In a time where so much information is being censored or suppressed, we have to keep the flow of reliable information going however we can!
I’ve also been asked by some people to share my credentials. I don’t claim to be all-knowing and while I have lots of thoughts on lots of things happening right now, I’m trying to keep my posts focused on the areas I have decades of expertise and direct experience in. I have a Master of Public Health in health and social behavior and a PhD in epidemiology from UC Berkeley, am a current member of the faculty at the UC Berkeley School of Public Health, and have been a busy public health consultant for the last 15 years, working closely with people working to improve health equity everywhere from small community-based organizations to the CDC itself, plus WHO, UNAIDS, and (once) USAID. I have plenty of critiques of these and other public health institutions. But in order for us to fix them we have to engage thoughtfully, not seek to destroy them first and ask questions later (or never at all).
Anyway, a few updates for this afternoon:
–If you’ve been hearing that PEPFAR was exempted from the funding freeze and therefore HIV medications and other lifesaving measures are continuing, please know that’s simply not true. Yes, memo went out granting an emergency waiver. And yes, I hear that some medications are going out the door again, in some countries. But in pretty much all cases, HIV testing and prevention activities have ceased. In many countries, new medication or other equipment and supplies are stuck at the border, or otherwise unable to move to where they need to go because there’s no one to handle the logistics. In practice, it doesn’t help to grant an emergency waiver and unfreeze funds if you’ve blocked the people who administer those funds from communicating with anyone, or if you’ve simply fired or put on administrative leave everyone who makes the program run.
–On Friday, it was announced that effective Monday (today—the next business day after the announcement), all funding coming from the National Institutes of Health would be limited to having 15% indirects. Unless you deal a lot with budgets this might not mean anything to you, and maybe all you’ve heard is that this decision will save an impressive $4 billion per year in NIH funds. The reality is that federal research grants pay direct costs that cover the research itself, but also a lot of additional funds that support the overhead of the institution (like the University of California, where I work, or Harvard, or Children’s Hospital of Philadelphia, just to name a few) that hosts the research. These overhead costs are paid through “indirects,” which are a percentage of the direct funds. Every 3-4 years, these institutions negotiate their particular indirect rate with the NIH, and then their operating budgets as an institution are built around (among other things) the expected indirects based on the research grants their institution is awarded. This announcement on Friday was the equivalent of an immediate $4 billion budget cut to universities, hospitals, and other research institutions around the United States. This is *catastrophic* for higher education in the US. It will debilitate our country’s ability to continue research that has kept the US on the cutting edge of health science research for more than a century—research to develop cures for cancer, treatments to prevent heart attacks and strokes, and ways to detect outbreaks before they explode into life-threatening pandemics. 22 states have already sued to block these cuts. This is a health research emergency. Just like with so many of these changes, if as a country we want to fix dysfunction or waste, we need to engage in thoughtful discussion about how to do this without simply gutting the programs that keep our parents, siblings, neighbors, and children alive.
–One of the major datasets that had been removed from CDC’s website, the Youth Risk Behavior Surveillance System (YRBSS), appears largely to be restored if you have the skills to download and analyze Access or ASCII data files, but key links to summarized results from prior surveys are still dead. As Tom Frieden (former CDC Director) posted on LinkedIn when this first happened a week ago: “The CDC’s Youth Risk Behavioral Survey is valuable for anyone who cares about America’s kids. It tracks trends in tobacco use, teen pregnancy and unsafe sexual behavior and has led to substantial improvements in teen health. The bottom line is we need this data to understand what’s really happening. Every day it’s not available, doctors, nurses, and state and local health departments are less prepared to support kids.” [Commentary from me: as someone who has specialized in sexual health promotion for decades now, I don’t like the phrase “unsafe sexual behavior,” which I think is stigmatizing and inaccurate…but the general point of his post stands strong.]
Someone wrote to me asking if this type of “pause” in communications is normal during times of government transition. A light/short “pause” is normal, to allow a new administration to catch its breath and reset expectations with the people working below. But what is happening now is absolutely NOT typical or normal. The MMWR is a critical information line to people providing medical care and public health work on the ground, and no prior administration has prevented it from being published (and notably, when this administration allowed it to be published after a 2-week pause, they blocked specific scientific articles from appearing, despite their having already been scientifically vetted and deemed a vital communication about developments in bird flu). Back when the pause was announced, a senior HHS official released a memo saying it was only going to last until Feb 1, and here we are on Feb 10 and with a few exceptions the pause has not been lifted. Instead, blatant censorship is becoming policy and most of the people I know who work for the feds have already been laid off, or are very scared of talking to anyone about anything. Meanwhile, they’ve already chiseled the USAID sign letters off the building of the headquarters in DC. This is not about a brief pause to reset communications, and it is very much atypical. Do not allow this to be normalized!