Katherine J. Wu | The Atlantic

A Cancer Treatment That Does More Than Scientists Thought

2026-04-09T11:00:00-04:00

By the time Fabian Müller met the patient at the center of his newest research paper, he was fairly certain that an experimental treatment was her last hope. The patient, a 47-year-old mother of two, had for years been battling three severe autoimmune diseases, all of which were triggering her body to attack components of her blood. Her doctors had made nine separate attempts to treat her conditions, but none of them had worked. By the start of 2025, she’d been confined to a hospital in Dresden, Germany, for more than two months, being dosed with multiple immunosuppressive drugs and receiving up to three daily transfusions of red blood cells, as her care team tried and failed to control a massive disease flare.

In desperation, the woman’s care team reached out to Müller, a hematologist-oncologist at the University Hospital of Erlangen, a roughly three-hour drive away by ambulance. In recent years, he and his colleagues have made a name for themselves pioneering experimental CAR-T cell treatments—a type of personalized immunotherapy originally developed for cancer—against a variety of autoimmune diseases, with promising early results. Small studies of CAR-T, as well as early results from several ongoing clinical trials, show that many people with autoimmune disease go into remission after treatment; some patients are now years out from CAR-T cell therapy and remain in good health without the help of any drugs. Müller hopes that this latest patient—the most complex autoimmune case to receive the treatment to date—will soon be able to say the same. She received CAR-T treatment early last year and has since returned to a mostly normal life. After years of being intermittently lashed to machines and tubes, she hasn’t needed a hospital stay in many months. (The patient has asked to remain anonymous to protect her privacy, Müller told me.)

Müller and other CAR-T researchers are cautious about forecasting the future of their technology. CAR-T is brand-new to autoimmune disease—it was first trialed in a patient in 2021—and scientists still aren’t certain how long remission might last or whether patients might experience long-term side effects. But for the first time, patients with some of the world’s most severe autoimmune conditions are entering prolonged remission after a one-and-done treatment. And many researchers are starting to think that CAR-T may offer people with autoimmune disease a new kind of hope: the possibility of permanent recovery.

Autoimmune diseases—a broad and complex category of ailments including rheumatoid arthritis and type 1 diabetes—have long puzzled researchers. For reasons that are still poorly understood, the body’s immune system, normally tuned exquisitely to root out and destroy invasive pathogens or sickly cells, begins to assault healthy cells instead. Although the conditions can be managed, usually with immunosuppressive drugs, scientists have never figured out a way to permanently jolt the immune system back on track.

CAR-T therapies could be exactly the kind of factory reset that the immune system needs. The treatment involves reengineering T cells—a type of immune defender—into chimeric antigen receptor T cells (hence, CAR-T) that can kill other cells of scientists’ choosing. In the case of many autoimmune diseases, that means targeting B cells, another variety of immune cell that is commonly responsible for the body mistakenly turning on itself. CAR-T treatments wipe out the misbehaving cells, allowing the body to, theoretically, restock its B cells with ones that leave healthy tissues alone.

So far, that theory has panned out. Early experiments—many of them headed by Müller’s team—suggest that CAR-T therapies can work against several different autoimmune diseases, including myositis, systemic sclerosis, ulcerative colitis, and myasthenia gravis, with few side effects. Across trials, including several recent studies from Müller and his colleagues, most of the dozens of lupus patients that researchers have infused with CAR-Ts have gone into remission, and stayed there for many months. Overall, CAR-T has been astoundingly successful against autoimmune disease, Marcela Maus, the director of the Cellular Immunotherapy Program at Massachusetts General Hospital, told me, especially considering CAR-T’s somewhat spotty track record against certain cancers. These experimental treatments also offer a major lifestyle improvement over traditional management of very severe and complex autoimmune disease, which can entail a lifetime of regularly dosing immunosuppressive drugs. And although CAR-T can trigger extreme inflammatory responses in some cancer patients, those risks don’t seem as common in people with autoimmune disease.

[Read: A ‘crazy’ idea for treating autoimmune diseases might actually work]

Müller’s recent patient still presented a new puzzle—not least because she suffered from three separate autoimmune diseases. In 2014, around the time she had her first son, she’d been diagnosed with autoimmune hemolytic anemia, in which the body rampantly annihilates its own red blood cells. Shortly after, she developed two other autoimmune conditions: one that caused her blood to clot excessively, and another that destroyed platelets, making her more prone to uncontrolled bleeding. Before falling ill, the patient had been active, energetic, “always doing a million things at once,” Müller told me. Within a few years of her diagnosis, though, she was struggling through daily tasks, unable to work, hospitalized for months every year. Her younger son, who’s about 8 years old, knew his mother “only as a sick person,” Müller said. In early 2025, the patient told Müller that she was willing to try whatever he and his colleagues had to offer. With each additional day of intensive, unsuccessful treatment, her risk of a serious complication was rising while her chances of survival were ticking steadily down.

Early last year, Müller and his colleagues extracted the patient’s T cells, programmed them to destroy most of her body’s B cells, and then infused the modified T cells back into her body. Her B cells quickly began to disappear, and within weeks, her bloodwork began to look roughly normal. A year out from treatment, she still has lingering fatigue, and has to undergo weekly bloodletting to purge the iron that built up in her body after receiving so much donated blood. But her outpatient doctor manages that care, and she no longer depends on drugs or blood transfusions. She’s spending time with her children in ways she never could before. As far as Müller’s team can tell, the treatment accomplished the immunological reboot they hoped for: Her body has since produced new B cells, and they so far seem unperturbed by any components of her blood, just as immune cells should be.

Not everyone will be so lucky. CAR-T therapy can cost hundreds of thousands of dollars or more. Germany allows people with serious autoimmune conditions to receive the treatment on the basis of compassionate use, and covers it through the country’s universal health-care system. But in the United States, the only reliable access to CAR-T for those patients comes through sparse clinical trials. Some researchers worry that certain patients won’t stay in remission, perhaps because they carry some sort of predisposition to generate rogue immune cells. And certain autoimmune diseases—especially those that might not hinge on misbehaving B cells—may be harder to treat with CAR-T. Wiping out a lot of T cells, for example, carries a high risk of pushing someone into an immunocompromised state, similar to AIDS, Avery Posey, a CAR-T expert at the University of Pennsylvania, told me. But new developments are in the works that could address some of those issues, Posey said. Scientists are tinkering with new ways to generate CAR-T cells more efficiently and cheaply, including via injections, somewhat similar to vaccines, that can coax patients’ bodies into reprogramming some of their T cells—that is, generating their own CAR-Ts in house. In some cases, the subsets of cells that CAR-Ts target can also be narrowed, so that only the body’s most problematic cells are taken out of commission, while healthy immune cells remain intact.

Müller remains encouraged by the fact that his first autoimmune patient, a young woman with lupus, is still doing well more than five years out from her CAR-T treatment. She’s since gotten her master’s degree and now works at his hospital, running clinical trials; they wave when they glimpse each other in the cafeteria. For now, her immune system seems to be behaving just as it should.

HHS Officials’ Year in Purgatory Is Ending

2026-03-31T18:17:58-04:00

Last week, the Department of Health and Human Services finally followed through on a plan it first outlined for several of its top officials nearly a year ago: It reassigned them to positions in the Indian Health Service.

Many of the officials who were sent the reassignments—a group that includes at least half a dozen top-ranking employees at the National Institutes of Health, the CDC, and other agencies—have been on administrative leave since last spring, when they were abruptly ousted from their roles without explanation, or any indication of how long their hiatus might last. So they were shocked last week when, with no preamble, they received phone calls, then a letter, informing them of their new role, and an April 8 deadline to decline or accept.

In most or all cases, accepting these new roles would represent a major career shake-up and force a move across the country: Many senior HHS officials are based in Maryland—where the FDA and the NIH are located—or near Atlanta, where the CDC is headquartered; the recent letters lay out reassignments to places such as Arizona, New Mexico, Oklahoma, North Dakota, and South Dakota. If the officials accept the reassignments, they’ll be expected to report for their new jobs no later than May 26. If they decline, the officials expect to be removed from federal service entirely.

I spoke with two of the letter recipients, along with several former HHS officials who were also placed on leave by the administration last spring; all of them requested anonymity to avoid professional repercussions. For several of the reassigned officials, April 1 will mark the one-year anniversary of when they were put on administrative leave, shortly after HHS initially proposed via email to reassign them to IHS. The two officials who recently received reassignments also told me that last week is the first time they’ve heard from HHS since May or June 2025, when they were asked to provide their CVs. After being left for so long in limbo, then given so little time to make this choice, some officials feel like HHS is pretending it didn’t ghost some of its highest-ranking, highest-paid employees for the better part of 12 months. “Honestly, it’s hilarious,” one official told me: HHS did do what it said it would. It just took a year to do it.

When reached for comment, Emily G. Hilliard, HHS’s press secretary, emphasized in an email that HHS was dedicated to improving the IHS and that “each executive who joins IHS will strengthen leadership capacity and support mission delivery.”

IHS is, unquestionably, in need of more staff, especially in its more rural and remote locations. For years, the agency’s vacancy rate has hovered around 30 percent (and, for certain roles, has climbed higher in some regions). Last spring, when dozens of HHS officials were initially put on administrative leave, Thomas J. Nagy Jr., HHS’s deputy assistant secretary for human resources, wrote to them in an email that American Indian and Alaskan Native communities deserve “the highest quality of service, and HHS needs individuals like you to deliver that service.” In January, the IHS also announced what it described as the “largest hiring initiative” in its history to address staffing shortfalls, noting that the effort had the full support of HHS Secretary Robert F. Kennedy Jr., who has described tribal health as a priority.

But the reassigned officials and the tribal-health experts I spoke with both questioned how well the new reassignments fit current IHS needs. The primary feature of the re-assignees, as a group, is that they were high-ranking officials with extensive experience in administrative leadership; many were running departments of hundreds of employees or more. Among those who received the proposed reassignment last spring were the directors of several NIH institutes, leaders of several CDC centers, a top-ranking official from the FDA tobacco-products center, a bioethicist, a human-resources manager, a communications director, and a technology-information officer. Meanwhile, IHS’s greatest need is for “hands-on clinical people,” such as physicians and nurses, David Simmons, the director of government affairs and advocacy at the National Indian Child Welfare Association, told me. “People in communications, HR, researchers? Those are not going to be the people who are going to be helpful on a daily basis,” Simmons said. “On some level, I have to ask the question: Why are they sending these kinds of people?”

Last week’s letters, also signed by Nagy, described new IHS positions, multiple of them located at small hospitals in some of the country’s most rural and remote regions, several officials told me. The roles come with titles such as “Chief of Staff” and “Senior Advisor,” but the letters don’t describe the specific responsibilities attached to those positions. I asked one official whether their credentials lined up in any way with their reassigned role. “Zero,” they told me. If senior-executive officials accept the reassignment, the letters say, they will keep their current salaries—a minimum of about $150,000, though many high-level reassigned officials make far more, two officials told me. The IHS will likely be responsible for the salaries of reassigned officials, one NIH official told me, even though its budget is a small fraction of the NIH’s; the official told me that, as far as they could tell, they would be making about as much as their new supervisors.

To build trust and effectively deliver care, health officials need to be deeply familiar with tribal communities’ needs and should have an understanding of the local culture, Simmons told me. In 2023, American Indians and Alaskan Natives had lower life expectancy at birth than any other racial and ethnic group in the United States; Native people are especially vulnerable to conditions such as asthma, diabetes, and substance-use disorder. Tribes also have a long history of being severely mistreated by the federal government. But the officials I spoke with told me that they were not aware of any reassigned individuals who identified as Native or had extensive background in working with such communities. Last year, Deb Haaland, a member of the Pueblo of Laguna and a Democratic candidate for governor of New Mexico, criticized the reassignment proposals as “shameful” and “disrespectful.” The experts I spoke with also weren’t aware of any attempts HHS had made since to thoroughly consult tribal leaders about these reassignments; in at least one case, when a reassigned official tried making contact with their new hospital, with their new hospital, their new supervisor expressed confusion about who the official was or why they were reaching out at all, three current and former HHS officials told me. (Hilliard did not address my questions about whether the IHS or tribal leaders had been consulted about the reassignments, how qualified the reassigned officials were to meet the agency’s needs, or why HHS made the reassignments now.)

Meanwhile, health experts across the country have felt the loss of these officials from top tiers of HHS, especially agencies that focus on public health. “At the local health department level, we depend on their expertise,” Philip Huang, the director of Dallas’s health department, told me.

What prompted HHS to finally end these officials’ administrative leave is unclear; many officials had wondered if their hiatus might stretch on indefinitely, until they themselves chose to resign, as many of their colleagues have. The action may have been triggered by guidance from the Office of Personnel Management, released after the officials were first put on leave and newly effective in 2026, that limits administrative leave connected to workforce reassignment to 12 weeks. The end of March coincides with that limit.

No matter the trigger, the officials I spoke with told me they feel roughly the same as they did a year ago: “They obviously don’t want us to take these jobs, and want us to leave on our own,” one official said. Firing federal officials is difficult, especially without clear cause, and none of the officials I spoke with could identify a valid reason that they or their colleagues had been in federal limbo since last spring. The officials I spoke with uniformly emphasized that filling IHS with qualified people is essential, but added that they didn’t fit the bill. And several officials told me they worry that, should many of the reassigned officials reject the government’s offer, IHS will have a harder time attracting the personnel it needs. HHS’s “goal is to get people out, and I think that has been the goal from the beginning,” another official told me. “It’s cruel and unkind and unprofessional.”

Some of the letter recipients still feel extreme pressure to accept their reassignment. One told me that they’re just weeks away from full retirement eligibility but can’t run out the clock before the acceptance deadline passes. “I might have to move,” the official said. And, as federal policy states, if HHS pays for any part of their relocation, they’ll have to remain in a federal job for at least a year. (Early-retirement options do exist, with fewer benefits; another official told me they’re taking this option, and accepting another job elsewhere.) Still, even as officials weigh their decision, they feel a new sense of finality: Their administrative leave is ending, and whatever hope they might have had of returning to the agencies they once worked at has been extinguished.

A New Level of Vaccine Purgatory

2026-03-18T11:50:22-04:00

On Monday, a federal judge issued a preliminary ruling with a harsh reprimand for the Trump administration: You’ve done this vaccine stuff all wrong.

The Trump administration likely broke the law, the judge’s 45-page decision argued, when it dismissed and abruptly reconstituted the CDC’s expert vaccine-advisory panel last June, stacking the committee with members who have aggressively questioned the safety of vaccines. Top health officials also probably acted illegally, the ruling said, when they made sweeping alterations to the nation’s childhood-immunization schedule in January, without the input of their own, remade panel.

If the decision becomes final, it stands to all but wipe away a year’s worth of vaccine-policy change at the CDC. The judge’s ruling calls for staying “all votes taken” by the panel since Health and Human Services Secretary Robert F. Kennedy Jr. remade it—essentially resetting the United States’ vaccine-policy clock to early 2025. But the ruling remains preliminary, and the Trump administration has already hinted at its intent to appeal. Andrew Nixon, the deputy assistant secretary for media relations at HHS, did not respond to a request for comment, but he told reporters this week that “HHS looks forward to this judge’s decision being overturned just like his other attempts to keep the Trump administration from governing.”

Since the Trump administration took office, states and professional medical societies have broken with the CDC, vaccine recommendations have splintered, and trust in federal health agencies, especially in their vaccine advice, has plunged. This latest ruling shifts the nature of the United States’ vaccine chaos, but the turmoil is far from done: Lawyers and judges could be arguing for months over who has the authority to set U.S. vaccine policy.

As things stand, the CDC’s national immunization schedule—and the primary committee that shapes it—is in a kind of purgatory. The current roster of the panel, the Advisory Committee on Immunization Practices (ACIP), should never have come to exist at all, the judge wrote, because it violated the Administrative Procedure Act: When Kennedy fired all 17 of the panel’s former members last spring and replaced them with a more vaccine-skeptical group, he eschewed the “rigorous screening that had been the hallmark of ACIP member selection for decades.” Kennedy’s ACIP, the ruling says, may also fail to fulfill a requirement of the Federal Advisory Committee Act, which calls for the membership of such panels to have “balanced” points of view. The ruling temporarily suspended the appointment of 13 of the 15 current ACIP members, most of whom lack “meaningful experience in vaccines,” the judge wrote. (The other two members were appointed in late February, after the plaintiffs filed their motion, and so were excluded from the decision.) As a result, the panel has been forced to postpone a meeting originally scheduled for this week.

All of that effectively leaves the U.S. without the advisory group that has most influentially shaped American vaccine policy for the past 60 years. “There is no functioning ACIP as of now,” Richard Hughes IV, a lawyer for the plaintiffs, told me. The nation has never been so suddenly stripped of its vaccine advisers, with no backup plan. Experts told me they’re unsure who, if anyone, will advise the CDC on its recommendations for vaccines in the coming months, when the agency might need to weigh in on brand-new immunizations against diseases that have so far lacked them, as well as as this fall’s slate of vaccines against COVID and flu, which are typically reformulated annually to keep up with viral evolution.

In theory, Kennedy or the CDC director—a position temporarily held by Jay Bhattacharya, who also leads the National Institutes of Health—could simply make a unilateral decision about future vaccine recommendations. But the judge also faulted Jim O’Neill, the CDC’s previous acting director, for doing exactly that in January, when O’Neill signed a memo announcing major changes to the agency’s immunization schedule that downgraded recommendations for several vaccines at once, without seeking ACIP’s advice. “The CDC cannot simply bypass ACIP in altering the immunization schedules,” the judge wrote. And because part of the judge’s ruling criticized the hurried way in which the current ACIP was assembled, Kennedy might have a difficult time summoning a fresh panel to replace most of his picks on short notice.

In the lawsuit that led to this week’s ruling, the plaintiffs—which include major medical groups, such as the American Academy of Pediatrics and the Infectious Diseases Society of America—challenged three of ACIP’s votes over the past year in particular. Last summer, on the advice of an anti-vaccine activist, the panel voted to stop recommending the use of flu vaccines containing thimerosal, a preservative with a proven safety record. In September, it opted to downgrade what was once a universal recommendation for COVID vaccines to guidance that Americans first consult a health-care provider. Then, in December, it voted to rescind a long-standing recommendation that all newborns receive a hepatitis-B vaccine, a change that health experts fear could cause cases of severe liver complications to skyrocket.

But if the ruling actually stays “all votes” taken by Kennedy’s ACIP, it could also undo moves the panel has made that are very much in line with what other versions of ACIP have or would have done, Dorit Reiss, a vaccine-law expert at UC Law San Francisco, told me. For example, the committee recommended the 2025–26 flu vaccines for all Americans six months and older, as it has done in years prior. It also recommended a new monoclonal antibody that can protect babies against RSV, the leading cause of infant hospitalization in the U.S., and qualified the shot for the Vaccines for Children program, which helps immunizations reach underinsured families. If those decisions are canceled, coverage for families that have relied on those shots could be compromised.

For now, the decision may accomplish more symbolically than it does practically. It holds that evidence and proper procedure are key to formulating vaccine policy in the United States. But the actions of both the Trump administration and the judge suggest that the government is still conflicted over just how crucial ACIP is. Kennedy and his allies have taken great care to fill the panel with people whose views align with theirs, a tacit endorsement of ACIP’s importance; at the same time, they have made some of their largest modifications to the national immunization schedule without the committee’s input. The judge’s ruling, too, emphasized the influence of ACIP, noting that the committee is the only body that can determine which immunizations qualify under Vaccines for Children—even as it has frozen ACIP’s ability to act for the foreseeable future.

The ruling does not erase, or even much lessen, the deep sense of unease over vaccine decision making in this country that has resulted from the past year of haphazard changes; if anything, a prolonged legal battle could further diminish public trust, Grace Lee, a former chair of the advisory committee and a pediatrician at Stanford, told me. Kennedy, O’Neill, and other administration officials have repeatedly cited a goal of restoring public trust when modifying the nation’s vaccine recommendations. But one recent poll found that trust in the CDC had dropped since the start of the second Trump administration, and that fewer than half of respondents now trust the agency at least “a fair amount” to provide reliable information on vaccines. Several professional medical societies, including the American Academy of Pediatrics, have broken away from CDC vaccine advice; “no serious health-care provider looks to ACIP anymore for advice,” Noel Brewer, a vaccine-behavior expert at the University of North Carolina’s Gillings School of Global Public Health whom Kennedy dismissed from ACIP last year, told me. Dozens of states have declared that they’re no longer following the CDC on vaccines, either. Americans, in effect, have been left with all too many options for whom to listen to about vaccines.

Even if court proceedings eventually revert the country’s immunization schedule to a version of what it was about a year ago—and even if the administration reverts ACIP to its typical process of rigorously vetting members—the U.S. will still be far from its previous vaccine status quo. Vaccination depends not just on the governing bodies that issue recommendations about shots, but also on Americans’ willingness to heed that advice—a far harder shift to reset.

Florida Is Trying to Ignore Measles Until It Can’t

2026-03-13T07:00:00-04:00

Out of the 30 states where measles has been detected in 2026, Florida currently ranks third in case counts. Since the start of the year, at least 132 confirmed or probable cases of measles have been reported across the state, where vaccination rates have consistently fallen below the threshold required to prevent outbreaks. The measles situation in Florida is, in other words, an urgent problem for the state that the state should be urgently addressing.

But on all things measles, the state’s health department has been mostly silent. The department’s measles landing page has no map of the state’s cases and no list of vaccination sites; its “Data and Statistics” section points to measles numbers that were last updated in 2024. In the months that measles has been spreading in the state, health officials have not issued press releases about the virus or launched information campaigns to caution residents about the risks. They have not publicly advertised the benefits of vaccines. Many of Florida’s health experts remain in the dark about their own state: “There has been no—capital N, capital O—communication to physicians, in particular pediatricians, about the outbreak,” Jeffrey Goldhagen, a pediatrician at the University of Florida at Jacksonville and the former head of the Duval County health department, told me.

Officials in other states are not being so coy. In South Carolina, where nearly 1,000 measles cases have been documented in recent months, the state health department holds weekly press briefings and has plastered an orange MEASLES OUTBREAK banner at the top of its website; in Utah, which has had more than 200 cases in 2026, the health department shares granular details about where the virus has been found. Even South Dakota, which has reported just 23 cases in the past year, provides a list of vaccination clinics at the top of its health department’s measles page.

Florida is the stark outlier—and has been headed in this direction for some time. Under the leadership of Governor Ron DeSantis and Surgeon General Joseph Ladapo, the state has spent the past few years bucking public-health wisdom. A year ago, when measles spread through a Florida elementary school, Ladapo allowed unvaccinated children to return to class instead of staying home to limit the size of the outbreak; in September, he and DeSantis announced that they intend to do away with all vaccine mandates. Now, by all appearances, Florida is testing out a head-in-the-sand approach to measles.

During an outbreak, health departments are usually the first line of defense. Few other entities can serve as a hub for public communication and a trove of data while coordinating across health-care systems and emergency services. In the dozens of states that have reported measles cases since the start of 2025, most health departments have offered a consistent and very public response: issuing press releases, mapping infections, sending health-care bulletins, hosting vaccination clinics. Last year, for instance, after measles started to spread in Texas, New Mexico health officials began pushing out information before the virus had been detected there; by the time New Mexico’s own 2025 outbreak ended, the state had logged 56,000 new immunizations, Andrea Romero, the state’s immunization-program manager, told me. Several of the state health officials I spoke with emphasized transparency as one of their core philosophies: “People have a right to know,” Natasha Bagdasarian, Michigan’s chief medical executive, told me.

In Florida, though, several of the doctors I spoke with weren’t even certain how many cases had been detected in their own county. “We cannot get any information on what is happening in various parts of the state,” Mobeen Rathore, a pediatric-infectious-disease specialist at the University of Florida at Jacksonville, told me. Researchers have been able to tap into Florida’s measles-case counts only via a poorly publicized database that is not linked on the health department’s measles page. Lauren Gardner, an infectious-disease modeler at Johns Hopkins University, where she and her colleagues run a national measles tracker, told me that Florida’s data stand out as unusually difficult to find, and of the 11 Florida physicians and epidemiologists I spoke with for this story, most were unaware that recent measles cases could be found on the state database. Even when cases hit Jacksonville, Rathore said, he heard about them only because some of his colleagues had seen them; pediatricians in the broader community, meanwhile, weren’t told at all.

In response to a request for comment, the Florida Department of Health’s communications director, Brian Wright, told me in an email that The Atlantic was “leaning on unverified third- and fourth-hand claims and calling it reporting.” The department did not respond to questions about why it has not readily publicized measles cases.

Florida’s health department used to be as reliable as other states’: As recently as 2019, its website clearly documented recent measles cases and described the measles-mumps-rubella vaccine as “the best way to prevent measles.” That information is now gone—and the experts I spoke with consistently described the measles content left on the health department’s website as superficial, biased, and even misleading. Although the website does warn about “suspected measles cases” in Collier County—which accounts for about three-quarters of the cases in the state—it then links to Collier’s health-department website, which links back to the state health department’s website. The state’s site also fails to mention that unvaccinated people are at high risk of severe illness; meanwhile, it promotes vitamin-A supplements as a possible treatment (as Health and Human Services Secretary Robert F. Kennedy Jr. has), even though supplementation is generally considered essential only for those with a deficiency, which is very rare in the United States.

Rana Chakraborty, a pediatric-infectious-disease specialist at the University of Miami’s Miller School of Medicine, told me that he has stopped relying on the health department for measles information and has instead been following the advice of the American Academy of Pediatrics and the Infectious Diseases Society of America. Health-care establishments across the state are now charting their own course as they prepare for future outbreaks. “We’re all scrambling a little bit to know what the right or best thing to do is,” Chakraborty said.

Even in Collier County, where dozens of cases have been detected at Ave Maria University since late January, information is spotty. Shannon Fox-Levine, who represents that region in the Florida chapter of the AAP, told me that she consistently hears from her colleagues in Collier that “there has been very little transparency from the school and the health department” about local measles cases—including whether officials have continued to detect spread. A page on Collier’s health-department website lists two clinics where vaccine appointments can be scheduled, but not much else; Ave Maria University has said that it has coordinated with the health department to perform contact tracing and testing, but it stopped releasing data about the outbreak in mid-February. (Neither Ave Maria University nor the Collier County health department returned a request for comment.)

The relative silence in and around Collier has made communicating with patients challenging, Fox-Levine told me. “We are the trusted source for our families,” she said. “When we don’t have answers, it can be hard to reassure them.” Many physicians also worry that the lack of public information has lulled the rest of the state into complacency: Surely, if Florida officials aren’t sounding the alarm, there’s little to worry about. “For the rest of Florida, it’s like, Measles? What measles?” one physician in southern Florida told me. (Several of the health experts I spoke with for this article requested anonymity to avoid professional repercussions for speaking about measles and vaccination without the permission of the health department or their university.)

Many of the Florida experts I spoke with said they didn’t blame health officials specifically for Florida’s minimalist response to measles. Across the health department, officials desperately want to do more to address measles cases, Goldhagen, who remains connected with many former health-department colleagues, told me. But “their hands are tied by the state.”

Several of the experts I spoke with—including one health-department employee—cited an environment of fear and restriction within Florida’s health department. The message from state leaders, they told me, has been that health officials are not to publicize outbreaks, or encourage quarantines, isolation, or vaccines. The state has embraced such hands-off policies since the coronavirus pandemic: In 2020, DeSantis strongly encouraged COVID vaccines for the elderly, but as political sentiment toward COVID vaccines and policy shifted, Florida began taking a more relaxed approach to infectious disease. In 2021, the state passed a law that restricted officials’ ability to quarantine students exposed to COVID; measles cases are not subject to such restrictions, but attitudes about the viruses appear to be similar, several researchers told me.

Unlike many other states, Florida runs a fairly centralized health department: The local health departments are staffed with state employees. “All the directors are scared enough that nobody talks,” one physician in northern Florida told me. The department has suffered serious budget cuts too in the past few years, and many health-department employees worry that doing the job they were hired for could now mean losing it altogether. (Neither the health department nor DeSantis’s office responded to my questions about how politics has shaped Florida’s measles response, or about the limits put on health-department employees.)

Still, where they can, many health officials are “working quietly to implement standard public-health practices,” the northern-Florida physician said. After two cases were detected at the University of Florida at Gainesville, for instance, health-department officials performed contact tracing, ultimately reaching some 1,000 people, Fred Southwick, an infectious-disease specialist at the university, told me. Health officials also recommended quarantines and isolation as appropriate—and people were able to seek vaccines through the health department as well as through the university or their own health-care providers, two physicians in Gainesville said. (Southwick spoke to me in a personal capacity, not on behalf of the University of Florida. In response to a request for comment, the university referred me to communications it had sent to its students, faculty, and staff about measles and then directed me to the health department; it did not answer my questions about the department’s degree of involvement or transparency in managing the cases.)

But these covert operations won’t cut it for much longer, experts told me. A key part of public health, Goldhagen said, is to be public about health, so that everyone has the opportunity to protect themselves and their community. Matt Hitchings, an infectious-disease researcher at the University of Florida at Gainesville, told me that “there are lots of places in Florida that appear to be right on the knife’s edge between sufficient vaccine coverage and not enough,” and although active messaging from the health department wouldn’t change every mind, Hitchings suspects that it could bump vaccination rates enough to prevent outbreaks in some of those regions. As things stand, two physicians told me that they’ve begun to imagine a future in which measles could soon be detected in nearly every single one of the state’s 67 counties.

DeSantis and Ladapo’s approach to infectious disease has been polarizing: Recent polls show that roughly 80 percent of Florida parents support maintaining current laws that require vaccines for schoolchildren—approximately in line with national attitudes. But Florida has become a firmly red state, and across the country, Republicans express doubts more frequently than Democrats do that immunizations are safe and beneficial. In Florida, the number of families seeking exemptions from vaccine requirements has been increasing steadily, and is now about 5 percent.

At some point, the health department may be forced to change tactics—if other states begin warning against travel to Florida, hospitals are overrun, or people begin to die. The “look away” strategy, after all, works only as long as a disease’s impact is small enough to ignore without political consequence. But Hitchings and others told me that they can’t yet picture what that shift might look like. “What is the endgame? I really don’t know,” Hitchings said. DeSantis has pitched Florida as a haven from liberal policies: In 2024, the state posted on its borders signs reading Welcome to the free state of Florida, advertising its commitment to personal choice. It may yet have to reckon with how the decisions of a relatively small number of individuals will affect the health of entire populations—who may soon have less of a choice about whether they get sick.

Jay Bhattacharya Might Get His COVID Capstone

2026-03-05T16:39:57-05:00

This time last year, Jay Bhattacharya’s main claim to fame was, in essence, a hot take on COVID. In 2020, Bhattacharya, then a health economist at Stanford University without specialized training in infectious disease, co-authored the Great Barrington Declaration, an open letter that downplayed the risk of COVID and called for most of society to reopen before the arrival of vaccines. Back then, health experts widely excoriated this laissez-faire approach as dangerous and ill-conceived; now Bhattacharya wields more power over the direction of U.S. health policy than most Americans ever have. When Donald Trump returned to office, he tapped Bhattacharya to lead the National Institutes of Health. And last month, Bhattacharya became the only person who has ever been tasked with directing the NIH and the Centers for Disease Control and Prevention at the same time.

As the acting director of the CDC, Bhattacharya’s tenure will likely be brief; Trump reportedly plans to name a new permanent director soon. But Bhattacharya clearly wants something from the agency. In his first email to CDC staff, he wrote that the federal government’s “decisions, communications, and processes” broke the public’s trust during the pandemic, and that “acknowledging this reality is a necessary step toward renewal.”

In practice, the CDC has been undergoing a kind of forced renewal for months. Since Robert F. Kennedy Jr. took over as the secretary of the Department of Health and Human Services, thousands of people have been pushed out of the CDC, and several prominent agency leaders have resigned their post. Last year, Kennedy also dismissed the entirety of the agency’s independent vaccine-advisory group, the Advisory Committee on Immunization Practices (ACIP), and replaced it with a more anti-vaccine cohort. Several of the CDC’s vaccine recommendations have been stripped down too—in many cases, “as far as they can go without affecting coverage guarantees” from insurers, Jason Schwartz, a vaccine-policy expert at Yale, told me. And the CDC has lacked a permanent leader since Susan Monarez, the most recent director, was abruptly ousted from her role last August. (Monarez asserts that she was forced out after she refused to rubber-stamp Kennedy’s restrictive and scientifically unfounded vaccine policies; Kennedy has contradicted this account, accused Monarez of lying, and said that she resigned after he pressed her on whether she was trustworthy.)

Bhattacharya himself remains steadfast in his pandemic-era views. More than five years after he first became a vocal opponent of COVID lockdowns, he continues to relitigate that position on podcasts, in interviews, and on social media. Lockdowns themselves might now be a moot policy point, but another of Bhattacharya’s pandemic sore spots, COVID vaccines, are still under active discussion at HHS.

For years, Bhattacharya has insisted that policies that pushed for widespread COVID vaccination violated “informed consent rights” and were “dangerous for public health.” He has disputed the abundant evidence that COVID vaccines are effective and safe. He has also argued that the continued investment in COVID shots has been a waste and that improving Americans’ baseline health is a better way to guard against future pandemics than stockpiling vaccines is.

In the lead-up to the midterms, Kennedy is reportedly nudging HHS away from attacking infectious-disease policy. But COVID vaccines, which are particularly unpopular among Trump’s Republican base, might still represent a politically palatable target, Dorit Reiss, a vaccine-law expert at UC Law San Francisco, told me. Several new members of Kennedy’s remade ACIP have repeatedly cast doubt on COVID vaccines’ safety; following that group’s advice, the CDC recently stopped recommending the shot to all Americans and now says that people should consult with their physicians before receiving one. Bhattacharya may oversee further downgrades to the CDC’s recommendations: At its next meeting, later this month, ACIP is scheduled to discuss COVID vaccines again—this time, weighing in on “injuries” that the shots might cause to the people who choose to receive them.

What exactly that discussion might touch on, or what the committee might vote on, isn’t yet clear. Although COVID vaccines do come with side effects, serious and lasting consequences are very rare; the shots are still a powerful protective measure against severe disease, especially for populations at the highest risk. Separately, some of the Trump administration’s FDA officials have faulted COVID shots for deaths in children, without publicly revealing evidence. But typically, the National Vaccine Injury Compensation Program, which is operated by a different agency at HHS, handles reports of adverse effects from shots. ACIP, meanwhile, is supposed to advise the CDC on which Americans should get which vaccines.

Any exaggeration of the harms of COVID vaccines by ACIP’s members could give the committee, and ultimately Bhattacharya’s CDC, justification to advise certain populations to stop taking the shots altogether. The net effect of such a change could be small; uptake for COVID shots, after all, is already low. But if the CDC or its advisers cast further doubt on the vaccines’ effectiveness and safety, that shift might seem to vindicate Bhattacharya’s long-standing views—that the immunity left behind from bouts of COVID “is stronger and longer lasting than vaccine-induced immunity,” and that unchecked infection among the young and healthy is an acceptable, and even desirable, pandemic strategy. For the CDC, an agency whose explicit goal is to protect public health by controlling and preventing disease, injury, and disability, the change would reinforce the idea that politics has come to supersede evidence under this administration.

When reached for comment, Andrew Nixon, the deputy assistant secretary for media relations at the Department of Health and Human Services, wrote that Bhattacharya “is focused on restoring CDC as the world’s most trusted guardian of public health through sustained reform and by ending the culture of insularity that eroded public confidence during the pandemic.” (Bhattacharya did not respond to a direct request for comment.)

Gigi Gronvall, an immunologist and a health-security expert at Johns Hopkins University, worries that Bhattacharya’s approach to previous outbreaks could also color the CDC’s response to current threats. Among the largest concerns is measles, which has sparked thousands of cases in the United States since the start of 2025 and may soon be declared endemic in the country again. HHS’s response to the virus’s resurgence has been unorthodox: Kennedy has acknowledged that vaccines are the most effective way to prevent the spread of measles and yet has also derided measles vaccines’ effectiveness and exaggerated their harms, and declined to directly urge families to immunize their children. (He has also inappropriately propped up nutritional supplements as a first-line defense against the virus.)

Bhattacharya has departed from Kennedy on measles vaccination in key ways. During his confirmation hearing last year, Bhattacharya said he was convinced by the data showing no connection between the measles, mumps, and rubella (MMR) vaccine and autism—a sentiment that Kennedy refused to convey during his own hearing. In January, on a New York Times podcast, Bhattacharya also described his distress that uptake of the MMR vaccine was “too low.” And in meetings at the CDC last week, Bhattacharya reportedly offered to publicly encourage parents to vaccinate their children against measles.

Some within the agency greeted this announcement with gratitude and enthusiasm. But Reiss and several other outside experts told me that such reactions only reinforce how low the agency’s standards have been set. In theory, Bhattacharya’s internal comments could presage a friendlier approach to vaccination from the federal government, but that has yet to materialize: In a video posted to social media this week, Bhattacharya, like Kennedy has done, lauded the protective powers of measles vaccination but stopped short of directly encouraging families to vaccinate. (Nixon disputed the notion that any of Bhattacharya’s comments on the MMR vaccine represented a departure from other HHS leaders. “Vaccination remains the most effective way to prevent measles, and Secretary Kennedy and other HHS principals have been very clear and consistent on this point,” he wrote.)

The measles vaccine, Bhattacharya has correctly noted, is more powerful than the COVID one, especially when it comes to reducing transmission. But containing measles outbreaks also requires substantial investment in contact tracing, quarantines, and public-health messaging that might restrict people’s movements and behaviors—all of which could run up against Bhattacharya’s sensibilities. The Great Barrington Declaration suggested that maintaining a relatively open society, largely free of mitigation measures, could keep deaths low while limiting other harms to the public. But it also implicitly accepted a level of suffering and death that most people in public health found untenable—a framework that could easily translate to today’s epidemic responses. Bhattacharya’s COVID rhetoric has at times mirrored Kennedy’s framing of measles: minimizing the severity of disease, dismissing infection as inconsequential for the young and healthy. I asked HHS whether, in Bhattacharya’s view, the country’s current measles outbreaks might warrant prolonged quarantines, strengthened vaccine mandates, or strict school policies—such as excluding unvaccinated children from classrooms after potential exposures—but Nixon did not answer that question.

Bhattacharya seems bent on “rewriting all of history retroactively to prove he was right all along,” Santiago Enrique Sanchez, a Stanford M.D.-Ph.D. student who has closely followed and written about Bhattacharya’s career, told me. Even if Bhattacharya’s time at the CDC will be brief, he seems eager to force the agency to acknowledge his version of reality while he’s in charge. As much as he may claim to be working to restore trust in the agency, his actions seem far more likely to achieve the opposite.

The Deaths Doctors Never Thought They’d See in the U.S.

2026-02-24T09:11:13-05:00

Of every 1,000 people the measles virus infects, it may kill as few as one to three. In a way, this can seem merciful. But the mathematics of measles is also unforgiving. The virus is estimated to infect roughly 90 percent of the unimmunized people it encounters; each infected person may pass the infection on to as many as 12 to 18 others. In large part owing to an ongoing outbreak in South Carolina, the United States is watching those risks unfold in real time. As of last Thursday, the CDC is reporting 982 cases of measles. That count is expected to break 1,000 this week; a tracker run by researchers at Johns Hopkins University that many experts consider more reliable has ticked past 1,000 already. By the numbers alone, another death seems inevitable, and inevitable soon.

Probabilities aren’t guarantees, of course. So far, 2026 may be seeing some improvements over 2025, when the U.S. documented more than 2,200 measles cases—more than in any year since 1991. This year, just 4 percent of measles cases have led to hospitalization, compared with 11 percent last year. Several factors could be contributing to that discrepancy, including how hospitals in South Carolina are reporting measles admissions or of more mild cases being diagnosed to begin with; experts aren’t yet sure.

That 4 percent, however, still represents 40 or so people who have ended up in the hospital with at least one of the conditions that can make measles so devastating—among them, pneumonia, respiratory failure, and brain disease. In South Carolina, multiple people, including children, have been hospitalized with a form of brain swelling called encephalitis, which can lead to permanent intellectual disability or deafness, and in some cases turn fatal.

Outbreaks are brewing elsewhere in the country too—Florida, Utah, Arizona. The nation is on the verge of losing the measles-elimination status it has held for 26 years, which would officially mean that the virus was once again routinely circulating in the United States. The majority of measles cases will remain somewhat mild. But as outbreaks continue, Americans will see where percentages mislead. Even if the rates of death and disabling disease remain roughly the same, as case numbers grow, so too will the absolute amount of suffering.

The calculus of the measles vaccine, meanwhile, should be comforting: A single dose of measles-mumps-rubella (MMR) vaccine can protect people against measles for decades at rates of 93 percent; two doses can protect at 97 percent. Some vaccines work mostly to keep people from getting very sick, but the measles one is powerful enough to prevent many infections from taking hold at all. Only 150 or so of 2025’s measles cases—7 percent—occurred in people known to have received at least one MMR dose. (The CDC and Johns Hopkins haven’t been reporting on hospitalizations by vaccination status.)

If those numbers still sound uncomfortably high, consider that 90 percent of American kids have gotten at least one MMR dose. The higher the vaccine coverage, the more cases will occur among the vaccinated—but also, the far fewer cases will occur overall. And studies have consistently found that when vaccinated people do contract measles, their cases are much milder and potentially less contagious than unvaccinated cases.

Still, certain factors, including genetics and immunocompromising conditions, can alter the level of protection a person gets from an immunization. Age, too, naturally erodes defenses, especially for people decades out from their most recent measles-vaccine dose. And not all vaccinated people are vaccinated in an optimal way. Some Americans, for instance, are too old to have been vaccinated with both modern MMR doses; children generally don’t receive their second injection until they’re about to begin kindergarten. The more a virus transmits broadly, the more easily it can exploit any vulnerability it finds. During a measles outbreak that began in the Netherlands in 1999, more cases were detected in vaccinated people living in mostly unvaccinated communities than in unvaccinated people in highly vaccinated communities—simply because low-vaccine communities were giving the virus far more chances to spread.

Unvaccinated people living among other unvaccinated people remain at the highest risk, Maia Majumder, an infectious-disease modeler at Harvard Medical School and Boston Children’s Hospital, told me. The current statistics reflect that: The large majority of measles infections—93 to 94 percent—are still happening in unvaccinated people. Last year’s largest outbreak, centered on West Texas, killed two school-age children, both of whom were unvaccinated.

Other consequences of measles can take years to become obvious. Because of a quirk in its biology, the virus can erase a person’s preexisting immunity against other pathogens, leaving them more vulnerable to all sorts of illnesses. The more severe the measles infection, the more thorough the damage. Another of measles’ worst and most insidious outcomes is subacute sclerosing panencephalitis (SSPE), an untreatable neurodegenerative condition that can take nearly a decade to manifest. Alex Cvijanovich, a pediatrician in New Mexico, told me that about two decades ago, she treated a middle schooler who had caught the virus as a seven-month-old, still too young to be vaccinated. The initial illness was tame, seemingly inconsequential. But around the age of 12, the boy—an honor student—“started getting lost between his classes,” Cvijanovich said. A spinal tap eventually showed that the virus had lingered in his neural tissue for more than a decade, causing irreversible brain damage. In the following months, the boy’s nervous system deteriorated until he could no longer control the flow of fluid into his lungs. He asphyxiated on his own body’s secretions just a few years after measles had been declared eliminated in the United States.

“It was the most horrible, devastating death of all my years of training and doing pediatrics,” Cvijanovich said. “I comforted myself by telling myself, I’ll probably never see this again.”

Now she is no longer so sure. SSPE, like many other measles complications, is rare, occurring in perhaps one out of every few thousand infections among the unimmunized. (Cases among the vaccinated are virtually nonexistent.) But children who catch the virus in infancy seem especially vulnerable.

To protect their patients from infection, Cvijanovich and her colleagues keep a “rash phone” outside of their office, for families bringing in children who look especially blotchy and red, so that a nurse can inspect them far away from other vulnerable kids. James Lewis, the health officer for Snohomish County, Washington, which has been battling a smaller measles outbreak for several weeks, told me that his department has been advising any patients with suspicious symptoms and a potential measles exposure to call ahead, so they can wait outside the doctor’s office until they can be seen inside. Some may even be evaluated in their car.

Not every place has the resources for such investments, or for the testing, contact tracing, isolation rooms, vaccine clinics, and other measures necessary to help stop measles outbreaks. And some experts worry that as measles continues to appear in confined environments—such as, recently, an ICE facility in Texas—adequate infection-prevention measures will too frequently fall short.

Measles is one of the most contagious viruses ever documented and requires near-comprehensive levels of vaccination—roughly 95 percent or more—in a community to prevent it from spreading. But uptake of the MMR vaccine has ticked steadily down in recent years. Experts anticipate further drops under the Trump administration, especially as Robert F. Kennedy Jr., the secretary of the Department and Health and Human Services and a longtime anti-vaccine activist, continues to restrict access to vaccines, dismiss vaccine experts, challenge vaccine manufacturers, and question vaccine safety. (HHS did not respond to a request for comment.) One recent modeling study found that a drop in nationwide MMR uptake of just a few more percentage points could lead to millions more measles cases over the next 25 years. And the more measles moves around, the more the risk to everyone will increase.

How Many Wolves Is Enough?

2026-02-16T08:00:00-05:00

Updated at 10:02 a.m. ET on February 16, 2026

The wolves arrived in May of last year, just days after Paul Roen had driven his cattle back up to their summer pasture in Northern California’s Sierra Valley. He started finding the bleeding bodies of calves—some still alive, so badly paralyzed that they’d need to be shot. After weeks of this, Roen finally saw a kill himself. “One wolf grabbed a cow and spun her around, while another grabbed a calf,” he told me. “He tore it into three pieces in 30 seconds.”

Every night, Roen would go out in his pickup truck and try to keep the wolves away from his animals, until exhaustion drove him to bed in the hours before dawn. He came to dread the sound of his cows bawling for their lost calves. By June, Roen, who is also a Sierra County supervisor, and his fellow ranchers had persuaded the state to intervene: A team started to patrol the Sierra Valley rangeland, harassing wolves with rubber bullets, sirens, and eventually drones. At one point, Roen said, officials even tried piling frozen beavers outside the wolves’ den to sate their hunger. But still, the kills continued.

What Roen and other ranchers wanted, really, was for the state to kill the wolves. But gray wolves, which were exterminated from California roughly a century ago, are still listed as endangered there, making it illegal to kill, harm, or harass them. By the fall, the same pack of wolves had taken down roughly 50 of Roen’s cattle, he estimates—more than he’d ever lost to mountain lions or any other predators, and a major proportion of the roughly 90 livestock killed or injured in the region. The state’s Department of Fish and Wildlife determined that this was “far outside any comparable experience across the state or the West,” and sanctioned the first wolf killings since the animals had returned to California in 2011. In October, officials tranquilized three adult wolves from a helicopter, then injected them with chemical euthanasia. They also shot a fourth wolf—a six-month-old pup—who’d been mistaken for a similar-looking adult.

The consequences of killing wolves are not what they might have been 50 years ago, when just hundreds of them were left in the contiguous United States and the federal government first declared the species endangered. Nowadays, thousands prowl the landscape—a fraction of the millions that may have once lived here, but still constituting one of the most successfully recovered species in the country. At this point, “I don’t think you can shoot and trap wolves out of existence,” Diane K. Boyd, a wildlife biologist who has extensively researched wolves, told me.

Some Americans are hoping that killing wolves could again become a national norm. Already a few western states are actively working to reduce their gray-wolf populations through annual hunts. When I asked Richard Egan, another California rancher, how many wolves should be in the state, he told me there was no correct answer other than zero. The country’s official stance is that gray wolves should live here. Americans are still deciding how many they can tolerate.

The tensions between today’s wolves and humans are, essentially, the same as they were in the 1800s. As expanding agriculture sent wild populations of deer and elk into decline, wolves began to prey instead on livestock—prompting people, in turn, to kill wolves. By the middle of the 20th century, decades of aggressive hunting, trapping, and mass poisoning had pushed the Lower 48’s gray wolves to the point of near extermination.

After decades of monitoring and intervention, some imperiled species are still barely staving off extinction; wolves’ evolutionary grit, meanwhile, has surprised even conservationists. Human initiatives have undoubtedly helped—particularly, the reintroduction of wolves to Yellowstone National Park and Idaho in 1995, which was driven by the Nez Perce Tribe. But on their own, gray wolves trickled across the Canadian border, back into Montana; after expanding throughout the Mountain West and Northwest, they wandered down into California. In 2021, the U.S. Fish and Wildlife Service moved to take gray wolves off the federal endangered-species list, though that decision has been under contention since.

With the return of gray wolves has come the return of gray-wolf problems. The wolves are facing greater pressures than they once did to find food in a country filled out with cities and people; naturally, they are again preying on livestock. Ranching, too, has become more challenging and less stable in recent years, amid droughts and rising feed costs. In California, in particular, where elk remain relatively scarce, and deer populations have been in prolonged decline, “there’s nothing to sustain these wolves but cattle,” Roen told me. One recent analysis found that a single wolf can cost a rancher up to $162,000. But ranchers remain limited in how much they can intervene. “If they killed every one of my cattle, I’d just have to sit and watch unless they threatened me personally,” Egan, whose cattle losses have roughly quadrupled since wolves arrived in his county, said.

In Oregon, too, where gray wolves have been established for longer, ranchers feel hamstrung. Kimberlee Kerns’s family has lost hundreds of sheep and cattle to wolves since 2009; the animals that survive tend to gain less weight and conceive fewer lambs and calves. To keep the sheep safe, her team has been herding them into pens every night, which raises the animals’ stress levels and makes it easier for them to get one another sick. And after being repeatedly vexed by wolves, Kerns told me, her cattle “want to fight the herding dogs”—which, although domesticated, are still technically the same species.

Ranchers and wolf advocates have been able to deter wolves from feasting on livestock on some properties, Karin Vardaman, who’s part of a group trying to minimize wolf-human conflict, told me. Ranchers can fly brightly colored streamers to spook wolves, and try to keep animals off terrain that might make hunting easier; they can dispatch horseback patrols on their property. But Egan and Roen said that they’ve seen those tactics fail, too—perhaps because the wolves quickly learn that flashy repellents pose no genuine threat. “They’re desensitizing the wolves to the point where they’re emboldened,” Egan said.

These gentler efforts, Egan and Roen argue, might carry more weight if local wolves understood that humans might kill them, too. And, of course, the more wolves die in these harvests, the fewer might trouble livestock.

Around the end of 2008, the year before Montana opened its first gray wolf-hunting season, animus against the predators reached a boiling point. A series of tougher-than-average winters had squeezed the local wildlife; hunters were driving into town with less to show for their efforts. “The hunters that year saw not as much deer, and wolf tracks everywhere,” Kent Laudon, a wildlife biologist who worked as a wolf specialist in Montana’s wildlife department for more than a decade, told me. Locals began to protest outside of his department’s office, calling for wolves to be purged. That winter, Laudon recalled driving across town and counting the bumper stickers, which were emblazoned with the silhouette of a wolf head and read Smoke a pack a day.

The next year, Montana’s quota for wolf kills debuted at 75. That number has grown steadily over the past couple of decades to more than 400. Quentin Kujala, the chief of conservation policy at Montana’s Department of Fish, Wildlife, and Parks, told me that the number of lethal wolf removals that officials have had to conduct due to livestock conflicts has decreased in that same time frame. But livestock conflicts—and complaints about them—also plateaued in the 2010s, and have stayed at roughly that level ever since. The state’s wolf population, too, has held rather steady at about 1,100 for several years. “We seem to have arrived at an equilibrium,” Kujala said.

For years, Montana’s official policy has said that the state must maintain at least 15 breeding pairs of wolves to keep them off the state’s endangered-species list. (Because of wolves’ complex social structure, researchers have disagreed on the size of the wolf population necessary to maintain that many breeding pairs—but according to Kujala, the state now relies on a very conservative estimate of about 450 wolves.) But locals and politicians disagree vehemently about how many wolves above that threshold they’d like to support. In 2021, the state government passed a law that called for reducing the wolf population to a “sustainable” level.

Apart from specifying that the number of wolves had to exceed the state’s endangerment cutoff, legislators never defined what such a sustainable level might be. Mike Phillips, a former Democratic member of Montana’s state Senate, told me that if the goal is to actually recover the species, humans should set their sights higher than just barely exceeding the threshold at which the animals might snuff out. Paul Fielder, a Republican member of the state’s House of Representatives and a longtime advocate for more aggressive wolf management, told me he sees little reason for the state to maintain more wolves than the bare minimum. “They’re four-legged terrorists,” Fielder said. “How many terrorists are okay in your neighborhood?”

Across the rest of the country, too, opinions about how to manage wolves tend to break along partisan lines—to the point where reminding people of their political identity can amplify their positive or negative feelings toward the animals. And although most Americans remain in favor of protecting gray wolves, only a very small minority of people in the U.S. regularly interact with the animals—primarily in rural regions. A few ranchers told me they were frustrated that so much of the wolves’ fate was being determined by people who wouldn’t have to live through the direct consequences.

Wolves do have a way of riling peoples’ emotions, Alma Sanchez, a carnivore biologist with the Nez Perce Tribe, told me—perhaps, she and others said, because conflicts over their future put into relief so many fault lines of American life, between urban and rural existence, between conservatives and liberals, between trust in government and a desire for individual sovereignty. Some researchers hoped that a few wolf killings might mollify ranchers, but recent studies have suggested that this approach can instead reinforce anti-wolf sentiment. In one infamous case in Wyoming—where wolves have been delisted since 2017 and can be hunted and trapped year-round in most of the state—a man was arrested in 2024 after he allegedly ran over a wolf with his snowmobile, then paraded her injured body around a bar before shooting her. (He has pleaded not guilty to the charge.)

And as Montana has found, the math of “fewer wolves, fewer problems” doesn’t always work out. Killing a wolf can destabilize its pack to the point where the remaining members become more likely to go after livestock. And although wolves do naturally prey on wild deer and elk, support for the notion that the predators are cratering wild game populations is mixed at best, several experts told me. In several cases, researchers have found that wolves’ effect on those species pales in comparison to the impact of factors such as disease, environmental conditions, habitat loss, and other predators. The benefits to livestock, too, may be quite modest: One recent study found that, across states, killing one wolf saves, on average, less than 10 percent of a single cow. For those reasons and more, several wolf researchers told me they remain skeptical that ever-increasing wolf killings will chart the path to coexistence. “If it’s not going to reduce conflict, or make you feel better about wolves, why do you want to kill wolves?” Naomi Louchouarn, a conservation ecologist with Humane World for Animals, told me.

Although some advocates for increased wolf harvests can point to an ideal—and low—number of wolves they’d like to aim for, the conservationists I spoke with didn’t feel comfortable identifying a “correct” number of wolves for the country. The answer, Sanchez told me, depends less on what the landscape can support and more on what Americans’ attitudes will. But people who want more wolves and people who want fewer both argue that the other side is letting their feelings about wolves get in the way of rational thinking. Fielder, while making the case that Montana needed fewer wolves, repeatedly told me that the worst way to approach wolf management was “entirely through emotion.” Days earlier, while advocating for the animals, Boyd, the wildlife biologist, had told me exactly the same.

This article has been updated to reflect which other predators have killed Paul Roen’s cattle.

The Only Thing That Will Turn Measles Back

2026-02-05T08:00:00-05:00

Since measles vaccination became common among Americans, the logic of outbreaks has been simple: When vaccination rates fall, infections rapidly rise; when vaccination rates increase, cases abate. The United States is currently living out the first half of that maxim.

Measles-vaccination rates have been steadily declining for several years; since last January, the country has logged its two largest measles epidemics in more than three decades. The second of those, still ballooning in South Carolina, is over 875 cases and counting. In April, measles may be declared endemic in the U.S. again, 26 years after elimination.

When and if the maxim’s second part—a rebound in vaccination—might manifest “is the key question,” Paul Offit, a pediatrician and vaccine expert at Children’s Hospital of Philadelphia, told me. Experts anticipate a shift eventually. Vaccine coverage has often been beholden to a kind of homeostatic pull, in which it dips and then ricochets in response to death and suffering. In 2022, for instance, in the weeks after polio paralyzed an unvaccinated man in Rockland County, New York, the families of more than 1,000 under-vaccinated children heeded advice to immunize.

During past outbreaks, though, health authorities at local, state, and federal levels have given that same advice—vaccinate, now—loudly, clearly, and persistently. In 2026, the U.S. is facing the possibility of more and bigger measles outbreaks, as federal leaders have actively shrunk vaccine access, dismissed vaccine experts, and sowed doubts about vaccine benefits. Under these conditions, many experts are doubtful that facing down more disease, even its worst consequences, will convince enough Americans that more protection is necessary.

After the first major rash of measles cases appeared in and around West Texas about this time last year, many local families did rush to get vaccines, including early doses for infants; some families living near South Carolina’s outbreak, now bigger than West Texas’s was, have opted into free vaccination clinics too. Even in states far from these epidemics, such as Wisconsin, health-care providers have seen an uptick in vaccination, Jonathan Temte, a family-medicine physician and vaccine-policy expert at the University of Wisconsin at Madison, told me. But, he said, those boosts in interest have been concentrated primarily among people already enthusiastic about vaccination, who were seeking additional protection as the national situation worsened. At the same time, many of South Carolina’s free vaccination clinics have been poorly attended; some community members hit by the worst of the outbreak in West Texas have stood by their decision to not vaccinate.

Protection against measles has always been fragile: Sky-high levels of vaccination—at rates of at least 92 to 95 percent—are necessary to stave off outbreaks. And after holding steady for years, uptake of the measles-mumps-rubella (MMR) vaccine has been dropping unevenly in communities scattered across the U.S. since around the start of the coronavirus pandemic, pulling down the nationwide average. Recent research from a team led by Eric Geng Zhou, a health economist at the Icahn School of Medicine at Mount Sinai, has found that, although many communities in the Northeast and Midwest have generally high MMR-vaccine uptake, others in regions such as West Texas, southern New Mexico, and the rural Southeast, as well as parts of Mississippi, don’t have much protection to speak of.

COVID can bear some of the blame for these patches of slipping vaccination. It disrupted families’ routine of visits to the pediatrician, leading to delayed or missed vaccinations. Those interruptions quickly resolved for some families, Zhou told me, but they remained for many others, lagging, for instance, among people of lower socioeconomic status who are less likely to have consistent access to health care and reliable health information. At the same time, the pandemic deepened political divides over public-health policies, including vaccination. In the years since, Republicans have become substantially more hesitant than Democrats about immunizing their children. “The COVID pandemic created this persistent divergence,” Zhou told me.

Pockets with under-vaccinated people have always existed, tracking alongside groups that are less likely to engage with all kinds of medical care, including people with less education or lower income, or those who belong to certain ethnic minorities. Anti-vaccine activists—including Robert F. Kennedy Jr., now the secretary of the Department of Health and Human Services—have also spent years spreading misinformation about the vaccine. But maybe most crucial, vaccination status clusters in communities—depending intimately on whether, for instance, children are raised by parents who are themselves vaccinated. The net effect of COVID, misinformation, and changing political tides is that the chasms between the vaccinated and unvaccinated have widened, an especially dangerous proposition for measles, a virus that is estimated to infect 90 percent of the unimmunized people it encounters.

Last year, as measles ignited in West Texas, some experts wondered whether attitudes about the MMR vaccine might shift once the virus killed someone. Since the start of 2025, three unvaccinated people have died from measles, two of them young children. But because that outbreak centered on several rural Mennonite communities that have long been distrustful of vaccines, many Americans seem to have treated those three deaths as a mostly isolated problem, Noel Brewer, a vaccine-behavior expert at the University of North Carolina Gillings School of Global Public Health, told me. (Brewer was a member of the CDC’s Advisory Committee on Immunization Practices before Kennedy overhauled the group entirely last year.)

More broadly, the disease still has a misleading reputation as harmless enough that “it’s not a big deal if you get it,” Rupali Limaye, a vaccine-behavior expert at Johns Hopkins University, told me. But even if measles’ severe outcomes were more common, Limaye and others were doubtful that many more Americans would be moved to act. COVID vaccines still offer protection against the disease’s worst outcomes, yet so far this winter, just 17 percent of adults and 8 percent of children have gotten a COVID shot. And although the seasonal flu typically hospitalizes hundreds of thousands of people in the U.S. each year, tens of thousands of whom die, flu-vaccine uptake regularly hovers below 50 percent. For measles, “how many deaths is enough to be a tipping point?” Offit asked. “I don’t know that.”

If anything, the nation’s top health officials have encouraged people to embrace the tolls of infectious illness. The Trump administration responded to the deaths last year with relatively tepid messages about the benefits of measles vaccines—which are excellent at preventing severe illness, infection, and transmission—all while promoting nutritional supplementation with vitamin A. More recently, CDC’s new principal deputy director, Ralph Abraham, described the prospect of measles becoming endemic in the U.S. as “just the cost of doing business.” Last month, CDC ended long-standing recommendations urging all Americans to receive an annual flu shot; later that week, Kennedy told CBS News that it may be a “better thing” if fewer kids get vaccinated against the flu. And Kirk Milhoan, the new chair of CDC’s vaccine advisory committee, recently questioned the need for the MMR vaccine, arguing that measles’ risks may now be lower than they once were, in part because hospitals are better equipped to treat the disease than they used to be.

When reached for comment over email, Andrew G. Nixon, the deputy assistant secretary for media relations at HHS, disputed the notion that the department has hindered the country’s response to measles, writing, “Under Secretary Kennedy, CDC surged resources and multiple states declared measles outbreaks over in 2025.” He added that “Secretary Kennedy and other leaders at HHS have consistently said that vaccination is the best way to prevent the spread of measles.”

The counsel of health-care providers, not federal health officials, remains a top predictor of whether people will immunize. But when vaccine uptake has wavered in the past, governments have been key to buoying those levels again. In the 1970s, for example, after safety concerns about a whooping-cough vaccine—later proved false—caused rates of uptake to plummet in the United Kingdom and spurred a series of major outbreaks, an eventual government-sponsored campaign helped limit the dip in vaccination to a few years. In the 2010s, rising rates of families seeking nonmedical exemptions for vaccination in California helped precipitate the state’s Disneyland measles outbreak, which spread to six other states, as well as Canada and Mexico; MMR-vaccination rates throughout California jumped above 95 percent only after new state legislation strengthened school mandates. And in the early 1990s, local health officials ended a Philadelphia measles epidemic—which by then had sickened at least 1,400 people and killed nine children—after they took the extreme step of getting a court order to compel community members to vaccinate children.

When governments withdraw support for vaccines, immunization rates can crater. In 2013, an unfounded safety concern about the HPV vaccine prompted Japanese health authorities to suspend strong national recommendations for the immunization; the move caused uptake among adolescent and young teenage girls to drop, from about 70 to 80 percent to less than 1 percent within a year, according to Brewer, who is co-authoring a research paper on the subject. Japan did not reinstate its HPV recommendation until nearly a decade later—and coverage has since recovered to only about half of its original baseline.

Nixon, the HHS spokesperson, wrote that the U.S. is now following the approach of peer nations that “achieve high vaccination rates without mandates by relying on trust, education, and strong doctor-patient relationships.” But Kennedy has also publicly discouraged people from “trusting the experts.” Limaye, who consults with local health-care providers, said that the biggest question that her contacts are now hearing from patient families is “Who am I supposed to believe?” Meanwhile, CDC’s website now contradicts the widespread and decades-long scientific consensus that vaccines don’t cause autism.

If MMR-vaccine uptake does rebound, experts suspect it will rise unevenly across the country, likely skirting the politically red regions where vaccination rates most urgently need to increase. In this way, the self-reinforcing nature of vaccination status is dangerous: Even while highly protected groups might double down on immunization, under-vaccinated groups can remain unprotected. Leaving enough places lingering below the crucial measles-vaccination threshold “will ensure repeated and large outbreaks,” Brewer said. West Texas and South Carolina were just the start; this year, measles will sicken more people, which means more deaths will follow, and likely soon. The Trump administration is testing how much resilience American vaccination rates have in the absence of federal support, and the answer emerging for measles so far is: not enough.

South Carolina Is America’s New Measles Norm

2026-01-27T09:24:36-05:00

Last year, starting in January, the United States experienced its largest documented measles outbreak in more than three decades, when an epidemic centered on West Texas sickened at least 762 people. Now a fast-moving outbreak in South Carolina seems poised to surpass it: Local officials have logged 700 infections, and the virus is still rapidly spreading.

As public-health officials scramble to contain the virus, they’re also trying to figure out whether these two outbreaks are connected—specifically, whether the version of the pathogen that kick-started the West Texas cases has been circulating within the nation’s borders ever since. If the answer is yes, it will mean that measles has once again become a permanent resident of this country, after 26 years of only limited outbreaks imported from abroad. Given that the U.S. clocked more than 2,200 measles cases in 2025—more than it has had in a single year since 1991—the experts I spoke with already consider this the reality that Americans are living in. One of the fastest-spreading viral diseases ever documented has once again become a routine threat.

At this point, researchers are working to find the connective tissue among some of the largest measles outbreaks in the U.S. within the past year, including the ones centered in West Texas, Utah, Arizona, and South Carolina. Technically, the epidemics still could have been caused by separate reintroductions of measles from at least one international source. But “that’s a hard stretch,” Robert Bednarczyk, a global-health researcher and epidemiologist at Emory’s Rollins School of Public Health, told me. The most likely and so far best-supported scenario, he said, is also the simplest one—that the virus spread so fiercely and quickly through these communities that it was able to hitch a ride elsewhere in the country when infected people traveled.

If further evidence proves that scenario true, the Pan American Health Organization could strip the U.S. of its official measles-elimination status—which the country has held since 2000—at a meeting scheduled for April. (A country achieves elimination status when it can show that the virus hasn’t been circulating for 12 consecutive months; it loses the status when researchers show that measles has been spreading for a year straight.) Already, PAHO has publicly confirmed that scientists have found the same strain of measles in Texas, New Mexico, Utah, Arizona, and South Carolina, as well as in Canada, Mexico, and multiple other North American countries. (In response to a request for comment, a PAHO spokesperson clarified that although these detections had been made, the committee was still seeking further evidence.)

Health officials also recently announced that South Carolina’s outbreak has seeded cases elsewhere, including Washington State. Still, the case for measles’ continuous transmission can’t yet be considered a slam dunk. To prove it definitively, researchers will need to show that geographically distant outbreaks in the U.S. are epidemiologically linked and that there is not sufficient evidence suggesting that the virus bounced back and forth between countries.

Two types of information are essential to these investigations. First, researchers look into the travel histories of infected people, who might have brought the virus from one state to another. Second, they compare genetic sequences pulled from the virus across locations. Measles mutates slowly enough that researchers can in many cases search for essentially the same strain when tracking its movements. But the virus does accumulate some changes in its genome, and the further apart two cases are in time, the more genetically distinct their genetic material should be. If measles was being continuously transmitted, scientists might expect to see slightly different iterations of the virus racking up mutations as it traveled, say, from Texas to South Carolina. If measles had been introduced separately to those locations, the sequences pulled from each state might more closely resemble genetic information from an international source, Pavitra Roychoudhury, a pathogen-genomics expert at the University of Washington, told me.

But some of the data that officials need may be lacking. For months, experts have been concerned that the U.S. has been severely undercounting its measles cases and that the virus had been circulating in some communities long before it was officially detected. Cases of the disease can be easy to miss, Helen Chu, an immunologist at the University of Washington, told me. The early days of measles are usually marked by common symptoms such as fever and cough; to the untrained eye, the virus’s rash can look like many of the reddish, patchy blemishes that many other pathogens cause. The overwhelming majority of measles cases in the U.S. have also concentrated in communities that have low vaccination rates, which often have less access to medical care and the sort of testing that would also collect viral samples. Many people who deliberately decline vaccination for their families are also skeptical of seeking medical care in general, or of public-health officials investigating outbreaks.

With inconsistent data, researchers may be left sorting through genetic sequences that neither point clearly to one another nor obviously implicate separate sources. “There’s a judgment call in that gray area,” William Moss, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told me. “How different is different?” The last time measles spread endemically in the United States, this sort of genomic analysis was not commonplace.

Should PAHO find that measles is spreading concertedly in the U.S. again, the nation’s leaders may shrug off the change. At times, top officials at the Department of Health and Human Services appear to have dismissed the notion of continuous spread: In November, Jim O’Neill, Health Secretary Robert F. Kennedy Jr.’s deputy and the CDC’s acting director, posted on social media that “preliminary genomic analysis suggests the Utah and Arizona cases are not directly linked to Texas.” (Neither the Trump administration nor PAHO has released the details about the data it reviewed or how similar any identified strains are.) And last week, the CDC’s new Principal Deputy Director Ralph Abraham described the prospect of the U.S. losing its measles-elimination status as “just the cost of doing business with our borders being somewhat porous for global and international travel.” Certain communities, he added, “choose to be unvaccinated. That’s their personal freedom.”

In an email, Emily G. Hilliard, HHS’s press secretary, echoed Abraham’s comments, describing current outbreaks as “largely concentrated in close-knit, under-vaccinated communities with prevalent international travel that raises the risk of measles importation,” and noting that the United States still has a lower measles burden than Canada, Mexico, and much of Europe do.

In practice, the April decision will be a matter of semantics. Whatever the outcome, the U.S. has been weathering a worsening measles situation for years now, as vaccination rates have ticked down and outbreaks have grown larger and more common. In the past year, the Trump administration has made it substantially more difficult for local public-health-response teams to address and contain outbreaks too. HHS reportedly delayed communications from the CDC to officials in West Texas and held back federal funds to fight the outbreak for two months. More recently, HHS pledged to send $1.4 million to address South Carolina’s outbreak, though it began months ago. (One recent analysis suggests that measles outbreaks of this scale can cost upwards of $10 million.) The administration has repeatedly downplayed the benefits of immunization, while exaggerating the importance of nutritional supplementation for combatting measles. Kennedy has also spent decades repeating disproved claims that vaccines such as the measles-mumps-rubella immunization can cause autism. (Hilliard wrote that Kennedy has consistently said that vaccination is the most effective way to prevent measles, but she also emphasized in her email that people should consult with health-care providers about whether vaccination is best for their family.)

Should immunity erode further—as experts watching the Trump administration’s actions expect it to—measles will find it even easier to move across the country, until epidemics bleed so thoroughly together that their links become irrefutable. Already, the nation’s leaders have made clear where the U.S. stands on measles: It is an acceptable norm.

The Flu Really Is That Bad

2026-01-10T08:00:00-05:00

The flu situation in the United States right now is, in a word, bad. Infections have skyrocketed in recent weeks, filling hospitals nearly to capacity; viral levels are “high” or “very high” in most of the country. In late December, New York reported the most flu cases the state had ever recorded in a single week. My own 18-month-old brought home influenza six days before Christmas: He spiked a fever above 103 degrees for days, refusing foods and most fluids; I spent the holiday syringing electrolyte water into his mouth, while battling my own fever and chills. This year’s serving of flu already seems set to be more severe than average, Seema Lakdawala, a flu virologist at Emory University, told me. This season could be a reprise of last winter’s, the most severe on record since the start of the coronavirus pandemic—or, perhaps, worse.

At the same time, what the U.S. is experiencing right now “fits within the general spectrum of what we would expect,” Taison Bell, an infectious-disease and critical-care physician at the University of Virginia Health System, told me. This is simply how the flu behaves: The virus is responsible for one of the roughest respiratory illnesses that Americans regularly suffer, routinely causing hundreds of thousands of people to be hospitalized annually in the U.S., tens of thousands of whom die. (So far this season, the flu has killed more than 5,000 people, including at least nine children.) Influenza is capable of even worse—sparking global pandemics, for instance, including some of the deadliest in history. These current tolls, however, are well within the bounds of just how awful the “seasonal” flu can be. “It’s another flu year, and it sucks,” Bell said.

Although flu is a ubiquitous winter illness, it is also one of the least understood. Scientists have been puzzling over the virus for decades, but many aspects of its rapid evolution and transmission patterns, as well as the ways in which our bodies defend against it, remain frustratingly mysterious. Flu seasons, as a rule, differ drastically from one another, and “we don’t have a great understanding of why one ends up being more severe than another,” Samuel Scarpino, an infectious-disease-modeling researcher at Northeastern University, told me. Experts’ flu-dar has also been especially out of whack in recent years, since the arrival of COVID-19 disrupted typical flu-transmission patterns. (An entire lineage of flu, for instance, may have been driven to extinction by pandemic-mitigation measures.) The virus is still finding its new norm.

Even so, a few things about this season’s ongoing torment are clear. Much of the blame rests on the season’s dominant flu variant—subclade K, which belongs to the H3N2 group of influenza. As flus go, H3N2s tend to be more likely to hospitalize and kill people; most of the worst flu seasons of the past decade in the U.S. have been driven by H3N2 surges. Subclade K doesn’t seem to be an unusually virulent variant, which is to say it’s probably no more likely to cause severe disease than a typical version of H3N2. But it does seem to be better at dodging our immune defenses, making the net effect similar, because it can lead to more people getting sicker than they otherwise would. That’s not a trivial effect for a disease that, even in mild cases, can cause days of high fevers and chills, followed by potentially weeks of that delightful run-over-by-a-truck feeling.

At UVA Health, Bell has seen a major uptick in people testing positive for the virus in recent weeks. Like others, his hospital is close to full, straining its capacity to treat other illnesses, he said. In Michigan, too, where Molly O’Shea cares for children at multiple pediatric practices, “we are seeing a ton of influenza, just a ton,” she told me. “Our schedule is overflowing.” Several of her school-age patients have wound up in the hospital, despite being previously healthy; a few have ended up with serious complications such as pneumonia and brain inflammation. The worst cases, she said, have been among the children who didn’t get their annual flu shot.

Flu vaccines are not among the most impressive immunizations in our roster. Although they’re generally pretty effective at protecting against severe disease, hospitalization, and death, they don’t reliably stave off infection or transmission. And they’re frequently bamboozled by the virus itself, which shape-shifts so frequently throughout the year, as it ping-pongs from hemisphere to hemisphere, that by the time flu vaccines roll out to the public, they’re often at least a little out of sync with what’s currently circulating.

That’s another aggravating factor this year. Researchers first detected subclade K in June, months after experts selected the strains that would go into the fall flu-vaccine formulation. Recent data suggest that vaccination may still elicit some immune defenses that recognize subclade K, and preliminary estimates from the United Kingdom suggest that this year’s formulations may be especially effective at preventing severe disease in children, who, along with the elderly, are highly vulnerable to the flu. (For all the misery my family endured, none of us ended up in the hospital—which suggests that our vaccinations did their job.)

Children also tend to be the biggest drivers of flu’s spread. “They are the source, many times, of explosions of transmission,” Lakdawala told me. In the U.K., for instance, which experienced an unusually early start to the flu season, school-age kids appear to have driven much of the epidemic, Scarpino pointed out. In the U.S., too, case rates among children have been particularly high. Although the vaccine primarily limits severe disease, it can also affect how quickly the virus travels through a community. And yet only about half of American kids get the vaccine each year, despite long-standing universal recommendations for annual immunization. “It’s a vaccine that parents have never really treated as a vaccine that every child should get,” O’Shea said.

Those choices might be influenced by the ways many people underestimate the flu—a term often used to describe any cold-weather ailment that comes with a runny nose, cough, or even gastrointestinal upset. In reality, flu has long ranked as one of the U.S.’s top 10 or top 15 causes of death—a scourge that, through its impact on the health-care system, the workforce, and the economy at large, costs the country billions of dollars each year. Against such a substantial threat, we should be using “everything in our toolbox to protect ourselves,” Lakdawala said.

Yet the Trump administration is actively impeding the process of flu vaccination. Health and Human Services Secretary Robert F. Kennedy Jr. has also said that it may be “a better thing” if fewer people are immunized against the flu—and insisted, incorrectly, that “there is no scientific evidence that the flu vaccine prevents serious illness, hospitalizations, or death in children.” The federal government recommended annual flu vaccines for all children until earlier this month, when HHS pushed through changes that demoted multiple immunizations from its recommended schedule. HHS now says that families should consult with their health-care provider before taking the shot. Such a recommendation suggests that the vaccines’ overall benefits are ambiguous enough to require discussion—and puts an additional burden on both patients and health-care providers, who can administer what was once a routine vaccine only after a conversation that must then be documented.

The nation’s leaders have also compromised one of the country’s best chances to develop more effective, better-matched flu vaccines in the future, by defunding research into mRNA vaccines. The current flu-vaccine manufacturing process takes so long that the included strains for the Northern Hemisphere must be selected by February or so—which provides plenty of time for the virus to evolve before the autumn rollout begins, as happened this year. “We pretty regularly have a bad match for the flu,” Scarpino said. mRNA vaccines promised the possibility of faster development, allowing researchers to stay more closely on the flu’s heels and switch out viral ingredients in as little as two or three months. That degree of flexibility also would have sped the response to the next flu pandemic.

In an email, Andrew Nixon, HHS’s deputy assistant secretary for media relations, disputed the characterization that the department’s new policies impede flu vaccination, writing, “Providers continue to offer flu vaccines, and insurance coverage remains unchanged. The recommendation supports shared clinical decision-making between patients and clinicians and does not prevent timely vaccination. People can continue to receive flu vaccines if they choose to do so.”

For the current season, much of the U.S.’s fate may already be sealed: Fewer than half of Americans have gotten a flu vaccine this season, while the virus continues to spread. “If you find yourself in a place where there are people sick with flu, you’re probably gonna get sick,” Scarpino said. That logic likely holds true for his own family, in Massachusetts, where flu activity has been high for weeks. They’ve so far made it through unscathed, but Scarpino said, “I feel like it’s a matter of time.”

The Giant, Voracious Sea Lions That Humans Cannot Stop

2026-01-07T08:00:00-05:00

Of all the schemes that humans have devised to keep sea lions from gorging on the salmon of the Columbia River basin, none has worked for long. Local officials and researchers have chased sea lions with boats and peppered them with rubber bullets; they’ve detonated noisy explosives. They’ve outfitted the docks where the animals like to rest with uncomfortable spinners, electrified mats, flailing tube men, and motion-activated sprinklers. (“Very surprisingly, they don’t like to get wet on land,” Casey Clark, a marine-mammal biologist at the Washington Department of Fish and Wildlife, told me.) At one point, the Port of Astoria dispatched a 32-foot fiberglass replica of sea lions’ primary predator, the orca, outfitted with real orca sounds, that almost immediately capsized. Scientists have captured sea lions and released them thousands of miles away, as far as Southern California. No matter the tactic, the result is largely the same: Within weeks, or sometimes even hours, the sea lions swim right back.

The waterways of the Columbia River basin, full of dams that corral salmon in tight spaces, are just too easy of a hunting ground for the sea lions to spurn. In especially hard-hit sections of the Columbia River, sea lions have eaten close to half of the spring Chinook run. “That’s a devastating amount of fish,” Jeremy Cram, the salmon-recovery coordinator at the Washington Department of Fish and Wildlife, told me—both for the region’s highly vulnerable fish and for the humans who want to catch and eat them.

So in recent years, officials made sea-lion removals more permanent, which is to say, more deadly. Since 2020, the states of Washington, Oregon, and Idaho, as well as a handful of local tribes, have trapped and euthanized more than 200 sea lions in and around the Columbia River—and have still fallen short of the limits allowed by federal law. With sea lions still eating thousands of salmon each spring at sites such as the Bonneville Dam, near Portland, some local fishers, tribal members, and politicians are pushing for the mammals’ body count to rise. “Ask yourself: Why? Why are these numbers so small?” Marie Gluesenkamp Perez, who represents Washington’s Third Congressional District, said at a hearing about the sea lions last month.

Not everyone agrees that more kills are needed. But at this point, all else has failed. To preserve the region’s salmon, more sea lions must go.

Sea lions have never been salmon’s primary threat: That honor belongs to us. More than a century of overfishing, industrialization, and hatchery mismanagement has brought several populations of salmon and their close relative the steelhead to critically low levels in the Pacific Northwest. To spawn, salmon must swim hundreds or even thousands of miles upstream from the ocean, and in the Columbia River and its many tributaries, their path is obstructed by a massive network of hydroelectric dams. Ladders can help fish circumvent these obstacles, but learning to navigate them can take the animals days. In a highly built world, salmon have a far harder time reproducing and surviving than they used to have.

Over the past 40 years, the United States has poured $9 billion into reversing the basin’s salmon and steelhead declines and currently spends more on those efforts than on any other endangered animal in the country. But efforts to mitigate human harms—restricting harvests, remodeling dams, breeding salmon in hatcheries—are yielding diminishing returns. Climate change has made habitat-restoration efforts more challenging, as have pollution from pesticides and even toxic tire dust. Conservationists aim to restore the annual number of returning adult salmon and steelhead to 5 million, but the population, on average, has been stagnant at around 2 million for decades.

Rehabilitating a river can take years to produce an effect, but cull a few sea lions from a dam, “and there’s a benefit the next day,” Clark said. In 2017, winter steelhead populations at Oregon’s Willamette Falls seemed almost certain to soon go extinct, Michael Brown, the marine-mammal program leader at the Oregon Department of Fish and Wildlife, told me. But after agency officials euthanized 33 adult male sea lions at the falls, the number of steelhead reaching their destination went from hundreds to thousands.

[Read: In one place, for one fish, climate change may be a boon]

Plus, killing a handful of sea lions can steer many more away from a site. In the same way that they quickly deduce that tube men can’t hurt them (in fact, some animals end up simply cuddling the warm fans that power them), sea lions notice when their peers venture upstream and fail to come back. After the lethal removals at Willamette Falls and the Bonneville Dam began, far fewer sea lions returned to the sites than the number that researchers expected. Nathan Pamplin, the director of external affairs at the Washington Department of Fish and Wildlife, told me the department estimates that sea-lion removal costs $203 for each fish saved—pricey, but no more expensive than other salmon-recovery efforts.

Still, the process of lethal removal is cumbersome. Under the 1972 Marine Mammal Protection Act, sea lions must be euthanized by a trained professional—a process that requires trapping the animals, which can weigh up to 2,000 pounds, then herding them onto a barge for transfer to a nearby facility. Robert DeLong, a former National Oceanic and Atmospheric Administration researcher who has studied sea lions for decades, told me that removal teams, which must activate the traps manually, could at first snare the animals during daylight hours. But some sea lions began sneaking out before the sun rose, requiring teams to entrap and handle them under low-light conditions—“a human-safety issue,” he said. A crew of about eight people, working from around 4:30 a.m. until the early afternoon, might be able to trap, kill, and necropsy just two to five sea lions in this manner, Doug Hatch, a fisheries scientist at the Columbia River Inter-Tribal Fish Commission, told me.

Gluesenkamp Perez told me she thinks the sea-lion-removal process should be simpler. Her preferred alternative is firearms—“engaging with these animals as animals, and not treating it like a petting zoo,” she said. Currently, shooting sea lions is illegal, but that hasn’t stopped locals from trying. Of the many sea-lion corpses that DeLong has necropsied for research, “the majority of those animals have pieces of buckshot or bird shot or rifle slugs in their musculature,” he told me. In the mid-aughts, Hatch said, firearms were quickly dismissed as a removal method at the Bonneville Dam because using them would have meant shutting down the interstate highway that runs past the dam, as well as clearing people out of the site, which is open to the public. But some tribes in the Pacific Northwest have been discussing using firearms to harvest sea lions and other pinnipeds for subsistence, as Alaskan Natives do, Cecilia Gobin, a conservation-policy analyst at the Northwest Indian Fisheries Commission, told me. Ultimately, Gobin argues, like Gluesenkamp Perez does, “If we are going to take these animals, the most humane way seems to be not to trap them, remove them to some off-site location, and euthanize them, but to have more of a targeted kill.”

Before the Marine Mammal Protection Act passed, in 1972, sea lions were in trouble, too. Years of overfishing had depleted their prey, and humans killed them for sustenance or in disputes over fish. But over the past half century, many local populations have rebounded, in large part by chasing their favorite foods inland.

The fact that sea lions are faring better than salmon has made it easier for humans to side with the fish. But regardless, salmon seem to hold more intrinsic value to us. In the state of Washington alone, the annual salmon harvest is worth roughly $14 million. Many Pacific Northwest tribes have subsisted on the fish for millennia and have woven them into their religions and languages. The right to harvest fish is enshrined in their treaties, but “there’s no way that somebody can sustain themselves as a fisher anymore,” Aja DeCoteau, the executive director of the Columbia River Inter-Tribal Fish Commission, told me. Some tribes in the region that traditionally hold First Salmon feasts to welcome the arrival of spring salmon from the ocean have waited for their catch in vain, forcing them to ask other tribes to donate a fish, Gobin said.

Sea lions are also ecologically essential, but not as much as salmon are. Researchers estimate that roughly 140 other species depend on salmon for food; among them are the Pacific Northwest’s critically endangered southern resident orcas—making sea-lion removals “management of a protected species to benefit a protected species, which may then benefit a protected species,” Clark told me.

[From the July 1946 issue: The salmon rise]

By law, the number of sea lions that can be lethally removed from the Columbia River basin is far below the number that researchers think would impede the animals’ recovery. But some scientists are hesitant to scale up to even those allowable levels. Although sea lions do appear to be measurably depleting salmon at some sites, including the Bonneville Dam and Willamette Falls, the evidence is shakier elsewhere in the region. Plus, removing sea lions from this delicate system may simply allow another predator to swoop in, including the many birds and other fish that also prey on salmon working their way through ladders. Alejandro Acevedo-Gutiérrez, a biologist at Western Washington University, told me he worries that pinnipeds have become an inadvertent scapegoat for salmon’s larger issues, simply because sea-lion-on-salmon predation events—loud, violent affairs in which the mammal beats the fish on the surface of the water, then noisily gnaws its flesh—are more visible than the effects of climate change.

Perhaps the sea lions’ greatest crime is indulging in salmon that humans would rather be feasting on. “We invested so much into all of this,” John North, the deputy fish-division administrator at the Oregon Department of Fish and Wildlife, told me. Decades of work and billions of dollars deep into salmon recovery, humans cannot allow the fish’s comeback to fall apart just because hungry sea lions have swum too far upstream. But salmon protection has never been only about keeping the fish safe. If salmon levels rebound, we can and will eat more of them, Cram said: “The real predator that those fish would go to is us.”

Rotavirus Could Come Roaring Back—Very Soon

2026-01-05T20:35:16-05:00

Of all the diseases that the U.S. government announced today that it will no longer recommend vaccines against, rotavirus is by no means the deadliest. Not all children develop substantial symptoms; most of those who do experience a few days of fever, vomiting, and diarrhea, and then get better. In the early 1970s, when no rotavirus vaccines were available and most children could expect to be sickened with the virus at least once by the end of toddlerhood, Paul Offit considered it to be no big deal, relatively speaking. In this country especially, rotavirus “was an illness from which children recovered,” he told me.

That perception shifted abruptly during Offit’s pediatric residency training, when he saw hundreds of severe rotavirus cases admitted to the Children’s Hospital of Pittsburgh each year. Although plenty of children weathered the infection largely without bad symptoms, others vomited so profusely that they struggled to keep down the fluids they desperately needed. Offit can still recall the nine-month-old he treated in the late 1970s who was hospitalized after her mother had struggled to feed her sufficient fluids at home. The infant was so severely dehydrated that Offit and his colleagues couldn’t find a vein in which to insert an IV; as a last resort, they attempted to drill a needle into her bone marrow to hydrate her. “We failed,” Offit told me. “And then I was the one who had to go out to the waiting room to tell this mom of a little girl who had been previously healthy two days earlier that her child had died.”

Within a few years, Offit had partnered with several other scientists and begun to develop a rotavirus vaccine. Their oral immunization, called RotaTeq and delivered as a series of sugar-sweet drops to infants, would ultimately be licensed in 2006. Today, it remains one of the two main rotavirus vaccines available to American children. Offit is now a pediatrician at Children’s Hospital of Philadelphia, where, he told me, “most residents have never seen an inpatient with rotavirus-induced dehydration”—thanks in large part to the country’s deployment of rotavirus vaccines, which reaches about 70 percent of U.S. children each year.

Now, though, the United States’ rotavirus shield stands to fracture. Today, the Trump administration overhauled the nation’s childhood vaccination schedule, shrinking from 17 to 11 the number of diseases it broadly recommends that all American kids should be immunized against. “After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Health Secretary Robert F. Kennedy said in a statement today. Among the vaccines clipped—including immunizations against hepatitis A, meningitis, and influenza—is the rotavirus vaccine, which the administration frames as more of a personal choice, allowable under consultation with a health-care provider but not essential, because the virus poses “almost no risk of either mortality or chronic morbidity.” Experts suspect that vaccination rates will plummet in response. If they do, rates of diarrheal disease are likely to quickly roar back, Virginia Pitzer, an infectious-disease epidemiologist at Yale, told me. (The administration’s nod to international consensus is tenuous at best; rotavirus also remains the leading cause of diarrheal death among young children worldwide.)

In an email, Andrew Nixon, HHS’s deputy assistant secretary for media relations, defended today’s decision as “based on a rigorous review of evidence and gold standard science, not claims from individuals with a financial stake in maintaining universal recommendations.” (Offit, who is a co-patent holder on RotaTeq, did profit from his invention but sold his interest in the vaccine more than 15 years ago and does not currently receive royalties from its sale.)

I called Offit to discuss the federal backtracking on the vaccine he once helped bring to market, and what the loss of protection will mean for future generations. Our conversation has been edited for length and clarity.

Katherine J. Wu: Rotavirus was once a disease that hospitalized up to 70,000 children each year. Since the arrival of the vaccine you co-invented, as well as another two years later, those rates have plummeted. What was it like to see a vaccine you helped develop have that sort of impact?

Paul Offit: I remember a meeting at Merck [the company that manufactured the vaccine] when they revealed the results of our big Phase 3 trial. [The presenter] showed the data, that it clearly was safe, in 70,000 children. And it was like 95 percent effective at preventing severe illness. She showed a map of the world, with Asia, Africa, Latin America studded with black dots, and each black dot represented 1,000 deaths. She said, “Now we have in hand the technology to prevent this.” Then she showed a picture of a map of the world where all those black dots were gone. And she put her head down, shoulders going up and down, and wept.

The vaccine was taken up relatively quickly, I think in large part because it was an oral vaccine and that is perceived as less difficult than a child getting a shot. To go from 1980 to 2006, and to start to see the incidence of the disease decline, it was just an amazing feeling.

Wu: What will it mean for this vaccine to no longer be recommended by the federal government?

Offit: My wife’s in private practice in pediatrics, and there certainly were many parents who she saw who were hesitant about getting vaccines. And I think it’s more convincing when you can say, “Look, this is a recommended vaccine. This is something that the CDC, the major public-health agency in this country, believes is important for your child to receive.” You can’t really say that now. And if you get rotavirus in early childhood, you have a chance of being one of those 70,000 children [who were hospitalized] before there was a vaccine.

Some diseases, you need to build up a susceptible population, like measles, which we eliminated from this country. That’s not true for viruses like rotavirus, flu, RSV. The virus is always circulating. So if you choose not to get a vaccine, you are at risk, because you may come in contact with that virus. So if there’s a fairly rapid erosion in vaccine rates, I think you would immediately see children suffering a preventable illness.

Wu: In a decision memo addressed to the acting director of the CDC, top officials at the Department of Health and Human Services downplayed the virus’s threat to American children and suggested that the decrease in rotavirus deaths that followed the approval of RotaTeq and another vaccine called Rotarix may instead have been attributable to factors “unrelated to the vaccine, including improved medical care, changes in diagnostic practices, or random fluctuations.” I’m curious what you make of that justification. Were there other reasons rotavirus might have been among the six vaccines targeted?

Offit: A phrase like almost no mortality—really? So the 20 to 60 children who died every year of rotavirus in this country, that’s okay? One child dying is too many, especially if you can safely prevent it. So I don’t agree with that.

Sure, right now the morbidity is low because of the vaccine, and certainly the mortality is largely gone because of the vaccine. We are once again exposing children unnecessarily to harm. There’s no advantage to this. There were 70,000 hospitalizations a year, which was not trivial, and virtually eliminating them was one of the major successes for vaccines in this country. And I don’t understand why you would ever back off that success.

I also just never imagined we would ever get to a time when the CDC, the nation’s No. 1 public-health agency, and the ACIP, which was a group of outside expert advisers who went through the science and made best recommendations, would get to the point where it was basically not a scientific organization anymore. It’s an organization run by an anti-vaccine activist who was a science denialist and conspiracy theorist. I mean, that’s where we are now. We don’t have the CDC anymore. We don’t have an ACIP anymore. I certainly never imagined that. [Editor’s note: Kennedy has an established history of anti-vaccine activism and of embracing conspiracy theories. Nixon, the HHS spokesperson, did not offer further comment on this criticism.]

Wu: This actually isn’t the first time that a rotavirus vaccine has lost a government endorsement. The U.S.’s first rotavirus vaccine, RotaShield, was taken off the market in 1999 after officials detected a rare intestinal-blockage complication. How does the current situation compare? Was there a safety reason to make current rotavirus vaccines less accessible to the public?

Offit: I was actually on the ACIP when that happened. [Editor’s note: Offit was no longer on the ACIP when his own vaccine was voted on.] The [rare side effect was] quickly picked up, and the vaccine was off the market within a little over a year. We care about vaccine safety. It depends on which paper you read, but anywhere from one in 10,000 to one in 30,000 children developed [the blockage]. You were still at greater risk of being hospitalized and dying from rotavirus, but the decision was made to take it off the market.

Wu: What do you think will be the future of the rotavirus vaccine you helped develop and bring to market, and watched help reshape the portrait of diarrheal disease in this country?

Offit: The American Academy of Pediatrics will certainly still recommend it. But younger pediatricians may be less compelled to offer this vaccine, because they didn’t experience this disease when they were in training. But I think what they hopefully realize is that this virus continues to circulate. It’s still out there. And the lower immunization rates, even a little, will cause children to suffer unnecessarily.

The Trump Administration’s Most Paralyzing Blow to Science

2025-12-30T08:00:00-05:00

For all of the political chaos that American science endured in 2025, aspects of this country’s research enterprise made it through somewhat … okay. The Trump administration terminated billions of dollars in research grants; judges intervened to help reinstate thousands of those contracts. The administration threatened to cut funding to a number of universities; several have struck deals that preserved that money. After the White House proposed slashing the National Institutes of Health’s $48 billion budget, Congress pledged to maintain it. And although some researchers have left the country, far more have remained. Despite these disruptions, many researchers will also remember 2025 as the year when personalized gene therapy helped treat a six-month-old baby, or when the Vera C. Rubin Observatory released its first glimpse of the star-studded night sky.

Science did lose out this year, though, in ways that researchers are still struggling to tabulate. Some of those losses are straightforward: Since the beginning of 2025, “all, or nearly all, federal agencies that supported research in some way have decreased the size of their research footprint,” Scott Delaney, an epidemiologist who has been tracking the federal funding cuts to science, told me. Less funding means less science can be done and fewer discoveries will be made. The deeper cut may be to the trust researchers had in the federal government as a stable partner in the pursuit of knowledge. This means the country’s appetite for bold exploration, which the compact between science and government supported for decades, may be gone, too—leaving in its place more timid, short-term thinking.

In an email, Andrew Nixon, the deputy assistant secretary for media relations at the Department of Health and Human Services, which oversees the NIH, disputed that assertion, writing, “The Biden administration politicized NIH funding through DEI-driven agendas; this administration is restoring rigor, merit, and public trust by prioritizing evidence-based research with real health impact while continuing to support early-career scientists.”

Science has always required creativity—people asking and pursuing questions in ways that have never been attempted before, in the hope that some of that work might produce something new. At its most dramatic, the results can be transformative: In the early 1900s, the Wright brothers drew inspiration from birds’ flight mechanics to launch their first airplanes; more recently, scientists have found ways to genetically engineer a person’s own immune cells to kill off cancer. Even in more routine discoveries, nothing quite matches the excitement of being the first to capture a piece of reality. I remember, as a graduate student, cloning my first bacterial mutant while trying to understand a gene important for growth. I knew that the microscopic creature I had built would never yield a drug or save a life. But in the brief moment in which I plucked a colony from an agar plate and swirled it into a warm, sugar-rich broth, I held a form of life that had never existed before—and that I had made in pursuit of a question that, as far as I knew, no one else had asked.

Pursuing scientific creativity can be resource intensive, requiring large teams of researchers to spend millions of dollars across decades to investigate complex questions. Up until very recently, the federal government was eager to underwrite that process. Since the end of the Second World War, it has poured money into basic research, establishing a kind of social contract with scientists, of funds in exchange for innovation. Support from the government “allowed the free play of scientific genius,” Nancy Tomes, a historian of medicine at Stony Brook University, told me.

The investment has paid dividends. One oft-cited statistic puts the success of scientific funding in economic terms: Every dollar invested in research and development in the United States is estimated to return at least $5. Another points to the fact that more than 99 percent of the drugs approved by the FDA from 2010 to 2019 were at least partly supported by NIH funds. These things are true—but they also obscure the years or even decades of meandering and experimentation that scientists must take to reach those results. CRISPR gene-editing technology began as basic research into the structure of bacterial genomes; the discovery of GLP-1 weight-loss drugs depended on scientists in the late ’70s and ’80s tinkering with fish cells. The Trump administration has defunded research with more obvious near-term goals—work on mRNA vaccines to combat the next flu pandemic, for instance—but also science that expands knowledge that we don’t yet have an application for (if one even exists). It has also proposed major cuts to NASA that could doom an already troubled mission to return brand-new mineral samples from the surface of Mars, which might have told us more about life in this universe, or nothing much at all.

Outside of the most obvious effects of grant terminations—salary cuts, forced layoffs, halted studies—the Trump administration’s attacks on science have limited the horizons that scientists in the U.S. are looking toward. The administration has made clear that it no longer intends to sponsor research into certain subjects, including transgender health and HIV. Even researchers who haven’t had grants terminated this year or who work on less politically volatile subjects are struggling to conceptualize their scientific futures, as canceled grant-review meetings and lists of banned words hamper the normal review process. The NIH is also switching up its funding model to one that will decrease the number of scientific projects and people it will bankroll. Many scientists are hesitant to hire more staff or start new projects that rely on expensive materials. Some have started to seek funds from pharmaceutical companies or foundations, which tend to offer smaller and shorter-term agreements, trained more closely on projects with potential profit.

All of this nudges scientists into a defensive posture. They’re compressing the size of their studies or dropping the most ambitious aspects of their projects. Collaborations between research groups have broken down too, as some scientists who have been relatively insulated from the administration’s cuts have terminated their partnerships with defunded scientists—including at Harvard, where Delaney worked as a research scientist until September—to protect their own interests. “The human thing to do is to look inward and to kind of take care of yourself first,” Delaney told me. Instability and fear have made the research system, already sometimes prone to siloing, even more fragmented. The administration “took two of the best assets that the U.S. scientific enterprise has—the capacity to think long, and the capacity to collaborate—and we screwed them up at the same time,” Delaney said. Several scientists told me that the current funding environment has prompted them to consider early retirement—in many cases, shutting down the labs they have run for decades.

Some of the experiments that scientists shelved this year could still be done at later dates. But the new instability of American science may also be driving away the people necessary to power that future work. Several universities have been forced to downsize Ph.D. programs; the Trump administration’s anti-immigration policies have made many international researchers fearful of their status at universities. And as the administration continues to dismiss the importance of DEI programs, many young scientists from diverse backgrounds have told me they’re questioning whether they will be welcomed into academia. Under the Trump administration, the scope of American science is simply smaller: “When you shrink funding, you’re going to increase conservatism,” C. Brandon Ogbunu, a computational biologist at Yale University, told me. Competition and scarcity can breed innovation in science. But often, Ogbunu said, people forget that “comfort and security are key parts of innovation, too.”

Measles’ Most Deceptive Trait

2025-12-18T08:00:00-05:00

In the early 1960s, American childhood was not what it is today. Many children spent hours playing unsupervised in the streets; they rode around in cars without seat belts, then came home to frozen dinners, served in front of TVs blaring cigarette ads. And at some point, they’d almost certainly get measles.

The illness—caused by a virus that is estimated to infect roughly 90 percent of the unimmunized people it comes into contact with—is widely considered one of the fastest-spreading diseases to ever plague humankind. Before the debut of the first measles vaccine, virtually every child in the country could expect to contract it by the time they finished middle school, making it an experience nearly as universal as entering a classroom, skinning a knee, or enduring puberty. “It was sort of a rite of passage,” Kathryn Edwards, a pediatrician and vaccine expert who retired from Vanderbilt University Medical Center in 2022, told me. Edwards, 77, is one of many people born before the first measles vaccine was licensed in 1963; she can vividly recall the pain, discomfort, and fear of having the disease.

The rise of measles vaccination changed all that, and by 2000, the disease had been declared eliminated from the United States, after public-health officials detected no transmission of the virus for a full year. But now measles outbreaks are igniting across the country in communities where vaccination rates have dropped—most recently in South Carolina, where officials have documented more than 130 infections, nearly all of them among unvaccinated people. The U.S. has now clocked nearly a year of continuous measles transmission; come January, the country will very likely lose the elimination status that took nearly four decades of vaccination to gain.

At this point, most Americans can still count on protection from the measles vaccines they received in childhood. And as long as the Trump administration does not completely remove access to those immunizations, the nation will not revert to anything close to its early-1960s state. Still, measles is so transmissible that even slight drops in protection can create space for the virus to infect widely. As outbreaks become common once again, Americans will have to confront just how insidious and difficult to control this virus can be.

One of measles’ most deceptive traits is that most cases, especially in healthy people, are relatively mild. On the one hand, that means that many survive the disease without serious lingering effects. Measles’ hallmarks include a few days of fever, followed by a migrating rash of flat red spots that disappear within the week; one of the disease’s most terrifying complications—brain swelling—occurs at a rate of just 0.1 percent. On the other hand, that means that many who survive the disease consider it of little consequence. In the mid-20th century, especially, measles was often shrugged off. Polio—which permanently paralyzed roughly one out of every 200 people it infected—“really scared the hell out of people,” Walter Orenstein, the associate director of the Emory Vaccine Center, told me. By comparison, measles registered to some as little more than an annoying, rashy blight. In 1960, the U.S. mortality rate was about one in 500,000, and even the surgeon general’s information specialists said the disease was “often welcomed as a guarantee of lifetime immunity.” During the first push for measles vaccination, in the ’60s, some people hesitated to get vaccinated, not because they feared harm from the vaccine, but because they thought, “What’s the big deal? I had measles; my kids can get it; fine,” Orenstein said. The country achieved widespread vaccination, in the end, after enforcing strict school mandates.

Measles was never inconsequential, though. Even a case that is initially “mild” can wipe out defenses that people have built up to other diseases—a kind of “immune amnesia” that can leave them more vulnerable to infection for months or years. Painful ear infections and prolonged bouts of diarrhea can accompany close to a tenth of measles cases. Some 5 percent of infections result in pneumonia that can eventually turn fatal; rarely, measles can also leave children deaf or blind. The disease also tends to hit undernourished, immunocompromised, and pregnant people particularly hard, and many of the severest cases tend to occur in the youngest children. This year, the U.S. has clocked more than 1,900 measles infections—the most the country has documented since 1992—and 11 percent have resulted in hospitalizations. Three people have died, two of them children.

William Moss, a measles researcher at Johns Hopkins University, remembers witnessing the measles resurgence that tore through New York in 1990 and 1991 and watching some of the children hit by the outbreak struggling to breathe as they battled pneumonia. Several of those children died. Measles is “not a harmless disease,” Orenstein told me. “But the vast majority of people did not see that.” That was part of the irony of measles’ omnipresence: Amid a sea of less severe cases, serious suffering and death could pass by unnoticed. And over the decades, as vaccination reduced the number of measles cases that people saw, the occurrence of those rare but terrible outcomes has decreased further still.

In this way, measles vaccination—already considered by some as not worth the effort—has become a victim of its own success, Stanley Plotkin, a virologist and one of the developers of a rubella vaccine, told me: By corralling the disease’s dangers, it has reduced the incentive to protect against them. The measles vaccine is one of the most effective vaccines ever developed, capable of providing decades of immunity at a rate of about 97 percent. Vaccination has been essential to eliminating measles from this country, and dozens of others around the world. But the vaccine can only manage that when a population matches that effectiveness with a nearly equally high level of immunization buy-in, Boghuma Kabisen Titanji, an infectious-disease physician at Emory University, told me. Researchers estimate that, to stave off measles outbreaks, about 92 to 94 percent of people in a community must be immune to the virus. Dip even slightly below that threshold, and the virus, once introduced, can and will gain a foothold.

Measles elimination, then, is a particularly tenuous state, Moss said—potentially, the most unstable elimination status for an infectious disease that a country can have. The virus is so fast-moving that any cracks in our defenses create an opening for it to slip through. As a discipline, public health operates at its best when it can get near-universal buy-in for preventing bad outcomes. But measles’ defining traits can run directly counter to that impulse: People are far less likely to opt into interventions when the problems they need to avoid are rare and tend to concentrate in society’s more vulnerable sectors.

In the U.S., community leaders managed to gain and keep that buy-in for a long time. By the time Edwards was completing her medical training in the 1970s, “we didn’t see measles very much,” she said. She assumed that downward trajectory would continue. To see that trend now reverse, she told me, feels like the negation of decades of hard work—so much so that she’s started to wonder what the point of her entire career has been. Instead of celebrating a 26th year of measles elimination, the U.S. is staring down the impending costs of resurgence.

As outbreaks become more routine again, even mild cases will exact a toll—emptying out classrooms, keeping parents and other caregivers from work, adding to the strain that wintertime viruses put on hospitals. A family that rushes an infected child to the hospital could inadvertently put an entire emergency room of people at risk; another that brushes off a fever might accidentally afflict an entire playgroup. Trying to track and contain a highly contagious virus—which requires interventions such as testing and rapid contact tracing—will tax public-health departments, too. One recent preprint estimated that across the many drains that the virus can put on medical systems, public-health responders, and economic productivity, an average measles outbreak can cost more than $750,000 to rein in.

Before measles becomes a common American experience again, it will creep into society’s unprotected crevices first. Children in unvaccinated pockets of the country are now developing measles’ telltale rash. Adults who were never vaccinated in their youth are falling ill, too, challenging health-care workers and epidemiologists to contend with a new reality of measles striking across the age spectrum. And as individuals who received their vaccines up to six decades ago reach old age, they’re becoming the unwitting subjects of a natural experiment: Researchers are nervously watching to see just how long their immunity might last. The worst outcomes will still be uncommon. But as measles returns to prominence, those numbers will inevitably rise, too.

The Most Feared Person at the NIH Is a Vaccine Researcher Plucked From Obscurity

2025-12-17T07:00:00-05:00

Updated at 12:29 p.m. on December 17, 2025

When Donald Trump nominated Jay Bhattacharya to be the director of the National Institutes of Health, a shake-up seemed inevitable. Typically, the agency—a $48 billion grant-making institution and the world’s largest public funder of biomedical research—has been led by a medical researcher with extensive administrative experience. Bhattacharya was a health economist without specialized training in infectious disease, who’d come to prominence for his heterodox views on COVID policies and who has criticized the NIH for stifling dissent.

The NIH has been transformed this year. And most of the layoffs, policy changes, and politically motivated funding cuts—notably, to infectious-disease research—have happened under Bhattacharya’s watch. But inside the agency, officials describe Bhattacharya as a largely ineffectual figurehead, often absent from leadership meetings, unresponsive to colleagues, and fixated more on cultivating his media image than on engaging with the turmoil at his own agency. “We don’t really hear from or about Jay very much,” one official told me. (Most of the current and former NIH officials who spoke with me for this article requested anonymity out of fear of retaliation.) Many officials call Bhattacharya “Podcast Jay” because of the amount of time that he has spent in his office recording himself talking. “Bhattacharya is too busy podcasting to do anything,” one official told me.

Instead, Matthew Memoli, the agency’s principal deputy director, “is the one wielding the axe,”the official said. This time last year, Memoli was a relatively low-ranking flu researcher at the NIH’s National Institute of Allergy and Infectious Diseases (NIAID). Then, in January, the Trump administration appointed him to be the agency's acting director. At the time, other NIH officials considered Memoli to be a placeholder, temporarily empowered to carry out the administration’s orders. But “there’s been no change since Jay got put in,” one NIH official told me. To the agency officials I spoke with, Memoli, now second in command, still looks to be very much in charge.

Neither Bhattacharya nor Memoli agreed to an interview; the Trump administration responded to my request for comment after this story was published. This account did “not reflect Dr. Bhattacharya’s leadership approach or the way decisions are made at NIH,” Andrew Nixon, a spokesperson for the Department of Health and Human Services, said in an email. “Dr. Bhattacharya has deep respect for the agency, its staff, and its scientific mission, which is rooted in gold-standard science and in the interests of public health.”

To better understand Bhattacharya and Memoli’s leadership, I spoke with 18 current and former NIH officials, whose positions at the agency have spanned a breadth of specialties and administrative roles, and reached out to several of Bhattacharya’s former colleagues. The officials’ first impressions of Bhattacharya—who has argued that the NIH could do more “to promote innovative science”—were of an outsider and a radical, whose ideas could have changed the agency for better or worse. In recent months, NIH officials have come to see him as so disengaged that they hardly worry about his impact. Memoli, by contrast, knows just enough about the agency—and, in particular, its approach to infectious disease—to help destroy it.

Memoli’s appointment to acting director in January floored his colleagues—many of whom had never heard his name before. Like Bhattacharya, Memoli had no previous track record of executive leadership or in overseeing the awarding of federal grants. But officials quickly deduced what about Memoli might have appealed to the administration: In 2021, he described COVID-vaccine mandates as “extraordinarily problematic” in an email to Anthony Fauci, then the director of NIAID, whom the Trump administration has repeatedly tried to discredit. Then, last year, when asked to submit a routine statement about diversity, equity, and inclusion, Memoli sent in one that called the term DEI “offensive and demeaning.” By September, the NIH, under Bhattacharya’s leadership, had done away with DEI statements for its scientists, describing them as “loyalty oaths” that Memoli had “courageously stood against.”

In his two months as acting director, Memoli enacted the Trump administration’s agenda with aplomb, pushing through the mass cancellation of grants focused on topics such as DEI, transgender health, and COVID-19; multiple NIH leaders were ousted while he was acting director, including Jeanne Marrazzo, who served as the director of NIAID until early April. “His major function was to do the administration’s bidding,” Michael Lauer, who led the NIH’s grant-making division before he departed the agency in February, told me.

That same month, while Memoli was still acting director, he began to call Health Secretary Robert F. Kennedy Jr.’s attention to the flu-vaccine research he’d done with his mentor, Jeffery Taubenberger, another NIAID scientist. By early May—after Memoli had been installed as Bhattacharya’s deputy, and Taubenberger as the acting director of NIAID—HHS had redirected about half a billion dollars, once set aside to develop new COVID-19 vaccines and drugs, to their vaccine work. (Outside researchers criticized the grant as an unjustifiably enormous sum; in an email to me in May, Memoli insisted that the grant would support “more than one project,” but did not answer follow-up questions about how much of that sum would furnish his research specifically.)

Part of a deputy’s job is to take some load off the director. But under normal circumstances, people “wouldn’t really notice who the deputy director is,” one official told me; the director is expected to set policy and lead. Although Bhattacharya has continued to reiterate his own goals for the NIH—including advancing more innovative research—his recent visions for the agency have largely followed administration talking points such as diverting resources toward chronic disease and clamping down on “dangerous” virological research. Yet the director seems out of touch with the reality of that agenda: In his public appearances, internal meetings, and on social media, Bhattacharya has delivered conflicting and sometimes erroneous accounts of the NIH’s grant-making policies. Both publicly and internally, he has fixated more on defending himself against criticism he received for his COVID-policy views from 2020 than on the NIH’s current state of affairs, several officials said.

Bhattacharya, in his own way, still seems to be serving the administration by championing its talking points. But Memoli is the one most visibly throttling the NIH’s capacity to fund research and pushing out some of the agency’s most experienced and internally respected leaders. To officials at the agency, his actions look like those of a leader who has been given broad discretion to shrink down the agency’s infectious-disease work—an area where he may have a few personal grievances. “People are afraid of him,” one official said, pausing. “I’m afraid of him.”

Memoli’s history at the NIH appears to have given him a particular zeal for dismantling it. In his two decades at the agency, Memoli has developed a reputation as a self-aggrandizing co-worker, eager to champion himself and dismissive of people he hasn’t felt he could benefit professionally from, three officials who worked with him prior to 2025 told me. At various points, scientists at the agency lodged complaints about his unprofessional behavior toward colleagues, two NIH officials told me. Memoli, meanwhile, complained that “he wasn’t being given enough,” one of them said. Some of his scientific work was solid, but peers inside and outside the agency criticized some as unremarkable, leaving Memoli with a chip on his shoulder, the two officials said.

Of the NIH’s 27 institutes and centers, NIAID, where Memoli once worked, has been among the hardest hit this year, losing most of its senior leadership and a large number of its infectious-disease-focused grants. Since January, multiple officials who denounced the administration’s stance on infectious diseases and vaccines have had Memoli brush aside their concerns in meetings, then been ousted from their roles, three officials told me.

Given the Trump administration’s desire to pare down infectious-disease research, NIAID and prominent officials such as Marrazzo, who succeeded Fauci as director, were always clear targets for cuts. (Yesterday, Marrazzo filed a lawsuit that named Memoli and Bhattacharya and that alleged that she was illegally fired after she had filed a whistleblower complaint about actions of NIH leadership that endangered public health; HHS declined to comment on the lawsuit.) But in some cases, three officials told me, Memoli appears to have pushed lesser-known officials out of their roles after more personal clashes, including Sarah Read, who was NIAID’s principal deputy director and who repeatedly questioned the circumstances of Memoli and Taubenberger’s sizable vaccine grant. (Read has since left the agency.) Memoli also recently detailed Carl Dieffenbach, the director of NIAID’s Division of AIDS, to another branch of NIH after the two clashed over the administration’s approach to HIV research. Days later, he gave Dieffenbach a scoring of one out of five on a performance review—potential grounds for termination—before human-resources personnel forced him to revise that rating, because he lacked evidence for it, two officials told me. (Read and Dieffenbach declined to comment.)

Memoli has also argued that funding for HIV-vaccine research—which Dieffenbach oversaw—is wasteful and should be cut. The NIH is expected to soon divert up to a third of its AIDS budget toward improving the delivery of existing HIV tools, such as the new drug lenacapavir. At least some of that push has come from Bhattacharya, who has publicly advocated (including on his own The Director’s Desk podcast) for reallocating HIV funds on the grounds that established interventions could resolve the AIDS crisis on their own. But whereas Bhattacharya has waffled when asked how such an investment would affect other research, two officials told me, Memoli has insisted in internal meetings that it should come at the expense of research into HIV vaccines, which is widely considered to be essential to ending the HIV pandemic. Despite being a vaccine researcher himself, he’s “gleefully making these cuts,” one official told me. “Because it means he did something.”

Allowing Memoli to be the executor of the Trump administration’s cuts could serve the independent-thinker persona that Bhattacharya has tried to cultivate. But the NIH officials I spoke with, and one scientist who knew Bhattacharya prior to his appointment at the agency, doubted that his distance was so calculated. Trying to discredit the scientific establishment from the sidelines is far easier than trying to enact reform from its center. At the NIH, the embittered insider may leave the more memorable legacy.

This story was updated to include a comment from the Department of Health and Human Services.

RFK Jr.’s Miasma Theory of Health Is Spreading

2025-11-19T12:42:27-05:00

Last week, the two top officials at the National Institutes of Health—the world’s largest public funder of biomedical research—debuted a new plan to help Americans weather the next pandemic: getting everyone to eat better and exercise.

The standard pandemic-preparedness playbook “has failed catastrophically,” NIH Director Jay Bhattacharya and NIH Principal Deputy Director Matthew J. Memoli wrote in City Journal, a magazine and website published by the Manhattan Institute for Policy Research, a conservative think tank. The pair argue that finding and studying pathogens that could cause outbreaks, then stockpiling vaccines against them, is a waste of money. Instead, they say, the United States should encourage people to improve their baseline health—“whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more.”

On its own, Bhattacharya and Memoli’s apparently serious suggestion that just being in better shape will carry the U.S. through an infectious crisis is reckless, experts told me—especially if it’s executed at the expense of other public-health responses. In an email, Andrew Nixon, the director of communications at the Department of Health and Human Services—which oversees the NIH—wrote that the agency “supports a comprehensive approach to pandemic preparedness that recognizes the importance of both biomedical tools and the factors individuals can control.” But more broadly, Bhattacharya and Memoli’s proposal reflects the spread of a dangerous philosophy that Robert F. Kennedy Jr., the secretary of HHS, has been pushing for years: a dismissal of germ theory, or the notion that infectious microbes are responsible for many of the diseases that plague humankind.

In his 2021 book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, Kennedy, a longtime anti-vaccine activist, argues that modern scientists have blamed too much of infectious disease on pathogens, which he suggests are rarely problematic, unless the immune system has been compromised by poor nutrition, toxins, and other environmental stressors. He credits sanitation and nutrition for driving declines in infectious-disease deaths during the 20th century; vaccination, he has baselessly claimed, was largely ineffective and unnecessary. In his view, germs don’t pose a substantial threat to people who have done the work of “fortifying the immune system”—essentially, those who have taken their health into their own hands.

In terms of general health, most Americans would benefit from improvements in diet and exercise. A strong emphasis on both has been core to the Make America Healthy Again movement, and in one important aspect, Kennedy and his allies are correct: The immune system, like other bodily systems, is sensitive to nutritional status, and when people are dealing with chronic health issues, they often fare less well against infectious threats, Melinda Beck, a nutrition and infectious-disease researcher who recently retired from the University of North Carolina, told me. Conditions such as obesity and diabetes, for instance, raise the risk of severe COVID and flu; malnutrition exacerbates the course of diseases such as tuberculosis and measles.

But applied to widespread infectious outbreaks, the MAHA prescription is still deeply flawed. Being generally healthy doesn’t guarantee survival, or even better outcomes against infectious diseases—especially when an entire population encounters a pathogen against which it has no immunity. Although some evidence suggests that the 1918 flu pandemic strongly affected certain groups of people who were less healthy at baseline—including undernourished World War I soldiers—“relatively healthy people, as far as we could understand, were the main victims,” Naomi Rogers, a historian of medicine at Yale, told me. Smallpox, too, infected and killed indiscriminately. HIV has devastated many communities of young, healthy people.

In his book, Kennedy relies heavily on the term miasma theory as a shorthand for preventing disease “through nutrition and by reducing exposures to environmental toxins and stresses.” He’s employing that phrase incorrectly: Historically, at least, miasma theory referred to the notion that epidemics are caused by bad air—such as toxic emanations from corpses and trash—and was the predominant way of describing disease transmission until scientists found definitive proof of infectious microbes in the late 19th century. But his choice of words is also revealing. In pitting his ideas against germ theory, he plays on a centuries-old tension between lifestyle and microbes as roots of illness.

In its early days, germ theory struggled to gain traction even among physicians, many of whom dismissed the idea as simplistic, Nancy Tomes, a historian at Stony Brook University, told me. After the idea became foundational to medicine, scientists still had to work to convince some members of the public that microbes could fell healthy people, too. In the early days of polio vaccination, when the virus still ran rampant in the U.S., some vaccine-skeptical Americans insisted that children were falling seriously ill primarily because their parents weren’t managing their kids’ nutrition well and “had disrupted the child’s internal health,” Rogers told me.

Over time, as pharmaceutical companies made global businesses out of selling antibiotics, vaccines, and antivirals, the products became a symbol, for some people, of how germ theory had taken over medicine. Accepting vaccines came to represent trust in scientific expertise, Rogers said; misgivings about the industry, in contrast, might translate into rejecting those offerings. In that skeptical slice of the American public and amid the rise of alternative-wellness practitioners, Kennedy has found purchase for his ideas about nutrition as a cure-all.

Since taking over as health secretary, he has on occasion made that distrust in germ theory national policy. In his book, he wrote that “when a starving African child succumbs to measles, the miasmist attributes the death to malnutrition; germ theory proponents (a.k.a. virologists) blame the virus.” Earlier this year, when measles raged through undervaccinated regions of West Texas, the secretary acted out his own miasmist theory of the outbreak, urging Americans to rely on vitamin-A supplementation as a first-line defense, even though deficiency of that vitamin is rare here.

But germ theory is key to understanding why outbreaks become pandemics—not because people’s general health is wanting, but because a pathogen is so unfamiliar to so many people’s immune systems at once that it is able to spread unchecked. Pandemics then end because enough people acquire sufficient immunity to that pathogen. Vaccination, when available, remains the safest way to gain that immunity—and, unlike lifestyle choices, it can represent a near-universal strategy to shore up defenses against disease. Not all of the risk factors that worsen disease severity are tunable by simply eating better or working out more. For COVID and many other respiratory diseases, for instance, old age and pregnancy remain some of the biggest risk factors. Genetic predispositions to certain medical conditions, or structural barriers to changing health habits—not just lack of willpower—can make people vulnerable to disease, too.

In their article, Bhattacharya and Memoli purport to be arguing against specific strategies of pandemic preparedness, most prominently the controversial type of gain-of-function research that can involve altering the disease-causing traits of pathogens, and has been restricted by the Trump administration. But the pair also mischaracterize the country’s current approach to pandemics, which, in addition to calling for virus research and vaccine development, prioritizes measures such as surveillance, international partnerships, and improved health-care capacity, Nahid Bhadelia, the director of the Center on Emerging Infectious Diseases at Boston University, told me. And Bhattacharya and Memoli’s alternative approach cuts against the most basic logic of public health—that the clearest way to help keep a whole population healthy is to offer protections that work on a societal level and that will reach as many people as possible. Fixating on personal nutrition and exercise regimens as pandemic preparedness would leave many people entirely unprotected. At the same time, “we’re basically setting up society to blame someone” in the event that they fall ill, Jennifer Nuzzo, the director of the pandemic center at the Brown University School of Public Health, told me.

Kennedy’s book bemoans that the “warring philosophies” of miasma and germ theory have become a zero-sum game. And yet, at HHS, he and his officials are presenting outbreak preparedness—and the rest of public health—as exactly that: The country should worry about environment or pathogens; it should be either pushing people to eat better or stockpiling vaccines. Over email, Nixon told me that “encouraging healthier habits is one way to strengthen resilience alongside vaccines, treatments, and diagnostics developed through NIH-funded research.” But this year, under pressure from the Trump administration, the NIH has cut funding to hundreds of vaccine- and infectious-disease focused research projects; elsewhere at HHS, officials canceled nearly half a billion dollars’ worth of contracts geared toward developing mRNA vaccines.

The reality is that both environment and pathogens often influence the outcome of disease, and both should be addressed. Today’s public-health establishment might not subscribe to the 19th-century version of miasma theory, but the idea that environmental and social factors shape people’s health is still core to the field. “They’re saying you can only do one thing at a time,” Bhadelia told me. “I don’t think we have to.”

The Epidemiologists Are Running for Office

2025-11-07T08:50:03-05:00

In his run for governor of Maine, Nirav Shah holds standard Democratic positions. He aims, his campaign says, “to fix housing, fund health care, feed kids, and fuel growth, while fighting back against the overreaches of the Trump administration.” But Shah’s background is less conventional: In addition to being a lawyer, he’s an epidemiologist who directed Maine’s CDC during the coronavirus pandemic and was the principal deputy director of the federal CDC until earlier this year. Shah decided to resign from the CDC in part because of Robert F. Kennedy Jr.’s confirmation as the secretary of health and human services. If he wins in 2026—a big if this early in the race—Shah suspects that he might be one of the first, if not the first, top CDC officials to secure such a prominent elected office.

Many science and health professionals have shied away from politics in the past. But as the Trump administration has rescinded its support for scientific research, restricted vaccine access, dismissed expert advisers, attacked doctors and scientists, and worked to curtail health-insurance coverage, researchers and health-care workers have had a surge of interest in running for office. Shaughnessy Naughton, the president of 314 Action, a political-action committee focused on electing Democrats with science backgrounds, told me that since January her team has seen almost 700 applications for candidate guidance, training, or funding, about seven times what the group would expect during an election off year.

Some of that interest has already translated into active campaigns. Candidates running in 2026 elections include a mathematician and a microbiologist, along with multiple pediatricians and former health officials. They are entering crowded races, in which even the primaries are months away. But many of these candidates argue that amid the administration’s attacks, voters will want to support scientifically minded politicians who can help fill the gaps in expertise that the nation’s leaders have left. Several told me that they specifically began their campaigns after Kennedy was confirmed and began to remake U.S. vaccine policy.

The number of candidates with science or health backgrounds is one more indication of how these fields are being forced to reckon with their role in the current political landscape. Plenty of science professionals still argue that their work shouldn’t be political. “Let’s get the politics out of public health,” Daniel Jernigan, who directed the CDC’s center for emerging and zoonotic diseases before resigning in protest of HHS’s approach to health policy, said at a rally in August. At the same time, the Trump administration’s attacks have created a political opening that many health and science experts are taking, even if it means politicizing science further.

Science and health representation in elected office is sparse: 3 percent of state legislators are scientists, engineers, or health-care professionals, according to Rutgers University’s Eagleton Institute of Politics. The majority of those politicians are Republicans, Eagleton data show; so are most of the STEM professionals currently in Congress. But as groups, both scientists and, at least in recent years, doctors have leaned liberal, and many of those now motivated to speak out against the Trump administration are Democrats, Kristoffer Shields, the director of Eagleton’s Center on the American Governor, told me. Hawaii’s Josh Green, the only Democratic physician currently serving in a state governorship, gained prominence during the coronavirus pandemic, when he advanced proactive mitigation measures as lieutenant governor. (This year, Green partnered with 314 Action to launch a $25 million campaign to elect 100 new Democratic physicians to office by 2030; he is up for reelection next year.)

Some science-minded candidates are entering electoral politics for the first time. For New Jersey’s Tina Shah (no relation to Nirav), an ICU physician now running for the U.S. House of Representatives, the push was the Trump administration’s approach to health care: She told me that she now regularly encounters patients who can’t afford medication or who are being denied coverage for important procedures. Others have made bids for public office before, including Abdul El-Sayed, a former health director with an M.D., who ran, unsuccessfully, for the Democratic nomination to Michigan’s governorship in 2018. He feels more confident in his current bid for U.S. Senate because the second Trump administration has made the harms of inaccessible care even more visible. He is gaining some traction: In the most recent quarter, he raised close to $1.8 million, the second-highest amount in his Democratic primary. Tina Shah, meanwhile, has raised more money from donors in a single quarter than any other Democrat in her district.

After the pediatrician Annie Andrews lost a congressional race in 2022, “I had no intention of running again,” she told me—then she changed her mind after watching Kennedy rise to the top of HHS. Andrews is running to unseat Lindsey Graham in the U.S. Senate, but she said she has found success in casting Kennedy—arguably the country’s most polarizing health secretary to date—as an opponent, too: “The more I speak out against the absurdity of RFK Jr. and his recent actions, the more traction I am getting.” For Richard Pan, a pediatrician and former California state senator, Kennedy’s threat is less abstract: When Pan was working on legislation that would make school vaccine exemptions harder to get, Kennedy, one of America’s most prominent anti-vaccine activists, traveled twice to Sacramento to oppose those measures, he told me. Pan’s now running for Congress in part to counteract Kennedy’s anti-vaccine policies at the federal level.

Many of the candidates I spoke with have considered just how much they want to lean into their credentials. For voters worried about health-insurance coverage or the future of research in the United States, scientists, health-care workers, and public-health experts may have particular appeal right now, Shields told me. Still, several of the candidates I spoke with told me they weren’t running “on an explicit science platform,” as Nirav Shah put it. The candidates I interviewed were all critical of Kennedy, but several were reluctant to fixate on him, arguing (as any politician might) that voters care more about changes that directly benefit their community.

In Nirav Shah’s view, behaving as though health and science are severed from politics is “a nonstarter.” As the Trump administration has worked to dismantle its own health agencies, members of Congress have fought to keep some of those agencies’ budgets intact. And as the administration has dismissed expert scientific advisers, state and municipal leaders have stepped in: 15 governors, for instance, recently announced the formation of a public-health alliance to dictate policy that diverges from the federal government’s. Although the coalition bills itself as nonpartisan, all of the participating governors are Democrats.

Under Donald Trump’s leadership, polarization around several scientific issues has deepened. The administration argues that research has been corrupted by ideology and claims that it’s restoring “gold-standard science.” Polls suggest that Republicans have been more supportive than Democrats of new restrictions on vaccine recommendations and research-funding cuts. If some Democrats are making an issue of the Trump administration’s record on health and science, so are Republicans. At least one Republican doctor running for the U.S. House has played up his opposition to mRNA vaccines; some members of Congress with health backgrounds who are running for reelection have embraced Trump-administration criticisms of COVID-era policies and gender-affirming care for children.

Several health and science professionals remain skeptical that getting into politics in any way will help their cause. Jernigan, the former CDC official, told me his call to “get the politics out of public health” at the rally meant that, for health policy, politics shouldn’t supersede evidence, not that politics can be fully extracted from public health, he told me. At the same time, he noted that enmeshing science and politics too deeply risks casting evidence and the practice of research as the business of only one political party. “Perhaps we are in a situation where there needs to be a more vocal, assertive public-health voice,” Jernigan told me. “But does it have to translate into political office? I don’t think so.”

And yet, the perception of public-health overreach has been a radicalizing force among Trump supporters; whether through electoral politics or not, any attempt to fight the administration’s actions may bolster its narrative that scientists have been corrupted by liberal ideology. When I asked candidates whether their campaigns might deepen partisan divides in attitudes toward science, many of them skirted the question—and few offered answers when asked how they’d cope with that reality. Instead, candidates told me that they felt fairly boxed in. “Politics came for us,” Andrews said. “You can’t fight bad politics by staying apolitical.”

What Happens When Trump Gets His Way With Science

2025-10-16T12:48:27-04:00

As Andrea Baccarelli, the dean of Harvard’s School of Public Health, prepared to open a virtual town hall earlier this month, members of the university’s graduate-student union gathered for a watch party with “Baccarelli Bingo” cards. The game boards were filled with phrases the dean was expected to use: “these are difficult times”; “i know it’s not a satisfying answer but we don’t know”; “… which is why we must be innovative!” At the center of the grid was a free space, bedazzled with emojis, that read, “no meaningful commitments made.”

Baccarelli’s stated goal was to provide an update on the school’s financial crisis. Of Harvard’s schools, HSPH has been by far the most reliant on government grants—and so was the hardest hit by the Trump administration’s cuts to federal research funding. In the spring, essentially overnight, the school lost about $200 million in support. Although a federal judge has ruled that those grant terminations were illegal, the school’s future relationship with the federal government remains uncertain. Long-term survival for HSPH would require dramatic change, Baccarelli said at the town hall: It needed to become less dependent on federal funds. In the process, it would have to cut $30 million in operations costs by mid-2027 and potentially slash up to half of its scientific research. HSPH is one of the most consequential public-health institutions in America: The school once contributed to the eradication of smallpox and the development of the polio vaccine, led breakthroughs linking air pollution to lung and heart disease, and helped demonstrate the harms of trans fats. If the Trump administration’s aim has been to upend American science, HSPH is a prime example of what that looks like.

But the school’s dean, too, has become something of an emblem—of how unprepared many scientists are to face this new political reality. At the town hall, Baccarelli had to address his controversial work linking acetaminophen—Tylenol—to autism and answer for how he’d communicated with the Trump administration about it. (Another Baccarelli Bingo square: “acetaminophen mentioned.”) At a press conference in late September, Donald Trump and several of his top officials announced that they would update Tylenol’s labeling to discourage its use during pregnancy, leaning heavily on Baccarelli’s research on the subject and on expert witness testimony he’d given. “To quote the dean of the Harvard School of Public Health,” FDA Commissioner Marty Makary said, “‘There is a causal relationship between prenatal acetaminophen use and neurodevelopmental disorders of ADHD and autism spectrum disorder.’”

Plenty of the school’s faculty were taken aback to hear Trump officials warmly referencing their dean, especially given that Tylenol’s connection to autism—a complex condition with many contributing factors—is shaky at best. Karen Emmons, an interim co-chair of HSPH’s department of social and behavioral sciences, told me she almost crashed her car when she heard Makary quoting Baccarelli on the radio. Many were also surprised to learn, from press reports, that Baccarelli had fielded calls about his research from Health and Human Services Secretary Robert F. Kennedy Jr. and National Institutes of Health Director Jay Bhattacharya earlier in September.

The dean’s interactions with the administration quickly became a new vulnerability for the school. As other experts criticized the methodology of Baccarelli’s work on Tylenol and called his claims about causality unfounded, Baccarelli began to look like a biased researcher, allied with the same political leaders “who are starving us of our funding and basically killing the school,” Erica Kenney, a nutrition researcher at the school, told me. In the view of many faculty members, Baccarelli had undermined the public position Harvard spent months cultivating—as a beacon of academic integrity, unwilling to bend to the administration’s political pressure. (Baccarelli declined interview requests for this story and answered a series of in-depth questions with a brief statement saying that he looked forward to “continuing the work of building a sustainable future” for the public-health school.)

At the town hall, Baccarelli seemed to recognize these consequences. “I’m really sorry about the impact this has had on our school,” he said. But he was also defensive, describing himself as a researcher who wanted to explain the value of his work and help set evidence-based policy. He had spoken with the administration as a scientist, not as a Harvard dean, he said, and hadn’t anticipated that Trump officials would focus so pointedly on his affiliation with the school. His instinct, in other words, was to treat science as severed from politics. He seemed unaware of how unrealistic that split now is for American scientists.

Some nine months into the Trump administration’s assault on academic science, Harvard’s public-health school has just about everything going against it that an American academic institution can. It is part of Harvard, which the administration has accused of failing to protect students from anti-Semitism. It has excelled in several fields that the administration has declared unworthy of federal funds: infectious disease, health equity, climate change, global health. About half of the school’s faculty contributes in some way to international research, which the administration has also taken a stand against. Many HSPH researchers are themselves from other countries—including roughly 40 percent of the school’s students—and their ability to stay here is uncertain under the Trump administration’s immigration policies.

Historically, nearly half of HSPH’s revenue and 70 percent of its research funding have come from federal grants. And unlike academics supported largely by tuition or endowments, HSPH researchers typically have had to bring in nearly all of their own research funds, including to cover their own salaries and those of staff and trainees. “Faculty members essentially function as a small business,” Jorge Chavarro, HSPH’s dean for academic affairs, told me. When researchers’ federal income dried up, they had to shrink those businesses. David Christiani, a cancer researcher, laid off four staff members; to pay the rest of his people, he told me, he’s blown through nearly half of the roughly $900,000 in discretionary funds that he’s accumulated since the 1990s. Roger Shapiro, an infectious-disease researcher, fired half of a research team in Botswana that has been studying the use of HIV antiretroviral drugs during pregnancy. Erica Kenney’s team will likely shrink from about a dozen people to three. And the school’s incoming cohort of Ph.D. students this year was half its usual size. (In 2018, I earned a Ph.D. in microbiology from Harvard’s Graduate School of Arts and Sciences. My thesis adviser, Eric Rubin, holds an appointment at the public-health school.)

When the funding crisis hit, Harvard distributed emergency funding across its schools. But what reached HSPH faculty offered little relief—in Christiani’s case, it was “too small to have kept anything going other than literally the freezers and some data management,” he told me. (The office of the Harvard University president did not respond to a request for comment.) The public-health school has put limits on the amount of discretionary funds that faculty can spend to keep their research going, to ensure the longevity of those resources during the crisis. “This is supposed to be the most flexible amount of money you have, so people try to save it for as long as possible,” one faculty member, who requested anonymity because they are not a U.S. citizen, told me. To plug the gaps, faculty have been frantically applying for nonfederal sources of money. But whereas grants from the NIH could total millions of dollars, many foundation grants come in the tens of thousands, not even enough to sustain a single postdoctoral fellow for a year.

As their professional world fell apart, many staff, students, and faculty waited for Baccarelli to articulate a clear path forward. He left the task of divvying up emergency funds to HSPH’s nine department chairs, and many researchers grew frustrated as different parts of the school scrambled to make ends meet in different ways. In one department, at least one faculty member has used personal funds to cover trainees’ travel expenses; the biostatistics department has pushed at least 10 Ph.D. students to do data-analysis externships in exchange for coverage of stipends. Across the school, three senior lecturers and three tenure-track junior faculty members have been notified that they will likely be terminated in 12 months, unless they secure alternative funding.

Some faculty members took those notices as a clear indication of HSPH’s more cutthroat future. One, who requested anonymity to speak about the school’s strategies, felt relatively secure because the school would “forfeit about $900,000 of overhead if they got rid of me,” they said. “When you become a financial liability, they cut you loose.” (Stephanie Simon, the school’s dean for communications and strategic initiatives, told me that prospects for future federal funding don’t motivate potential terminations, but also that grant reinstatements could prompt the school to rescind the notices for the tenure-track faculty.)

Baccarelli has repeatedly declined to say how many people the school has laid off this year, a common point of frustration among the HSPH scientists I spoke with. “So many of us have left, and you can’t tell us the impact?” said Matthew Lee, a former HSPH postdoctoral fellow who lost his position this summer because of the funding crisis. At the town hall, Baccarelli said that the university had asked him not to share those details. But he did share that HSPH had already cut $16 million from its operations budget, $7 million of which accounted for losses in personnel.

This was the path forward. In the brief statement he sent in response to my questions, Baccarelli said that he had “developed and communicated a strong vision for the future of the school.” The statement linked to a strategic vision on the HSPH website, which acknowledged that the school “cannot maintain the status quo” but asserted that it would emerge as “a focused, resilient, and unambiguously world-class school of public health.” Left unsaid was that it would almost certainly be a smaller, less enterprising one.

In many ways, Baccarelli, who assumed the deanship at the start of 2024, has limited power: He can’t force the Trump administration to relinquish funds, or raid the pool of money that Harvard University holds centrally. Still, for months, many trainees and faculty have been calling for their dean to “stand up more forcefully” to the administration’s siege on science and defend his school’s most vulnerable researchers, Sudipta Saha, a Ph.D. student at HSPH and the vice president of Harvard’s graduate-student union, told me. Before the town hall, the school’s faculty council conducted a poll—unlike anything they’d seen before, several faculty told me—about the dean’s ability to do his job and the impact that the Tylenol debacle will have on the school. (The results have not been made public, but at the town hall, Baccarelli described the feedback as “very direct.”) Several of the faculty I spoke with defended the dean. “He did nothing wrong,” David Christiani told me; Karen Emmons and Erica Kenney emphasized that they were sympathetic to his plight. But most of the HSPH researchers I spoke with said they were deeply frustrated with him.

To his critics, Baccarelli’s recent actions have revealed how willing he is to play fast and loose with scientific certainty, at a time when much of the scientific establishment has denounced the Trump administration for doing exactly that. Baccarelli’s research focuses on topics such as air pollution and aging, but for years he has had a side interest in Tylenol use during pregnancy. In 2023, he gave expert-witness testimony on behalf of plaintiffs suing the maker of Tylenol, for which he was paid about $150,000 and spent some 200 hours preparing. In that testimony, Baccarelli asserted that taking the drug during pregnancy was not just linked to neurodevelopmental conditions such as autism but probably caused them. Neither his own research nor others’ has demonstrated such a strong conclusion, and the presiding judge picked up on that. Although Baccarelli was “the plaintiffs’ lead expert on causation,” she noted, he had co-authored a study in 2022 arguing that more research was needed before changing recommendations for using Tylenol during pregnancy. She ultimately excluded his testimony.

Baccarelli later seemed concerned about how he’d come off in the case, Beate Ritz, an epidemiologist at UCLA who studies neurodevelopmental conditions, told The Atlantic. According to Ritz, Baccarelli approached her at a conference and explained that he wanted to write a paper to clarify why he’d concluded that Tylenol should be used cautiously: He had been accused of being in it for money, and hoped to set the record straight. Ritz agreed to collaborate with Baccarelli. Their resulting manuscript, published in August, stopped short of saying that Tylenol use during pregnancy caused autism, but argued for a strong link between the two. Since the Trump administration thrust the study into the limelight, several other scientists have lambasted it, saying it overemphasizes evidence that supports the authors’ preset biases. (Ritz told The Atlantic that she asked Baccarelli and her other co-authors to correct an early version of the paper because it gave undue weight to lower-quality studies. But she stands behind the final version.)

When Kennedy called, Baccarelli wanted to promote his findings as any other researcher would, he said at the town hall: “As a scientist, I felt it was my responsibility to answer his questions.” He said he had not discussed the school’s financial situation with the administration. He also declined to attend the press conference on autism; instead, he released a statement that day noting that further research was needed to determine a causal relationship between the drug and autism, but advising “caution about acetaminophen use during pregnancy.” (Andrew G. Nixon, the director of communications for the Department of Health and Human Services, did not answer my questions about the administration’s association with Baccarelli, but acknowledged that some recent studies other than Baccarelli’s “show no association” between Tylenol and autism. The administration’s current guidance “reflects a more cautious approach while the science is debated,” he wrote.)

Baccarelli’s intentions were understandable, Emmons told me: “He doesn’t want to give up his science.” At the same time, though, “when you’re a dean, you’re always a dean.” Baccarelli’s assumption that he could selectively cleave himself from his role at the school, several HSPH researchers told me, was at best clueless and politically unsavvy. At worst, it represented reckless neglect of his duty as the primary steward of his school’s reputation and future. Even in a less politically charged climate, Baccarelli’s controversial paper and overzealous witness testimony might have blemished his reputation. Under current conditions, they cut against his own vision of leading a world-class institution—which requires proving to other parts of the research enterprise that the school has maintained its commitment to scientific rigor.

Prior to this year, many HSPH researchers saw the school’s reliance on federal funds as a strength. Government support was exceptionally stable, and HSPH researchers were exceptionally good at winning it. By Harvard’s standards, the school’s endowment was not its primary boasting point—public-health alumni don’t tend to become billionaires —and in times of wider financial turmoil, HSPH remained well insulated, Amanda Spickard, the associate dean for research strategy and external affairs, told me. Now, for the first time, the school is confronting the risks of sourcing half of its operating budget from a single entity.

The government was public health’s ideal funder in part because it could play science’s long game: funding research that might not be immediately profitable or even beneficial. That pact is now broken, and as the school seeks alternative routes, several researchers worry that some of the most important science will be the fastest to fall by the wayside. If, as some faculty suspect, more commercializable research is likelier to survive at the school, HSPH also risks abandoning a core public-health mission—meeting the needs of the underserved—and detracting from Baccarelli’s own strategic vision of building “a world where everyone can thrive.”

I asked multiple faculty members in top leadership roles how HSPH planned to deal with these imbalances. None of them delivered satisfying answers. Spickard and Jorge Chavarro both mentioned getting faculty to think more creatively about pursuing funding. Both also acknowledged that some faculty will lose out more than others. (Emmons, the interim department co-chair, suggested that making research more interdisciplinary could appeal to funders across a wider range of fields.) Chavarro also said that HSPH leadership planned to clarify which of the school’s decisions are temporary, emergency measures versus actions that will guide the school long-term. But when I asked for examples from each of those categories, he hesitated, and ultimately named only emergency actions.

Although more than a month has passed since a federal judge declared the grant terminations at Harvard illegal, money is only just starting to trickle back to the public-health school, and several faculty told me they still don’t have access to their funds. (An internal communication sent by Baccarelli last week indicated that the university was still “in the process of reconciling the payments.”) HSPH has also been cautious about lifting spending limits on its faculty, in part because Harvard worries that the administration will continue to appeal the judge’s decision, or otherwise renew or escalate its attacks, Christiani told me. Late last month, HHS referred Harvard for debarment, which would block the institution from receiving any federal funds in the future.

Many HSPH scientists expect that this is far from the end of the most difficult era of their career. A few pointed toward William Mair, who studies the links between metabolic dysfunction and aging, as one scientist already stretching to do the kind of interdisciplinary work that might help the school survive. In recent months, Mair has been reaching out to colleagues across the school to collaborate on a healthy-aging initiative that will draw on multiple public-health fields. But Mair, too, has had to whittle his lab down to just five people and shelved many of the team’s more ambitious experiments. Originally from the United Kingdom, he came to the U.S. nearly 20 years ago for his postdoctoral fellowship, then stayed in the country that he felt was the best in the world at supporting science. (He became a citizen earlier this year.) “I don’t want to leave this community,” he told me. “But every minute I stay here at Harvard is currently detrimental to my own science career.” The university that once promised to buoy scientific aspirations now feels like a deadweight.

Tom Bartlett contributed reporting.

Pediatricians Can’t Bear These Costs

2025-10-03T11:35:05-04:00

Ask most pediatricians about the finances of vaccines, and they’ll tell you that vaccines are not a big moneymaker. Providing them might generate some profit, but generally, “the margin you make is exceptionally small,” Robert Lillard, the medical director of the Cumberland Pediatric Foundation, told me.

Health Secretary Robert F. Kennedy Jr., without citing specific evidence, has claimed otherwise—that vaccination generates massive profits for doctors. In a June interview with Tucker Carlson, he put it at “50 percent of revenues to most pediatricians,” and said those profits create “perverse incentives” to push shots on their young patients. This description is so far from reality that Rana Alissa, the president of the Florida chapter of the American Academy of Pediatrics, told me that any actual vaccine provider would find it laughable. In fact, immunization is a dicey-enough financial proposition that the administration’s anti-vaccine policies already are discouraging providers from stocking some immunizations.

Pediatrics is one of the lowest-paid specialties in medicine. Now the Trump administration’s approach to vaccines “has made the job of being a pediatrician that much more challenging,” Jason Terk, a pediatrician in northern Texas, told me. “Is that going to hasten people leaving the practice? Probably.”

Health-care providers purchase roughly half of the vaccines given to children in the United States directly from manufacturers, sometimes paying hundreds of dollars per dose. They don’t recoup any costs until they administer those vaccines to privately insured patients, and bill the companies. That’s an enormous up-front investment for pediatric practices, generally second only to employees in terms of cost. At Scott Huitink’s pediatric practice in Tennessee, his team spends well over half a million dollars a year purchasing vaccines from manufacturers, he told me.

The other half of pediatric vaccines are purchased by the federal government, then distributed to providers across the country through the Vaccines for Children Program to support the immunization of children whose families can’t otherwise afford it. Regardless of who pays for the doses themselves, pediatricians’ offices must then shoulder the costs of storage and administration: specialized refrigerators, alarms to monitor for temperature issues, highly trained staff. Insurers generally reimburse for some of those costs, but not for unexpected problems—a refrigerator failure, a dropped vial, a dose drawn into a syringe and then declined by a patient’s family. Lose just one vaccine, and providers may have to administer dozens more to break even. In one study from 2017, 12 percent of pediatric practices and 23 percent of family-medicine practices surveyed reported that they had stopped purchasing at least one vaccine because the financial risk was too great. (In those cases, they can refer families to local health departments or pharmacies to receive those immunizations.)

Providers have generally counted on consistent vaccine recommendations from the federal government to create relatively predictable demand. But this year, they cannot. President Donald Trump has advocated for Americans to delay or space out vaccines—waiting until the age of 12 to receive a hepatitis-B shot, normally given on the first day of life, or taking the measles, mumps, and rubella shots separately. Kennedy, meanwhile, has touted the debunked claim that MMR vaccines cause autism, and baselessly described COVID and HPV vaccines as dangerous. He has also repopulated the CDC’s Advisory Committee on Immunization Practices, or ACIP, with researchers who have little to no experience in vaccine science or have publicly endorsed anti-vaccine views and who are now restricting or removing recommendations for various vaccines.

When reached for comment, Andrew G. Nixon, the director of communications at the Department of Health and Human Services, wrote via email, “Claims that this administration is undermining pediatricians or seeking to reduce childhood care are categorically false. Vaccine policy is guided by gold standard science and radical transparency.” The White House did not return a request for comment.

Some of these actions are affecting pediatricians’ vaccine purchasing directly. In its first meeting, for instance, Kennedy’s ACIP voted to remove recommendations for flu vaccines that contain the preservative thimerosal, following the counsel of an anti-vaccine activist. Most flu vaccines in the U.S. were already thimerosal-free. But Terk, in Texas, told me that about 70 percent of his practice’s supply of flu shots contained the compound, which prevents contamination in multidose vials. Switching over to single-dose, thimerosal-free vials eats up far more space in refrigerators, forcing his practice to place more frequent orders of fewer, more expensive doses. Under Kennedy’s leadership, the FDA has also restricted the approvals for COVID shots, while the ACIP has substantially softened recommendations for their use—prompting weeks of scramble for pharmacies, doctors’ offices, and patients, as they have tried to figure out who is eligible for the shots and whether insurers will cover them.

For a time, staff at Weill Cornell Medicine were having patients sign waivers pledging to pay out of pocket if insurers wouldn’t cover COVID shots, Adam Stracher, the system’s chief medical officer, told me. That has since stopped, as providers have grown more confident that coverage will come through. (AHIP, the national trade association that represents the health-insurance industry, has pledged to continue covering vaccines, including COVID vaccines, through the end of 2026. But not all insurance plans are expected to fall under that umbrella, experts told me.) Other pediatricians, who might normally place orders for autumn vaccines in the late spring or early summer, waited until Kennedy’s ACIP met to discuss the shots in September. Terk, for instance, didn’t receive his first batch of shots until the end of September; prior to that, he had to turn away families that wanted the vaccine.

Eliza Varadi, a pediatrician in South Carolina, told me that the murkiness around insurance coverage, coupled with lower demand, has prompted her practice to start ordering COVID vaccines just one box at a time—each a batch of 10 doses—to minimize the potential for loss. “We’re very nervously waiting for the claims to go through the insurance companies, to make sure they are being paid,” Varadi told me. “We could be okay, or we could lose several thousand dollars.” (Providers can sometimes return unused vaccines to manufacturers, but in many cases, only for credit or a partial refund.)

Because neither Kennedy nor Jim O’Neill, the CDC’s acting director, has yet signed off on the ACIP’s new recommendations for COVID vaccines, states haven’t been able to order the shots through the Vaccines for Children program. “The program basically said, ‘You can’t order COVID vaccines. We don’t know when you can. We don’t know when you’ll have them, or if you’ll have them at all. But at this point, all orders will be denied,’” Varadi told me. The lack of availability is now creating a two-tiered system of vaccine access, Deborah Greenhouse, another South Carolina pediatrician facing similar issues, told me. (Nixon did not respond to questions about this disparity, or when states would be able to order COVID vaccines through VFC.)

The downturn in COVID-vaccine purchasing may be bleeding into other shots. As orders of COVID shots have decreased, so have orders for flu and HPV vaccines, Lillard, of the Cumberland Pediatric Foundation, said. (Several pediatric practices in Tennessee purchase vaccines through Cumberland, which runs its own vaccine buying group.) Greenhouse told me she’s been encountering far more resistance to the HPV vaccine in recent months, with families citing misinformation they’ve heard on social media. “It happens several times a week at this point,” she said.

In general, demand for vaccines had already fallen, especially since the start of the coronavirus pandemic. At the same time, Lillard told me, the cost of labor and the price tag of many individual vaccines have continued to rise, while payments from insurance companies have remained relatively flat. Now that the federal government has adopted an antagonistic stance toward vaccines, the business of immunization looks even worse. Under these pressures, Varadi expects that more pediatricians will soon decide to stop offering certain vaccines.

By helping to keep children healthy, vaccines actually drive down demand for pediatric services, Alissa, of the Florida Chapter of the American Academy of Pediatrics, pointed out. In theory, pediatricians abandoning vaccines would help their businesses. But as the Trump administration continues to feed doubts about shots, doctors are being forced to confront just how costly vaccine hesitance can be. Greenhouse’s visits are now stretching out longer, she told me—putting her behind schedule, or leaving no time for other important discussions about her patients’ health. Families in many parts of the country are now requesting personalized, delayed vaccination schedules, which can drastically increase the number of routine visits that families must make, Huitink told me, as well as provider workloads. Juggling all of these bespoke schedules for families, Stracher said, makes mistakes more likely. Several pediatricians told me they worry that they and their colleagues might eventually need to see fewer patients, or cut other costs at their practice to compensate. “You’re going to see physicians leaving the workforce because of this,” Varadi told me.

Pediatrics has for years been enduring a workforce shortage—to the point where pediatrics training programs are struggling to fill slots. “We cannot find, we cannot hire, we cannot recruit,” Anita Henderson, a pediatrician in Mississippi, told me. And the pediatricians I spoke with told me they expect that deficit to worsen. So when more children fall ill amid rising rates of outbreaks, fewer doctors will be available to care for them.

Kennedy’s Handpicked Vaccine Committee Is a Mess

2025-09-18T18:50:33-04:00

Updated at 11:08 a.m. on September 19, 2025

Three months into its tenure, in a muddled and chaotic meeting, Robert F. Kennedy Jr.’s handpicked vaccine advisory committee managed to take down one of its planned targets.

On Thursday, its members voted to limit the national guidance for a childhood vaccine that has helped protect infants against some of the most dangerous and fast-spreading viral diseases in the United States. If the CDC adopts the committee’s advice, the agency will no longer recommend the combination measles-mumps-rubella-varicella (MMRV) vaccine for kids younger than 4, defaulting their first dose of protection against MMR and chickenpox to two separate shots.

But although the committee also discussed delaying the first dose of the hepatitis-B vaccine from birth to at least one month old for most infants, it could not take a clear swing at revising the current recommendations. Instead, it decided to table any vote on that vaccine.

The committee’s focus on these two vaccines seems to be an agenda of Kennedy’s own design. In the past, the panel, known formally as the Advisory Committee on Immunization Practices, or ACIP, has considered changes in guidance prompted by evidence—a new shot being brought to market, the release of new data on a vaccine’s effectiveness or safety. Now Kennedy himself is driving much of what the committee discusses, including Thursday’s deliberations on hepatitis B and MMRV, Demetre Daskalakis, the former director of the CDC’s National Center for Immunization and Respiratory Diseases, told us. “Those were dictated topics,” he said. (A spokesperson for the Department of Health and Human Services told us via email that Susan Monarez, the most recent CDC director, approved the agenda before she was fired last month. Monarez did not respond to a request for comment.)

These vaccines are among the most vulnerable to challenge on the grounds that they appear more risky or seem less necessary than the rest of the immunizations the CDC recommends. Some other high-income countries, for instance, do not recommend the hepatitis-B vaccine universally at birth; MMRV vaccines have been linked to an increased risk of certain side effects in children under 2. Helen Chu, an infectious-disease specialist at the University of Washington, sees no reason to alter the recommendations for these vaccines, but can imagine how they’d fit into a broader strategy, she told us: “If you were going to pick, these are good ones to pick off first.” (Chu was a member of ACIP until Kennedy abruptly dismissed her in June along with the other 16 sitting members.)

The committee may have kept the recommendation for hepatitis-B vaccines intact for now. But each revision to the national immunization schedule makes it that much easier for Kennedy’s ACIP to cast other vaccines as dispensable. “It’s more the principle,” Daskalakis said at The Atlantic Festival on Friday—“that they, with no data, with no reason to do it, have just removed a vaccine from the pediatric schedule.”

To Margot Savoy, a senior vice president at the American Academy of Family Physicians, this looks like “a very calculated approach.” (The AAFP is one of several professional medical societies that recently published vaccine recommendations that openly diverge from the CDC’s in response to Kennedy’s overhaul of U.S. vaccine policy.) Many of Kennedy’s initial attacks against immunizations have focused on COVID vaccines, capitalizing on lingering and highly politicized resentment over pandemic-era policies. And in June, at the first meeting of Kennedy’s newly reconstituted ACIP, the committee voted to drop its recommendations for flu vaccines containing the mercury-based preservative thimerosal—a decision that played on decades-old fears, fueled by anti-vaccine activists, that the compound can cause harm, despite years of evidence showing that it doesn’t.

Those early decisions were relatively limited in their impact. Last flu season, fewer than 5 percent of flu vaccines in the U.S. contained thimerosal. COVID-vaccine uptake had already been declining for years and was never very high among children; the previous iteration of ACIP was already considering paring back some of the recommendations for COVID vaccines before Kennedy fired all the sitting members. But those restrictions also paved the path for this week’s votes, which will limit the country’s options to protect its children in the years to come.

In an email, the HHS spokesperson defended Kennedy’s ACIP, writing that the committee “is guided by gold standard science and will make any recommendations based on the totality of evidence presented to them. HHS has not, and will not, limit access to vaccines.”

Compared with MMR and varicella vaccines that are administered separately, MMRV vaccines do have a higher risk of febrile seizures (which, while frightening to watch, usually resolve on their own and don’t generally carry long-term risks). The CDC once recommended MMRV over separate shots, but as the data on seizures emerged, the agency shifted its guidance to prefer giving the first dose of the MMR and varicella vaccines separately. Several ACIP members suggested on Thursday that the vaccine and its side effects were still poorly understood, and that safety issues would crater trust in vaccines overall.

But the experts we spoke with pushed back on that notion. The CDC previously kept MMRV as an option in part to offer more choices for families—especially ones that don’t interact regularly with the health-care system or prefer fewer injections. Edwin Asturias, a pediatrician at the Colorado School of Public Health and one of the ACIP members Kennedy dismissed in June, told us. Each year, about 10 percent of families opt to give MMRV as their child’s first dose, a spokesperson for the pharmaceutical company Merck, which manufactures the vaccine, told us. Removing that option, experts said, could dissuade some families from vaccinating their children against those viruses at all.

ACIP also considered MMRV’s status in the Vaccines for Children program, which offers shots to millions of families that can’t afford them. In a confused and extremely unusual series of votes on Thursday evening and Friday morning, the committee voted first to preserve MMRV in the program, then to remove it; the children eligible for that program—roughly half of American kids—can now no longer receive it before age 4.

While discussing the hepatitis-B vaccine—which Kennedy has refused to say doesn’t cause autism, even though studies show no association—some committee members spent hours casting doubt on the vaccine’s safety, despite being shown again and again strong evidence that it’s one of the safest shots made today. “I’m just not sure I see the data that suggests: Where is the benefit?” Retsef Levi, one of the ACIP members, said. Martin Kulldorff, the committee’s chair, also pushed CDC officials to compare the U.S. vaccination schedule with those of other developed nations that don’t recommend a universal birth dose.

But the discussion was punctuated by heated pushback from other meeting attendees, including liaisons from multiple professional medical societies, CDC officials, and the minority of ACIP members that has voted against substantial changes to the immunization schedule. They pointed out that other wealthy nations that skip the universal dose at birth also differ from the U.S. in other ways—universal health care, higher hepatitis-B screening rates, and better prenatal care. In the U.S., about 12 to 16 percent of pregnant women are never tested for the virus at all. Babies can also contract the highly infectious pathogen shortly after birth from family members, caregivers, children, and even surfaces. “I have not seen any data that says that there is any benefit to the infant of waiting a month,” Adam Langer, a CDC official who presented background information about hepatitis B shots, said during the meeting, “but there are a number of potential harms.”

On Friday morning, the entire committee, except for Kulldorff, voted to table any decision about this vaccine. “There’s enough ambiguity here and enough remaining discussion about safety, effectiveness, and timing that I believe that a vote today is premature,” Robert Malone, one member of the committee, said. ACIP did not specify when the matter would be raised again.

Still, the committee made its choice about MMRV at breakneck speed. In advance of meetings, ACIP has typically assembled work groups that would evaluate the evidence on vaccines, then share their analyses with their colleagues and the public. Major decisions would not be made without an assessment of the benefits and risks of each option. All of that has gone out the window. Experts from professional societies, in the past invited to advise committee members, have been barred from participating in work groups; five committee members were added to ACIP just days before the meeting. At a Senate hearing yesterday, Debra Houry, who resigned recently as the CDC’s chief medical officer, told senators that she was discouraged by a senior adviser at the agency from providing data or asking questions about changes to the hepatitis-B recommendation.

This ACIP, experts pointed out, seems uninterested in discussing vaccines’ benefits. Instead, it has been building the case that many vaccines pose excessive risk, and that the U.S. is pushing far more of them than are necessary. The intention seems to be to “cast the previous committee as less concerned about safety than they are,” Kelly Moore, a former ACIP member and the president of Immunize.org, a nonprofit supporting immunization, told us. They appear to be suggesting that the CDC has saddled the public with an unsafe, bloated vaccine schedule that Kennedy’s chosen cohort will now fix.

These early shifts—less COVID vaccination; fewer options for flu, MMR, and chickenpox vaccines—may seem benign enough. But that may be part of the point. Kennedy and his allies are testing the waters, but they’re also accustoming the public both to the idea of fewer vaccines and to the routine of doubting vetted immunizations. The more logical their early choices seem, the more reasonably Americans might assume the ones that follow are too. “By the time people realize we’re in a bad way, we’re going to be so far in a bad way, we won’t be able to get back out,” Savoy told us. Whether vaccine infrastructure disappears by erosion or rapid demolition, the end result will be the same: a nation far less protected than it once was and could still be.

How RFK Jr. Could Eliminate Vaccines Without Banning Them

2025-09-18T11:50:00-04:00

Updated at 8:06 p.m. ET on September 18, 2025.

The world’s market for vaccines, as it exists today, depends on the United States. The U.S. has poured immense resources into the design and development of vaccines, and has paid far higher prices for doses than most other nations can afford. The federal government has issued broad vaccine recommendations, generating strong, consistent demand. “That’s a predictable market,” Richard Hughes IV, a public-health-law expert and the former vice president of public policy at Moderna, told me. It’s also a huge one. Seth Berkley, the former CEO of Gavi, which supports the immunization of about half the world’s children, told me that the U.S. accounts for 35 to 40 percent of global vaccine revenue at a minimum, more than all of Europe combined.

But since the start of this year, when Robert F. Kennedy Jr.—one of the nation’s most prominent anti-vaccine activists—took charge of the Department of Health and Human Services, the federal government has signaled that it is no longer a reliable partner in the business of vaccines. The Trump administration has fired vaccine experts, tightened vaccine regulatory policies, restricted vaccine recommendations, and spread misinformation about vaccines’ harms. It has halted its funding of Gavi. It has canceled hundreds of contracts for vaccine research across multiple agencies. “Even before the change in policies that are being implemented now, vaccines were a difficult business,” Andrew W. Lo, an economist at MIT, told me. “It’s just become that much harder.”

In response, companies are paring back. Multiple vaccine makers suffering from the American government’s recent attacks have announced layoffs or a demerger of their vaccine division, as their stocks fall. These include Moderna, which HHS recently stripped of more than $700 million in grant funding for its pandemic-flu shots. Also among them is the Australian biotechnology company CSL, which sells two flu vaccines to the U.S. that contain thimerosal, a mercury-based preservative that Kennedy’s handpicked CDC vaccine-advisory panel recently recommended against, despite decades of evidence showing the additive is safe. (Last month, CSL noted that a recent dip in flu-vaccine uptake in the U.S. had put “competitive pressure” on its vaccine profit margin; a CSL spokesperson told me in an email that the company expects American vaccination rates to recover, adding that their recent demerger was “not in response to U.S. market dynamics” and instead a vote of confidence in the business’s future. Moderna declined to comment.) More instability is likely ahead. The CDC’s vaccine advisory panel meets again today and could vote to restrict guidance for several immunizations, including ones that protect infants against measles, mumps, rubella, chicken pox, and hepatitis B.

When reached for comment, an HHS spokesperson wrote over email that “Secretary Kennedy serves the American people, not the interests of Big Pharma,” adding that the department was “not limiting access to vaccines, but rather returning focus to the doctor-patient relationship.”

Legitimate critiques can be made of the pharmaceutical industry’s incentives and pricing strategies. But from a financial standpoint, vaccines have always been a bit of an underdog for pharmaceutical companies. As preventive products, designed for healthy people, they’re held to an especially high safety standard—a requirement that reliably drives up the expenses of development and testing—and they need to be widely accessible, which puts pressure on manufacturers to keep their price tags low. Individual vaccines are also used, at most, a few times over a lifetime—another cap on potential revenue. What’s more, “it’s very hard to charge money for something that patients don’t immediately need,” Lo told me: They might clamor for a new heart medication or cancer drug, but persuading healthy people to inject a foreign substance into their body can be trickier. Throughout the past half century, the vaccine industry has also been threatened repeatedly by lawsuits over potential vaccine side effects.

To their makers, then, vaccines are a big risk for a potentially low reward. That makes the market for them one of the most fragile in the pharmaceutical industry, Rajeev Venkayya, the former head of Takeda Pharmaceuticals’ vaccine unit, told me. Those realities have driven plenty of vaccine makers out of the market, experts told me—whether via mergers, bankruptcy, or strategic decisions to focus on other products. In 1967, 26 companies produced vaccines for the U.S.; by the mid-2000s, fewer than half a dozen were left—and the nation was staring down shortages of nine of the 12 childhood vaccines recommended at the time.

In the two decades since, the industry has rallied, Berkley told me, especially as profitable “blockbuster” vaccines, including pneumococcal vaccines, HPV vaccines, and, most recently, COVID-19 vaccines, have grown into billion-dollar markets or more in the United States. The U.S.’s deep pockets helped—as Berkley pointed out, the federal government pays about 20 times what Gavi does for pneumococcal vaccines—but so did federal policies that have increased incentives and lowered risks for manufacturers. And when the public’s trust in vaccines has been threatened, often the government has emphasized that American immunizations have been well vetted and urged the public to continue getting them, Jesse Goodman, who served as the FDA’s chief scientist until 2014, told me.

Now the Trump administration is doing essentially the opposite—most dramatically, so far, for COVID vaccines. Trump’s FDA has limited who can access the shots and made seeking approval for new versions more difficult. The CDC has also muted its COVID-vaccine guidance. Every expert I spoke with for this story expected more changes to the regulatory pipeline that all vaccines must pass though. And the people Kennedy has chosen to oversee vaccine policy and sit on the CDC’s vaccine-advisory commitee—COVID contrarians and vocally anti-vaccine researchers—are making the U.S. a highly unappealing market for all vaccine makers, experts told me.

Without clear, strong recommendations, demand will likely be uneven, making it difficult for manufacturers to estimate how much product to make; without vaccine experts using evidence to advise the government, companies can’t trust that the clinical-trial data they produce, vouching for vaccine safety and performance, will be fairly or accurately assessed. Across the National Institutes of Health and the Biomedical Advanced Research and Development Authority, Trump officials have also defunded billions of dollars’ worth of vaccine-related grants. That includes half a billion specifically for mRNA-based vaccines—jeopardizing the development of future immunizations, including those designed to protect against pandemic flus. And new roadblocks in the approval process will hinder companies trying to bring products to market, making the up-front costs of research, development, and testing that much bigger a gamble. “All of this creates more chaos and uncertainty for vaccine manufacturers,” Grace Lee, a pediatrician and a former chair of ACIP, told me. “Why would you take these additional risks, where it is not clear from week to week what will happen?”

Large, long-established pharmaceutical companies with wide-ranging drug portfolios will likely have the resources to weather a dip in demand. But smaller biotechnology companies, which already tend to operate on thin margins, “will get out of the business,” Lo told me—which, in turn, will likely discourage other vaccine-focused companies from starting up. Venture capitalists have taken note of the circumstances: “The sense right now is that the market’s going to be unstable,” Berkley told me. “This is not the time to invest heavily in new or better products.”

The Trump administration could also nudge companies to exit the vaccine business by making them more vulnerable to legal risk. Most immediately, Kennedy could rescind a pandemic-era declaration that has protected COVID-vaccine manufacturers from excessive liability. He has also announced his intention to amend the Vaccine Injury Compensation Program, which experts worry could take the U.S. back to a time when lawsuits nearly destroyed the vaccine market. Congress established the VICP in the 1980s, after a flood of litigation against the makers of a pertussis vaccine persuaded all but one company supplying the U.S. to stop selling it. (The lawsuits were spurred in part by since-debunked claims that the vaccine caused permanent brain damage.) Today, the program simultaneously acknowledges the rare but very real side effects of vaccines, and gives vaccine makers an important liability shield. Funded by a tax on manufacturers, it offers compensation for certain vaccine injuries that are already backed by evidence; other claims are heard in a kind of vaccine court. Major alterations to the program, Anna Kirkland, the author of the book Vaccine Court, told me, would require Congress to act. Still, some experts told me they fear that Kennedy could push for autism to be added to the list of compensable vaccine injuries, as part of his effort to advance the debunked narrative that vaccines cause the condition. That change could flood the program with claims, rapidly drain it, and give manufacturers another reason to pull away from making vaccines.

The exit of even just a handful of manufacturers from the U.S. market could mean shortages of certain vaccines, on disastrously quick timelines. In 2004, for instance, the U.S. lost half of its supply of seasonal flu vaccine after one of the country’s two flu-shot manufacturers at the time, Chiron, temporarily shut down one of its factories because of potential contamination. Several vaccines on the American childhood immunization schedule still rely on only one or two manufacturers, Goodman told me. Among them are the shots that guard against HPV, varicella, and rotavirus.

A wind-down in vaccine manufacturing for the U.S. wouldn’t just invite outbreaks of known diseases. The country would also be exceptionally ill-equipped to respond to the next pandemic. Manufacturers managed to debut the world’s first COVID-19 vaccines in less than a year—a record—because the government was eager to fund their development and because companies could trust that the government would buy them. That mRNA vaccines would arrive first was never a foregone conclusion, either; Operation Warp Speed succeeded in part because federal agencies offered resources to a wide range of vaccine companies. Several of the experts I spoke with agreed: If a new pandemic were to ignite in the current climate, “Operation Warp Speed Part 2 would not operate at warp speed,” Lo said.

If the U.S. vaccine market shrinks, it can rebound, as it has before. But the amount of time that will take, experts told me, will depend heavily on just how thoroughly vaccine infrastructure is dismantled. Already, the scale of destruction is unlike any they have ever seen before. Perhaps, if the world is fortunate, demand and supply will rebound within a couple of years, Goodman said. But if manufacturers go out of business, if factories close, if some vaccines have their licenses entirely stripped, rebuilding could take decades. For now, most Americans continue to strongly support vaccination. But if Kennedy and the rest of the Trump administration succeed in draining the U.S. of its vaccine supply, Americans could soon be forced into a position where they cannot access immunizations—no matter how badly they may want them.

The HHS Officials Being Paid Six Figures to Do Nothing

2025-09-15T07:00:00-04:00

When she succeeded Anthony Fauci as the director of the National Institute of Allergy and Infectious Diseases, Jeanne Marrazzo felt that she’d landed “probably the most important infectious-disease job in the world,” she told me. After decades of working in academia, she now had the power to influence, nationwide, the science she knew best—overseeing 4,500 employees at a $6.5 billion institute, the second largest by budget at the National Institutes of Health, the world’s largest public funder of biomedical research.

Marrazzo had been on the job for only a year and a half, however, when the Trump administration placed her on administrative leave. She lost access to the NIH campus and, at least through official channels, to her staff, she told me; she could no longer sign into her laptop or phone. On paper, she would remain NIAID’s official director, but in practice she had been pushed out.

That was at the beginning of April. In a near instant, she went from days filled, morning ’til evening, with meetings, phone calls, and lively scientific discussions to “no structure,” she told me. The first month or two, she “was too stunned to do much” at all, she said, beyond wrestling with feelings of humiliation over the situation she’d been forced into.

Marrazzo isn’t alone in purgatory. She is one of roughly 100 officials whom the Department of Health and Human Services placed on administrative leave—or sent to, as some of them call it, HHS’s rubber room—in the winter or in spring, without explanation or a sense of when or how their status might change, according to a senior HHS official with direct knowledge of their circumstances. (Several of the HHS officials I spoke with requested anonymity to avoid retaliation from the Trump administration.)

Their status is distinct from that of many HHS employees who remain on leave as part of the administration’s deferred resignation program (who will be out of their jobs at the end of September), or who were part of a reduction in workforce and are stuck in limbo as litigation stalls their termination. But together, all of these on-leave officials constitute a group of thousands, estimates Abigail André, the executive director of the Impact Project, which has been tracking federal workers’ fates during President Donald Trump’s second term.

Their sheer number suggests that the United States government has spent tens, if not hundreds, of millions of dollars since the start of April on idled health workers. “I’m being paid to not work,” Aryn Backus, a health-communications specialist with the CDC’s now-dismantled Office on Smoking and Health who has been on leave for months as part of the contested reduction in workforce, told me. In some cases, federal officials are being paid a lot to not work. I spoke with nearly a dozen officials indefinitely stuck in the rubber room whose annual salaries range from about $150,000 to $400,000. (When reached over email, HHS Press Secretary Emily G. Hilliard declined to respond to my questions about officials who remain on administrative leave, citing a restraining order and providing no further context when asked.)

In the past, administrative leave from the federal government has generally been used as a designation employers can assign when allegations about an employee’s performance or conduct have been raised. It has been known to drag out before—in some cases, for years, amid lengthy personnel investigations. But as a rule, prolonging administrative leave past a few days is regarded as “just not an appropriate use of taxpayer dollars,” one senior NIH official told me. And what’s played out recently—leaving dozens of people on administrative leave for months, in the absence of alleged misconduct and without a clear path toward resolution—is unheard of, a senior NIH official who has been on administrative leave since the spring told me. In July, the Office of Personnel Management released new guidance, effective in 2026, that will limit administrative leave connected to workforce reassignment to 12 weeks. But it did not specify whether that time limit, which can be jointly waived by OPM and the Office of Management and Budget, would apply retroactively to officials who have been on leave for months already. (OPM and OMB did not respond to a request for comment.)

Firing federal employees is generally difficult, especially without clear cause. That stability minimizes turnover, even when administrations shift. But the Trump White House has used administrative leave as a workaround, seemingly as a way to select the individuals they are most eager to prune, officials told me. For many senior HHS officials, in particular, placement on administrative leave “was just a pretext to get us out of the office,” Emily Erbelding, the director of the Division of Microbiology and Infectious Diseases at NIAID, who has been on administrative leave since April, told me. This way, as she sees it, the Trump administration wouldn’t risk being sued for wrongful termination, but could nudge officials toward resigning on their own.

Once the department places officials on leave, its options are limited, the senior NIH official told me: It “can keep us, fire us illegally, or reassign us and have us quit.” So far it’s mostly just ignored them. On March 4, all seven former members of the NIH’s now-defunct Sexual and Gender Minority Research Office were put on administrative leave on vague terms: No potential reassignments were mentioned, and none of the officials have received correspondence from the agency or department since, two officials told me. A few weeks later, dozens of officials across HHS—many of them in leadership roles, including Marrazzo and the directors of several other institutes, divisions, and centers—were told that they would be put on leave, and that the department was proposing to reassign them, several officials told me. The notice also mentioned that the Indian Health Service was “a critical area of need.” At the end of August, a small number of those people received notice that they had been reassigned to a Health Resources and Services Administration position in Missouri, three officials told me. At least one of them chose to retire instead. But most of those who were sent the Indian Health Service letter received only a request for their CVs in the spring, and have heard nothing since.

These officials say they were never given an explanation for being put on leave. Many of them focused on topics that the administration has said it doesn’t want to fund (infectious disease, HIV, sexual health, DEI, gender research) or led institutes that the administration or Republican members of Congress have proposed altering, eliminating, or consolidating. NIAID’s leadership was especially hard-hit, and several officials I spoke with saw those leave placements as part of the administration’s revenge campaign against the U.S.’s response to COVID, and the public-health experts who drove it, Fauci among them. (Fauci’s wife, Christine Grady, was also among the NIH officials placed on administrative leave in April; she chose to retire.) In Erbelding’s case, she told me she suspects that the administration may have singled her out in part because she led a division that had awarded funds to the Wuhan virology lab at the center of the controversial lab-leak theory on the pandemic’s origins, which Trump and his allies have embraced as fact. NIAID had also been one of the institutes most vocally challenging the administration’s funding cuts. Marrazzo knew she had a target on her back: As early as February, she told me, she stopped furnishing her office with personal items, anticipating that she’d soon have to port them home again. (Earlier this month, Marrazzo and Kathleen Neuzil, who once directed the NIH’s Fogarty International Center and was placed on leave under similar circumstances as Marrazzo, sent whistleblower complaints to the Office of Special Counsel, accusing the Trump administration of illegally forcing them out of their jobs.)

Some officials, like Grady, have retired, while others, like Neuzil, have found positions outside of government and resigned. But the administration’s actions have also made their particular job market tough, Aryn Backus told me. Universities have been stripped of funding; pharmaceutical companies are wary of the FDA’s shifting regulatory landscape. All of the officials I spoke with told me they’d been actively seeking other employment for months, but had found few prospects. Multiple senior NIH officials also told me that the agency has made their job search harder. As employees, they still need approval from their supervisor to give talks, volunteer, or otherwise participate in events related to biomedical research. But some have struggled to get it, they told me. The clearest explanation they’ve received, from ethics officials who help manage such requests, is that Matt Memoli, the NIH’s principal deputy director, to whom several of them still report, has insisted that the rubber-room officials submitting these requests have been reassigned and are no longer under his purview. “Leadership is not acknowledging that we report to them, so they are not responding or approving,” one of those officials told me.

In theory, some of these officials could still return to their jobs. Backus joked that she feels snared in a prolonged situationship with the federal government: “It’s like waiting for my toxic ex to call.” But for now, she doesn’t have a position to return to, because the administration eliminated the office she was part of. Others, like Marrazzo, don’t see the appeal anymore. Running an institute at the NIH once meant deciding how to guide the country’s investment in health research, based primarily on the needs of the public and on the merit of the projects being funded; that job functionally no longer exists, she said. And under politicized leadership at HHS, “going back there right now sounds awful,” the senior NIH official told me. “My worst nightmare.”

The occupants of the rubber room do recognize that their situation—paid leave—could be worse. Some told me they will not resign: If the Trump administration wants them out so badly, it must cut them. “I want to force them to come up with an exceptional reason why I’m not good enough to keep serving the American people,” one official told me. But being stuck in limbo also has costs. As a scientist who has now, for months, been unable to present at national conferences or publish scientific papers—the core products of research—“my self-esteem is in the dumpster,” that official said. And, multiple officials told me, their lawyers say that they don’t have sufficient grounds to sue HHS over damages such as wrongful termination, unlike those who have been officially separated from their jobs.

Five and a half months in, Marrazzo is now filling her days with what productivity she can: traveling, speaking, job hunting—and far more reading, birding, and “thinking about next steps” than she has ever been accustomed to. It doesn’t feel like enough. “I’ve never not worked,” she told me. “It feels like slacking.” And her status haunts her. She regularly encounters people who are surprised to learn that she is still on administrative leave: They assume that she resigned, or was fired by the administration. The NIH has appointed an acting director to lead NIAID in her absence; the institute’s website currently lists her as the former director. She’ll gently correct people who call her that; at the same time, “I don’t know how to introduce myself,” she said. When she gives talks, she lists herself as the institute’s director on her introduction slide, and appends an asterisk that notes that she’s on leave. Officially, the title is still hers. But she is no longer quite sure what that means.

A Massive Vaccine Experiment

2025-09-05T14:23:00-04:00

Two and a half years ago, Ashish Jha was the White House’s COVID-19 response coordinator, a job that meant getting as much of the country as possible on board with the federal government’s approach to public health. For much of this summer, he’s been doing the opposite of that.

As Robert F. Kennedy Jr., the secretary of the Department of Health and Human Services, dismantles nearly every core component of the country’s vaccine infrastructure—defunding vaccine research, restricting access to shots, spreading mistruths about immunizations, purging experts who might threaten his anti-vaccine agenda—“I’m spending all my energy trying to help states come up with how they’re gonna manage this situation,” Jha told me. He, like many others in public health, wants Kennedy removed, and for the government to push back against HHS’s new direction. The best way to achieve that, he said, “is for states to do a sharp break with ACIP and CDC, and basically declare CDC defunct.” In June, Kennedy dismissed the entire roster of ACIP—the CDC’s Advisory Committee on Immunization Practices, which for decades has used scientific evidence to guide the agency’s nationwide vaccine recommendations—and has since been restocking the panel with anti-vaccine researchers who lack relevant expertise. The CDC “no longer has any credibility as a public-health entity,” Jha said. “States have to do it themselves.”

And some states are. This week, Washington, Oregon, and California announced that they would form a coalition to issue their own vaccine recommendations. Hawaii joined soon after. Several states in the Northeast might do the same. Several professional medical societies, including the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, have revolted against the government, and last month published immunization guidelines that diverge from the current CDC’s. These secessions—each driven by a loss of faith in the scientific soundness of the CDC’s recommendations—seem designed to destroy the agency’s credibility. “I’ve told folks, ‘In the not too distant future, you won’t be able to believe anything that’s on the CDC’s website regarding vaccines,’” Nirav D. Shah, who served as the CDC’s principal deputy director until February, told me.

Kennedy’s recent actions may just be the opening salvo. “We’re on the threshold of an even more transformative period,” Jason Schwartz, a vaccine-policy expert at Yale, told me. Kennedy has promised that, with a report assembled in a few short months, HHS will soon end the years-long debate on the drivers of autism—which Kennedy has repeatedly and baselessly linked to vaccines, despite decades of evidence debunking that claim. Kennedy is also reportedly eager to yank mRNA COVID vaccines off the market—which would remove any option to immunize children under 12, including highly medically vulnerable ones, against the coronavirus. Later this month, his handpicked ACIP could vote to restrict several more immunizations, including ones that protect babies against hepatitis B, measles, mumps, rubella, chicken pox, and RSV. (Kennedy has maintained that people who want COVID vaccines will be able to get them. When reached for comment, Emily Hilliard, HHS’s press secretary, wrote that “ACIP remains the scientific body guiding immunization recommendations in this country, and HHS will ensure policy is based on rigorous evidence and Gold Standard Science, not the failed politics of the pandemic.”)

“We’re watching a massive experiment unfold,” Bruce Gellin, who directed the National Vaccine Program Office from 2002 to 2017, told me. A united front is one of the best defenses against infectious disease: The science supporting vaccination holds true everywhere, and pathogens don’t respect state borders. “It doesn’t make any rational sense for a kid in Pennsylvania to get a different vaccine recommendation than a kid in Ohio,” Jha said. But a version of that is what the country is about to try. The federal government has functionally abdicated its role in keeping Americans safe from dangerous illness. In the vacuum it has left, states will chart their own paths, almost certainly in diverging directions. Florida this week announced that it would abandon vaccine mandates entirely. The country’s defensive shields against disease are shattering, in ways that could take decades, even generations, to mend.

In the U.S., the job of deciding which vaccines people must get has largely fallen to the states. But for decades—essentially since the 1960s, with the inception of ACIP—states have mostly chosen to hew to what the CDC says about how and when people should immunize. And in the 1990s, the nation’s medical experts, realizing the costs of divergent advice, aligned their recommendations with the CDC’s too.

After a major measles resurgence began in 1989, scientists moved to add a second dose of the MMR vaccine to bolster protection—but the American Academy of Pediatrics and the CDC’s vaccine-advisory panel disagreed on the optimal time to administer it. “It caused a lot of confusion,” Walter Orenstein, who directed the country’s National Immunization Program from 1993 to 2004, told me, as providers felt torn between following their professional society and the government. And so “every major medical organization came together to issue a single immunization schedule”—one that would harmonize with ACIP’s. Although states still make independent decisions about how to require shots in schools, the nation has long stood behind one grand, unifying theory of how its people should approach infectious disease.

That synchronization was premised on an agreement that scientific evidence, above all else, would guide vaccine recommendations. That same premise is now pushing professional societies and states to diverge from the CDC’s guidance. This week, the governors leading the West Coast contingent of defections issued a joint statement saying the CDC had “become a political tool that increasingly peddles ideology instead of science.” In a statement outlining its own vaccine recommendations, the AAP specifically called out Kennedy’s flagrant disregard for expertise, noting that AAP leaders would, in contrast to the CDC, “continue to provide recommendations for immunizations that are rooted in science.”

When I asked HHS about states’ recent departures from precedent, Andrew Nixon, the department’s director of communications, answered only about “blue states,” criticizing them for pushing “unscientific school lockdowns, toddler mask mandates, and draconian vaccine passports during the COVID era.” But HHS has also signaled its support for states that align with Kennedy’s push for less vaccination. Last month, the department sided with West Virginia’s governor in a fight with its board of education by urging the state to allow religious exemptions for school vaccine requirements; this week, HHS doubled down on that position, issuing guidance that states participating in the federal Vaccines for Children Program, which offers vaccines to kids whose families can’t otherwise afford them, “must respect state religious and conscience exemptions from vaccine mandates.”

Kennedy seems to believe that the evidence is on his side. At a congressional hearing yesterday, he repeated his past claims that mRNA vaccines are dangerous and deadly, despite overwhelming evidence showing that the shots have saved millions of lives and come with only rare risks. And he is surrounding himself with people who won’t argue otherwise. In the past seven months, he and his allies have ousted several top health officials whose read of the evidence hasn’t aligned with his—most recently, Susan Monarez, who directed the CDC until last week, when Kennedy and Trump fired her after she reportedly refused to preemptively rubber-stamp recommendations from the secretary’s bespoke ACIP. (Kennedy, in this week’s hearing, described this recounting of events as a lie.) And they have installed into positions of power at HHS several researchers—many of them lacking vaccine or infectious-disease backgrounds—with fringe vaccine views.

The government’s scientific advisers, too, are now ideological allies rather than independent experts. ACIP, which as recently as June was filled with 17 scientists whose backgrounds spanned vaccinology, pediatrics, infectious disease, public health, and more, now includes individuals who have advocated for pulling mRNA shots from the market, denounced COVID vaccines at an anti-mandate rally, and publicly argued that their child was injured by the MMR vaccine. Within scientific branches of government, the currency of checks and balances has always been data; Kennedy and his allies have forcibly dismantled those guardrails. “They’ve replaced everybody who could push back on the administration,” Fiona Havers, a former CDC official who quit the agency in June in protest of Kennedy’s anti-vaccine actions, told me. The true power of the federal government’s various health agencies, several federal health officials told me, rests with the scientific expertise of its people. But as of this year, expertise is no longer the hallmark of HHS.

Kennedy has done more than simply meddle with recommendations. Over the past century or so, the federal government has thrown its weight behind every major part of the country’s vaccination pipeline: funding vaccine research, scrutinizing and regulating shots, advising the public on how to use them, and helping monitor vaccine safety and performance. Kennedy has introduced a clog into just about every part of this system. The infrastructure that offers Americans routine protection against up to 18 different infectious diseases “took decades to build,” Havers said. “Kennedy has managed to destroy it in a very quick amount of time.”

Many of those changes are reversible, in theory. Personnel can be rehired; ACIP members’ term limits will run out; new leaders can rewrite policies. Those people and policies, though, will not be effective if the public overall has become less inclined to listen to them. Governors, physicians, and public-health experts are arguing for a calculated rift with the federal government because it’s necessary to meet the political moment, Jha told me: Restoring the CDC’s integrity requires first persuading the public to discount it. Eventually, these experts acknowledge, if they regain control of the federal health apparatus, they’ll have to ask the public to trust in those same agencies again. In the interim, they are hoping most Americans will keep looking to scientific and medical experts as a source of constancy—even as they embroil themselves in a fight with the nation’s leaders.

That gamble might not pay off. When experts moved to harmonize the country’s vaccine schedules in the 1990s, the recent outbreak had laid out the stakes and benefits of synchronization clearly. “It wound up being easy,” Orenstein told me. The differences between the AAP’s recommendations and the government’s “were fairly minor” too. This time, though, the schisms between the CDC and the states and professional societies go far beyond the timing of an additional dose of vaccine. They’re about whether scientific evidence should guide the country’s approach to immunity—and, ultimately, how much say the federal government has in how Americans protect themselves.

The likeliest catalyst for a quick realignment would be a severe uptick in disease—local epidemics, another pandemic. Even then, many of the experts I spoke with fear, the country’s vaccine infrastructure, having been razed, could not easily contain those outbreaks, and the U.S. would struggle to rebuild its health agencies to their former strength. “The more of the system is destroyed, the longer it will take to rebuild,” Gellin told me. And the more lives will be needlessly lost in the meantime.

Already, states and health-care providers are having to fight to preserve access to vaccines. Recommendations for immunization may be relatively straightforward to adjust state by state. But if the FDA alters the licensure of certain vaccines—or strips it away entirely—the shots might simply not be available, even in parts of the country where people are told to get them. The FDA has already limited approval for COVID vaccines enough that the current AAP recommendations for the shots won’t be easy to follow this fall, for instance. Some state laws also prevent pharmacists from administering vaccines that haven’t been recommended by ACIP—a snarl that’s prompted pharmacies to limit access to COVID vaccines in more than a dozen states. Insurers, too, have traditionally followed CDC recommendations when choosing what vaccines to cover. States have some leeway to change these dynamics: This week, Massachusetts became the first state in the country to require its insurance carriers to cover vaccines recommended by its Department of Public Health “and not rely solely on CDC recommendations.” Today, New York’s governor signed an executive order to allow pharmacists to prescribe and administer COVID-19 vaccines, even without ACIP’s okay. Still, the federal government’s vaccine safety net is impossible to replace. More than half of American kids are eligible for the federal $8 billion Vaccines for Children Program, which relies entirely on the guidance of ACIP to decide which immunizations to cover.

Kennedy, meanwhile, is finding other ways to crater the availability of shots. He has already canceled funding to vaccine makers, including Moderna—but policy changes, too, could deter companies from manufacturing more shots or developing new ones. The secretary also recently announced his intention to remodel the Vaccine Injury Compensation Program, put into place in the 1980s to limit pharmaceutical companies’ exposure to lawsuits over vaccines’ health effects—and, by extension, to protect the stability of the nation’s vaccine supply. Some experts worry that Kennedy could make it easier for claims to be paid out, potentially, in part, by pushing to add autism to the list of compensable health issues—an anti-vaccine concession that could rapidly overwhelm the system, and leave manufacturers more vulnerable to liability, Gellin told me. Vaccines have never been a terribly lucrative product for pharmaceutical companies; under financial and political pressure, their market could quickly collapse. “Even in good times there’s fragility in this complex system,” Anne Schuchat, who served as the principal deputy director of the CDC until 2021, told me.

The consequences of the current fracturing may not be apparent right away. Immunity takes time to erode. “If we stop vaccinating today, we would not have outbreaks tomorrow,” Orenstein said. When the fallout lands, Kennedy could be long out of the government, and limiting the damage he’s done will be someone else’s problem.

Scientists Are Caught in a Political Trap

2025-08-23T08:00:00-04:00

Practicing science in the United States has become more politically fraught in the past seven months than it has ever been in this country’s history. As the Trump administration has fired vaccine advisers, terminated research grants in droves, denied the existence of gender, and accused federal scientists of corruption while publicly denigrating their work, the nation’s leaders have shown that they believe American science should be done only on their terms.

As of late, some in the scientific community have been pushing back, organizing marches and rallies, publicly criticizing government reports and agency priorities, and quitting their jobs at federal agencies. Professional medical societies have banded together to sue the Department of Health and Human Services over Secretary Robert F. Kennedy Jr.’s unfounded restrictions of COVID vaccines and dismissal of vaccine experts. Academic scientists have done the same, to fight for grant funding. Researchers are convening extragovernmental panels to evaluate evidence on vaccines; the American Academy of Pediatrics has published vaccine recommendations that deviate from the CDC’s, and several states in New England are mulling doing the same. This week, for the second time, hundreds of HHS officials have signed a public letter criticizing the department’s leaders for interfering with the integrity of their work.

And yet, these counterattacks may be ensnaring scientists in a catch-22. Their goal is to defend their work from political interference. “If scientists don’t ever speak up, then the court of public opinion is lost,” one university dean, who requested anonymity to avoid financial retaliation against their school from the federal government, told me: Americans would have little reason to question the government’s actions. But in retaliating, scientists also run the risk of advancing the narrative they want to fight—that science in the U.S. is a political endeavor, and that the academic status quo has been tainted by an overly liberal view of reality. “When you face a partisan attack, it’s extremely hard to respond in a way that doesn’t look partisan,” Alexander Furnas, a science-policy expert at Northwestern University, told me. “It’s a bit of a trap.”

Many scientists prefer to view their work as largely severed from politics. But in practice, politicians control how science is funded and how its findings are codified into policy. Some science has also been actively coded as partisan: The existence of climate change has been publicly questioned by conservative groups; since the early days of COVID vaccines, skepticism of them has split along party lines. And studies show that trust in the scientific community has been eroding among conservatives since the 1970s. Still, for decades, science in the U.S. has enjoyed bipartisan support. Furnas’s unpublished research, for instance, has found that over the past 40 years, Republicans have appropriated more money to science than Democrats.

But if any previous politicizations of science were matchsticks tossed onto embers, the Trump administration “has been pouring gasoline,” Azim Shariff, a social psychologist at the University of British Columbia, who has studied how the politicization of science influences trust in it, told me. Many of the administration’s assaults have been openly political—its leaders have repeatedly criticized American research as riddled with problematic ideologies, and claimed that the Biden administration manipulated science for its own purposes. And it has treated academic centers of science as threats that must be forcibly dismantled. “There is virtually no part of science that is not seen as belonging to one side, particularly the Democrats,” the university dean told me. “Science in general has been cast as being the work of one party, while those of another party destroy the system as it exists.” (HHS and the White House did not return requests for comment.)

Government scientists in particular have usually stayed out of the political fray. The federal workforce is largely made up of rule followers, Anna Yousaf, a scientist in CDC’s respiratory-virus division who signed her name publicly to this week’s HHS letter, told me. (She and other federal employees I spoke with emphasized that they were talking in their personal capacity, rather than on behalf of their agency.) “In terms of feeling comfortable about this? I don’t,” Yousaf said. But now these scientists’ livelihoods are on the line, as well the scientific principles they’ve dedicated their careers to.

And many fear for their personal safety. Earlier this month, a man who had expressed “discontent with the COVID-19 vaccinations” fired hundreds of rounds at the CDC’s headquarters, killing a police officer. The shooting, and the administration’s muted response to it, was a major motivation for Fiona Havers, who recently quit her job at the CDC in protest of Kennedy’s actions, to sign her name to the letter. Kennedy’s inflammatory accusations about public-health officials—including calling the CDC “a cesspool of corruption”—have “endangered the lives of my friends and former colleagues,” she told me. (Kennedy’s earliest response, a post on X, came the day after the shooting; two days later, HHS released the administration’s only official statement to date. Neither acknowledged the role that misinformation about COVID vaccines may have played, and hours after HHS’s statement, Kennedy publicly criticized the CDC’s pandemic response, arguing that the government said “things that are not always true” to persuade the public to get vaccinated.)

Many of the scientists I spoke with for this story insisted that they didn’t feel their actions were political—and expressed concern over them being perceived as such. Although they were fighting back against the government, they told me, their intentions are to advocate for evidence. That line feels especially important to hold, they said, as Kennedy and other political leaders repeatedly flaunt their disregard for facts and scientific consensus. “We have not made this political,” Susan Kressly, the president of the American Academy of Pediatrics—which has sued HHS, boycotted meetings of its vaccine advisory committee, and continued to recommend COVID-19 vaccines for populations that the CDC does not—told me. “It is the politicians doing that.” Georges Benjamin, the executive director of the American Public Health Association, one of the professional societies that has sued HHS, told me that he felt similarly. “People tend to think of us as very much left-leaning,” Benjamin said, but the APHA, like the AAP, identifies as nonpartisan. He and Kressly each pointed out that their society has criticized the government during both Democratic and Republican administrations. For example, both groups were among the organizations that, in 2024, called out the Biden administration for delaying prohibitions on menthol cigarettes and flavored cigars.

In the past, scientists have successfully engaged in advocacy without polarizing public perceptions of them and their work. And enough Americans object to the Trump administration’s campaign against science that Floyd Zhang, an economist who has studied public attitudes toward science, told me he could see trust in researchers increasing now. His research has shown that engaging politics can hurt scientists: In 2020, after the scientific journal Nature endorsed Joe Biden for president, Trump supporters who were told about the endorsement lost trust in the journal—and in scientists in general. Researchers, he said, seemed to be speaking out of turn—Who are you, telling me how to vote? But he thinks what’s happening in 2025 may play out differently. Scientists’ advocacy—for themselves, their institutions, and scientific principles—should look like scientists staying in their lane, and fighting on behalf of science.

Still, some scientists are behaving more like political activists and politicians. The writers of the HHS letters understand that defending their idea of the department requires political allies: Ian Morgan, a postdoctoral fellow at the National Institutes of Health and one of the signers of both letters, told me that a main goal of the public outcry is to stir up further congressional support. A social-media account run by anonymous NIH officials explicitly calls out the “rightwing billionaires” who are trying to corrupt their agency. And scientists and physicians have cited the Trump administration’s actions as motivation in their run for Democratic congressional seats.

Their choice of party is not just a protest against this administration. Scientists, as a group, lean more Democratic and less Republican than the rest of the public, a trend that seems to have intensified in recent decades. Pediatrics—the subgroup of medicine that communicates most regularly with families about vaccines—is among the most left-leaning medical specialties.

Already, public opinion on the Trump administration’s siege on science divides along party lines. An April poll from the health nonprofit KFF showed that a majority of Republicans supported Trump’s massive cuts to staff and spending at federal health agencies, whereas nearly all Democrats opposed them. (Another, more recent survey, from the Civic Health and Institutions Project, noted more muted enthusiasm from Republicans—but still found that more Republicans approved of Trump’s attacks on science than did not.) More Republicans than Democrats support slashing funding to universities, too. And 41 percent of Republicans say that HHS’s recent changes to vaccine policy will make people safer, compared with just 4 percent of Democrats.

Whatever the scientists’ intentions, their actions may inadvertently bolster the Trump administration’s case that scientists represent a particular liberal worldview. Shariff, the social psychologist, has found in his research that—even when politicization aligns with their own beliefs—“people don’t like to see their science politicized,” he told me. “They lose trust in it.” That decline in trust, Shariff predicts, will concentrate among those on the right, who “will see science as more politicized than they did before,” he said, “because it’s taking a side.”

If that happens, the administration could leverage the validation of public opinion as permission to escalate. Trump and his appointees have loudly asserted that their vision for science in America is the correct one, representing truth rather than politics. In their view, the problem originated with the scientists who allowed ideology to infiltrate their thinking, fell prey to the distortive influence of industry, and discouraged the public from doing “your own research.” They seem ready, too, to blame scientists for the ongoing fracas. In July, NIH Director Jay Bhattacharya sat down with some members of his staff to discuss the letter they had signed, calling for a restoration of the agency’s scientific integrity. After a fairly cordial meeting, Bhattacharya’s staff invited him to join them at a pro-NIH rally—perhaps even speak, Sarah Kobrin, a branch chief at the National Cancer Institute who attended the meeting, told me. “That appeared to anger him,” Kobrin said. Bhattacharya declined and stood to leave, adding, “I’m disappointed that you are politicizing this.”

The Two-Word Phrase Unleashing Chaos at the NIH

2025-08-19T11:49:44-04:00

Since January, President Donald Trump’s administration has been clear about its stance on systemic racism and gender identity: Those concepts—championed by a “woke” mob, backed by Biden cronies—are made-up, irrelevant to the health of Americans, and unworthy of inclusion in research. At the National Institutes of Health, hundreds of research studies on health disparities and transgender health have been abruptly defunded; clinical trials focused on improving women’s health have been forced to halt. Online data repositories that contain gender data have been placed under review. And top agency officials who vocally supported minority representation in research have been ousted from their jobs.

These attacks have often seemed at odds with the administration’s stated goals of fighting censorship in science at the NIH and liberating public health from ideology. But its members behave as though they have no dogma of their own—just a wholehearted devotion to scientific rigor, in the form of what the nation’s leaders have repeatedly called “gold-standard science.” This pretense—that the government can obliterate entire fields of study while standing up for free inquiry—is encapsulated by what’s become a favored bit of MAHA rhetoric: All research is allowed, the administration likes to say, so long as it’s “scientifically justifiable.”

On Friday, the phrase scientifically justified appeared several times in a statement by NIH Director Jay Bhattacharya that set the agenda for his agency and ordered a review of all research to make sure that it fits with the agency’s priorities. “I have advocated for academic freedom throughout my career,” he wrote in a letter to his staff that accompanied the statement. “Scientists must be allowed to pursue their ideas free of censorship or control by others.” But his announcement went on to warn that certain kinds of data, including records of people’s race or ethnicity, may not always be worthy of inclusion in research. Only when its consideration of those factors has been “scientifically justified,” he wrote, would a project qualify for NIH support.

That message may seem unimpeachable—in keeping, even, with the priorities of the world’s largest public funder of biomedical research: NIH-backed studies should be justified in scientific terms. But the demand that Bhattacharya lays out has no formal criteria attached to it. Scientific justifiability is, to borrow Bhattacharya’s description of systemic racism, a “poorly-measured factor.” It’s imprecise at best and, at worst, a subjective appraisal of research that invites political meddling. (Neither the NIH nor the Department of Health and Human Services, which oversees it, responded to my questions about the meaning and usage of this phrase.)

Judging scientific merit has always been one of the NIH’s most essential tasks. Tens of thousands of scientists serve on panels for the agency each year, scouring applications for funding; only the most rigorous projects are selected to receive portions of the agency’s $47 billion budget—most of which goes to research outside the agency itself. All of the thousands of grants the agency has terminated this year under the Trump administration were originally vetted in this way, by subject-matter experts with deep knowledge of the underlying science. Many of the studies have been recast, in letters from the agency, as being “antithetical to the scientific inquiry,” indifferent to “biological realities,” or otherwise scientifically unjustified.

The same language from Bhattacharya’s email appears in other recent NIH documents. Last week, an official at the agency sent me a copy of a draft policy that, if published, would prohibit the collection of all data on people’s gender (as opposed to their sex) by any of the agency’s researchers and grantees, regardless of their field of study. It allows for an exception only when the consideration of gender is “scientifically justified.” The gender-data policy was uploaded to an internal portal typically reserved for agency guidance that is about to be published, but has since been removed. (Its existence was first reported by The Chronicle of Higher Education.) When reached for comment, an HHS official told The Atlantic that the policy had been shot down by NIH leadership, but declined to provide any further details on the timing of that shift, or who, exactly, had been involved in the policy’s drafting or dismissal.

Still, if any version of this policy remains under consideration at the agency, its aims would be in keeping with others that are already in place. One NIH official told me that one of the agency’s 27 institutes and centers, the National Institute for General Medical Sciences, has, since April, sent out hundreds of letters to grantees noting, “If this award involves human subjects research, information regarding study participant ‘gender’ should not be collected. Rather, ‘sex’ should be used for data collection and reporting purposes.” Payments to those researchers, the official said, have been made contingent on the scientists agreeing to those terms within two business days. “Most have accepted,” the official told me, “because they’re desperate.” (The current and former NIH officials who spoke with me for this article did so under the condition of anonymity, to be able to speak freely about how both Trump administrations have affected their work.)

Collecting data on study participants’ gender has been and remains, in many contexts, scientifically justified—at least, if one takes that to mean supported by the existing literature on the topic, Arrianna Planey, a medical geographer at the University of North Carolina, told me. Evidence shows that sex is not binary, that gender is distinct from it, and that acknowledging the distinction improves health research. In its own right, gender can influence—via a mix of physiological, behavioral, and social factors—a person’s vulnerability to conditions and situations as diverse as mental-health issues, sexual violence, cardiovascular disease, infectious diseases, and cancer.

The Trump administration has expressed some interest in gender-focused research—but in a way that isn’t justified by the existing science in the field. In March, NIH officials received a memo noting that HHS had been directed to fund research into “regret and detransition following social transition as well as chemical and surgical mutilation of children and adults.” That framing presupposes the conclusions of such studies and ignores the most pressing knowledge gaps in the field: understanding the long-term outcomes of transition on mental and physical health, and how best to tailor interventions to patients. (Bhattacharya’s Friday statement echoed this stance, specifically encouraging “research that aims to identify and treat the harms these therapies and procedures have potentially caused to minors.”)

According to the draft prohibition on collecting gender data, NIH-employed scientists would be eligible for an exception only when the scientific justification for their work is approved by Matthew Memoli, the agency’s principal deputy director. Memoli has played this role before. After Trump put out his executive order seeking to abolish government spending on DEI, Memoli—then the NIH’s acting director—told his colleagues that the agency’s research into health disparities could continue as long as it was “scientifically justifiable,” two NIH officials told me. Those officials I spoke with could not recall any instances in which NIH staff successfully lobbied for such studies to continue, and within weeks, the agency was cutting off funding from hundreds of research projects, many of them working to understand how and why different populations experience different health outcomes. (Some of those grants have since been reinstated after a federal judge ruled in June that they had been illegally canceled.)

The mixing of politics and scientific justifiability goes back even to Trump’s first term. In 2019, apparently in deference to lobbying from anti-abortion groups, the White House pressured the NIH to restrict research using human fetal tissue—prompting the agency to notify researchers that securing new funds for any projects involving the material would be much more difficult. Human fetal tissue could be used in some cases, “when scientifically justifiable.” But to meet that bar, researchers needed to argue their case in their proposals, then hope their projects passed muster with an ethics advisory board. In the end, that board rejected 13 of the 14 projects it reviewed. “They assembled a committee of people for whom nothing could be scientifically justified,” a former NIH official, who worked in grants at the time of the policy change, told me. “I remember saying at the time, ‘Why can’t they just tell us they want to ban fetal-tissue research? It would be a lot less work.’”

The NIH’s 2019 restriction on human-fetal-tissue research felt calamitous at the time, one NIH official told me. Six years later, it seems rather benign. Even prior to the change in policy, human fetal tissue was used in only a very small proportion of NIH-funded research. But broad restrictions on gathering gender data, or conducting studies that take race or ethnicity into account, could upend most research that collects information on people—amounting to a kind of health censorship of the sort that Bhattacharya has promised to purge.

The insistence that “scientifically justifiable” research will be allowed to continue feels especially unconvincing in 2025, coming from an administration that has so often and aggressively been at odds with conventional appraisals of scientific merit. Robert F. Kennedy Jr., the head of HHS, has been particularly prone to leaning on controversial, biased, and poorly conducted studies, highlighting only the results that support his notions of the truth, while ignoring or distorting others. During his confirmation hearing, he cited a deeply flawed study from a journal at the margins of the scientific literature as proof that vaccines cause autism (they don’t); in June, he called Alzheimer’s a kind of diabetes (it’s not); this month, he and his team justified cutting half a billion dollars from mRNA-vaccine research by insisting that the shots are more harmful than helpful (they’re not), even though many of the studies they cited to back their claims directly contradicted them. Kennedy, it seems, “can’t scientifically justify any of his positions,” Jake Scott, an infectious-disease physician at Stanford, who has analyzed Kennedy’s references to studies, told me.

Bhattacharya’s call for a full review of NIH research and training is predicated on an impossible, and ironic, standard. Scientists are being asked to prove the need for demographic variables that long ago justified their place in research—by an administration that has yet to show it could ever do the same.