Pandemic preparedness ‘dramatically eroding' under Trump, experts say
Amid controversial dismissals for independent advisers and staff at health agencies, alongside lackluster responses to the bird flu and measles outbreaks, experts fear the US is now in worse shape to respond to a pandemic than before 2020.
H5N1, which has received less attention under the Trump administration than from Biden's team, is not the only influenza virus or even the only variant of bird flu with the potential to spark a pandemic. But a subpar response to the ongoing US outbreak signals a larger issue: America is not ready for whatever pathogen will sweep through next.
'We have not even remotely maintained the level of pandemic preparedness – which needed a lot of work, as we saw from the Covid pandemic,' said Angela Rasmussen, an American virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. 'But now, we essentially have no pandemic preparedness.'
Related: Bird flu reinfections at US poultry farms highlight need for vaccines, experts say
'I'm concerned on a number of fronts,' said Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health.
Those concerns include a lack of quality information from officials, weakened virus monitoring systems, and public health reductions at the federal, state and local levels.
'The thing that I am most concerned about is the veracity of information coming out of the health agencies,' Nuzzo said.
In the ongoing outbreaks of measles, for example, Robert F Kennedy Jr, the secretary of health and human services, has downplayed the severity of the disease, spread misinformation about the highly effective vaccine to prevent measles, and pushed unproven treatments.
'The communications on measles gives me deep worries about what would happen in a pandemic,' Nuzzo said. 'If a pandemic were to occur today, the only thing we would have to protect ourselves on day one would be information.'
The H5N1 outbreak has been plagued by incomplete information, an issue that began in the Biden administration but has amplified under Trump.
In Arizona, 6 million chickens were killed or culled at a Hickman's Family Farms location because of H5N1 in May. That's about 95% of the company's hen population in the state. Hundreds of workers, including inmate laborers, are now being dismissed as Arizona braces for egg shortages.
We're not testing – it's not that there are no new cases
Angela Rasmussen
Yet even as H5N1 outbreaks continue to spread on farms and wreak havoc on the food supply, no new bird flu cases have been reported in people for months.
'I am concerned that we may not be finding new infections in humans,' Nuzzo said – and a lack of testing may be the culprit.
'We're not testing – it's not that there are no new cases,' Rassmussen said.
The last bird flu case in a person was listed by the US Centers for Disease Control and Prevention (CDC) on 23 February.
At that point, at least 830 people in the US had been tested after contact with sick animals. This kind of testing – monitoring the health of people who regularly work with H5N1-infected animals – is how the vast majority of cases (64 out of 70) have been found in this outbreak.
But then, several CDC officials overseeing the bird flu response were fired on 1 April.
Since then, only about 50 people in the US have been tested after exposure to sick animals – and no positive cases have been announced.
It's also been difficult to understand the extent of the outbreak and how the virus spreads among animals.
'We still just don't have a good picture of the scope and scale of this outbreak – we never really have. And until we have that, we're not going to be able to contain it,' Rasmussen said.
'It's extremely bad,' she continued. 'We don't have any information about what's happening right now. The next pandemic could be starting, and we just don't know where that's happening, and we don't have any ability to find out.'
We're seeing health departments scrambling. That infrastructure is just dramatically eroding
Jennifer Nuzzo
Huge reductions in the public health workforce and resources has led to less monitoring of outbreaks, known as disease surveillance.
'Cutting back on that surveillance is leaving us more in the dark,' Nuzzo said.
The CDC clawed back $11.4bn in Covid funding in March. This funding was used to monitor, test, vaccinate and otherwise respond to public health issues at the state, local, territorial and tribal level.
'We're seeing health departments scrambling,' Nuzzo said. 'That infrastructure is just dramatically eroding.'
International monitoring programs to address outbreaks before they expand across borders have also been cancelled.
'We have taken for granted all of those protections, and I fear that we are poised to see the consequences,' Nuzzo said.
Trump's crackdown on immigration also poses a major challenge in detecting cases and treating patients during outbreaks.
'A lot of the people who are most at risk are strongly disincentivized to report any cases, given that many of them are undocumented or are not US citizens,' Rasmussen said. 'Nobody wants to go get tested if they're going to end up in an Ice detention facility.'
When cases are not detected, that means patients are not able to access care.
Although it's rare for people to become sick with H5N1, for instance – the virus is still primarily an avian, not a human, influenza – this variant of bird flu has a 52% mortality rate globally among people with known infections.
Allowing a deadly virus to spread and mutate under the radar has troubling implications for its ability to change into a human influenza without anyone knowing.
And if such changes were detected, widening gaps in communication could be the next hurdle for preventing a pandemic, Nuzzo said.
'Communication is our most important public health intervention. People, in order to be able to know how to protect themselves, need to have access to facts, and they need to believe in the messengers. And the communication around the measles outbreaks are deeply eroding our standing with the American people.'
Even stockpiled vaccines and other protective measures, like personal protective equipment, take time to distribute, Nuzzo added. 'And flu is a fast-moving disease that could cause a lot of damage in the months it would take to mount a vaccination campaign.'
The US government's cancellation of its $766m contract with Moderna to research and develop an H5N1 vaccine also signals a concerning strategy from health officials, Nuzzo and Rasmussen said.
Other restrictions on vaccine development, like a new plan to test all vaccines against saline placebos, is 'going to make it extremely difficult to approve any new vaccine' and would 'have a devastating impact on our ability to respond to a potential pandemic', Rasmussen said – especially in a rapidly moving pandemic where speed matters.
'You don't have time for that if this virus causes a human-to–human outbreak,' Rasmussen said.
All of these policies mean the US is less prepared for a pandemic than it was in 2020, she said. And it also means there will be preventable suffering now, even before the next big one strikes.
'We are actively making people less safe, less healthy and more dead,' Rasmussen said.
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And if such changes were detected, widening gaps in communication could be the next hurdle for preventing a pandemic, Nuzzo said. 'Communication is our most important public health intervention. People, in order to be able to know how to protect themselves, need to have access to facts, and they need to believe in the messengers. And the communication around the measles outbreaks are deeply eroding our standing with the American people.' Even stockpiled vaccines and other protective measures, like personal protective equipment, take time to distribute, Nuzzo added. 'And flu is a fast-moving disease that could cause a lot of damage in the months it would take to mount a vaccination campaign.' The US government's cancellation of its $766m contract with Moderna to research and develop an H5N1 vaccine also signals a concerning strategy from health officials, Nuzzo and Rasmussen said. Other restrictions on vaccine development, like a new plan to test all vaccines against saline placebos, is 'going to make it extremely difficult to approve any new vaccine' and would 'have a devastating impact on our ability to respond to a potential pandemic', Rasmussen said – especially in a rapidly moving pandemic where speed matters. 'You don't have time for that if this virus causes a human-to–human outbreak,' Rasmussen said. All of these policies mean the US is less prepared for a pandemic than it was in 2020, she said. And it also means there will be preventable suffering now, even before the next big one strikes. 'We are actively making people less safe, less healthy and more dead,' Rasmussen said.
