The lasting impact of the administration’s changes to health science

0:00When President Trump appointed Robert F. Kennedy Jr. to head the Department of Health and Human Services, the goal was clear. Make America healthy again. Make America healthy again. Kennedy, who promotes vaccine disinformation, has been a longtime skeptic of the experts who set health policy for the United States. And over the course of the past year, he has made major changes to governmental institutions and policies, driving out scores of experts and officials. In an unprecedented move, Secretary of Health and Human Services Robert F. Kennedy Jr. is replacing all members of the Advisory Committee on Immunization Practices.

0:35Thousands of federal health agency workers lost their jobs last week. Whole laboratories and divisions were shut down. Universities and other institutions doing medical research could lose out on billions of dollars of federal funding. This past week, Kennedy and Trump fired the head of the Centers for Disease Control, Susan Menares, just weeks after she'd been confirmed by the Senate. Menares reportedly refused to go along with Kennedy's orders on changing vaccine policy and the boards that helped set it. Several other officials have followed her exit, including Dr. Daniel Jernigan, the now former director of the National Center for Emerging and Zoonotic Infectious Diseases.

1:13My concern right now is that there is a gutting of those scientific professionals from the agency. The recent turmoil has sent shockwaves through the public health sector, leading some to expect the worst. More confusion, more chaos, more uncertainty, and I think, unfortunately, a lot more sickness. Consider this. The Trump administration has made massive changes to the departments in charge of public health. So what does that mean for the health of most Americans? We will hear from an emergency medicine physician and public health policy professor. From NPR, I'm Scott Detfro.

2:00It's Consider This from NPR. Health and Human Services Secretary Robert F. Kennedy Jr. has made drastic moves to the nation's public health sector. Craig Spencer is an emergency medicine physician and a public health policy professor at Brown University. I started our conversation by asking him his reaction to last week's firing of the CDC director and the resignations of several other top CDC officials. Well, what we've heard over the last seven days has been chaos and confusion and uncertainty, but it really just heightens what we've been hearing over really the last six to seven months since this administration has come in.

2:36And if you recall, just within days of the second Trump inauguration, the CDC was pulling down web pages and was replacing, you know, long trusted epidemiology with ideology. And so this is a continuous drip, drip, drip of what I see as really unfortunate and bad news, destabilizing not just for the CDC, but for the health of the country and the red flags that were raised by the folks who quit the CDC over the past couple of days. some of the most dedicated, incredible professionals, some of whom I know and know the quality of their work. The flags that they raise, the things that they've been saying in interviews since then, should make us all concerned, whether you're committed to MAHA, the Make America Healthy Again movement, whether you're MAGA, neither, both, don't care about political labels, because this is going to have acute and long-term impacts on the health of all Americans.

3:30Give me one or two specifics that you're most worried about. Well, the thing that I've been most worried about but as someone that's worked a lot internationally in humanitarian crises, responding to disease outbreaks, is that over the past six months, we've torn apart the disease surveillance systems that the U.S. has helped set up for decades in places all around the world to make sure that when the first cases of Ebola or Marburg or another concerning disease emerges, it's able to be quickly identified, responded to, with the support of the local government, the local country, that has selfish implications as well, because that means that we're able to prevent it before it spreads here.

4:10We have seen across a lot of different areas of federal government, the suppression of research programs that go against the Trump administration's political agenda in the world of climate change, right? We have seen the firing of the head of the Bureau of Labor Statistics after an economic report that the president didn't like. Now we have seen the firing of the head of the CDC and many other top officials. Given all of that, I am wondering whether it comes to recommendations for shots this fall, whether it comes to other information, do you, at this point going forward, trust what the CDC recommends on these key issues?

4:48Honestly, it's really, really hard. And it pains me to say this because the CDC has been the preeminent agency to give us this information. But even hearing people like Dr. Dimitri, who left the CDC a couple days ago, who resigned, he's even saying that he doesn't think that you can trust the information or the recommendations coming out from the CDC. You had Bill Cassidy, who was really that swing vote to put RFK Jr. at the head of HHS, who said that if the ACIP, this Advisory Council on Immunization, goes ahead in a couple weeks, that we shouldn't be able to, we're not going to be able to trust the recommendations that come from that.

5:29You have multiple states coming out trying to think about what the most recent guidance on COVID vaccines from the FDA and the increasing restrictions on availability for those for different populations, what that means for Americans. And so right now, whether you're Democrats, Republicans, left, right, whatever it is, We have an agency where it's really hard to trust the recommendations that are coming out. We're hearing that senior staff are not able to brief RFK Jr. And that gold standard science, which he keeps preaching about, is actually just my way or the highway. And that is remarkably concerning as we go into another potentially bad RSV COVID and flu season.

6:11I also want to get your response in the context of public health policy to the argument that we hear coming from that. This was the argument with Menard's firing and other things. I'm the president of the United States. I ran on this policy. I was put into the White House. So if you disagree with me, I'm going to fire you. I mean, this is incredibly concerning, right? There needs to be disagreements. We've heard from a lot of the folks that have senior leadership positions right now in this administration. Jay Bhattacharya at NIH, Marty Macri at the FDA, RFK Jr. himself, who said in his confirmation hearings, I want to hear different viewpoints.

6:46That is what he projected his leadership to be. But that's not what's happening. We're seeing decisions that are being made unilaterally. And the result is that just because these guys had contrarian ideas during the pandemic doesn't mean that their dictates are exactly what we need right now. We get good policy by sitting down in a group, by talking about data, by thinking about areas where the data doesn't exist, where we can fill in expertise so that we can make policy recommendations. That does not appear to be what's happening right now, at least according to the people who walked off their job at the CDC this week.

7:20I want to bring this all back to the ground floor. You're an emergency medicine physician. This world that we are talking about where you just can't quite trust what the CDC is saying, what does that look like in an emergency room come January, come February at the peak of infectious disease season? This looks really concerning, quite frankly. It looks like confusion for my patients that don't know what shots they should be getting, whether they can get them, whether they need a prescription. We're seeing right now that in over a dozen states, the COVID vaccine can only be obtained if you have a prescription from a physician.

7:56But as we've already said, a lot of folks don't even have physicians where they can get one. So does that mean they're going to come to me in the emergency room to get a prescription for COVID vaccine where they may be exposed to things like COVID? I think it looks like more confusion around what vaccines kids may potentially be able to get. And there is, I think, in the short and the long term, the very worrying possibility that RFK Jr. is not necessarily going to take away all vaccines, but like they've done for COVID, make it a lot harder to get, make it more confusing to get, make it so that you have to jump through a lot more hoops to get COVID vaccines or to get routine vaccines.

8:32And that is what it looks like in the emergency rooms across the U.S. as country. More confusion, more chaos, more uncertainty, and I think, unfortunately, a lot more sickness. Dr. Craig Spencer, thank you for talking us through all this. Thank you.

8:54This episode was produced by Tyler Bartlom. It was edited by John Katcham. Our executive producer is Sammy Yenigan. It's Consider This from NPR. I'm Scott Detrow.