Senate Republicans and the White House yesterday agreed to a plan to remove $400 million in cuts to the President's Emergency Plan for AIDS Relief (PEPFAR), as part of negotiations under way on President Donald Trump's $9.4 billion recissions package, Politico and other news outlets reported. The announcement was met with praise and relief from many public health experts.

Launched in 2003 under former President George W. Bush, PEPFAR has been one of the marquee US foreign health policy programs and has been credited with saving 26 million lives. It was among the funding pauses and cuts announced in the early days of the second Trump administration, and a recent study suggested that PEPFAR's elimination could lead to 500,000 child deaths over the next 5 years, with 1 million more infected and 2.8 orphaned after their parents die.

Testament to strong bipartisan support

PEPFAR had traditionally received strong bipartisan support, and multiple Republican senators have raised concerns about cuts to the program. The White House also signaled potential plans to protect programs related to maternal health, malaria, tuberculosis, and nutrition.

Following the announcement, the Infectious Diseases Society of America and the HIV Medicine Association issued a statement saying reports that the Senate and White House will amend the recissions package to exclude cuts to PEPFAR is a testament to strong bipartisan support for the program. "While we agree that preserving PEPFAR funding is crucial, the infrastructure and other programs that support its implementation must also be saved from funding rescissions for it to be fully effective."

The groups pressed lawmakers to preserve global health programs that address TB, malaria, and child and maternal health through the State Department, USAID, and other lifesaving programs "to ensure that decades’ worth of U.S. investments are not wasted."

A new review published in JAMA Network Open describes how often ethics are incorporated in infectious diseases international clinical practice guidelines (CPGL) and finds planning and actual consideration of ethical issues in infectious disease CPGL are limited.

To perform the analysis, the authors conducted a systematic search for CPGL specific to infectious diseases published between January 2021 and December 2023 in three guideline databases, most from high-income countries. 

The authors of the study reviewed 115 CPGL and found only 32 (27.8%) dedicated a section or paragraph to ethical considerations. Only a single CPGL mentioned issues of gender balance policies in authorship.

Affordability most often addressed

Costs of diagnostics and treatment affordability were mentioned in 53 guidelines analyzed, while 41 guidelines mention cost or benefit centered on the patient. Access to care was addressed in 50 of the guidelines, but allocation of resources was addressed in only 35 of the guidelinesanalyzed. 

The most common ethical issues addressed were related to justice (including affordability and access to care).

“Less than a third of CPGL dedicated a section or paragraph to ethical considerations, and only half of guidelines addressed minority populations,” the authors wrote. “The most common ethical issues addressed were related to justice (including affordability and access to care).”

The authors said more planning for and attention to ethical considerations is crucial. 

“Complex ethical issues apply to the field of infectious diseases because of disproportionate disease burdens in vulnerable populations and the public health risks related to the spread of infection,” they wrote.

Allowing nursing-home visitors was safe for residents during the COVID-19 pandemic—even during community case surges and before vaccine availability, concludes a study published yesterday in the American Journal of Infection Control.

An Emory University–led research team analyzed and modeled weekly data on visitor policies, resident COVID-19 infections, and community case rates from 677 Ohio nursing homes from November 1, 2020, to January 3, 2021.

"Nursing home residents were particularly vulnerable to COVID-19 with over 100,000 COVID-19 related deaths reported in 2020," the authors wrote. "As a response, in March of 2020 the Center for Medicare and Medicaid Services recommended, and most states issued, bans on outside visitors to nursing homes." 

Ohio was the only state that collected facility-level visitation data after ending its visitor ban on October 29, 2020.

Role of infection-control measures

In total, 226 to 327 nursing homes allowed visitors during any week of the study period, 316 to 448 banned visitors, 207 always allowed visitors, and 289 always prohibited them. 

Allowing visitors in the context of adequate personal protective equipment and social distancing was safe, even in a period with large increases in community infection rates and before vaccine rollouts.

Among nursing homes that permitted visitors in a week in 2020, the proportion with a new COVID-19 case rose from 9.5% the week of November 1 to 49.3% the week of December 6. A similar increase was seen among nursing homes that forbade visitors. Except for the first 2 weeks of the study, there were no differences in infection rates between the two facility types. 

Marginal models suggested that visitors weren't linked to the unadjusted rates or adjusted odds of new infection among residents (odds ratio, 0.92). 

Several factors may have influenced the findings, including partial resident immunity from COVID-19 infection early in the pandemic and the strict infection-prevention measures that may have been in place when allowing visitors, the researchers said.

"Allowing visitors in the context of adequate personal protective equipment and social distancing was safe, even in a period with large increases in community infection rates and before vaccine rollouts," they wrote.

• In its latest weekly update today, the US Centers for Disease Control and Prevention (CDC) today reported 21 more measles cases, bringing the national total since the first of the year to 1,309 cases in 40 states. Two more outbreaks were reported, putting the total at 29 for the year, up dramatically from all of 2024, when 16 outbreaks were confirmed. So far, 88% of the nation's cases have been linked to outbreaks, and 92% of people infected with the virus this year were unvaccinated or have an unknown vaccination status. Last week, the United States passed the post-elimination record number of cases set in 2019. Many of the cases earlier in the year were linked to a large outbreak in West Texas, but since then there have been numerous smaller outbreaks in undervaccinated populations as well as sporadic travel-related cases.
• Quest Diagnostics yesterday announced the launch of a new diagnostic test for Oropouche virus, a disease primarily spread by biting midges and some mosquito species that has spread in parts of the Americas, including the Caribbean. In the United States, several infections have been reported in people exposed during travel to Oropouche outbreak areas. In a statement, the company said the polymerase chain reaction (PCR) test will be available with a prescription by the end of the month and that its advanced lab in San Juan Capistrano, California, will perform the test. Serology testing will be available by the end of the quarter.
• The US Department of Agriculture (USDA) yesterday announced new measures to reduce foodborne illnesses. USDA Secretary Brooke Rollins announced the measures during the opening of the new Midwestern Food Safety Laboratory in St Louis. Some of the steps include quicker and broader Listeria testing, updating training and tools for Food Safety Inspection Service (FSIS) inspectors, reopening stakeholder discussion on strategies to reduce Salmonella illnesses, strengthening state partnerships, and empowering the FSIS inspectors to take compliance actions.