When public health goes dark, the nation pays the price
Two weeks into the Trump administration, external communication from federal health agencies, including the Centers for Disease Control and Prevention, with the nation and world has gone dark.
In the latest information flow restriction, public health data and guidance on several CDC websites have disappeared.
Seeing this massive communication shift, we must ask if the limits, even short-term, endanger American lives. Active, serious public health risks are here now.
Highly pathogenic avian flu caused by the H5N1 virus is of foremost concern and has the potential to cause serious illness. H5N1 is found in every state and the number of human cases in the U.S., although low, is rising. Yet communication and guidance from the CDC about highly pathogenic avian flu is now arrested.
This virus has found its way into commercial dairy and poultry farms. It is also found in backyard birds and is the source of infection for a recent death in Louisiana. Fortunately, no human-to-human transmission has been seen, which, if it occurs, will lead to serious community spread.
Infectious disease surveillance requires global and national collaboration. Yet, the CDC can no longer communicate with longstanding partners, including the World Health Organization.
The CDC cannot even communicate with America. Over the last year, the CDC held briefings about H5N1 and posted real-time surveillance data. Yet, federal guidance for the public has stopped. Control now falls to states, with varied public health capacities. The fate of the recently allocated $306 million in federal funding for bird flu control is in question, too.
The public in the blind can now rightfully ask, how do I know if the milk my child drinks is safe? Can I get sick from my backyard chickens? Is H5N1 mutating, making it spread person-to-person? What is the status of H5N1 vaccine development?
The answer to these questions ordinarily rests with CDC, but not now.
On the fifth anniversary of the start of the COVID-19 pandemic, we can reflect on the consequences of inadequate testing and political imperatives aimed at minimizing testing and case reporting. Four months into the COVID-19 pandemic, President Trump said that if America reduced COVID-19 testing, “we'd have very few cases, if any.” Yet, more than 800,000 COVID-19 deaths happened afterward.
Although we are only five years removed from the start of the COVID-19 pandemic, 45 years have passed since the beginning of the HIV epidemic. There are more than 30,000 new cases of HIV per year in the U.S. HIV appeared in the U.S. in 1981. Rather than focus on solutions, members of President Ronald Regan’s administration and others stigmatized it as the “gay plague.” Funding for control was belatedly allocated, contributing to its spread and mortality.
Thankfully, we can now end the HIV epidemic through point-of-care and home testing, antiviral agents that can dramatically reduce the risk of infection spread and public health outreach.
Yet, valuable information about HIV is no longer on CDC websites, caught up in anti-LGBTQ politics. The fate of the long-standing U.S. President’s Emergency Plan for AIDS Relief is in question, too, as the Trump administration halted the distribution of HIV drugs in poor countries.
Community health promotion is a pillar of public health and healthcare and is based on understanding the risk factors of illness.
In the U.S., nearly 50 percent of children, more than 40 million, are on Medicaid or related federal insurance. Children qualify for Medicaid if the income of their parents or guardians is within about 130 percent of the federal poverty level, which is about $30,000 per year for a family of four. Another 42 million adults in the U.S. are on Medicaid, which saw significant expansion during the Obama administration.
Because Medicaid spending was more than $871 billion in 2023, it is rightfully under scrutiny. Yet demographic and lifestyle data need to be analyzed to understand healthcare utilization and illness risks. Thus, Medicaid programs involve examining racial, ethnic and economic disparities.
Yet, with the current anti-DEI position of the Trump administration, such programs will be peeled back, leading to increased medical costs as social determinants of health are ignored.
Children, too, will bear the consequence of data elimination.
Children are struggling in education, behavior and health, and these issues vary by gender, race, ethnicity and socioeconomic factors. The CDC Youth Risk Behavior Surveillance System is a critical survey conducted since 1991. It provides insight into many issues, including pediatric mental health, tobacco and illicit substance use, and sexual activity.
The system’s results show alarming rates of depression and suicidal thoughts among children and substantial rates of risky behaviors. However, if you try downloading recent reports, you will see they are no longer available.
Information about vaccines and vaccine-preventable illnesses is being curtailed, too.
The federal Vaccine for Children Program just celebrated its 30th year and has prevented 32 million hospitalizations,1,290,000 deaths and $540 billion in direct costs. With the rising influence of anti-vaccine organizations and, to doctors' regret, fewer children are being vaccinated. Thus, we will inevitably see outbreaks of vaccine-preventable diseases, including measles and polio.
Despite all this, some vaccine-related information has disappeared from CDC websites, too.
Considering the antivaccine statements made by current administration members, one can wonder if the CDC will be able to show local vaccination rates. Will the CDC show measles outbreak data?
When it comes to healthcare and public health, one can suppress facts, data, collaboration and expert guidance for only so long. These tactics may make some politicians feel better, shielding them from our imperfect world and complex health problems.
Yet, curtailing CDC communication with the public will only put us at risk for the looming public health threats.
Scott A. Rivkees, M.D., is a professor of Practice at the Brown School of Public Health. He is the former state surgeon general and secretary of Health of Florida.
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