0:01

It's Lindsay Smith -Rodgers from the

0:03

Public Health On Call podcast. Whether

0:05

you're a healthcare professional, a student,

0:07

or just want to be informed,

0:09

Public Health On Call breaks down

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today's public health headlines and issues

0:13

on topics like viral outbreaks, abortion

0:15

access, vaccines, climate change, and more.

0:17

Listen as experts answer today's public

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the Johns Hopkins Bloomberg School of

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Public Health. You can find us

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wherever you subscribe to podcasts or

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at publichealth .jhu

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and host of the Every Girl

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Podcast, where we cut through the

0:43

noise with realistic, expert -backed advice to

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of life while still loving the

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really authentic to you, including the

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clothes you wear. In partnership

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with Nordstrom, we're helping you

1:00

update your spring wardrobe so

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your best self. Nordstrom brings

1:06

you the season's most wanted

1:08

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1:10

People, and Princess Polly, all

1:12

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1:14

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the styles that you'll wear

1:18

on repeat this spring. Free

1:20

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1:22

-store pickup make it easier

1:24

than ever. Shop now in

1:26

stores and at Nordstrom .com.

1:31

From the first whisper

1:33

that Robert F. Kennedy,

1:35

Jr. could become America's top

1:37

health official, questions started

1:39

flying. Do we know how

1:42

RFK, Jr. is expected

1:44

to reform health and

1:46

human services? What would

1:48

Kennedy actually do as

1:50

Secretary of HHS? His nomination

1:52

has drawn criticism from a host

1:54

of public health leaders. He's a

1:56

vocal critic of vaccines. There

1:58

were some questions about - on vaccines like

2:01

the polio. And agencies that

2:03

regulate our drugs and food

2:06

supply. Including about what millions

2:08

of Americans eat and drink

2:11

each day. Months went by

2:13

with more speculation than clear

2:15

answers. Now, eight weeks into

2:18

Kennedy's tenure at HHS were

2:20

getting answers and they're coming

2:23

fast. Today. We take stock

2:25

of Kennedy's first decisions at

2:28

HHS and explore how they

2:30

are transforming health in America.

2:33

From the studio, Lelander Davis

2:35

Institute at the University of

2:37

Pennsylvania, I'm Dan Gorenstein. This

2:40

is train-off. He's made big

2:42

changes. We will start with

2:45

jobs and spending. Kennedy has

2:47

cut both across HHS. Producer

2:50

Melanie Evans has been working

2:52

to keep tabs on the

2:55

scope of what's happening. Hi,

2:57

Melanie. How's it going? Dan,

3:00

I am trying to keep

3:02

up, but the cuts Kennedy

3:04

has made have been sprawling.

3:07

Here's what I can safely

3:09

say. Kennedy has embraced the

3:12

Trump White House ethos of

3:14

sweeping, blunt, abrupt. changes. You

3:17

spoke last week to Julie

3:19

Rauvener from KFF Health News

3:22

about Kennedy's restructuring of HHS.

3:24

I think she used the

3:27

word sledgehammer. She did more

3:29

than once and Melanie as

3:31

you know last week HHS

3:34

laid off some 10,000 people

3:36

closed regional offices and eliminated

3:39

entire departments. Kennedy said he

3:41

is streamlining the agency saving

3:44

1.8 billion dollars a year

3:46

without sacrificing essential services like

3:49

Medicare and Medicaid, but we

3:51

know Kennedy is doing more

3:54

than handing out pink slips.

3:56

That's right. HHS has also

3:58

canceled more than 11 billion

4:01

dollars in funding to states.

4:03

This is money they were using

4:06

to fight disease outbreaks, prepare

4:08

for emergencies, and treat mental

4:10

illness and substance abuse. This

4:12

is money Congress set aside

4:15

during the pandemic to help with

4:17

the response. State and local

4:19

governments still had time to spend

4:21

that money. HHS instead abruptly

4:24

rescinded the funding saying

4:26

the pandemic is over. It was

4:28

out of the blue. and it left

4:30

public health agencies with no time to

4:32

plan for the fallout, like at the

4:35

Dallas County Health and Human Services

4:37

Department. No preparation, no advance

4:39

warning. This particular grant that

4:42

we received directly was rescinded

4:44

effective the day before, so

4:47

it's like a done deal.

4:49

That's Dr. Phil Huang, who

4:51

runs the department. He founded

4:53

his grant had disappeared on

4:55

a Tuesday morning around 6 AM by

4:57

email. Phil quickly

4:59

started trying to figure out what was

5:02

going on. And I was a little

5:04

uncertain about, and I think I forwarded it

5:06

to some other people I said, you know,

5:08

what is this? He texted people, he

5:10

knows, in Texas government, he emailed health

5:12

directors and other states, and he soon

5:14

realized that one grant was not the

5:16

end of it. And it started to trickle

5:19

in that this is happening, you know, it

5:21

is what's happening across the country. Ultimately,

5:23

Dallas County lost federal

5:26

funding from three canceled

5:28

grants. The agency immediately

5:31

laid off staff, 21 people. Dan,

5:33

they mostly worked in disease

5:36

control. This includes

5:38

epidemiologists and immunization

5:40

staff. Wait. Texas is at

5:42

the center of a growing

5:44

measles outbreak. Two children who

5:46

died. The latest number of

5:49

infections is now 505. At

5:51

least 57 have been hospitalized.

5:53

Nearly all are unvaccinated. Yes,

5:55

and Phil has been making a

5:57

push to boost vaccinations and kit.

5:59

I contacted all of the superintendents

6:02

for all the public school

6:04

districts in Dallas County and

6:06

then also all the superintendents

6:08

for the private school districts

6:10

that had low vaccination rates

6:12

as well as all the

6:14

daycare centers. He signed a letter

6:16

about vaccinations to schools to hand

6:18

out to parents and he offered

6:20

to bring pop-up vaccine clinics to

6:22

schools. Well how is Phil gonna do

6:25

that now? He can't. We're having

6:27

to tell them we don't have now the

6:29

staff to be able to do what we

6:31

were talking about doing. Dan, what's

6:33

happening in Dallas County is

6:35

happening across the country. The

6:37

HHS grants that were canceled.

6:40

flow to local health departments,

6:42

sometimes directly, sometimes through states.

6:44

States also relied on funding.

6:46

The money went to salaries

6:49

for epidemiologists, lab technicians, technology

6:51

staff. It paid for new

6:53

equipment to upgrade diagnostic laboratories,

6:55

and it went to subcontractors

6:58

to help states prepare for emergencies.

7:00

So is Phil described, Melanie,

7:02

with the money gone, I'm assuming that means

7:04

so are the jobs in the services?

7:06

People are trying to figure out how

7:09

to keep some programs going, but the financial

7:11

hit is just too big to avoid

7:13

losing some staff and services. An organization

7:16

that represents 35 of the biggest cities

7:19

in the country said their members lost

7:21

more than a half a billion dollars.

7:23

Utah has cut 37 jobs. Maine

7:26

let 40 people go. North Carolina

7:28

said it lost funding for more

7:30

than 80 jobs, including epidemiologists to

7:32

help with disease control. It's been

7:35

intense because on the other end

7:37

of these are my neighbors and

7:39

members of our community. Like government

7:42

workers are people in our community

7:44

who also deeply care about our

7:46

communities and serve them. That's Ryan

7:48

Jury. He's North Carolina's acting

7:51

senior deputy for the Division

7:53

of Public Health. North Carolina

7:55

lost an estimated $230 million

7:57

when HHS canceled the grant.

8:00

on March 25th. Ryan's

8:02

been kind of shell -shocked. It's just

8:04

been a really intense couple of days, weeks, and

8:06

lots of long hours. And I've lost track

8:08

of what the days are in the week, to

8:10

be honest. So Ryan in

8:12

North Carolina and Phil in Dallas

8:14

are reeling from what seems like a

8:16

lack of forethought in the cuts. Overnight,

8:20

they are racing to plug gaps.

8:22

Gaps like North Carolina's ability

8:24

to investigate disease outbreaks, Dan. In

8:28

the wake of all of this, people are

8:30

just kind of baffled and really worried. Chrissy

8:33

Giuliano at the Big Cities Health Coalition

8:35

summed it up best for me. I

8:37

do not think

8:39

anyone expected the dismantling of

8:42

the federal public health infrastructure

8:44

to be so dramatic and

8:46

so quick and so haphazard.

8:48

And I think that is,

8:50

it's going to cost lives.

8:52

It's going to cost real

8:54

money. It's important to say,

8:57

Dan, that Chrissy and others told me

8:59

that agencies should always look for

9:01

ways to improve efficiency. They don't object

9:03

to a reorganization, but what

9:05

they're seeing is more chaotic. This

9:08

is not just a routine reorganization

9:10

to be more efficient. Like,

9:12

this is the least efficient thing

9:14

that is happening in Washington. The

9:17

day I spoke with Chrissy, a

9:19

judge temporarily froze action by HHS

9:21

after 23 states sued to keep

9:23

the funding. Melanie,

9:29

we've been talking about roughly

9:31

$11 billion at HHS

9:33

canceled to states at the

9:35

end of March. It

9:38

strikes me that these aren't

9:40

the only HHS grants

9:42

to be abruptly cut off,

9:44

right? That's right, Dan. Budgets

9:46

across HHS under Kennedy are

9:48

also part of the Trump

9:50

White House's broader agenda to

9:52

terminate federal spending for diversity,

9:54

equity, and inclusion efforts, and

9:56

more broadly, to shrink the

9:58

budget. So that's led to

10:00

canceled grants and contracts under the National Institutes

10:02

of Health. Yeah, a few

10:05

weeks ago we did a show

10:07

where two researchers at Johns Hopkins

10:09

were talking about the uncertainty and fear

10:11

they have about their work being

10:13

shut down. When we

10:15

come back, we look at

10:17

where Kennedy has made moves in

10:19

two closely watched areas of

10:21

health policy. Food and Vaccines.

10:37

I remember talking to my sister

10:39

on the phone before I opened

10:42

the email that had those results and

10:44

I was just crying. Uncertainty is

10:46

everywhere in medicine. Like, what if I'm

10:48

not allergic to my implant? Like,

10:50

what is happening to me? But we

10:52

don't always know what to do

10:54

with it. I will never forget one

10:57

orthopedist who, when I didn't improve

10:59

on the basis of his diagnosis and

11:01

treatment, said to me, you know,

11:03

patients like you are really unsatisfying for

11:05

doctors. Join award -winning medical storytelling podcast

11:07

The Nocturnists as we dig into

11:09

the grey zone. Stories of ambiguity,

11:12

uncertainty and medical mystery from

11:14

clinicians and patients. When we talk

11:16

about in medicine, we use

11:18

a shared decision -making model. We're

11:20

sharing all the information and come

11:22

to a decision together. It's

11:24

not really how it works. When

11:27

people come in with kind of vague

11:29

symptomatology and gaps in the history, I

11:31

would just go straight, Joe, and say, now tell me

11:33

what's really wrong with you. And

11:36

out it would come. First episode

11:38

drops this spring. See

11:41

you there. I'm Josie Santy, health

11:43

coach, wellness editor and host of

11:45

the Every Girl podcast where we

11:47

cut through the noise with realistic,

11:49

expert -backed advice to help you thrive

11:51

in every category of life while

11:53

still loving the person that you

11:55

already are. And part of

11:57

loving yourself is being really authentic to

11:59

you. you, including the clothes you wear.

12:02

In partnership with Nordstrom,

12:04

we're helping you update

12:06

your spring wardrobe so

12:08

your style is fit

12:10

for your best self.

12:12

Nordstrom brings you the

12:14

season's most wanted brands,

12:16

like skims, mango, free

12:18

people, and Princess Polly,

12:20

all under $100, from

12:22

trending sneakers to beauty

12:24

must haves. We've curated

12:26

the styles that you'll

12:28

wear on repeat this

12:30

spring. Free shipping, free

12:32

returns, and in-store

12:35

pickup make it

12:37

easier than ever. Shop

12:39

now in stores and

12:41

at Nordstrom.com. Kennedy is

12:43

moving quickly to remake

12:45

HHS. He's laid off

12:47

and pushed out experts

12:49

across agencies, closed departments,

12:51

and cut spending. But

12:53

he has also made

12:55

moves on another front,

12:57

policy. Kennedy has taken some

13:00

early steps on food and vaccine

13:02

policy. These are two areas where

13:04

Kennedy's personal views raise questions about

13:07

his priorities. Melanie is back to

13:09

walk us through it through at

13:12

all. Hey, Melanie. Hey, Dan. So

13:14

let's start with food. Perhaps the

13:16

one area where RFK Jr. has

13:19

pretty wide support, right? Yes, he's

13:21

gone after processed foods and

13:24

food additives as contributors to

13:26

poor health. Now this is

13:28

core to make America healthy

13:30

again, that movement, taking on

13:32

food production and nutrition to

13:35

go after chronic disease. Yes,

13:37

and he has moved very quickly

13:39

on this front. Kennedy last

13:41

month directed the FDA to

13:43

explore ways to close a

13:45

regulatory loophole for substances in food.

13:48

Emily Broadlieb at Harvard

13:50

University explained to me, companies

13:52

can include a substance now if the

13:54

companies say it's safe. There are a

13:56

lot of things being used in food that it's

13:58

very hard to know it. they are for both

14:00

because the company hasn't ever told FDA and

14:02

because some of them, depending on what they are,

14:05

may or may not really have to be

14:07

mentioned on the label even. Emily told

14:09

me she's hopeful Kennedy will tighten

14:11

this loophole. The next step could

14:13

be a proposed rule, Dan. Okay.

14:16

So he's pushing ahead on food

14:18

policy. This is the one area

14:20

where Kennedy's views are welcomed by

14:22

pretty much everyone apart from big

14:25

food, right, the industry. Now, Melanie,

14:27

vaccines. Kennedy's

14:31

long history of vaccine skepticism prompted

14:33

a lot of people to

14:35

wonder what policies he may go

14:38

after. What has he done

14:40

there? What's that accounting? Dan,

14:43

Reuters and other news

14:45

outlets reported HHS under Kennedy

14:47

is planning a large

14:50

study of vaccines and autism.

14:53

Let me pause you for

14:55

a second here, Melanie.

14:57

It's important to say that

14:59

many prior studies have

15:01

debunked the idea that vaccines

15:03

cause autism, though Kennedy

15:05

has repeatedly linked them. Correct.

15:07

Kennedy's new study is being

15:10

criticized as irresponsible by scientists

15:12

and autism groups for that

15:14

very reason. The country's

15:16

deadly measles outbreak is getting worse.

15:18

So is his response to

15:20

the measles outbreak underway in Texas.

15:22

House Secretary Robert F. Kennedy Jr.

15:24

is expected to travel to Texas

15:26

today where there have been nearly

15:28

500 cases since January. 57 of

15:30

those patients have been hospitalized and we

15:33

know now there have been two

15:35

fatalities. Dr. Tom Frieden ran the

15:37

CDC for eight years, including

15:39

during a measles outbreak. When

15:41

there's a measles outbreak, there's a

15:43

tried and true way of

15:45

stopping it. You increase vaccination

15:47

rates, you engage with communities, you

15:49

listen to what the concerns

15:51

are, you promote vaccination among those

15:53

at risk. Tom and others

15:55

have come down hard on Kennedy

15:57

for his public response to what's happening

16:00

in. Texas, like a comment he

16:02

made at a cabinet meeting

16:04

in February. It's not unusual.

16:06

We have measles outbreaks every

16:08

year. As cases have climbed,

16:10

Dan, public health and infectious

16:12

disease experts have wanted to

16:14

hear from Kennedy what they

16:16

want to hear from any

16:18

HHS secretary. An urgent call

16:20

to slow the outbreak through

16:23

vaccination. Instead, he's made comments

16:25

like this, speaking on Fox

16:27

News with Sean Hannity. We

16:29

should have transparency, we should

16:31

have informed choice. There are

16:33

adverse events from the vaccine,

16:35

it does cause the deaths

16:37

every year, it causes all

16:39

the illnesses that measles itself,

16:41

cause encephalitis, and blindness, etc.

16:43

And so people ought to

16:45

be able to make that

16:48

choice for themselves. And what

16:50

we need to do is

16:52

give them the best information

16:54

and encourage them to vaccinate.

16:56

The vaccine does stop the

16:58

spread of the disease. I

17:00

want everyone to just hear.

17:02

I mean, Melanie, he acknowledges

17:04

that the vaccine helps, but

17:06

that's anything but urgent. More

17:08

than that, his comments are

17:10

misleading. The vaccine is safe.

17:12

Kennedy left out some essential

17:15

context. There are no deaths

17:17

from the vaccine in healthy

17:19

people. Rare cases of death

17:21

from side effects have occurred

17:23

in immun uncompromised children. Dan,

17:25

the vaccine is not recommended

17:27

for these children. Now a

17:29

second child has died in

17:31

the outbreak and this weekend

17:33

Kennedy did say the vaccine

17:35

is the most effective way

17:37

to stop infections from spreading.

17:40

Yes, and Tom Frieden, an

17:42

infectious disease specialist, said they

17:44

welcomed Kennedy's comment. Tom still

17:46

sees a real risk to

17:48

public trust in vaccines from

17:50

Kennedy's earlier actions. We've seen

17:52

very misguided discussion of cod

17:54

liver oil and steroids and

17:56

antibiotics. These are not ways

17:58

to prevent measles. Only effective

18:00

way to protect people from

18:03

measles is with vaccination.

18:05

This really speaks to maybe

18:07

the biggest question many had

18:09

about Kennedy in the role

18:11

of HHS secretary. People wondered

18:14

how he would use his

18:16

role to influence public opinion

18:18

on vaccination. Over the weekend,

18:20

Republican Senator Bill Cassidy

18:23

from Louisiana went on social

18:25

media to say, everyone should

18:27

be vaccinated. Those were his

18:29

exact words. Cassidy also said,

18:32

top health officials should be

18:34

clear on this before another

18:36

child dies. Monie, that seems like

18:38

a comment aimed right at

18:40

Kennedy. Public health advocates

18:42

are closely watching RFK Jr. right

18:44

now, Dan. There's a lot

18:46

of concern over what he's

18:49

doing related to the CDC's

18:51

advisory committee on immunization practices.

18:53

Sure. We talked in January

18:56

about this obscure committee, the

18:58

ACIP. Its members are typically

19:00

clinicians and scientists, and they

19:02

evaluate and recommend who should

19:05

get vaccinated. Right. And a lot of

19:07

people trust and follow those

19:09

recommendations, including doctors and

19:11

states, and typically the

19:13

CDC, not Kennedy. He's

19:15

criticized many committee members

19:17

as being beholden to

19:20

pharmaceutical companies. Yeah, I mean,

19:22

in early March, the CDC

19:24

launched a new website that

19:26

lists the conflicts of interest

19:28

disclosed by current and former

19:30

ACIP members. Yes, Kennedy often

19:32

describes the committee as compromised.

19:35

He has also said he

19:37

wants to root out conflicts.

19:39

Dan, let me be clear. The ACIP

19:41

already requires members to

19:43

declare conflicts and recuse

19:46

themselves from votes. Tom sees

19:48

this as a move to

19:50

delegitimize the credibility of the

19:52

committee. For RFK Jr. to

19:54

say that the ACIP is

19:56

severely conflicted is false and it

19:59

undermines are confidence in

20:01

vaccine recommendations. I spoke

20:03

with some people whose names are listed

20:06

on that website and they agreed with

20:08

Tom. The ACIP for years has

20:10

operated in the public eye with

20:12

a clear policy on conflicts of

20:14

interest. They do all of this to

20:16

build trust in their decisions. So

20:18

where is this headed, Melanie? Well,

20:20

as secretary, he's got the

20:22

power to make fundamental changes to

20:24

the ACIP. He can remove and name

20:27

members to the committee at will.

20:29

He has not taken any steps

20:31

like that. The first public meeting

20:33

of ACIP is later this

20:36

month in April. I know people

20:38

are going to be watching for any

20:40

sign of his approach to vaccines.

20:43

So at the top of the

20:45

show, right, we talked about all

20:47

of these questions, about what maha

20:50

would look like. Melanie, with vaccines

20:52

in particular, as you know, many

20:54

have worried will see a full-scale

20:57

assault. Is that where this is

20:59

headed? It's hard to say Dan,

21:02

what will happen next with vaccine

21:04

policy, but I do believe we

21:06

will know soon. One of the

21:08

things that's been clear as I've

21:10

covered Kennedy these last five months

21:12

is that when it comes to

21:15

his priorities, he doesn't hold back.

21:17

Monie Evans, thanks so much

21:19

for your reporting on

21:21

this. You're welcome Dan. I'm

21:23

Dan Gorenstein. This is Trinity.

21:30

If you enjoyed today's episode of tradeoffs,

21:33

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21:35

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21:50

Offs team is producers Melanie Evans

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Catherine, director, Catherine, director, director, Catherine,

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director. Lucer, Leslie Walker. The trade-off

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theme song was composed by Ty

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Siderman with additional music this episode

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from Blue Dot Sessions and Epidemic

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Sound. Additional thanks to Sarah Rosenbaum

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and Paul Hunter. Thanks also to

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all our listeners who helped to

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support our work including Kelly Osmanson,

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William Bog, Alica Garel, Andy Fitz,

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and Janea Jones. Our media partner

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West Health, the California

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Health Care Foundation, the

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Efforts, and the Leonard

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Davis Institute at the

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University of Pennsylvania. Our

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staff, advisors,

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or funders. health coach wellness editor

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and host of the Every Girl

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podcast where we cut through the

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noise with realistic expert backed advice

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to help you thrive in every

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category of life while still loving

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