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slash DSB. Hey what's news listeners,

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it's Sunday April 27th. I'm Luke

0:20

Vargas for the Wall Street Journal

0:22

and this is What's News Sunday,

0:25

the show where we tackle the

0:27

big questions about the biggest stories

0:29

in the news by reaching out

0:31

to our colleagues across the newsroom

0:33

to help explain what's happening in

0:35

our world. And this week, at

0:37

home and abroad, America's approach to

0:40

public health is changing rapidly. Tens

0:42

of thousands of federal health workers

0:44

are poised to lose their jobs.

0:46

State health departments are seeing billions

0:48

in funding from Washington being zeroed

0:50

out. And foreign aid cuts are

0:53

interrupting programs for malaria prevention and

0:55

treatment of HIV. But along with

0:58

cuts, new programs and new priorities

1:00

are rising up in their place.

1:02

So what's in store as the

1:05

US embarks on its biggest public

1:07

health shakeup in modern history?

1:09

Let's dive in. While we can't list all

1:11

of the changes that are being made

1:13

to the U.S. public health system,

1:16

but let me run through a

1:18

few of them very quickly. The

1:20

Department of Health and Human Services

1:22

is shedding around 20,000 employees within

1:24

the Centers for Disease Control and

1:26

Prevention. Entire departments are being eliminated,

1:28

including for HIV prevention, violence prevention,

1:31

and injury prevention. Also gone at

1:33

the CDC, is a team that

1:35

maintained a database of injuries and

1:37

violent deaths, which was widely relied

1:39

upon by policymakers and researchers. And

1:41

in a move that will be

1:43

felt beyond the beltway, the administration

1:46

has cut off billions of dollars

1:48

in federal grants that were awarded

1:50

to state and local health departments

1:53

for a range of programs, like

1:55

tracking infectious diseases or treating addiction,

1:57

that is being challenged in the

2:00

courts, but in the meantime... some

2:02

state health departments have already begun

2:04

layoffs. With me today are Wall

2:07

Street Journal health business editor Jonathan

2:09

Rockoff and senior writer Betsy McKay.

2:11

Jonathan, lots of changes clearly afoot

2:14

here. What reasons is the administration

2:16

giving for this shakeup? A lot

2:18

of this comes from this criticism

2:20

of the pandemic response and how

2:23

overarching the public health response to

2:25

the pandemic was and this feeling

2:27

that because the public health authority

2:29

sort of overstepped their authority, we

2:31

need to rein it back. And

2:34

we see this most saliently in

2:36

vaccines. There's a lot of criticism

2:38

on the right about mandating vaccines

2:40

and things like that. And so

2:42

a lot of the cuts have

2:45

been targeted at vaccines in

2:47

particular. Yeah, John is absolutely right.

2:49

We are at the tail end of

2:51

a very bruising pandemic, very bruising to

2:54

public health in the sense that there

2:56

was a lot of anger. and

2:58

backlash and that remains in the view

3:00

that government was not efficient. More

3:03

broadly speaking, the administration says

3:05

chronic diseases are worsening and

3:07

changes need to be made.

3:09

So there's two things here.

3:11

There are the philosophical changes.

3:13

They view a smaller, more

3:15

effective government and more focused

3:17

on chronic diseases. Then there

3:19

is the immediate impact of

3:21

the changes being made suddenly and

3:24

the disruption that that causes.

3:26

difficult to conjure up, possibly

3:28

a re-emergence of certain diseases or

3:31

at least slowed efforts to try

3:33

and cure others, right? Yeah, absolutely,

3:35

because when you disrupt a

3:38

public health program or any

3:40

health program, you are going

3:42

to have consequences, if not

3:44

immediately, certainly down the line.

3:46

You know, an important part

3:48

of fighting HIV is not

3:50

treating people already infected

3:52

with HIV, but... preventing people

3:55

from getting it, giving them

3:57

access to pre-exposure prophylaxis. Educate...

3:59

many other programs and most of

4:02

them seem to be targeted for cuts.

4:04

We already see right now that no

4:06

matter who's in charge that there are

4:08

going to be public health threats and that

4:10

whoever is in charge is going to

4:12

have to deal with them. Right now we're

4:14

seeing this measles outbreak in the southwest

4:16

and then some other states and we're

4:18

also dealing with bird flu. So

4:20

these threats remain. I think part

4:22

of what the Trump administration and

4:24

Robert F. Kennedy Jr are doing

4:27

is sort of rethinking thinking what the

4:29

balance should be, and as Betsy has

4:31

sort of laid out, I think there's

4:33

a different sense of what we should

4:35

invest our preventative resources in, and whether

4:38

that should be in something like HIV

4:40

or whether it should be in chronic

4:42

diseases. Yeah, take us into what we're

4:44

seeing around chronic disease, a pullback in

4:47

monitoring maybe, and yet Robert F. Kennedy

4:49

Jr. very focused on what he believes

4:51

to be the root causes of certain

4:53

health issues in the United States. Well,

4:56

it's a little unclear. He's definitely

4:58

been out front about how

5:00

he thinks we need to

5:02

do more to prevent chronic

5:04

diseases, but we haven't necessarily

5:07

seen a lot of specifics

5:09

around how he would do

5:11

that. So that's TBD. What

5:13

we have seen is skepticism

5:15

about vaccines and about some

5:17

of the other sort of

5:19

infectious disease prevention efforts. And

5:22

then we see Robert F.

5:24

Kennedy Jr. himself. using mixed

5:26

descriptions of the efficacy and

5:28

safety of the vaccines and agencies

5:30

in HHS beginning efforts to take

5:33

a look at the safety and

5:35

efficacy of the vaccines, even though

5:37

most researchers say that's already been

5:39

settled and that vaccines are

5:41

really good and they prevent

5:43

diseases like measles and they

5:45

don't cause autism. One other

5:47

thing to note here is

5:49

the other sort of early

5:52

tangible impact that we're seeing

5:54

in the public health care

5:56

spaces and research. There's been

5:58

cuts to NIH and other. of

6:00

medical research. So for the

6:02

last generation, a lot of

6:04

the progress that we've seen

6:06

against serious diseases like cancer

6:08

has started in government-funded academic

6:10

laboratories, which have found the

6:12

causes of the diseases, insights

6:15

that lead to drugs to

6:17

treat those diseases. And what

6:19

may happen, but we aren't

6:21

sure yet, is that that

6:23

sort of link between government

6:25

funding academic advances may be

6:27

broken. We have got to

6:29

take a short break, but

6:32

when we come back, we

6:34

will look at what happens

6:36

when the US pulls back

6:38

on public health spending domestically

6:40

and abroad. Stay with us.

6:43

Jim Bullard, one of the

6:46

nation's foremost economists and respected

6:48

scholar leaders, is now Dean

6:50

of Purdue University's, Mitch Daniel's

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School of Business. He's helping

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equip next-gen leaders and visionary

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founders for an evolving tomorrow.

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The Daniel School is tech-focused,

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data-driven, and STEM-infused, specializing in

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new tech, AI, and emerging

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engineering fields. This is how

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the future of business is

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built. Join us at Purdue.

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University slash DSM. All

7:20

right, before the break, we were

7:22

talking about some of the changes

7:24

coming to public health priorities and

7:27

funding in Washington. And John, I

7:29

just want to ask you, before

7:31

we start looking abroad, aren't there

7:34

other entities in the US that

7:36

could step in here, be it

7:38

states, philanthropies, the private sector to

7:40

cover any funding gaps that emerge?

7:43

This gets at the underlying debate.

7:45

We've been doing things for the

7:47

past generation a certain way, but

7:49

there's no reason why we have

7:52

to do them that way. And

7:54

I think the Trump administration, to

7:56

its credit, is taking a hard

7:58

look at how we've been doing

8:01

things, and the government has been

8:03

this huge funder of medical reform.

8:05

But philanthropies have also funded medical

8:07

research and pharmaceutical companies and other

8:10

health care companies have also funded

8:12

research. And perhaps with the Trump

8:14

administration's prodding, that will get rejiggered

8:17

and we'll see a different amount

8:19

of life sciences industry funding of

8:21

academic labs, for instance. What people

8:23

say in the academic world, for

8:26

instance, is that without that government

8:28

funding we might not see a lot

8:30

of the basic research that has led

8:32

to advances against cancer, against

8:34

high cholesterol, against other diseases

8:36

because there needs to be

8:38

sort of a minimum level

8:40

of government funding of

8:42

basic research before industry and

8:45

philanthropy is willing to step

8:47

in. Betsy, something similar is happening

8:49

abroad. John referring there to going

8:51

back to square one on the

8:53

domestic public health funding model and

8:56

challenging old assumptions. That is kind

8:58

of what's happening as the US,

9:00

namely pulls back US Agency for

9:02

International Development projects for public health

9:05

around the world. Yeah, it's another

9:07

rethink. The State Department and the

9:09

administration have said there's a lot

9:11

of waste. in our funding, we're

9:13

funding a lot of things

9:15

around the world, we need

9:18

to rethink this and we

9:20

need to reevaluate exactly what

9:22

we want to fund. Secretary

9:24

of State Marco Rubio has

9:26

said that some of the

9:28

health programs that USAID funded

9:31

will be continued, but they

9:33

must qualify as serving American

9:35

interests, which is a pretty broad

9:37

definition. USAID was sort

9:39

of the epitome of the

9:41

United States' exercise of soft

9:43

power internationally. It didn't have

9:46

direct benefit to the United

9:48

States. It didn't help us

9:50

erase trade deficits or trade

9:52

deals or have any sort

9:54

of direct benefit. And the

9:56

Trump administration has completely rethought

9:59

that approach. We are already

10:01

seeing, just on the African

10:03

continent, health systems racing to try and

10:05

respond to a change in US funding,

10:07

Nigeria announcing measures to try and soften

10:09

the impact of these USAID cuts and

10:11

finding other ways they can fund their

10:14

health programs in South Africa. Scientists maybe

10:16

trying to find a silver lining here

10:18

saying this maybe is the opportunity the

10:20

continent needed to break its dependence on

10:22

foreign aid. Betsy, do we have an

10:24

idea of what that alternate model would

10:26

be? I know you spoke into a

10:28

lot of people as you try to

10:30

understand the effects of these cuts specifically

10:33

abroad. What's their thinking?

10:35

Well, it's difficult to understand what

10:38

that model would be right now.

10:40

Certainly every country that has lost

10:42

money, I mean, some African countries

10:44

are heavily, heavily dependent on donors

10:46

abroad. They have two things they're

10:48

looking at. One, how much money

10:50

can they themselves put up? Many

10:52

of these countries are servicing a

10:54

lot of debt and so don't

10:56

have as many funds as are

10:59

needed to keep everybody on HIV

11:01

prophylaxis or to combat tuberculosis in

11:03

the way that they need to.

11:05

The second thing is, can they find

11:07

other donors abroad? The US has been

11:09

a leader not only in giving

11:11

most of the governmental funds and pulled

11:13

other countries along with it. We're

11:15

going to give this much money. How

11:17

about you step up too? With

11:19

that gone, there's less incentive.

11:21

So it's a real

11:23

problem. The goal has always

11:25

been to help these

11:27

countries ultimately become independent. But what

11:30

global health advocates argue is

11:32

we're just not there yet.

11:34

Global health leaders have a

11:36

lot of concerns about HIV,

11:38

tuberculosis, and other infectious diseases

11:40

resurging. And while that would

11:42

happen in other countries, it

11:44

matters to us because as

11:47

we saw from the pandemic,

11:49

we live in a global

11:51

world. Anything that starts in

11:53

Africa, Southeast Asia, wherever can

11:55

come to us very quickly.

11:58

And so that's really big

12:00

reason why we have helped build

12:02

up health systems and surveillance capabilities

12:04

around the world. Jonathan, that seems

12:06

like kind of a theme as well, present

12:08

in some of the changes happening stateside as

12:11

well, right? You know, you can get a

12:13

problem under control, but then you ease off,

12:15

declare victory too soon, and you risk needing

12:17

to spend a lot more resources in the

12:19

future to get things back under control. We've

12:22

grown comfortable with a United

12:24

States where measles hasn't run

12:26

rampant, where there isn't polio,

12:28

where we're not dealing with

12:30

tuberculosis outbreaks all over, where

12:32

children are drinking fluoridated water

12:34

and avoiding a lot of

12:36

cavities and tooth decay. There

12:38

are, as we've discussed, reasons

12:40

why we would want to

12:42

take a look at how

12:44

we've... done all these infectious

12:46

disease and other public health

12:48

efforts in the United States,

12:50

and whether the mix of

12:52

federal and state funding for

12:55

those efforts needs to change,

12:57

and whether philanthropies and industry

13:00

needs to step up more. But what

13:02

public health folks argue we don't want

13:04

to do is to go back to

13:06

a place where the threat of polio

13:09

was... prevalent, where we

13:11

are dealing with measles

13:13

outbreaks spreading around the

13:15

country, where we are

13:17

seeing more and more

13:19

people developing HIV-AIDS. And so

13:21

the worry that they have is while

13:24

we take a look at how we've

13:26

done public health for a

13:28

generation, are we going to go

13:30

back to the place that we

13:33

thought we had left behind? Jonathan

13:35

Rockoff is the Wall Street Journal's health

13:37

business editor and Betsy McKay is a

13:39

senior writer for the journal. John Betsy,

13:42

thank you. Thank you. And that's it

13:44

for what's new Sunday for April 27th.

13:46

Today's show was produced by Charlotte

13:48

Gartenberg and Anthony Bancey, supervising producer

13:51

Sandra Kilhoff and deputy editor Chris

13:53

Sinzley. I'm Luke Vargas and we'll

13:56

be back tomorrow morning with a

13:58

brand new show. Until then. Thanks

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for

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Discover the business school

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of the future

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at purdue .university .tsb.