“This is the stuff of nightmares,” virologist Dr. Angela Rasmussen told me earlier this week, as she discussed the rising chance of bird flu mutating this flu season. Hospitals are treating regular flu and bird flu patients in the same wards, increasing the potential for bird flu to pick up genes from other flu strains in a way that would facilitate human-to-human transmission.

Rasmussen is a professor both at the University of Saskatchewan, in Canada, and at Stony Brook University, in New York. An expert in vaccines, she has been an outspoken critic of the Trump administration and DOGE’s assault on the country’s scientific research and disease-monitoring infrastructure.

With DOGE-mandated cuts destroying vital public health systems, “we’ve disabled our monitoring. We’ve disabled our response capabilities,” she explained. In other words, if bird flu starts circulating in the community, the public health surveillance systems that DOGE has gutted likely won’t catch it until it spreads exponentially and hospitals are overrun. “It’ll be like one day everything’s fine and the next day it’s a bird flu pandemic.”

If that happens, Rasmussen fears a second set of failed responses: The country has in its stockpile only 10 million doses of the one vaccine thought to work against bird flu, and Robert F. Kennedy Jr.’s health department could refuse to issue an Emergency Use Authorization for vaccines.

Musk-Trump’s first month in office has represented such an all-out assault on the functionality of government that it’s hard to comprehend the totality of what is happening. But one way to view it is that each Trump appointee heading a different aspect of the federal system has their own destructive potential. When acting in concert, the result will be catastrophic. We are already witnessing huge foreign policy shifts; the purging of the Justice Department, and the use of Justice Department resources to go after Trump’s enemies; the escalating human rights violations against immigrants; the politicization of the military and national security systems; the expansion of huge tax cuts for the wealthy, paid for by equally huge cuts to medical coverage for the poor; the attacks on the free press; the rampaging assault on anything to do with diversity, equity, or inclusion in the federal workforce, private sector, and federally funded institutions, including colleges and universities; the breakdown of any and all guardrails designed to prevent self-dealing and conflict of interest at the highest echelons of government; and an unprecedented assault on the concept of public health.

It’s the latter that has been on my mind this week.

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March 2025 Issue

Public health comes with a lot of acronyms, and it’s easy to tune out when trying to navigate these arcane administrative byways. But this regime, riding a wave of its MAGA base’s hostility to scientific expertise in the wake of the Covid-19 pandemic, has sunk its teeth into even the most obscure of public health offices. Its efforts to reorient the country away from vaccines and from cutting-edge medical and scientific research on a host of issues are hitting almost every area of science.

Trump 2.0 is using creative measures to bottle up the distribution of research funds, even in the face of court orders. It is refusing to schedule vital meetings of advisory boards, and attempting to impose draconian cuts to public health research institutions. It is also taking Musk’s chain saw to the public health workforce, firing contract workers—scientists who work on government projects are often on five-year contracts—and full-time staff. The result is that at every level of government there are fewer people left to respond to crisis—and fewer career professionals who can act as a bulwark against the worst impulses of the new leaders in the US Department of Health and Human Services.

Let’s start with these leaders. First, there’s Robert F. Kennedy Jr., renowned anti-vaxxer and alternative medicine faddist, who is now in charge of HHS. The incoming head of the Centers for Disease Control and Prevention, David Weldon, is also an anti-vaxxer, a fierce opponent of abortion, and supports laws that would allow insurance companies not to pay for reproductive health services. Jay Bhattacharya, Trump’s nominee to head the National Institute of Health, was a leading proponent of a reckless herd immunity approach to Covid-19, even as most public health experts warned that such a response to a new respiratory disease would result in enormous fatality numbers.

The Kennedy-Weldon-Bhattacharya troika is bad enough, but even before their confirmations, Trump was churning out one destructive executive order after the next. In the wake of Trump pulling the US out of the World Health Organization, the CDC stopped sharing its flu surveillance data with its global partners, making it far more difficult for scientists to accurately gauge what strains of flu they should be selecting to vaccinate against for next year’s Northern Hemisphere flu season.

As the government ramps up its war on anything that could conceivably be seen as “DEI,” scientific grants to PhD candidates from marginalized communities have been blocked, thus putting at risk the careers of these young scientists and also scrapping a huge amount of vital research on racial disparities in healthcare and the provision of care. My colleague Gregg Gonsalves recently wrote a powerful piece on this.

When Trump issued an executive order “pausing” the distribution of all government grants, he was promptly rebuffed by a judge issuing a preliminary injunction against the decision. But, by statute, new NIH grants have to be approved by an advisory committee, and notice of the advisory committee meetings has to be published in the Federal Register. The administration ordered the NIH to put an indefinite stop on the publishing of any notices in the Federal Register; as a result, the committee can’t meet, and no grants are being approved.

Add into that the efforts—again, currently on hold thanks to court intervention—to limit reimbursement to universities for “indirect costs” associated with their research to 15 percent of a grant, from current levels that are frequently north of 50 percent, and the effect is magnified. Slashing indirect costs means labs won’t be able to pay for electricity, janitors won’t be able to clean science buildings, administrative staff responsible for managing grants will be out of jobs. All told, if these cuts are permitted to proceed, leading research institutions stand to lose billions of dollars, putting at risk America’s status as a world leader in the area of scientific and, especially, medical research.

As for vaccine access, with an escalating measles epidemic in Texas and New Mexico, and the ongoing spread of Mpox, not to mention the looming threat of bird flu, one would think that any sane administration would want its vaccine advisory committee to be on full alert. Instead, this week’s meeting of the Advisory Committee on Immunization Practices (ACIP) was abruptly canceled and not rescheduled; the chair found out about the cancellation through reading about it online. Similarly, this week another committee charged with working out what flu strains to vaccinate against in the 2025–26 flu season also saw its meetings cancelled, with no new date scheduled. That’s a recipe for catastrophe next year, since it could mean the US won’t have a flu vaccine tailored to whatever strains are circulating. ACIP data on Mpox, which disproportionately hits the LGBTQ community, was temporarily removed from government websites; and although it was subsequently restored, Rasmussen is deeply concerned that it will also fall victim to the war on DEI.

The virologist thinks it is likely that the administration will soon stack ACIP’s board with anti-vaxxers who will come up with objections to mRNA vaccines, the MMR vaccine, and the polio vaccine. While these recommendations wouldn’t result in the vaccines’ being summarily withdrawn, they would make it more likely that insurers could opt not to cover them and that doctors would opt not to suggest that patients receive them.

The assault on science doesn’t end there. The Epidemic Intelligence Service workforce, which investigates disease outbreaks, was targeted for firings, as was the Laboratory Leadership Service, which trains people who staff public health labs. Rasmussen estimates that the LLS lost half of its molecular testing capacity as a result.

Staff were also fired at the National Center for Biotechnology Information, which stores vital data on biotechnology developments. Various divisions of the FDA were decimated. And most members of a CDC-assigned team of technology specialists from the US Digital Service, who were working on the country’s disease surveillance system, and on developing software to better identify emerging epidemics, also lost their jobs. Senior team member Itir Cole, who resigned rather than wait to be fired, wrote on LinkedIn, “On the day I resigned, nearly all of my team was fired, locked out of their computers without time to transition responsibilities. No real cause was given. No one in my chain of command was consulted.”

Cumulatively, these actions leave America grievously exposed to preventable disease outbreaks and raise the risk for the world of global pandemics. These actions are so fundamentally wrong that it’s hard to find any benign explanation for them. They represent the purest distillation of Musk-Trump’s nihilism. Of all the areas of destruction that DOGE is unleashing, it is in the field of science, and in medical research in particular, that the consequences will likely prove most devastating.