Updates from cruise ship inspections to Harvard.

Fearless, funny, and expertly vetted updates on what is happening to public health in the US.

I didn’t post anything last week, not because there wasn’t anything important happening in the world of public health, but because it was all just a little too much. Between the daily news updates of colleagues who had been kicked to the curb after years (decades, often) of service, and dystopian rule changes and restrictions sure to Make America Sicker Again—not to mention my own work, trying to hold all the pieces together for a series of projects that have increasing uncertainty about future but also real increasing need for success—by the end of each day I just didn’t have any fuel left in the tank for an update.

But so much continues to be happening in Public Health USA, so it’s time to summarize some recent highlights and lowlights you might have missed:

After years of advocacy to finally improve the way we collect SOGI (sexual orientation and gender identity) data in government and government-funded settings so that people who are trans and gender diverse aren’t invisible—lumped in inappropriately with gay men or cisgender women, so we can’t understand health disparities for this population or how best to overcome them—an announcement was made in late February that CDC will “no longer process transgender data” to comply with Trump’s executive order. Of course, this announcement came before HHS laid off all the people involved with the huge, longstanding federal studies like the National HIV Behavioral Surveillance, so now in many cases they’re not going to be processing cisgender data, either. Speaking of trans people, at this point almost every single existing research project funded by NIH to study transgender health has been terminated without notice, and in a truly cruel twist the Trump administration has instead instructed the NIH to allocate precious remaining funds to “studying regret” that transgender people may feel after they transition. To be clear: this is similar to RFK Jr. asking a discredited anti-vaxxer to study whether vaccines cause autism after gutting vaccine-related research nationwide—we already know this answer and it’s disingenuous to pretend that all we need is a “well done” study to bring the “truth” to light. Many, many studies have already conclusively demonstrated that regret after gender affirming surgery is extremely rare among trans people. Plus, in case this is the first time you’re reading this series, this is not how scientific inquiry is supposed to happen.
Per this public tracker, there are 781 known NIH grants that have been summarily terminated, and when you add in CDC, SAMHSA, FDA, and others, that number jumps to 1295 terminations that the federal government is directly reporting as of Friday. It’s clear this is an undercount, but it’s what we know now. Here’s a very important statistic: if you throw the data in the official HHS PDF of terminations into excel and total the columns, you can see that the amount of funding taken back by the federal government through these terminations is just over $7 billion. This is the part they’re proud of. But you can ALSO see that the total amount already expended on these same terminated grants is just shy of $14.6 billion. To be clear, this means that $14.6 billion US taxpayer dollars have now been totally wasted on research studies that won’t produce anything, because even if they had already enrolled all the participants, collected all the data, and been ready to share results, now the funding is gutted and those results won’t see the light of day. People have to stop work, and we’ll never know what they were supposed to find. To be even clearer: this is the point. It’s not about saving money, it’s about burying scientific findings on topics where they want to promote their own unscientific agendas: primarily related to trans people, LGBTQ+ people, HIV, and vaccine hesitancy.
Speaking of it not really being about saving money, as you know there were more than 10,000 federal employees RIFed (aka laid off as part of a Reduction in Force of the federal government) from HHS the week before last. Lest you think this was a budget-minded way to reduce federal spending, spending on personnel at federal health agencies accounts for less than 1% of their budget. It’s not about saving money, it’s about creating wreckage out of the systems designed to keep us safe. For example, do you like taking cruises? This year alone there have been 10 norovirus outbreaks on cruise ships in the US., plus an outbreak of E. coli and another presumed to be Ciguatera. CDC’s team of cruise ship inspectors is funded through fees paid by cruise companies, so this effort to inspect ships twice per year to help keep cruisers healthy costs taxpayers nothing. But the Trump administration fired this team while they were in the middle of responding to two outbreaks. It’s not about saving money, it’s about protecting big business through reducing oversight and regulation that can hurt their bottom line. Keep this in mind if you have any plans to go on cruises anytime in the near future! Norovirus is very contagious and hand sanitizer doesn’t kill it, so don’t be relying on that in line for the buffet.
Cuts to HHS don’t just impact federal employees, and make Americans more likely to become sick, they also make us less safe. Did you know that many of the cuts made to HHS directly impact our ability to prepare for biological attacks that might be deliberate (aka protection against bioweapons)? After 9/11 and the anthrax attacks that you might remember from 2001 (if you’re at least as old as me), the Republican administration at that time (GW Bush) created new positions and programs within HHS to improve our biosecurity. On the other hand, the Trump administration has fired dozens of people from the Administration for Strategic Preparedness and Response (ASPR) and the Biomedical Advanced Research and Development Authority (BARDA) whose jobs are meant to keep us safe during biological emergencies. Meanwhile, at the direction of Defense Secretary Hegseth, the U.S. Naval Academy has been removing hundreds of books from its library in Annapolis because they have content related to diversity, equity, and inclusion. At least we can feel comfortable that our Secretary of Defense is focusing on the most important issues to keep us safe in the United States while the biosecurity defenses at HHS are dismantled.

But I would remiss to only focus on the bad things, because two extraordinarily good things happened in the last few days:

The American Public Health Association released one of the strongest statements in recent history, entitled Secretary Kennedy and his policies are a danger to public health. APHA is known for being generally non-partisan, and one that is a “primary voice for public health advocacy,” but as a result frequently finds itself critiqued by more left-leaning public health advocates as being too wary of focusing on structural and systemic factors like poverty or racism that contribute to health inequities, particularly when that would require challenging wealthy and powerful industries or institutions in US society. Critiques aside, this statement was one of the first institutional statements that spoke unequivocally about RFK Jr., and pulled no punches. The statement describes RFK Jr.’s “poor and thoughtless management,” and “implicit and explicit bias and complete disregard for science.” Executive Director Georges C. Benjamin ends the statement with this: “As a physician, I pledged to first do no harm and to speak up when I see harm being done by others. I ask my colleagues to join me and speak up. Secretary Robert Kennedy is a danger to the public’s health and should resign or be fired.” I stand in applause with this direct call, joining APHA in speaking up and calling for RFK Jr’s resignation or firing. I hope you do, too. 5calls.org can help you do this easily!
There’s another leader who took a brave stand today: Harvard released a statement to the Trump Administration saying that it would not comply with the administration’s demands, and that the demands were unlawful. (In another ironic twist, the letter was co-signed by Robert K. Hur, who was appointed by Trump himself in 2018 to serve as the US Attorney for the District of Maryland, and oversaw the investigation into Biden’s alleged mishandling of classified documents while VP). If you want to see the demands made to Harvard, they are here. Harvard’s President Alan Garber also sent a letter to the broader Harvard community, which included the now much-quoted statement, “No government — regardless of which party is in power — should dictate what private universities can teach, whom they can admit and hire, and which areas of study and inquiry they can pursue.” Why is this so brave? After Columbia University caved to the administration’s demands many throughout higher education shuddered. If an Ivy League university like Columbia couldn’t withstand the pressure, what did that mean for the rest? But Harvard is the first to say NO. This is wrong and we will not stand for it. We will not cave. Try your best; we will stand firm. And of course they knew what would happen: within hours they were informed that $2.2 billion of funds due to Harvard will be frozen in retaliation. We’ll have to wait and see how this story plays out. But for now, I hope that Harvard can stand strong. By doing so, they send a signal to other universities that they, too, must stand up for their values and missions to educate and protect their student bodies. Harvard now provides an opportunity for other schools to join them in solidarity, and stand together with them in saying NO to what this administration is doing. Why am I talking about this higher education issue in an update about the state of public health? To be clear: the steps this administration is taking against high-profile universities are not about preventing antisemitism, or protecting civil rights. They are about power, and winning, and causing harm. The health and wellness of students is in the crosshairs. In fact, the Harvard School of Public Health is specifically named in the original letter from the Trump Administration as one that must be audited because they “fuel antisemitic harassment or reflect ideological capture.” While it’s not yet clear which grants are being cut as part of the $2.2 billion slap, the grants that had been announced as under review by the feds include not just those that affect the education of current students at Harvard, but grants for research at Mass General Hospital, the Dana-Farber Cancer Institute, and Boston Children’s Hospital, affiliated with Harvard. You might think Harvard is just a snooty ivory tower full of people who have to work their Harvard affiliation into every conversation—but there’s a reason everyone’s heard of Harvard. The amount of life-changing research that has come out of Harvard University and its affiliated hospitals is staggering, including the smallpox vaccine, the PET scan, and even telemedicine. I can almost guarantee that you or your loved ones have benefitted directly from these advances in your lifetime. A government trying to shut down health-related research at a place like Harvard is not a government that wants to Make America Healthy Again. Let’s stand with them for standing up for themselves—and us.