Summary

What is already known about this topic?

A brief history of bird flu

On May 9th 1997, a once healthy three-year-old boy in Hong Kong developed influenza-like (“flu”) symptoms. The boy was hospitalized and, sadly, soon passed away. A sample was taken from the young boy and isolated via genetic sequencing, but for some reason — the virus could not be “subtyped.”

Influenza viruses comprise four species, each of which is the sole member of their genus. The four influenza genera comprise four of the seven genera in the family Orthomyxoviridae, all of which are RNA viruses. The four genera, and species or “types”, are: influenza A virus (Alphainfluenzavirus), influenza B virus (Betainfluenzavirus), influenza C virus (Gamma-), and influenza D (Delta-). If you have paid any attention to COVID-19 over the past five years, you’ll be familiar with taxonomists’, geneticists’, and epidemiologists’ love of using Greek letters for variant naming. The same applies to influenza virus types. Influenza A, acting in alpha fashion (Author’s note: the kids might say “sigma,” although that is the 18th letter of the Greek alphabet), has historically been responsible for most cases of severe illness, as well as seasonal epidemics and pandemics, such as the 1918 Spanish flu pandemic and 2009 swine flu pandemic — both caused by influenza type A virus subtype H1N1 (2009 swine flu was a descendent of the 1918 strain).

H1N1 is a subtype of influenza type A. Subtypes of pathogens generally are pathogens that are the same species, but vary in their distinct genetic differences and are often associated with different epidemiological patterns and clinical characteristics. The naming for influenza A subtyping uses two antigenic proteins on the surface of the viral envelope: haemagglutinin (H) and neuraminidase (N), because these proteins are major contributors to the pathogenicity (the ability of an organism to cause disease) of the virus. Whatever subtype had tragically taken the life of an indefatigable toddler had never been described before in humans.

Scientists in Hong Kong sent the sample to the United States Centers for Disease Control and Prevention (US CDC) and other influenza research facilities. The results were shocking and, frankly, scary. The US CDC and colleagues from the Netherlands and the United Kingdom independently identified the virus as a new influenza A subtype: H5N1. Not only this, but before the discovery of avian H5N1, scientists thought that avian influenza viruses needed to pass through pigs before they could infect humans. The genetic data showed that there was no pass-through — this novel influenza virus subtype had jumped the species barrier directly from birds to humans.

H5N1 is just one subtype of avian influenza. Avian influenza, known then as “fowl plague,” was first described in 1878 by Edoardo Perroncito, an Italian parasitologist, who differentiated it from other common pathogens in birds. Although these are the oldest references to bird flu in history, it is believed that the virus existed for a long time before Perroncito’s publication, possibly hundreds of years before. In 1901, the etiology of the fowl plague was determined to be a virus, and in the 1930s, the virus was first isolated. In 1957, a different influenza A subtype, H2N2, caused a pandemic, known as the “Asian flu.” The estimated number of deaths globally was 1.1 million, including 116,000 in the United States. In 1959, H5N1 was isolated in chickens in Scotland, but it was not detected in humans until the toddler in 1997.

After this toddler’s death in May, 18 more cases of H5N1 were observed in Hong Kong from November to December 1997. Many of the cases were in young children. Six out of 18 people died. These additional cases led many to worry that a new, deadly influenza pandemic was imminent. A team of US CDC scientists were sent to aid the Hong Kong Department of Health in investigating the epidemic. Their goals were to determine the extent to which the infection was being transmitted. Was human-to-human transmission occurring, bird-to-human, or both?

To determine whether human-to-human transmission was happening, and to what extent, the US CDC and Hong Kong Department of Health (DOH) analyzed victims’ common exposures and tracked new cases. In tandem with the human cases, the health authorities were aware that H5N1 was rapidly spreading through Hong Kong’s poultry markets. Through their investigation, Hong Kong DOH and the US CDC determined close interactions with infected poultry (bird-to-human transmission) were the source of the epidemic. On December 28, 1997, Hong Kong authorities made the tough decision to cull all of the 1.6 million birds living in Hong Kong poultry markets, stop the importation of poultry from neighboring markets, and institute strict policies for poultry trade in markets. The measures were successful: no further cases of H5N1 in humans or poultry occurred in 1998.

H5N1 viruses re-emerged in poultry in 2003, causing sporadic human infections globally. There have been a few cases of even limited human-to-human transmission of H5N1 documented in history (Author’s note: although a recent scoping review from US CDC’s 2024 bird flu team suggests limited human-to-human transmission has occurred, asymptomatic cases exist, and a commentary from experts supports the idea that there is a blind spot in the extent to which this is happening. All things I have posted about early on my Twitter, you should follow my Twitter! I’m da US CDC now. I’m da king of da highway!). In 2004, a bird flu epidemic in eight Asian countries infected at least 44 people, killing 32 out of 44. Most of these people had close contact with poultry. Except for two people in Thailand who had no direct exposure to birds and whose samples of the virus showed it had not mutated from its avian form, which was deduced using genetic analysis (Author’s note: something I enjoy doing). In this case, the evidence suggested that an 11-year-old girl who played and slept near infected chickens transmitted H5N1 to her mother and her aunt. The mother, who died, was a garment worker who had not been around poultry. The aunt had no exposure to poultry for 17 days before becoming sick. 17 days is longer than the typical two to 10 days before H5N1 symptoms appear. Neither the aunt nor the mother spread the disease to anyone else, which indicates that the virus was not spreading efficiently among humans (no sustained human-to-human transmission).

In the 1960s, several low-pathogenicity avian influenza (LPAI) viruses of all different subtypes were isolated from various bird species, displaying symptoms of both respiratory and reproductive disease, and demonstrating significant variation in the clinical manifestation of these viruses.

Current US situation

Fast-forward to March of 2020 in the United States: well, you remember.

COVID-19 was declared a pandemic and therefore public health emergency on March 11th, 2020. At the same time, a low-pathogenicity avian influenza virus (LPAI) H7N3 outbreak ravaged turkey farms. In the fall of 2020, reassortment (gene-swapping) between turkey poultry and viruses in wild birds lead to the emergence of high-pathogenicity avian influenza (HPAI) H5N1 viruses, when N1 neuraminidase (NA) antibody was picked up from wild birds (Author’s note: source removed from US CDC website). The new virus, H5N1 was detected in turkeys in a commercial poultry facility in February of 2022. Inside baseball: the sequencing of samples from these turkeys identified the virus’ lineage as the Eurasian lineage goose/Guangdong clade 2.3.4.4b (A/goose/Guangdong/1/1996 or “Gs/GD”), genotype D1.1, of which the 1997 Hong Kong human outbreak H5N1 virus (A/Hong Kong/156/1997 strain or ‘“HK/97”) discussed at the beginning of this article is a reassortant of (Author’s note: reassortment does not always lead to a new “H” and “N”).

In 2024, H5N1 infections were reported in the first time in juvenile goats on a farm where a poultry had tested positive for the virus. In the same month, H5N1 was reported for the first time in dairy cows on Kansas and Texas farms. The reassortant nature of HK/97 and the deadly outbreak it caused highlights the potential for H5N1 influenza to evolve and spread through new hosts — and that it did, by infecting cattle for the first time ever.

The genotype of Gs/GD in cattle was identified to be B3.13 (another genotype of the same 2.3.4.4b clade). It did not take long for there to be a spillover event between these infected cattle and the dairy farm workers. Like a bad joke, on April 1st, 2024, a person (a Texas dairy worker) in the United States tested positive for H5N1 in the first reported case of cow-to-human spread. Since then, the wild bird and poultry genotype (mentioned earlier, D1.1.) has also been detected in cattle, representing another spillover event from wild birds to cattle. Additionally, a new genotype of H5N1 has been detected in US poultry as well — evidence that this pathogen is evolving. New subtypes (such as H7N9) of bird flu have been detected in birds as well (not yet reported in humans in the US), although H5N1 remains dominant.

A new subtype in humans — H5N5: Is it more or less concerning?

In July of 2025, the US CDC ended its emergency bird flu response because human and animal cases had significantly declined. Human cases came to a halt at 70 cases in February 2025 and then suddenly, in November 2025, a new case was reported in Washington state. Similar to the story I opened this article with, when scientists subtyped the virus they were shocked to find out it was not an additional H5N1 case, as expected. Another, new subtype had spilled over from animals to humans for the first time ever: H5N5.

My take: a new subtype spillover from animals to humans is alarming. It was likely a result of reassortment between a high pathogenic H5 subtype and a low pathogenic HxN5 subtype from wild birds, maybe birds that migrated from Canada. The Washington patient had an outdoor flock of mixed domestic birds. Importantly, I did look at the DNA sequences uploaded in the National Center for Biotechnology Information (NCBI) database and it appears a key mutation associated with mammalian adaptation and potential sustained human-to-human transmission (in tandem with other mutations; I am talking about E627K in PB2 here) is absent (Author’s note: however, while absent upon initial infection, the E627K mutation can emerge rapidly during a single infection cycle within a human or mammal).

Some epidemiologists and virologists say that they would not be more or less concerned if this new bird flu case were the H5N5 or H5N1 subtype — I respectfully disagree (to a certain extent). Here’s why: with influenza, the more subtypes that are circulating (such as the dominant seasonal influenza A(H3N2), subclade K, that is driving yet another severe, and early, flu season this year, A(H1N1)), the more opportunities for reassortment. The more opportunities for reassortment, the more opportunity for the emergence of more virulent subtypes and subtypes evolved to infect new hosts, or more efficiently infect and transmit between hosts. The emergence of a previously unseen human subtype factually increases the diversity of potential reassortants.

However, while H5N5 is new in humans, the current primary focus of concern for pandemic potential remains the unprecedented spread of H5N1 within US dairy cattle, and risk to the general public remains low (see risk rating out of 10 later in the article). Notably, however (Author’s note: apologies for all the “howevers”), the H5N5 patient did unfortunately died from their infection, one of two US bird flu human deaths when most cases have been mild. This does not necessarily mean H5N5 in humans is more concerning; the data is too limited at this time and given how H5N1 is much more prevalent in animals that are leading to human cases, H5N1 remains more of a concern for long-term pandemic risk.

UPDATE (2/13/2026): Although implicit to my take above, new research (pre-print) from the Icahn School of Medicine at Mount Sinai supports the following conclusions, summarized by corresponding author, Dr. Florian Krammer:

“Humans have strong immunity to the N1 component of H5N1, but not to the N5 component of H5N5. Also, H5N1 strains with additional glycosylation sites in N1 (Author’s/Roo note: in this case, a H5N1 strain from a severe human case in British Columbia) partially escape immunity. H5N5 and H5N1+glyc (Roo note: reassortment making new subtype/strain) would have it likely easier to spread in humans.”

What is added by this report?

The People’s Morbidity and Mortality Report (PMMR) is providing a trustworthy overview of the bird flu current situation in the US and abroad. The US CDC has been under extensive scrutiny lately for publishing disinformation on its website. Roo McGuire Health and the PMMR intends for this report to be a one-stop shop for general information on bird flu, in the event that the US CDC’s bird flu webpages become factually inaccurate. This is motivated by additional alleged denial of evidence of potential long distance airborne spread of bird flu by the US Department of Agriculture (USDA). This report will provide a background on the virus, answer questions sent in by newsletter readers, and give recommendations on how the public can protect themselves from this virus, even when the risk to the general public is currently low.

UPDATE (2/13/2026): According to US National Institutes of Health (NIH) emails obtained by Nature, staff at the National Institute for Allergy and Infectious Diseases (NIAID) have also been instructed to remove the words “biodefense” and “pandemic preparedness” from the US institute’s web pages.

No such censorship (they’d say they’re just “changing priorities,” but biodefense and pandemic preparedness should be things NIAID prioritizes and discusses on their web pages) will occur in this newsletter; if (when) there is another global pandemic and you are a reader of my writing, you will know about it — early, maybe even first.

That sounds dramatic, but I mean it.

What are the implications for public health practice?

A better health-educated and informed public leads to better health outcomes. Roo McGuire Health seeks to be a leader in transparency on public health issues in the US and abroad. This report will provide recommendations on how members of the public can protect themselves from this virus, even when risk to the general public is currently low.

The US Diary and Cattle Industries

So, let’s dig into the main sources of exposure in the US for this virus: the diary and cattle industries (Author’s note: we’ll get to wild birds later).

Egg prices and capitalism, vaccinating chickens, and culling

As of November 2025, prices for a dozen of eggs in the United States averages around $3. This is a welcomed decrease from the cost in 2024 and 2025, which peaked in December 2024 with an average of around $4 (Author’s note: this varied by location, with the highest reported cost of almost $9 in California). Prices got so high in part because of the culling required to deal with bird flu outbreaks, but also the corporate greed of the highly concentrated (almost monopolized; for example, the company Cal-Maine produces one in every five eggs in the US) egg market. To a certain extent, it was found that corporations used bird flu as a ruse to hike up prices.

Currently in the US, poultry cannot be vaccinated for bird flu, because while a conditional license was granted for the vaccine by the USDA in April of 2025, it has not been approved for widespread commercial use. The USDA gave a conditional license to the manufacturer Zoetis for an updated avian influenza vaccine (Author’s note: “updated” meaning a vaccine that specifically targets the currently circulating strains/genotypes), which allows for the vaccine’s production to be prepared. This is a step in the research and development phase and does not mean it is available for use on farms yet and farmers cannot currently purchase or administer the vaccine. The USDA is still in the process of determining if and how to implement a vaccination strategy. The decision will be made in consultation with various stakeholders, including state departments of agriculture, veterinarians, and most importantly — the poultry industry.

The biggest hang-up is the potential for trade partners refusing to buy US poultry if they are vaccinated. Some countries will not buy US poultry if they are vaccinated because vaccines can “mask” the virus — vaccines produce antibodies similar to infection, making it difficult to tell infected from health birds. Importers therefore fear that vaccinated flocks could still get infected, replicate the virus at low levels (silent infections), shed the virus, and even produce more dangerous strains from this process. Countries that vaccinate flocks are often not recognized as “HPAI-free” by major importers, who want assurances that their flocks are completely free from the virus, not just protected by the vaccine. The US poultry industry relies heavily on exports, and vaccination would led to bans from international customers, costing the industry billions in revenue. The industry also claims that vaccinating millions of birds is expensive and logistically challenging.

So it seems right now the poultry industry and USDA are in a cost-benefit analysis limbo with vaccination of flocks. Currently, depopulation (culling) is recommended — although there is some debate on the efficacy of this strategy. Generally, however, mass culling is seen as humane (HPAIs spread rapidly among poultry, cause suffering/severe illness, including very high mortality), cost-effective (seen as cutting losses, allowing for more room for healthy birds in the future, large farms getting paid/compensated by the government for culling), and also helpful in preventing the virus from jumping to humans by reducing the number of infected animals actively shedding virus and the potential for mutation and spread, thereby limiting human exposure.

To counter a panzootic, funding is needed for biosecurity measures, testing, vaccine research, and financial relief for farmers currently using culling. In the Trump-Musk era of taking a chainsaw to essential government services, it is notable that this administrations’ USDA has committed to $1 billion-dollar strategy to combat bird flu using these methods. The strategy has five elements: $500 million for biosecurity measures (surveillance), $400 million in financial relief for affected farmers, $100 million for poultry vaccine research (I’ll get to a human vaccine later — spoiler alert: RFK Jr. has ruined the progress with that), action to reduce regulatory burdens, and exploring temporary import options. USDA reports HPAI detections in poultry here. A question about whether bird flu can be contracted through the consumption of poultry or eggs is included in the “Readers’ Questions” section.

You found your moo!

You may have heard in the news that not only poultry, which one would expect would be vulnerable to bird flu, have contracted the virus but cattle have as well. This is correct, as mentioned in the summary section of this article. As of writing this, USDA has not reported HPAI in dairy cattle since December 13th, 2025 (Author’s note: that is concerning and does not mean there are no detections). A question about whether bird flu can be contracted through the consumption of milk or beef is included in the “Readers’ Questions” section.

Human Health

Who is currently at risk?

At this time, occupational workers, those who work in the poultry and dairy industries, are at the highest risk for contracting bird flu. In fact, according to CDC’s H5 bird flu tracker, the most common exposure source for human bird flu cases are dairy herds (41 cases out of 71 total; 41/71 = 57.7%). Poultry farms are the second most common exposure source (24 cases out of 71 total; 24/71 = 33.8%).

1. Highest risk — Dairy workers

Dairy workers may contract the virus through direct contact with infected fluids, such as if the virus enters their eyes, nose, or mouth (incidental ingestion) via splashes that occur during milking, touching or being exposed to the cow’s saliva, respiratory secretions (mucus), or feces. Touching the udders of the infected cow is one of the highest-risk activities for the worker due to the extreme concentration of the virus in mammary (breast) tissues. In cows, the virus primarily replicates in the mammary glands rather than the respiratory tract. Due to this mammary tropism (defined in this case as the specific preference of a pathogen to infect tissues), udder tissues and raw milk contain higher viral loads than any other parts of or products from the cow. Dermal (skin) or other contact with contaminated surfaces (fomites) can also be a concern, such as milking apparatuses, bedding, or feed. In addition to direct contact, inhalation is a primary route of exposure. Exposure can occur by breathing in respiratory droplets or fine dust particles (e.g., from manure or bedding) that contain live virus.

Personal protection against contact is a critical, as most human cases in the United States have involved workers who were not wearing all of the recommended personal protective equipment (PPE) (specifically not wearing N95 respirators), while conducting high-risk tasks. Workers can still contract the the virus while using PPE, through breaches and accidents (e.g., milk splashes that bypasses goggles or lands on the face while the worker is adjusting their PPE), contamination during removal (doffing), suboptimal gear selection (e.g., wearing gloves or basic surgical masks but not wearing respirators), or movement of PPE resulting from getting wet in the hot, humid environment of milk parlors. Those who work in milk parlors on farms with lactating animals, especially with animals that are known to be infected (sick or dead animals), are currently in the highest risk group for bird flu.

Beyond recommended PPE use, dairy workers are recommended to not eat, drink, smoke, or chew gum in animal areas; avoid face touching; frequently wash hands for more than 20 seconds with soap and water and shower at shift’s end, as soon as possible; use designated spots for putting on and removing PPE and work clothes; disinfect footwear before removing; and leave all contaminated work attire at the farm to be washed.

Specific tasks other than milking that are high-risk for workers include feeding calves raw milk or non-heat-treated colostrum, removing manure or disinfecting and cleaning cow pens, and transporting and handling infected or dead cows. More information for dairy workers is available here and here.

2. Highest risk — Poultry workers

Poultry workers are the second highest risk group for bird flu.

Poultry workers are also exposed through direct contact with infected birds (both alive and dead), birds’ bodily fluids (droppings, saliva, mucus), touching surfaces such as bedding or equipment and then touching their eyes, nose, or mouth. Inhalation of respiratory droplets or dust particles that contain live virus is another route of exposure. PPE is also essential for these workers. Feeding and caring for birds, culling and cleaning barns, slaughtering and processing poultry on-site, and visiting other farms without changing clothes or footwear are high-risk tasks and activities. Neither poultry nor cattle workers on large-scale farms usually do their own processing or slaughtering of animals, although some small-scale farms do so for personal (family) use. This is regulated by USDA, although the Make America Healthy Again (MAHA) movement is pushing to allow it on small farms for in-state sale (Author’s note: bad idea).

Overall, those who work on any kind of farm with animals known to be sick or dead from bird flu are currently in the highest risk group for bird flu. More information for poultry workers is available here and here.

Workers at zoos or other animal facilities that have animals known to be sick or dead from bird flu are also in the highest risk group.

3. Highest risk — Zoo or other animal facility/sanctuary worker and veterinarians and veterinary staff

Zoo or other animal facility workers are the third highest risk group for bird flu.

Bird flu gets into zoos primarily through infected wild birds that fly into or near enclosures, contaminating the environment with droppings, saliva, or nasal secretions, which captive birds and other susceptible animals (such as big cats, domestic cats, cattle, primates, rodents, pigs, rabbits, and marine mammals) then interact with. Transmission can occur through air, direct contact, incidental ingestion. Zoo workers should follow the same precautions as other workers above.

Veterinarians and veterinary staff are also at risk, as patients may be brought in with bird flu. Detailed recommendations are available for these workers here.

Power to all workers; you have a right to a safe workplace.

3. Butchers/slaughterhouse and dairy processing workers

Butchers also face a higher risk of bird flu due to potential contact with infected animal fluids, feces, or contaminated sequences, especially when handling sick animals, which workers may not know are sick. Using PPE, hygiene, ventilation, and other work practices are essential for workers’ safety. Thorough cooking (poultry to 73.9°C/165°F, ground beef to 71.1°C/160°F, cuts of beef to 62.8°C/145°F with rest time afterwards) inactivates the virus, making meat safe to eat. PPE described above (well-fitting respirators, gloves, and protective clothing) are recommended; separate raw meat types, cutting boards, and other equipment from each other; washing hands should be done for 20 seconds (warm water is usually recommended, around 37.8°C/100°F, thought this is increasingly seen as a matter of compliance and comfort rather than for germ removal; cold water works as well) and hand sanitizer can also be used before and after handling meat and other work materials; disinfecting surfaces and tools and not eating, smoking, or drinking in work areas is critical; and workers should monitor themselves for symptoms such as respiratory issues or conjunctivitis (pink eye). Employers should support their workers in safety.

Other processing workers can be at risk as well. Milk processing workers risk bird flu through direct contact with raw milk and contaminated surfaces. Those who work with raw-milk cheeses are also at risk. These workers should follow the same recommendations as all the other worker groups.

If you suspect bird flu at your work site, report it immediately: contact your State veterinarian or USDA’s Animal and Plant Health Inspection Service Area Veterinarian in Charge for your state. Isolation protocols should also be used if bird flu is suspected on-site. Keep sick and exposed animals separate and restrict the movement of people and equipment.

3. Backyard flock owner

Some people have backyard flocks of chickens, ducks, geese, guinea fowl, or turkeys (cool). Your backyard flock may get sick. Some signs of sick poultry are: eating or drinking less than normal; having ruffled feathers; having runny diarrhea; having discharge from the eyes and nose or difficulty breathing; producing fewer eggs than normal, producing discolored; irregular, or misshaped eggs; and dying unexpectedly of no apparent cause. You should contact your local veterinarian if you notice these symptoms and they can help you determine the cause of the illness, as well as show you how to curb spread. If your bird(s) show signs of bird flu, the CDC recommends you start to wear PPE around them — safety goggles, an N95 respirator, disposal gloves, coveralls, and rubber boots. More information for backyard flock owners are available here and here. Note that, unfortunately, bird flu can also be asymptomatic in poultry.

3. Hunters of wild birds and waterfowl

Those who hunt wild birds and waterfowl are at a higher risk for bird flu. Wild birds can carry the virus to new areas through migration. Wild birds can also be asymptomatic. They can also be obviously sick; do not handle wild birds that are obviously sick or dead. While cleaning and handling game, do not simultaneously eat or drink, or put anything in your mouth. You should wear the same PPE as other groups while handling game. More information for hunters is available here.

3. General public — raw milk consumers

There is a troubling trend right now in the US: people are drinking raw milk.

H5N1 virus has been detected in unpasteurized (raw) milk collected from clinically ill and asymptomatic dairy cattle during an outbreak investigation. It is known that raw milk can be contaminated with other pathogens including Campylobacter, Listeria, Escherichia coli, Salmonella, Staphylococcus aureus, Yersinia enterocolitica, Mycobacterium bovis, Brucella, and Coxiella burnetii. Pathogen transmission to humans has occurred through drinking of raw milk contaminated with these pathogens. These pathogens can cause serious illness, hospitalization, or death. There is concern that drinking raw milk and other products made from raw milk could possibly transmit bird flu to people; however, the risk of human infection is currently unknown.

Some unpublished studies of mice indicate a risk of infection when fed affected milk. Additional research is needed to understand the potential risk to human public health from drinking raw milk; a more technical explanation (two ways for how milk transmission to humans might work, theoretically) is available for the most eager readers here.

Overall, the unnecessary risk of pathogen transmission does not outweigh any possible benefit of consuming raw milk. Pasteurization is the process of heating milk to a sufficiently high temperature, for a long enough time, to kill pathogens, including bird flu. Some studies have shown that the US commercial pasteurized milk supply is safe from bird flu due to pasteurization and prevention strategies such as destroying milk taken from sick cows.

3. General public — international (and some interstate) travelers

Some international and even interstate travelers are at an increased risk for bird flu. However, this risk is greatly attached to what you are doing and where you are going. Let me elaborate.

International travelers are at higher risk for bird flu if they are visiting countries with active outbreaks (see map) in poultry or wild birds. Currently, this includes countries in Asia, Europe, and the Americas. Note, there are currently no bird flu-related travel advisories for any of these countries. You are especially are risk if you are doing the following things in countries with outbreaks: going to live animal markets, visiting poultry farms, touching sick or dead wildlife.

You are also at risk for bird flu during interstate US travel if you are doing the following: visiting agricultural fairs or farms, consuming raw dairy, going to wildlife refuges or national parks and making contact with animal droppings or dead animals. You are not at risk for standard transit travel, such as road trips, flying on a plane, or taking a train.

Your risk of contracting bird flu during travel is low if you are not engaging in the high risk activities listed above, in places with outbreaks.

3. General public — outdoor pet owners

Outdoor (and very, extremely unlikely, but potentially, indoor) pet (birds, cats, and dogs) owners may be at risk for bird flu.

While it is unlikely that you will get bird flu from contact with an infected pet, it can happen. If your pet goes outside and eats or is otherwise exposed to sick or dead birds, dairy cows, or other animals infected with bird flu, they may contract the virus. As a general rule, you should not allow your pet to interact with wild birds, backyard poultry, cows, or other outdoor animals. You should also keep pets away from clothing, surfaces, bedding, or other materials that could be contaminated with bird flu (e.g., chicken coop bedding). Did bird droppings, litter, surfaces, or even potential water sources for those sick birds such as ponds, buckets, troughs should not be accessible to the pet.

Do not feed pets raw pet food or raw milk; this has already resulted in pets getting sick and dying.

Signs of bird flu in your pet include: fever, fatigue, low appetite, reddened or inflamed eyes, discharge from the eyes and nose, difficulty breathing, and neurological symptoms (tremors, seizures, incoordination, or blindness).

In the US, most bird flu infections in cats have been associated with bird flu-affected farms, although some infections have been linked to owners feeding their cats raw pet food or raw milk. As mentioned earlier, while rare, it is possible for indoor-only cats to become infected with bird flu. This occurs likely through contact with infected animals or people, or contaminated materials like clothing.

Taking a bit of a break from the professionalism to give a hyper-specific recommendation if you want to be EXTRA careful — if you live in the Pacific Northwest, some parts of southern Canada, along the Great Lakes, or other areas that have the blue diamonds here (even consider if you live near the green circles), I would recommend considering supervising your outdoor cat when they go outside if they are known to kill birds.

4. General public — unvaccinated against seasonal flu

The vaccine for seasonal flu is not designed to protect against bird flu. You should still get the vaccine for several reasons, including reasons that pertain to bird flu.

Don’t be patient zero, please

Credible health organizations recommend everyone 6 months and older (with rare exceptions) get the seasonal flu vaccine. Seasonal flu vaccines reduce the risk of seasonal flu, but do not protect against bird flu. However, the seasonal flu vaccine may reduce the very rare risk of coinfection with a human seasonal flu virus and an avian flu virus at the same time, and therefore the theoretical risk of reassortment between the two viruses which could potentially lead to the development of a novel subtype, strain suited to cause a pandemic.

Cross-protection

Studies indicate that seasonal flu vaccines may provide some, if any, limited cross-reactive antibodies and overall partial, weak (widely considered insufficient) protection against bird flu strains — not complete immunity. While seasonal vaccines may help, they cannot substituted specialized, pandemic-preparedness vaccines, which should be designed for the dominant circulating subtypes and strains of bird flu (H5N1 strains). Vaccination against seasonal flu is recommended for groups mentioned above, but especially for dairy and poultry workers to reduce the risk of co-infection and reassortment.

A little extra on seasonal flu, 2025-2026

Getting the seasonal flu vaccine is important this, and every, season. It is not too late to get your flu vaccine — many providers offer shots into late winter (February) and even Spring (April/May). Generally, it is best to get your flu shot in early fall — however, this year’s dominant (approximately 90% of cases!) sub-strain/variant (A/H3N2 subclade K (2a.2a.3a.1); or “K(J.2.4.1)”; various strains) seemed to peak later than the usual time period, although it is not clear yet if cases have officially peaked in the US. While some surveillance measures showed slight declines in early January, experts believe this may be due to holiday-related lags in reporting; high levels of activity are expected to continue. H3N2 seems to have prolonged epidemics in some countries in the Southern Hemisphere, or caused an earlier than normal start to some countries in the Northern Hemisphere (not the US, although there was early severity).

As anticipated by experts like myself who monitor pathogens globally, year round (we watched H3N2’s activity and mutations as it rose in cases during the later part of southern hemisphere’s flu season, around July/August 2025; Michael, in particular, deserves recognition), there is a mismatch between the dominant H3N2 subclade K sub-strain/variant and the seasonal flu vaccine (the selection of viruses used in the vaccine was made in February 2025). Mismatches decrease the efficacy of the vaccine, but the vaccine is still recommended because it contains the pre-mutation “parent” strains and is still effective in reducing severe illness and reducing/preventing community transmission (although it does not eliminate transmission entirely).

Due to this mismatch and overall number of new, key mutations in the dominant sub-strain/variant (allowing for increased immune evasion of the virus), 2025-2026 has been a severe flu season. Technically, the US CDC has deemed this season “moderately severe,” with high severity in children and moderate severity in adults. Record-high (or highs that have not occurred in decades, highs compared to expected levels) doctor’s visits, weekly positivity rates, and some locations’ weekly hospital admission admissions for flu have been reported in the US this year. With so much seasonal flu circulating like this, epidemiologists worry about increased chances for rare reassortment with bird flu in a co-infected individual, and therefore potential emergence of a strain suited to cause a pandemic.

UPDATE (2/13/2026): The US FDA has also made the poor decision to decline reviewing a proposed more effective mRNA seasonal flu vaccine (Author’s note: our current seasonal flu vaccines are usually inactivated virus vaccines, recombinant influenza vaccines, cell-based flu vaccines, live attenuated flu vaccines, or high-dose/adjuvanted vaccines, not mRNA vaccines; this denial is likely motivated by a bias against mRNA technology by this administration). There’s been some weird back-and-forth about this, but it seems that Dr. Vinay Prasad was behind the denial and FDA will stand by it.

Moderna releasing a statement about the denial (“does not further our shared goal of enhancing America’s leadership in developing innovative medicines”) and its announcement after significant investment (years of work, hundreds of millions of dollars in testing, recruiting thousands of enrollees) is unusual.

3. General public — pregnant women, infants, and young children

Pregnant women, infants, and young children are considered more vulnerable to bird flu according to the current available research.

A systematic review found a 90% mortality rate for mothers (90.0%, 27/30) and their babies (86.7%, 26/30) when women were infected with bird flu during pregnancy. Note that risk of bird flu is still low to the general public as there is still no known sustained human-to-human transmission (however, our knowledge of if this is happening is complicated by the presence of asymptomatic cases, as discussed in the introduction of this article). Also, overall, the number of human bird flu cases in all of history is limited, making our conclusions limited as well. Regardless, these findings suggest that pregnant women and their infants are high vulnerability groups for bird flu. These high vulnerability groups should avoid contact with birds, and if exposed to the virus, should immediately seek medical attention.

Pregnant women

In addition to high potential mortality rates for pregnant women, infants, and young children, there are other special considerations for these populations. For pregnant women, pregnancy causes the immune system to change, which often leads to selective, temporary modulation which makes pregnant women more vulnerable to certain infections. Given these changes, pregnant women are generally more susceptible to severe infection, complications, and death from infection. Experts are urgently recommending early inclusion of pregnant women in bird flu pandemic planning and vaccine trials. The WHO also recommends immediate antiviral treatment (ideally within 48 hours of symptom onset) for pregnant women with suspected or confirmed H5N1, since the benefits outweigh risk.

Infants and young children

Children, especially those under the age of 5-years-old, are also susceptible to severe complications, including pneumonia, acute respiratory distress syndrome (ARDS), and brain swelling. Children of this age are more vulnerable for several reasons.

Firstly, young children’s immune systems are still developing and they have less “immunological memory.” Unlike older children and adults, younger children lack prior exposure to older seasonal flu strains that may provide some cross-reactive protection against novel viruses like H5N1. This concept applies to certain age groups being exposed to previous pandemic viruses as well. For example, a recent study found that the highest cross-reactive neuraminidase antibody levels were seen among those who were school-aged children during the 2009 H1N1 flu pandemic, with similarly high levels in adults born before 1947, who had likely been exposed to early H1N1 influenza viruses.

Secondly, children have smaller, narrower airways that can become clogged with mucus or inflamed more easily than those of adults. Research also suggests that certain bird flu viruses, specifically H5N1, can bind more readily to specific receptors in the lower respiratory tract of children, due to their different receptor distribution in the lungs than adults.

Thirdly, young children demonstrate behaviors that increase their risk. Young children may play in outdoor areas that may have contaminated bird droppings, touch animals, and generally have poor hand hygiene (and frequent hand-to-mouth behavior).

3. General public — immunocompromised and elderly

If you are immunocompromised, or an older member of our society, you expect this.

Immunocompromised people

Immunocompromised people are at higher risk for severe illness, prolonged infection, complications, and death from bird flu. Being immunocompromised is a condition where your immune system is not working properly. Just like other pathogens, bird flu is a greater threat to the health of those who are immunocompromised because their immune systems cannot fight off infection as well as others.

An effort must be made to protect this, as well as the other vulnerable high risk groups, from bird flu. Prolonged infection and more common co-infection in immunocompromised individuals may also increase reassortment risk. PPE such as high quality respirators (N95 or others) is recommended to be used by immunocompromised people and people in close contact with them. Those displaying bird flu symptoms are advised to isolate and seek immediate medical help; do not spend time around immunocompromised people or in spaces with a high density of immunocompromised people (hospitals/clinics). Hospitals should require mask use, specifically respirators (N95 or others).

Public spaces should invest in maintaining high indoor air quality, which means using a combination of: enhanced filtration, increased ventilation, and active air disinfection, as bird flu can be carried in small-particle aerosols (5 to 10 micrometers) or in dust. Key strategies include using HEPA air purifiers, MERV 13 or higher filters in HVAC systems, and ensuring that relative humidity stays between 40 to 60% to reduce viral stability. Government programs continue to be funded (like the American Rescue Plan (ARP) being used to provide MERV filters in schools) and implemented to provide these technologies and training to spaces in which people congregate (churches, schools, etc.).

Elderly people

Older people, particularly those 65 and older, are at a higher risk for bird flu. This is due to their weaker immune systems and potential underlying chronic conditions (i.e., heart disease, diabetes, or asthma). Note, however, the potential differential immunity by age mentioned earlier, which is that some older adults may have higher immunity to H5N1 compared to younger people do to exposure to past influenza viruses. Similar to seasonal flu, older adults are more susceptible to severe, even fatal outcomes if infected with bird flu. Again, an effort must be made to protect this, as well as the other vulnerable high risk groups, from bird flu. The aforementioned respirator use and indoor air quality improvement measures should be taken in places where elderly people spend time (i.e., nursing homes).

3. Lowest risk — General public — all groups

If you’re none of the above things, your risk for bird flu infection and illness is currently very low.

Current research suggests that healthy older children and younger adults (age range of 10 to 29-years-old) are at lowest risk for bird flu. This does not mean that this group is exempt from taking precautions. Public health is a collective effort. You can protect yourself from bird flu by taking the precautions described above and we, as a society, can protect from bird flu by implementing institutional and community safeguards (i.e., biosecurity efforts; widespread use of clean indoor air technology; funding surveillance and contact tracing; encouraging respirator and other PPE use; investments into vaccines for poultry and humans and vaccine stockpiling; scaling up of therapeutics like Tamiflu; development of rapid diagnostic tools; increasing vaccine uptake for seasonal flu vaccines and encouraging uptake of the bird flu vaccine when needed and available; and health education).

I have been asked in the past to rate the pandemic risk for bird flu (or just “Roo, how bad is this?”), out of ten. I would still rate the total risk a 3 to 4 out of 10, learning toward 4 at this time (3-4/10). If sustained human-to-human transmission (needed for a pandemic; non-sustained human-to-human transmission raises risk as well, but not to the same degree because of this fact) starts to occur, I would increase that rating to 6/10. This rating does not just come out of my behind; it is supported by the risk ratings from US CDC and WHO, as well as a specific US CDC tool called the Influenza Risk Assessment Tool (IRAT). IRAT’s results for bird flu viruses in the US are published here (risk range of 4.0 to 7.9 for three 2.3.4.4b strains; average risk scores for the emergence of two other strains being 5.9 to 5.21, with average risk scores to impact public health as 5.91 to 6.00, putting them in the mid-range of the moderate risk category). This report was from May 2025.

How fast does bird flu spread?

I have also been asked: how fast does bird flu spread? Well, it depends (Author’s note: yeah. Scientists seem to always say that, don’t they?).

First, let’s talk about recognizing symptoms and distinguishing bird flu from seasonal flu, so we know what to look for in general, but especially in the event that general spread does occur. Bird flu symptoms include a fever, a cough, sore throat, muscle aches, fatigue, and sometimes conjunctivitis, or pink eye (a significant distinguishing symptom from seasonal flu). Eye issues are a common hallmark symptom for human bird flu cases, but not always present. Additionally, diarrhea, nausea, and vomiting occur early on in bird flu infection and are not as common in adults with seasonal flu. Currently, the severity of bird flu is also higher than seasonal flu, with pneumonia, ARDS, respiratory failure, and inflammation occurring more commonly in severe bird flu cases.

Second, now that we know what to look for when bird flu cases emerge, let’s talk about our favorite metric: R₀! The R₀, or the basic reproduction number, of an infection is the expected number of cases directly generated by one case in a completely susceptible population (no previous immunity, either through past exposure or vaccination). This metric is a theoretical metric, as we know susceptible individuals will have some immunity to bird flu through the cross-reactive antibodies from influenza mentioned above, but it is a useful metric to simulate the higher-end of what spread could look like.

The R₀ for bird flu in humans is very low, since sustained human-to-human transmission has not yet been established. Currently, the human-to-human R₀ is less than 1, meaning it would likely die out on its own, often estimated to be 0 and 0.25 (however, the “local R₀” has been reported as higher in some outbreaks). The limitation here is that there is no known sustained human-to-human transmission and we have a very small sample size for total human bird flu cases. This means we do not know what the R₀ could be if bird flu adapts to better infect humans, although we can guess. Modeling based on previous influenza pandemics suggests that mutated H5N1’s R₀ could range from 1.0 to 2.5 or higher, like the 1918 Spanish flu (1.0 to 3.0). The speed of spread relies on this value, as well as the morality rate, and speed of public health interventions.

So, third, let’s talk about bird flu’s mortality rate. Bird flu’s human mortality rate is currently over 50% of confirmed cases. However, this is also limited by the small sample size of cases. Additionally, bird flu’s mortality rate may decrease as it may lose genes contributing to its lethality in humans as it makes adaptations necessary for sustained human to human transmission. Lastly, the true fatality rate may be lower because some cases with milder symptoms may not have been identified as bird flu, and therefore would be excluded from the official Case-Fatality Rate (CFR) (Author’s note: Infection Fatality Rate, or IFR, estimates the chance of death for anyone who catches the virus, including those who never got tested or were asymptomatic; CFR is ratio of confirmed deaths to confirmed cases).

Regardless, this is an extremely concerning, high mortality rate. This may be the initial mortality rate of the virus as it spreads, and then it may reduce. It may also not. Generally, pathogens that kill over 50% of hosts usually “burn out” when it comes to spread (Author’s note: there are some exceptions to this rule that I will write about in my Pathogen Watch List article, where I talk about how epidemiologists predict pandemics and which pathogens we’re watching! It’ll be interactive! Subscribe for that, if you want). So if the mortality rate stays high, the spread may be limited by it; the mortality rate for the 1918 Spanish flu, for reference, was over 2.5%. This is one of those things where we have to admit we just do not know.

Lastly, let’s talk about PPE and other protection to stop spread. To stop a bird flu pandemic now, the world must focus now on preventing animal-to-human spillover through the rigorous use of biosecurity measures, animal vaccination, and use of PPE. In the event of a pandemic, PPE should also be used among the general public (widespread use of respirators), molecular surveillance and contact tracing must be funded and performed quickly, clean indoor air should be supported through technology-use, and widespread vaccination must be prioritized.

Readers’ Questions

Answering your questions from Twitter. If you have any questions, it would be my pleasure to answer them. Feel free ask at X.com/@roomcguire.

How concerned should we be about bird flu? On a scale of 1-10?

Answered above in the “all groups” section! :)

How fast will it spread if human-to-human occurs?

Answered above in “how fast will it spread?” section.

I am a butcher. Am I safe?

Answered above in “butchers” section.

Is there a vaccine? When will it be available to the public?

There is currently no widely available bird flu vaccine for the public, although the US (and other governments) is stockpiling existing vaccines (not tuned to the current strains) and developing new ones (tuned to current strains) for high-risk groups (above) and potentially the general public in the case of a pandemic. Moderna, for example, is developing mRNA vaccines that target H5 and H7 viruses. $700 million in bird flu vaccine development contracts to the company were cancelled by RFK Jr. in a anti-mRNA vaccine move, but they secured alternative funding (significantly reduced) from the Coalition for Epidemic Preparedness Innovations (CEPI).

The US CDC has candidate vaccine viruses (CVVs, strains that human vaccines would be based on) ready, and some trials demonstrate that intranasal H5N1 vaccines may block transmission better than traditional vaccines.

Vaccines for poultry are available, but not yet widely used due to the reasons in “the US Dairy and Poultry Industries” section. The same issues are present for vaccinating cattle. There are no approved or authorized bird flu vaccines for cattle in the US, although research is active.

UPDATE (2/13/2026): Centivax also has just started its Phase 1A (a long way to go!) first-in-human trial of Centi-Flu 01, a pan-influenza universal flu vaccine (supposed to be for all flu subtypes, including pandemic flu). We’ll see how it does.

Can you get bird flu from eating eggs or poultry? Can I have my runny eggs?

Ah, I love runny eggs too.

Bird flu can be present inside or on the shell of eggs from infected hens, but risk to human health is very low. This is because 1) proper cooking (cooking to an internal temperature of 71°C/165°F kills the virus), and 2) safeguards (throwing away infected eggs) prevent most infected eggs from reaching the consumer. Unfortunately, running or undercooked eggs are generally not recommended. To ensure safety and destroy the virus, eggs should be cooked until the yolk and white are firm, cooked to the internal temperature above. While the risk of contracting bird flu from eggs is low, consuming runny or raw eggs carries a higher, unnecessary risk compared to fully cooked eggs.

As for consuming poultry, it is also highly unlikely for you to get bird flu. You should also cook to the above temperature, avoid cross-contamination when handling raw meat (clean cutting boards, utensils, countertops immediately after handling it), and practice good hand hygiene (20 seconds of washing hands with soap after handling it). It is recommended to only purchase meat that has been inspected for wholesomeness by USDA.

Can you get bird flu from drinking milk or eating beef or cheese?

It is widely accepted that pasteurization kills bird flu in milk and cheese products. Raw milk and cheese should be avoided. Beef is also generally safe and risk is extremely low; beef should be cooked to 71°C/160°F if in the form of ground beef. Beef should be cooked to 62.8°C/145°F (with a 3-minute rest afterwards) if in the form of a whole cut. It is not recommended to consume rare or raw beef and the same precautions (avoiding cross-contamination, hand washing) taken with poultry should be taken for beef.

Author

Miranda M. Mitchell, MPH

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Publication: Roo McGuire Health will cover emerging public health topics in the US and globally, aiming to resist Trump’s anti-science agenda and provide credible health information during the current “information blackout” caused by government and academic funding cuts.

Author: Miranda Mitchell, MPH (“Roo McGuire”) is an environmental health scientist. Opinions are her own and do not represent the institutions she was previously affiliated with. She is a graduate of Emory University and Emory University’s Rollins School of Public Health, as well as former intern at the Office of Children’s Health at US EPA Headquarters in Washington, D.C., graduate work-study at US CDC Headquarters at its Roybal Campus in the National Center for Emerging Zoonotic Infectious Diseases (NCEZID), Oak Ridge Institute for Science and Education (ORISE) fellow and full-time employee at US Agency for Toxic Substances and Disease Registry (ATSDR) at US CDC’s Chamblee Campus. Her Master’s thesis, published in Emerging Infectious Diseases (EID), investigated the potential transmission dynamics and genetic diversity of a bacteria in bats and their ectoparasites. Her areas of expertise are health risk assessment, environmental health science, molecular biology, and infectious disease epidemiology. She currently makes public health and political educational content here and on Twitch.tv/roomcguire, while she awaits her first child and hopes to pursue a doctorate sometime after 2028. She has never received any money from pharmaceutical companies and declares no conflicts of interest.

A bizarre health campaign has rolled out across social media.

Following the reveal of a new inverted food pyramid and related nutritional guidelines — which include the recommendation of consuming more animal protein, classifies butter and beef tallow as “healthy fats,” and removes specific daily limits for alcohol consumption — from the United States Department of Agriculture (USDA) and Department of Health and Human Services (US HHS), a slew of posts about drinking whole milk have been released by both agencies and the White House. It seems these posts started on January 11th, 2026, a day declared “National Milk Day.”

National Milk Day was created by the USDA apparently to commemorate the start of milk delivery in sealed, sterilized glass bottles in 1878. Sealed, sterilized milk delivery was considered a significant step for food safety and public health (although, as we will discuss in this article, the health benefits of milk consumption are complicated). Descriptions of National Milk Day also state it was created to honor dairy farmers and the “cultural significance of milk,” and promote milk’s nutrients like calcium, protein, and vitamin D. This national day, its description, and this whole milk public health campaign smells of the behemothic influence of the US dairy industry, which has a total economic impact of around $780-794 billion annually. The industry provides millions of jobs and billions in wages and tax revenue, and accounts for about 3.5% of US gross domestic product (GDP). Importantly, the US dairy industry is highly consolidated, dominated by a few massive dairy cooperatives like Dairy Farmers of America (DFA), Land O’Lakes, and California Dairies, which control the majority of the market and threaten the profitability of small farms. These companies invest in staying powerful through a rich marketing, lobbying, and research apparatus. It appears that the Make America Healthy Again (MAHA) movement, which has captured US federal health agencies, is receptive to Big Dairy’s investments.

If you haven’t seen the posts in this health campaign — I envy you.

It started with USDA Secretary Brooke Rollins posting a picture of herself smiling with a glass of milk on National Milk Day: “Drink Whole Milk.” Then, a more threatening, theoretically machismo, “Art of the Deal”/The Apprentice-esque photo of President Donald Trump was posted by USDA. “Drink up, America,” the post says. Donald is leaning over his oval office desk, a glass of milk in front of him, and he has a “milk mustache” — a motif that is reminiscent of the “Got Milk?” adverts of the 1990s (a campaign which was obviously an effort by the dairy industry and USDA to influence the public to drink more milk and even to perceive milk as unequivocally healthy). “The Milk Mustache is Back.” “Drink Whole Milk.” Another post from the White House shows Trump holding old-fashioned glass milk bottle carriers. Then, a video of Secretary Rollins joined by dairy farmers was posted. In the video, Rollins and the farmers advocate for drinking whole milk and eating whole foods in schools, with one farmer suggesting that there should be more government programs to support this.

On January 14th, 2026, President Trump signed several executive orders and bills. One of which was the Whole Milk for Healthy Kids Act of 2025. The bill revises requirements for milk provided by the USDA’s National School Lunch Program. Schools participating in the program are required to provide milk that is consistent with the most recent dietary guidelines for Americans, which would now be the ones that were recently released. Prior to this bill and the new guidelines, USDA regulations required milk to be fat-free or low-fat. This was an Obama-era policy that started in July 2012 as part of the 2010 Healthy, Hunger-Free Kids Act, with the intention of combating childhood obesity by reducing saturated fat intake (more on this later). The 2025-2026 bill modifies these requirements to allow for whole milk.

Notably, previous USDA regulations also required that the average saturated fat content of the lunches provided be less than 10% of the total calories. Under the 2025-2026 bill, fluid milk is excluded from the saturated fat content calculation. This is pretty blatant and fits with a criticism of the new dietary guidelines from some nutritionists which states that it is impossible for a person to keep their saturated fat consumption below 10% of the total calories under the new guidelines (the math isn’t math-ing).

A creepy social media campaign

The White House’s “Rapid Response 47” Twitter account posted a video of President Trump signing this bill. Trump asks two little girls standing next to him whether he should sign it or not. He signs it, then he briefly reaches out and touches one of the little girl’s hands. He passes the signed bill to a little boy also standing there. The interaction personally makes me uncomfortable, given the recent release of more files on American pedophile Jeffrey Epstein, which included mentions and allegations of child abuse against Trump himself. As cult members do to protect their leader, members of MAHA and MAGA online are claiming that feeling such discomfort is “projection,” or “says more about” the person made uncomfortable than Trump. The mental gymnastics required to deny the creepiness of an alleged pedophile posing with kids next to a jug of milk, especially if you believed in QAnon, are Olympic-level. We’ll see you in Los Angeles in 2028!

But things were just starting to get weird. The USDA then posted a video of transphobe, fifth-place loser, now conservative grifter Riley Gaines drinking whole milk and donning a milk mustache. The text accompanying the video said: “Nutrition shouldn’t be controversial. It’s common sense.” This is approximately when these posts started to get attention online, with netizens asking why there was a seemingly sudden focus on whole milk and making fun of MAHA and MAGA for only knowing this one failed, relatively unknown athlete and using her in a campaign that is supposed to echo “Got Milk?” (which included Britney Spears, Beyoncé, Rihanna, Serena Williams, Venus Williams, Batman, Mario, and SpongeBob).

Then the White House account posted an image of a Donald Trump character in a barn that looks exactly like one from the beloved game Stardew Valley. “We’re bringing back Whole Milk and Making America Healthy Again!,” the character says. “Whole milk is back,” the post says, although whole milk has always been commercially available and the only real changes that have occurred are the US dietary guidelines and the requirements for milk in school lunches. Netizens grew more confused and annoyed, stating that there is probably little overlap between Stardew Valley players and MAHA and MAGA and imploring the creator of the game, Eric Barone or “ConcernedApe,” to sue the administration for using the game’s likeness.

It gets worse. On January 15th, Secretary Kennedy posts an artificial intelligence (AI)-generated video of himself drinking a glass of whole milk, which transports him to the clurb. While showing off his milk mustache, he dances in a state of pure euphoria with his glass of milk to Kato feat. Jon’s song “Turn the Lights off,” a reference to a meme of John Hamm dancing in the show “Friends & Neighbors.” These people cannot create their own aesthetics for the life of them.

And now, the worst one: on January 17th, the USDA posted an AI-generated video of three children drinking milk. “Kids deserve real nutrition. Always have,” the post reads. The kids are posing with three cups of milk, wearing Peter Pan collars (a “trad”/traditional aesthetic), bows for the girl, stockings, and are all white and blonde or blonde-ish. This video, which netizens say evokes the uncanny valley, as well as an aesthetic of an 1800s child tuberculosis ward, was the final nail in the coffin. Netizens began to ask: why are they suddenly talking about whole milk so much? What’s going on here? This is weird. So, let’s talk about the reason why.

An easy “win” for MAHA

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UPDATE (1/20/26): PAHO plans on reviewing the US’ measles elimination status in April 2026 (later than January, earlier than June).

UPDATE (12/8/25): A technicality may save the US from losing its measles elimination status after January 17th (20th, officially). The technicality is that the Utah and Arizona outbreak measles strain may be genetically different enough from the one that started in Texas, that the strain in Utah and Arizona resulted from a different imported case(s) and lead to separate domestic transmission. This means that the domestic transmission started by the Texas outbreak was technically *interrupted* (the outbreak stopped) and the clock restarts (similarly to how we avoided losing this status in 2019). We are currently waiting on this genetic data and analysis from CDC, but preliminary data does suggest these are the same strain, but have slight genetic differences — enough to cast doubt on their relation. Regardless, all health metrics tested in this article are still bad, again similarly to the close call of 2019, and if the Utah and Arizona outbreaks continue and spread for 12 month period, US measles elimination status may be lost since the date they started. This is good news, but we must remain vigilant given all other health metrics — especially MMR vaccine coverage %. My opinion right now is that this technicality will allow US to maintain its measles elimination status when reviewed by PAHO next month. That would put us in the clear until at least June 2026 and hopefully we stay in the clear.

Summary

What is already known about this topic?

In 1978, the United States (US) Centers for Disease Control and Prevention (CDC) set the goal to eliminate measles from the nation by 1982.

Elimination of disease is defined as a reduction to zero of the incidence of a specified disease in a defined geographic area (i.e., the US) as a result of deliberate efforts; continued intervention measures are required (i.e., continuous vaccination). Example: neonatal tetanus in the US.

The eradication of disease is another phrase that is often misused to mean local elimination. The eradication of disease is defined as “permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.” Example: smallpox.

Although the CDC did not meet its goal, the widespread uptake of the measles vaccine (the combined measles, mumps, rubella, “MMR,” vaccine was introduced in the US in 1971) dramatically decreased measles disease rates. For example, in 1981, the number of reported measles cases was 80% less than the previous year. Despite this progress, several measles outbreaks in 1989 among vaccinated school children led the CDC’s top vaccine panel, the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP) to recommend a second dose of the MMR vaccine for children. As a result of this recommendation, as well as increased first-dose MMR vaccine coverage, reported measles cases dropped even more.

The estimated effectiveness of two doses of a measles-containing vaccine to prevent infection is 97%. CDC currently recommends children receive their first measles dose between 12 and 15 months of age, and the second dose between four and six years of age, prior to entering the school system. Measles vaccines in general (beyond the common combined MMR, such the single measles vaccine) have been available in the US since 1963 and are safe and effective at protecting against illness as well as infection and transmission of the virus. Currently, the most common measles-containing vaccine remains to be the MMR vaccine.

In epidemiology, it is estimated that when greater than 95% (>95%) of the population has immunity to measles (via vaccination or previous infection), herd immunity is reached. This means that measles transmission is interrupted and large outbreaks (greater than 50 outbreak-associated cases, >50 cases) will not happen. Thus, at least 95% coverage with two doses of the measles vaccine is often the goal for immunization campaigns and is the current Healthy People 2030 target in the US.

Unfortunately, US measles vaccination rates among school children have been on the decline in recent years. The national vaccination rate fell from 95% in 2019 to 92% in 2023, with a recent (June 2025) county-level analysis from Johns Hopkins University (JHU) showing that out of 2,066 counties studies, 1,614 counties (78%) reported drops in vaccinations. In this dataset, JHU researchers found the average county-level vaccination rate fell from 93.92% pre-pandemic to 91.26% post-pandemic—an average decline of 2.67%, moving us further away from the 95% herd immunity threshold. This coverage varies significantly across states, ranging from as low as 79.6% in Idaho to 98.3% in West Virginia for the 2023-2024 school year. Currently in 2025, 92% of reported measles cases occurred in unvaccinated people.

Measles was declared eliminated from the US in 2000.

The basic definition of elimination for measles in the US (a more extensive definition and benchmarks are described later in this article) is the absence of:

1. large outbreaks (>50 outbreak-associated cases) and;

2. continuous, uncontrolled domestic transmission, spread of disease, for greater than 12 months (>12 months)

The verification of elimination status was first done through an internal CDC and external expert review, comparing against pre-set benchmarks. The CDC’s National Immunization Program officially declared measles eliminated in the US in March 2000. An effort was also taken in 2011 by CDC to have external experts re-verify US measles elimination status. The effort resulted in an agreement that measles elimination still applied.

The US continually to reviews measles elimination status, in particular through an external expert committee called the US National Sustainability Committee for the Elimination of Measles, Rubella, and Congenital Rubella Syndrome. The Pan American Health Organization (PAHO) also monitors elimination status for the Americas. PAHO meets regularly to review evidence and issue reports on the measles elimination status of PAHO member states. The US has consistently received a “sustained elimination” status, including in PAHO’s most recent November 2024 report.

25 years after the historic 2000 accomplishment, the US has reported more cases of measles, 1,618 confirmed cases as of October 21st, this year than any year since 1992 (end of year total cases was 2,200). Only 23 of these cases were reported among international visitors to the US, which suggests that the vast majority of cases have resulted from domestic transmission.

Measles outbreaks have been reported in 41 states. 43 outbreaks (cumulative number of measles outbreaks reported by CDC, defined as three or more related cases, >3 cases) have occurred this year in the US. Of this year’s 43 outbreaks, 87% of confirmed cases (1401/1648) are outbreak-associated, meaning outbreaks are driving the cases. In comparison, only 16 outbreaks were reported in 2024, 69% of which (198/285) were outbreak-associated.

Outbreak-associated cases of measles, especially in an increasingly vaccine- and public health-skeptical population, makes sense as measles is one of the most contagious diseases in the world. Measles’ basic reproduction number (R₀), or the estimated average number of measles cases resulting from one case in a population with no prior immunity, is 12 to 18.

Although the majority of measles infections are not severe, health complications can occur in approximately 30% of cases (20%, or 1 in 5 people with measles will be hospitalized). Additionally, 1 to 3 out of 1,000 people will measles will die. The risk for severe outcomes is higher for babies, young children, and immunocompromised people. Of the 1,618 confirmed measles cases as of October 21, 2025, 198 (12%) of cases were hospitalized and three deaths have occurred. Beyond the risk of infection itself, measles can also have long-term impacts on the immune system that may leave the infected person (especially a child) more susceptible to negative outcomes from other, future infections. Those who recover from measles infection generally develop long-term immunity to it.

State and local health departments play leading roles in measles prevention and response work, but rely on funding and other support from the federal government (such as collaboration with staff at HHS and CDC). This funding and support has been devastated by staffing decreases and funding cuts executed by the current administration. Additionally, increased skepticism among the public about the safety and effectiveness of measles vaccines, driven by non-evidence-based rhetoric and policies (lack of or decreased access to quality and affordable education and healthcare), and an overall increased distrust of health officials has led to lower vaccination rates.

The US is not the only country facing a large number of measles cases and outbreaks in 2025. Mexico (4,645 confirmed cases as of writing) and Canada (5,090 confirmed cases) have also battled large outbreaks this year. Just like the US, these outbreaks are primarily located in communities with low vaccination rates. In fact, Canada is likely to lose its measles elimination status next month — sooner than the US — as the country has now (as of late October 2025) exceeded the 12-month observation window for sustained domestic transmission. PAHO will review Canada’s elimination status next month.

Through October of this year, the World Health Organization (WHO) reports that the total confirmed measles cases globally is 177,469. Outside of the Americas, countries with the highest number of measles cases are: Yemen (19,420), Pakistan (13,227), and India (10,368). Higher global circulation of measles means an increased risk for international travel-acquired cases to the US, which in turn can lead to more domestic outbreaks.

What is added by this report?

In this edition of the People’s Morbidity and Mortality Weekly Report (PMMWR), I argue that if current trends hold through the rest of the year 2025, the US may plausibly lose its measles elimination status in early 2026, based on prior benchmarks and definitions.

What are the implications for public health practice?

As stated in KFF’s article on measles elimination status (Author’s note: much of the points in this section are paraphrased from their article, I found the last paragraph in particular summarizes the stakes well), US measles elimination was a significant public health achievement. US measles elimination was made possible by consistent investments in vaccination efforts; disease prevention; control and response; and a societal commitment to a goal.

US measles elimination status is currently at risk and may be rescinded after 2025 in early 2026. Losing measles elimination status would signify that the aforementioned societal commitment to measles prevention and control no longer exists in the US. Additionally, the loss of US measles elimination status would be a harbinger for a future in which measles is endemic (endemic disease is defined as “the constant presence of a disease or infectious agent within a given geographic area or population group; may also refer to the usual prevalence of a given disease within such area or group”) to the US and large outbreaks and sustained transmission are normalized. This future would mean more hospitalizations and deaths, particularly among children, from a disease that is preventable.

Other implications for public health practice might be schools and daycares having to determine whether to close their schools to reduce transmission in the event of an outbreak. To protect from disease, this can be necessary, but prevention (i.e., meeting the herd immunity threshold via >95% childhood vaccination coverage) would have eliminated the existence of such choices, which themselves impact the mental health and finances of students, parents, and teachers. The societal costs of measles outbreaks are high and regular outbreaks would further strain our weakened public health systems in the US.

I recommend a reversal of cuts in staffing and funding for local, state, and federal public health departments, as well as Medicaid, Medicare, and threats to Affordable Care Act (ACA) subsidies (i.e., reversing of the One Big Beautiful Bill Act (OBBBA)’s stricter verification requirements for premium tax credits, which may end automatic re-enrollment for many and require manual verification for new enrollees); a societal re-dedication to elimination and vaccination campaigns dedicated to achieving the >95% two-dose measles vaccination herd immunity threshold goal; and increased health education on measles and vaccination. I additionally recommend the resignation of RFK Jr. from his position as HHS Secretary for his promotion of misinformation about measles and vaccines.

If US measles elimination status is rescinded after 2025, in early 2026, I recommend the default re-observation of 12-months’ data following the recension, during which public health interventions that have previously been successful are used such as: declaring public health emergencies in affected areas; vaccination mandates for public spaces and institutions, i.e., schools, which includes informed consent; closing of affected schools until cases subside; fines for parents not vaccinating children against measles prior to school enrollment and attendance; and limitations to school attendance based on vaccination status.

Methods

Full definition and benchmarks for US measles elimination

Although I provided a basic definition of US measles elimination in this article’s summary, I provide additional definitions and benchmarks in this article and compare the first 10 months of 2025 data to develop conclusions regarding the measles elimination status.

Hypotheses

H₁: US measles elimination status in the US may plausibly be rescinded, based on previous definitions and benchmarks, after January 17th, 2026.

(Null) H₀: US measles elimination status in the US may not plausibly be rescinded, based on previous definitions and benchmarks, after January 17th, 2026.

Per the guidelines developed by the US and other PAHO members states, measles elimination is defined at a basic level as:

Interruption of endemic measles virus transmission for a period greater than or equal to 12 months, in the presence of high-quality of surveillance.

As previously mentioned, conversely measles is considered endemic in a given area is continuous, sustained transmission occurs over a 12-month period.

In the process of reviewing US measles elimination status, CDC and external experts use several epidemiologic and programmatic indicators, including: measles cases and transmission patterns, public health measures and response capabilities, and vaccination rates, to determine if endemic measles transmission has been “interrupted” and whether surveillance is “high-quality.”

Application of US measles elimination definition and benchmarks for assessment of health data from the 2001 to 2011 study period

When the external experts re-assess and re-verify measles elimination in 2011, they looked at data from the decade of 2001 to 2011. In their review, they used the following lines of evidence to determine if endemic measles virus transmission was interrupted in the presence of high quality surveillance (i.e., US measles elimination, summary credit goes to KFF):

1. There were fewer than one reported measles cases per 10 million population;

2. The majority (>50%) of measles cases were imported and most imported cases did not lead to further US spread — only 40% of cases were imported over the study period;

3. The number and size of measles outbreaks over that period were small (small outbreak defined by less than 5 cases): a total of 64 outbreaks (median 4 outbreaks/year), with a median outbreak size of 6 cases. Only 16 outbreaks included 10 or more cases;

4. Measles vaccination rates among children were sustained at high levels (>95%) over the study period, with no significant differences in coverage by race/ethnicity;

5. Data from national surveys indicated that population immunity to measles was above the “herd immunity” threshold; almost all age groups had seropositivity rates for measles antibodies over >95%, and;

6. Data on laboratory testing and case investigation performance indicated that US surveillance adequately and quickly identified measles cases and transmission chains, meaning high-quality surveillance occurred during the study period.

2018-2019 New York measles outbreak

Before 2025, the largest outbreak of measles (1,249 cases) since the 2000 US elimination was one in 2018-2019. In late 2018, internationally-imported measles cases ignited a large outbreak clustered in a number of tight-knit communities with low vaccination rates in New York City, as well as surrounding counties (most notably, Rockland County). State and local officials implemented public health measures to fight the outbreak including: declaring a public health emergency, mandating vaccinations, and collecting fines from parents who did not vaccinate their children. This led to 60,000 MMR vaccine doses being delivered in the affected areas. The officials led strong communication and outreach efforts. Health officials also closed schools where measles outbreaks occurred, prohibited unvaccinated children from attending school.

In 2018 through 2019, the CDC provided technical assistance and support to New York, and made clear, positive statements about how vaccinating against measles is important. Then-CDC Director Robert Redfield stated: “I encourage all Americans to adhere to CDC vaccine guidelines in order to protect themselves, their families, and their communities from measles” and that “organizations had been deliberately targeting these communities with inaccurate and misleading information about vaccines.” President Trump agreed, stating “vaccinations are so important” and encouraging parents to vaccinate their children against measles. This kind of federal support, rhetorically or otherwise, is strained, at best, in 2025.

As a result of dedicated public health work, the New York outbreak was contained in less than 12 months, with transmission being considered interrupted by August 2019. Therefore, US measles elimination status was threatened that year, but not rescinded due to successful public health intervention.

Data Collection

The 2025 measles data in this review is sourced from the US CDC, here. It includes health data through October 21st, 2025.

The 2001-2011 measles data in this review is sourced from US CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases, here (download). It includes health data through September 30th, 2011, although provisionally reported measles cases through December 31st, 2011 are mentioned.

The 2018-2019 measles data is sources from US CDC’s MMWR, here.

Results

Comparison of first 10-months 2025 metrics to 2001-2011 US measles elimination study period metrics

As previously stated, the US has reported more cases of measles, 1,618 confirmed cases as of October 21st, this year than any year since 1992 (end of year 1992 total cases was 2,200). Although many of these US outbreaks began with imported cases (only 23 of these 1,618 cases were reported among international visitors to the US), a higher percentage of cases this year resulted from domestic transmission than importation than previous years. Additionally, US MMR national vaccination rates in recent years have declined below the herd immunity threshold goal of >95%.

Compared to the 2001 to 2011 elimination period, all 2025 metrics (number of total confirmed cases, confirmed measles cases in different states, number of outbreaks, percent of cases imported versus domestic, number of hospitalizations and deaths) are worse. In the 2001 to 2011 elimination period, 64 outbreaks occurred over a decade — 43 outbreaks occurred over 10 months of this year. In the 2001 to 2011 elimination period, 40% of cases were imported (60% domestic transmission) — in 2025, only 12% of cases were imported (88% domestic transmission). In the 2001 to 2011 elimination period, one measles death occurred — in 2025, there have been three deaths.

Comparing the first 10 months of 2025 to the 2001 to 2011 metrics, I get these results:

1. As of October 2025, there are greater than one reported measles cases per 10 million population — there are ~46.6 measles cases per 10 million people (number depends on 2025 US population estimate, this is for 1,618 cases per 347.3 million people);

2. As of October 2025, the majority (>50%) of measles cases were not imported and most imported cases did lead to further US spread — only 12% of cases were imported over the 10 month study period;

3. The number and size of measles outbreaks over that period were large (small outbreak defined by less than 5 cases): a total of 43 outbreaks in one year, with a median estimated outbreak size, based on available data, of 15.2 cases (Author’s note: this is a highly uncertain estimate based on what data was available from each state or jurisdiction — a limitation. The median number of cases could range from 3 to 16, or more. Feel free to estimate yourself. Note that for some outbreaks, such as the Texas outbreak are extremely large, with 762 cases). A few outbreaks included more than 100 cases, and the estimated median outbreak size is over 10 cases;

4. Measles vaccination rates among children were not sustained at high levels (>95%) over the study period, with the national kindergarten MMR vaccination coverage at 92.5% in 2025. In 2025, there are also significant differences in coverage by race/ethnicity, such as disparities affecting minority groups including Black and Hispanic/Latino children. These disparities are due to socioeconomic limitations, education levels, cultural and information barriers, and disparities in the quality of prenatal healthcare received. Vaccine coverage is also low among some religious groups due to religious exemptions, both historically and in 2025, with such groups driving some of the larger 2025 outbreaks due to their largely unvaccinated, close-knit populations.

5. For national survey data, official 2025 National Health and Nutrition Examination Survey (NHANES) data is is not yet available on whether population immunity to measles was above the “herd immunity” threshold (NHANES data are collected over a two-year period, a new cycle began in early 2025), although vaccine coverage is estimated above (see bullet 4) using studies, administrative data, and other household surveys; NHANES does not have available 2025 data yet on all age groups’ seropositivity rates for measles antibodies — a limitation, and;

6. There is limited publicly available data on laboratory testing and case investigation performance to indicate that US surveillance is adequately and quickly identifying measles cases and transmission chains, so there is a limitation in determining whether high-quality surveillance is still occurring during the study period — a limitation.

Comparison to 2019, a year of threats to measles elimination (New York)

Many data points this year are also worse than those from 2019, when U.S. measles elimination status was last threatened. For example, from January to October 1, 2019 (by which time the large outbreaks centered in New York had been contained), there had been 1,249 total measles cases, and 22 total outbreaks across 17 states; in 2025 those numbers have already been surpassed.

Conclusion

Based on past definitions and benchmarks used for determining US measles elimination, it appears that if current trends hold through the remainder of the year 2025 and into early 2026, US measles elimination status in the US may plausibly be rescinded after January 2026. This would be determined after the 12-month observation period of sustained transmission concludes, after January 17th, 2026.

Discussion & Limitations

State and local health departments are primarily responsible for measles outbreak response, with support from the federal government. Currently, programmatic metrics on state and local health departments’ measles prevention efforts (such as response times) and capacity (such as number of staff working on any given outbreak) are often not made publicly available, which means defining whether US surveillance is still “high-quality” is difficult. However, in 2025, state and local public health departments have faced significant funding cuts from the federal government in comparison to past years, which likely has impacted capacity to track and respond to outbreaks. In the recent past, the federal government has provided the majority of funds for state and local health departments’ budgets. NHANES 2025 data on all age groups’ seropositivity rates for measles antibodies is also not yet available. The estimated median number of cases for the 2025 measles outbreaks is also based on currently, publicly, available data. The availability and timeliness of these data varies greatly by state or jurisdiction, making this number highly uncertain.

The states most affected by measles outbreaks in 2025, such as Texas, New Mexico, and now Utah and Arizona, have not taken the actions New York did in 2019 (such as local vaccination mandates, school attendance limitations, and fines). Although CDC has provided technical assistance and funding support for outbreak epicenters, the HHS Secretary Robert F. Kennedy, Jr. has understated the health risks of measles infection. He has also made mixed, leaning toward negative, statements in the past about the importance of vaccination. Another example in addition to his statements in 2019 about Samoa, is his and other Trump health officials’ (including President Donald Trump himself) recent focus on separating out the vital MMR vaccine into three vaccines, which would likely increase opportunities for infection if not taken simultaneously and could potentially affect insurance coverage of either the combined or monovalent vaccines, especially low-income children in special programs such as Vaccines for Children (VFC), decrease overall access to these vaccines for working class families due to possible increased doctor’s visits and related fees, increase distress for children getting vaccinated, among numerous other limitations, such as lack of market motivation to develop and roll-out monovalent vaccines for these diseases in the US — reasons which are often scoffed at, which makes me crazy (Author’s note: this is probably the first MMWR-inspired publication to have a bit of editorialization, sorry. I am mad at “officials” manufacturing consent for this unnecessary move that puts children’s health at risk. People are currently, and historically, doing so likely for profit and ego). RFK Jr. has instead encouraged what he deems to be “alternative treatments,” such as treating measles with vitamin A supplements rather than preventive vaccination, which has resulted in hospitalizations of children for vitamin A toxicity from overdoses.

Additionally, as mentioned earlier, national measles vaccination has declined over the past half-decade, with childhood measles rates dropping below the 95% threshold. Some public opinion polling has shown that parents are frequently exposed to medical misinformation about measles and the MMR vaccine, with nearly 20% of US adults in 2025 responding that they believe the false claim that “getting the measles vaccine is more dangerous than becoming infected with measles” (poll respondents selected “probably” or “definitely true” for this statement).

Recommendations & Implications for Public Health Practice

I recommend a reversal of cuts in staffing and funding for local, state, and federal public health departments, as well as Medicaid, Medicare, and threats to Affordable Care Act (ACA) subsidies (i.e., reversing of the One Big Beautiful Bill Act (OBBBA)’s stricter verification requirements for premium tax credits, which may end automatic re-enrollment for many and require manual verification for new enrollees); a societal re-dedication to elimination and vaccination campaigns dedicated to achieving the >95% two-dose measles vaccination herd immunity threshold goal; and increased health education on measles and vaccination. I additionally recommend the resignation of RFK Jr. from his position as HHS Secretary for his promotion of misinformation about measles and vaccines.

If US measles elimination status is rescinded after 2025, I recommend the default re-observation of 12-months’ data following the recension, during which public health interventions that have previously been successful are used such as: declaring public health emergencies in affected areas; vaccination mandates for public spaces and institutions, i.e., schools, which includes informed consent; closing of affected schools until cases subside; fines for parents not vaccinating children against measles prior to school enrollment and attendance; and limitations to school attendance based on vaccination status.

Authors

Miranda M. Mitchell, MPH

Credit for aggregation of many of the sources and information used in this article goes to this KFF article.

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Publication: Roo McGuire Health will cover emerging public health topics in the US and globally, aiming to resist Trump’s anti-science agenda and provide credible health information during the current “information blackout” caused by government and academic funding cuts.

Author: Miranda Mitchell, MPH (“Roo McGuire”) is an environmental health scientist. Opinions are her own and do not represent the institutions she was previously affiliated with. She is a graduate of Emory University and Emory University’s Rollins School of Public Health, as well as a former intern at the Office of Children’s Health Protection (OCHP) at US Environmental Protection Agency (EPA) Headquarters in Washington, D.C., graduate work-study student at US Centers for Disease Control and Prevention (CDC) Headquarters at its Roybal Campus in the National Center for Emerging Zoonotic Infectious Diseases (NCEZID), and Oak Ridge Institute for Science and Education (ORISE) fellow and full-time employee at US Agency for Toxic Substances and Disease Registry (ATSDR) at US CDC’s Chamblee Campus. Her Master’s thesis, published in Emerging Infectious Diseases (EID), investigated the potential transmission dynamics and genetic diversity of a bacteria in bats and their ectoparasites. Her areas of expertise are: health risk assessment, environmental health science, molecular biology, and infectious disease epidemiology. She currently makes public health and political educational content here and on Twitch.tv/roomcguire, while she awaits her first child. She hopes to pursue a doctorate sometime after 2028. She has never received any money from pharmaceutical companies or any other funding source other than individual subscribers and declares no conflicts of interest.

Sunday, September 28th was the 25th anniversary of the Food and Drug Administration (US FDA) approving the pill mifepristone for use in abortion. The FDA quietly approved another generic version (identical to name-brand) of the drug on Tuesday, September 30th, before the current government shutdown. Now, Health and Human Services (US HHS) Secretary Robert F. Kennedy Jr., in a letter to Republican state attorneys general, says that he plans for the FDA to re-review the safety of the drug (seemingly specifically for use “without sufficient medical support or supervision,” or use by those who get the pill via telehealth or mail-order, more on that later).

Mifepristone is one of the two of the most common early pregnancy abortion pills, and is used in combination with the other most common pill, misoprostol (63% of abortions in 2023 were medication abortions using mifepristone and misoprostol). The combination is 97% effective during the first 63 days of pregnancy (9 weeks), but has also been shown to be effective in the second trimester (14 weeks). However, it is only approved by FDA through ten weeks of gestation. WHO has approved it through twelve weeks.

Mifepristone is safe and effective — the study RFK Jr cites as reasoning for his review is not peer-reviewed and methodologically flawed

Decades of high-quality research demonstrate that mifepristone is exceedingly safe. As stated earlier, mifepristone medication abortions have an over 95% success rate, with serious complications only occurring less than 1% of the time. According to the FDA, there were five deaths associated for mifepristone use for every 1 million people in the US who have used the drug since its approval in 2000 — a death rate of 0.0005%. That makes this pill safer than penicillin and Viagra. People often take Viagra without medical supervision. I am assuming we’ll be reviewing the safety of taking that pill without medical supervision soon as well.

As expected, the study that Kennedy cites as his reasoning (notably suggested by the Republican attorneys general for him to cite) for a new review of the drug has a deluge of issues. This study, which claims that approximately 11% of women who take mifepristone experience “serious adverse events” is not peer-reviewed, not transparent about its data source, and does not well-define such serious adverse events. The study’s vague definition of serious adverse events does not fit FDA’s definition and could be overcounted due to the diagnostic codes used — if you’re a returning reader of Roo McGuire Health, think back to Dr. Retsef Levi’s bogus emergency cardiovascular events and COVID-19 vaccination in Israel study, which the Israel Health Ministry criticized as possibly overcounting true cardiovascular events because calls could be related to other events such as suicides and chronic illness. In addition to this, both of the authors appear to have previously been associated with The Heritage Foundation, a self-proclaimed “research and educational institution whose mission is to build and promote conservative public policies” with a deep history of influence in Trump’s administrations. The “study” was “published” (again, not peer-reviewed), on the Ethics and Public Policy Center (EPPC) website, which is a conservative think-tank that has been criticized for its political bias in its research.

Mifepristone is necessary — it is a safe abortion option that is also used in the event of miscarriage, painful uterine growths, postpartum hemorrhaging, and more

Mifepristone is a vital tool in reproductive health. Conservatives have attacked this medication for decades precisely because it is a safe, effective, and accessible form of abortion. In 2021, the FDA removed the requirement for mifepristone to only be dispensed in person, allowing mail-order and telehealth services to increase access to the medication. In addition to use for abortion, mifepristone is an important medication for managing miscarriage, uterine fibroids (non-cancerous growths in the uterus), postpartum hemorrhaging, and other conditions.

Let’s be clear — this move by Kennedy is a political move by himself and Republicans to appease a pro-life constituency, and is not informed by science. It is abundantly clear that this administration does not care about child-bearing people’s health, women’s health in general, infant and children’s health — in fact, this administration wants these people to needlessly suffer. Across the board, for experiences that this administration’s men in particular will probably never have, their message to us is: “Tough it out.”

Credit for aggregation of many of the sources used in this article goes to my alma mater’s newsletter, Emory Rollins School of Public Health’s Public Health News. Learn about public health topics and possibly furthering your own public health education here.

Publication: Roo McGuire Health will cover emerging public health topics in the US and globally, aiming to resist Trump’s anti-science agenda and provide credible health information during the current “information blackout” caused by government and academic funding cuts.

Author: Miranda Mitchell, MPH (“Roo McGuire”) is an environmental health scientist. Opinions are her own and do not represent the institutions she was previously affiliated with. She is a graduate of Emory University and Emory University’s Rollins School of Public Health, as well as a former intern at the Office of Children’s Health Protection (OCHP) at US Environmental Protection Agency (EPA) Headquarters in Washington, D.C., graduate work-study student at US Centers for Disease Control and Prevention (CDC) Headquarters at its Roybal Campus in the National Center for Emerging Zoonotic Infectious Diseases (NCEZID), and Oak Ridge Institute for Science and Education (ORISE) fellow and full-time employee at US Agency for Toxic Substances and Disease Registry (ATSDR) at US CDC’s Chamblee Campus. Her Master’s thesis, published in Emerging Infectious Diseases (EID), investigated the potential transmission dynamics and genetic diversity of a bacteria in bats and their ectoparasites. Her areas of expertise are: health risk assessment, environmental health science, molecular biology, and infectious disease epidemiology. She currently makes public health and political educational content here and on Twitch.tv/roomcguire, while she awaits her first child. She hopes to pursue a doctorate sometime after 2028. She has never received any money from pharmaceutical companies or any other funding source other than individual subscribers and declares no conflicts of interest.

In her Op-Ed piece published yesterday, September 4th, 2025, 29-day US CDC director Dr. Susan Monarez wrote:

During my first week as CDC director, a gunman opened fire on our Atlanta headquarters on Aug. 8. Investigators recovered more than 500 shell casings at the scene and more than 180 rounds struck CDC campus buildings. Officer David Rose was killed.

Investigators found documents in which the gunman expressed his discontent with Covid [sic] vaccines, indicating his actions were driven by vaccine distrust. Amid the trauma, hundreds of CDC employees told me the same thing: We need to take immediate steps to rebuild public trust. That’s the CDC I know: service before self.

Just as we began to recover, I was confronted with another challenge—pressure to compromise science itself.

Dr. Monarez reveals in the Op-Ed that, in Washington meeting requested by her boss, US Health and Human Services (US HHS) Secretary Robert F. Kennedy Jr. directed her to preapprove the recommendations of CDC’s vaccine advisory panel, the Advisory Committee on Immunization Practices (ACIP). In early June, Kennedy removed all 17 sitting members of the panel, stating in his own Op-Ed that ACIP was “plagued with persistent conflicts of interest,” and that “[f]ew committee members completed full conflict-of-interest forms—97% had omissions.”

This statement is contrary to a recent analysis of COIs on federal vaccine committees, published in the Journal of the American Medical Association (JAMA) by researchers from University of Southern California (USC) and the Center for Science in the Public Interest. On average, 6.2% of CDC ACIP members have reported a COI at any given meeting since 2016. An even lower percentage was reported among members of the Food and Drug Administration (FDA’s) Vaccines and Related Biological Products Advisory Committee (VRBPAC), which is the committee that recommends whether vaccines should be approved by the FDA — only 1.9% of members reported COIs at any given meeting since 2016. A co-author of the letter, Peter Lure, MD, MPH, a former FDA commissioner, said in a USC press release: "Secretary Kennedy is right that conflict of interest is an important issue, but he is wrong that it is present at substantial levels on HHS vaccine advisory committees.” For those reading who do not have full access to JAMA, University of Minnesota’s Center for Disease Research and Policy (CIDRAP) provides a good overview of the authors’ methods here.

Notably, the analysis included COIs that may not have even met the level of COI that is defined by ACIP or CDC, including COIs related to research support from CDC or National Institutes of Health (NIH), which holds intellectual property rights to the vaccines it licenses. The most frequently reported COI was research support at 10.1%. Personal income from vaccine makers accounted for less than 1% of COIs among ACIP members since 2016. The average rates of recusal were 1.3% and 7.4% for CDC ACIP and FDA VRBPAC, respectively.

Overall, significant progress has been made regarding COIs on vaccine committees since the early 2000s, due in part to policy changes, but also due to increased public scrutiny. Although it is important to remain vigilant of COIs, it is a fact that they have been reported at historically low rates on both committees for years.

In spite of the facts, Kennedy used this rationale to fire all 17 members of ACIP just two hours after publishing his Op-Ed — and then started to replace them with his own cast of characters.

“Not anti-vaxxers,” but if it walks like a duck and quacks like a duck…

Before announcing his picks, Kennedy said: “We’re going to bring great people into the ACIP panel — not anti-vaxxers — bringing people on who are credentialed scientists.” To refute this claim and demonstrate the gaslighting occurring here, I wanted to provide readers with the first in-depth article on the backgrounds of three of these new ACIP members. Here are some of the people who are issuing vaccine guidance at the highest level of our government:

1 — An activist nurse, doctorate in public health who argues vaccines caused her son’s autism

One of the new appointees is Dr. Vicky Pebsworth, an American nurse, doctorate in public health and regional director for the National Association of Catholic Nurses and a board member and volunteer director for the National Vaccine Information Center (NVIC), a group that is widely criticized to be a leading source of vaccine mis- and disinformation and fearmongering. The Center advocates for vaccine exemptions and argues that mRNA COVID-19 vaccines should not be recommended for anyone. NVIC is not affiliated with HHS’ National Vaccine Advisory Committee (NVAC), despite the similarity in their names.

Dr. Pebsworth has argued for decades that her son’s autism was caused by vaccination — a causal assumption that decades of large-scale studies and systematic reviews refute. Experts on the anti-vaccine movement report that her anti-vaccine stance “probably” outdates Kennedy’s. Pebsworth spoke at a 2020 meeting of FDA’s VRBPAC, where she identified herself as the “research director” for NVIC and “mother of a child injured by his 15-month well-baby shots in 1998.” In the meeting, she stated that NVIC’s position is that any “coercion and sanctions to persuade adults to take an experimental vaccine, or to give it to their children, is unethical and unlawful.”

Pebsworth was also part of a 2020 lawsuit against COVID-19 vaccine mandates, aligning with Kennedy’s agenda. Pebsworth made a declaration to the federal court, stating that “increases in the number of vaccines in the CDC schedule may be causally related to increases in the rates of chronic illness.” Pebsworth signed this legal declaration seemingly on behalf of a group (“The Control Group,” as they call themselves, headed by self-described “patriotic grandmother” Joy Garner) and its study (a survey motivated by litigation, similar to the infamous, heavily-retracted Andrew Wakefield Lancet study, who personally played a significant part in Pebsworth’s radicalization) which surveyed nearly 1,500 “holistic” and “vaccine awareness” families asking them about the health of fully unvaccinated people in comparison to vaccinated people (assumed “99%+ vaccinated population” from CDC Chronic Diseases data), in an attempt to prove that those who are unvaccinated are healthier than those who are vaccinated. It is unclear whether Pebsworth received financial compensation for her declaration. (Author’s note: While not inherently “bad” per se, scientific studies motivated by litigation carry significant risks of bias and other issues and should require more scrutiny than other research. I will discuss this and more in a later piece, “How to read and understand scientific studies, by someone who probably paid way too much money to learn how to.”)

Pebsworth acknowledges in her declaration that the TCG American Survey was an informal pilot survey, “suitable to generate testable hypotheses” - particularly, the working hypothesis that vaccines are “a responsible suspect in the Nation’s pandemic of chronic diseases, disabilities, and disorders, and result in injured and dysfunctional immune systems” (Author’s note: Definitionally not what a pandemic is) — and goes through the survey’s strengths and limitations, but overstates the implications of its statistical analyses and findings. If you’re interested in the exact reasons why I am saying that, here is a more scathing analysis/debunking of the survey by surgical oncologist Dr. David Gorski. Regardless of valid criticism, this study is still often used as a talking point by members of the anti-vaccine movement.

Through her association with NVIC, Dr. Pebsworth represents a voice from the oldest prominent anti-vaccine organization in the US on ACIP.

2 — Anti-mRNA vaccine professor of operations management, former IDF intelligence official, author of a study which was debunked by his own former government’s health ministry

Meet Dr. Retsef Levi, another new ACIP member and now head of ACIP’s COVID-19 workgroup (COVID-19 WG), which no longer allows CDC staff or other external non-voting liaisons to be members, only allows them to be invited consultants to the WG “to provide data and presentations…and answer questions…on an ad hoc basis” and non-voting liaisons who can participate in discussions and ask questions (a significant change from the past structure: CDC staff used to co-led this group as voting members, while external experts were discussion-only non-voting liaisons and both were allowed on workgroups). Dr. Lakshmi Panagiotakopoulos, a CDC Medical Officer, co-led the COVID-19 WG before resigning in June 2025.

Dr. Levi is a professor of operations management at Massachusetts Institute of Technology (MIT)’s Sloan School of Management and faculty leader for Food Chain Supply Analytics. He does not have a health or epidemiology degree.

According to multiple sources, Levi has claimed that mRNA vaccines can cause harm and even death, and called for them to be removed from the market in a previously pinned X (formerly Twitter) 2023 post. In the video embedded in the post, Dr. Levi cites his own study on “[i]ncreased emergency cardiovascular events among under-40 population in Israel during vaccine rollout and third COVID-19 wave,” which Israel’s Health Ministry (MOH) refutes in another X post from 2022. The Israel MOH refutes the study’s claims of a link between COVID-19 vaccines and increased cardiac arrest calls in the 16-39 age group, emphasizing that 59% of cases involved unvaccinated individuals, while only 17% of cases were vaccinated within 30 days prior (Author’s note: this post is in Hebrew, so feel free to correct me in the comments if I got the translation wrong). The MOH writes that an analysis of emergency medical services (EMS) data showed that the “cardiac arrest” labels by paramedics lacked medical confirmation and that there was a 63% rise in these calls in Israel since 2019 unrelated to vaccines (related to causes like chronic illness and suicide), which is supported by peer-reviewed critiques of EMS data accuracy in studies. The MOH debunking post also references evidence from a 2022 CDC MMWR study, a 2021 Nature study, and a 2022 UK study that all highlight the fact that COVID-19 itself poses a greater cardiac risk (persistent for up to a year post-infection) than vaccines, concluding the thread by stating this. An independent fact check concurs with these criticisms of the study. Overall, observational studies like Levi’s can be misleading because, while they may show two things happening simultaneously, they do not establish that one causes the other — especially when relying on incomplete or unreliable data. Levi has kept this post up, despite studies showing that mRNA COVID vaccines are safe and effective and have saved millions of lives.

In the most recent (as of writing this) June ACIP meeting, Levi represented his vaccine skepticism in discussions on COVID-19 vaccination guidelines (in this meeting, ACIP was supposed to vote on those guidelines, but ultimately did not — more on that later). When presented with evidence showing that vaccines containing the preservative thimerosal (one of the items members did vote on in that meeting, endorsing removal, which is a more symbolic than scientific decision) are safe, Levi disagreed — stating that although evidence indicates that individual vaccines containing thimerosal are not harmful, concluding that they haven’t caused harm “is a tricky notion” and opined that there may be harm based on cumulative exposure (ACIP June 25th Meeting timestamp: starts around 3:01:53). (Author’s note: Outdated information that ignores decades of evidence affirming the safety of thimerosal as a preservative in vaccines was also officially presented to the committee during this session by new HHS employee Lyn Redwood, former president of the Children’s Health Defense, an anti-vaccine group founded by Kennedy). In this meeting, Levi was also one of two committee members to vote against recommending Merck’s FDA-approved respiratory syncytial virus (RSV) antibody, Enflonsia, for use in infants, a recommendation that was endorsed in this meeting.

According to his faculty description at MIT, Levi spent nearly 12 years in the Israel Defense Forces (IDF), as an intelligence officer. After leaving the military, Levi joined an “emerging new Israel hi-tech company as a Business Development Consultant.” His “industry-based” collaborative research seems to be contradictory to the self-proclaimed original anti-industry sentiment of Kennedy (which he has thus far betrayed, particularly regarding stricter regulation of pesticides — including four pesticide ingredients that may definitionally be PFAS), although some of his research seems to focus on moderating the purely economic motives of industry through risk management. However, according to his description, it appears Levi currently leads a multi-year US-China collaborative effort to develop “new predictive risk analytics tools and testing technologies and platforms to address core food safety challenges in China” — using a multi-million dollar award from the Walmart Foundation (Author’s note: which, unfortunately, has done some good work, probably in an attempt to absolve for Walmart’s low wages, labor practices that have caused concern, past alleged use of overseas sweatshops, and selling of food produced by prison labor).

I will preface this next part by saying that my own political opinions have no influence on my application of the scientific method. When I started my largest social media profile in 2023, focused on criticizing Israel for its genocide of the Palestinian people, I included the statement: "Opinions expressed are my own and do not express the views or opinions of my employer” — a standard practice for federal employees expressing opinions online. Although not full-time federal employees (FTEs), ACIP members are Special Government Employees (SGEs). I would imagine that SGEs would want to put this disclaimer on their social media profiles. Levi does not do this. Recently, he retweeted a post from his colleague Talia Khan about the FIRE Org giving MIT an “F” in political tolerance. The post suggested that “universities are radicalizing students. If they do not act, more violence will follow” after commenting on the recent murder of controversial conservative debater and Turning Point USA co-founder, Charlie Kirk, who he has also retweeted in the past (in addition to NY Post opinion, billionaire Bill Ackman, and other right-wing voices).

In another post, Levi states that “MIT trains woke minds that fail to see the only genocidal entity in Gaza is Hamas is known [sic],” suggesting that the valedictorian speech in the video in the post “[called] for genocide” (it did not: it called for supporting aid efforts, an arms embargo, and for MIT to “cut ties,” presumably with Israeli weapons manufacturers). His stances on this have nothing to do with his bad science, but not distinguishing that his social media does not represent the views of his employer makes me wonder whether Kennedy is doing what he accused the preceding version of the CDC of doing: elevating “political ideologues who pose as scientific experts” to key posts in vaccine guidance.

3 — Joe Rogan guest (now-removed video, by YouTube, but the episode is still made available by Rogan on Spotify) who likened US vaccine uptake to the “mass formation psychosis of Nazi Germany,” horse breeder, medical doctor/biochemist and self-proclaimed “inventor” of mRNA vaccines

Buckle up for this one.

I will preface this section by saying that there was an interesting phenomenon of formerly credible scientists who went off the rails during the height of the COVID-19 pandemic. I have many theories as to why I think this happened, (sneak peak: crazy-making from incorrect information being disseminated by respected institutions — which sometimes happens in science as we learn new information in an unprecedented situation, but is often inexcusable, especially depending on the magnitude of and intent behind the error and the role of the institution; the arguably unprecedented aspects of this pandemic and its responsible pathogen; pure bigotry; an attention-seeking/“pick-me” attitude in a conspiratorial, scientifically-illiterate, fear-mongering media environment; a desire to profit off of the pandemic; and personal, ego-driven vendettas against and/or valid grievances with others in the field), and perhaps I could write another piece about it if you are interested, but feel free to put your own theories in the replies.

Dr. Malone is an American physician and biochemist, known for his early work on mRNA technology and drug repurposing (investigating novel therapeutic applications of known drugs). Malone is credited for the first successful transfection (published 1989) of designed mRNA packaged within a liposomal nanoparticle, a major feat in molecular biology — a bunch of fancy words meaning that he and his team artificially introduced a lab-created mRNA (mRNA that encoded for luciferase, which translates into a light-producing protein) into eukaryotic cells (in this case, human, rat, mouse, frog and fly cells) using an also specially-designed delivery particle. A year later, he also contributed to a paper (published 1990) with Dr. Jon A. Wolff, Dr. Dennis A. Carson, and others, which first suggested the possibility of synthesizing mRNA in-lab to trigger desired protein production (Author’s note: I had trouble finding this exact paper for some reason). Since 2021, Malone has promoted himself as the inventor of mRNA vaccines, a statement that is repeated online despite the fact that this invention is more often attributed to the lead authors on the pioneering papers he contributed to (such as Wolff and Dr. Philip Felgner) and to the significant following mRNA vaccine technology advancements by Drs Katalin Karikó and Drew Weissman, as well as Dr. Derrick Rossi, the co-founder of Moderna. Like many scientific inventions, mRNA vaccines are the result of decades of contributions from hundreds of scientists, including Malone. Anonymous COVID-19 experts and researchers, including those who worked closely with Malone, support the claim that “[w]hile he was involved in some early research into [mRNA] technology, his role in its creation was minimal at best.”

Under the Trump administration (early 2020), Malone was involved in research out of Defense Threat Reduction Agency (US DTRA), a defense agency and a combat support agency within US Department of Defense (US DOD) for countering weapons of mass destruction (WMDs) and the US Nuclear Security Enterprise. Malone was part of research out of DTRA’s DOMANE program — Discovery of MCMs (medical countermeasures) Against Novel Entities. Malone was involved in DOMANE’s research into the heartburn medicine famotidine (Pepcid) as a possible COVID-19 treatment. Malone’s interest in the drug candidate was sparked by his own early observational data which suggested that use may be associated with higher COVID-19 survival (published 2021). In late February of 2020, Malone was so convinced of famotidine’s efficacy for COVID-19 treatment that he took it himself when he got the disease. He posted on LinkedIn that he had figured out the proper dose and was the first to take the drug to treat COVID-19.

While employed by Alchem Laboratories as Chief Medical Officer, Malone then posited that famotidine may target an enzyme that SARS-CoV-2 (the virus causing COVID-19) uses to reproduce. He recruited a computational chemist to help design a 3D-model of the enzyme based on SARS-CoV-2’s genome and comparisons to the 2003 SARS virus (SARS-CoV-1). After seeing encouraging preliminary results, Alchem and New York’s Northwell Health initiated a clinical trial on famotidine and hydroxychloroquine (April 2020), also supported by US Biomedical Advanced Research and Development Authority (BARDA). Malone resigned from Alchem shortly after the trial started, citing a “difficult work environment” (a spokesperson for Northwell also described him as “difficult to work with” as plans for the trial progressed). Here’s what allegedly went down leading to a $21 million study crashing and burning: approximately two weeks after the contract was awarded, Science Magazine released an article describing the deal. In the article, Dr. Michael Callahan, a study collaborator of Malone’s and a well-connected infectious disease expert at Massachusetts General Hospital who worked in Wuhan in late 2019 and advisor to Dr. Robert Kadlec, a retired Air Force colonel who served as Assistant Secretary of Health and Human Services for Preparedness and Response (Administration for Strategic Preparedness and Response, ASPR, agency executive) at the time, was credited as the “first to call attention to [famotidine] in the United States.” The piece briefly mentioned Malone’s work, but the majority of the credit went to Callahan and Dr. Kevin Tracey from Northwell. Malone did not like this.

In an email to Science Magazine’s editors, Malone challenged Callahan’s story of data he had collected in China, where Callahan said that 600 severely ill COVID-19 patients took famotidine antacids and their disease was observed to be milder than patients of a similar age and health status who had never taken the drugs. Callahan has never published these data. Malone wrote: “No one that I am aware of has or had ever seen the data from Wuhan that Michael [Callahan] alludes to. He promised to show me these data, but never did.” A senior Science editor responded that, although the magazine also could not independently confirm Callahan’s account, it would not issue a correction because the magazine considered Callahan’s version of the story to be anecdotal (Author’s note: I do not like that response. In my opinion, many involved here gave way too much credence — and MONEY — to the famotidine idea with little early robust evidence. Its use has ultimately shown mixed results and it is not officially recommended as a COVID-19 treatment). Shortly after Science published the piece, the FDA reported a national shortage of Pepcid AC and other antacids containing famotidine.

To Malone, the reply from Science meant war. In more LinkedIn posts, Malone reportedly accused Tracey and another doctor of inappropriately demanding to be included as authors on a new famotidine and COVID-19 study (Author’s note: it is unclear whether this refers to the trial here and I cannot find Malone’s LinkedIn to verify). A Northwell official advised Tracey to ignore Malone and Malone promptly received cease-and-desist letters to stop disparaging them. Northwell’s official email to Tracey said that “[Malone] just wants back into the discussion and primary credit for the discovery, such as it is at this stage.” In the end, Northwell also paused the trial, apparently because of a shortage of hospitalized patients. A $21 million flop — how’s that, DOGE?

Malone and a collaborator later proposed a special issue to Frontiers in Pharmacology publishers, which would focus on early observational studies on the use of existing medications as treatment for COVID-19, but the publishers ultimately rejected two of the papers selected (one on famotidine, one on ivermectin, an anti-parasitic drug, due to “a series of strong, unsupported claims” and found it did not “offer an objective nor balanced scientific contribution”) and removed a rework of the ivermectin paper and this entire special issue from its website.

Malone started receiving criticism in mid-2021 for propagating COVID-19 conspiracy theories and misinformation, including: making dangerous and false claims about the toxicity of spike proteins generated by some COVID-19 vaccines, promoting the unevidenced efficacy of ivermectin and hydroxychloroquine as COVID-19 treatment, and tweeting a later retracted study that questioned vaccine safety. Malone has falsely claimed that Moderna and Pfizer-BioNTech mRNA vaccines could “worsen COVID-19 infections,” and that the FDA had not granted full approval to the Pfizer vaccine in August 2021. Despite all of this, Malone admitted in a July 2021 interview that he got the Moderna mRNA COVID vaccine, stating that he got it because he was suffering from long COVID, that “the data at the time suggested it improved outcomes,” and because he and his wife “needed to travel.”

Malone also shared a deceptive video on Twitter falsely linking athlete deaths to COVID-19 vaccines, specifically suggesting a 17-year-old Indiana high school football player, who died in 2013 from sudden cardiac arrest resulting from an undiagnosed heart condition, had died from COVID-19 vaccination. He deleted the video from his Twitter after receiving a cease-and-desist (a pattern for Malone) letter from the child’s family, later stating he did not know the video was doctored. He was permanently suspended from Twitter in December 2021 for his repeated sharing of COVID-19 misinformation. He sued the site for this. His account was allowed to return when Elon Musk bought the site, now sitting at 1.3 million followers.

In a 2022 interview, Malone stated the unsupported claim that COVID-19 vaccines are “damaging T-cell responses and causing a form of AIDS,” saying he had “lots of scientific data” for this claim, but not citing any of it. Representing perhaps his most public lie, Malone claimed on a December 2021 episode of the the Joe Rogan Experience (JRE) podcast that “mass formation psychosis” was developing in American society as a reaction to COVID-19, comparing it to the rise of Nazi Germany. The term “mass formation psychosis” is not in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and usually not recognized as a medical term by mental health practitioners. YouTube removed the interview from its platform, but Joe Rogan keeps the episode up on Spotify, despite the fact that Spotify received an open letter from 270 scientists, nurses, physicians, and academics about the content in the podcast. Representative Troy Nehls (R-TX) enter a full transcript of the episode into the Congressional Record.

Dr. Malone was also the Chief Medical Officer of a group called The Unity Project, a group against COVID-19 vaccine mandates. He has spoken at large anti-vaccine rallies and now runs a Substack, where has 355,000 subscribers and posts dank memes. Malone does put the disclaimer that I criticized Levi for not using on this Substack, but not on his much larger twitter account.

His most recent Substack post is about the role of ACIP as a committee that issues guidance to advise the CDC Director (or the HHS Secretary when there is no CDC Director), which is correct, but then argues that the regulation of vaccine policy is the responsibility of states and “is a states rights issue” (Author’s note: I’ll debate this next) and that ACIP’s official reported COIs are not the only form of “COI,” but that the committee has historically been “captured” by CDC bureaucracy (ACIP has always comprised of independent non-CDC members and CDC members, as stated in Levi’s section) and claimed that CDC bureaucrats have controlled the committee’s “agenda, scope, information sources, and membership,” presenting little concrete evidence of this. That is not the definition of a COI and it can be an opinion, but it is not a fact. Additionally, given Dr. Monarez’ account of Kennedy pressuring her to rubber-stamp the new committee’s recommendations, it seems Kennedy exhibited this alleged control himself.

Again, part of what he writes is correct: “In sum, ACIP absolutely does not have either authority nor mission to ‘set vaccine policy for the United States’”. Setting policy and standard of care involves an interaction between the US Federal Government, State Government, and state authorized health care practitioners (which may include pharmacists in some states),” but he also oddly says “[f]rom the perspective of the Federal Government, this role is specifically the responsibility of the Executive branch (POTUS and/or designee).” This seems to simultaneously suggest that vaccine policy is the authority of the states, yet also up to the President.

Returning to the “states’ rights” argument, this article seems to advocate for what I have argued is the balkanization of public health, a process involving the fragmentation of a country or region into multiple smaller, hostile independent states that are considered to be governed quite differently, rooted in the depiction of events from the 1912-1913 Balkan Wars and incidents occurring in the Balkan Peninsula during War War I. Malone cites Dobbs v. Jackson Women’s Health Organization (2022) to make this point, pulling this quote from Justice Alito’s majority opinion: “only legitimate unenumerated rights — that is, rights not explicitly stated in the Constitution — are those ‘deeply rooted in the Nation’s history and tradition’ and ‘implicit in the concept of ordered liberty,’” a subjective judgement that Malone is using to argue public health policy is not something that ‘the Nation’s history and tradition’ gives federal control over. In contrast to this opinion, I would point to the Interstate Commerce Clause in Article I of the US constitution, which grants the federal government the power to regulate trade and transportation between US states, thereby preventing state-imposed trade barriers (something that emerged under the failure of the Articles of Confederation), and fostering a national free market. This clause has been expanded over the centuries and now applies to a multitude of things crossing states. Thinking of a pop culture example, in the cult classic television show, Twin Peaks, Officer Dale Cooper from the Federal Bureau of Investigation is called in because victim Ronette Pulaski wanders across a railroad bridge out of Washington into Idaho (across state lines). Diseases do not know state borders and therefore, a central (See: “Centers of Disease Control and Prevention”) federal agency to control and prevent them is in the public interest. The CDC’s collaboration with states, local, tribal agencies and governments has led to many success stories regarding interstate and intercountry (for the sovereign tribes) outbreaks. Foodborne illness outbreaks are a prominent example for this, as food consumed in one state may have been produced and transported from another.

These are just some of the ACIP members Kennedy selected in June, not to mention Dr. Martin Kulldorff, who co-authored the Great Barrington Declaration with Dr. Jay Bhattacharya, the new Trump-appointed NIH director. The Great Barrington Declaration is a letter that questioned lockdowns and other public health measures early in the COVID-19 pandemic advocating for low-risk groups to develop herd immunity through exposure to the virus (somehow also arguing that vulnerable people could simultaneously be protected and, I guess, ignoring the risk of chronic effects of infection, long COVID) and Dr. Cody Meissner, a professor of pediatrics and medicine at Dartmouth College's Geisel School of Medicine, and previous member of ACIP who made 12 COI disclosures during this time on committee from 2008 to 2012 according to a CDC database, criticized recommendations to mask children in an Op-Ed co-written with the current FDA Commissioner Dr. Marty Makary, and indicated support for Kennedy’s decision to remove healthy children and pregnant women from the COVID-19 vaccine schedule (Author’s note: before some chud starts to argue that they did not remove them and it says you can use “shared clinical decision-making” — the messaging on this was completely incoherent); and Dr. James Pangano who seems to have also signed the Great Barrington Declaration.

As of September 15th, more members of ACIP have been announced, such as: Dr. Catherine Stein, who downplayed COVID-19’s severity during the height of the pandemic in early 2021 and argued that Ohio Department of Health’s COVID-19 dashboard inflated the number of deaths; Dr. Kirk Milhoan of the Independent Medical Alliance, an organization that reportedly stated on its website to be “dedicated to treating patients affected by… vaccine-related cardiovascular toxicity due to the spike protein” and has promoted ivermectin use for COVID-19, published a paper claiming the mRNA vaccines led to more cases of the heart condition myocarditis than the virus itself, called for the shot to be removed from the market, and joined Representative Majorie Taylor Greene (R-GA) on a vaccine-injury panel; and Dr. Evelyn Griffin an obstetrician/gynecologist (OBGYN) who spoke a 2024 Louisiana “Health Freedom Day” promoting a removal of vaccine mandates.

I will note that some new members seem to be less noncontroversial, to my current knowledge: Dr. Joseph R. Hibbeln, Dr. Hillary Blackburn, and Dr. Raymond Pollak (Author’s note: Fired but Fighting, an organizing effort among HHS workers who were fired by DOGE, reports Dr. Blackburn is a vaccine skeptic, but I have not found corroborating evidence for this quite yet. Notably, she is also the daughter-in-law of Senator Marsha Blackburn (R-TN). Additionally, Dr. Hibbeln is a psychiatrist who is reported by Fired but Fighting to think that diet is the cure for most diseases). Overall, I personally do not feel confident in the membership of this new board and their ability to make unbiased decisions on the vaccine recommendations they will be voting on — and neither should you.

CDC director fired for refusing to rubber-stamp this committee’s recommendations, as allegedly requested by Kennedy — and the CDC leaders who resigned in solidarity

Dr. Monarez goes on to write in her Op-Ed:

Reporters have focused on the Aug. 25 meeting where my boss, Health and Human Services Secretary Robert F. Kennedy Jr., pressured me to resign or face termination. But that meeting revealed that it wasn’t about one person or my job. It was one of the more public aspects of a deliberate effort to weaken America’s public-health system and vaccine protections.

I’m gone now, but that effort continues. One of the troubling directives from that meeting more than a week ago: I was told to preapprove the recommendations of a vaccine advisory panel newly filled with people who have publicly expressed antivaccine rhetoric. That panel’s next meeting is scheduled for Sept. 18-19. It is imperative that the panel’s recommendations aren’t rubber-stamped but instead are rigorously and scientifically reviewed before being accepted or rejected…

Those seeking to undermine vaccines use a familiar playbook: discredit research, weaken advisory committees, and use manipulated outcomes to unravel protections that generations of families have relied on to keep deadly diseases at bay. Once trusted experts are removed and advisory bodies are stacked, the results are predetermined. That isn’t reform. It is sabotage.

Public health shouldn’t be partisan. Vaccines have saved millions of lives under administrations of both parties. Parents deserve a CDC they can trust to put children above politics, evidence above ideology and facts above fear.

I was fired for holding that line. But the line doesn’t disappear with me. It runs through every parent deciding whether to vaccinate a child, every physician counseling patients, and every American who demands accountability.

If we stay silent, preventable diseases will return—as we saw with the largest measles outbreak in more than 30 years, which tragically killed two children. If we act, the facts can still prevail.

I could not have said this better myself. I completely agree — I once stated something similar to the third paragraph. And others agreed as well — three major CDC leaders resigned the day of her firing: Dr. Demetre Daskalakis, former Director of the National Center for Immunization and Respiratory Practices (NCIRD), Dr. Daniel Jernigan, former Director of the National Center for Emerging Zoonotic Infectious Diseases (NCEZID), and Dr. Debra Houry, former Chief Medical Officer and previously Deputy Director of the CDC. These are heavy-hitters at CDC and Dr. Debra Houry, for example, is an extremely cautious, apolitical person. I got quite sick (ironically) the day this happened. Although there are still thousands of amazing scientists at CDC and ATSDR working hard to maintain its mission, to me, these leaders leaving indicates the beginning of the end of the US CDC as we once knew it.

This firing and resignation followed the FDA narrowing its approval of the updated COVID-19 mRNA booster vaccine for only those who are 65 years and older or had a qualifying (high-risk) condition and the presumption that CDC’s ACIP would recommend the same. Now, on the eve of their September 18th and 19th meeting, the committee is considering narrowing the age recommendation, moving it up from 65 to 75 years-old. The committee also reportedly plans to review unverified (anyone, patients and providers, can submit adverse events for additional review and to generate hypotheses/more study in the mentioned database) Vaccine Adverse Event Report (VAERS) data in a FDA presentation on “children who died after receiving the COVID-19 vaccine.” The FDA is also allegedly scouring datasets for case reports of congenital deformities in babies after their mothers received the COVID-19 vaccine during pregnancy. This, in conjunction with Dr. Monarez being asked to pre-approve recommendations, indicates that ACIP is not interested in honest, scientific, and democratic discussions and voting, but rather creating a spectacle, a façade of honest deliberation that hides their true intent: to restrict access to or outright not recommend, stigmatize, and influence the removal/ban vaccines from the market entirely.

Topics covered in Part II: the recommendations of the next ACIP meeting and why these recommendations are misguided, CDC problems during past Democratic *and* Republican administrations, the CDC shooting, an argument for universal healthcare, the cost of decreased vaccine access, how to resist lies, and an official call for RFK Jr.’s resignation

I hope you enjoyed (as much as you could!) today’s article. Please consider supporting Officer David Rose’s, the first responder killed in the August 8th, 2025 US CDC shooting, GoFundMe here.

Publication: Roo McGuire Health will cover emerging public health topics in the US and globally, aiming to resist Trump’s anti-science agenda and provide credible health information during the current “information blackout” caused by government and academic funding cuts.

Author: Miranda Mitchell, MPH (“Roo McGuire”) is an environmental health scientist. Opinions are her own and do not represent the institutions she was previously affiliated with. She is a graduate of Emory University and Emory University’s Rollins School of Public Health, as well as a former intern at the Office of Children’s Health Protection (OCHP) at US Environmental Protection Agency (EPA) Headquarters in Washington, D.C., graduate work-study student at US Centers for Disease Control and Prevention (CDC) Headquarters at its Roybal Campus in the National Center for Emerging Zoonotic Infectious Diseases (NCEZID), and Oak Ridge Institute for Science and Education (ORISE) fellow and full-time employee at US Agency for Toxic Substances and Disease Registry (ATSDR) at US CDC’s Chamblee Campus. Her Master’s thesis, published in Emerging Infectious Diseases (EID), investigated the potential transmission dynamics and genetic diversity of a bacteria in bats and their ectoparasites. Her areas of expertise are: health risk assessment, environmental health science, molecular biology, and infectious disease epidemiology. She currently makes public health and political educational content here and on Twitch.tv/roomcguire, while she awaits her first child. She hopes to pursue a doctorate sometime after 2028. She has never received any money from pharmaceutical companies or any other funding source other than individual subscribers and declares no conflicts of interest. She apologizes for the HBO “Chernobyl” quote, but not really, that show is awesome. Real quotes from chemist Valery Legasov’s tapes are available here.