Avian flu could define Trump’s second presidency

The bird flu’s been around for generations. But this year, concerns have spiked after it jumped to humans and other mammals, leading to at least 58 confirmed cases in the United States among mostly farmworkers. 

Another, more obvious, cause for worry: The response to the prospective health crisis will soon be under the direction of President-elect Donald Trump. The former and future president will arrive in office next month with a track record of downplaying the severity of Covid-19, pushing unfounded cures, sharing conspiracy theories, and brandishing xenophobic rhetoric regarding Covid-19. A Lancet study found that under the Trump administration the US could have averted 40 percent more Covid-19 deaths than similar, high-income, G7 countries, and that’s partly due to the Trump administration’s manner of handling the crisis by politicizing masks and publicly dismissing its threat. 

Additionally, Trump is angling to bring prominent vaccine deniers to oversee agencies crucial to the nation’s bird flu response. If Trump gets his way, the Centers for Disease Control and Prevention will be led by Tom Weldon, who has sought to remove the agency’s ability to conduct vaccine safety research and has spread vaccine misinformation himself. He also tapped Robert F. Kennedy Jr. to “go wild on health” as the director of Health and Human Services. Kennedy was labeled one of the “Disinformation Dozen” for spreading misinformation about the safety of the Covid-19 vaccine, and his anti-vaccine efforts contributed to a deadly 2019 measles outbreak in American Samoa. He has also stated “there’s no vaccine that is safe and effective,” and is apparently a fan of raw milk, which can be a conduit for spreading bird flu.

And more dangerous public health policy could be on the horizon. Project 2025 placed a target on the back of the CDC, calling it “perhaps the most incompetent and arrogant agency in the federal government,” and proposed cutting it in half. Eight former CDC directors, including Trump’s 2017 and 2018 appointees, opined that such a policy would “cost lives and damage the economy.” 

The CDC has always been intertwined with politics, from its director appointments to lobbying for money from congress. Yet the Covid-19 pandemic saw the CDC take on a new level of distrust and a decline in reputation, especially from Republicans. It led Congress to require congressional approval for a CDC director instead of just a tap from the incoming administration, making Weldon the first CDC nomination to undergo congressional scrutiny and approval.

This is all part of the larger, Covid-era “politicization of the CDC,” says epidemiologist Jessica Malaty Rivera, a public health expert and host of the COVID Tracking Project series with Reveal. 

“Public health became public enemy number one for a lot of folks that are coming in with this new administration,” Malaty Rivera said. 

Public health in America has long been considered underresourced and disconnected, and that lack of data-sharing and organization was on full display when the Covid-19 pandemic took hold in 2020. 

Reveal’s Peabody-nominated COVID Tracking Project series explored how the government struggled to procure essential data to guide the Covid-19 response, navigate bureaucratic hindrances in the midst of an emergency, and mend a fragmented response to the pandemic. Many of these issues rested on weak data infrastructure and a lack of funding to support local public health agencies, causing the federal government to rely on a volunteer-led data collection effort. Public health agencies are working on fixing those issues, but the anticipated cuts will likely stymie those efforts and exacerbate the systemic problems.

“The public is looking at this new administration to come in and ‘clean house’ because they’re looking at this as retribution for how they experienced the Covid-19 pandemic,” Malaty Rivera said.

Not all systems have improved since the pandemic. During the 2020 outbreak, the federal government got every hospital to report Covid-19 data, making hospitalization data the most real-time indicator of the severity of surges. It provided the nation with immense public health surveillance capacity, but the Biden administration scaled this back and now the CDC surveils an estimated 10 percent of the nation’s population, leaving the United States with limited information about the ongoing spread and risks of viruses like avian flu.

Last year, Biden-appointed CDC Director Dr. Rochelle Walensky told Reveal that the CDC is unable to require states to share essential response data with them. She offered a potential solution: “Working with Congress, I think we could create authorities that would protect privacy, that would protect individuals, but that would allow… swift and nimble public health responses that we don’t have with the data systems we have in place right now,” Walensky said.

But Congress did not grant the CDC those data authority powers, and the possibility of this seems even less likely under the next administration. 

Walensky resigned from her post at the CDC soon after this interview aired, replaced by the current CDC director, Dr. Mandy Cohen. Cohen has conducted few interviews and largely centered the agency’s messaging on prepared public appearances and social media posts. The CDC denied multiple requests by Reveal for an interview with Cohen. However, Cohen answered questions swirling about the CDC’s future at a roundtable discussion in Raleigh, North Carolina, a day before the election.

“A well-funded CDC allows communities to thrive, but we all need to bring the data and the evidence to show that that money is working well here,” said Cohen.

A week after Trump’s election, she spoke about how the CDC might fare in the face of this next administration at a public health summit. She shared concerns for the proposed budgets that would “zero out” their ability to do work. 

“Fundamentally, folks want to make sure we have an entity that is ready to respond to health threats and that means we need data infrastructure to identify those things [and] have people who are talented to understand how to respond,” Cohen said. “This kind of work and that infrastructure takes resources and you need to maintain it.”

With the looming threats of Project 2025 and a vaccine denier poised to lead the agency, Malaty Rivera believes the CDC is about to “have its legs cut off” by the incoming administration. She believes the impact of this will extend globally as it will also slash funding to international health organizations that “help keep vaccine preventable diseases from becoming outbreaks and epidemics, and then pandemics, potentially.”

Although Malaty Rivera hasn’t seen the type of changes in the bird flu virus that would cause pandemic “alarm bells,” it is still a growing issue that is testing the US’s public health response systems. Malaty Rivera sees the Biden administration repeating some of the same Covid-19 mistakes, like a lack of available rapid testing and data transparency. 

“I don’t see our management of H5N1, which is already really bad, improving under a new administration,” said Malaty Rivera. “It’s about to get worse.”

The CDC still sees bird flu as a low risk to the public. The outbreak appears largely contained to farm animals and farmworkers, with the majority of human cases in California. While the CDC is monitoring bird flu outbreaks through wastewater systems, there seems to be a lack of a robust testing system that makes experts believe the current case count is likely an undercount. 

Last month the CDC said it has seen no evidence of human-to-human transmission. But several people who contracted the bird flu have reportedly not been in contact with infected animals, raising fears about human-to-human spread. There is still trepidation from public health experts about an unlikely but possible path: that the seasonal flu and bird flu could cohabitate in a person infected with both, and mutate into something more capable of infecting humans. It’s why the CDC has encouraged seasonal flu shots in hopes of reducing the chance of co-infection.