With the second Trump presidency looming, experts are concerned about a host of emerging issues in public health, including immunization practices, biomedical research, federal funds, and fears about bird flu.
ARTHUR REINGOLD; reingold@berkeley.edu
Reingold is a professor of epidemiology who has dedicated his research to the prevention and control of infectious disease.
Reingold told the Institute for Public Accuracy: “I’m hardly alone in the academic public health and biomedical community raising concerns based on the views that have been publicly made clear about figures like Robert F. Kennedy Jr., the incoming head of NIH, and the incoming CDC director. I serve on the Advisory Council on Immunization Practices (ACIP). In theory, [these new leaders] could decide not to accept the advice of ACIP or other committees, or change the composition of the committees. They might be able to fire existing members or else wait for their terms to expire, but it’s unclear how quickly they could replace them with people whose views align with theirs. A large proportion of ACIP members were just appointed, and the terms are four years. It will take a while for those seats to turn over, unless they were somehow voted out by majority rule.
“The biomedical community is also concerned about pauses in infectious disease research. These appointees are not a good omen for biomedical research funding. On the other hand, most public health in the U.S. is done by cities, counties, and states. Public health laws are almost all state laws, not federal laws––but, on the other hand, the feds can coax, cajole, coerce, and bribe states by withholding funding.
“A state like California already does things very differently than a state like Florida or Texas. That will continue to be the case. California, for instance, has very stringent school entry requirements for vaccinations, with very few exceptions for religious or medical reasons. Could the federal government withhold funds for that? I don’t know––I’m not a lawyer. But [the feds] could in theory make life difficult for these states. We are worried about that, even in California, where we have a good health department––particularly in immunizations, where we have one of the best approaches and sets of rules in the country.
“While public health laws are state-specific, a lot of the money does come from the federal government. In response to Covid-19, there was a gush of federal money to states, and a lot of that money was used in the Covid response. That money is basically all used up. Individual states have to step up and fund public health at a reasonable level, but even progressive states like Massachusetts, California or New York are going to have a tough time replacing that federal money with state and local sources like income tax.
“Regulatory agencies like the EPA are generally trying to reduce population-level exposures to toxic substances, pesticides, and lead. That’s a good thing, and in theory, RFK Jr. should support that based on his efforts in the past. On the other hand, the incoming administration is talking about limiting the scope of regulatory agencies like the EPA, and the Supreme Court has made it clear that judges, rather than technical experts at agencies, should be making these decisions. In theory, RFK Jr. should be all over that.”
In addition, Reingold addressed concerns about bird flu in California. “We have more dairy herds than any other state. Bird flu is here, but so far the impact on human health has thankfully been negligible. Nobody can predict whether that will continue to be the case or whether there will be catastrophic changes in the virus that create a pandemic that puts Covid to shame. More testing of cattle and wastewater is starting to happen, and the Department of Agriculture is mandating more testing. It sounds easy to suggest that dairy workers undergo frequent testing, but the reality is that it’s not easy to do: a lot of those workers are poorly paid, worried about their income, worried about their deportation status. They’re not necessarily keen to get tested and found out to have the virus. The owners of dairy farms likewise don’t happily greet public health [workers] when they come to test cows. If cows are found to be positive, these farms have to destroy their milk, quarantine their herd, etc. You don’t get instant cooperation from owners of the dairy herds. There are always political and economic ramifications to what we do in public health. That’s a fact.”