What they’re doing is incredibly damaging to our level of preparedness in the U.S.
If you want to lose some sleep, here are three articles about the current state of pandemic preparedness that will keep you up at night.
What Would Happen to Americans in a Bird Flu Pandemic?
The Trump administration has pushed out seasoned public health officials across the government, including firing (and then partially rehiring) even more CDC staff just last month. Secretary Kennedy has severely undermined the credibility of the Advisory Committee on Immunization Practices and announced changes to vaccine recommendations via social media. The national security office charged with preventing and responding to biological threats has, once again, been eliminated, along with the pandemic office established by Congress to prepare the United States to respond to biological threats. The US Department of Health and Human Services (HHS) has also canceled investments in mRNA vaccines, a platform that would allow rapid development and scale up of vaccine manufacturing in a pandemic.
Meet The Anti-Vaccine Activist Who Could Lead the Response to the Next Pandemic
Historically led by doctors, military officers or career public health officials, the Administration for Strategic Preparedness and Response (or ASPR, pronounced “Asper”) is now being directed instead by John Knox, a firefighter turned anti-vaccine conspiracy theorist with no background in management or public health.
Six current and former senior Health and Human Services Department officials told MSNBC that in elevating Knox, HHS Secretary Robert F. Kennedy Jr. has placed an unqualified activist atop one of the federal government’s most critical health agencies…
Those HHS veterans described ASPR under Knox as adrift: Experienced scientists and senior staff members have left or been pushed out; key roles in the agency have been filled with conspiracy theorists and advocates of false Covid treatments; and hundreds of millions of dollars in mRNA research contracts have been canceled, without good reason.
The Pandemic Next Time
In the past 10 months, President Donald Trump’s secretary of the Department of Health and Human Services (HHS), Robert F. Kennedy Jr., has abruptly dismantled those efforts—along with parallel initiatives to spot emerging viral threats. Cuts to specific programs are difficult to track. But it’s clear that more than $1 billion in drug and vaccine development investments have been scuttled and more than $1 billion in anticipated funding is in limbo. “What they’re doing is incredibly damaging to our level of preparedness in the U.S.,” says virologist Cristina Cassetti, who helped oversee what for years has been the world’s largest portfolio of pandemic preparedness R&D at the National Institute of Allergy and Infectious Diseases (NIAID) until she quit in April. “The U.S. is leaving a huge gap”…
To develop vaccines against the flu threat, the U.S. turned to the technology that changed the course of the COVID-19 pandemic: mRNA. Operation Warp Speed, the multibillion-dollar crash program that Trump championed during his first term, delivered mRNA vaccines to market 11 months after SARS-CoV-2 was identified, faster than many experts deemed possible. That speed made mRNA an exciting tool for combating pandemics. “If you’re trying to beat the raging fire of a new epidemic, there’s nothing even close,” says Cassetti, who is now a consultant to CEPI. In June 2024, BARDA awarded Moderna up to $176 million to speed development of mRNA vaccines against H5N1. This January it announced it would give Moderna up to $590 million more to develop products against five other menacing subtypes of avian influenza viruses.
In May, however, HHS notified Moderna that BARDA was canceling the contracts. “After a rigorous review, we concluded that continued investment in Moderna’s H5N1 mRNA vaccine was not scientifically or ethically justifiable,” an HHS spokesperson said in a statement. The technology “remains undertested,” it said, and Biden’s administration had “concealed legitimate safety concerns from the public”—language that echoes Kennedy’s frequent criticisms of mRNA vaccines.
Three months later, HHS announced BARDA was beginning a “coordinated wind-down” of mRNA vaccine development, terminating 22 projects that totaled nearly $500 million in investments. “the mRNA platform is no longer viable,” said NIH Director Jayanta “Jay” Bhattacharya.
Of course, we can do more than speculate about how our current medical establishment might handle a future pandemic, we can examine their actual track record regarding measles, pertussis, flu, and COVID. It’s not pretty. Instead of protecting the vulnerable, they’ve deliberately left them exposed.
During high transmission times, older people should be offered home delivery of groceries and other essentials.
With this harsh dose of reality firmly in mind, we can rewind to October 2020, the signing of the Great Barrington Declaration (GBD). Although it was just a 1-page document written under the watchful eye of a pro-tobacco, child labor advocate, its authors claimed it miraculously cracked the code to perfectly solve COVID. All public health officials had to do was “protect the vulnerable” (defined as those older than 60-70), let “natural immunity” work its magic, and the virus would fade away in 3-6 months. Not bad, right? Listen to Dr. Bhattacharya discuss his first 1-page pandemic plan.
Obviously, there is nothing inherently wrong with “protecting the vulnerable”, which the GBD termed “focused protection.” However, telling public health officials to do this was like a coach telling their players to “score more points than the other team.” It’s the perfect plan, but it’s not a good one, and it will fail, a point I made in my article The Great Barrington Declaration Wasn’t a Plan for Public Health Officials. It Was a List of Absurd Demands of Them.
In their FAQ section, the GBD’s authors claimed they provided a clear roadmap for how public health officials might protect vulnerable people. Yet, their answer to the question “How do we protect older people living at home?” was just 4-sentences long and contained inactionable absurdities such as “During high transmission times, older people should be offered home delivery of groceries and other essentials.”
Obviously, writing that sentence was a lot easier than actually delivering groceries and other essentials to millions of homebound seniors. Dr. Jay Bhattacharya, one of the three authors of the GBD, had obviously given no thought to how public health officials might actually do this. In an interview from October 2021, a year after the publication of the GBD, he said:
We could have offered free DoorDash to older people. I mean, yeah, it would depend on the community and the living circumstances. It would be a local thing, right?
However, the impossibility of the GBD was its entire point. It allowed its authors to portray public health officials as incompetent fools. In that same interview, Dr. Bhattacharya blamed them for not figuring out how to implement his plan. He said:
The public health community that I know has all kinds of creative ideas of how to help people in a population be protected against disease. They’re very creative generally in thinking of ways to do focus protection for many, many diseases and conditions.
“It was a failure of imagination on the part of public health,” Dr. Bhattacharya concluded. After all, he told them exactly how to conquer COVID. They just refused.
The best pandemic preparedness playbook for the United States is making America healthy again.
Along with his Principal Deputy Director Dr. Matthew Memoli, Dr. Bhattacharya recently released a new 1-page pandemic plan in an article titled NIH Directors: The World Needs a New Pandemic Playbook. The Pandemic Accountability Index penned a devastating takedown, while Drs. Jeremy Faust and Angela Rasmussen did a thorough refutation of every line.
As such, I will limit my discussion to their actual plan to handle a new virus. It was very different from the GBD and it’s foundational principle of focused protection. Dr. Bhattacharya’s new plan is much simpler: vulnerable people should stop being vulnerable. He wrote:
We should learn from recent example: a metabolically healthy population, physically active and eating nutritious food, will cope far better in the face of a novel pathogen than a population facing a severe chronic-disease crisis…
Ultimately, public health agencies encouraging people to take whatever steps they can to improve their health will have a dramatic effect during the next pandemic. Whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more, anything that makes the population healthier will prepare us better for the next pandemic. The best pandemic preparedness playbook for the United States is making America healthy again.
That’s it! That’s the entire plan. It’s terrain theory all the way down.
Like the GBD, Dr. Bhattacharya’s suggestion that Americans should be “healthy again” isn’t inherently wrong. It would be great if people smoked less and walked more. However, that’s hardly a brilliant insight, and it’s been tried before. Dr. Fauci made it a point to encourage exercise as early as March 2020, and unlike Dr. Bhattacharya, he led by example- Dr. Anthony Fauci Is an Avid Runner, Even When He Works 19-Hour Days.
Clearly, there is a big difference between telling people to stop smoking and walk more and actually getting them to achieve these laudable goals, especially in this administration where the headlines read: Why CDC Cuts Are Being Called ‘The Greatest Gift To Tobacco Industry In The Last Half-Century’ and Dismantling CDC’s Chronic Disease Center ‘Looks Pretty Devastating’ To Public Health Experts. Their plan to lower the cost of GLP-1 medications, however, is a clear positive step.
Moreover, healthy people are not totally spared from dangerous viruses, and while many diseases can be altered with lifestyle adjustments, many others cannot. My patients with advanced MS can’t regrow myelin by hitting the gym, and no one can reverse aging, the top risk factor for severe COVID. Babies were also highly vulnerable, and we have no idea whom a novel pathogen may target. The average age of death in the 1918 pandemic was just 28.
We would have
So, what changed? Why does Dr. Bhattacharya’s new 1-page plan reject “focused protection”, the central premise of his previous 1-page plan? Obviously, the core difference between today and 2020, when Dr. Bhattacharya wrote the GBD, is that he is the medical establishment, and so he’s drastically lowered his expectations for what they might be expected to do in a pandemic.
When Dr. Bhattacharya was out of power, he demanded his predecessors become activists and use vast government powers to instantly insulate “vulnerable” people as COVID raged around them. He gained fame and glory by claiming he “would have” accomplished these amazing feats himself had YouTube not stood in his way. He marketed himself as a superhero with magic powers to bend SARS-CoV-2 to his will. Everything would have been just fine.
Amazingly, a lot of people believed his “would have” statements and these imagined accomplishments catapulted him to the head of the NIH. Now that he has real-world responsibility for the first time however, Dr. Bhattacharya has left that fantasy behind in his new 1-page pandemic plan. He’s not boasting about the wonderful things he “will do” should a new virus emerge. He doesn’t claim that his administration is full of people who will be “very creative in thinking of ways to do focus protection“. He no longer expects them to deliver groceries and other essentials. In fact, he doesn’t expect them to do anything at all.
As such, his new “plan” isn’t really a plan. It’s an admission that should there be a new pandemic, he’s not competent enough to do any of the incredible things he supposedly “would have” done regarding COVID. It’s also an announcement that he won’t even try. In his vision, it’s not his job to “protect the vulnerable”. Rather its citizens’ job to render themselves “not vulnerable” and make his life easier.
And if they can’t do that, tough luck. As countless people recognized, MAHA is all about blaming patients for their illnesses and causally blowing off those who might succumb to viruses. They had underlying conditions. The same way Dr. Bhattacharya blamed public health officials previously, he is setting the stage to blame the American people for their fate moving forward. After all, Dr. Bhattacharya told them to put down their cigarettes, put on their walking shoes, and instantly make themselves healthy. What more could be expected of him?
A lot actually. Dr. Bhattacharya is not just a spectator anymore. It’s his job to deliver concrete results for the American public. Specifically, it’s his job to enact his pandemic plan and get Americans to stop smoking and start exercising. I’m ready for him to dazzle us all with his prowess.
Unfortunately, I don’t think that’s going to happen. While a lot has changed, the only constant thing is that whether he is in or out of power, Dr. Bhattacharya doesn’t expect anything of himself. It’s never his job to get things done. His role is merely to write 1-page “plans” telling others what to do and blaming them if they fail. His core message is this:
If COVID-26 arrives, you’ll be totally on your own. Caring, capable government scientists won’t be there to help you in any way.
And for the first time ever, I completely believe him.
