Episode 202: The Bells Still Ring

Chris Dall: Hello and welcome to the Osterholm Update, a podcast about infectious diseases and public health featuring Dr. Michael Osterholm. Dr. 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, Dr. 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. In recent weeks, federal health officials have seemingly downplayed the dramatic rise in US measles cases over the past year, with one recently suggesting that the potential loss of measles elimination status is simply, quote, the cost of doing business. But during a press conference last week, South Carolina state epidemiologist Linda Bell highlighted what those costs can be, telling reporters that the state's unprecedented measles outbreak, which now stands at 933 cases, is leading to serious complications, including hospitalizations among children and pregnant women. Some of these complications include encephalitis or inflammation of the brain in children and pneumonia, and additionally, several pregnant women who were exposed required administration of immune globulin to protect against the high risk of complications from measles to pregnant women and their newborns that they could infect. Bell told reporters The ongoing measles outbreaks in South Carolina and other parts of the country, including the Immigrant detention facility in Texas, will be among the topics we covered this week on The Osterholm Update, episode 202. We'll also discuss a recent poll on Americans trust in vaccine information from the CDC. Bring you the latest on US respiratory virus activity. Explain the controversy over a US funded hepatitis B vaccine trial in Africa, bringing some good news on US funding for global health. And answer an ID query about Nipah virus. And we'll bring you the latest installment of this week in public health history. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.

Dr. Michael Osterholm: Thank you, Chris, and welcome back to the podcast family to another episode. I promise you, we have a lot to cover today, but we'll try to do it effectively and with information that you can use. For those of you who might be joining us for the first time or only rarely welcome. We appreciate having you with us. I hope that you find the information that we're sharing is helpful, and feel free to give us your feedback on how we can improve this podcast to more effectively give you the information you're looking for. Let me start out by just saying we've all got a friend, a family member, a coworker suffering through a winter virus. Or maybe it's been you who's gone through it. Fever, cough, chills, fatigue. Sound familiar? This has been a real doozy of a respiratory virus season, and we're still in the thick of it. To all the health care workers and hospital staff working in emergency departments, urgent cares, and hospital wards, we are dedicating this episode to you. We know that this respiratory season isn't just more of the same. Across the US, flu activity has surged to exceptionally high levels this winter, with millions infected and hospitalizations skyrocketing. Recent public health reporting has estimated over 18 million Americans have been affected by flu this season, with hundreds of thousands of hospital admissions and thousands of deaths, including both in children and adults. Influenza activity has been classified as very high in many states, driven by a particularly transmissible strain that circulated more broadly in earlier than usual. At the same time, other respiratory viruses like RSV have continued to sweep through communities, adding layers of strain to facilities already stretched thin. Health agencies across the country have issued alerts about the simultaneous circulation of influenza and RSV, warning that this overlap increases pressure on hospitals and clinics during what is already a very challenging season.

Dr. Michael Osterholm: Those of you working in healthcare settings don't need to hear the statistics because you've seen it playing out in front of you. Emergency rooms running full ICU beds filling up staffing is stretched beyond its limits, and dedicated professionals stepping up again and again and again. You're treating not just a higher volume of patients, but patients with complex, overlapping respiratory conditions along with chronic health issues. So to every healthcare worker listening, thank you, thank you, thank you, thank you for your resilience during these especially rough months and for showing up when the system feels pushed beyond what it can handle. We dedicate this episode to you and to everyone holding the line through this extra challenging respiratory season. Now moving on though, to some moments of light and good news today here in Minneapolis. Uh, we actually see sunrise at 7:18 a.m., sunset at 5:36 p.m.. That's a whole ten hours, 18 minutes and 52 seconds of sunlight. We're gaining about 2.5 minutes of sunlight every day. Remember, it wasn't all that long ago, on December 21st, when we only had eight hours and 46 minutes of sunlight. That means our days are 102 minutes longer here in the Twin Cities. Love that light. To my dear, dear friends in Auckland, New Zealand, at the Occidental Belgian Beer House on Vulcan Lane today your sunrise is at 6:48 a.m., your sun set at 6:21 p.m. that's 13 hours, 33 minutes and 17 seconds of sunlight. We're getting there. You, unfortunately, in New Zealand, are losing sunlight at about two minutes and 10s a day. But as I've said over and over again, we are very, very happy to share our sunlight with you.

Chris Dall: Mike, let's start with measles. As of last Friday's CDC update, the US now has 733 confirmed measles cases and South Carolina's upstate outbreak, which began last year and is now the largest in the nation, continues to grow. As we discussed on our last episode, Advisory Committee on Immunization Practices Chair Kirk Malone recently suggested that we are in the middle of a natural experiment of what happens when unvaccinated people get measles. Well, what we're seeing in South Carolina, Mike, is providing an example. So if we see more outbreaks like this across the country, what can we expect to see in terms of complications?

Dr. Michael Osterholm: Well, Chris, let me first of all say I must restrain myself from saying what really is on my mind, listening to the ACIp chair calling this a natural experiment. It is simply not true. It is just plain wrong. And let me just add that by the time we get done with this particular question, I hope I've laid out for you why. What we have seen to date is just a start to what is going to be a very long and tragic experience with measles. Let me be really clear. We do not need an experiment to know what happens when unvaccinated people get measles. Before the introduction of the first measles vaccine in 1963, 3 to 4 million people in the US were infected annually, resulted in approximately 50,000 hospitalizations, 1000 cases of encephalitis, and 500 deaths every year. Due to the widespread implementation of MMR vaccine recommendations, measles was declared eliminated from the US in 2000. However, I am absolutely certain that within the months ahead, we, like most countries around the world, will in fact lose their measles elimination status. The inevitable is coming. As you just noted already, Chris, South Carolina is currently combating the largest outbreak in the country, with over 920 cases since last October and a recent surge in cases over the past few days. The outbreak is centered in Spartanburg County, which has a larger number of private schools with low vaccination rates. Amongst the cases in South Carolina, 95% are unvaccinated or have an unknown vaccination status, 90% are in children, and 26% are in children under five years of age. I am particularly concerned about that last category. Children under five years old, and that's because they're at higher risk of suffering from severe measles complications like pneumonia or encephalitis.

Dr. Michael Osterholm: Pneumonia is the most common cause of death from measles in young children, and encephalitis, although more rare, can lead to permanent hearing loss or intellectual disabilities. With a growing number of measles cases in the US, we are likely to see a growing number of measles related complications, particularly in our young kids. Vaccination is by far the best way to prevent measles in all age groups. We all know that, unfortunately, given recent events in Minnesota, we've been hearing about some families that are hesitant to visit clinics or hospitals for routine vaccinations. I'll talk more about that in just a moment. But for now, I'd like to give a shout out to the Hennepin Healthcare's Pediatric and Postpartum Mobile Health teams right here in the Twin Cities of Minneapolis and Saint Paul. They have provided health care, including vaccines, to those unable to go to in-person clinic visits. And of course, the reason for that inability to get to those clinics is because they are concerned about their Black or brown skin, resulting in them being pulled off the street. Let me just add one last perspective on where measles is going. I know that throughout the course of my career, I've often referred to as "Bad News Mike." Well, I've also stood by my predictions and I'll let my record speak for itself. Here's one of my predictions. I can't give you the exact chances I think that this particular scenario has, but I think it sure is very likely. Let's take Canada and what's happened there. In the last year. In 2025, the Canadians experienced 5450 cases of measles. Two deaths occurred in preterm infants.

Dr. Michael Osterholm: Something that I had never seen in all my years of measles work back in the 1970s and 80s. But if you look at what's happened in Canada and compare it to what might be happening here in the United States, there are some very eerie similarities. For example, we have been looking closely at the actual levels of vaccination in Canada, throughout the entire country, and compared that to what we're seeing with levels of vaccination here in the United States. Again, I refer you back to a very thoughtful, comprehensive piece on vaccination rates in the United States that was published several weeks ago in the Washington Post. We are including a link in our show notes. So you can go back to that article if you'd like. Bottom line is Canada, with a population of 40 million people, had 5450 cases of measles this year. I think we're on track to replicate that. And if that were to be true with our population of 340 million people, we could expect, based on the rates in Canada to see up to 46,000 cases of measles a year in this country. Think of that 46,000 cases. Now, that may seem hysterical. That may seem. Oh, that'll never happen. Let me tell you that. Many people never thought for a moment that measles elimination could be eliminated in a country like the United States, and it's being wiped out. I point out these numbers to you and compare ourselves to Canada, in the sense that we have to take this situation very seriously, very, very seriously. Measles, I believe, will be a major challenge in our public health programs in the years to come.

Chris Dall: We also found out last week that there has been a measles outbreak at the nation's largest immigrant detention facility in Dilley, Texas. This is, of course, a place where many immigrants who've been detained here in Minneapolis have been sent. Given the administration's crackdown on immigration and reported plans for more of these type of facilities around the country, this seems to be a potential source for wider spread of measles or other infectious diseases. I can't think of a better incubation environment for transmission of measles than a detention facility. Infectious Diseases Society of America CEO Jeanne Marrazzo told The Washington Post. Your thoughts? Mike.

Dr. Michael Osterholm: Chris, the very fact that we have to think about this is really a tragedy. This measles outbreak is just one of several examples of ongoing public health concerns at immigration detention facilities in this country right now. As you mentioned, measles has been detected at a facility in Dilley, Texas, one of the many facilities housing immigrants who have been detained in recent weeks in Minneapolis and throughout the country. Two cases have been identified at Dilley, and since then, quarantine measures have been implemented, including restricting movement from the facility. Another immigration facility in Texas, Camp East Montana, has detected two recent tuberculosis cases. The detection of infectious diseases in these centers is not surprising. Congregate settings often have challenges controlling infectious diseases. Many of you may recall the jails and prisons struggled significantly to control the spread of COVID 19 during the height of the pandemic. Child care centers and college dormitories often experience similar challenges, but there are some things that just make these detention centers highly opportunistic for infectious agents. The fact is that unlike traditional jails and prisons, which house adults, many children are incarcerated in these facilities, as well as many parents or teachers know children have less immunity to infectious diseases compared to adults. They also have more hand-to-mouth behaviors, and they make sanitation and hygiene difficult, increasing the vulnerability to the transmission of infectious agents. Detaining children in crowded conditions accelerates the speed of the disease far faster than detaining only adults. Let me also just add, what I'm about to share with you is information that we've been able to glean from a number of different sources as to what's going on inside of these detention centers, namely information included in the Texas Tribune articles, those in the ACLU article, and finally, our own Minnesota Star Tribune has also published substantial information on what's happening in detention centers here in Minnesota.

Dr. Michael Osterholm: Given the fact that we have to be so concerned about any kind of infectious agent transmission in facilities like we're talking about here. Now imagine if the conditions lead to even more transmission. And let me just summarize quite clearly, conditions in these facilities are far worse than we would expect to see in jails and prisons, let alone environments like child care centers. There have been reports of medical neglect, including life saving medications that are withheld or administered incorrectly and inconsistently. Last year, a total of 53 deaths occurred in individuals that were in ICE or Customs and Border Protection custody, many due to suspected medical neglect, in addition to medical neglect. There are reports of physical abuse and sexual abuse, and including that of minors. In addition to the deaths of Alex, Pretti and Renée Good. Six people have died in ICE custody in 2026. One of those deaths was also ruled a homicide. On top of physical violence and medical neglect, those incarcerated in these facilities are facing chronic food shortages. One woman detained in the Whipple Federal Building here in Minneapolis described receiving one sandwich a day for food and being locked in a bathroom with no working sink for 24 hours. Food quality is also a significant challenge. There are many reports of spoiled food and bugs in the food given to the incarcerated children and adults. Widespread vomiting, diarrhea, and rapid weight loss have all been reported. According to that ACLU article I noted written in December, detainees at detention site at Fort Bliss military base in El Paso, Texas, have described the tents they are held in as flooded with foul water mixed with urine and feces.

Dr. Michael Osterholm: Detainees have gone days without soap, clean clothing or access to showers. These heartbreaking human rights violations have very real public health consequences. Reports of these conditions only intensified fear among residents in Minnesota who were afraid of being detained by ICE, regardless of their immigration or documentation status. We are hearing of many families that desperately want to vaccinate their children, in part due to their fears of being exposed to measles if they were to be incarcerated in one of these facilities. But sadly, these same families are missing their routine vaccination appointments because they cannot safely leave their homes to get to a hospital or clinic. I know this is very difficult for many of you to hear. It was certainly difficult for us to share with you, especially living in Minneapolis and seeing what is happening to our neighbors who make our community so wonderful to live in. I want to remind all of you that this is not about partisan politics. This is about human rights and public health. Two things will always be at the core of everything we do in public health. To our listeners who have sent our team messages of support, we can't thank you enough. That is why we will always refer to you as a podcast family. I urge you all to continue to find ways to help in whatever capacity makes sense for you. And as always, we will keep you posted as this situation unfolds. I hope that soon we have much better news to share with you.

Chris Dall: Let's turn now to vaccines. A recent poll from KFF shows that among Americans who've heard about recent changes to the recommended childhood vaccine schedule, more say the changes will have a negative impact than a positive impact. And that's by a 2 to 1 margin, 54% to 26%. Mike, this appears to be some good news. Could it be that the efforts of groups like CIDRAP and the American Academy of Pediatrics is cutting through the noise from the federal government?

Dr. Michael Osterholm: As the KFF poll showed, public trust in the CDC is near the COVID 19 pandemic low, amid the ongoing restructuring of federal health agencies and vaccine advisory panels. Turnover among CDC leadership and broad revisions to federal vaccine policy made in a scientific vacuum. In the past six years, trust has plummeted from 85% of all Americans and 90% of Republicans to less than 50% in both groups. Only 38% say federal health agencies make decisions based on science rather than personal beliefs, and 34% believe that federal officials make decisions without outside influence. When it comes to the revised CDC childhood vaccine schedule, 29% of adults say they have no confidence at all. Just as striking, especially in the context of HHS Secretary Robert F. Kennedy Jr.'s claim that the childhood vaccine schedule change will rebuild America's trust in public health. 53% of adults who were aware of the changes say that it lowered their trust in federal health agencies, compared with 14% who say it cemented their trust. Let me repeat that 53% of the adults who are aware of the changes say that they lowered their trust in federal health agencies, compared with 14% who said it cemented their trust. That's a trend that can hardly be supported by the idea that this administration was going to make vaccines more trustworthy. These results show that most Americans see through Kennedy. Smoke and mirrors and recognizes the lack of evidence based decisions. The KFF poll also showed that 82 and 81% of adults, respectively, are still confident in vaccines, such as those against polio and measles, mumps and rubella, and most also trust the efficacy and safety of hepatitis B and flu vaccines.

Dr. Michael Osterholm: Although those proportions are lower at 70% and 65%, sadly, trust is lowest for the COVID vaccine, with 31% saying they are not at all confident that they're safe for our children. I hope that, as you put it, we are cutting through the noise from the federal government. CIDRAP Vaccine Integrity Project and the American Academy of Pediatrics, which recently announced that it will continue recommending routine childhood vaccinations against 18 diseases rather than the 11 the CDC now advises should reassure parents that these vaccines are safe and effective, and that no new data have surfaced to the contrary. In addition, I'm very encouraged by CIDRAP's new collaboration with Unbiased Science and the Evidence Collective. Last week, Unbiased Science founder and CEO Dr. Jess Steier and colleagues published their first report on the CIDRAP website, in which they detailed the current state of U.S. vaccine policy. I can't be more impressed with their excellent work, which aims to help you understand what's happening on the US vaccine landscape, where it's happening and why it matters, so you can get involved if you want to. In their report, they discuss the CDC vaccine schedule overhaul in striking detail. They also set the scene surrounding the legal and political landscape and describe how it dovetails with state legislation, the misguided investigations targeting pediatricians who vaccinate conflicts of interest, and the dismantling and circumventing of the vaccine decision making body.

Dr. Michael Osterholm: In addition, and this is another important point, they talk about how the federal attack on vaccines isn't over. Just last week, the chair of the Advisory Committee on Immunization Practices, or as we call it, the ACIP, said that the committee is reevaluating all the vaccine products on the market and describe the current measles outbreak as kind of a natural experiment to see what happens to unvaccinated people, namely children, when they are infected. One piece of fallout that Steier and colleagues address is that the federal changes have given anti-vaccine groups an opportunity to question why, if the federal government no longer recommends certain vaccines, most states still do. They outline efforts in seven states to weaken or drop recommendations, including in schools for some vaccines. But medical organizations and most states are maintaining the science based recommendations, and the courts are considering challenges. Doctor Steier and colleagues recommend contacting your state lawmakers and attending hearings to urge your government to hold firm. We can and will fight back to ensure that our nation's children and adults are protected against preventable and often life threatening infectious diseases. And this is truly an opportunity for you to get involved. We'll have in the show notes some links that you can go to that will actually help you know, what kind of activities in your local area are going on, where you can be of help.

Chris Dall: In another spot of good news, the House of Representatives recently passed a $9.4 billion package for global health programs that, while less than what was allocated in 24 and 2025, is still significantly more than what the Trump administration requested. At the very least, Mike, Congress seems to understand the importance of US funding for global health programs. Can we celebrate?

Dr. Michael Osterholm: Well, Chris, let me start out by saying that the movement we're seeing in the Congress to help support funding for programs that have historically been at the very foundation of public health is great news. But let me finish my comments here and you may wonder, does that matter? Well, this latest total of support is less than the $12.4 billion allocated to global health programs the past several years. It's more than two and a half times the amount proposed by the administration, which was only $3.7 billion. So from that perspective, it could have been a much different story. And like you said, I think this clearly shows that many members of Congress on both sides of the aisle recognize the value of US investments in global health. Obviously, from a humanitarian standpoint, this funding supports things like HIV prevention and treatment, maternal and child health programs, vaccination efforts, nutrition programs, and some of the basic health system support that's really needed in places which may not otherwise have it. Simply put, these are investments that save lives. But on top of the humanitarian piece, there's also a very real strategic elements of these global health investments, which can be important from the standpoint of national security. Remember, infectious diseases don't respect borders, whether it's HIV, Ebola, COVID, you name it. That's the lesson we're all familiar with. So when we choose to help prevent, detect and control outbreaks globally, we're also protecting ourselves at the same time, there's also the idea of health diplomacy and US credibility on the global scale. For decades, our global health programs, whether through USAID or other organizations, have served as the cornerstone of soft power. With these initiatives, we've been able to establish and build trust, strengthen alliances, and basically position ourselves as a reliable partner in times of crisis.

Dr. Michael Osterholm: On the other hand, and when these programs or investments suddenly go away, the exact opposite can happen and it leaves opportunities for others to step in. Likewise, we've seen some of the consequences that have come as a result of cuts this past year. An editorial published in The New York Times this past Sunday spoke to some of the consequences of gutting USAID. With thousands of health clinics closed, HIV treatment programs disrupted, food aid shriveling up and beyond. Suffice it to say, there are no shortages when it comes to the number of challenges that exist. But there's also a lot of good that can be done with this kind of funding. So to me, again, this is welcome news. But at the end of the day, the money allocated doesn't necessarily mean it will get spent. We've already seen the White House invoke a concept called impoundment, which means that they withhold the money despite the fact that Congress allocated that money and directed where it goes. Impoundment is a very controversial area, and I might add that it only got more controversial this past week when the president announced that he was going to withhold large amounts of state and local public health dollars from the federal government in those states that are considered blue states and only make it available to those who are red states. Now, obviously, the courts are going to have an important part to play in how this will all get handled. But the bottom line is, is that until the money is actually in the bank accounts for these organizations, I wouldn't trust that it's going to come at the same time. Congress, thank you for what you have done to step up. We just need you to step up more.

Chris Dall: Now it's time for the US respiratory virus update. Mike, last year we saw a rebound in US flu activity in mid winter after an initial surge and a decline. Are we in for a repeat of that pattern this year?

Dr. Michael Osterholm: Well let me start out by just making it clear this virus has proven itself to be incredibly unpredictable this season. So Chris, I don't know. But this is what I do know As a quick reminder, during our last episode, we reported that flu activity was decreasing across the board. This included emergency department and outpatient visits for influenza like illness, and influenza B was starting to increase, accounting for 6% of the subtype specimens. Although we were seeing those decreases, we were focused on the school age population of 5 to 17 years old who were the only age group experiencing an increase in ED visits, resulting in an influenza diagnosis. The concern was that this was a potential sign of a looming rebound in activity. Well, since our last episode two weeks ago, we watched as outpatient visits for influenza like illness increased from 4.4% to now two weeks later to 4.7%, and then back down now to 4.4%. Similarly, the percentage of ED visits resulting in influenza diagnosis went from 3.2% during our last episode to 3.4% last week, and now again, back down to 3.3% currently. These trends are really consistent across nearly all age groups, with the exception of the 5 to 24 and 25 to 49 year old age groups, who saw very slight increases in outpatient visits for influenza like illness over the past week.

Dr. Michael Osterholm: So, to conclude, what I've just shared with you is it doesn't look like the influenza virus activity is picking up in any notable way. The further we get out into the springtime, the less likely we're going to see that second peak arrive. So now, at this point, I actually believe that we may actually avoid that big second double peak. That would be great news. Chris, I know I sound like a broken record when I say that we're in a waiting period, especially as we continue to see influenza B activity continue to slowly increase, now accounting for 7% of subtype cases. Remember, we have been impacted largely the past few months by influenza A activity. If we think back to a typical flu season, we tend to see an increase in influenza B activity near the end of the flu season, and influenza B tends to cause more severe disease in children. So far this season, there has unfortunately been over 60 pediatric deaths, with 16 of those being reported since our last episode, with less than 50% of us children having received a flu vaccine this year, which will discuss again later in this episode.

Chris Dall: And what's going on with COVID and RSV?

Dr. Michael Osterholm: Well, starting with COVID, the wastewater concentrations are hinting at a potential upcoming increase in activity in the coming weeks. Nationally, the wastewater concentration is still considered moderate, but it has been increasing. The Midwest and Northeast have also both experienced increases in wastewater concentrations of SARS-CoV-2 over the past week, with the Midwest being now considered very high. The northeast being moderate and the South and West considered low. Nine states have very high concentrations. Meanwhile, eight have high concentrations, and most of all of these are being reported from the Midwest and the northeast. Remember, the COVID wastewater activity is a leading indicator, meaning it can tip us off to what we might see in the next few weeks in terms of cases and hospitalizations. Since our last episode, however, ED visits and hospitalizations for COVID 19 have declined across every age group. As I mentioned in our last episode, the XFG variant continues to be the predominant variant, and there are not any alarm bells ringing about any other variants that are currently on the table. But we'll be sure to keep everyone updated if that changes. Remember, the increase in severe illness that can occur with the arrival of new new variant is important to keep in mind. At the risk of sounding like another broken record, this RSV update is going to sound very similar to our last episode. RSV activity remains elevated across the country. The national wastewater concentration continues to increase, but is still considered low, though it's just below the threshold to be considered moderate.

Dr. Michael Osterholm: Concentrations are increasing in every region except the South, which is still considered moderate. The South had the highest wastewater concentrations of any region until this week, but the northeast has now surpassed the concentrations reported in the South. Three states, namely Kentucky, Virginia, and West Virginia, are considered very high in three states. Alabama, Georgia, and Massachusetts are considered high. Overall, emergency department visits for RSV have remained the same since our last episode, including for the 1 to 4 and the 5 to 17 year old age groups, which we had a close eye on because of the increases in RSV ed visits that they experienced leading up to the last episode. Since then, the less than one year old age group is now the exception, being the only age group to experience an increase in ED visits over the past two weeks. Hospitalizations for RSV have slightly increased over the past two weeks, with 0 to 4 year olds groups now driving this increase. I know these respiratory updates sounded more like the same thing that we've been reporting, but that means we're not seeing any significant, unexpected changes in spikes in activity. That does not mean it's time for us to declare that we have won the battle against these viruses, especially with the increase in wastewater concentrations. But I do hope we can start reporting decreases in activity sooner rather than later.

Chris Dall: A recent poll from the University of Michigan found that only 42% of Americans over 50 have received a flu or COVID vaccine in the last six months. So, Mike, what would your message be to those people? How would you convince them that getting vaccinated against COVID and flu is a good idea?

Dr. Michael Osterholm: Well, as a listener out there, if you know anything about CIDRAP and me, let it be that we tried our very best to lead with science as all public health recommendations, decisions and communications should be. I can't convince anyone to get a vaccine, but I can provide them with all the best science to help them make an informed decision. With the findings of this poll, it's clear that many of these individuals simply did not believe that they needed them. This poll was conducted from December 29th, 2025 to January 13th, 2026. It's very current. It asked adults aged 50 to 98 about their vaccination status, as well as reasons for not receiving a vaccine. Of the nearly 3000 participants in the poll, 42% had not received a flu or COVID vaccine in the past six months. Only 29% reported having received both the COVID and flu shot, and 27% reported having received just the flu shot. The poll results are further broken down into age groups, and these findings provided a little relief. Our own CIDRAP news reporter, Laine Bergeson, helped to break down the subgroup results of the poll incredibly well, and I'm going to read a section of the CIDRAP news article which will be linked to the episode description. She wrote, quote, nearly half 46% of adults aged 75 and older who face the highest risk of severe disease, said that they had received a COVID vaccine in the past six months, compared with 37% of those aged 65 to 74 and 20% of those ages 50 to 64. Flu vaccination rates were higher across all age groups, 76% among those 75 and older, 64% among those ages 65 to 74, and 42% for those aged 50 to 64. Adults with at least one chronic health condition were more likely than those without such conditions to have received both vaccines.

Dr. Michael Osterholm: But gaps remained. Nearly 4 in 10 respondents with chronic conditions said that they had not received either vaccine in the past six months. The poll also highlights a group of growing risk older adults who have never received a COVID vaccine. 1 in 5 adults aged 50 to 64 reported never being vaccinated against COVID, along with 12% of those ages 65 to 74 and 7% of those 75 and older. Unquote. So now let me summarize the leading reason given for choosing not to vaccinate was that people didn't think they needed it. An answer given by nearly 30% of adults who had not received flu or COVID shots. This was followed by concerns about side effects and believing the vaccines are not effective. These findings provide me with a little bit of relief. Chris. It's good to see that the highest risk age group for serious illness, hospitalization or death did in fact have the highest vaccination rates. I also am encouraged by the fact that less than 1% of adults who are not vaccinated for COVID 19 report it was because they didn't think they were eligible, despite the recommendation changes made last year by the new administration. To say that those who are 50 to 64 without a chronic condition did not need a vaccine. Obviously, that message hasn't gotten down to the population. Thank God. It's really clear from these data that we need major improvements in public health messaging and communication, and that they are essential. I believe why we have a very long and tough road ahead of us. We must stick with the importance of public health messaging, to tell the truth, to provide the most current updated science, and to let people hopefully make rational choices about what it means to protect themselves.

Chris Dall: Now it's time for our ID query. We've received some emails in the past few weeks about Nipah virus in the wake of some recent cases in India. Mike, can you remind our listeners what Nipah virus is and what kind of threat it poses?

Dr. Michael Osterholm: Well, Chris, I've seen the concern about Nipah virus circulating widely in the news this past month, too, and that is certainly reflected in the numerous emails we received over the past few weeks. And I can understand why it might seem alarming. To many. This feels similarly to the early days of the SARS-CoV-2 pandemic a virus from a bat reservoir. Early transmission in Asia, no licensed treatment or A vaccine and a case fatality rate that is quite high between 40 and 75%. Timing is also a concern. Lunar New Year is approaching when millions of people travel across borders and celebrate in large gatherings, particularly in Asia. Luckily, we can dispel the myth that this is COVID all over again. For our listeners of the podcast. You'll be familiar with me using the phrase a virus with wings. That's how I describe something with true pandemic potential a virus that actually has high transmissibility, meaning that it can be efficiently spread from person to person via the airborne route. Again, airborne transmission is especially critical in terms of making a virus one with wings. Nipah virus has some important differences. It primarily resides in bat reservoirs in South Asia, and can sometimes spill over via an intermediary host like pigs. The pigs also get infected from the bats. So in a sense it's still an animal to animal then to human transmission model. Human infection usually occurs through contact with saliva of an infected bat, either through eating contaminated fruit or tree sap, which the bats have also been feeding upon. Human to human transmission is possible, but requires close contact with infected body fluids.

Dr. Michael Osterholm: The most recent case was found in the outbreak of West Bengal were in healthcare workers, which is not uncommon for viruses like Nipah. But unlike influenza and Coronaviruses, Nipah struggles to maintain that sustained chain of transmission in the community. Standard precautions like PPE, isolation and quarantine tend to be very effective if cases are identified quickly. Another key factor with Nipah is that the disease is typically quite severe in humans. Asymptomatic or mildly symptomatic individuals are less likely to be walking around in the community and unknowingly spreading the virus through personal contact. Historically, some outbreaks, like in Malaysia and Singapore, have led to significant spread and mortality, but in recent years, clusters in Bangladesh and India have been relatively small and contained quickly. At this point, the outbreak in West Bengal appears to be contained, so I anticipate news coverage will wind down significantly in the days ahead. I will note that CIDRAP partnered with the Wellcome Trust a few years ago, and published an updated 2024 roadmap for research and development of medical countermeasures against Nipah virus. It's a relatively technical document, but the bottom line is encouraging progress is being made towards tools that could prevent or limit the impact of future outbreaks. Although I don't believe Nipah has any chance of becoming a global pandemic, it is a devastating disease that deserves our attention and resources to minimize human suffering. These are the kinds of neglected tropical diseases that, while less attention getting than COVID, still pose risks to their respective regions and the need for ongoing vigilance, research and action.

Chris Dall: Finally, CIDRAP news reporter Liz Szabo in December was the first to report on the CDC's funding of a controversial hepatitis B vaccine trial in the West African country of Guinea-Bissau. That study is now on hold because of some of the ethical concerns surrounding it. Mike, can you explain to our listeners why this trial and the CDC's funding of it is so controversial?

Dr. Michael Osterholm: Well, Chris, let me just start out by saying it's unfortunate we even have to talk about this because it actually lays out what I believe is a totally unnecessary activity that is unethical and dangerous, and it's all to score an etiologic point. It's controversial for several reasons, which I'll do my best to highlight here. As you mentioned, this whole situation basically centers around a proposed hepatitis B vaccine trial planned for Guinea-Bissau, a country located in West Africa that would randomly assign newborns to either receive a first dose of hepatitis B vaccine within 24 hours of birth or at six weeks of age, which is the country's current routine practice. Again, the trial, which received $1.6 million in funding from our own CDC, was put on pause by Guinea-bissau's government to allow for further scientific and ethical review. At this time, it remains unclear to many of us exactly just what the status is in terms of this on hold or pause, and whether or not it's likely that this study will show back up again. Now, the first and biggest issue with this proposed study is that the hepatitis B birth dose is not experimental, but rather a globally recommended standard of care. In fact, the World Health Organization has long advised all newborns received their first dose of hepatitis B within 24 hours of birth because it dramatically reduces the risk of transmission from a chronically infected mom to a child.

Dr. Michael Osterholm: Remember, more than 90% of newborns infected with hepatitis B as a result of exposure to blood and body fluids during the delivery process end up developing a chronic infection, which can result in outcomes like liver failure, liver cancer, and premature death. For context, the prevalence of hepatitis B in Guinea-Bissau is around 19%, which is very high. So this isn't just a theoretical concern. It's very, very real. On top of that, it's worth noting the country actually plans to introduce a universal hepatitis B birth dose nationwide in 2028. The reason it hasn't already done so is because of the associated costs and logistics required to implement the program. So in other words, it's not because of scientific uncertainty about whether the birth dose works. It's just the practical challenges of putting these types of things in place with the limited resources a country may have for health. And that's where the ethical tension really comes into play. The group proposing this study, which is a team of researchers in Denmark, have argued that no infants participating in this trial would be worse off than under existing care, since Guinea-Bissau does not currently provide a birth dose. Remember, the trial would involve 7000 infants receiving a birth dose and 7000 infants receiving a dose at six weeks of age, which is the current practice there, but a practice that also means in the interim period between birth and six weeks of age, the child now becomes infected in their mind.

Dr. Michael Osterholm: The trial could basically help determine if there is differences in outcomes. If you're administered the first hep B dose of six weeks versus at birth, what difference in outcomes are you trying to look for? However, once an intervention in this case a birth dose hepatitis B vaccine which is known to be safe, effective and life saving, delaying or withholding it for research purposes, especially in a high risk population, raises significant ethical concerns. Even if the delayed dose reflects current practice, another key question is who in fact stands to benefit from this research? Again, this isn't an efficacy trial to determine whether the birth dose works. We already know the answer to that. It's a yes, yes, yes. And the country of Guinea Bissau has already indicated there are shifting to a universal birth dose. So what's the goal? Well, lots of people, including Africa. CDC officials, are concerned about this, especially given the dynamics involved with a different type of research in low income settings. In other words, is this really about science advancing local priorities and upholding global standards of care, or is this more so about finding an avenue to justify external policy decisions? Well, layered on top of all this, believe it or not, are some additional concerns recently raised about this group leading the study and some of their research priorities? The research group is the Bantam Health Project and it's based out of Denmark.

Dr. Michael Osterholm: In a commentary published in a peer reviewed journal, vaccine, a separate group of Danish researchers looked into the past vaccine trials conducted by the Bandim Health Project and raised concerns about incomplete or missing reporting of primary outcomes. In other words, they found that for multiple reasons, it was difficult or impossible to locate complete results for the main questions those trials were designed to answer. There is every belief that if a particular result came back not consistent with what they had intended or hoped for, they just didn't report the result. So altogether, there's just a lot of red flags raised when it comes to this study and An important unresolved questions. I hope that this does not become another example of Tuskegee and the kind of research that was done by our own government that actually was a primary violation of the highest ethical standards in research.

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

Speaker3: Well, Chris, today we're actually celebrating the 85th anniversary of the first injection of penicillin, one of the first and most revolutionary antibiotics ever discovered. Think about that. It was only 85 years ago. For those who are over age 65 to 70, you probably had parents who could recall stories from their parents of not having antibiotics and what that meant at that time, and how much the antibiotic era changed outcome with infectious diseases. As I think many of you may know, penicillin was first discovered in 1928 by Alexander Fleming at Saint Mary's Hospital in London. Fleming was studying Staphylococcus and had accidentally left a petri plate of the bacteria out in the laboratory while he was on vacation. When he returned, he realized the petri dish was covered in mold. Upon further examination, Fleming discovered the mold was actually killing the Staphylococcus bacteria. Fleming initially called his discovery mold juice, then later renamed it penicillin. I guess mold juice just didn't quite roll off the tongue. Fleming struggled to purify penicillin into a usable form and gained little recognition from the scientific community after his initial discovery. About a decade later, a team of researchers at the University of Oxford took up Fleming's work. Penicillin was difficult to produce in mass quantities, especially if the scientists were going to begin treating humans.

Dr. Michael Osterholm: The team started cultivating the mold in bedpans, bathtubs, and eventually custom vessels that would increase the fermentation. Oxford even hired a team of six women called the "Penicillin Girls", to oversee the operation. Together, the team at Oxford was able to produce a purified penicillin and even started testing on mice with some success. That brings us to this day February 12th, 1941. That's when Albert Alexander, a 43-year-old English policeman, became the first human to receive an injection of penicillin. Alexander had scratched his mouth while gardening and developed a life threatening bacterial infection affecting his eye and lungs. His health started to improve days after receiving penicillin. Unfortunately, due to wartime circumstances, the supplies ran out before Alexander could be fully cured. He died a few weeks later, on March 14th, 1941. Alexander's death did not dissuade the Oxford researchers. Instead, it encouraged them to find ways to produce more supply and led them to successfully treat patients with penicillin down the road. It's estimated that penicillin has saved over 500 million lives since its invention. We thank the life saving antibiotic and the collaboration of so many different scientists, researchers and everyday people like Albert Alexander who came together to bring penicillin to our modern world.

Chris Dall: And Mike is someone who writes about antibiotic resistance for CIDRAP news. That is an amazing story that I was not aware of. So that's really interesting. Mike, what are your take home messages for today?

Speaker3: Well, Chris, again, trying to summarize it in three different messages is always difficult, but you deserve to have the bottom line message. First of all, measles. Measles, measles and measles. Trust me, this is going to be a very difficult year in the United States. And we're going to see the continued global threat of measles. I think the idea that we're concerned about whether we're going to lose our measles elimination is really misplaced. That thing's long gone. It's going to be long gone in many countries. We need to understand that if, in fact, we are to follow the route that Canada has taken, which I believe there's every possibility of that. Imagine our country within a year's time period in the near future, seeing over 45,000 cases of measles a year. That would make a couple thousand cases seem like a good time. And that's a real challenge. But we have to consider that possibility. We need to do everything we can to boost childhood immunizations right into adulthood. We have many young adults today that have neither been previously infected or vaccinated. Our vaccine efforts cannot just be to young children. The second message is flu and COVID. What's going to happen I don't know. I think right now it's a little up, a little down, a little up, little down. I don't see any evidence of major surgeries in either one. So I'd say right now, you know, it should be in good shape.

Dr. Michael Osterholm: But I do think it's important that, particularly for those who are at increased risk for serious illness, hospitalizations and deaths with either COVID or flu, to remember how important those vaccines are. And the KFF survey surely pointed out there are a lot of people that could benefit from those vaccines, reducing the likelihood of serious illness, hospitalizations and deaths, and have not availed themselves to those vaccines. And finally, the third piece is just trusting vaccines. We are in the fight of a lifetime to win the hearts and minds and souls of people around the world that vaccines are, in fact, an incredible gift that save lives, that minimize pain and suffering and that they should be trusted. We'll see what happens the next year. Will we see greater risk to our vaccine enterprise system? What will happen with this administration's efforts to continue to minimize vaccine availability, or at least make recommendations? That makes it difficult. We will continue to pursue the promotion of vaccines using good science as part of the Vaccine Integrity Project. Trust us for that. And as I've said over and over again, we will bend and we will bend, but we will not break. We will do everything we can to make sure that the vaccine enterprise system in this country is alive and well.

Chris Dall: And Mike, finally, we have a slightly different closing for this week, don't we?

Speaker3: Well, Chris, this is an unusual closing.

Dr. Michael Osterholm: Let me acknowledge that up front. And it's one that has a story to set the table for this. Let me remind everyone who is a routine listener of this podcast. I don't need to tell you what the Christmas time episode is that we always play, in addition to our regular information episodes, that is the Polar Express. And as you know, The Polar Express, which was published in 1985, written and illustrated by Chris Van Allsburg, is something very near and dear to me. And the very last line in that book is something that I think about every time I hear a bell. And that is, though I've grown old, the bell still rings for me, as it does for all who truly believe. So I have this thing about bells. The story really begins on Wednesday, January 28th, when we were at the height of the pain and suffering occurring with the activities here in Minnesota and ICE. And it was on that day that Bruce Springsteen published a song that he wrote called "The Streets of Minneapolis." He wrote that and recorded it in several days. And I would urge any of you to go listen to it if you haven't, because I think it captured the feelings and the sense of what was happening in Minnesota. Well, I listened to that song for about 20 times, and after one full box of Kleenex, I decided we ought to do something here that's positive.

Dr. Michael Osterholm: So I thought about, wouldn't it be wonderful if we could, in fact, get a number of churches to ring their bells in unity that following Saturday? And so I contacted Ann Svennungsen. Ann is a retired Lutheran bishop, somebody that I got to know during COVID and said, how? How can I connect with the churches? What can we do? Well, she sent me to Rebecca Sundquist, the founder of City of Bells. Rebecca is a remarkable woman who I have such respect for, who has contacts all over the country in regards to bells and the sounds that they provide us. So the following Saturday, we actually had a number of churches in the state of Minnesota through the network that Rebecca helped set up. That actually rang their bells at noon for 15 to 20 minutes. I happened to be downtown between two large churches, and the sound was just simply remarkable. So based on that experience, we went to work. And last Saturday, there were hundreds of churches in Minnesota around the country that actually, at noon central time, rang their bells for at least ten minutes. It was simply remarkable. And as assistant podcast producer Ruby Guthrie, who has a lot of experience in recording, actually helped us out where she went and stood outside the Basilica of Saint Mary's in Minneapolis.

Dr. Michael Osterholm: And last Saturday she recorded The Bells. And I gotta tell you, it's very emotional. And all I can say is, I hope that every church in this country Rings the bells on Saturday at noon central time, just to show unity and listen to the beautiful sound of the bells. So I close this podcast with that incredible sound. I can still hear these bells. I know that you too can hear them. And I leave you with the Saturday noon bells of the Basilica of Saint Mary's in Minneapolis. Well, now that you've heard the bells, I hope you feel equally moved. Again, thank you to the podcast team. Thank you Ruby. Thank you to all of you out there who continue to provide us with the kind of feedback and information that is so helpful to us in trying to do right by you. I hope all of you have a safe two weeks until the next podcast. And just remember, if there was ever a time to be peaceful, it's now. So we're in this for a while yet. I gotta tell you, I am so proud of being a Minnesotan. I am so proud of that. It's now the time to remember what we can be, not what we have been made to be. Thank you. Be kind. Be safe.

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. This podcast is supported in part by you, our listeners. The Osterholm Update is produced by Sydney Redepenning, Elise Holmes and Ruby Guthrie. Our researchers are Cory Anderson, Meredith Arpey, Leah Moat, Emily Smith, Claire Stoddart, Angela Ulrich and Mary Van Beusekom.