In pretty much every meeting I’ve been in this week (and as a consultant I go to a LOT of meetings with a lot of different people), the meeting has started with someone tentatively saying, “How are you?” and the rest of the people looking glum, looking down at their desks, and someone mumbling something like, “You know.” Or “As well as can be expected.” Three different colleagues reached out this week just to check in and ask how I was doing. I did the same for others; these little showings of support are so critical to those of us in this field right now, because it’s anguishing to see your entire career and everything you believe in gutted in just four weeks in the name of “government efficiency” and counteracting “woke ideology.” My colleagues and I aren’t ideologues, despite what the rhetoric out there might lead you to believe. Public health workers have devoted their lives (usually with very little pay, I might add) to try to bring about changes that will save lives and improve health for those around them, especially those who are constantly left out or mistreated by our traditional social service systems. We’re being told our work is wasteful. That we should stop talking about the ways that people of color and people who are trans or non-binary are set up to fail in our systems—and thus are more likely to be sick and die sooner than other Americans—because that’s discriminating against white people, or because two sexes are a “biological reality” even when any actual biologist will tell you that it’s much more complicated than that. I’m not writing these updates because I want to rail against the current federal administration (I have other outlets for that). I write these updates because there’s such a flood of information flying around right now that it’s hard to keep track of what’s real and what’s not, and I hope that if people outside of public health can easily access a summary of vetted, trustworthy information they will feel compelled to speak up and try to do something about it. This stuff is going to affect all of us, if it isn’t already, and whether we realize it or not. We should all sit up and take notice, and ask ourselves whether this is really OK. (Spoiler alert: it isn’t.)
A few updates since I last posted on Monday:
–The House Budget Committee approved a budget resolution that directs the House Energy and Commerce Committee to reduce the deficit by at least $880 billion in cuts to programs under their purview over 10 years, which a “policy explainer” circulated by House Budget Chair Jodey Arrington indicated would likely be achieved primarily through cuts to Medicaid. On Tuesday, Trump went on Sean Hannity’s show on Fox News and said “Medicare, Medicaid—none of that stuff is going to be touched,” and then yesterday he endorsed this bill anyway. To keep this in perspective, earlier this year the GOP Budget Committee estimated that imposing new work requirements for Medicaid eligibility would only cut $100 billion, so there would be a lot more drastic measures that would need to be taken to hit this newly proposed mark for cuts. It’s expected that the full House will vote on the budget resolution when it returns from recess next week, and you should call your congresspeople right away to voice your concern, especially if you have Republican representatives. You should be very concerned! Many people live in states where the Medicaid program has a different name (like Green Mountain Care in Vermont, or TennCare in Tennessee), so they may not even realize they could be affected. Medicaid covers nearly 24 million women of reproductive age in this country. Along with the related Children’s Health Insurance Program (CHIP), it covers health services for nearly HALF of all children in the US. Schools receive roughly $4.5 billion in Medicaid funding each year, supporting school nurses, speech-language pathologists, occupational therapists, school psychologists, and social workers, among other things.
–As we hear about all this need to cut expenses, it’s important to remember that cuts today can have severe financial consequences in future years. As Your Local Epidemiologist posted on substack yesterday (if you don’t follow YLE, you should: https://yourlocalepidemiologist.substack.com), public health interventions tend to offer a huge return on investment down the line, which means cutting public health expenses now is likely to lead to ballooning costs later.
Pulled directly from YLE’s post:
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Opioid crisis response efforts. For every $1 invested in overdose prevention, $4 is saved in health care and criminal justice costs.
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The Vaccines for Children Program prevents 42,000 deaths annually, saving $10.50 for every $1 invested—amounting to $2.2 trillion in taxpayer savings.
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Community weight loss programs. Every $1 invested yields a return of $16.70.
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Mental health interventions. Every $1 invested in collaborative care models (integrated mental health treatment within primary care settings) yields a return of $6.50 in health care savings and improved worker productivity.
Here’s another one that’s very important right now: Flu vaccines for seniors. Every $1 spent on those programs has a whopping $60 savings in health care costs, since even though we throw around the word “flu” for all sorts of things, actual influenza infection with actual influenza is *awful.* I had it once and was out of work for 7 straight sick days (plus weekend recovery time). I couldn’t even get off the couch, and I was a healthy person in my 20s. It can absolutely be deadly for the older people in our community: 19,000 people in the US have died already this year from influenza, in a particularly bad flu season, worse than we’ve seen since the 1990s.
–Why am I highlighting the return on investment for flu vaccines for seniors? The dominoes are already starting to fall related to vaccination programs. The same day RFK Jr. was confirmed as HHS secretary, the Louisiana health department stated it would no longer publicize any mass vaccination events. A few days later, leadership at CDC’s National Center for Immunization and Respiratory Diseases told staff that HHS had reviewed their “Wild to Mild” flu vaccination campaign—which had been shown to be very effective at helping people understand that there are benefits from flu vaccine even if it doesn’t prevent someone from getting the flu, because it lessens symptoms and severe disease (just like with the COVID vaccine)—and the campaign was being discontinued, effective immediately.
There are other things about RFK Jr’s positions on vaccines that are very alarming to people in public health, and should concern even people who consider themselves to be vaccine skeptics. In 2021, RFK Jr. said “We should not be giving Black people the same vaccine schedule that’s given to whites, because their immune system is better than ours.” A lot of people worry about this because this statement sounds disconcertingly similar to language used in eugenics, which is the scientifically incorrect idea that there are biological differences between different races. (Perhaps the most notable eugenicists were Nazis, who used these arguments to support their efforts to exterminate entire races of people.) This concern was raised during RFK Jr.’s confirmation hearings, and he doubled down, saying “the Poland article suggests that Blacks need fewer antigens than [whites].” In 2014 a study was published with Gregory Poland as senior author (which RFK Jr. seemed to be referencing) and did indeed find that of almost 2000 people, those of African descent had significantly higher rubella antibody levels after receiving the rubella vaccine than people who were Latinx or white. But that doesn’t mean African Americans don’t need as much vaccine antigen to be protected against disease—the study didn’t even look at that. In fact, one of the study’s authors, Richard Kennedy (no relation), specifically told NPR in an interview after the hearing that suggesting African Americans should have different vaccine schedules was “twisting the data far beyond what they actually demonstrate.”
Repeating the results of this limited study as evidence to drive decision-making is what’s known as “cherry picking,” since there’s lots of other research RFK Jr. could be citing that demonstrates otherwise, including a 2013 study also by the same scientists that looked at smallpox vaccine and found that people of European descent had a stronger immune response than people of African or Hispanic descent. Presumably, RFK Jr. doesn’t share those points because they don’t support his preferred narrative about vaccine safety and the benefits of vaccination. But that’s not how decision-making based on scientific information is supposed to work—you’re supposed to review all the available information and use that full picture to make decisions.
During those same hearings, in conversation with Senator Murray, he also said “I recommend that children follow the CDC schedule, and I will support the CDC schedule when I get in there, if I’m fortunate enough to be confirmed.” He also told Senator Cassidy—the Republican who was thought to be the main barrier to RFK Jr.’s nomination advancing to a full vote—that (per Cassidy) “If confirmed, he will maintain the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices without changes.” The Advisory Committee on Immunization Practices, or ACIP, is a panel of experts that offers guidance to CDC on vaccine approvals, and influences which vaccines health insurers cover.
But as so many predicted, RFK Jr. appears to have lied in order to get the votes he needed to be confirmed. Yesterday, he indefinitely postponed the scheduled ACIP meeting (which was due to be held on Feb 26-28 to discuss vaccines for COVID-19, meningococcal virus, influenza, RSV, HPV and mpox). On Feb 18 he said in an address to HHS staff that “nothing is off limits” in his quest to address chronic disease rates in children, including examining childhood vaccine schedules.
“Nothing is off limits.” Believe them when they say that.