Whiplash.

If you are anything like me, these days you wake up and think “What in the world happened while I was sleeping? Is the Strait of Hormuz open today? Or closed?” This is even more true if you live in California like I do, since the east coast has had hours of awake time to post on social media, make newsworthy decisions, or even start testifying before Congress while we were still asleep.

If you’re not someone who works in public health, then you might find the constant reversals with the Iran negotiations and the Strait of Hormuz to be surprising (though probably not). To those of us in public health, it’s just another day, because this absurdity is part of the professional water we swim in now. That’s actually part of the strategy. And it’s exhausting.

Lest you think I’m being hyperbolic, here are just a few examples of the public health-related news in the last few months that have given many of us professional whiplash:

Jan 13, 2026: The news broke that almost $2 billion of funding to the Substance Abuse and Mental Health Services Administration (SAMHSA) was being immediately rescinded, slashing overnight more than 2,000 programs designed to support Americans struggling with mental health or substance use issues. These programs included:

• 417 programs aimed to prevent suicide,

• 465 programs addressing alcohol use

• 351 programs supporting mental health for Americans living with HIV

• 218 programs for Americans with depression

• 573 grants focused on mental health and substance use services in rural areas

Perhaps you think these cuts are justified because there have been such great improvements in mental health and substance use in this country recently! No. That is incorrect. The U.S. still has the highest rate of overdose deaths of any country in the world, by a lot. Our overdose rate is about 13x that of Germany, and almost 5x that of Australia. We also win the gold medal for having the highest suicide rate of any high-income country, at 14 deaths per 100,000 people—double the rate of the United Kingdom, for example. When the National Bureau of Economic Research compared suicide rates in 16 economically comparable countries, 12 experienced reductions in suicide rates from 2000 to 2020, and of the four that didn’t (the U.S., the U.K., the Netherlands, and Brazil) the U.S. had by far the biggest increase in suicide rate over that time. And by SAMHSA’s own data, among the 4.8 million people with in the U.S. with an opioid use disorder, less than 1 in 4 receive medications designed to help them stop or stabilize use. Seems like a great time to cut $2 billion of funding to address these dismal statistics! With a form letter, no less, that said nothing more than that the funding termination was “effective immediately,” because the services “no longer aligned with the agency’s priorities.”

Jan 14, 2026: After about 36 hours of panicked advocacy from many thousands of public health professionals raising the alarm about these eliminated funds—I cannot express how many emails, text messages, and social media posts flooded into my life during that window—an HHS official told the press that never mind, the money was being restored. No reason given.

“These are cuts he should not have issued in the first place,” Representative Rosa DeLauro (D-CT), the top Democrat on the House Appropriations Committee, told the New York Times. “This episode has only created uncertainty and confusion for families and health care providers.” Ya think? It took a few days for everyone to recover from that whiplash.

Feb 4, 2026: News started to leak that the White House had instructed CDC to rescind $600 million in public health funding from California, Colorado, Illinois, and Minnesota, because of vague concerns about “waste and mismanagement.” Or perhaps less vague concerns about those states being led by Democrats who were speaking out against Trump? Again, panic. These planned cuts, which were confirmed by multiple sources over the subsequent week, were mostly to state and county public health departments. They were funds that were meant to modernize data systems, manage disease outbreaks, and pay for staff who oversee programs meant to keep the most vulnerable citizens safe. Almost immediately, the attorneys general of those four states sued the Trump Administration, claiming the cuts were politically motivated and illegal.

Mar 12, 2026: A federal judge agreed, issuing a preliminary injunction that blocked the cuts until the case could fully be adjudicated, noting that “Plaintiffs are likely to succeed on their claim that OMB’s targeting of them for HHS cuts…is arbitrary, capricious…” He also said “the harm to plaintiffs from OMB’s effort is irreparable and intangible. Plaintiffs are sovereign states, equal to the other states of the Union. To undermine one set of states that are similarly situated to other states inflicts intangible harm to the established system of governance. The loss of capacity to fund and maintain public health infrastructure puts the health of plaintiffs’ residents in jeopardy.” Agreed. More panic averted. At least for now. But these were (are) profound cuts, only temporarily stopped, and it was a very stressful 5 weeks while people in these four states prepared for the dire impacts.

Feb 3, 2026: The FDA issued a letter to Moderna letting them know it was refusing to review their application for a license for their new mRNA influenza vaccine. Why is this such a big deal? As Jonathan Cohn explained well, “This was not a decision to reject the Moderna vaccine. It was a refusal even to think about approving it. The FDA rarely takes such a step, and when it does it’s usually because an application is missing a whole component or includes suspect data. Nobody is suggesting Moderna’s application has those kinds of issues.” So what happened leading up to this letter in February?

Well, in April 2024, Moderna sent the FDA their proposal for testing its new vaccine. They spelled out the clear plan for testing the vaccine. The FDA reviewed the proposal and noted that for people over age 65, the new mRNA vaccine should be compared to the high-dose influenza vaccine (as recommended by CDC for people in that age group), not the standard dose. The problem was that Moderna was testing the vaccine in Europe, where the high-dose influenza vaccine wasn’t readily available. Moderna and the FDA agreed that if they proceeded with comparison to the standard dose in all age groups, then their new vaccine might not be recommended by CDC for people age 65 and older, but that the FDA would still review their submission. This was explicit. In writing. And typical of this kind of process. Moderna invested an estimated $500-$700 million to develop and test this vaccine, with this commitment in place.

In August 2025, the results of the Moderna trial were in: The mRNA vaccine was 27% more effective at preventing symptomatic cases of flu and 49% more effective against hospitalization when compared to the standard-dose vaccine now commonly used. At that time, the FDA said the trial had been properly conducted and encouraged the company to apply for licensure after such promising results. Importantly, Moderna had gone an extra step and performed an additional study in 2,200 people over age 65 comparing the levels of protective antibodies compared to the high-dose vaccine. (The mRNA did, indeed, induce significantly higher levels of antibodies to flu in that age group, even when compared to the high-dose vaccine.) This was great news! Our current flu vaccine isn’t fantastic. It’s better than nothing (and I, for one, get my flu shot every year—as should you!) but it’s slow to make, and we could do better with the antibody protection it offers.

Your Local Epidemiologist summed up the issue very well, so I’ll just quote her:

Flu vaccines help, but they’re far from perfect. In most years, they reduce the risk of hospitalization by roughly 40–60%. (To compare, the measles vaccine is 97% effectiveness against severe disease). Flu changes quickly, which means innovative vaccines are needed.

There are two potential advantages of mRNA technology:

1. Speed: mRNA vaccines can be updated much faster than traditional flu vaccines (3 months vs. 6 months), so they could catch up to flu mutations more quickly.

2. Immune response: Early research suggested stronger immune responses, including T cell and memory B cell responses that were comparable to or stronger than those from enhanced flu vaccines used in older adults.

Feb 11, 2026: The news broke that FDA staff responsible for reviewing these applications had in fact planned to proceed with the review when FDA Center for Biologics Evaluation and Research Director Vinay Prasad overruled them, and unilaterally sent the “refuse-to-file” letter to Moderna. This is not how this is supposed to work. In fact, David Kaslow, the head of the FDA’s vaccine office, wrote a detailed memo explaining why the FDA should review Moderna’s application. But he was not in charge, Vinay Prasad was. That same day, the Wall Street Journal (not exactly known for its progressive takes) published a headline that read: “Vinay Prasad’s Vaccine Kill Shot: Does the White House Know the Harm He’s Doing to Public Health?” Inside the article, the author wrote, “This is arbitrary government at its worst.”

OK, but Prasad was in charge. Why is it such a big deal that he made this decision?

1. Regulators similar to the FDA in Europe, Canada, and Australia have all accepted Moderna’s application for review. This means people who live in Europe, Canada, and Australia are likely going to be able to get a new, faster, and better flu vaccine soon, and in the U.S. we’ll be stuck with the old version.

2. It is well accepted that continuity matters in places like the FDA, despite the change in political leadership in the U.S. every 4-8 years. This is because vaccine and drug development is a slow process. Most vaccines and drugs we benefit from took 5-10 years to develop. Companies invest hundreds of millions of dollars to develop something new, which is why they discuss and negotiate with FDA along the way—if their product ends up to work like they hope, then they want to make sure their application gets reviewed and their product gets FDA approved, so it can be used in the U.S. (and sold in the U.S., helping the company recoup its investment). If a political appointee can just overrule career staff and normal processes without good reason, then companies will no longer have an incentive to invest hundreds of millions of dollars. This hurts medical innovation, which ultimately harms our future health.

Feb 12, 2026: Moderna announced it’s pausing new Phase 3 trials for their other infectious disease vaccines, including vaccines being tested to protect against Epstein-Barr virus, herpes, and shingles. These are viruses you don’t want. But again, if companies think their hundreds of millions will be for naught because someone appointed by Trump doesn’t like vaccines, well, then we’re not going to see newer and better vaccines coming to market. That means we’ll be stuck with older, less effective vaccines—or no vaccine at all (like is currently the case for Epstein-Barr virus and herpes).

Mar 6, 2026: FDA Commissioner Marty Markary announced that Vinay Prasad was out as Director of FDA’s Center for Biologics Evaluation and Research. Again. I am celebrating this. (Again. Talk about whiplash.) But the damage is done. What does it mean for you? In the short term, this fall you’re going to get access to the old version of the flu vaccine. You should still take it. But in the long term, we need a turnaround from FDA or all of our access to newer and better vaccines will suffer.