at what we call randomized controlled trials. This is where half the population gets a certain treatment and half gets a placebo. And when you have an illness like influenza, that's pretty common. You can actually do a randomized controlled trial. And it would mean maybe enrolling 10,000, 20,000 people or whatever. But it's doable. But if you're looking at influenza deaths, particularly in children, you know, in a year where you may have 200 deaths, you would have to enroll most of the country in a randomized controlled trial in order to follow those vaccinated, those not vaccinated over a period of time.

Dr. Osterholm: And it might very well be that in a year's time, even though there was a real benefit from the vaccine, you wouldn't pick it up just because of the small numbers. Well, that's where in fact, we have another type of vaccine effectiveness measure called a test negative design study, where basically we look at people coming into emergency rooms or urgent cares and are coming in for a respiratory like illness, like flu. They're tested. They're found positive or negative. Well, the reason that's important is because we then take in all of the positive people to look and see how many were vaccinated for flu. We look among those who were ill, but not with influenza, who are then therefore similar in many regards because they too were being seen for medical care. And how many of them were vaccinated? Those test negative design approach has become the major tool we use for most respiratory illnesses. Well, the fact that the Cochrane review didn't include that information, just the randomized controlled trials for which there are very few because, again, of the size. Mr. Kennedy didn't understand that. The good news is we absolutely have strong real world evidence that influenza vaccines protect children from severe outcomes. One of the studies demonstrating this benefit is from our own Vaccine Integrity Project's very own systematic review and meta analysis, published just a few months ago in the New England Journal of Medicine.

Dr. Osterholm: Our incredible team of clinicians and scientists found significant reductions in severe pediatric outcomes for influenza, reducing hospitalizations and ICU admissions between 40 and 70%. Let me repeat that we found significant reductions in severe pediatric outcomes for influenza, reducing hospitalizations and ICU admissions between 40 to 70%. But it's not just our CIDRAP team's work that shows the benefit. Multiple large real world studies using this test. Negative design consistently show the vaccines effectively protect children from severe outcomes with influenza. One CDC authored study looked at the 2018 2019 flu season and especially difficult year due to an antigenically drifted H3N2 strain, which may sound famILIar given this year's challenges. Even in that tough season, the vaccine was more than 40% effective against hospitalizations for children. So when Mr. Kennedy suggested fewer children, getting flu vaccines is a good thing, it is just patently false and frankly, dangerous language. Last year marked a record high in pediatric deaths from influenza, 285 deaths confirmed to date, and that number still may increase as final reporting is done. Based on current trends, this season may very well also have a highly increased number of fatal cases of influenza in children and adults. How can you justify not informing parents of the risk of severe influenza and the fact that these vaccines are safe and effective. To me, that is unconscionable. And yet that is what has happened.

Chris: One more item here on vaccines. CIDRAP's Vaccine Integrity Project last week announced its next effort. Mike, what can you tell us?

Dr. Osterholm: It's discussions like these that only underscore the importance of the Vaccine Integrity Project. The public needs independent, evidence based vaccine information and times when the waters are only getting murkier. That is why, as we announced last week, our next evidence review will focus on the HPV vaccine. It is clear to us that this vaccine would be a target of this administration, as Secretary Kennedy labeled the HPV vaccine as, and I quote, the most dangerous vaccine ever invented, unquote, and claimed that it actually increases cervical cancer occurrence. So I want to give you, our listeners, a little background on the vaccine and its successes that emphasizes the need for continued research and reinforcement, not undermining as Secretary Kennedy continues to do. HPV, or human papillomavirus, is a very common virus transmitted during skin to skin contact, often during sexual activity. There are more than 200 subtypes of the virus, and around 40 of those can infect the genital area, mouth, and throat, sometimes causing warts. Most infections, though clear on their own thanks to your own immune system. But two subtypes, in particular 16 and 18, are linked to the largest proportion of HPV related cancers. This discovery was made in 1983 and sparked decades of research and development. In 2006, the Merck Company received a license for their quadrivalent HPV vaccine, Gardasil four, which offers robust protection against HPV six, 11, 16 and 18, and they reduce cancer cases by around 70%.

Dr. Osterholm: The vaccine was initially just licensed in a Multi-dose series for girls ages 9 to 26, in the US, but expanded to cover boys of the same age range in 2009. Merck released Gardasil 9 in 2014, which, as the name suggests, provides protection against nine HPV subtypes. Expanding to cover viral subtypes less commonly associated with warts and cancer, but still linked. Since its introduction, infection with high risk HPV subtypes have decreased around 85% in teen girls and 80% in young adult women. These results, due to continued expansion of vaccine use and coverage with adequate doses, are a major win for domestic and global public health. Given the vaccine's proven impact and the troubling rhetoric from high-ranking officials, HPV was the clear choice for our next review. We're working to refine the scope, but one of the major questions that keeps coming up is why the vaccine schedule moved from recommending a multi-dose HPV vaccine series to a single dose. Up until last week in the US, patients ages 9 to 14 are recommended to receive two doses, and while three doses are typically recommended for those who start the series on or after their 15th birthday. Observational data may support that one dose provides sufficient coverage against HPV related cancers, but there are no randomized studies that actually look at vaccine efficacy since the single dose was considered below the standard of care.

Dr. Osterholm: It may be true that one dose is enough for effective and durable protection, but it also may not be true. However, I'm not confident the move from multi-dose to single-dose immunization was made based on any kind of careful consideration of the evidence in the context of the disease landscape. In the US, the HPV vaccine available in the US is not even approved for a single dose by the FDA. Ultimately, I think this is going to further undercut confidence in the vaccine and lead to more confusion by implying that if more than one dose is not safe for your child, then parents should opt out altogether. We'll share more details in the coming weeks about the scope of this work, but for now, know this we take this topic very seriously. We're also excited to announce the formation of our new Board of Advisors with VIP, a group of nationally recognized leaders in medicine, public health policy, communications, research, and government. This board will provide strategic guidance and scientific expertise to ensure that the rigor, transparency and the public interest remained at the heart of the Vaccine Integrity Project's work now and in the future.

Chris: All right, so now we're finally getting to the flu. Mike, what is the latest on US flu activity? And this is the year that appears to be shaping up to be a severe flu season. Who's getting hit hardest right now?

Dr. Osterholm: Well, Chris, I'm cautiously relieved to report that some flu metrics are starting to show signs that the activity may have peaked. But I put emphasis on cautiously, especially after last season's double peak that occurred the last full week of December. Outpatient visits for influenza-like illness, what we call ILI, was the highest percentage in at least 30 years, at 8.2%. That means for all the people that were seen in medical offices around the country, 8.2% on testing were positive for influenza. For reference, the only seasons that have come close to this was in fact the previous year. 2024 2025, when it peaked at 7.8%, and then in 2009 2010 at 7.7%. Well, these data that I report for you are actually the percentage of outpatient visits for influenza-like illness compared to all visits. Also, we look very carefully at what we call test positivity. Of those who are tested, how often are they found positive? And unfortunately, this year we set a record at 32.9% of all people tested actually were positive for the virus. This is the highest it's been in the last ten flu seasons. I'm a bit relieved to report that both of these metrics have improved as we cross into January. Test positivity has decreased from 32.9% now down to 24.7%, which is actually lower than reported during our last episode two weeks ago. I again want to emphasize that we're certainly not out of the woods. Activity is still very high, and some of these decreases could be due to changes in the health-seeking behavior over the holidays.

Dr. Osterholm: With that in mind, the week of New Year's holiday, 7.2% of outpatient visits were for ILI, which is still higher than our last episode, but down from 8.2% last week. Interestingly, when looking at the breakdown of outpatient IOI visits by age, the percentage of visits for ILI decreased for all age groups under 50. Over the past two weeks, but it increased somewhat in both the 50 to 64 and the 65 and older age group. I want to draw your attention to this because, as we've discussed in previous episodes, H3N2 seasons tend to result in more severe disease in older populations than kids. Based on the percent of outpatient visits for ILI, 25 states are now considered to have very high flu activity, down from 38 states during our last episode. 16 states in the District of Columbia are considered high, five are moderate, and three are now actually considered low. If we look at emergency department visits for flu, they also decreased over the past week with the overall ED discharge diagnosis of influenza being 6.3%, down from 8.5% a week ago, but still up from 5.5% during our last episode. Looking at the age specific breakdown, ED visits for flu decreased in every age group, except again for those over 65, which remained steady at about 5.3%. And regionally, ED visits are decreasing across the country. While the northeast has been seeing the highest percentage of ED visits for flu currently at 7.2%, down from almost 9%, and the West has the lowest currently at 4.9%, down from 6.2% a week ago.

Dr. Osterholm: Hospitalizations have also started to decline over the past week overall, in every age group except the 65 and older group, which continues to have the highest rate of hospital admissions for all groups. Hospitalizations in older adults have a rate nearly four times that of 0 to 4 year olds, which was the next highest age group. Unfortunately, there have been nine pediatric flu deaths since our last episode, bringing the season total to 17. More than 97% of US cases continue to be influenza A, with 92% of those influenza A viruses that were subtype B and H3N2. Of those who were H3N2 and underwent additional characterization, 92% were H3N2. Subclade K, that subclade that we've talked about in previous podcasts. Overall, these numbers are heading in the direction we want them, but we're nowhere near the end of the flu season. In fact, if last year taught us anything, we may not even be done with this initial wave. All that is to say, continue doing what you can to protect yourself and those around you. And please stay at home if you feel sick. And if you are sick, be certain to avail yourself to antiviral medications if possible. They can be very helpful in reducing your risk of serious illness.

Chris: And what are we seeing in terms of COVID and respiratory syncytial virus activity?

Dr. Osterholm: Well, Chris, it seems our break from COVID may be over and activity is beginning to increase across much of the country. The national wastewater concentration is considered high and increasing concentrations are increasing across every region. Concentrations are the highest right here in the Midwest, where they're considered very high, followed by the northeast, which is considered high, while the South is moderate. The West remains very low. Nine states are considered very high. 12 are high, ten are moderate and six are low, and 11 in the District of Columbia are very low. Hospitalizations are increasing slightly, and the ED visits have also continued to increase in nearly every region, with wastewater data being a leading indicator for COVID activity. I would not be surprised to see these numbers increase more in the coming weeks, especially in the Midwest and Northeast, which have already seen an uptick in ED visits for COVID-19. Test positivity for SARS-CoV-2 has also increased, with about 5% of tests coming back positive, up from 3.8% during our last episode. We don't have a variant update to provide since our last episode. As far as we know, XFG continues to account for the majority of US cases, but at the time of that update in mid-December, XFG 14.1 was on the rise, accounting for 15% of cases. As I shared with you in the past, I really do not know how to interpret these variants and what they mean. I've heard a lot of people prognosticate about one thing or another with them, only to be wrong six weeks later. Now shifting over to RSV, activity is elevated across much of the country, and we continue to see signs that the activity is starting to increase.

Dr. Osterholm: Wastewater concentrations are increasing across every region, those still considered very low nationally as well as in the Midwest, Northeast, and West, while concentrations in the South are now considered moderate. Four states, Alabama, Arkansas, Louisiana, and West Virginia, have wastewater concentrations that are considered very high, while in others Georgia, Kentucky, Massachusetts, and Washington are considered high. 11 are moderate, six are low, and 22 in the District of Columbia are very low. Test positivity continues to increase, now at 4.6%, up from 4.1 during our last episode. ED visits associated with RSV continues to increase slightly, currently at 0.5%, up from 0.4% two weeks ago. Hospitalization, on the other hand, have decreased slightly over the past week, but not in the 65 year old and older age group, which has seen hospitalizations for RSV increase every week since the beginning of December. Remember, the 65 year old and older age group is also the only age group that experienced an increase in influenza hospitalizations last week, so this group is clearly being hit especially hard at the moment. We're in the depths of the respiratory season, and increasing COVID-19 activity is going to stir things up even more. All we can do is get your vaccines, wash your hands, take all the precautions you can. Whatever you do, please stay home if you're sick. If you're in public settings with large number of people in indoor air, consider wearing your N95.

Chris: Well, that leads us nicely into our ID query. This week we received a question from Ford about the RSV vaccine. Ford, who's 73 years old, recently went to his local pharmacy to get his COVID, flu and RSV vaccines, and he was told by his pharmacist that the CDC says the RSV vaccine is not currently an annual vaccine. So here's what Ford asked. Can you please explain? The vaccine schedule with the RSV vaccine? Is one shot good forever? If not, please explain. What is the best practice? What are the current limits, if any, of the current CDC position on repeated RSV vaccinations?

Dr. Osterholm: Well, Chris, let me first of all, just thank Ford for submitting this question. I can understand the confusion here because there are different recommendations for RSV vaccination for different age groups. The CDC currently recommends the RSV vaccine for adults aged 50 to 74, and who are at increased risk of severe illness, or all adults greater than 75 years of age. Those at increased risk for severe illness include those with chronic heart or lung disease, those with weakened immune systems, those living in a nursing home, or those with other medical conditions. There are three RSV vaccines licensed for adults in the US, all of which are administered as a single dose. It is not considered an annual vaccine, although the CDC website does include a recommendation to get vaccinated during the months of August to October prior to the onset of respiratory virus season. Currently, repeated doses of any RSV vaccine are not recommended, but we'll keep our listeners updated if there are any changes to this recommendation. Another risk group for which the RSV vaccine is recommended is women 32 to 36 weeks of pregnancy from September through January. This is recommended because RSV is especially dangerous for infants and young children. Antibodies from the vaccine can be passed during the pregnancy in utero. There's currently only one licensed vaccine for the use in pregnant women Pfizer's Abrysvo. For infants born to women who do not receive a vaccine during pregnancy, there is an RSV monoclonal antibody, which is administered from October through March so that the infant is protected during the respiratory virus season. Given what we discussed earlier in this episode, we know that vaccine recommendations are always subject to change as new information becomes available, or the more unfortunate scenario in which previously trusted public health institutions are no longer following the science. We promise to keep our listeners aware of any vaccine recommendation changes, whether that be CDC, state public health agencies and, of course, our medical societies.

Chris: Now it's time for a special segment to mark the 200th episode of the Osterholm Update. Mike, I don't think you or I or anyone who's been involved with this podcast would have thought when we launched our very first episode on March 24th, 2020, that we'd have 200 episodes under our belts and would still be doing this podcast. So today, we've invited two people who've been very critical to the success of this podcast to join us to share their thoughts on this milestone.

Dr. Osterholm: Thank you Chris. And indeed, it is quite remarkable that we're still here after 200 podcasts. I want to just emphasize something you just said about this team, which I'll get to in a moment. But the point that's really important to understand is that a podcast is a team effort. It's never just one person. Even though I might be the voice of it. The information that we gather comes from this incredible team, the whole production of putting the podcast together. Um, you know, going through the taping of it and to actually correct the mistakes or to tie together sentences that otherwise were left loose by me. And so from that standpoint, I can't say enough about the support I've had. And we all have had at CIDRAP with this podcast. Let me just say that it's a real honor for me today to actually introduce to this audience two different individuals, one who's actually been on the podcast once before, Doctor Sydney Redepenning, who actually started with CIDRAP, with the very first podcast broadcast in 2020 as an undergraduate. Today it is doctor redefining what a history. She literally lived through her entire educational experience to get to her PhD through the podcast, and she has been here for all 200 episodes. Someone who's not here with us today.

Dr. Osterholm: Maya Peters, who was actually very instrumental in helping set up this podcast in the early days, uh, was involved with more than 60 of the podcasts, the broadcast, and, uh, all I can say is that, uh, I wish you were here today, but thank you very much for all that you did. And then last but not least, is someone who has played a very key role in helping us expand on the content of our podcast: Elise Holmes. Elise has been here for 100 of the podcasts. She came on board as a professional epidemiologist and, has now also decided to go on and get her PhD with us, as well as serve as a professional epidemiologist. Elise has been very key to helping us develop the content for this podcast, as well as doing much of the editing and the work with it. So, Elise, you got in halfway through and I'm sure it seems like a lifetime for you. So that that gets me to the to. The first question I have is for you, Syd, 200 episodes that actually have occurred as you have grown up in this profession, from an undergraduate student to now, doctor, what would you say were the most important moments of the podcast for you throughout this entire time?

Sydney: There's so much that stands out to me because so much has changed and grown with the podcast over the last six years, that it's hard to single out a few moments, but I think of it more as almost eras of the podcast. We had our initial response during the height of the COVID pandemic, in the early days, where it felt like people were really looking for a voice and we were able to be a part of that. And at that time, I was playing a much smaller role in the podcast than I am now, because my role has also grown and evolved over the past six years. But even being able to be a part of it and to be able to see what it looked like from the inside was so impactful to me at that early stage of my career because I learned a lot about how do epidemiologists and scientists look at very nebulous data and come out with what they think are the best policies, or the best ways that we can protect ourselves when we don't have a lot of data? And the thing I think I took away the most from that time was that one thing that, Mike, you were willing to do, and then kind of in turn, that the team was able to contribute to, is being really honest about what we don't know and bringing humility into science, because that's something that while I learned so much in the classroom during my education, I think that humility piece can't exactly be taught in a lecture. It can't be taught in an assignment or in a paper. That's something you have to see to learn.

Sydney: So that's something that stood out. And then I think I will always look back at our 100th episode as something that is one of my high points for this podcast, where we had lots of different people sending in recordings or for some. I set up Zoom sessions and Squadcast. Sessions to record with them, to talk about what the podcast meant to them and to. Thank you for the effort that you had made and that Chris had made to get us to 100 episodes. Just being involved in that effort and leading that effort to reach out to people and thinking. You know, I'm reaching out to people. We did it as a surprise for you. So normally my connection to. Those folks would be you. So I thought, I don't know if I'm going to hear back from them when it's just me who they don't know. But the response was overwhelming, and that solidified for me how much of an impact the podcast was having that I could email Sanjay Gupta's, you know, staff and say, hey, I work for the Osterholm Update. You know, would you be willing to send us something and have this overwhelming quick? Absolutely, yes. Everyone had so many wonderful things to say about Mike and about Chris and about the work that we do. I think it was the first time that it hit for me in that type of a way, the impact that we had on people. And then I think now thinking about the shift that we've made to covering policy issues would sort of be the third, the third piece of most important moments, because that was a tough conversation and a tough series of conversations we had after the new administration came into power.

Sydney: And how are we going to talk about this in a way that feels unbiased but feels honest, and we can't ignore the policy issues, but we also know people are coming to us because they don't want politically partisan inclined commentary on what's happening. They want data and they want facts and they want evidence, but they also want to be told what's going on and what it means. And that's a really hard balance to strike. So being able to not just be a part of it, but also to have been a part of the conversations of how does that happen and how can we do it, and how can we do it in a way where we're not scaring people to death? As Mike likes to say, we scare people into their wits, not out of their wits. But all of those things are they're fun phrases. But the actual work that goes into doing that is challenging and it's hard. And so being able to learn as a student and now as someone early into my career with my PhD, how all of this works and how we get from point A of here's this decision that RFK made. What does it actually mean? And everything that goes into from that happening to what we say about it has been so incredibly impactful. And I am could never say enough how grateful I am that this has been. As you said, Mike, my entire educational journey has been spent at this podcast and that that means a really great deal.

Dr. Osterholm: Well, thank you very much, Sydney. And I might comment. This past Saturday night, I had the opportunity to spend some time with Andrea Mitchell, the NBC anchor, and she was one of the voices that you had on the 100th podcast. And when we were discussing this, she could not believe we were now at 200. And so even people like that were quite surprised by that. And so thank you. I can't say enough about all the very important contributions you've made to this. So, Elise, looking to you, you were a little bit newer into the scene, but nonetheless, you've got right into it. And, uh, we're up to your eyeballs in this podcast. What are your really memorable moments about the podcast?

Elise: Well, I think there are a number of memorable moments. I think some highlights and maybe I'll say some lowlights. I guess I'll start with some of the moments that were more challenging in some of my previous work. We've had to deal with anti-vaccine sentiment, with measles outbreaks, with some of those really big, challenging things. And I think it's been hard to see that resurgence or even persistence of some of those things over time. We always hope that those things will just continuously improve as we get more information out there, as more people speak up for public health. And so I do think it's been concerning as we've seen, you know, we are potentially close to losing elimination status for measles in this country, as we've reported, these huge surges in measles cases. So I think that's been you know, it's been a notable part of being a part of the podcast. I think more of the couple of highlights that I can really think of. One is actually I got to share a moment of joy, which was something we used to have as part of our closing segments. So back in 2023, I got to share a moment of joy that my son was born. And so I came back from maternity leave and got to continue working on the podcast. Share that. It was a little bit of a rough journey.

Elise: And the other Doctor Osterholm at the the NICU at the U of M was our attending doc in the NICU and was just a joy to work with and got to come right back into the podcast and and keep going. And our whole podcast family supported us in that. So that was a major moment of joy. And then the other one that I really think of is, um, monitoring the ACIP meeting back in the day when the ACIP was a very different type of group. But when they were reviewing the evidence on whether or not it was safe and effective to give kids under the age of five COVID vaccines. And I remember sitting and watching that meeting and hearing what different experts had to say and taking really diligent notes, knowing we were going to provide our listeners with that information and that they were going to make decisions based off of that. And I think that that was really meaningful and and really exciting to to have that deep dive look at what ACIP was doing. And obviously that has a different perspective, a different color on that now than it did back then. But I think it's still a highlight to see public health in action and see that. Evidence to recommendations framework thriving.

Chris: So Elise and Sydney, many elements of this podcast remain the same as they were in the very first episode, but our focus has changed, in part because COVID is no longer the emergency that it was. We are not flying by the seat of our pants, just trying to keep up with all the data that was coming out. But the big issue is that we have a lot of new public health issues that need to be addressed, and that's especially been the case since last January. So how do you both view the way this podcast has evolved, and is there kind of a through line from the first episode to the 200th episode? Is is our mission still the same? And I'll start with you said.

Sydney: Yeah, thank you. And you're right. There are, you know, so many things that have changed throughout nearly six years and 200 episodes. But there are two things that stand out to me as relatively consistent over the years, and that is for the most part, we have been with sort of breathing room in between reaching people during different times of public health emergency. You know, as you said, for the first several years, that crisis was COVID. And when I was thinking back to our 100th episode, which aired during the later part of the 2022 Omicron surge, when things were starting to look up a little bit in terms of our COVID numbers. And I was thinking at the time, I remember, what will this podcast look like when we reach episode 200? I was assuming, you know, COVID cases and hospitalizations and deaths will continue to wane. What are we going to talk about by the 200th episode? And will there even be a demand for our voice in public health anymore? You know, will people still want to listen to us? And then in the years that followed, it kind of had these, like, little fires popping up in public health that kept us in demand. There was the global mpox outbreak in the summer of 2022. That kind of took off right as the Omicron major wave was winding down. And then right as mpox cases started to wane. We had a really challenging winter respiratory virus season in 2022 to 2023. During that winter and then after that resolved, we started seeing H5N1 in cattle and all of these other infectious disease issues that weren't a crisis in the way that COVID was, but it seemed that there was this steady stream of either emergencies or at least topics of interest that kept people coming to listen to us.

Sydney: So that's when we kind of felt this shift from being a COVID podcast to being an infectious diseases podcast. And I remember feeling, and I still feel very thankful, but also humbled that the trust that we built with listeners around the issue of COVID seemed to carry over into all of these other infectious disease issues, which at the time we really didn't know if it would. And then, of course, you know, the biggest change in recent years was that dramatic shift that none of us could have really anticipated in the way that it's played out. That being the dramatic cuts to public health at the federal level and the rise of anti-science. I think if you had told any of us in our very early podcast meetings in 2020 that we would still be doing this six years later, but that we would be doing it in part because RFK Jr was now the HHS secretary and had appointed anti-vaccine advocates to the ACIP that USAID was defunded. All of these different things, I think we could have hardly wrapped our minds around those events in and of themselves, let alone the fact that we would be a voice kind of guiding people through all of the chaos. And it's definitely a bittersweet feeling, because I could never say enough how much we value our listeners for their trust in us, and that they want to hear from us about these things and all of their supportive messages and everything.

Sydney: But in some ways, I also know we'd all prefer to live in a world where public health was in a better place and people didn't need or want to hear from us on such chaotic issues. But on that note, I think the other thing that's been consistent for me over the years, and that I think, is the reason that we've been a voice on these issues, is that though we never, ever waver on sharing evidence-based information and sticking with the data, we've also never forgotten the importance of the human side of things. That started in our fifth episode, when Mike shared a dedication about his friend, Doctor Alan Kind, who had passed away in the early months of the pandemic. And that wasn't something that we had planned out in advance. It wasn't something we talked about in the podcast prep meeting. It was just Mike speaking from the heart about a person who mattered to him and who mattered to a lot of people. It wasn't a strategic move, something we thought would get us more listeners. It was just real. And I think that really resonated with people in a way that we weren't expecting. And if anything, I think we maybe thought we'd get some of the opposite of people asking us to stick to the facts and to talk about personal things in another setting.

Sydney: But I think our listeners valued hearing from Mike not just as a scientist, which of course they do value hearing from you as a scientist, Mike, but they value hearing from you as a person. And that's what we were able to bring. And after that, the team really never looked back and continued to share information in that way of never compromising on the data, never compromising on the facts, but also never, ever compromising on the human side of why we're doing this. And the way that that's looked has changed over time. As Elise mentioned, for a while we were doing moments of joy. Before that it was beautiful places, celebrations of life, acts of kindness. You know, we've always shared sunlight. The way we've done it has evolved. Other things have evolved. Our team has grown from just a very small group to now. Over the years, I think we've had 13 different people working on this podcast in different capacities. So there's been a lot of growth, but those guiding things of reaching people during tough times and reaching people with humanity during challenging times have stayed the same. And I think it's the reason why we've been able to stay and continue doing this for 200 episodes. And I know that working on this has left an impact on each and every one of us who have been a part of the podcast, and I'm eager to see how that will continue to evolve by the time we reach our 300th episode, though, hopefully during better times for public health.

Chris: Your thoughts? Elise?

Elise: Sure. Well, the podcast certainly has changed, and I think it has been really interesting to watch that. I do agree, Chris. There is a through line though, and so I think the evolution has been an honest reflection of what it looks like in public health, because public health grows and changes over time, and especially over the last six years. As Mike mentioned in the intro before I came to CIDRAP, I've been working in public health for a while, both at the state and local level, and when the COVID-19 pandemic began, the majority of us working public health got an email at some point, often in March, that said, here's your new assignment, and we had to do that on top of our existing work that we're doing, because you can imagine newborn screening, lead monitoring, none of those things went away. And so as I'm, you know, sitting in a, in a room in Saint Paul and answering phone calls, learning about provider guidance and trying to tell an ER doc, you know, when they need to wear a respirator or when they don't and how they need to store it. I was sitting next to, you know, on one side I had someone that worked Food, Pools, and Lodging that was taking water samples in hot tubs and hotels. And another person that was doing TB follow up and all of a sudden we were doing COVID work, but we were still on the side on our emails trying to manage everything else going on in life. And I think that's kind of what this podcast has evolved with as well. You know, we've really focused on COVID as an urgent crisis, but we also recognize that all the other issues in public health continued. And so we haven't, you know, we we haven't strayed from COVID.

Elise: We haven't forgotten COVID. We don't think that COVID is done with or it's no longer a serious health threat. But we recognize that public health will never be a singular issue, even during a pandemic. So, you know, we've talked about on this podcast pretty regularly declining childhood vaccination rates that continued that amplified during the pandemic. And, Chris, you and I work alongside each other at CIDRAP on antimicrobial resistance. That's another long-standing public health issue that really got a lot worse during the pandemic and we're still grappling with. So I think the podcast growth evolution reflects the reality of the field and how interconnected public health is and and how that really affects our communities. The other change that I think is a little, maybe lighter in tone, but I'm still very proud of, is the addition of our public health history segment. I'm a little bit of a amateur history buff, and so being able to weave that into our work felt like a great opportunity, And I do think beyond just serving as kind of a personal interest and hobby, it actually does serve a deeper purpose, especially for those of us that are feeling burnt out, whether that's from COVID or from federal actions or just the different challenges happening in our neighborhood. Looking at history, I think gives us perspective, and it shows how really ordinary people confront problems both big and small, and how they make a difference. It reminds us that our shared history has included a lot of harm that still impacts communities and still requires a lot of recovery and healing. And I think it also demonstrates that we're a part of history, and the story isn't over yet, and we still get to shape what happens next.

Dr. Osterholm: Well, thank you to both of you for your very thoughtful comments. You know, to close out this segment, I know that you've taken the opportunity to bring us some numbers to understand a bit about the podcast and the listeners. And so if you could, I'd think it would be wonderful to share those numbers on this 200th episode date.

Sydney: Thank you, Mike. Well, as you all know, this is our 200th regular episode, but we've also had six special episodes, and that's a total of 221 hours of content from us over the years. Our most listened to episode was Thank You, Doctor Jenna, which had nearly 90,000 downloads across different platforms. This was back in 2021, and our most used song was Friends by Elton John, which we've used nine times. We've had a number of fun special guests over the years. Twice, we've had physician Jena Wurt on the podcast to discuss how she had handled and seen challenges during COVID as a physician. For our fifth podcast anniversary last year, we had the podcast team on to be interviewed by Mike so we could share all a little bit more about what we do in our experience at CIDRAP and on the podcast. Um, and then we also had the team that worked on Mike with his latest book, The Big One, which included myself, as well as Mike's coauthor Mark Olshaker, and our researcher Anne Hannigan Grace. And then we've had a number of people that sent in, as I had mentioned earlier, special recordings for our 100th episode, including Doctor Sanjay Gupta, Andrea Mitchell, as Mike mentioned, Neel Kashkari and then my very favorite guests that were included on that 100th episode and the ones that we had all decided were the most critical were Mike's grandchildren that sent in recordings for the 100th episode. Elise, I know you have a few more things you want to highlight, so I'll hand it over to you.

Elise: Sure. A couple more that I have to highlight, as you mentioned, Sydney, 200 full episodes. A lot of favorite titles, but if I had to call out my absolute favorite, I think it's lungs and others. I think that's a favorite of Mike's as well. A number of different special segments, and you've mentioned that as well. You know, we have our daylight, which is obviously some people's favorite. I think actually a lot more people have written in to say that they like it than that they don't. And to our listener emails, there's the now famous Occidental Belgian Beer House on Vulcan Lane in Auckland, New Zealand. We have received emails from 13 listeners with pictures of them enjoying the Occidental, and I hope that if anyone didn't send a picture that they'd be willing to do so. A reminder that we do receive a lot of emails, but we read each and every one, even though we don't have time to respond to all of them. And with those emails, we had the chance to hear people's beautiful places, moments of joy, celebrations of life. One of which I got to contribute to. And in terms of dedications, that's again, that's another special segment we have opening. And those have ranged from things that are a lot more serious, like the loss of close friends and loved ones, those battling long COVID people who have lost their jobs due to federal cuts. But there have also been some really light-hearted ones. On episode 77, we actually dedicated the podcast to Big Bird after he received his COVID vaccine. So I think that really highlights that there's a lot of numbers here, but there's a lot of people and the people that have contributed to making the podcast, as well as the listeners who have really shaped it over time.

Dr. Osterholm: And I'd like to also express my thanks and just hope everyone who's a podcast listener understands. Now you see that team effort I talked about was alive and present here. That's really what is important about the podcast family is that we are all part of that and we never, never take that for granted. So thank you.

Chris: Sydney and Elise, thanks for joining us today.

Sydney: Thank you so much, Mike and Chris, for having us. Cheers to the next 100 episodes.

Elise: Thanks for having us, Chris and Mike.

Chris: So, Mike, what are your take-home messages on this 200th episode of the Osterholm Update?

Dr. Osterholm: Well, first of all, this is not really a message. But again, it's a heartfelt thank you to all the listeners who have hung in there with us. Uh, I've received emails, even in the past day, from people who are anxiously looking forward to the 200th episode, and they are very proud to say that they have listened to all of them to date. Wow. Amazing. But I think in summary today we can say, number one, the flu season is still a challenge. And in fact, if you develop influenza like illness, it's very important to use antiviral drugs if in fact you're somewhat at increased risk for severe illness. The flu season is not done yet. It may be getting better, but not done in that same light. We're now watching carefully to see what COVID does. Will it piggyback onto the flu season? Will it take off after flu starts to come down? We don't know. Second of all, we have a truly systematic effort to reduce vaccine use in our country, and it's led by Misinformation from our federal government. We will continue to battle that. CIDRAP is committed to the Vaccine Integrity Project. We will stand up and stand out in this kind of a setting, but we have to know it is a full frontal assault right now on vaccines. And finally, based on the dedication I shared with you and the discussion that is happening in many, many homes around the country, the world is in a bad place right now. Just straightforward. Simple, a bad place. But now is the time for us not to give up. Now is the time for us to stand up and stand out. And as I indicated in the dedication, now is the time for us to identify in our own communities what can we do individually to make for a better community? That's really, truly important.

Chris: And Mike, as our listeners know, we always pick a closing song for each episode. Or sometimes it's a poem, sometimes it's a quote. A lot of the times, many times it's a song and it's been a real struggle for all of us on the team to figure out what an appropriate song is for this moment we are experiencing here in Minnesota and everything that's going on nationally. What have you chosen?

Dr. Osterholm: Well, this may be a stretch to apply it to the current situation, but you know, we're in just one very difficult storm right now. Very difficult storm. But I've always known and believed in the fact that after each severe storm, there surely may be a rainbow. And already I can tell you, I am setting my sights on not just getting through this situation, but how one day can we build back better. The public health system that we once enjoyed and for that matter, how public health plays an important positive role in our lives. And so, amongst all the tears and the raindrops of this past week, I can honestly say that I want to focus on rainbows today and remind us that we'll get through this. This particular song has been used five times before in episode 35, The Last Mile to the Last Inch on December 10th, 2020. On episode 78, Breakthroughs and Boosters. On November 18^th, the 2021 episode 121, Thank You, Dear Doctor Jena Part Two on December 29th, 2022. Episode 168 Better Times released on October 17th, 2024. And finally, last but not least, Episode 177 We Cannot Give Up or Give In on February 20th, 2025. Of course, by now I'm sure you've guessed The Rainbow Connection. It's a song from the 1979 film, The Muppet Movie, with music and lyrics written by Paul Williams and Kenneth Ascher. The song was performed by Jim Henson as Kermit the Frog during the film's opening number, where it opens with Kermit sitting alone in a log in the swamp, playing the song on his banjo.

Dr. Osterholm: The song is an integral part of Kermit's character's arc, which it establishes his dream of making millions of people happy, which motivates his journey to Hollywood throughout the film. The Rainbow Connection reached number 25 in the Billboard Hot 100 in November 1979, while the song actually remained in the top 40 for seven weeks in total. Williams and Ascher received an Academy Award nomination for Best Original Song at the 52nd Academy Awards. So here it is, a song that, from my perspective, is an anthem for our future. The rainbow connection why are there so many songs about rainbows and what's on the other side? Rainbows are visions, but only illusions and rainbows have nothing to hide. So we've been told. And some chose to believe it I know they're wrong. Wait and see. Someday we'll find it. The rainbow connection. The lovers, the dreamers and me. Who said that every wish would be heard and answered when wished on the morning star? Somebody thought of that and somebody believed it. Look what it's done so far. What's so amazing that keeps us stargazing? And what do we think we might see someday we'll find it. The rainbow connection. The lovers, the dreamers and me. All of us under its spell. We know that it's probably magic.

Dr. Osterholm: Have you even been half asleep? And have you heard voices? I've heard them calling my name. Is this the sweet sound that calls the young sailors? The voice might be one and the same. I've heard it too many times to ignore it. It's something that I'm supposed to be. Someday we'll find it. The rainbow connection. The lovers, the dreamers and me. The rainbow connection. Thank you again for being with us today. 200 episodes. Crazy, isn't it? Thank you for your feedback, your support. It means everything to us. We will continue to be here as long as anybody wants to listen. Doing what we can to help make your lives better while you in turn help make our lives better. So thank you, Chris. Thank you for 200 episodes. It's been amazing working with you. Anyone listening to this podcast, you can't not recognize Chris's voice after the second word's out. And it has become a very important foundational piece of this podcast. So thank you very much, Chris. I hope all of you have a good two weeks. We'll continue to keep focused on what's happening here in Minnesota and trying to do our best to see the rainbow connection and what it might mean to us one day. So in the meantime, be kind, be thoughtful. We surely need it more now than ever. Thank you, thank you, thank you. Be kind and be safe.

Chris: 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. This podcast is supported in part by you, our listeners. If you would like to donate, please go to CIDRAP. The Osterholm Update is produced by Sydney Redepenning, Elise Holmes and Aron Woldeslassie. Our researchers are Cory Anderson, Meredith Arpey, Leah Moat, Emily Smith, Clare Stoddart, Angela Ulrich, and Mary Van Beusekom.