The US Centers for Disease Control has not updated its bi-weekly bird flu (H5N1) situation summary since 17 January – even if it finally published a limited edition of its Mortality and Morbidity Weekly Report (MMWR) on Thursday, 6 February. In the wake of the CDC information flow shutdown and the US withdrawal from WHO, Dr Lynn Goldman, Dean of the Milken Institute School of Public Health, spoke with Health Policy Watch about how public health communications and global health collaboration remains all the more critical.

The highly pathogenic avian influenza has affected millions of US poultry birds since December 2024, with Ohio accounting for 10 million of these birds where infections were detected, according to the US Department of Agriculture (USDA). The pathogen, which has sickened 68 people and caused one death, led global experts to criticize the US response as inadequate and “inept” – long before the Trump administration began to curtail reporting operations of the US Centers for Disease Control.  

Politicizing the federal workforce

Now, educating the public and the agricultural workforce about the risks of bird flu, and how to combat them, has only become more complicated by the ongoing communications pause imposed by the Department of Health and Human Services, says Goldman, who also served in the US Environmental Protection Agency (EPA) during the administration of former US President Bill Clinton (1993-2001).

But Goldman expressed hopes that specialised US government agencies will remain anchored by civil service professionals, where “people are really just serving the public…They’re not serving a politician. They’re serving the public. They are experts, and we’re proud that they’re there for merit, not loyalty.”

However, that civil service workforce is shrinking rapidly. 

About 65,000 of 2.3 million federal employees – including those who work at key public health agencies such as US CDC, the US Department of Health and Human Services – have taken up the Trump administration’s offer to resign now, with pay until September. And on Friday, the new US administration was poised to lay off nearly 95% of the US Aid and International Development agency’s (USAID) workforce, following a freeze on operations announced earlier this week. Only 294 of the more than 10,000 employees worldwide appear set to remain. 

Rubio claims that @USAID lifesaving assistance for health and humanitarian needs will continue. But his team just communicated that the entire agency will be imminently reduced from 14,000 to 294 people. Just 12 in Africa. pic.twitter.com/8uvyjcXKeA

— Atul Gawande (@Atul_Gawande) February 6, 2025

The implications for public health range from impeded infectious disease communication, slowed research, and hampered global collaboration, according to Goldman. 

Bird flu response jeopardized

Since last year’s ongoing avian flu outbreak, the US has seen 67 human cases and one death – and countless poultry, dairy cows, and wildlife sickened. Most of these cases originated in dairy herds or poultry farms. And on 31 January, a new variant of H1N5 was reported in a dairy herd in Nevada, according to the US Department of Agriculture (USDA). Egg farmers must cull or depopulate their flocks if the virus is detected. New York state shut down live poultry markets 7 February after bird flu was detected.

“As this flu spreads around, it is affecting the price of eggs and eventually will increase the price of milk as well,” said Goldman.

In fact, over the past month, eggs prices in the US soared to an average of $5.30 per dozen, up from $3.50 the same time last year. The situation is complex, and the communications “need to be very finely tuned,” argued Goldman.

“It’s very complicated to communicate to the public the risks around food products,” Goldman added, referring to issues such as risks of virus transmission through raw milk consumption. “It’s very complicated because you don’t want to create untoward concern because of the way you communicate it. 

“Stopping the communications means you’re not controlling the public health threat, because a good part of doing your job in public health, especially with regard to infectious diseases, like bird flu, is that you communicate.”

Communicating with the public is not the only aspect that worries Goldman. For physicians, the recent tumult in the transition has meant the relative lack of messaging from the federal government on bird flu can impact medical practice.

“As a pediatrician, I want to always have up to date information about what’s going on with bird flu. I need to know what’s going on if I’m in the clinic seeing people. Is this something I should be looking for? Has it been identified in my part of the country? That’s important for doctors to know.”

Halting NIH grant reviews – ‘highly unusual’ with a severe ‘financial downside’

While the Trump administration’s decision to freeze health communications and grants processes for a short transition period might be “fairly normal,” the halt to routine NIH grant review meetings is “highly unusual,” Goldman observed.

“I don’t know why you want to throw a wrench into that work,” said Goldman, adding, that new staff may simply be uninformed about research – although that is worrisome as well. “Maybe they’re just coming from a very negative point of view about the government and don’t understand those things.” 

The grant review meetings, also known as study sections, are often scheduled far in advance and they focus on the peer review of new scientific proposals on biomedical topics, such as cancer therapeutics. Although some reviews were reportedly resumed this week, NIH advisory panels across several research areas remained in hiatus. The National Science Foundation (NSF) pause of grant review panels also was ongoing as of this publication. 

“We are so dependent on the NIH to develop the science that we need for protecting the health of the public. No corporation does what they do. No one else will do it, including philanthropy.” The NIH is the largest single public funder of biomedical research in the US, with a $48 billion budget. Everything from the discovery of hundreds of new drugs, gene therapy and vaccines can trace its funding back to the NIH. Every $1 investment in this biomedical research yields a $2.46 return, according to the Office of Budget. 

With almost an entire month’s pause on the grant process, there could be a serious “financial downside,” noted Goldman. “This one month halt on meetings could result in a reduction in NIH expenditures for the year, unless they can play catch up. 

“And it’s important, as expenditures are what support scientists to do the research we need.”

Censoring diversity criteria in clinical trial research – a particularly acute impact

In addition to the CDC pages on urgent outbreaks like bird flu, the main page of the Food and Drug Administration’s “Diversity Action Plan” guidelines to pharmaceutical companies for including diverse populations in clinical trials of new new medicines and vaccines also has been taken down. That’s despite the fact that decades of research shows that considering ethnicity, gender, age and other similar factors is essential for assessing a vaccine or medicine’s overal efficacy.  

Helping to oversee the entire Department of Health and Human Services’ management is the HHS Office of the Inspector General (OIG), an independent watchdog responsible for fighting waste, fraud, and abuse in the department. On 31 January, the Trump administration fired 17 Inspector Generals, including the HHS IG. The two-sentence termination emails took the IG community by surprise, as the role is intended to be independent and non-partisan. 

“It’s not just the NIH, but it’s an effort across the federal government to politicize all the personnel in the government,” said Goldman. She noted that “it is part of our process” for certain but not largescale to occur during administration transitions. 

Goldman hopes the nominee to head the NIH, Dr Jay Battacharya, will outline his vision for the agency during his hearing process, which is not yet scheduled. “That is something all of us – the American public, the scientific community, and the public health community – need to hear from him.”

WHO withdrawal, USAID shutdown means US is ‘lagging behind’

The Trump administration’s decision to begin pulling the US out of the World Health Organization, the specialized United Agency which enjoys support from 194 member states since its founding in 1948, sent reverberations through the global health community. The administration also ordered CDC to cease communicating with the WHO. Similarly, the recent moves to dismantle the US foreign aid agency, USAID, which has saved tens of  millions of lives through work targeting maternal and newborn health, malnutrition, malaria, tuberculosis and HIV, threatens to leave a “vacuum” for geopolitical adversaries.

The impending shutdown of USAID is unconstitutional and reveals complete ignorance or indifference to how vital its work — in global health, conflicts, disasters and beyond — is to Americans and humanity. https://t.co/TfmcYP5Tuh

— Atul Gawande (@Atul_Gawande) February 3, 2025

“Russia and China are cheering the work of DOGE [Department of Government Efficiency]. It’s not efficient to destroy capacity. We’re talking about world class expertise. It’s not an overhaul, it’s a destruction,” said Dr Atul Gawande, former global health head at USAID, in a CBS interview about the agency. He also noted that the fallout means monitoring for bird flu has been cut off in 49 countries, and that the malaria program has been shut down. 

“Health provides an entryway for us to engage with countries, many of whom we may not agree with, and to have diplomatic conversations and other conversations. If that is lost, it will have tremendous consequences for the U.S.’s security and long-term economic and political outlook,” Dr Judd Walson, chair of International Health at Johns Hopkins, said in an interview 28 January. 

“If we actually have an approaching bird flu pandemic, [withdrawing from WHO] would make that doubly worse, because we need global collaboration when epidemics are erupting globally,” said Goldman.

When it’s not just a local problem, we need to be able to share the data from across the world.”

Image Credits: Julio Reynaldo, CDC, NIH.