The only thing worse than the painful death of a child is the easily preventable painful death of a child.
Already, as a result of the Trump administration’s attack on the public health community, which includes defunding the U.S. Agency for International Development and Gavi, the Vaccine Alliance, many children are dying unnecessarily.
According to the New York Times, this may result in 1.2 million children dying and 75 million not receiving routine vaccinations over the next five years.
In a memo leaked to the Times, a USAID insider projected that the defunding would likely cause:
rising maternal and child mortality in 48 countries; up to 18 million additional cases of malaria per year (166,000 additional deaths); hundreds of millions of polio infections (200,000 children paralyzed), just when we are close to eradicating this disease; 1 million children to be untreated for severe acute, often fatal, malnutrition each year; 28,000 new cases of Ebola and Marburg annually, increasing healthcare spending (in a 2014 case, one Ebola patient cost New York’s Health Department $4.3 million); increased cost from treating patients with multidrug-resistant TB (treating one patient costs more than $154,000, and there will be a 30 percent increase in drug-resistant TB); and uncontrolled outbreaks of Mpox and bird flu, perhaps 105 million cases in the U.S. alone.The “savings” from cutting USAID funding quickly turns into excessive spending on preventable conditions. Even more costly is the loss of soft power, which enhances U.S. security around the world.
This thoughtless cost-cutting is not only immoral and needlessly cruel, but it is extremely bad business as well. For example, a study showed that for every dollar spent on USAID agriculture research, the U.S. earned a return of $8.52 in new jobs, exports, and further economic growth.
Defunding USAID is not the only case of recent penny-wise, pound-foolish U.S. government actions with deeply serious consequences for public health. After withdrawing from the World Health Organization, we have no say in where and how the organization directs its vital resources, while cutting ourselves off from WHO’s critical early warning intelligence on potential epidemics and other health dangers.
Likewise, in cutting funding for Gavi, which has saved the lives of 19 million children, we are raising the eventual budget burden while increasing human suffering. Additionally, Health and Human Services Secretary Robert F. Kennedy Jr. canceled the Food and Drug Administration meeting to update next year’s flu vaccine. This may presage a less effective flu shot for the fall 2025 flu season.
The White House also scrapped its Office of Emergency Preparedness. The government is slashing the Centers for Disease Control staff, cutting its HIV and other critical research programs and prohibiting it from dispensing vital information or even from contacting WHO.
Stupidly, we are spending taxpayer dollars restudying a vaccine/autism connection after exhaustive investigations showed no relationship. We are wasting time and resources with conspiracy theories speculating that HIV is not the cause of AIDS (it is), and an irresponsible linking of SSRIs to mass shootings (there is no link). Studies of vaccine hesitancy, a major cause of the loss of protective herd immunity, have been canceled.
We have cut the National Institutes of Health’s research budget by $4 billion, leaving important studies unfinished, losing critical medical talent and putting a chill on future cancer, heart disease and infectious diseases research. Patients in the middle of studies are being left hanging.
Cutbacks have further undermined public health information systems, disease surveillance and tracking with effective tools like wastewater testing, the upgrading of research and testing labs and programs to curb infections in nursing homes.
Amid a deadly expanding measles outbreak, the HHS secretary pushes good nutrition, cod liver oil, and Vitamin A as the solution (they will not cure the disease) while the highly effective vaccine is reduced to “a choice” in an environment where overall vaccination rates are dropping precipitously.
Fourteen states reported rates below 90 percent for the 2023-2024 school year, compared to only three states in the 2019-2020 school year. In the last year, over 30 states experienced declines in the rates of all state-required vaccines, with more states apparently joining the trend.
Meanwhile, an avian flu strain transmissible between mammals lurks in the background with pandemic possibilities.
All of these actions, individually and collectively, represent an aggressive assault on public health, eroding trust in reliable sources of information and compromising understanding of current threats to the health of all Americans.
It took centuries to build public trust in real, solid science from the ignorant and disease-plagued Dark Ages. Suddenly, all that careful work of thousands of smart, caring scientists and physicians is being overthrown in an instant while many, either because they have been bullied or misinformed or are just cowardly, remain silent.
What’s clear is that we cannot, must not, wait to speak out, or many people, including millions of children, will unnecessarily die.
Jonathan Fielding, MD, MPH, MA, MBA, is a distinguished professor of health policy and management and of pediatrics in the Schools of Public Health and Medicine at UCLA. Peter Katona, MD, has been clinical professor of medicine at the UCLA David Geffen School of Medicine in Infectious Diseases and adjunct professor of Public Health at the UCLA Fielding School of Public Health in Epidemiology. Seth Freeman, MPH, is an Emmy-winning writer and producer for television, a playwright and a journalist, who writes about technology, education, policy and public health.
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