Episode 177: We Cannot Give Up or Give In

Chris Dall: Hello and welcome to the Osterholm Update, a podcast on COVID-19 and other infectious diseases with Doctor Michael Osterholm. Doctor Osterholm is an internationally recognized medical detective and Director of the Center for Infectious Disease Research and Policy, or CIDRAP, at the University of Minnesota. In this podcast, Doctor Osterholm draws on nearly 50 years of experience investigating infectious disease outbreaks to provide straight talk on the latest infectious disease and public health threats. I'm Chris Dahl, reporter for CIDRAP news, and I'm your host for these conversations. Welcome back, everyone, to another episode of The Osterholm Update podcast. If there's a single headline over the past week that most succinctly sums up how public health officials and infectious disease experts are feeling about the confirmation of Robert F. Kennedy Jr. as the secretary of the Department of Health and Human Services. It can be found in The Atlantic magazine. The title of the article, written by Atlantic staff writer Nicholas Florko on February 13th, says simply RFK Jr. Won. Now what? Despite all the warnings about Kennedy's long history of spreading misinformation about vaccines and some of the very agencies he's now charged with overseeing and the concerns about how he could undermine US vaccine policy.

Chris Dall: Kennedy was confirmed by the US Senate in a 52 to 48 vote. The question now for those who remain deeply concerned is what comes next. That's where we're going to start on this February 20th episode of the podcast, as we evaluate the changing public health landscape in Washington. We'll also discuss the layoffs at the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration, and explain how the proposed cuts in indirect costs paid by NIH on research grants could affect medical research. We'll then turn to our regular updates on COVID, flu and RSV. Answer an ID query on the culling of chickens amid the H5N1 avian flu outbreak. Discuss the measles outbreak in Texas and examine a new vaccine policy being adopted in Louisiana. And we'll bring you the latest installment of this week in public health history. There is a lot to get to in this episode, but before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.

Dr. Osterholm: Well, thank you, Chris, and welcome back to the podcast family. We're glad to have you with us again. We have a lot to cover. As Chris noted, and for those who might be visiting us for the first time, we welcome you. I hope we're able to provide you with the kind of information you're looking for. And most importantly, we hope you come back and you give us your feedback about how we might be able to improve this podcast. Typically, when I start a podcast, I have a pretty good idea about what I want to say and in ways that hopefully can, in short order, give you a sense of what this podcast for this given day might seem like. I don't know what I feel right now in terms of what I want you to feel. I, like you, have so many different feelings swirling around at the same time. But one thing I do want you to know, as crazy as life is right now, as difficult as it is with all that is happening within our federal government and what that means for science, public health, medicine, I have to say we have to have resolve. Now is the time where we stand straight. We stand with purpose and we say, okay, you know what? We're going to be there. We're going to show up, and we will do what we can to make differences.

Dr. Osterholm: And today I'll talk about a bit of what I think some of those differences might be that we can do something about. And so please stay tuned with this podcast with that in mind. It has been a whirlwind to start this year, to say the least. It's hard to believe how much has already happened in just these last few weeks, and we're still only in February before the month passes us by. I'd like to use this dedication segment to celebrate two timely occasions that feel especially important to acknowledge in today's world. First, February is Black History Month, an annual celebration of the profound contributions African Americans have made to our society and an acknowledgment of their central role in US history in the fields of science, medicine, and public health. There have been countless black leaders and experts who have driven critical research, developed groundbreaking treatments, and dedicated their lives to improving medical care for all people. Among them, I want to especially recognize William Warrick Cardozo, who pioneered research on sickle cell anemia. Charles Richard Drew, a physician whose work on blood plasma preservation saved countless lives during World War II and earned him the title The Father of the Blood Bank. And Bill Jenkins, a public health researcher who fought for the end of the Tuskegee Syphilis Study and founded organizations dedicated to improving health outcomes for people of color.

Dr. Osterholm: I also want to acknowledge that February 11th, which is marked the 10th anniversary of the International Day of Women and Girls in Science. This day, established by the United Nations, honors the crucial role that women and girls play in science and technology while promoting equal access and full participation in STEM fields from trailblazers like Madame Marie Curie, Rosalind Franklin and Florence Nightingale to contemporary leaders such as primate scientist Jane Goodall, pioneering geneticist Jennifer Nuzzo and biogerontologist Cynthia Kenyon, all women who have certainly made an undeniable impact on science and medicine. And I could go on and spend the rest of the podcast just highlighting these advancements by the women who have played such a key role in our STEM research. I'm continually inspired by my colleagues who have overcome barriers of discrimination and inequality to bring their expertise and leadership to the field of public health, despite ongoing efforts to silence diverse voices and ignore the challenges that minority groups have historically faced and continue to face, the reality is that our institutions are stronger because of the diverse backgrounds, perspectives, experiences and expertise of those who have earned their place at the table. Efforts to dismantle pathways for inclusion or equal access to participation in leadership will only hinder our country's growth and innovation. History teaches us that breaking down barriers, encouraging full participation, and ensuring fair treatment benefits everyone and I mean everyone.

Dr. Osterholm: Now, let me move on to that bright spot of the entire podcast. For those who are ready to shut it down for a minute or two. Please do. But for the rest of us that want to celebrate here on February 20th in Minneapolis-Saint Paul, a city that's been pretty darn cold this week, we actually are happy to report, however, that sunrise is now at 7:05 a.m., sunset at 5:48 p.m. that's ten hours, 43 minutes and 12 seconds of sunlight. We are now gaining three minutes and one second of sunlight a day. And in fact, the maximum gain will experience occurs at three minutes and nine seconds on March 13th. So, we're almost at the maximum new light increase per day. Celebrate that it's soon going to be spring. And for all of our dear friends and colleagues in Auckland, New Zealand, at the Occidental Belgian Beer House on Vulcan Lane, your sunrise today was at 6:56 a.m., your sunset at 8:11 a.m. You had 13 hours, 14 minutes of sunlight today, but you're losing it at about the rate of two minutes and 16 seconds a day. Yep, won't be long and will both be about in the same position. And then we promise to share our sunlight with you.

Chris Dall: Mike, I really do think that Atlantic headline sums up how many public health and infectious disease experts are feeling right now. I think our audience knows how you feel about Mr. Kennedy. We've been talking about him since he was nominated to be HHS secretary. So, the question now is, how does everyone in the field move forward? And what does standing with resolve look like?

Dr. Osterholm: Well, Chris, first of all, let me just remind our listeners and I hope it's evident in every podcast that this is true. Our job here is just to call balls and strikes. That's what I will do. I will continue to do that. I will continue to support whoever performs in the way that we believe is beneficial to the public's health. I will be critical of those who do not. And it doesn't matter to me what party they're in, where they live, what they do for a living, how much money they have, etc. etc. etc. it's about balls and strikes, but let me just set the tone for, I think, one of the more confusing aspects of what's happening right now, and that is the fact that somehow a wrong is being righted with all of these decisions regarding budget cuts and firings and so forth. So let me just set the stage. There are many of you who likely listen to this podcast, and also listen to another podcast by American historian Heather Cox Richardson. A podcast that I find to be incredibly helpful, and I just want to set the tone for some of the discussions we're having today, because I think they really do give us a sense of what are the real issues before us. First, let me share with you what Miss Cox Richardson shared earlier this week in talking about what's happening with the action against the federal government employees and the freezing of budgets and so forth.

Dr. Osterholm: She said, and I quote, for example, Americans think that the US spends too much on foreign aid because they think it spends about 25% of the federal budget on such aid, while they say it should only spend about 10%, in fact, it spends only about 1% of our entire budget on foreign aid. Similarly, while right wing leaders insist the government is bloated, in fact, as Elaine Kamarck of the Brookings Institute noted last month. The US population has grown by about 68% in the last 50 years, while the size of the federal government's workforce has actually shrunk. It is smaller than it was 50 years ago. And as Cox Richardson said, what has happened is that federal spending has expanded by five times as the US has turned both to technology and to federal contractors, who now outnumber federal workers by more than 2 to 1. These contractors are concentrated in the Department of Defense. At the same time, the budget deficits have been driven by tax cuts under Presidents George W. Bush and Donald Trump, as well as the unfunded wars in Iraq and Afghanistan. In addition, the Treasury actually ran a surplus when Democratic President Bill Clinton was in office in the 1990s. When asked, Americans say they don't actually want to get rid of government programs. A late January poll from the Associated Press-NORC Center for Public Affairs Research.

Dr. Osterholm: A Gold Standard pollster for Public Attitudes found that only 29% of Americans wanted to see the elimination of a large number of federal jobs, with 40% opposed. 29% had no opinion. Instead, 67% of adults believed the US is spending too little on Social Security. 65% thought it was spending too little on education, and 62% thought it was spending too little aid for the poor. 61% thought it was spending too little on Medicare, and 55% thought that it was too little spending on Medicaid. 51% thought the US should spend more on border security. What Cox Richardson was really sharing with us here is that the actual perception of what is needed to be done to improve our lives, to make it better for all of us, is often at odds with the actual data. I share this part with you because while I'm not trying to make a political statement here, I'm just trying to bare the facts as they are and say, why are we acting as we are in terms of firing employees and what we're talking about with budgets? Well, we surely have a deficit. How does and where does that come from? We need to deal with that. None of us disagree with that. And if it means that we need to reduce the number of employees in our government, then we should do it with great surgical precision. Right now, what's happening is we're using a machete.

Dr. Osterholm: And in that machete, we are also not only ending the employment of a number of people, but we're ending the employment of critical people for our government. And I think we don't yet understand that this same type of thinking and the same type of action is actually playing out. With regard to Secretary Kennedy and his role now at HHS, what will happen? We believe there will be many actions taken which will not be in accordance with what the data tells us is actually real. We have to understand that we can feel bad about it. We can debate it. We can do all the things that will help nothing get done differently. And so now is the time that we really need to think about what is it that we can do to make a difference? Well, first of all, we know that public health in the very first instance is local. Today we're going to talk about that on the podcast in terms of some of the outbreaks that are happening and what's happening in state governments. I promised you that we would find ways, as part of the CIDRAP podcast family, to actually respond, to do something, not to just sit at home, wring our hands and think, oh my, the sky is falling. I know that's easy to do because I could do that myself, but I won't. I'm going to stand up.

Dr. Osterholm: I will promise you that we have some things in the works at CIDRAP, where we will be announcing them in the near future, that we are taking on specific aspects of what's happening right now, with productive ways that we can actually interface every day with whatever the current administration does, and we can help others do better. Trust me on that one. It's coming. But for you, I'm going to be talking today about events happening at the local level, vaccine policies or lack of vaccination overall science policies in general that happen in the school board meetings. They happen at city council meetings; they happen at regional health department meetings. They happen in county level meetings. These are the kinds of things right now. Please be involved, get involved, find out what the issues are and if they are not in keeping with the best of science and the information that we have and know, then you need to be involved. And yes, at the federal level, the courts are going to have to play a key role in however it this all works out. We know right now that we have compromised our public health response capacity. I'm going to talk about that today with very specific examples I know that that's something that you and I would like to change, but we can't necessarily do that. But there is another effort at the federal level to at least address that.

Dr. Osterholm: But again, let me focus the podcast listeners, particularly from the United States, because I know we have a number of international podcast listeners. We must start at the local level, and those of you who are listening outside the borders of the United States are not citizens of this country. Please hang with us. Our country has done so much good for the world over so many decades. Now is a challenging time. We need to hang together. We as Americans still care about you. We as Americans. As evidenced by the information presented by Heather Cox Richardson. We believe that foreign aid is important and that it should be available. We do believe in taking care of people. And so, as I start this podcast today and respond back to your very thoughtful question, Chris. What do we do with Mr. Kennedy? Well, we stay sharp, we stay alert. We understand what's happening. We anticipate the best we can, and we try to support all of ourselves who care. And we start at the local level. And so, I hope that this podcast provides you some of that information. I hope that it gives you a sense that we are not done in. We don't have to just sit there and take it. We can actually respond and hopefully for all of us, make it a better world over the next four years than otherwise would happen.

Chris Dall: So, Mike, you mentioned some of the job cuts at the federal level in that answer, and let's get into that. The confirmation of Robert Kennedy was followed the very next day by the news that the Trump administration was eliminating an estimated 5200 jobs from CDC, NIH, FDA, and other agencies within the Department of Health and Human Services. Now, we don't have an exact figure on how many people have been dismissed at this point, but it's clearly in the thousands. What kind of impact are these cuts going to have on these agencies and on public health?

Dr. Osterholm: Well, Chris, let me reiterate something I just said. We're here to call balls and strikes, and I'm going to try to do that the best I can with this information. Also, let me be very clear. I recognize we have a federal deficit issue that's very real. Now, one could argue that why does that deficit occur? Well, when you look at the current spending in this country and between looking at Medicare and Medicaid, Social Security and the Defense Department and interest on the debt, that covers a lot of it right there. All the other things we're talking about, the other departments that are of part of the federal system really contribute a very small part of that deficit. Now, we may need to cut workers in terms of reducing our deficit. But at the same time, remember that those are the easy cuts. It's cutting all of the other departments, particularly some of the larger ones like defense, that we have to deal with. So, I don't want to for a moment appear to be naive and think, oh boy, Pollyannaish, you should be supporting public health. So and so. But we have a return on our investment that is remarkable in public health. Now, Chris, in terms of the employees that you talked about, these cuts are going to be nothing short of devastating. My heart goes out to all of those who have been impacted by these layoffs, and the most of all, the confusion that's causing so many hard working, intelligent and talented people, many who are just entering the first days of their career are losing their jobs because of this administration's determination to, in a sense, dismantle the public health systems that keep people safe.

Dr. Osterholm: It is truly heartbreaking. Before I get into the consequences of these layoffs for public health, I want to clarify what we do and don't know. And there's a lot of rumors floating around out there and a lot of incorrect information, and I don't want to contribute to that. So, I will try to provide what numbers I have with all of the caveats of how I got them, where they came from, and why they might be wrong. The biggest thing that remains unclear is that many people will lose their jobs in the coming weeks. Initial reports suggested that 5200 jobs would be cut from the CDC and NIH. Then on this past Friday, the CDC was informed that around 1300 employees, which is more than 10% of their workforce, would receive notices of termination over the weekend. It left many people feeling desperate for now having lost their job. However, as of Tuesday, 750 CDC employees had actually received letters of termination. There were employees at the CDC with probationary status hired under what was called title 42.

Dr. Osterholm: I had talked about that before in previous podcasts. Title 42 employees are generally highly educated individuals who are hired with this status because it provides a greater flexibility for pay structure or through a fellowship program. I want to be clear that, contrary to what supporters of this administration may suggest, these fellowships are not wasteful. Government spending CDC fellowship programs like the Laboratory Leadership Service and the Epidemic Intelligence Service conduct absolutely essential outbreak detection and investigation services and provide the training grounds for our senior leaders of tomorrow. Fellows in these programs typically have doctoral level degrees, usually MDS or PhDs. Public health experience in this country is dependent on the people who work in these programs, and the experience they gain to be future leaders in the public sector and private industry. We know nearly all of the laboratory Leadership Service employees have been fired, leaving a gaping hole in our future disease surveillance infrastructure. Additionally, EIS officers were told on Friday to expect termination notices, but they did not receive them over the weekend. It is unclear now whether these layoffs are still yet to come, or if the administration has changed their minds. Similarly, the NIH has initially been told that 1500 jobs would be cut by the end of the weekend, but somewhere between 1000 and 1200 employees actually received termination notices.

Dr. Osterholm: In addition to the 750 title 42 employees that received termination letters, an additional 400 CDC employees took the deferred resignation buyout offer. It still remains unclear if they will actually see the money that they were promised by the federal government. This means that, at the very least, we may have lost over 1100 CDC employees, and if the administration follows through on the other layoffs they've threatened, we could lose a total of 1700 CDC employees, which is about 14% of their staff. And we will feel the impacts all across the country. It will take longer to detect outbreaks. And when they are identified, state and local health departments will lack essential support for CDC to respond. I will be blunt and say again that part of the reason for the uncertainty is that Secretary Kennedy has repeatedly changed the numbers he provides when asked about these layoffs, and in some cases, I believe he just hasn't been truthful, he said in an interview on Thursday that if you've been involved in good science, you'd have nothing to worry about. If you care about public health, you have nothing to worry about. Most of the termination letters that were sent used similar language, citing the ability, knowledge and skills of the employee, stating that their performance has not been adequate to justify further employment.

Dr. Osterholm: We know based on the layoffs that have occurred at CDC and NIH this past week, that couldn't be further from the truth. They have cut some of the best and brightest public health has to offer, who care deeply about the public's health and conducting good science. And finally, I just want to say that while all of this is devastating, none of it is surprising or should have been a surprise. This is exactly what was outlined in project 2025, a document that I detailed in one of our podcasts last November before the election. I bring this up not to let everyone know that, yeah, we thought this was going to be a serious problem, but because we need to take these people seriously, both with the administration, with policymakers in the future, I'm reminded of the Maya Angelou quote when someone shows you who they are, believe them the first time. This isn't about any kind of Partisan agenda. This isn't me telling you to always vote or never vote for one political party over the other. It's just a simple reminder that if political administrations promise to dismantle systems that keep this country safe and give us the quality of life we both hopefully desire, we must believe them or we will suffer the consequences. Now it's our job to figure out how to minimize those consequences.

Chris Dall: And for our listeners, stay tuned. We'll keep you updated on these job cuts as they happen. As it's become clear, things are happening very quickly in Washington and we are just trying to keep a pace of them as we can. Mike, I want to turn now to the news that NIH is planning to cut its indirect costs on medical research grants to universities and hospitals to 15%, a move that was supposed to go into effect on February 10th, but was subsequently halted by a federal judge in response to a lawsuit filed by the University of Minnesota and other universities. This feels like really old news at this point because so much is happening, but it's big news and it might all seem a little wonky to the general public. Mike, but can you explain why this is important and the impact it could have on medical research in this country?

Dr. Osterholm: Well, Chris, first of all, let me elaborate and just say that it's not just medical research. It's going to be all research. For example, the National Science Foundation, which funds some of the most critical basic physics, science and so forth in this country, is going to be on the line. Now, I recognize as a university professor someone who has now had a 50-year history with this university and am very proud of that. I am very proud of my association these past 50 years with this university. We are often seen as somehow the liberal elite, people who believe that they know more than everyone else. Well, let me just say, I hope that doesn't come across for me because I'm learning a lot every day. And thankfully to you and to the podcast team, you helped teach me that. But there is an important understanding that is really missing from this discussion about what is all this debate about funding and this thing called direct and indirect costs. And the indirect costs have been presented as universities way of just getting rich or stashing away big bucks. And that's not true. When you look at the direct cost of research, when we put in for a research project, we fund it with the people that are going to do the work, the immediate equipment in a given laboratory or whatever it's going to take. But we don't fund the building, the lights. We don't fund the laboratories that are highly specialized that we use sometimes, but they have to be there for whenever we need to use them.

Dr. Osterholm: We have many, many costs associated with how we do our research. The safety of the research, the oversight to make certain that we have no conflicts of interest among researchers, etc. When I think about those things, that's what we call indirect. So, I may have a project that is going to cost, let's just say $50,000, and it covers all the personnel costs. etc. etc. But because I need to draw blood samples from these people, and I need to have them run in a laboratory, and I need to have that laboratory be capable and available. Somebody has to pay for that. So, when I have direct costs, I cover everything that's directly in my control. But the university has to pay for all those buildings, all the information systems, the technology, all of that. That's indirect. Let me give you the best example I can think of. I own a trucking business. I get paid when I pick up a package at point A, and I end up driving it to point B, and I charge enough so that I pay for the cost of the truck upkeep, original purchase, I pay for the driver. I pay for the gas that's in the truck. I pay for insurance. I do all those kinds of things and then take that out of my profit. So, whatever I charge has to cover that. But what I don't pay for is the road that I'm driving on the interchanges, the intersections, the stoplights, the snow plowing, the pothole filling, all of those things.

Dr. Osterholm: I don't pay for that directly. That's indirect. That's what we as our governments pay for. But if that wasn't there, imagine the cost. It would be for me to try to drive my truck from point A to point B, but I had to make the road. Imagine what that would be. So think of indirect cost as the road, the intersections, the stoplights, the snow plowing, the fixing of the roads, the new bridges, all of that. That's indirect. That covers for everybody. The direct is my actual cost of taking that truck from point A to point B. Well, that's the way it is in a university. So, when we get paid a direct cost, we know how to negotiate that. And it's fairly straightforward. You can just lay out the cost. There it is. But the indirect is actually negotiated with the university and the NIH on a relatively frequent basis. So, if we have to buy million-dollar machines to do our work, which actually happens, we then have to pay for those. And it's interesting. So, we now have 55% indirect at the University of Minnesota. Meaning that if I basically have a grant for $100,000, there's an additional $55,000 that goes to the university to cover all these other costs. Well, that may sound exorbitant, but we surveyed a number of private companies that do a lot of work in research and therefore have direct and indirect costs of that. We found that on average, these companies spend between 1 and $5 for every dollar spent on direct as indirect, meaning that they spend more on indirect than they actually do on the direct itself.

Dr. Osterholm: And so, I think this is an important distinction. So please don't think that the universities are getting rich. Don't think that the universities are somehow out there to squeeze a little bit more out of the federal government when it's not deserved. Somebody has to pay for all that equipment that we use, all the things that we do, all the buildings that we have, all the electricity, all the IT issues, etc. That's indirect. So, I hope this is helpful in trying to kind of level the playing field on this discussion, because right now, 15% indirect to a university will mean the loss of millions, because we do millions and millions and millions of dollars of research. And if anyone ever has looked at the economic studies of what an institution of higher learning like, for example, my institution, the University of Minnesota, what that brings back to the state of Minnesota in dollars invested in our research versus the dollars that end up actually being in the state. It's a remarkable investment. It sure beats any stock market out there that I've seen. And so, I just hope that you can support us, because if we don't get this indirect, I can guarantee you we will shut down a lot of very important research, much of it lifesaving research, the kinds of amazing results that help us all live better lives.

Chris Dall: Mike, it should be noted that this arrangement that NIH has had with universities is one of the reasons why the United States is a leader in scientific research.

Dr. Osterholm: Thank you, Chris, for really bringing that point up, because that is often missed. We are the envy of the world for what we produce and how we produce it, and many of the benefits that we experience in our lifetimes come from basic research right here in our universities, whether it's about health issues, whether it's about environmental issues, transportation, all of these things I can go through over and over again. Much of the technology world today has had its basic research and development initially funded on university campuses, which then have allowed for an explosion of many of the very important tools that we use today. So yeah, we are the envy of the world. And I will say right now, if we shut down this research, it will start to get done in at least some ways, but not in this country. We're already learning of European universities and some in Asia that are just waiting to make offers to US based researchers who can't find work here because of our lack of awareness of what we're doing with this kind of machete approach to cost containment.

Chris Dall: Well, let's turn now to the latest respiratory virus trends, which, of course, is the very reason why we started this podcast. And for this episode, we're going to start with flu, because right now flu is everywhere. Mike, what is going on? And do we have any idea how this season's flu vaccine is performing?

Dr. Osterholm: Well, Chris, influenza is absolutely everywhere right now and it doesn't seem to be going anywhere just yet. In our last episode, we discussed the double peak and flu cases for the first time since 2019-2020 flu season. We were also nearing historic levels for the percentage of outpatient visits for influenza like illness, at 6.9% of all outpatient visits. Since that episode, it hasn't stopped, and we're now at 7.8%, the highest level for influenza like illness and outpatient visits in more than 20 years. Levels are elevated across the entire country, but highest in the South. 35 states and the District of Columbia are experiencing very high levels of outpatient influenza like activity. Nine are high. Two are moderate. Two are minimal, and only one is low. Vermont still has insufficient data to estimate what's happening. The age breakdown of these outpatient visits has remained constant, with the youngest age group having the highest percentage and the lowest in the 65 and older age group. However, the school age kids 5 to 17 years old, have the highest percentage of ED visits for influenza than any other age group right now. There are more than 50,382 patients admitted to hospitals with influenza over the past week. This is a 32% increase compared to our last episode with. At that time, we thought it was really high. We now have the highest hospitalization rates in the 65 and older age group. Since our last episode, there have been additional 21 pediatric deaths, making that 68 for the season, contributing to the 16,000 deaths since the beginning of the flu season.

Dr. Osterholm: Since our last episode. Flu deaths have actually outpaced COVID fatalities, with flu now accounting for 2.6% of deaths during the most recent week, compared to 1.5% for COVID. Now, as far as our vaccines are working, Chris, it’s tough to tell because we're still in the middle of the season. But there is a Canadian group, one very skilled in doing this work that performed a preliminary analysis based on specimens collected between October 27th, 2024 and January 18th of 2025. They estimated that the current vaccine is about 53% effective against H1N1 and 54% effective against H3N2. When I'm talking about effective, this means preventing someone having to actually seek out medical care, whether it be with a physician, an urgent care, or a hospital. So, think of that. The vaccine is still protecting you at least half the time against that kind of an event. Not a great vaccine in terms of perfection, but a darn good vaccine in terms of at least giving me some protection. So far this season, 48% of subtype specimens have been H1N1 and 51% have been H3N2, an amazing split right down the middle for these two viruses. Note that we've really seen no detection of any noticeable activity with H5N1, and I'll be talking more about that in a moment.

Dr. Osterholm: Historically, our flu vaccines have been anywhere from 19 to 60% effective. So the mid 50s is actually pretty good for what we have. We need improved flu vaccines, which is something I've said for decades. But for what we have now, I'll take 54% effective. And please note that our center continues to be actively involved in working towards getting new and better improved flu vaccines. I've talked about this before. We have what we call the influenza vaccine roadmap work that we're doing, and our goal is one day to get us a vaccine that has durable protection against all the different strains of influenza that might be seen in a given season, and with the idea that we get much, much higher protection. So let me just conclude by saying, yep, influenza is everywhere and it's not going away anywhere soon. This is proving to be truly a historic flu season for reasons we don't know why, but it surely is classified as a high severity season for every age group for the first time since the 2017-2018 season, please don't ignore this. Please don't. Get a flu shot yet, and please make sure your kids are vaccinated. It just isn't worth the risk. And although much of the flu season may be behind us, there are still a number of days ahead where a flu shot obtained now could still provide you with some very important protection.

Chris Dall: And what's going on with COVID and respiratory syncytial virus?

Dr. Osterholm: Well, the national COVID situation has remained relatively stable over the past few weeks. The national waste water level is still considered high, but is decreasing slightly. This decrease can be attributed to the south, which is the only region currently seeing wastewater concentrations decrease, although it is still considered high there. The Midwest is also experiencing high wastewater concentrations, while the northeast and the West are considered moderate. Hospitalizations and deaths attributed to COVID-19 are both decreasing for the most recent week of hospitalization data, which is for the week ending February 8th. 1.5% of inpatient beds and 1.4% of ICU beds were occupied by COVID patients. This is about 10,000 inpatient beds and about 1400 ICU beds, which is a 2.7% decrease respectively, for each. From our last episode, weekly deaths seem to have peaked a few weeks into the new year and are now decreasing this week, with the most recent complete data, we lost 922 Americans to COVID, which came right after a week with 983 COVID deaths. These are not the weeks during Omicron. We were seeing 25,000 deaths each week, but these are still devastating numbers, especially when you remember that these are not just numbers, these are people's loved ones. So far this year, there have been 2835 deaths with COVID listed as the underlying cause of death and an additional 1400 that lists COVID as a contributing cause of death. So COVID is still here, but fortunately, it's not the problem we're seeing like we are with influenza right now. Let's look at the breakdown of who is dying because of COVID-19 since the beginning of 2025, all COVID deaths have occurred in individuals who are aged 40. This is important to note in how it is in contrast to what we see happening with influenza.

Dr. Osterholm: 93% of individuals who have died from COVID have been in over age 65. This is the group that we surely should be targeting vaccine doses for. It's not too late to get your additional dose if your time to dose, meaning since your last one makes you eligible again. The older you are, the higher the risk of actually dying from COVID. And we do have to say right now we're in a good place with children. In summary, while we tend to report 65 and older groups as one block, the majority of COVID deaths this year have been in individuals over age 75. Hey, I'm not far from that. What this really highlights is the need for better and improved vaccines. We know that the current vaccines we have are good, but they're not great with efficacy waning significantly over time. We're several months out from the last doses, and I'm getting lots of questions about when people can get another dose, as I noted just a moment ago. The good news is that if you are 65 or older, you are eligible to receive two doses of the 24-25 COVID vaccine six months apart. So, you're probably getting pretty close to that point. Let me just say a few words about RSV. As far as it's concerned, there isn't much to say, Chris. The national wastewater levels are considered low and the emergency department visits are considered moderate but decreasing rapidly. Hospitalization for RSV has decreased since our last episode, with just under 6100 patients occupying inpatient beds and 1200 occupying ICU beds. The CDC estimates that since October, there has been anywhere from 6300 to 15,000 RSV deaths in the US. Still very sizable numbers. But the good news is RSV activity is on the decrease.

Chris Dall: Now it's time for our ID query. And this week we received a question from a listener who wanted to understand the reason why poultry farmers have to kill so many birds when they have outbreaks of H5N1 avian flu on their farms. They wrote in talking with the coworker, some questions about bird flu came up, and I don't have great answers. I suspect you can help us. The main question why are the birds being culled if the disease is no threat to us when the meat is properly cooked? As someone online pointed out, the infected dairy cows aren't being culled. I understand that's because the milk is being pasteurized and pasteurized milk is safe. So, could these birds, most of which likely aren't infected yet, be saved and still put into the food system? It seems like such a waste on several levels. So, Mike, this is a question I've had myself. Can you provide some insight on this and give us the latest numbers on the H5N1 outbreak?

Dr. Osterholm: Sure. Chris and I want to thank this listener for this very perceptive question. There are really two main reasons that production facilities holding poultry birds opt to call their flocks at the first indication of an avian influenza outbreak. The first reason is that H5N1 causes severe clinical illness in poultry birds, affecting multiple organs and leading to deterioration of their health, often within 48 hours of infection. The mortality rate in chickens is somewhere between 90 and 100%, meaning that almost all of the birds will become infected, will not recover. They will also suffer miserable deaths. I've seen firsthand what this disease can do to chicken flocks. And trust me, these are not healthy animals that you would want to continue to see suffering, much less feed to your families. So culling is really the most humane option in these scenarios. This stark outlook in poultry birds differs from the disease outlook we've observed in dairy cows, where far fewer animals develop symptoms or die from this condition. The mortality rate is less than 2% on the average among infected cows. I don't want to sound as if I'm minimizing the situation in dairy cattle, but there is a distinction in H5 clinical outcomes between poultry and cows. The second reason the facilities make the decision to cull their flocks, often as soon as the disease is indicated, is that they plan to seek compensation from the USDA Indemnity Program. This federal initiative aims to dampen the blow that facilities face by paying for some losses and costs associated with a high path influenza outbreak.

Dr. Osterholm: However, the important distinction that the USDA makes is that they will pay for live birds and eggs that must be destroyed, but not for animals that have died of H5N1. So there is an incentive by a farmer to detect and report positive animals as soon as possible to ensure that the farmers can get the highest settlement possible for their depopulated flock. But as we just discussed, the outlook for susceptible animals in H5 positive flocks is bleak. Live animals living in close quarters with infected ones are unlikely to see the other side of the crisis. I might add that at this point, there is a discussion that is ongoing with regard to the use of vaccines in poultry, and while they have not been used up to this time because it then creates a certain issue with international trade and whether the animals can be shipped to other countries. But in fact, I believe that you're going to see in the very near future that policy changing, just to see if that in itself will be effective in reducing the impact on poultry. The other issue to keep in mind is that the USDA has recently announced that because of the cost of these indemnification programs for H5N1 infected poultry, that they cannot continue at that rate to indemnify all these farmers. That is going to create an incentive, I think, for farmers to look carefully at what kinds of actions they can take to actually reduce Transmission of the H5N1 virus into these flocks.

Dr. Osterholm: Clearly, it is associated with biosecurity issues, meaning humans going from one farm to the other where they might carry the virus on their clothing, on their boots, etc. not cleaning in and out, going into a facility where they're supposed to shed their clothes, put on clean clothes, go, in some cases actually showering in and out. We just have a lot of problems, as I've talked about in previous podcasts, where I think we're seeing some wind driven virus getting into these barns off of fields where waterfowl have recently been, who also had H5N1 infection. That's going to be a much tougher road to hoe, and I think the industry really has to look at that. Let me just give a brief update on what's happening right now with H5N1 and the dairy cattle world. USDA APHIS has confirmed six more H5N1 detections in dairy cattle since our last podcast. Three are from California, two from Nevada, and now most recently one from Arizona. These last two states really reflect new spillover events, meaning that now, as opposed to the B3.13 strain of the virus that we've seen primarily in the dairy cattle outbreak. Now for both Arizona and Nevada, these actually are D1.1 spillovers into cattle. And these were picked up through milk testing. The national total is now at 972 herds. 77% of which are in California. I have concerns about the accuracies of these numbers, as we just found out that very recently, some of the data is now 2 to 3 months behind in terms of actually getting posted from herds that are found positive by states in terms of the bird poultry side of the house.

Dr. Osterholm: Hundreds of thousands more commercial birds have been hit by age five, many of which are egg layers, which is part of what is driving the egg prices so high in the US. The demand for eggs is the same, but the supply has been decreasing by the day. As was reported in mid-February. Of the 146 reported H5N1 detections in poultry in the last 30 days, 25 of them have been in commercial table egg laying facilities, affecting over 16 million birds. 17 of these operations alone were in Ohio. And just one footnote I think that's worth noting here surely has been a crazy week for the USDA, as well as it has been for the other government agencies with regard to individuals being fired. It turned out that on Friday, the USDA laid off 25% of their staff in the 14-person central office of the National Animal Health Laboratory Network. This is the Office that Coordinates frontline diagnostic components for outbreaks like H5N1, African swine fever and foot and mouth disease. Well, guess what? They realized that was a big mistake. And now as a result of that, they are attempting to locate these individuals who have had their computers shut off with email no longer existing, so that they can actually un-fire them and bring them back, realizing that it was a major mistake to have done that.

Dr. Osterholm: Let me comment briefly on human cases. There have been additional human cases of H5N1 detected in the US over the last week. A patient from Wyoming but hospitalized in Colorado who was likely exposed to infected backyard poultry, and a patient in Ohio who was in contact with deceased poultry from an H5N1 commercial population. And third, a patient from Nevada who was exposed to infected dairy cattle while working on the farm. The CDC website currently reports 68 confirmed cases of human H5N1 infection in the US, though this figure comes from limitations that existed before and after the new administration took office. 64 of the 68 cases were detected through targeted H5 flu surveillance and four were detected through national flu surveillance. Finally, a CDC study that was delayed in publication due to the communication halt finally came out from CDC last week. It found that three of 150 sero-surveyed veterinarians working with dairy cattle across 46 states were positive for H5N1 antibodies, although none recalled having any symptoms. These findings imply that the current case count perhaps somewhat significantly, underestimates the actual number of spillover cases. And what I mean by underestimates. I'm not talking about thousands or even hundreds necessarily, but it surely could be possible that we're seeing 2 to 3 times the actual number of cases in the community of infection versus ones we're picking up in clinical illness.

Chris Dall: Now let's turn to some other infectious disease news. And Mike, you alluded to this earlier. This is an issue that is taking on new prominence with Robert F. Kennedy Jr. As the secretary of the Department of Health and Human Services. There is a measles outbreak going on in Texas right now. What can you tell our listeners about it?

Dr. Osterholm: Well, Chris, these numbers are changing literally by the day. So, by the time anyone hears this particular podcast, they could have a significant increase in cases. But as of Wednesday, there were 58 measles cases reported so far in the Texas outbreak. Four have been unvaccinated people, and the rest were all in unvaccinated individuals or individuals with unknown vaccination status. 48 cases have occurred in children, six in adults and foreign individuals whose age is yet unknown. 13 of the 58 cases have been or are currently hospitalized at this time. This outbreak is occurring in a rural part of Texas where opposition to vaccines is common. In Gaines County, school children had an 18% vaccine exemption rate. This does not include their home-schooled children, who public health officials in the area speculate have even a higher rate of vaccine refusal. Many of the cases have been concentrated in the Mennonite population in Gaines County, which is highly under-vaccinated. I want to note that many of the measles cases have occurred in children who are home schooled, or who attend small private schools. There is a narrative among many anti-vaccine groups that home schooled children, or those attending smaller private or charter schools, don't need vaccinations because they lack significant exposure to these harmful pathogens. This could not be further from the truth.

Dr. Osterholm: Viruses like measles are so highly contagious, and large schools and daycares are certainly not the only way to be exposed. All children, including those who are home schooled or go to very small schools, need these lifesaving vaccines. Local public health in Texas is responding. As of right now, 2000 additional doses of the MMR vaccine have been sent to the area with hopes of getting children vaccinated. Many potentially vaccinated children who were exposed to have received an additional dose to boost their immunity. Unfortunately, there has not been a large uptake of the MMR vaccine among the unvaccinated population in the Gaines County area. Sadly, because of the low vaccine uptake and the nature of the measles virus, I expect that we'll see many more cases occur, both reported and unreported. This is not at all unexpected, considering the low vaccination rate and the lack of herd immunity in this area, but it is a tragic situation nonetheless. The MMR vaccine has an excellent safety profile, is highly effective, has prevented disabilities, and saved so many lives over the years. The fact that public health in our country is now being led by someone who has made a career out of discouraging this vaccine in particular, and spreading disinformation about it, is truly an unfortunate situation.

Chris Dall: Well, Mike, that measles outbreak and this next item brings us back in a way to where we started this episode. Last week, Louisiana Surgeon General Ralph Abraham ordered staff at the Louisiana Department of Health to stop engaging in media campaigns and community health fairs to encourage vaccination. He also wrote a post on the department website explaining his justification for the move. Here's some of what Abraham wrote: There are some appropriate examples of government recommendations, such as encouraging routine screenings like colonoscopies or pap smears, and facilitating access, especially for the poor. But promotion of specific pharmaceutical products rises to a different level, especially when the manufacturer is exempt from liability for harms caused by the drug, as is the case for many vaccines. It is understood that the products pushed will benefit some and cause harm to others, but public health pushes them anyway with a one size fits all collectivist mentality whose main objective is maximal compliance. Abraham went on to say, As Americans, we should recognize that our rights come to us as individuals. We should reject this utilitarian approach and restore medical decision making to its proper place between doctors and patients. Mike, is this the message we're going to be hearing from like-minded states and maybe at the federal level over the next four years?

Dr. Osterholm: I don't know, but I fear that you may be right. This message from the Louisiana Surgeon General is both infuriating and heartbreaking. How do I even begin to respond to this mockery of life saving science and national embarrassment? Anti-science messaging is much, much more than just words. It also results in the potential of serious illness and deaths, among most of all, our youngest of our citizens. Unfortunately, this message is becoming commonplace with friends, family and on social media. The suggestion that individuals should rely solely on their doctors is simply unfeasible. Louisiana, for example, faces a significant shortage of primary care physicians, with 60 of the state's 64 parishes designated as health professional shortage areas. This means nearly every region of the state has a patient provider ratio exceeding 3500 to 1. Low-income families are especially vulnerable, as they are disproportionately impacted by this health care deficit, and their ability to access care only worsens with potential rollbacks to Medicare and Medicaid. We do not exist as isolated individuals. No, we do not. Rather, we live with interconnected communities, large and small and sometimes complex. We rely on each other for our collective health and well-being, whether it's following traffic safety laws or getting vaccinated to protect ourselves and those around us. We must work together to promote the public's health. Vaccines, in particular, serve as a cornerstone of this effort. By preventing disease outbreaks. We've seen firsthand how crucial immunizations like the MMR vaccine are to safeguarding our communities. Why would we want to revert to a time when you no longer are protected by the collective strength of our communities. The most tragic part of reading this announcement is we know it will undoubtedly cause harm to those most vulnerable our children, the sick, the elderly, and the poor. There have been countless lives saved by safe and effective vaccines growing the actual number of preventable infectious diseases. It's unethical to censor a public health guidance, and to cherry pick what information that you allow your constituents to access, plain and simple. Case closed.

Chris Dall: Now it's time for this week in public health history. And Mike, I'm starting to think of this as our second light segment because it brings some brightness amidst all the darkness. Who are we celebrating this week?

Dr. Osterholm: Chris, for our Public Health History segment this week, I want to talk about one groundbreaking institution, its impact over the last 130 years and what is at stake now. In 1887, a young physician, Joseph Kenyon, started a one room laboratory at the Main Service Hospital in Staten Island, New York. The entire Marine Hospital Service was funded by a collection of $0.20 from each service member's monthly paycheck. Doctor Kenyon's laboratory was quick to make public health contributions, isolating cholera bacteria with his microscope to demonstrate the importance of confirming diagnoses for clinical and public health purposes. Doctor Kenyon remained the only full-time staff member for decades, but did begin to train junior scientists on monitoring air and water quality near Washington, D.C. by 1901, Congress appropriated $35,000 to construct a laboratory in the capital with the purpose of primarily investigating infectious diseases. As the laboratory grew, it began to encompass other scientific areas, from chemistry to zoology. The staff also grew to include not just physicians but PhD scientists and expanded to basic science discoveries rather than just clinical and translational studies alone. In 1930, Congress passed the Ransdell Act, which changed the name of the Hygienic Laboratory to the National Institute of Health, or NIH. Most importantly, it authorized fellowships for early career scientists to train with some of the best of the best and further the country's and the world's understanding of basic science and medicine. I think it's really important to note this happened in the midst of the Great Depression, an incredibly difficult economic situation. And yet public funding for research was seen as a critical investment.

Dr. Osterholm: The NIH continued to flourish with new support and funding on issues from cancer to industrial hygiene. By the end of World War Two, each division and the agency were implementing grant programs for nonfederal scientists and fellowships to scientists and training to continue to expand on the boom in scientific knowledge at this time, during what is known as the Golden Age of the NIH. The agency's budget expanded from $8 million in 1947 to more than $1 billion in 1968. I could go on for hours, perhaps even every podcast, for the rest of the year. On the numerous accomplishments both federal scientists and grantees supported through the NIH, 174 scientists supported by the agency have achieved Nobel Prizes in 2023. The agency distributed nearly more than $35 billion in grant awards to more than 2500 universities, hospitals, small businesses and other organizations in the US and around the world. This funding supports nearly 300,000 scientists each year. That includes approximately 30,000 graduate students and 30,000 postdoctoral trainees who conduct research that is essential to advancing science, medicine, and public health. The NIH is the backbone of science. Defunding this institution and laying off staff will have an unspeakable toll on this country in the world that will be felt for decades, if not generations. To the NIH scientists, trainees and students listening. Thank you for your incredible contributions to the world. We will continue to fight for you because our lives and those of our kids and grandkids depends on you.

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

Dr. Osterholm: Chris, as I said at the beginning of the podcast, we were going to cover a lot and I was going to try to leave you with the idea with things we must and can do. And yes, these are dark days for public health. Things are going to get more challenging, but we cannot. We cannot give in and give up. We must be part of what is the solution. And what this means right now for most of you is get involved locally. Get involved in your school boards, your city councils, your county meetings. Write your legislators. Make sure that what you're doing in your communities still uphold the best in public health. Continue to talk to your congresspeople. Make certain that they understand the importance of what is happening in your district. Is all about the support from Washington, DC. CIDRAP will come forward in the near future with actual things that you can do that will affect more of a national information perspective. Just know that it's coming and understand that the public's perception right now of what is happening is, at best confused. As I shared with you the comments from Heather Cox Richardson, the problem with financing our government isn't about how many people work in the federal government. The issue with a deficit is real. Not denying that, but the solution should take carefully crafted and understood precision action.

Dr. Osterholm: Surgical knives should be used in each and every situation to really get at what that cancer is that's there. We need to get rid of machetes. Will never work. The collateral damage is huge and it will be unsuccessful. The second point. We must not back down. Don't. Don't back down. Don't get discouraged. Hang in there. Stick with it. Whatever the cause is. And it might not be just about public health, you know, it may be all about the issues of the environment. It may be about the understanding of what happens in the education of your children. Get involved now. Understand what the issues are and use all your heart and soul to fight for them. And finally, I just want to add that because influenza is still causing such damage to our society, please, if you have not been vaccinated, you're over age 65 in particular. Get vaccinated. And as we're seeing this big increase in kids and serious illness, hospitalizations and now deaths. I would surely recommend your kids getting vaccinated, but you need to do it as soon as possible, because I don't know how many more weeks we have left of this high number of cases. But even if you have some protection in the first ten days, you will surely reduce the risk of yourself, your children, your loved ones in general, developing a severe influenza illness.

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

Dr. Osterholm: Well, Chris, I again wanting to leave all of us on somewhat of a brighter mood than much of the podcast. We give you a reason to do. And you know how I am with my oldies but goodies. I love them, okay. I can't help it. So, I've picked one that I've used four other times on the podcast. I think this is almost a record on December 10th of 2020. Way back in episode 35, the title was The Last Mile to the Last Inch on November 18th, 18, 2021. In episode 78 Breakthroughs and Boosters on December 29th, 2022, in episode 121, it was thank you, Doctor Jenna. Part two. And finally, the last time I used it was in October 17th, 2024. In episode 168 Better Times. This is a song that will be familiar to many of you. It's one that I simply love and it is timeless for me. The Rainbow Connection is a song from the 1979 film The Muppet Movie, with music and lyrics written by Paul Williams and Keith and Kenneth Ascher. The song was performed by the late Jim Henson as Kermit the Frog in the film. Rainbow connection reached number 25 on the Billboard Hot 100in November of 1979, with the song remaining in the top 40 for seven weeks in total. Notably, Williams and Ascher received an Academy Award nomination for the Best Original Song of the 52nd Academy Awards In 2020, Rainbow Connection was deemed culturally, historically, or esthetically significant by the Library of Congress and selected for preservation in the National Recording Registry. Here it is. Rainbow connection as sung by Jim Henson. 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.

Dr. Osterholm: 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 someone believed it. Look what it's done so far. What's so amazing that keeps us stargazing? And what do you think you might see? Someday we'll find it. The rainbow connection. The lovers, the dreamers and me. A thank you so much for being with us again. I hope we were helpful to you in terms of understanding the many challenges we face today. We clearly need to hang together as this podcast family, and we need to do what we can to not only respond to the challenges we are seeing coming from Washington, which is to help all of our own family members who are hurting our friends who are hurting. That's such an important task right now and a gift that we can give each other. I want to again thank the podcast team for their efforts here. Chris. Thank you. You keep the ship on the straight sail. I also want to thank you for your comments. I love the pictures, by the way, that are coming in from the Occidental Belgian Beer House. It turns out that this is becoming a podcast haven. Uh, just in the past week, we've had several parties from the United States who have been down there and have and sent us their pictures. So, thanks again and please be kind. Right now, be safe and be brave. Thank you so much.

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