Sorry CDC - RFK Jr. is Here to Stay (for now)

We may be forced to "Let Them", so let's revisit the 5 Stages of Grief...

It’s been an unbearable week for public health in the U.S and world-wide. The U.S. Centers for Disease Control (CDC) the unquestioned world leader in public health has totally imploded, not through neglect or lack of resources, but by a calculated and conscious effort from an aggrieved minority of pandemic-emboldened vaccine deniers and conspiracy fabulists hitching a ride via Robert F. Kennedy Jr. on the “Make America Great (and Healthy) Again” Movement to currently unstoppable political dominancy. I don’t think for a minute that a majority of Americans support dismantling the CDC’s disease response infrastructure or limiting vaccine choices for our kids. However, the politics of the moment have aligned to produce exactly that result, with no immediate prospects for relief in sight.

Here are 2 (of many) recent articles analyzing last week’s massacre of CDC senior leadership:

The Atlantic: 'It Feels Like the CDC Is Over’

Washington Post: As CDC crumbles, fears grow about vaccines, pandemics and health crises

While the preceding articles dealt with likely consequences of the leadership vacuum in public health, an article in Sunday’s Washington Post lays out the political reality we face in thinking that somehow the RFK Jr nightmare will just “disappear”:

Washington Post: As RFK Jr. upends America’s public health system, Trump cheers him on

…In Kennedy, Trump has found a key political ally, with the president and his aides believing that Kennedy’s “Make America Healthy Again” movement helped swing last year’s election. He’s been a co-conspirator, who has shared and amplified Trump’s own skepticism about vaccines. And, yes, he is a member of the most famous family in Democratic politics, bearing a surname that the brand-conscious president has been happy to cite as a sign of his political power.

“The Kennedys were synonymous with the Democratic Party,” said White House spokesman Kush Desai. “Now the scion of the Democratic Party, RFK’s son, is a Republican Cabinet official. When he touts the ‘Kennedy,’ it is part of that theme.”

Fertile ground for partnership

The two men talk often in person and over the phone, enjoying a connection forged by their similar ages, experience in the spotlight and shared conviction that they are destined to remake America, according to White House officials and others who have spoken with both men.

Trump sought to work with Kennedy in his first term — proposing that the longtime anti-vaccine activist and former environmental lawyer oversee a national commission reexamining vaccine safety — before his aides and outside experts talked the president out of it. The two men reconnected during last year’s presidential race, when Kennedy emerged as one of the Trump campaign’s top surrogates, electrifying crowds and helping with fundraising. Trump publicly pledged that, if elected, he would allow Kennedy to “go wild” remaking the nation’s health system.

The president’s anger at the public health establishment was stoked during the coronavirus pandemic, when he accused the “medical deep state” of seeking to undermine his 2020 reelection campaign by not moving more quickly to expedite coronavirus vaccines. He also lashed out at public health officials such as Anthony S. Fauci, blaming them for publicly contradicting him.

The pandemic also helped erode trust in federal health agencies — only one-third of MAGA supporters say they trust the CDC’s vaccine recommendations, according to polling conducted by KFF last month. As a result, the political cost of attacking them has diminished, and Trump and Kennedy’s allies have defended their slash-and-burn tactics as necessary.

More than any other Cabinet official, Kennedy has his own power center and political appeal. A Gallup poll conducted in July found that Kennedy racks up higher favorability ratings than Trump, Vice President JD Vance and other prominent figures associated with the administration. Some Democrats, such as Colorado Gov. Jared Polis, have continued to praise Kennedy and characterized him as an ally in fighting the food and drug industries….

Finally, a piece in the Atlantic lays out perils in scientists becoming politically active. For many years, scientific endeavor rested comfortably beyond politics. However, that has become more uncertain as one party has become more rooted in anti-intellectualism. The ground has changed beneath our feet, and we in the scientific world have not appreciated that assumptions we hold regarding the value of “alleged” human and animal health advancement are not universally accepted in a very cynical political environment: The Atlantic: Scientists Are Caught in a Political Trap

We are caught in this situation without a clear path out at this point. Where do we turn? We are naive to think that a magical solution will somehow arise to put all the pieces back together to pre-pandemic harmony. After reflecting on the political realities in the past day or so, I think we all need to take a deep breath and apply “The Let Them Theory”. I just bought the Audible version of this best seller and have previewed the first 2 chapters. The premise of the book is that we must give ourselves permission to acknowledge situations as they exist in the short term, rather than futile struggling against unchangeable realities. This is not the same as passive acceptance; rather, it involves accepting our inability to change factors controlled by others. The corollary freedom presented by letting go of what can’t be controlled is that it allows us to imagine what we can control. The author, Mel Robbins, labels this as “Let Me”. Briefly, in applying this approach to the current CDC crisis, we can’t rescind all the damage to public health and vaccine progress at the moment, but we can collaborate over time with creative efforts to counteract its worst effects.

The 5 Stages of Grief

Returning to a concept I visited in a column last August - let’s revisit the grief process in responding to loss. I earlier discussed this related to dairy farmers, the industry and regulators reacting to the very unexpected threat of H5N1 in their industry. Today, it’s appropriate for those of us involved in public health to identify stages of grief in our reactions to current events at CDC and beyond. Here are the Five Stages once again:

The most valuable function in this approach may be to normalize each part of the flood of emotions that we are all feeling right now. Denial, anger, bargaining, and depression are all normal reactions that will take many forms and varying amounts of time for each of us to process. None of us can rush these stages or just “talk ourselves out of it.” I have no counseling skills whatsoever; however, this is a time of great loss for many, when professional help will be needed by many to cope with emotional crises.

It’s important to remember these are shared losses that we are suffering together. The losses are likely not over yet, as further upper leadership changes bring new distasteful policy expectations across the agency. We need to be ready to further support affected individuals as the reality of twisted “scientific” approaches are forced upon CDC by HHS leadership and pre-selected advisory groups. I believe that dedicated scientists see settled truth as existential and non-negotiable. That is why Dr. Monarez and the 3 Unit Leaders had to resign. Others will face the same dilemma, but perhaps with less financial flexibility to take principled stands. Those individuals will need a world of emotional and nonjudgemental support as they chart perilous decisions. In some cases, “Let Them” may include going along to maintain a career in the short term.

Monday - Signs of Backtracking?

Once again, STAT (please subscribe for the hottest health news source online!) was first to report a Truth Social post indicating that President Trump may be wavering in support for the RFK Jr. CDC massacre:

Trump says CDC is ‘being ripped apart’ over Covid products, calls for drugmakers to prove their benefits

WASHINGTON — President Trump on Monday urged pharmaceutical companies to publicly prove that their Covid-19 products work, saying in a Truth Social post that the Centers for Disease Control and Prevention is “being ripped apart over this question.”

“I want the answer, and I want it NOW,” he wrote in what appeared to be his first public acknowledgement of recent tumult at the CDC.

Drug companies have long shared findings with government regulators and the public showing that their Covid-19 products are overwhelmingly safe and effective. In his post, Trump said he has been shown data demonstrating the vaccines and drugs are effective and have saved millions of lives, but he accused the companies behind the products of not sharing that information publicly — or with officials at the CDC.

Trump used the post, which comes five days after the ouster of Susan Monarez as director of the CDC and resignation of several other top officials, to urge companies to “clear up this MESS, one way or the other.”…

I won’t even pretend to reconcile that gibberish with any predictions for lessened support for RFK in the Trump administration. No one has a good crystal ball for predicting Trump Administration policy or personnel changes.

CDC, One Health and Agriculture

I had the privilege of working with several CDC units during my time at USDA, especially the Influenza Division and the One Health Office. Each is housed in separate units of the organizational structure, but both lost their leaders in the massacre last week.

The One Health Office (led by Dr. Casey Barton Behravesh) is housed under the National Center for Emerging and Zoonotic Infectious Diseases, formerly led by Dr. Daniel Jernigan. This office led the U.S. interagency One Health effort related to COVID, which also included multiple units within USDA as well as other federal agencies. The entire portfolio mushroomed as SARS-CoV-2 virus was identified in an expanding group of domestic and wild animals from 2020 onward.

USDA has collaborated with the Influenza Division for over 20 years, given the avian origin of the virus and its disease status in poultry, swine, horses, dogs, cats, and now cattle. The Influenza Division is a section of National Center for Immunization and Respiratory Diseases (NCIRD), led until last Friday by Demetre Daskalakis, MD, MPH. The USDA national swine influenza surveillance program originated through seed money offered to USDA by the Influenza division back in 2007. That funding kickstarted a joint effort to better understand the genomics of the swine influenza virus, especially related to its occasional spillover into humans at fairs and other events. That early pilot program remains today as a shining example of successful interagency One Health collaboration to advance disease agent knowledge across species.

Other cross species zoonotic agents also tie CDC units with various USDA program and research entities. We will become all too aware of what we’ve lost as the cuts and leadership gaps develop at CDC over the next several weeks and months. I doubt that the HHS Secretary and his MAHA lieutenants have any concept of how to effectively govern the talent that remains. Hopefully the inertia of “doing the right thing” among the many dedicated remaining employees will carry on much of the work on despite all the drama at the top.

Looking forward on Tuesday

Maya Goldman in Axios reported today:

RFK Jr.'s vaccine plan faces September tests

After roiling the leadership of the Centers for Disease Control and Prevention, Health Secretary Robert F. Kennedy Jr. is poised to make more moves this month that will test how much free rein he has within the administration.

Why it matters: Republicans are counting on Kennedy and his MAHA base to deliver in the midterm elections. But more bulldozing of evidence-based public health policy could fray his support within the White House and Congress…

Nine former CDC directors who served under Democrat and Republican presidents condemned Kennedy's actions to dismantle the agency on Monday….

The big picture: Kennedy's core base sees him "really taking hold of HHS, which is no easy task," Joseph Varon, president of the Kennedy-aligned group Independent Medical Alliance, said in an email.

"We expect more fireworks from those deeply opposed to reform, but the Secretary has the President's confidence, so we're looking forward to an acceleration of reform activity," Varon added.

Reality check: Kennedy supporters were key to delivering Trump the White House last year, and their backing for GOP candidates is a political asset going into the midterms, according to Chris Meekins, managing director at Raymond James and a first-term Trump health official…

What they're saying: "September is shaping up to be yet another month of MAHA wins — and another month of the same, tired hysteria from Democrats who have yet to show any regret for shoving unscientific mandates and school closures down the throats of everyday Americans during the COVID era," White House spokesperson Kush Desai told Axios.

HHS communications director Andrew Nixon said in an emailed statement that the MAHA movement has spread across the country under Kennedy and President Trump, and its mission "will continue to move forward at full momentum."

The Axios piece lists several imminent September Fireworks coming from the newly RFK-purged CDC:

• New members of senior leadership will be installed in the coming weeks, CDC acting director Jim O'Neill, a top adviser to Kennedy, wrote on X. These leaders will likely be much more responsive to MAHA ideology, making CDC guidance less independent and peer reviewed. Time will tell just how far into the ranks the purge will reach as professional staffs must weigh working under increased politically charged oversight in the face of decreased budgets.

• The “Geier Committee” will deliver a report on the “environmental causes of autism” this month. Earlier this year David Geier was appointed by Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. to lead a federal study examining a discredited link between vaccines and autism. Geier's appointment and controversial history of promoting disproven theories and unproven treatments for autism drew widespread criticism from medical and autism advocacy communities. The overwhelming scientific and medical consensus is that there is no link between vaccines and autism. Continued research into the causes of autism has pointed toward a combination of genetic and environmental factors. The Geiers' theories have been repeatedly debunked and condemned by scientific bodies. Regardless, look for fireworks as this “expert panel” likely paints a picture of a “government coverup” of critical data purportedly showing a link between childhood vaccine use and autism.

• RFK Jr.’s handpicked Advisory Committee on Immunization Practices (ACIP) is set to meet on the availability of COVID boosters on Sept. 18. This committee has already been skeptical of COVID vaccination efficacy and mass vaccination policies in general.

• Also expected in September are simplified dietary guidelines and a presidentially commissioned report on ways to reduce chronic disease in children.

• The expectation is Kennedy will use the CDC to stoke more questions about vaccines' safety and effectiveness — and possibly erect more barriers by effectively limiting access without technically banning them. President Trump on Monday questioned whether the COVID shots developed during his first term are safe and effective after Kennedy limited who can get them and said that pharmaceutical companies need to publicly substantiate their success. Some blue states are reportedly considering issuing different public health guidance from the Trump administration's, in a sign they're increasingly comfortable picking a high-profile fight with Kennedy.

Nature Still Holds the Cards

However, how this all ultimately plays out is beyond the control of RFK Jr. or anyone else, and rests squarely on what viral challenges will we face this winter and beyond. We know we will have endemic seasonal influenza and COVID at some level of severity. How large will the challenges be, and will the selected strains match well to protect those of us choosing (and allowed) to be vaccinated?

We will also have some level of H5 in dairy herds and poultry flocks (one today reported in South Dakota commercial turkeys). Will these outbreaks stay tame, scattered, and free of human-to-human spread with severe illness? Odds are that we will have at least one hospitalization of a human, and likely one or more severe multi-flock or multi-herd outbreaks. If animal epidemics heat up, pressures on human preparedness will rightfully increase.

Then there is an ongoing worldwide pandemic threat, certainly including H5N1, plus myriad other possibilities. Diagnostic capabilities for influenza and coronavirus in both animals and humans are more robust than ever, but funding and readiness is in retreat. We also badly need more robust early detection capabilities in both humans and animals. We could not detect SARS-CoV-2 in 2020 “at speed” in humans, and I’m not convinced we have rectified that deficiency in the face of an exploding animal or human epidemic since then.

This is where MAHA is completely clueless. There isn’t enough cod liver oil and non-ultra-processed food in the world to stop a raging highly transmissible virus. We can’t dismantle our readiness, response, and vaccine infrastructures that protect us from viral pandemics without suffering severe consequences. It’s one (insane) thing for RFK Jr. (with the blessing of Secretary Rollins) to advocate that H5N1 should “burn through” poultry flocks to generate immunity; few will accept that as a viable human public health countermeasure as corpses pile up.

If we fall into a severe influenza or COVID season, or if a novel pandemic befalls us, RFK Jr. will quickly slink away as the President returns to “Trump”eting Operation Warp Speed mRNA vaccines as the solution for the crisis.

Nature is ruthless in balancing excesses (including ideological ones); it’s tragic that we collectively will have to undergo so much pain and loss of life in this “Let Them” cycle. “Let me” (all of us) be looking for ways to accelerate the return to those things we are trained and impassioned to pursue - excellence in Science, Human and Veterinary Medicine, Public Health, One Health, and CARING for lives we were born to protect.

John