• What 1,500 videos tell us

• Why calm loses in an attention economy

• Cure claim on Tuesday, sales pitch on Wednesday

• What the data tells us we should do differently

• And in the news…

What 1,500 videos tell us

In the 18 days between April 24th and May 12th, an analysis of over 1,500 hantavirus videos identified across TikTok, Instagram, and YouTube found they were watched 1.16 billion times. TikTok alone accounted for 95% of those views. The attention spike was enormous and brief: 128 million views on May 4th, the day the first deaths were reported, then a steep decline — down to 4.8 million views by May 12th. Most of the audience had moved on before the quarantine in Nebraska even started.

Independent creators, not news organizations, generated 52% of the outlier views, over 258 million. Doctors generated 2%. Videos tagged with fear and anxiety themes pulled in 69 million views. Videos explicitly comparing hantavirus to COVID, 88 of them, drew 27 million. The content that performed best was emotional, not informational.

Why calm loses in an attention economy

TikTok doesn’t distribute content based on who you follow. It distributes based on what keeps you watching. A 653-follower account posted a hantavirus video and got 487,000 views. A 14,200-follower account got 3.2 million. The algorithm doesn’t know or care whether the person talking is an infectious disease specialist or someone who made their first video that morning. It rewards content that triggers emotion. Calm, accurate content does not get the same distribution.

Dr. Rubin, an allergist with 2.2 million TikTok followers, posted a reassuring “Do I need to panic?” video that got 5.7 million views — one of the top-performing doctor videos in the dataset. But that was one video against a flood of hundreds.

A study in Science quantified the structural problem: false news reaches people about six times faster than true information and is 70% more likely to be shared. The driver is novelty. False claims feel new and emotionally charged. True information tends to be hedged and careful. In an attention economy, hedged loses.

This is the environment in which about half of Americans under 50 now get health information from influencers and podcasts. The first voice many people heard about hantavirus was not the CDC. It was whoever the algorithm served them.

Cure claim on Tuesday, sales pitch on Wednesday

On May 7th, a Houston ENT doctor named Mary Talley Bowden posted on X that ivermectin “should work” against hantavirus. The post reached 3.5 million views. Former Rep. Marjorie Taylor Greene amplified it, recommending ivermectin, vitamin D, and zinc to her followers. The next day, Bowden posted that she’d be selling ivermectin to Texans for up to $110, no prescription needed.

The claim is wrong on basic biology — hantavirus replicates in the cytoplasm, not the nucleus, so ivermectin’s proposed mechanism doesn’t apply. Four physicians told PolitiFact they knew of zero evidence for ivermectin against any hantavirus. But Bowden didn’t need to be right. She needed to be first.

This is health misinformation as a business. The Carter Center estimated that advertisers spend roughly $2.6 billion a year on misinformation websites. NPR found that during COVID, 147 key anti-vaccine accounts grew their followings by at least 25% and now monetize through subscriptions, supplements, and speaking fees. Bowden was reprimanded by the Texas Medical Board in 2025 for prescribing ivermectin at a hospital where she didn’t have privileges. She built her audience during COVID. Every new health scare is a new product launch. Cure claim on Tuesday, sales pitch on Wednesday.

What the data tells us we should do differently

The usual answer is fact-checking, but doing so ahead of time. But a 2024 review of outbreak communication found that reactive fact-checking arrives too late in most cases. The false claim has already shaped beliefs by the time the correction is published. Three randomized trials published in 2025 found that teaching people to recognize manipulation techniques before they encounter specific claims, also known as prebunking, reduced susceptibility by 20-30%.

But even if prebunking works at the individual level, the platform architecture still funnels attention toward content that triggers emotion rather than informs. And the platforms that once created friction against false claims dismantled their health misinformation teams between 2022 and 2024.

The hantavirus outbreak involves fewer than 20 confirmed cases worldwide. In the same period, over 1,500 videos about it were watched over a billion times. The problem is not that bad actors post false claims. It's that the platforms amplify them. The moderation teams that once pushed back were dismantled. The public health agencies that should be posting were never on TikTok to begin with.

And more in the news…

• What media coverage is missing

• The bill COVID left behind

• The quarantine debate is a proxy fight

• Tedros understood the assignment

• What happens when medical logic meets public fear

• What the media owes its audience right now

• And more in the news…

What media coverage is missing

Turn on the news right now and you’ll hear a lot about hantavirus. How it spreads. What the symptoms are. Whether the quarantine in Nebraska is strict enough. Whether 42 days is long enough. Whether the testing protocol is right.

These are real questions. But they are not the real story.

The real story is that millions of people are watching this unfold and feeling something they can’t quite name. It’s dread. It’s the sense that this has happened before and it’s about to happen again. It’s COVID, still sitting in their nervous system, and a new virus just woke it up.

TIME reported that social media and Reddit are filling with people saying “I can’t do this again.” Psychologists explain why: major events like COVID rewire the brain’s threat-detection system. A new outbreak triggers the old alarm. The response is not about the new threat. It’s about the last one. It’s a trauma response.

It’s like a couples therapist watching a husband and wife fight about who’s doing the dishes. A bad therapist thinks the fight is about the dishes. A good therapist knows it’s about feeling unseen, unheard, or taken for granted. If you only fix the chore schedule, the couple comes back next week fighting about the trash.

We are talking about the dishes. We are not covering the something bigger.

The bill COVID left behind

Many Americans came out of COVID traumatized, and their primary takeaway was that the government restricted them too much. They remember the shutdowns, the school closures, the businesses that went under, the mandates that felt arbitrary and the guidance that kept changing. They do not want to live through that trauma again.

That is what’s shaping how they react to hantavirus. Nobody is asking the general public to quarantine. The 42-day quarantine applies to 18 cruise ship passengers, not to them. But they are watching, and what they want is containment — of those passengers, of that virus, of the possibility that this spirals into another round of restrictions on their lives. Lock it down over there so it doesn’t reach us over here.

The political fallout reinforced this instinct. Over 30 states passed laws gutting the authority of public health agencies. A study across 23 countries found that 23% of people said COVID made them less willing to get any vaccine. Trust is lower. Institutional capacity is thinner. The public knows it, even if they can’t name it. So when they hear some passengers might go home, the reaction is not about quarantine policy.

The quarantine debate is a proxy fight

When Jake Tapper asks on CNN why these passengers aren’t being forced to stay, it sounds like a question about quarantine policy. It’s also a proxy for something deeper: can we trust the government to contain this before it becomes our problem? When Governor Pillen tells Nebraskans that “no one who poses a risk to public health is walking out the front door,” he’s trying to reassure a public that remembers being told COVID was under control when it wasn’t.

When people on social media demand that passengers be locked on the ship, or that quarantine be enforced by the military, those demands are not proportional to the actual risk. Fewer than 20 people worldwide have been confirmed with this virus. The WHO and CDC both assess the risk to the general public as low. But the public is reacting to the last outbreak, not this one. They remember being told “the risk is low” in January 2020 and watching the world shut down two months later.

The demand for strictness is a demand for protection. It comes from fear, not cruelty.

Tedros understood the assignment

The public wants force. But force is exactly what won’t work for a 42-day quarantine.

Research on quarantine compliance shows that the single best predictor of whether people cooperate is whether they feel respected. During SARS, voluntary compliance exceeded 90% without enforcement, because people were given clear information, support, and dignified treatment. Forced quarantine can produce compliance on day one. But over 42 days, the psychological toll builds. The Lancet review found that quarantine causes PTSD, confusion, and anger, and that harm increases sharply after the first week. The biggest risk factors are not the virus. They are bad information, stigma, and feeling abandoned.

The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, seems to understand this. He flew to Tenerife and spoke to residents and passengers directly. He didn’t lead with case counts. He led with emotion, saying he understood that memories of 2020 were surfacing. He quoted a passenger who said “we’re not headlines, we are human beings.” He praised Spain for showing “not just the obligation part, but the compassion and solidarity.”

Tedros was doing what a good therapist does. He named the feeling before he addressed the problem. That approach isn’t just kinder than forced confinement. It is more likely to keep 18 people cooperating for six weeks.

What happens when medical logic meets public fear

The American response has been operationally competent but emotionally tone-deaf. The quarantine at the University of Nebraska Medical Center is one of the best-equipped facilities in the world. But there’s no agreed testing schedule for people without symptoms. The start date of the 42-day clock hasn’t been settled. Dr. Angela Hewlett, the medical director of the biocontainment unit, has said she encourages passengers to stay, not that they must. Some will go home. Other exposed passengers are already monitoring from home across as many as seven states, including some who disembarked before the outbreak was confirmed.

These details will become flashpoints. When someone hears “some passengers can go home,” they don’t hear a medical judgment about low-risk exposures. They hear: the government is letting potentially infected people walk around in my community. The reaction will be anger — not because the public is irrational, but because nobody has explained the reasoning in a way that addresses their actual fear.

What the media owes its audience right now

It would mean saying, out loud and early, that most people watching are not afraid of hantavirus. They are afraid of another pandemic — the shutdowns, the job losses, the isolation, the death, the feeling that the people in charge didn’t have it under control. That fear is driving the demand for strict quarantine, the outrage when passengers are allowed to go home, the social media posts calling for military enforcement. None of it is really about 18 cruise ship passengers. It’s about what happens if this gets out.

And it would mean addressing the hardest part: the public wants strictness because they think strictness equals safety, but the evidence shows that the quarantined passengers are more likely to cooperate for 42 days if treated with dignity than if treated like prisoners. Dignity is not leniency. It is the strategy most likely to achieve what the public actually wants, which is containment. COVID taught us what happens when public health measures are imposed without trust. The backlash didn’t protect anyone. It made everyone less safe.

People came out of COVID determined not to let it happen again. That determination is now expressing itself as a demand for strict quarantine of 18 cruise ship passengers who pose very little risk to anyone. The intensity of the reaction tells you everything about the depth of the wound.

Hantavirus is not COVID. The risk is low. The quarantine is targeted. But the fear is real, and it’s not about the virus. It’s about what the last virus did to us.

And more in the news…

What the director said vs. what the staff have been told

Yesterday on CBS Evening News, Dr. Jay Bhattacharya, the NIH director and acting CDC director, said CDC staff can work with the World Health Organization again. No waivers. No restrictions. Not just for emergencies, but for everything.

Inside the CDC, thirty-five out of thirty-six staff informed me they’d received no such update. Their last guidance: waivers were still required or communication was simply not allowed. One described the current process for getting permission to engage with WHO as seventeen emails deep, with no answer at the end. Only one person reported that they were working normally without need of a waiver.

“Nothing has changed,” one CDC employee wrote. “We are in the same stance.”

This would be notable on its own. It is part of a pattern that now defines how the CDC is run, or, more precisely, how the CDC is described in public versus how it operates in practice.

WHO restrictions: lifted on TV, enforced in practice

The United States formally withdrew from the World Health Organization on January 22, 2026, completing a process that began with President Trump’s executive order a year earlier. During that year, the U.S. stopped funding WHO, recalled all personnel embedded with the organization, and began handling global health work through direct country-to-country deals instead.

For CDC staff, the withdrawal came with rules. Anyone who wanted to engage with WHO — attend a meeting, join a call, share data — needed approval. In practice, that approval process was slow, opaque, and, according to multiple staff, functionally designed to produce the word “no” without ever saying it.

Staff in at least one division were fired for working with WHO after the withdrawal notice went out. They won their cases before the Merit Systems Protection Board and were reinstated. But the message landed.

“People in our division were fired for theoretically working with WHO after the withdrawal notice,” one CDC employee said. “Until we hear officially that something has changed, we will not be working with them again.”

When Bhattacharya said the restrictions were gone, his own employees had to figure out whether the policy was real by polling each other. Thirty-two checked in. All thirty-two said they’d heard nothing. One suggested, half-seriously, that colleagues could just attach the Instagram clip to their internal request as documentation.

The hiring freeze that isn’t a freeze

Bhattacharya has also said there is no hiring freeze at the CDC. He told staff the agency is “open for business” and looking to “shore up some of the gaps” left by the loss of roughly a quarter of its workforce over the past year.

CDC employees describe something different. Staff say they cannot even transfer to funded, open positions within the agency — lateral moves that don’t add headcount or cost. This has been the case for more than a year. The agency’s human resources staff were moved to a centralized HHS office as part of the department’s 2025 reorganization, and the HR operation has been described as overwhelmed, unable to process routine personnel actions.

NIH, by comparison, is posting jobs and giving priority hiring status to staff who were let go in the reductions in force. CDC is not. Jobs listed on USAJobs for CDC do not prioritize separated staff the same way.

An estimated 300 people remain on administrative leave, many of them from programs Congress specifically funded — chronic disease prevention, maternal health, vaccine education. The money is there. The positions are authorized. The people who used to fill them are sitting at home, drawing paychecks, doing nothing, because the agency cannot or will not process their return.

Then there are the Title 42 staff — scientists hired under a special authority that allows the CDC to recruit and retain top researchers on renewable terms, sometimes for decades. This year, all renewals require HHS approval. The result is that scientists whose programs want to keep them are being functionally fired by HHS, often despite strong performance or critical program need. Some find out they’ve been renewed on their last day. Many hold out hope and it never comes. Some divisions have stopped advocating for renewals altogether and told their Title 42 staff to start looking for new jobs before their terms expire.

In practice, there is no hiring freeze. There is also no hiring. And the staff the CDC already has are being slowly bled out through expiring appointments that no one will approve.

The communications pause that isn’t a pause

In January 2025, the Trump administration ordered a communications pause across federal health agencies. CDC couldn’t update its website, release case numbers, issue health advisories, post on social media, or meet with external partners. The pause was supposed to last until February 1, 2025.

Bhattacharya has said the pause is over. CDC staff describe something closer to a permanent bottleneck. All external communications must be cleared by HHS or a political appointee. For some groups, this amounts to a functional pause — not because a memo says communications are frozen, but because the clearance process is slow enough that timely communication becomes impossible.

The result is the same as the pause. It just doesn’t have the same name.

The money that doesn’t move

Congress appropriated money for CDC programs. That money is not going out the door. Grants are delayed. Award announcements aren’t being prepared. When they do get released, applicants — state health departments, universities — get compressed timelines to apply.

In January 2026, the administration briefly paused more than $5 billion in public health infrastructure grants to states, then reversed the pause within 24 hours. The White House began apportioning CDC’s budget on a month-by-month basis, citing the need for external reviews. Unobligated funds will expire on October 1.

Taxpayer money, appropriated by Congress for public health, is sitting in accounts. The staff who would spend it are on leave. The systems that would process it are centralized and backlogged. The grants that would distribute it are delayed. The result is not a cut. Congress didn’t cut the funding. It is something quieter: money that exists on paper but does nothing in the world.

The pattern

Bhattacharya told CDC staff his goal was to take politics out of public health. He wasn’t able to explain what the politics in public health at CDC supposedly were. The next day, he spoke at CPAC.

The pattern is consistent. Say there is no hiring freeze while hiring is frozen. Say communications are flowing while clearance requirements choke them. Say WHO restrictions are lifted while staff still need seventeen emails to get a non-answer. Say the money is there while it sits unspent.

None of these are lies in the narrow, technical sense. There may be no memo titled “Hiring Freeze.” There may be no document labeled “Communications Pause” still in effect. Bhattacharya may believe, when he speaks to a CBS News anchor, that CDC staff can work with WHO. But the people inside the agency describe a reality that the director’s public statements do not touch.

The effect is a kind of governance by announcement. The policy is whatever the director says on television. The operations are whatever the bureaucracy enforces. And the two aren’t connected.

For an agency whose core job is to tell the public what is true about disease, this is not a small problem. If the CDC’s own director can announce a policy that his own employees don’t recognize, the agency’s ability to communicate reliable information, about anything, is worth questioning.

• Andes hantavirus is now on U.S. soil

• Can U.S. hospitals diagnose Andes hantavirus?

• The Andes hantavirus therapy that was defunded

• What’s left of the U.S. outbreak response system

• And more in the news…

Andes hantavirus is now on U.S. soil

Eighteen passengers from a hantavirus-stricken cruise ship arrived in the United States early Sunday morning. One is in a biocontainment unit in Nebraska after a “mildly positive” PCR test. Two more are at Emory University in Atlanta, one of whom is symptomatic. Fifteen more are in quarantine, and about seven others who returned home earlier are being monitored across five states.

The virus is Andes hantavirus, the only hantavirus known to spread person-to-person. Three people have died in the outbreak linked to the MV Hondius, an expedition cruise ship that spent the Antarctic season in the South Atlantic. Cases are now being tracked in more than a dozen countries.

The public health response is real and moving fast. But two basic tools are missing: a way to diagnose the virus quickly and anything to treat it.

Can U.S. hospitals diagnose Andes hantavirus?

There is no widely available approved PCR test for Andes virus available to U.S. hospitals. The CDC’s own interim guidance from May 10th confirms this.

PCR tests detect the virus itself and are most useful early in illness, when a patient first develops a fever and clinicians need an answer fast. Companies sell hantavirus PCR kits, but they are labeled “research use only.” They have not been validated under CLIA, the federal standard that governs lab testing on patient specimens. That means hospital labs cannot run them on patients and act on the results.

What is available are antibody tests, IgM and IgG, offered through the CDC, some state and academic labs, and Quest Diagnostics. But antibody tests detect the immune response, not the virus. They don’t turn positive until later in the illness, after the immune system has had time to react. They don’t help in the early window when it matters most.

A handful of state labs have filled the gap on their own. California’s viral disease lab has a validated hantavirus PCR originally built for Sin Nombre virus that can also detect Andes. Nebraska’s public health lab developed and validated its own assay specifically for this outbreak. These are state-by-state fixes, not a national system.

If a returning passenger in Texas or Florida develops symptoms tomorrow, their specimens would likely need to ship to the CDC or one of these few state labs. That adds transit time at the exact moment when speed counts.

The Andes hantavirus therapy that was defunded

There is also no FDA-approved treatment for Andes hantavirus. No antiviral. No specific therapy. Care is entirely supportive: oxygen, mechanical ventilation, and in the most severe cases, ECMO, a machine that takes over the work of the heart and lungs.

The most advanced therapeutic candidate was a monoclonal antibody developed at Albert Einstein College of Medicine and the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick. It protected hamsters against Andes virus in a study published in 2022. But the NIH funding for that program expired in 2024 and was not renewed. The work was shelved.

Moderna announced an early-stage vaccine collaboration with the Army and Korea University in 2024, but it has not been studied in humans and is years from clinical use. Last summer, the Trump administration pulled funding for Moderna’s broader mRNA vaccine contracts as part of a wider decision to defund the entire BARDA mRNA vaccine portfolio.

If a quarantined patient progresses to the severe cardiopulmonary phase of Andes virus infection, there is nothing specific to give them.

What’s left of the U.S. outbreak response system

The biocontainment capacity is also thin. Nebraska’s unit has five rooms, but one is now a lab. Realistic capacity for Andes virus patients: two to three beds. A broader National Special Pathogen System does exist, with regional treatment centers across the country.

Meanwhile, the federal leadership picture is its own constraint. HHS Secretary Kennedy said, “we’re not worried” about the hantavirus outbreak. But that disregards how many Americans are feeling right now. Prior to taking office, Kennedy said that we needed to take a break from infectious diseases, and he’s waging war against the safest, most effective, and most cost-effective tools we have to combat viruses: vaccines. The CDC director position has been vacant for over eight months. Dr. Jay Bhattacharya, the NIH director, is also moonlighting as acting CDC director. He acknowledged on CNN that it’s hard to wear both hats. The FDA commissioner is reportedly being fired. There is no surgeon general. USAID has been effectively dismantled. The U.S. has withdrawn from the World Health Organization. It took until Friday for the CDC to alert clinicians. And they haven’t felt the need to give the American public regular daily briefings.

That’s the real story here: the science is working, but the institutions meant to translate it into public understanding and confidence, and into coordination and getting things done on the ground, have been gutted. Public health is a lot like the military. It’s about the chain of command, operations, and logistics.

Here’s a concrete example of what’s being gutted: South Africa was able to quickly sequence this virus and confirm what strain it was. They could do that because the U.S. had invested in genomic sequencing infrastructure there through PEPFAR, the HIV program. That same program has now been cut.

We’re lucky hantavirus isn’t good at causing pandemics. Next time, we may not be so lucky.

And more in the news…

Jessica Dean: And Dr. Céline Gounder joins us now. She’s an infectious disease specialist and epidemiologist. Doctor, you’ve also written extensively on the hantavirus. Thank you so much for being here with us to talk through all of this. Rafael just went through kind of where things are. What is your assessment of how effective the response has been so far to contain this outbreak?

Dr. Céline Gounder: I think my biggest concern has been the lack of communication to the American public. We as clinicians did not receive a health alert until Friday afternoon. It seems to have been timed with the, uh, plans around the 17 Americans being returned home. But I think the American public had a lot of questions leading up to that as to how are these Americans going to be quarantined, what is the testing protocol?

And I think because of that absence of leadership and communication, that raised a lot of questions. People are understandably very scared coming out of the COVID pandemic and asking themselves, “Is this a replay of what we saw in 2020?”

Jessica Dean: Yeah, and to that end I want you as the medical professional to lay this out for people.

How concerned should the general public be?

Dr. Céline Gounder: Yeah, the risk to the general public remains really low. I think of it this way. COVID was a wildfire. It spread through the air. People who did not have symptoms could still infect other people, and the entire world was fuel for the COVID virus. Hantavirus is like a wet log in a stone fireplace.

It requires direct, sustained contact with a sick person. The virus infects deep lung tissue, so it doesn’t get coughed or breathed out in large enough amounts to cross a room. Hantavirus is not a new virus. This is a virus we’ve been studying for decades, and infectious disease specialists understand how this virus moves the way, say, an engineer or electrician might understand how electrical current moves through a wire.

So the material here, the virus here, determines the outcome, and every data point from the outbreak so far is consistent with what the science would predict.

Jessica Dean: And so now we have these 17 Americans who are being flown to this quarantine center in Nebraska where our understanding is they’re going to be evaluated, and from that it will be determined if they will be able to then, uh, go home and be monitored for, for some 42 days or if they’ll stay there in Nebraska.

From the outside looking in, I think a lot of people go, “Wait a minute, shouldn’t they just stay at the outbreak center in Nebraska?” Would you help people understand that process?

Dr. Céline Gounder: Yeah, so they’re assessing the level of exposure. So how much contact, how close of contact, how intense of contact did they each have with known hantavirus cases?

And this is in fact identical to what was done for Ebola back in the 2014 to 2016 epidemic in West Africa. I was an Ebola aid worker. When I landed at Newark Airport, they gave us thermometers and cell phones and diaries to log our symptoms, to check in. And then depending on our level of exposure, we were quarantined differently.

So my level of exposure was I had no known contact with somebody with Ebola without wearing protective equipment, so my level of risk was very low. And I could quarantine at home, which I did for three weeks. And so it’s a similar kind of stratification of risk and determining what level of quarantine is needed accordingly.

Jessica Dean: And what will it be like once. I mean, you kind of just went through what it was like for you, but they’re going to an actual facility in Nebraska. How might that be different?

Dr. Céline Gounder: Well, it depends. So some of them, the low-risk people would be allowed to quarantine at home, which was my experience.

For those who are being kept at the National Quarantine Center, so this is the only federally funded quarantine center in the United States, they have experience with this kind of thing. They handled the quarantine of the COVID passengers on the cruise ship early in 2020. People may remember.

I think people are having flashbacks to that moment. But this center handled that quarantine, and they have practice doing that. The advantage here is hantavirus is actually a far less contagious, infectious virus. So the stakes in that respect are lower, and the other thing that’s really important here is for people who are high risk for developing severe hantavirus disease, they need to be near a medical center that has the capacity for ECMO, which is the heart and lung bypass machine, because when they develop that kind of severe disease, that’s the only thing that can save them.

And so this is actually very much in their interest if they’re at higher risk for infection.

Jessica Dean: And I heard you at the top of our conversation talking about the lack of communication, what you perceive as a lack of or it could be better communication. How else would you evaluate the CDC response to all of this?

Dr. Céline Gounder: Well, we have not heard from the HHS secretary. We have not heard... We, in fact, don’t have a confirmed CDC director. We finally heard from the acting director, Jay Bhattacharya, who’s wearing two hats, in fact. He’s also the NIH director. We heard from him today on Jake Tapper’s show. We don’t have a confirmed surgeon general.

The FDA commissioner has just been fired. We really have a massive void of leadership at the very top to communicate with the American public, and I think we should be having daily situation updates for the American public to understand not only what is the risk to us, but also what is being done to address the situation aboard the cruise ship.

Jessica Dean: All right. More to come. Dr. Céline Gounder, great to have you on. Thank you so much.

• A letter to 900,000 people about one cruise ship.

• Andes virus spreads through close contact, not through the air.

• COVID was the wildfire. Hantavirus is the wet log.

• The agency whose name contains the word “control” isn’t controlling anything.

• The pathway from science to public understanding has been severed.

• Virologists aren’t guessing, but biology can surprise.

• COVID taught distrust. No one taught what comes next.

• A functioning public health system is the difference.

• And in the news…

A letter to 900,000 people about one cruise ship.

Today, the Director-General of the World Health Organization did something unusual. Tedros Adhanom Ghebreyesus wrote a personal letter to the people of Tenerife.

He didn’t issue a press release or file a technical brief for health ministers. He wrote directly to the residents of a single island in the Canary Islands, because a cruise ship was heading toward their port, and they were afraid.

The ship is the MV Hondius. It left Antarctica in March carrying 146 passengers and crew from 23 countries. Three people have died of hantavirus. Five more cases have been confirmed. The ship is set to dock at Granadilla, Tenerife, on May 11. Passengers will be moved in sealed vehicles through a cordoned corridor and sent home.

Tedros assured the people of Tenerife that their risk is low. He said he would travel to the island himself to watch the operation. He thanked Spain for its solidarity. He asked residents to trust the plan.

The letter is thoughtful. It is also one of the most telling documents of the entire outbreak. What it reveals has little to do with hantavirus and everything to do with what comes after a pandemic breaks public trust.

Here’s what we know about hantavirus so far.

Andes virus spreads through close contact, not through the air.

The virus on the MV Hondius is the Andes strain. It spreads through close contact, for example, sharing a bed, caring for a sick person, or handling bodily fluids. Based on decades of research on hantaviruses, it does not spread through the air. You cannot catch it by sitting in the same room, walking through the same port, or breathing the same breeze on a dock in Tenerife.

WHO has said so directly. So has every virologist who has looked at the data. The case count has been stable for more than 48 hours. No one on the ship is showing symptoms. The flight attendant who spent hours in a sealed cabin with a confirmed case tested negative.

Everything we understand about this virus’s transmission — built over decades of studying hantaviruses — points away from pandemic potential. But many are asking, understandably, how we can be confident about that.

COVID was the wildfire. Hantavirus is the wet log.

A fire chief looking at two fires can tell you how each one will behave. A dry forest in drought season with 40-mile-per-hour winds is going to become a wildfire. A wet log in a stone fireplace is going to smolder and die. The chief isn’t guessing. The chief understands the fuel, the conditions, and how fire moves.

COVID was the wildfire. It spread through the air. People who felt fine passed it to strangers in grocery stores. The entire world population was fuel.

Hantavirus is the wet log. It requires direct, sustained contact with an infected person’s body fluids. People who feel fine don’t spread it. The virus infects deep lung tissue, which means it doesn’t get coughed or breathed out in large enough amounts to cross a room. The fuel is limited.

When the mechanism is this different, the expected outcome changes. That’s what research and experience tell us, and so far, it’s what we’re seeing in this outbreak.

The agency whose name contains the word “control” isn’t controlling anything.

So why did the head of a 194-country health agency need to write a personal letter to one island?

The institutions that should be translating this science into public confidence have been silenced, sidelined, or torn apart.

Acting CDC Director Jay Bhattacharya posted his first public statement on the hantavirus outbreak on May 8th, weeks after the first death. He said the risk to Americans is low. He said “clear, written health guidance” had been sent to American passengers “through the State Department.” And he described the CDC’s role as “lending its technical expertise.”

The first Health Alert Network notice didn’t go out to U.S. clinicians until Friday afternoon. No public guidance has appeared on the CDC website, and no CDC official has spoken to the media on the record. Seven Americans are being monitored across five states, and no public protocol exists for their follow-up.

The chief of the CDC’s Vessel Sanitation Program — the unit that handles disease on cruise ships — just retired and hasn’t been replaced. The agency’s budget has been cut. The U.S. pulled out of the WHO. The CDC’s international disease research network, CREID, was defunded.

The pathway from science to public understanding has been severed.

This is what it looks like when you hollow out public health infrastructure, and then an outbreak shows up. The science still functions. Scientists are still watching, testing, and refining what they know. The pathway from that evolving knowledge to public understanding has been cut. So the Director-General of the World Health Organization — responsible for the health of 8 billion people — spends his Friday writing to 900,000 residents of Tenerife to explain that a cruise ship is safe to dock.

Virologists aren't guessing, but biology can surprise.

An electrical engineer can look at a wire and tell you it will carry 15 amps safely and fail at 50. I couldn’t tell you that. I’m not an electrician. But it’s not a guess. The engineer understands, in a way that I don’t, the properties of copper, how heat moves through metal, and how resistance works. The material determines the outcome.

Virologists understand something similar about viruses, with a caveat. Biology is messier than copper wire. Viruses can surprise us, and our understanding updates as new data comes in. Sequencing results from the MV Hondius strain are still pending. If they reveal unexpected mutations, the assessment could shift. But the fundamental principles of transmission — how a pathogen moves between people — are well established. A virus that spreads through the air and passes between people who feel healthy has pandemic potential. A virus that requires close contact with body fluids and only becomes contagious when a person is severely ill has far less capacity to spread. Those principles guide every public health assessment, and right now, every data point from this outbreak is consistent with them.

COVID taught distrust. No one taught what comes next.

COVID taught the public that experts can be wrong, that governments can be slow, and that a new virus can shut down the world. All of that was true. What no one took responsibility for teaching afterward was the other half: how to tell the difference between a virus that can do that and one that cannot. SARS-CoV-2, the virus that caused COVID, was a new virus. We were learning as we went. The hantavirus family, which includes the Andes virus, is not new. We don’t know everything there is to know about it, and what we tell the public could change as we learn more. That’s how science works. It’s a process, the scientific process. It’s not set in stone. Honest risk communication means saying: here is what we know now, here is what we’re still figuring out, and here is how guidance might evolve.

That kind of communication requires institutions willing to show up and talk — in real time, in public, with the humility to say what they don’t yet know alongside what they do. It is the opposite of silence followed by a single tweet.

But every outbreak now lands in the same void, the same fear, the same memory of 2020. Without trusted institutions explaining risk, every cruise ship becomes a plague ship, every port a frontline, and the Director-General of the WHO becomes a therapist.

A functioning public health system is the difference.

Tedros’s letter to Tenerife is generous and kind. It is also evidence of a system failure. The head of a global health agency should not need to fly to an island to personally tell its residents that a ship is safe to dock. That job belongs to national health agencies, public health officers, and government officials with the standing and trust to say: we have looked at this, here is what we know, here is what we’re still learning, here is what you can expect.

There is no vaccine for hantavirus. There never has been. We could have developed one, but the case counts have historically been too small to attract the investment, and the political urgency too low to justify the public funding. Hantavirus is a neglected disease, the kind that doesn’t generate enough market return to develop a product, until it shows up on a cruise ship carrying passengers from 23 countries. Then, for a few weeks, everyone pays attention. Then they stop.

The MV Hondius will dock in Tenerife on Sunday. The passengers will be moved off the ship. Monitoring will continue for 42 days. The outbreak, by every available measure, is winding down.

What is not winding down is the condition that required Tedros’s letter. The gap between scientific understanding and what the public can absorb keeps growing, and the institutions designed to bridge it are being taken apart by the same governments asking their citizens to stay calm.

And in the news…

• May 9th

• May 8th

• May 7th

https://kffhealthnews.org/health-care-costs/trumprx-reality-check-drugs-not-always-cheaper/

https://www.cbsnews.com/news/drug-prices-trumprx/

Since his second term started, President Donald Trump has announced, negotiated, or floated a flurry of initiatives aimed at taming the excesses of the pharmaceutical industry.

No surprise. About 60% of American adults are “worried about being able to afford prescription drug costs for themselves or their families,” a recent KFF nationwide poll showed. More than 80% consider the price of prescription drugs “unreasonable,” and most support increased regulation to lower costs. Americans pay about three times as much as people in other countries for the same prescription drugs.

Last July, Trump sent letters to 17 drugmakers, demanding they voluntarily lower drug prices. Then the president said he’d negotiated with more than a dozen pharmaceutical executives one by one at the White House. In December, he announced that he had compelled them to agree to “most favored nation” pricing on Medicaid, the government coverage for low-income Americans.

Then came the unveiling of TrumpRx, a site where cash-paying patients could find discounted medicines, and a promise to speed biosimilar products — generic versions of certain high-priced specialty drugs — by cutting through FDA red tape.

The scope of these grand gestures remains uncertain. But it’s certainly less than what the announcement promised, partly because many details of the negotiations, even which drugs are covered, are hazy.

White House spokesperson Kush Desai did not answer queries about TrumpRx.

Medicaid already buys drugs at deep discounts. And other patients may well have better options through commercial drug discount programs, which offer far more products, or through their insurance and associated drug company copayment cards.

So, for all Trump’s showmanship, the share of Americans likely to benefit from these options remains slim, even if some people do come out ahead.

“If it makes a difference to any patient, it’s a win,” said Mark Cuban, a billionaire investor on his own mission to bring down drug prices. He pointed to discounted pricing on TrumpRx for branded fertility drugs and GLP-1 weight loss drugs for people without insurance or whose plans don’t include coverage. Cuban launched the Mark Cuban Cost Plus Drug Co., known as Cost Plus Drugs, in 2022 to sell drugs cheaply by eliminating middlemen — buying from factories and selling directly to consumers. Most of the drugs he sells are generics.

Aaron Kesselheim, a professor of medicine at Harvard Medical School whose research focuses on drug prices, said the Trump announcements are “one-off agreements made for publicity purposes. They don’t change anything about the way drugs are priced.”

He added: “The agreements are opaque and unenforceable.”

It was unclear, for example, which drugs would be sold at “most favored nation” prices or how exactly that was defined. But, clearly, not all were.

Doing the Math

46brooklyn, a consulting firm and data project that tracks brand-name drug prices, found that close to 1,000 brand drugs went up in price in January 2026. What’s more, 2025 had the highest number of list price increases ever. “This is not a material change, it’s business as usual,” said Antonio Ciaccia, the company’s co-founder.

In the first week of 2026, Pfizer raised the list prices of 71 drugs by an average of 5% and lowered the price of only one, by 9.8%, the data project found.

The biggest win for patients has likely been the Trump administration’s quiet continuation of a Biden administration program: Medicare drug price negotiation for expensive drugs. The negotiated discounts on the initial 10 drugs — from blood thinners to insulins to medicines for inflammatory disorders — went into effect Jan. 1. With reductions in price of well over 50% on some products, the estimated $6 billion in annual savings allowed the program to cap Medicare patients’ out-of-pocket spending on Part D prescription drugs at $2,000 for 2025 and beyond.

What Patients Will Find in the Mix-and-Match World of American Pricing

The Centers for Medicare & Medicaid Services initially negotiated prices for 10 brand-name drugs, effective this year, aiming to yield significant savings for enrollees and taxpayers. Just one of those, Farxiga, is available on TrumpRx, with a coupon valid only for cash-paying patients not enrolled in a government health plan. GoodRx offers a discount similar to Medicare’s, while Mark Cuban’s online pharmacy, Cost Plus Drugs, offers a generic version for a fraction of the price.

An additional 15 high-priced drugs — including popular weight loss and cancer drugs — were subject to negotiation in 2025, with discounted Medicare prices taking effect next year. And 15 more high-priced drugs are set for negotiation this year. All told, the 40 negotiated drug prices are expected to save Medicare well over $20 billion a year.

Even as these discounts take effect, drug industry lobbyists have been working to limit the impact, with some success. For example, the One Big Beautiful Bill Act exempts drugs for rare diseases from negotiations.

Still, “this is historic because it’s the first time the United States has negotiated prices, like every other developed country,” Kesselheim said. “And guess what? Innovation didn’t stop.”

Of course, these discounts benefit only Medicare enrollees. The newer Trump administration initiatives help some other patients, but they are limited and require knowledge of how to access the discounts.

Trump’s One-on-Ones

The president’s televised appearances with the heads of major drug companies resulted in deals, but few, if any, will mean much to patients. For example, after Trump met with Albert Bourla, CEO of Pfizer, the company announced discounts on 30-plus drugs. Bourla called the deal “a win for American patients, a win for American leadership, and a win for Pfizer.”

The discounts are offered via TrumpRx, which, in turn, offer coupons co-branded on GoodRx.com, which already offers discount coupons for many hundreds of medicines.

Pfizer made hay of the deal, announcing it was part of Pfizer’s broader, landmark most favored nation, or MFN, agreement with the U.S. government, enabling patients to pay lower prices for their prescription medicines “while strengthening America’s role as the global leader in biopharmaceutical innovation.”

Pfizer spokesperson Steven Danehy cited a press release from September noting that the TrumpRx site offers patients savings that “range as high as 85%.”

Most of the list features brand-name drugs, competing with far cheaper generic versions from other manufacturers, such as the cholesterol-lowering drug Colestid, which TrumpRx lists for “50% off” at $127.91. Generic versions cost about $17 on the Cost Plus site.

This means the branded companies aren’t making a sacrifice by offering them at lower costs as reflected on Trump’s portal, said Sean Tu, a patent law expert at the University of Alabama. “That’s a sale they would not have made if not for TrumpRx.”

Others are very old drugs, such as Cortef, or hydrocortisone, whose 5-milligram branded Pfizer version is listed at $45 on TrumpRx, half its list price of $91.80. It sells for far less on Cuban’s Cost Plus site. Still others, such as the $607.20 HIV treatment Viracept, are useful only in combination with other drugs that are not discounted.

Last week, TrumpRx added Amgen’s Humira, for years the world’s best-selling drug, at $950 a dose, down from a list price of nearly $7,000. But Humira lost its patent protection in 2023, and biosimilars — essentially generic equivalents — have since come to market. More to the point, two of those biosimilars are listed on TrumpRx for as little as $207.60 a dose.

Since most of the TrumpRx products are available only to customers without insurance who pay cash, the arthritis drug Xeljanz’s drop from $2,277 to $1,518 a month would still leave it unaffordable.

A Few Notable Deals

The much-touted TrumpRx site, launched Feb. 6, consists largely of Pfizer’s 30 drugs (30 of roughly 85) with a smattering of discounts likely to generate headlines.

These include three fertility drugs from EMD Serono, a subsidiary of the pharmaceutical giant Merck KGaA, the most expensive of which, Gonal-F, has a list price of $966 but is only $168 per IVF cycle using a TrumpRx coupon.

They will save women thousands of dollars — although the overall cost of fertility treatment will continue to put them beyond the reach of many, since drugs represent only a portion of the payment.

The TrumpRx discounts could reduce the $15,000-to-$25,000 cost of a single fertility treatment cycle — women typically need two or three cycles to become pregnant — by about 10%, said Sean Tipton, spokesperson for the American Society for Reproductive Medicine. In some European countries, each cycle costs about $3,000.

In exchange for lowering those prices, EMD Serono got tariffs lifted on its mostly overseas-produced medications. It also won the right to a sped-up FDA approval process for a fertility drug it’s been marketing heavily in Europe.

Another newsworthy offering on the site resulted from a deal with Novo Nordisk for Wegovy, its GLP-1 drug for weight loss and diabetes, with the price reduced to as little as $199 a month for the pen. (Many insurers cover such drugs only for diabetes, leaving those who are interested in losing weight paying out-of-pocket. Zepbound, Wegovy’s Lilly & Co. competitor, is also on the list, at $299.)

Pressure has been building on Novo and Lilly to lower the U.S. price of their GLP-1 drugs. The compounds have lost patent protection in India, and pressure from customers buying overseas will likely increase when generic Wegovy goes on sale in Canada, for as low as $73 a month, possibly this year.

In the United States, meanwhile, dozens of patents should keep Wegovy generics off the market until 2039, said professor Robin Feldman, a patent expert at the University of California Law-San Francisco. A recent report from the research group I-Mak delved into several ways patent manipulation keeps generics off the U.S. market long after they are available in European countries and Canada.

And while the Trump administration has vowed to approve biosimilars more rapidly to ensure more competition and lower prices, that may not have much impact. The big hurdle in getting generics and biosimilars to market is often not FDA approval, but the time it takes to override the thickets of patents that U.S. law allows manufacturers to deploy to protect their intellectual property.

For example, in 2021, the FDA approved a generic of Otezla, a popular drug for psoriatic arthritis, but it will not hit the market until 2028. Its entry would require drugmakers to pay rebates to Medicare if they charged the program more than other developed countries for “single source” drugs and biologics. That would essentially allow the Medicare program to piggyback on other countries that negotiate the prices of some of the most expensive medicines. Those programs are still going through the rulemaking process and, again, would benefit only those covered by the Medicare program and only indirectly.

The average patient-consumer, if willing to pay cash, may find some bargains. But getting the best deal could take a lot of mixing and matching, forcing patients to become choosy shoppers, eyeing deals for essential medicines as they would for a carton of milk or eggs.

Data reporter Maia Rosenfeld contributed to this article.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

• From the Korean War to the Four Corners: how hantavirus was discovered.

• Sweeping a shed is the most common way people catch it.

• The virus makes blood vessels leak, and the immune system makes it worse.

• 890 cases in 30 years, almost all west of the Mississippi.

• The most important diagnostic question: have you been around mice or rats?

• There is no cure. Survival depends on ICU support and timing.

• Rodent-proofing is cheap, proven, and more reliable than protective gear.

• Each outbreak revealed something new about how the virus spreads.

• Animal-waste diseases cause 450,000 infections in the U.S. each year.

• The agency responsible for tracking these diseases lost a third of its staff.

• The bottom line on hantavirus risk and prevention.

• And in the news…

From the Korean War to the Four Corners: how hantavirus was discovered.

Hantavirus is a family of viruses carried by rodents like mice and rats. The animals don’t get sick from it. They shed the virus in their urine, droppings, and saliva.

The virus was first recognized during the Korean War, when over 3,000 United Nations troops fell ill with a mysterious kidney disease. Scientists didn’t isolate the virus until 1978. They named it after the Hantan River in South Korea, near the demilitarized zone where the soldiers were stationed.

The American form of the disease — hantavirus pulmonary syndrome, or HPS — was discovered in 1993 after a cluster of young, healthy people in the Four Corners region of the Southwest died of sudden lung failure. Investigators traced the cause to a previously unknown virus carried by deer mice.

There are two main diseases hantavirus causes, depending on the strain:

• Hantavirus pulmonary syndrome (HPS) is found in the Americas. It attacks the lungs and heart. The case fatality rate ranges from 12% to 45%, depending on the strain. In the United States, it has averaged around 40%.

• Hemorrhagic fever with renal syndrome (HFRS) is found in Europe and Asia. It attacks the kidneys. The fatality rate ranges from less than 1% to about 15%, depending on the strain.

Worldwide, an estimated 200,000 to 300,000 people are infected each year. More than half of the kidney form are in China. In the Americas, about 300 cases of the lung form are diagnosed annually, mostly in Argentina, Brazil, and Chile.

There is no approved vaccine in the Americas or Europe. There is no effective antiviral drug for hantavirus.

Sweeping a shed is the most common way people catch it.

People catch hantavirus by breathing in tiny particles from dried rodent urine, droppings, or saliva. This usually happens when someone disturbs an area where mice or rats have been living: sweeping a shed, cleaning out a cabin, opening a barn that’s been closed up, or moving stored boxes or firewood.

The virus can also spread through a rodent bite or by touching a contaminated surface and then touching your nose or mouth. These routes are less common.

The incubation period — the time between exposure and getting sick — can range from about a week to as long as eight weeks, with illness most commonly beginning around three weeks after infection.

Almost all hantaviruses spread only from rodents to people. The one exception is the Andes virus in South America, and a person can be contagious before symptoms begin. The virus has been detected in blood up to two weeks before symptom onset, and in saliva and nasopharyngeal secretions during the early stages of infection. The risk is highest just before or during the first fever, through sexual contact, kissing, or sleeping in the same room.

In 2018-19, an outbreak in Epuyén, Argentina, produced 34 infections and 11 deaths through person-to-person contact. A separate prospective study in Chile that followed household contacts of Andes virus cases found that sexual partners had a roughly 18% secondary attack rate, compared to about 1% for other household contacts. A 2021 review called the overall evidence for person-to-person spread “weak” and “limited to some parts of Argentina and Chile.” No other hantavirus strain has been shown to pass between people.

Dr. Greg Mertz, emeritus professor of internal medicine at the University of New Mexico, has studied hantavirus for 32 years. Even with Andes virus, he said, the risk from close contact is small. A person can share a bed with someone who is sick and still not get infected.

After three decades of investigating outbreaks and studying how the virus spreads, Mertz said the requirement for close contact makes large-scale spread impossible. Super-spreader events, where dozens of people become ill, have happened in Argentina. Mertz said hantavirus will not cause a pandemic.

The virus makes blood vessels leak, and the immune system makes it worse.

Hantavirus attacks the lining of small blood vessels, making them leak. In the lung form, fluid seeps into the air spaces in the lungs. In the kidney form, the kidneys are damaged and can stop working. Some people also develop myocarditis, inflammation of the heart muscle. The body’s own immune response adds to the damage. Patients often develop low platelet counts, which means their blood doesn’t clot well.

HPS (the lung form)

HPS progresses through stages:

• First stage (2-7 days): Fever, muscle aches, headache, chills, stomach pain, nausea. It looks like the flu. This is when misdiagnosis is most likely and most dangerous.

• Second stage: A sudden shift to coughing, trouble breathing, fast heartbeat, and falling blood pressure. The lungs fill with fluid and the heart can fail rapidly. Heart failure is what kills most patients who reach the hospital. Mertz said the time from first symptoms to the critical stage is typically just a few days. Once a patient enters the cardiopulmonary phase, the risk of death can be measured in hours.

• Recovery: For survivors, recovery takes weeks to months. Some patients have lingering fatigue and reduced exercise tolerance.

HFRS (the kidney form)

HFRS passes through five phases: fever, low blood pressure, decreased urine output, increased urine output, and recovery. Symptoms include high fever, headache, back and stomach pain, and bleeding (such as nosebleeds). Some patients need dialysis to clean their blood when the kidneys fail.

890 cases in 30 years, almost all west of the Mississippi.

Since 1993, the United States has recorded 890 confirmed cases of hantavirus pulmonary syndrome. About 30 per year. 96% occurred west of the Mississippi. New Mexico and Colorado have the highest counts.

70% to 80% of patients are men. The average age is 34.

Occupations with higher risk:

• Forestry workers face the highest occupational risk, 2.9 times the odds of infection compared to the general population.

• Farmers are at 1.9 times the risk.

• Construction workers, especially those demolishing old buildings.

• Military personnel training outdoors.

• Anyone cleaning enclosed spaces — cabins, sheds, barns, basements — that have been closed up and occupied by rodents.

About 40% of U.S. patients reported direct rodent contact or cleaning a rodent-affected area before getting sick.

Other risk factors:

• Living in rural areas, which increases both exposure and the time it takes to reach a hospital.

• Living in dry areas, especially in the western U.S.

• Smoking has been linked to one type of hantavirus in Europe.

• Certain genes that affect the immune response may increase severity.

One pattern scientists have noticed: in places where many people have been exposed to hantavirus over time, like Paraguay and Panama, where seroprevalence runs 17% to 40%, people tend to get milder disease. In places where fewer people have been exposed, like the U.S., Chile, and Argentina, where seroprevalence is under 3%, disease tends to be more severe.

The most important diagnostic question: have you been around mice or rats?

Diagnosing hantavirus early is difficult. The first few days look like the flu, COVID, or many other infections. The critical clue is a history of rodent exposure combined with rapid respiratory decline and a low platelet count.

Doctors use blood tests to look for antibodies against the virus or for the virus itself. They also look for a rising hematocrit (red blood cell concentration) and unusual white blood cells. If initial tests come back negative, repeat testing 72 hours after symptom onset is recommended.

Asking the patient about recent contact with rodents or rodent-affected spaces is one of the most important steps in making the diagnosis.

There is no cure. Survival depends on ICU support and timing.

There is no cure for hantavirus. Treatment is supportive, meaning doctors manage symptoms and keep the body functioning while the immune system clears the virus.

Standard care includes:

• IV fluids, with careful monitoring of electrolytes

• Medicines to support blood pressure

• Supplemental oxygen

• Mechanical ventilation (a breathing machine) for severe cases

• Dialysis if the kidneys fail

For the most severe cases: Extracorporeal membrane oxygenation (ECMO) can take over for the heart and lungs. When started early, before full cardiovascular collapse, survival rates with ECMO are around 80%. ECMO requires a specialized team and equipment found at major medical centers. Mertz said anyone with a known exposure should stay within reach of a major city and a tertiary care hospital. The only way to detect infection before symptoms appear is PCR testing of blood, which is not routinely available outside of hospitals.

Experimental treatments under investigation:

• Convalescent plasma, blood products from people who have recovered, showed lower death rates in an open study in Chile for Andes virus infections.

• Monoclonal antibodies are being tested.

• Favipiravir, an antiviral drug, showed promise in animal studies when given before the virus spread widely in the body.

Treatments that did not work: Ribavirin showed no benefit for the lung form. Methylprednisolone, a steroid, also failed to improve outcomes.

Rodent-proofing is cheap, proven, and more reliable than protective gear.

Prevention comes down to two things: keeping rodents out of buildings, and cleaning safely when rodent contamination is present.

Keeping rodents out

• Seal any opening larger than a quarter inch with steel wool, metal mesh, or caulk.

• Store all food, including pet food, in thick, sealed containers.

• Remove woodpiles, brush, and clutter from around the outside of buildings.

• Use snap traps for ongoing rodent control.

Rodent-proofing works. In studies, sealed buildings had significantly fewer rodent infestations. A program in a Native American community in New Mexico dramatically reduced rodent activity. After the 2012 Yosemite outbreak — 10 visitors infected, 3 dead from staying in cabins with mouse-infested insulation — the park sealed structures and reduced the deer mouse population over the next six years.

Cleaning rodent-contaminated areas

• Open windows and doors for at least 30 minutes before entering.

• Never sweep or vacuum dry rodent droppings. This is the most common way the virus gets into the air.

• Spray surfaces with a 10% bleach solution and let it sit for at least 10 minutes.

• Wipe up with a wet mop or sponge.

• Wear rubber gloves and a properly fitted N95 mask.

• Double-bag dead rodents and contaminated waste.

For workers in high-risk jobs

• Training on hantavirus risk and recognition.

• Proper protective equipment.

• Written cleaning procedures for rodent-contaminated areas.

• Knowledge of early warning signs.

Studies show that even trained workers don’t always follow safe cleaning practices, particularly when they encounter rodents unexpectedly. This is why keeping rodents out of buildings in the first place matters more than relying on protective gear alone.

Each outbreak revealed something new about how the virus spreads.

Four Corners, 1993: The outbreak that put hantavirus on the map in the Americas. A cluster of deaths in the Southwest led to the discovery of Sin Nombre virus in deer mice. Scientists later linked the outbreak to an El Niño cycle that had boosted vegetation, thereby increasing the mouse population and human exposure.

Yosemite, 2012: Ten visitors contracted Sin Nombre virus; three died. Nine of the ten had stayed in tent cabins with foam insulation that attracted nesting deer mice. 14% of trapped mice in the cabin area carried the virus. All 91 tent cabins were dismantled.

Epuyén, Argentina, 2018-2019: The largest documented person-to-person hantavirus outbreak. Thirty-four infections, 11 deaths. Researchers identified super-spreaders and confirmed transmission through close contact, particularly among sexual partners.

Gene Hackman household, 2025: Betsy Arakawa, wife of actor Gene Hackman, died of hantavirus in their home, where investigators found rodent infestation. Despite prolonged close-quarters exposure, Hackman did not contract the virus, a reminder that even sustained household contact does not guarantee transmission with non-Andes strains.

Animal-waste diseases cause 450,000 infections in the U.S. each year.

Hantavirus is one of many illnesses people catch from animal urine, droppings, and saliva. In total, animal-contact illnesses cause roughly 450,000 infections, 5,000 hospitalizations, and 76 deaths in the United States each year.

Salmonella from backyard chickens is now the leading source of animal-contact salmonella in the U.S. Between 2009 and 2021, nearly 9,000 outbreak-linked illnesses, close to 1,800 hospitalizations, and 15 deaths were reported across all 50 states.

Leptospirosis is a bacterial infection spread through rodent and dog urine. Over 1,000 U.S. cases were reported between 2014 and 2020. The fatality rate is 10%. Cases are rising, particularly in New York City’s Bronx borough and in Hawaii, Puerto Rico, and the Southeast after flooding events.

Histoplasmosis is caused by fungal spores in soil enriched by bat and bird droppings. In the Ohio and Mississippi River valleys, 60% to 90% of residents have been exposed. Most cases are mild or asymptomatic, but it can be fatal for immunocompromised people.

Tularemia from rabbits and rodents rose 56% during the 2010s. About 100 to 250 cases per year, concentrated in Arkansas, Missouri, Kansas, and Oklahoma.

Plague still occurs in the rural Southwest — a few cases per year from flea bites on infected rodents.

Cryptosporidium and E. coli from cattle are common at petting zoos and farms.

Toxoplasmosis from cat feces poses particular risks for pregnant women.

The pattern across these diseases is similar. The mechanisms are understood. The prevention is largely structural: housing quality, pest control, sanitation, and occupational safety. The populations most at risk tend to have the least access to those protections.

The agency responsible for tracking these diseases lost a third of its staff.

The CDC is the primary federal agency responsible for tracking and investigating these diseases.

As part of a broader HHS restructuring, the CDC’s workforce was cut by about 2,400 employees. Former officials have said the agency lost about 3,000 people overall through layoffs, buyouts, and resignations. The Epidemic Intelligence Service, the CDC’s outbreak investigators, was initially threatened with cuts but ultimately spared, and a new class was exempted from the hiring freeze. In October 2025, about 1,000 CDC employees received reduction-in-force notices. Roughly 600 remained terminated after hundreds of notices were reversed.

The CDC's Vessel Sanitation Program, which handles cruise ship health inspections, lost all of its full-time civilian employees before being reinstated when the National Center for Environmental Health was restored. The HHS Office of Infectious Disease and HIV/AIDS Policy, which oversaw the Ending the HIV Epidemic initiative and childhood vaccination efforts, was eliminated. Three of 20 port health stations now have no staff.

In January 2026, the United States completed its withdrawal from the World Health Organization, a process the White House initiated a year earlier. HHS and the State Department also rejected the amended International Health Regulations, the framework countries use to share information about cross-border outbreaks. The administration is now proposing to spend $2 billion a year to rebuild the global disease surveillance and outbreak response functions the U.S. previously accessed through WHO at a fraction of that cost.

These changes affect the country’s capacity to detect, investigate, and respond to outbreaks of hantavirus and the broader category of animal-waste diseases described above.

The bottom line on hantavirus risk and prevention.

Hantavirus is rare in the United States, about 30 cases per year, but it is one of the deadliest viral infections a person can contract, with a fatality rate of ~40% for the lung form.

There is no vaccine and no antiviral treatment. Survival in the worst cases depends on reaching an ICU with ECMO capability quickly.

The best prevention is keeping rodents out of buildings and never sweeping or vacuuming dry rodent waste. These measures are proven and low-cost.

Hantavirus is part of a broader group of diseases spread through animal waste. Taken together, these diseases cause roughly 450,000 illnesses in the U.S. each year. The prevention for most of them is structural — housing quality, pest control, sanitation, and occupational safety.

The public health infrastructure responsible for tracking and investigating these diseases has been significantly reduced over the past year.

And in the news…

https://www.npr.org/2026/05/06/nx-s1-5812588/what-to-know-about-the-hantavirus-outbreak-on-transatlantic-cruise

• The gap between what MAHA sells and what MAHA voters want.

• Everyone distrusts Big Food and Big Pharma. MAHA didn't start that.

• Vaccines are MAHA’s only original position, and voters reject it.

• MAHA’s own voters aren’t especially moved by MAHA.

• Healthcare costs lead every other issue for MAHA voters.

• Six months to the midterms, and MAHA has no answer on costs.

The gap between what MAHA sells and what MAHA voters want.

The Make America Healthy Again movement has a theory about what’s wrong with American health. It involves food dyes, pesticides, corporate capture of federal agencies, and vaccines that need “reevaluating.” It does not, as far as I can tell, involve the price of going to the doctor.

This is a problem. Because when you ask MAHA’s own voters what they most want the government to do about health, 42% say lower the cost of health care. Restricting chemical food additives comes in at 21%. Reevaluating vaccine safety lands at 10%.

The movement’s flagship issue finishes second by a two-to-one margin among the movement’s own supporters. Its most controversial issue barely registers.

These findings come from KFF’s April 2026 Health Tracking Poll, which surveyed 1,343 U.S. adults and offers the clearest picture yet of what MAHA supporters actually care about and how far that is from what MAHA’s leaders are talking about.

Everyone distrusts Big Food and Big Pharma. MAHA didn’t start that.

About 41% of U.S. adults say they support the MAHA movement. Among voters, the number is 43%. The coalition skews Republican: two-thirds of MAHA supporters identify as Republican or Republican-leaning, and a majority of MAHA voters also back the MAGA movement.

But here’s what makes the poll interesting. The concerns MAHA has raised — food additives, pesticides, and corporate influence over health agencies — are not MAHA's concerns. They’re everyone’s concerns.

Three-quarters of U.S. adults say there isn’t enough regulation of chemical additives in food. Nearly two-thirds say the same about pesticides. These majorities hold across party lines and across MAHA status. Democrats, Republicans, independents, MAHA supporters, non-supporters — they all agree.

Only 21% of adults trust pharmaceutical companies to act in the public’s best interest. Only 25% trust food and beverage companies. Only 36% have confidence the FDA acts independently. These numbers are low across the board, regardless of whether someone supports MAHA.

So the food safety agenda isn’t a MAHA position. It’s a national consensus that MAHA is trying to claim.

Vaccines are MAHA’s only original position, and voters reject it.

Where MAHA does break from the mainstream is vaccines. And that’s exactly where the public breaks from MAHA.

The KFF poll finds that voters trust Democrats over Republicans on vaccine policy by 41% to 25%. Six in ten voters disapprove of the Trump administration’s handling of vaccine policy. Nearly half strongly disapprove.

This tracks with KFF’s earlier findings on CDC trust, which showed trust in the CDC at its lowest point since COVID. The public viewed HHS’s changes to the childhood vaccine schedule negatively by a two-to-one margin. Even among parents who’d heard about the changes, more said they’d hurt children’s health than help.

A KFF/Washington Post survey of parents added detail: 85% of parents support more regulation of food dyes and additives, cutting across party lines. But MAHA parents are more vaccine-skeptical. 58% lack confidence in the CDC and FDA on vaccine safety.

The pattern is consistent. The food safety stuff is popular because it’s already popular. The vaccine stuff is MAHA’s own contribution. And the public doesn’t want it.

MAHA’s own voters aren’t especially moved by MAHA.

You might expect MAHA voters to rally behind the movement’s signature figures and policies. They do… sort of.

About 72% of MAHA voters approve of the Trump administration’s handling of food policy. But only 32% “strongly approve.” On vaccine policy, 67% approve, but just 29% strongly approve. On HHS Secretary Robert F. Kennedy Jr.’s job performance, 69% approve, but again, only 32% strongly approve.

In each case, the share of MAHA voters who disapprove is roughly equal to the share who strongly approve. KFF calls these “fairly tepid ratings for a group that aligns with Kennedy’s signature movement.” That is a polite way of saying the movement’s own base is not especially moved.

Healthcare costs lead every other issue for MAHA voters.

At least half of MAHA voters say health care costs will have a “major impact” on whether they vote in the midterms (51%) and which party’s candidate they support (56%). Those numbers are higher than the share who say the same about vaccine policy (36% and 40%) or food safety (43% and 45%).

This is consistent across the MAHA coalition regardless of party. Among MAHA-supporting voters, 57% of Democrats, 43% of independents, and 40% of Republicans say lowering health care costs is their single most important health priority. For each group, costs lead the next item by at least 14 points.

And it isn’t just MAHA voters. KFF’s earlier April tracking data found that health care costs are voters’ top economic concern heading into the midterms: 55% say costs will have a major impact on whether they vote, 61% on who they vote for. Democrats hold a double-digit trust advantage on health care costs (40% vs. 27%). And 67% of the public says Congress did the wrong thing by not extending the ACA’s enhanced tax credits, a live pocketbook issue that affects millions of people’s insurance premiums right now.

The MAHA movement has no position on any of this.

Six months to the midterms, and MAHA has no answer on costs.

When MAHA supporters are asked, in their own words, why they support the movement, the most common answers are wanting people to be healthier (19%) and removing harmful substances from food (15%). Only 5% mention health care access and affordability. Just 4% mention vaccines.

So even the movement’s self-described purpose doesn’t match its political agenda. Its supporters want a healthier population. Its leaders are focused on vaccine schedules and food dye bans. And the thing that would most affect the health of the population — whether people can afford to see a doctor, fill a prescription, or keep their insurance — isn’t on the agenda.

With six months until the midterms, voters already trust Democrats more than Republicans on health care costs, vaccine policy, and keeping federal agencies independent of corporate influence. Voters are evenly split on food additive safety, the one area where MAHA has the closest thing to a foothold.

The MAHA movement set out to make America healthy again. Its voters would settle for making America insured again. Nobody’s offering that.

• A hantavirus outbreak at sea, and the country that built WHO isn't part of the response.

• Three dead in five weeks, starting with a fever on day five.

• Hantavirus gets into the air from rodent droppings. Then it hits the lungs.

• Hantavirus doesn't spread between people, with one possible exception.

• The investigation is running. Five countries and WHO are involved.

• The agencies, the officers, and the legal frameworks that were dismantled.

• The CDC was told to focus on infectious diseases. Then it was stripped of the capacity to investigate one.

• The risk is probably low. Proving it requires the investigation the U.S. can't join.

A hantavirus outbreak at sea, and the country that built WHO isn't part of the response.

A cruise ship is anchored off the coast of Cape Verde with 149 people on board, three passengers dead, and a virus no one expected to find in this setting. The World Health Organization is coordinating the investigation. The United States — which helped build the WHO, funded it for decades, and had 17 of its citizens aboard — withdrew from the organization earlier this year.

The official word from the WHO’s European regional director: “low risk to the public.” No need for panic or travel restrictions.

Three dead in five weeks, starting with a fever on day five.

The MV Hondius left Ushuaia, Argentina on April 1. It sailed to Antarctica, then across the Atlantic to the British territory of Saint Helena, and is now stuck off Cape Verde. There are 149 people on board; 17 are American.

The first passenger got sick on April 6, five days into the voyage. Fever, headache, stomach symptoms. He was a 70-year-old Dutch man. He died on April 11. No lab test was performed.

His 69-year-old wife accompanied his body to Saint Helena. She got sick on the flight to Johannesburg. She collapsed at the airport and died in the emergency department on April 26. Her PCR came back positive for hantavirus.

A British passenger developed fever, shortness of breath, and pneumonia on April 24. He was evacuated to South Africa. He is in intensive care in Johannesburg with confirmed hantavirus.

A German passenger died on May 2 after a four-day illness. She progressed from fever and fatigue to death in less than a week.

Three more people on board have fever and gastrointestinal symptoms. They’re being evaluated.

Hantavirus gets into the air from rodent droppings. Then it hits the lungs.

Hantavirus is a family of viruses carried by rodents. People get infected by breathing in tiny particles from rodent urine, droppings, or saliva — usually when sweeping out a shed, opening a cabin that’s been closed up, or disturbing a nest. The virus gets into the air. You breathe it in. You may not know anything is wrong for one to five weeks.

Then it hits fast.

The disease has two forms. In Asia and Europe, it attacks the kidneys. In the Americas, it attacks the lungs and heart. The American form, hantavirus pulmonary syndrome, is the one on this ship.

It starts like the flu. Fever, muscle aches, fatigue. That lasts a few days. Then the lungs fill with fluid and blood pressure drops. Patients can go from walking around to needing a ventilator in hours. Most deaths happen in the first 24 hours after hospital admission.

The case fatality rate for hantavirus pulmonary syndrome ranges from 12% to 45%, depending on the strain. There is no antiviral drug that works. There is no vaccine approved in the Americas. The only thing that reliably saves people in the worst phase is ECMO, a machine that takes over for the heart and lungs while the body fights the virus. ECMO requires a specialized team at a major hospital.

Since tracking began in 1993, the U.S. has recorded 890 cases. About 30 per year. Roughly 36% die.

Hantavirus doesn't spread between people, with one possible exception.

Hantavirus does not normally spread between people. You get it from rodents. That’s been the rule for every known strain — except one.

Andes virus, first identified in Argentina in 1995, is the only hantavirus with documented person-to-person transmission. The ship departed from Argentina.

The evidence for person-to-person spread is contested but real. In 1996 in El Bolsón, Argentina, close contacts of infected patients got sick 19 to 40 days later — the first genetic evidence of human-to-human spread. In 2014, full viral sequencing confirmed it in three cases. From November 2018 through February 2019, a person-to-person outbreak in Epuyén, Chubut Province, Argentina, caused 34 infections and 11 deaths — the largest documented cluster. The researchers identified "super-spreaders." Sexual partners of infected people had a 17.6% secondary attack rate, compared to 1.2% for other household contacts.

A 2021 review in the Journal of Infectious Diseases called the evidence “weak” and “limited to some parts of Argentina and Chile.” The reviewers couldn’t rule out that people in those clusters were just exposed to the same rodent source.

If there are no rodents on the ship and if the virus spreads among passengers anyway, that would suggest that the infection can be transmitted from person to person. Argentina’s Tierra del Fuego province, where Ushuaia sits, has never recorded a hantavirus case. If the exposure didn’t happen in port, it happened on the ship. And if it happened on the ship without a rodent source, it happened between people.

But answering that question requires investigation. The kind that involves trapping rodents on the ship, swabbing surfaces, sequencing the virus, testing all 149 passengers for antibodies, and mapping who got sick when.

The investigation is running. Five countries and WHO are involved.

Here is what is currently happening. South Africa’s National Institute for Communicable Diseases is running sequencing and metagenomics on the confirmed cases. Additional samples were sent to the Institut Pasteur in Dakar, Senegal. WHO activated its International Health Regulations notification, the system that notifies every member country’s health ministry in real time. Argentina shared the passenger and crew lists with each person’s home country through their IHR focal points. Spain has agreed to receive the ship in the Canary Islands for a full investigation and disinfection.

The system is working. Multiple countries, multiple labs, simultaneous action.

But the United States is not part of it.

The agencies, the officers, and the legal frameworks that were dismantled.

In January 2025, the administration signed an executive order withdrawing from WHO. The withdrawal took effect January 22, 2026. The U.S. also rejected the amended International Health Regulations, the legal framework that governs exactly this kind of cross-border outbreak investigation. U.S. personnel were recalled from WHO offices worldwide. CDC employees were barred from co-authoring papers with WHO staff.

Without WHO membership, the U.S. no longer has access to WHO’s surveillance databases or its working groups.

That’s the international side. Domestically, it’s worse.

By the end of 2025, between a quarter and a third of CDC employees had been fired, roughly 4,300 people.

In February 2025, the administration terminated approximately 1,300 CDC employees, including all 50 first-year Epidemic Intelligence Service officers, the disease detectives whose entire job is to investigate outbreaks like this one.

The EIS has been called the “crown jewel“ of American public health. Its officers are trained specifically to go where disease is happening and figure out why. Some of those firings were later rescinded, then another wave hit in October, cutting 40 more second-year EIS officers and 30 program coordinators. Some of those were also rescinded.

The CDC's Vessel Sanitation Program, the unit specifically responsible for cruise ship health, lost all of its full-time civilian employees in early 2025. They were later reinstated when the National Center for Environmental Health was brought back.

The pattern holds across the agency: fire, partially reinstate, fire again. The churn itself does damage. Institutional memory and knowledge has been lost in the process.

The HHS Office of Infectious Disease and HIV Policy was eliminated.

The Morbidity and Mortality Weekly Report, CDC’s flagship scientific publication, the journal that publishes outbreak findings, had its entire staff fired. Some were later reinstated.

The CDC was told to focus on infectious diseases. Then it was stripped of the capacity to investigate one.

HHS Secretary Robert F. Kennedy Jr. said during his confirmation hearing that he wanted to “give infectious disease a break“ because it had been NIH’s “principal preoccupation.” He announced a reorganization to refocus CDC on “its original mission of infectious disease.”

Then he fired the disease detectives. Gutted the cruise ship inspectors. Withdrew from WHO. Rejected the International Health Regulations. Eliminated the Office of Infectious Disease and HIV Policy.

The agency was told to focus on infectious diseases and simultaneously stripped of the people, the international partnerships, and the legal frameworks required to investigate one.

The risk is probably low. Proving it requires the investigation the U.S. can't join.

The hantavirus on the MV Hondius likely won't become a pandemic. The WHO assessment is probably correct. Hantavirus is hard to catch. Even the Andes virus strain, under the worst interpretation of the evidence, spreads only through close contact: sexual partners, people sharing a bed, tongue kissing. The virus has been detected in blood up to two weeks before symptoms begin, and in saliva and nasopharyngeal secretions during early illness, meaning people can be contagious before they know they're sick. That makes the transmission window wider than it first appears. But the close-contact requirement limits how far it can spread. It does not spread through casual exposure the way flu or COVID does.

But “likely” requires proof. And proof requires investigation.

In February 2020, when COVID appeared on the Diamond Princess cruise ship in Japan, a fully staffed CDC deployed a team, coordinated internationally through WHO, and published findings in MMWR. All 3,711 people aboard were tested. That investigation produced critical early data on asymptomatic transmission that shaped the global pandemic response.

In 2024, when Legionnaires’ disease appeared on two cruise ships, CDC’s Vessel Sanitation Program conducted epidemiologic, environmental, and laboratory investigations, identified the source (private balcony hot tubs), and notified operators through “regularly scheduled calls with industry partners.” Both cruise lines fixed the problem. Investigation to resolution.

In 2026, 17 Americans are aboard a ship with a confirmed hantavirus outbreak, and the United States has no formal role in the investigation. It left the organization coordinating the response. It rejected the legal framework governing it. It fired the people who would have done the work.

The virus on the ship will be identified. The sequencing will come back. The investigation will be led by South Africa, Senegal, the Netherlands, Spain, and the WHO. The answer will arrive.

It will just arrive without us.

• Saphier auditioned for Surgeon General by disqualifying the woman who had the job.

• Each nominee enters as a MAHA champion and breaks on the vaccine question.

• The clinical conservative vs. the wellness influencer.

• Box 1: MAGA-aligned

• Box 2: MAHA-aligned

• Box 3: Respected by peers? The credentials are real, but so is what she said on Fox News about vaccines.

• During a measles outbreak, she told parents delaying MMR was fine.

• She called to halt adolescent COVID vaccination, and then Delta hit.

• She says vaccines save lives and then gives permission to skip them.

• Cassidy blocked Means over MMR. Saphier's record gives him more material, not less.

• What this tells you about MAHA.

Saphier auditioned for Surgeon General by disqualifying the woman who had the job.

In May 2025, Dr. Nicole Saphier went on the Clay and Buck podcast and laid out three boxes a Surgeon General should check. She was talking about Casey Means, the wellness entrepreneur Trump had just picked for the job. The boxes: Be aligned with Trump. Be aligned with MAHA. And be respected enough by other doctors that they’ll follow your lead.

Means failed the third box, Saphier said. She never finished her residency. Her medical license had been inactive since 2024. Doctors would not follow someone who hadn’t finished training.

On Wednesday, Trump pulled Means’s nomination and replaced her with Saphier — a breast-imaging radiologist at Memorial Sloan Kettering, Fox News medical contributor, and the woman who wrote the book called Make America Healthy Again in 2020, four years before Kennedy adopted the phrase.

Now her three boxes apply to her.

Each nominee enters as a MAHA champion and breaks on the vaccine question.

Saphier is Trump’s third Surgeon General pick. The pattern matters more than the person.

The first nominee, Dr. Janette Nesheiwat, was pulled in May 2025 after Laura Loomer attacked her vaccine views and questions about her credentials came up. The second, Casey Means, stalled for a year. Her nomination expired under Senate rules. Trump renominated her, but Republican Senators Susan Collins and Lisa Murkowski blocked her over two things: her lack of medical training and her refusal to fully endorse the MMR vaccine.

The clinical conservative vs. the wellness influencer.

Wednesday’s announcement showed something the White House has been managing quietly: MAHA is not one movement. It’s many.

Saphier’s version is clinical-conservative. Chronic disease prevention. Personal responsibility. Anti-Affordable Care Act (ACA). Skeptical of mandates but not of vaccines themselves. She talks like a practicing doctor: board certification, peer review, and evidence.

Kennedy’s version — carried by Means and her brother Calley Means — is wellness-influencer. Metabolic health. Institutional distrust. Supplement-adjacent. The language is disruption, not medicine.

The White House chose between those factions. It chose against Kennedy.

The reaction made the split visible. Kennedy posted on X praising Means as “one of the MAHA movement’s most powerful evangelists.” He did not mention Saphier. Calley Means posted a long thread calling Cassidy “a mindless avatar for his donors and a blind defender of the status quo system that is profiting from American sickness.” He did not mention Saphier either. Both MAHA leaders praised the person who was replaced and ignored the person who replaced her.

Trump, meanwhile, called Cassidy "a very disloyal person" who had engaged in "intransigence and political games," confirmed he had nominated Means "at the recommendation of Secretary Kennedy," and told Louisiana Republicans to vote Cassidy "OUT OF OFFICE" — all in the same batch of posts that announced Saphier.

The message to Cassidy is clear. The message about MAHA is clearer: the movement that wants to run American health policy can’t agree on what it believes about vaccines.

Box 1: MAGA-aligned

Easy pass. Saphier has been a Fox News medical contributor since 2018. She wrote Panic Attack: Playing Politics with Science in the Fight Against COVID-19 in 2021. She opposed vaccine mandates. She defended physician latitude on hydroxychloroquine and ivermectin. She said, “Blanket universal mandates have no place in the United States anymore.”

She passes Box 1 cleanly. This is also the box that makes the other two harder.

Box 2: MAHA-aligned

This is where Saphier has the strongest claim of anyone Trump has considered. She published Make America Healthy Again in 2020. Kennedy didn’t use the phrase until 2024. She holds the copyright. Her argument: Americans don’t need government-run health care. They need to take better care of themselves. The ACA ignores “something crucial: personal responsibility.”

In November 2024, she wrote on X: “Four years after I wrote this book, I am finally seeing the momentum and enthusiasm to Make America Healthy Again.”

She is the original MAHA author. The political logic of the pick is obvious.

Box 3: Respected by peers? The credentials are real, but so is what she said on Fox News about vaccines.

The credentials are real. She is board-certified by the American Board of Radiology. She did a fellowship at the Mayo Clinic. She teaches at Weill Cornell. She runs breast imaging at MSK Monmouth. That profile is far stronger than Means’s.

But the Surgeon General’s job is not breast imaging. It is population health, vaccines, addiction, and risk communication. Saphier is a radiologist who spent eight years on Fox News talking about infectious disease, pandemic policy, and childhood vaccines — none of which are her field. During COVID, she was criticized for exactly this.

The deeper problem is what she said. Two documents, four years apart, form a pattern.

During a measles outbreak, she told parents delaying MMR was fine.

On February 11, 2025, the Texas measles outbreak had already hit 124 cases. Saphier went on Fox News and did two things at once. She said the MMR vaccine’s risk-benefit “makes sense” and the schedule “is what is recommended.” She also told parents: “There have been children who have died from the MMR vaccine. You have to acknowledge that when you have the conversation.” That claim needs context. The IOM’s 2012 review found that deaths from vaccine-strain measles infection have occurred, but only in immunocompromised children who should not have received the live-virus vaccine in the first place. The cases are extremely rare. Saying “children have died from the MMR vaccine” to a general audience of parents during an outbreak, without that context, implies a risk to healthy children that the evidence does not support. Then she said that if parents didn’t want to vaccinate on time, “I think it’s OK to have that conversation and let them wait.”

She suggested parents delay MMR until their kids were past the age when signs of autism typically show up — between 1 and 3. “Maybe let the parent get their child through that time, and if there aren’t signs of autism, then maybe they’ll feel better about being able to vaccinate their children.”

She blamed the CDC for causing the hesitancy, arguing that lumping the COVID vaccine with MMR on the childhood schedule made parents doubt all vaccines. “Because they lumped them together, you have now more vaccine hesitancy with MMR.”

She said symptoms of autism “start to show around the time we’re giving all these vaccines, so it makes sense to kind of think they may be related.” That reasoning — two things happen at the same time, so one might cause the other — is the foundational mistake of the anti-vaccine movement. Andrew Wakefield built his fraudulent 1998 paper on it. In the same segment, Saphier herself cited a Danish study of more than 650,000 children that found no link between MMR and autism. Then she told parents it made sense to delay anyway.

She also said the CDC and AAP should be “less stringent” on vaccine schedules, leaving the choice to parents.

The CDC schedule is timed to when kids face the greatest risk. The first MMR dose is given at 12–15 months because that’s when a mother’s antibodies fade and the child becomes vulnerable. Measles is most dangerous in children under 2; they have the highest rates of hospitalization, pneumonia, and encephalitis. Delaying until a child is “past the autism window” means leaving them unprotected during the period of greatest danger.

The risks of that delay go beyond the infection itself. Measles wipes out existing immune memory, leaving children more vulnerable to other infections for years after they recover. And in children infected before age 2, measles carries a risk of SSPE — a fatal brain disease that can appear a decade later — at rates far higher than previously understood. Research also consistently shows that children who fall behind on the vaccine schedule are less likely to catch up. A parent who delays at 12 months doesn’t always come back at 4.

That outbreak killed two children in Texas. They were unvaccinated.

She called to halt adolescent COVID vaccination, and then Delta hit.

In June 2021, Saphier published a Fox News op-ed: “Let’s pause COVID vaccination for our kids.”

It wasn’t about mandates. It was about the program itself. She wrote that “universal vaccination campaigns should be halted in adolescents and even young adults until more safety information becomes available.”

She speculated, without published evidence, that the vaccine might cause MIS-C, a serious inflammatory condition, in healthy children. MIS-C had not been linked to vaccination. It still hasn’t.

This was a signed, bylined op-ed. She put her name on a call to halt a vaccination program and added a disclaimer at the bottom: her views were “separate and apart from her position as a physician at Memorial Sloan Kettering Cancer Center.” MSK wanted distance. She published anyway.

Weeks later, the Delta wave hit. Pediatric COVID hospitalizations climbed sharply through the summer and fall of 2021. The sharpest rise was among unvaccinated adolescents, the group she had told to stop getting vaccinated.

She says vaccines save lives and then gives permission to skip them.

When Saphier faces a childhood vaccination program, her response is to slow it down. Raise speculative safety concerns. Push the decision to parents. Criticize the agencies that set the schedule.

Every word the Surgeon General says about MMR during an outbreak becomes federal guidance. The hedges, the “maybes,” the “I think it’s OK to wait” — those land differently when they come from the nation’s doctor.

Cassidy blocked Means over MMR. Saphier's record gives him more material, not less.

Senator Bill Cassidy blocked Casey Means because she wouldn’t fully endorse the MMR and hepatitis B vaccines. Cassidy is a gastroenterologist. He chairs the HELP Committee.

Saphier’s confirmation hearing, if it happens, will center on the same question that sank Means: Will you fully endorse childhood vaccines on the current CDC schedule?

Her record makes that harder than it looks. She told parents during an outbreak that delaying MMR was “OK.” She signed an op-ed calling to halt adolescent COVID vaccination before Delta. She can’t wave those away.

To clear the question, she’d need to say she was wrong. That’s hard for anyone under oath. It’s harder when your public brand is built on the claim that you were right about COVID and the establishment wasn’t.

What this tells you about MAHA.

Three nominees. Three failures or stalls. Each time, the same problem: MAHA’s vaccine politics meet the Senate’s minimum bar for what a Surgeon General has to say.

Nesheiwat was pulled before she reached the committee. Means couldn’t clear it. Saphier has a stronger résumé than either, but two published pieces — in her own words, arguing against childhood vaccination programs — give Cassidy the same material he used against Means.

The deeper question isn’t whether Saphier can be confirmed. It’s whether any MAHA-aligned nominee can hold this office without first walking back the part of MAHA that opposes the childhood vaccine schedule. The White House has tried a family medicine doctor, a wellness entrepreneur, and a radiologist. The job keeps breaking the nominee.

Maybe the problem is the job. Or maybe the problem is what MAHA asks its nominees to believe.

https://the1a.org/segments/has-rfk-delivered-on-maha-promises/

• Kennedy told Congress he promotes the MMR. Yet his World Cup plan is testing booths, not vaccination.

• Food dyes, SNAP restrictions, and the version of MAHA you’re supposed to see.

• Courts are already blocking the food wins. The corporate pledges are voluntary.

• What the food wins are covering for.

• Cutting mRNA funding doesn’t just slow vaccine work. It slows cancer research.

• 420 anti-vaccine bills in state legislatures, and the groups behind them are tied to MAHA.

• The asymmetry: reversible wins, irreversible damage.

• 286,000 unprotected kindergartners and a disease that erases immune memory.

• He didn’t start the fire. His job is to put it out. He’s removing the extinguishers.

Kennedy told Congress he promotes the MMR. Yet his World Cup plan is testing booths, not vaccination.

Last week, HHS Secretary Robert F. Kennedy Jr. told Congress he “promotes the MMR” vaccine and called it “vital to keeping children healthy.” That same week, U.S. measles cases hit 1,792 — the largest outbreak in over three decades. 92% of those patients were unvaccinated.

When Senator Bill Cassidy pressed him on measles preparedness for the FIFA World Cup this summer — 11 U.S. host cities, millions of international visitors — Kennedy said HHS was “laser-focused” on prevention. His plan: “booths and testing booths and institutions all over the games.” Testing. Not vaccination drives. Not catch-up MMR campaigns. Not mobile clinics. Testing.

Kennedy would like you to focus on what he says. The real story is what his agency does.

Food dyes, SNAP restrictions, and the version of MAHA you're supposed to see.

MAHA — Make America Healthy Again — polls well because much of it is easy to agree with. Food dyes are being phased out. Major food companies have committed to reformulating products. Eighteen states are restricting sugary drinks from SNAP purchases. A bipartisan coalition — from California to West Virginia — has introduced over 140 food additive bills.

This is the part of MAHA that the White House wants you to see.

Courts are already blocking the food wins. The corporate pledges are voluntary.

But even here, the ground is shaky. Courts have already blocked West Virginia’s dye ban and Texas’s food labeling law. The corporate pledges are voluntary. And when MAHA’s food faction pushed for action on glyphosate — the weed killer Kennedy himself has called a carcinogen and sued over — the White House signed an executive order to make more of it. “I guess I’m a Democrat now,” one MAHA influencer wrote in her chat groups.

What the food wins are covering for.

While the food debate plays out in grocery aisles, something harder to undo has happened to America’s vaccine system.

Last June, Kennedy fired all 17 members of the CDC’s Advisory Committee on Immunization Practices. This is the body that sets the federal vaccine schedule. He put anti-vaccine activists in their seats, including the research director of the National Vaccine Information Center. He canceled a pro-vaccination ad campaign during an active measles outbreak. He rolled back COVID vaccine recommendations for children and pregnant women. He defunded mRNA vaccine research.

Cutting mRNA funding doesn't just slow vaccine work. It slows cancer research.

That last item gets less attention than it should. mRNA technology isn’t just about COVID. It’s being tested for cancer, autoimmune diseases, and other infections. Early trials have shown promising results for pancreatic cancer — a disease that kills most people who get it. Cutting mRNA funding doesn’t just slow vaccine work. It slows cancer research.

“This is really a dismantling of the post-World War II federal science infrastructure,” I said on NPR’s 1A. “The reason the United States is at the top of these fields — tech, biotech, biomedical research — is because of that federal investment. It’s what sets us apart. Now China is rapidly catching up, and there are very real biosecurity risks that would result from our falling behind.”

420 anti-vaccine bills in state legislatures, and the groups behind them are tied to MAHA.

At the state level, an AP investigation found over 420 anti-vaccine bills introduced in legislatures across the country. Well-funded groups tied to Kennedy and MAHA are pushing them. The rollback isn’t just federal. It has roots now.

The asymmetry: reversible wins, irreversible damage.

Here is what’s easy to miss. MAHA’s food wins are mostly voluntary corporate pledges and state laws that may not survive court challenges. Its vaccine damage is institutional — captured advisory committees, defunded research, dismantled public messaging. A company can reverse a dye pledge with a press release. The vaccine damage will outlast Kennedy’s time in office no matter what happens in November.

Measles has an R₀ of 12 to 18. It is one of the most contagious diseases we know of. It wipes out immune memory, leaving kids more vulnerable to other infections for years after they recover. And in children infected before age 2, it carries a risk of SSPE — a fatal brain disease that can show up a decade later — at rates far higher than we used to think.

286,000 unprotected kindergartners and a disease that erases immune memory.

Kindergarten MMR coverage has dropped to 92.5%. That leaves about 286,000 kids unprotected in a single school year. The U.S. will likely lose its measles elimination status — held since 2000 — when the Pan American Health Organization reviews the data in November.

He didn't start the fire. His job is to put it out. He's removing the extinguishers.

“The moral injury that people working in public health are currently suffering is tremendous,” I told 1A. “When my colleagues and I went into this field, public health is not a very high-paying profession. We do this because we want to help. And then when you see somebody who claims he’s fighting corporate interests, when that is completely the opposite. He’s lining the pockets of many of his friends in the supplements and wellness industries. I can’t even begin to put into words the despair that many in my field are experiencing right now.”

Kennedy told Congress the outbreaks started before he took office. True enough. But before he took office, he ran one of the country's biggest sources of vaccine misinformation. And his job now isn’t to say who started the fire. It’s to put it out.

He has chosen, instead, to quietly remove the fire extinguishers.

• The FDA declared safety and admitted it has no safety standard in the same document.

• The U.S. has no legal limit for any of these metals in baby formula.

• Abbott killed babies. ByHeart hospitalized 51 infants. Formula testing requirements have not changed.

• The framing works because it gives newsrooms an easy headline.

• Trap one: repeating “safe” without asking what it means.

• Trap two: mistaking volume of testing for adequacy of response.

• Trap three: the political framing that buries the regulatory failure.

• Same data, different ruler, opposite conclusion.

• Formula is essential. That is the argument for standards, not against them.

The FDA declared safety and admitted it has no safety standard in the same document.

The FDA tested 312 formula samples from 16 brands for heavy metals, pesticides, PFAS, and phthalates. Pesticides and mercury came back clean. But arsenic showed up in 94% of samples, lead in 80%, and cadmium in about two-thirds. These are trace levels — from soil and water where ingredients are grown. They are not a reason to panic or stop using formula.

The U.S. has no legal limit for any of these metals in baby formula.

But the U.S. has no legal limit for any of these metals in baby formula. The EU has limits. Canada has them. Australia has them. So when the FDA calls formula “safe,” there is no standard behind that word. The agency admitted as much on the same page — it is still “working to establish action levels.” It declared safety and acknowledged the absence of a safety standard in the same document.

Abbott killed babies. ByHeart hospitalized 51 infants. Formula testing requirements have not changed.

This is happening against the backdrop of two contamination crises. In 2022, Cronobacter bacteria at an Abbott plant in Michigan killed at least two babies and caused a national formula shortage. Last year, at least 51 infants across 19 states were hospitalized with botulism linked to ByHeart formula — a brand that had already received an FDA warning letter for mold, insects, and contamination failures. Formula makers are still only required to test for two germs. The one that caused the ByHeart outbreak is not one of them. Recalled cans were still on store shelves weeks after the recall.

Budget cuts are hitting the people who investigate formula outbreaks.

Meanwhile, the FDA has been losing food safety staff to federal budget cuts. The CDC and state and local health departments have lost the people who actually investigate outbreaks. The people tasked with monitoring for both chemical and microbiological problems are being asked to do more with less.

The framing works because it gives newsrooms an easy headline.

Now here is the part I want you to pay attention to: how this story gets covered is itself a test.

The FDA’s press release is designed to reassure. It leads with quotes from HHS Secretary Kennedy — “protecting our children’s health is nonnegotiable” — and anchors on big numbers: 312 samples, 120,000 data points. The word “safe” appears repeatedly. The framing works because it gives newsrooms a clean headline: FDA’s Largest-Ever Test Confirms Baby Formula Is Safe.

That headline is wrong, but it is easy. And once it circulates, the details become almost impossible to inject into the conversation. This is what information researchers call Brandolini’s asymmetry: it takes far more effort to correct a misleading claim than to produce one.

There are three traps in how this announcement gets covered.

Trap one: repeating "safe" without asking what it means.

The FDA used the word. Reporters will repeat it. But the U.S. has no enforceable standard for what “safe” means in infant formula. The word is a regulatory assertion with nothing behind it. Repeating it without noting that is not reporting.

Trap two: mistaking volume of testing for adequacy of response.

120,000 data points sounds thorough. 312 samples sounds like a lot. But the question that matters is not how much testing was done. It is what action follows. The answer, so far, is none.

Trap three: the political framing that buries the regulatory failure.

Kennedy’s involvement guarantees that coverage will split along political lines. Outlets sympathetic to the administration will cover this as proof that his “Make America Healthy Again” agenda is working. Outlets hostile to it will use the arsenic numbers to scare parents. Neither is accurate. The data are real. The framing is misleading. The regulatory gap is the story, and it predates this administration.

Same data, different ruler, opposite conclusion.

Consumer Reports’ own testing found concerning arsenic levels in over half the formulas it tested, using European standards as a benchmark. That divergence — the FDA calling the same reality “safe” while Consumer Reports flags it as “concerning” — shows how much the framing depends on which ruler you use. The U.S. has chosen not to have a ruler.

Formula is essential. That is the argument for standards, not against them.

Millions of babies and parents depend on infant formula. This is not a reason to stop using it. It is a reason to ask why we are still testing without setting standards, still losing the people who catch problems, and still calling the results reassuring.

• The annual ritual of corporate climate commitments.

• Researchers checked the science. Almost none of it was there.

• What greenwashing looks like in practice.

• Shoppers, investors, and lawmakers all rely on these claims.

• Legal consequences are starting to arrive.

• How the industry steered public health guidance, and now, climate narratives.

• "Sustainable" means nothing without proof.

The annual ritual of corporate climate commitments.

Every year, the biggest meat and dairy companies in the world put out long reports about what they’re doing for the planet. The reports are full of pledges. Promises. Timelines. The word “sustainable” appears a lot.

Researchers checked the science. Almost none of it was there.

A new study in PLOS Climate checked whether any of it holds up.

Researchers at the University of Miami and New York University looked at 1,233 environmental claims from 33 of the world’s biggest meat and dairy companies, including Tyson, Smithfield, and Hormel. The claims came from company sustainability reports and websites published between 2021 and 2024.

Of those 1,233 claims, three were backed by peer-reviewed science. Three.

The rest, 98%, qualified as greenwashing.

What greenwashing looks like in practice.

Some were vague promises about the future with no clear plan to get there. Smithfield pledged to go “carbon negative by 2030.” Tyson aimed for “net-zero by 2050.” Nearly 38% of claims fell into this category: big goals, no roadmap.

Others were so small they barely counted. Hormel highlighted a thinner turkey tray. Another company added a recycling logo to its packaging. These are real examples from the study.

Shoppers, investors, and lawmakers all rely on these claims.

This matters because meat and dairy production accounts for roughly 14.5% of global greenhouse gas emissions. That’s a huge share. And the reports these companies publish shape how shoppers choose products, how investors move money, and how lawmakers write rules. If the reports are mostly fiction, so are the decisions based on them.

Legal consequences are starting to arrive.

The timing is hard to ignore. Just months ago, Tyson settled a greenwashing lawsuit and agreed to stop calling its beef “net-zero” or “climate-smart” for the next five years. The company had been saying things the science didn’t support — and got caught.

How the industry steered public health guidance, and now, climate narratives.

This isn’t the first time the meat industry has shaped the story to suit its interests. It has a long track record of steering public health guidance to keep meat at the center of the American plate.

Now it’s doing the same thing with climate.

"Sustainable" means nothing without proof.

The next time a food company tells you its products are “sustainable,” ask one question: where’s the evidence? According to this study, the answer is almost never in the report.

• A 2002 study scared doctors away from hormone therapy for two decades.

• The FDA finally removed the black box warnings.

• Estrogen patch sales tripled in five years.

• Roughly 20 estrogen patch products are now in short supply.

• Estrogen patches are cheap, hard to make, and no one built extra capacity.

• Stopping estrogen suddenly brings the symptoms crashing back.

• What doctors say to do right now.

A 2002 study scared doctors away from hormone therapy for two decades.

The Women’s Health Initiative linked estrogen to heart disease, stroke, and breast cancer. Doctors stopped prescribing it for menopause symptoms like hot flashes, night sweats, and brain fog. Later research showed those risks had been overstated, especially for women under 60. But by then, an estimated 50 million women had gone without treatment or been talked out of it.

The FDA finally removed the black box warnings.

On November 10, 2025, HHS announced it would strip the bold safety warnings — called “black box” warnings — from hormone therapy products. By February 2026, new labels were approved for six products, with 29 more drug companies submitting changes.

Estrogen patch sales tripled in five years.

Women listened. Sales went from about 46.5 million units in 2020 to more than 142 million in 2025, according to IQVIA data reported by the Wall Street Journal. By February 2026, about 1 in 20 women aged 45 to 54 had a prescription for estrogen. But no one made sure there would be enough patches to go around.

Roughly 20 estrogen patch products are now in short supply.

Brands like Dotti and Lyllana are on back order with no clear return date. Others ship in small weekly batches. Some pharmacies have stock one day and nothing the next. The shortage could last up to three years. The FDA still has not declared an official national shortage, but some regions or suppliers are facing supply issues.

Estrogen patches are cheap, hard to make, and no one built extra capacity.

This is a math problem, not a factory breakdown. Patches need special materials and dedicated production lines. Manufacturers were already running at full speed. But margins on generic drugs are thin. No company invested in extra capacity, and new lines take years to build. Tariffs on overseas drug makers have added more pressure.

Stopping estrogen suddenly brings the symptoms crashing back.

Hot flashes, sleepless nights, brain fog can return quickly without treatment. Switching to a different brand or form of estrogen is possible, but you may need to get prior authorization from your insurance company for an alternative. Women with blood clot risks can’t safely switch to pills.

What doctors say to do right now.

Don’t stop on your own. Call other pharmacies, including your mail order pharmacy and independent pharmacies. Ask your doctor about a temporary switch. Refill early.

The FDA corrected one 22-year mistake. It just made a new one: telling millions of women to get a treatment, then leaving the supply chain to figure itself out.

• Schedule I was scientifically wrong, and rescheduling fixes that.

• Strong evidence for four conditions, weak or missing for the rest.

• Patients are running ahead of the science.

• Dispensary products look nothing like what was tested in trials.

• One in three medical users develops problem use within a year.

• Support for marijuana legalization is falling, not rising.

• Rescheduling was step one. Here's what step two looks like.

• From the archives…

Schedule I was scientifically wrong, and rescheduling fixes that.

On April 23, 2026, the Department of Justice announced it was moving marijuana from Schedule I to Schedule III under federal drug law. Schedule I is for drugs the government says have no medical use. Schedule III is for drugs with medical use and a moderate risk of dependence, the same category as testosterone and ketamine.

The change followed a December 2025 executive order directing the attorney general to lower marijuana’s classification. The White House said the goal was to expand research and protect patients in states that had already legalized medical cannabis.

Schedule I was scientifically wrong. Marijuana does have medical uses. Keeping it in the same category as heroin made the whole scheduling system look absurd and created real barriers to clinical research. Rescheduling removes those barriers. But it does not, on its own, fill the gap in evidence that matters most to patients.

Strong evidence for four conditions, weak or missing for the rest.

In November 2025, JAMA published the largest review of cannabis research to date, covering more than 2,500 studies.

Strong evidence supports marijuana for a short list of conditions: long-term nerve pain, nausea and vomiting from chemotherapy, muscle stiffness from multiple sclerosis, and certain childhood seizure disorders like Dravet syndrome and Lennox-Gastaut syndrome. For sleep problems, anxiety, PTSD, and Alzheimer’s disease, the evidence is weak or missing.

Even where the evidence is solid, the benefits are small. For chronic pain, doctors would need to treat 11 patients before one gets meaningful relief beyond a placebo. On a standard 10-point pain scale, the average improvement was half a point.

The FDA has approved exactly three marijuana-based drugs: cannabidiol (Epidiolex) for childhood seizures, dronabinol (Marinol) for HIV/AIDS-related weight loss and chemotherapy nausea, and nabilone (Cesamet) for chemotherapy nausea. These are the uses where the benefits clearly outweigh the risks. They cover a small fraction of the people who use medical marijuana.

Patients are running ahead of the science.

More than 4.1 million Americans were enrolled in state medical marijuana programs in 2022, up 4.5-fold from 2016. The top reason is chronic pain, at about 48%. Anxiety is 14%. PTSD is 13%.

The share of patients using marijuana for conditions with strong scientific backing has been shrinking. In 2016, 85% of medical marijuana patients had evidence-supported conditions. By 2022, that fell to 54%. States kept adding qualifying conditions. The research did not keep pace.

This is exactly why rescheduling for research matters. We need rigorous trials on the conditions for which millions of patients are already using marijuana. Right now, those patients are running ahead of the science.

Dispensary products look nothing like what was tested in trials.

The JAMA review raised a second concern. Clinical trials that showed benefit used products with THC levels below 10%. THC is the chemical in marijuana that produces a high and is linked to most side effects. Dispensary products labeled “medicinal” average 19% THC. “Recreational” products average 22%.

That gap carries consequences. High-potency marijuana, above 10% THC, carries measurably higher risks. Users report psychotic-like experiences at nearly twice the rate of those using lower-potency products (12% vs. 7%) and anxiety disorders at a higher rate (19% vs. 12%). Clinical guidelines recommend against smoking or using high-potency marijuana for medical purposes.

What patients buy at a dispensary looks nothing like what was tested in the studies.

One in three medical users develops problem use within a year.

Cannabis use disorder, problem use that meets clinical criteria for addiction, affects 29% of medical users within six to twelve months. One in three patients who smoke marijuana 20 or more days a month develops cannabis hyperemesis syndrome: severe, repeated nausea and vomiting, which is one of the conditions marijuana is supposed to treat.

Daily smoking doubles the risk of heart disease (2% vs. 1%) and nearly triples the risk of stroke (3% vs. 1%), even after accounting for tobacco. Marijuana also changes how the body processes common drugs, including blood thinners, seizure medications, and antidepressants.

The patients most likely to use medical marijuana are the most vulnerable to its harms. In health records, 61% of medical marijuana users had conditions where it posed added risks. Mental health disorders showed up in 36%. Substance use disorders in 22%.

Support for marijuana legalization is falling, not rising.

Gallup polling from October 2025 found 64% of Americans view marijuana positively, down from 70% a year earlier. Republican support fell from 53% to 40%. YouGov polling from April 2026 found 53% support legalization, down from 60% in 2022. That softening tracks with growing visibility of cannabis-related harms — emergency room visits, psychotic episodes, hyperemesis — that were less common when marijuana was harder to get.

Rescheduling was step one. Here's what step two looks like.

Rescheduling was the right call. What it should unlock, and what will determine whether it actually helps patients, is a wave of rigorous, well-designed clinical trials on the conditions people are already using marijuana for. Trials that test products at the potency patients actually buy, not the low-dose formulations from a decade ago.

Beyond research, the clinical system needs structure. About 29,000 doctors authorized medical marijuana in 2022. More than half were in general practice. There is no standard training. There is no standard list of approved products. There is no system to make sure what patients buy at a dispensary has anything to do with what was studied in the trials.

The federal government just told patients that medical marijuana is real medicine. Now it has to build a system that treats it like one.

From the archives…

• One city left with clean air.

• The Clean Air Act worked for half a century.

• The smoke problem the Clean Air Act was never designed to handle.

• The EPA removed health from the math.

• Children are the population most biologically vulnerable to air pollution.

• Southern California proved that cleaner air builds bigger lungs.

• Racial gaps in pollution deaths widened 16% in a decade.

• AI infrastructure is being sited in communities already overburdened by pollution.

• The law that made American air breathable is under siege from climate and policy.

• Gone from the spreadsheet, not from the emergency room.

One city left with clean air.

Two years ago, five American cities earned clean grades on all three major air pollution measures. This year, one did. It’s Bangor, Maine.

The American Lung Association released its 27th annual "State of the Air" report today, Earth Day, and the picture is simple. Air quality in the United States is getting worse.

Some 152 million people live in counties that failed at least one air pollution measure. That’s 44% of the country. Among them: 33.5 million children, or 46% of everyone under 18. More than 7 million kids live in places that failed all three.

The Clean Air Act worked for half a century.

For half a century, the Clean Air Act was one of the clearest success stories in American public health. The EPA estimated its 1990 amendments alone would prevent over 230,000 early deaths and 2.4 million asthma attacks per year by 2020, with benefits outweighing costs by more than 30 to 1. Air got cleaner. Lungs worked better. Children in Southern California saw their rates of clinically low lung function drop from nearly 8% to under 4% as pollution fell.

That progress is now reversing.

The number of people living in counties with unhealthy ozone — the lung-searing gas also known as smog — rose by nearly 4 million over last year’s report. More than 129 million Americans now live in areas that earned an F for ozone. The trend is driven by two forces arriving at the same time: a climate that produces more wildfire smoke and extreme heat, and a federal agency that has chosen this moment to step back.

The smoke problem the Clean Air Act was never designed to handle.

Wildfire smoke is now a dominant force in American air quality. A 2023 study in Nature found that smoke has stalled or reversed PM2.5 improvements across the country, especially in western and midwestern states. Researchers estimate that climate change contributed to roughly 15,000 wildfire-related pollution deaths in the U.S. over 15 years. Under a high-emissions scenario, one projection puts annual smoke-related deaths at over 70,000 by 2050.

This would be a reasonable moment to strengthen protections. The EPA has done the opposite.

The EPA removed health from the math.

Over the past year, the agency has weakened enforcement of clean air rules and rolled back regulations on power plant and vehicle pollution. It has also taken a step that sounds bureaucratic but is structurally devastating: the EPA removed health-related information from its economic analyses of regulatory changes. This means the costs of air pollution to children, families, and communities will no longer be counted when the agency decides whether to weaken or eliminate a rule.

Put plainly: the agency has changed the math so that sick kids don’t show up in it.

Children are the population most biologically vulnerable to air pollution.

Children are not a minor footnote in air pollution science. They are the population most biologically vulnerable to it. Their lungs are still growing. They breathe more air relative to their body size than adults. They spend more time outside. Exposure during childhood doesn’t just cause symptoms — it causes lasting damage. The research is extensive and consistent.

PM2.5 — the fine soot that comes from wildfires, diesel engines, power plants, and wood stoves — penetrates deep into the lungs and, in children, can cross into the brain through the olfactory bulb. A meta-analysis of six studies found that each 1 microgram per cubic meter increase in PM2.5 was linked to a loss of about 0.27 IQ points. That’s a small number per child. Applied to 33.5 million children breathing failing air, it’s a population-level cognitive toll.

Traffic-related pollution — particularly nitrogen dioxide — is a major driver of childhood asthma. A global burden study estimated 4 million new cases of childhood asthma per year linked to NO2, with 64% in cities. In the U.S., a large cohort study found that PM2.5 and NO2 exposure in the first three years of life was tied to asthma by early childhood.

Southern California proved that cleaner air builds bigger lungs.

Southern California's Children's Health Study tracked kids from age 10 to 18 and found that those growing up in more polluted communities reached adulthood with measurably smaller lungs. When the air later improved, the next generation’s lung function improved too. The biology responded to the policy. It will also respond to its absence.

There is also this: the air you breathe depends heavily on who you are.

Racial gaps in pollution deaths widened 16% in a decade.

People of color in the U.S. are more than twice as likely as white individuals to live in a county that fails all three air pollution measures. Hispanic individuals are more than three times as likely. A 2021 study in Science Advances found that Black and Hispanic Americans bear 56% and 63% excess PM2.5 exposure relative to their share of consumption-driven emissions. The disparity holds across income levels and geography. A 2022 study of public schools found that students from marginalized racial and ethnic groups face consistently higher NO2 and PM2.5 at school — the place where children spend most of their waking hours.

These gaps have not closed with time. National PM2.5 levels have fallen, but the most polluted neighborhoods in 1981 were still the most polluted in 2016. And between 2010 and 2020, racial disparities in PM2.5-linked premature deaths widened by 16% overall and 40% for Hispanic communities.

AI infrastructure is being sited in communities already overburdened by pollution.

While the air grows more dangerous and the burden remains unequal, a new source of pollution is emerging. Data centers — powered largely by fossil fuels — consumed 1.5% of global electricity in 2024 and are projected to account for nearly 10% of electricity demand growth through 2030. Harvard researchers have begun quantifying the health costs of fossil-fuel plants built to power AI infrastructure. A UC Riverside/Caltech study projects data centers could contribute to 600,000 asthma-related symptom cases by 2030. These facilities are disproportionately sited in communities of color.

The peer-reviewed health evidence for data centers is still thin. The electricity demand is not.

The law that made American air breathable is under siege from climate and policy.

So this is where things stand. The law that made American air breathable for half a century is being dismantled from two directions. Climate change is loading the atmosphere with wildfire smoke and heat-driven ozone that the Clean Air Act was never designed to handle. And the agency responsible for enforcing that act is rolling back protections, weakening standards, and — most quietly — removing health from the calculations used to justify those decisions.

The EPA's own analysis of one power plant rollback projects up to 1,100 additional PM2.5-related deaths and 120 additional ozone-related deaths by 2035. The Environmental Protection Network estimated that rolling back 31 regulations could lead to 200,000 premature deaths and 100 million additional asthma attacks.

Gone from the spreadsheet, not from the emergency room.

Those numbers will no longer appear in the EPA’s cost-benefit analyses. Because the agency decided they don’t count.

Thirty-three and a half million children are breathing air that fails federal standards. Their lungs are still being built. And the government has found a way to make them disappear.

• Fiscal responsibility has a $1 billion per day blind spot.

• What $1 billion buys in health care.

• The war spends the CDC’s workforce budget in 102 minutes.

• Only one of them makes you prove you deserve help.

• The budget tells you what the government values.

Fiscal responsibility has a $1 billion per day blind spot.

I was listening to the New York Times’ The Headlines this morning and heard an early estimate that the United States is spending roughly $1 billion a day on the war in Iran. That got me thinking.

The One Big Beautiful Bill Act, signed in July 2025, cut $911 billion from Medicaid over the next decade. CBO and KFF analyses project that the law will increase the number of uninsured people by about 10.9 million by 2034, with roughly 7.5 million of that coming from Medicaid changes.

The law added work requirements for some Medicaid expansion adults, tightened eligibility and verification rules, restricted some immigrant access to coverage subsidies, and limited state financing mechanisms used to support the program. The stated reason was fiscal responsibility.

So here is a useful exercise. What does $1 billion actually buy in American health care?

What $1 billion buys in health care.

At today's costs, $1 billion is enough to cover about 101,000 people on Medicaid for a full year at about $9,859 per person per year, based on 2023 federal data.

The same $1 billion covers roughly 151,600 people’s ACA insurance premium subsidies for a year, based on the average advance premium tax credit of $549.69 per month reported by CMS in early 2025. Those enhanced subsidies are scheduled to expire at the end of 2025 unless Congress acts to extend them.

One billion dollars also buys about 4.93 million primary care visits at a federally qualified health center, using the 2025 Medicare payment rate of $202.65 per visit. Or 303,000 days of care in a community hospital. Or 379,000 years of Medicare prescription drug coverage. Or 17.7 million standard flu shots. Or the salaries of 8,170 epidemiologists or 13,400 community health workers or 7,330 registered nurses — for a year.

Those are daily figures. One day of war, converted into health care.

The war spends the CDC's workforce budget in 102 minutes.

Now multiply by 365. $365 billion per year is about 39% of total annual Medicaid spending. It is roughly a third of Medicare. It is 7% of all U.S. health spending. It could fund 37 million people on Medicaid for a full year, or 55 million people's ACA health insurance subsidies, or 23 million veterans' health care for a year. These are not hypothetical line items. Coverage subsidies and beneficiary payments flow through existing federal and state channels: Medicaid claims systems, ACA Marketplaces, and VA facilities.

For context, the entire Medicaid unwinding after the pandemic stripped coverage from about 25 million people. One year of war spending is large enough, in budget terms, to cover the cost of restoring coverage for tens of millions of people.

Now consider the agencies being cut. The CDC’s total budget in fiscal year 2024 was $9.22 billion. One year of war spending equals about 40 CDC budgets. Assuming a $71 million CDC public health workforce funding line, then $1 billion a day in war spending would equal that amount in about 102 minutes. The war spends that in about 102 minutes. The administration’s proposed fiscal year 2026 budget would have cut NIH by nearly $18 billion, roughly 40% of its funding. The war spends that much in 17 days.

The entire annual budget for the Strategic National Stockpile — the federal reserve of drugs, vaccines, and medical supplies meant to protect Americans in a crisis — is $1 billion. BARDA, the agency that develops medical countermeasures against chemical, biological, radiological, and nuclear threats, runs on $1.05 billion a year. Also one day. The Hospital Preparedness Program gets $240 million a year. The war burns through that by lunchtime. The entire HRSA Health Center Program — which funds community health centers serving more than 32 million patients — runs on $6.12 billion. About six days.

The Indian Health Service, which provides care to 2.8 million American Indians and Alaska Natives, operates on about $8.2 billion a year, roughly $2,900 per patient. At current war spending, the entire IHS budget is covered in eight days. Doubling it would cost another eight.

The VA health care system serves 9.1 million enrolled veterans across 1,380 facilities on about $118 billion a year. The PACT Act created a $12 billion funding shortfall in fiscal year 2025, requiring emergency supplemental appropriations. The war covers that shortfall in 12 days.

Only one of them makes you prove you deserve help.

At $911 billion over ten years, the OBBBA represents an extraordinary reduction in Medicaid funding and one of the largest cutbacks in the program’s history. KFF has concluded that the law would reverse major coverage gains associated with the ACA.

At $365 billion a year, the war in Iran will cost roughly $911 billion in two and a half years. The decade of Medicaid austerity and the war exist on the same fiscal timeline, but only one of them came with a formal public estimate of how many people would lose health coverage. Only one imposes work-reporting and recurring eligibility burdens on people seeking care. Only one triggers work-reporting requirements and 90-day redetermination cycles. Only one requires a person to prove, repeatedly, that they deserve the money.

The budget tells you what the government values.

National health spending hit $5.3 trillion in 2024 and is projected to reach $8.6 trillion by 2033. The Medicare Hospital Insurance Trust Fund is projected to be depleted in 2033. The uninsured rate rose in 2024 for the first time in five years. HHS is being reorganized and downsized — about 20,000 positions eliminated, HRSA and SAMHSA folded into a new agency, and about $1 billion in SAMHSA mental health and substance use programs proposed for elimination.

The argument for all of this is the same: we cannot afford it.

But $365 billion a year is going to a war, with no estimate of who loses coverage, no proof of work, and no forms to fill out. The constraint was never money. It’s what we value.

Instead of 37 million Medicaid enrollees or 1.8 billion primary care visits or 6.5 billion flu shots or 365 years of the Strategic National Stockpile, $1 billion buys a war. Every day, for $1 billion, with no paperwork required.

• Nearly half of U.S. generics come from India, and India’s oil is going through a war zone.

• Which medications are most at risk?

• Would a ceasefire fix this?

• What should people do?

Nearly half of U.S. generics come from India, and India’s oil is going through a war zone.

It’s a chain that most of us never think about.

Nearly half the generic prescriptions filled in the United States come from India. Your blood pressure pill, your metformin, your amoxicillin — there’s a good chance it was made in a factory outside Mumbai or Hyderabad.

Those factories need oil to make your medicine. Not just to power the plant. The drugs themselves are made from oil — solvents, coatings, blister packs, IV bags, syringes, and vaccine vials. Nearly all of it starts with petroleum. Even Tylenol begins with chemicals pulled from crude oil.

About 40% of India’s crude has historically come through the Strait of Hormuz. Shipping through the Strait is down 90% since the war began. Indian pharma exports dropped 23% in March — the steepest monthly decline in five years. The International Energy Agency reported that chemical plants across Asia were already cutting output by 10-30%. BASF, a major supplier of drug ingredients, raised prices up to 20%.

Which medications are most at risk?

Two groups.

The first is everyday generics — blood pressure pills, statins, metformin, common antibiotics, and basic painkillers. These are cheap drugs with tiny margins. Makers can’t absorb big cost jumps, so they raise prices or stop making the drug. 217 generic products were dropped by Indian makers in the first quarter of 2026 — 83% more than the same period last year, per FDA data. When makers start dropping products, shortages follow.

The second is drugs that must stay cold — insulin, cancer treatments, certain vaccines, and biologics. The major air cargo hubs they move through — Dubai, Doha, Abu Dhabi — shut down when the war began. Gulf air cargo capacity fell 79% in the first week. Those hubs are slowly coming back, but capacity is still far below normal and rates have roughly doubled. Companies are rerouting through Jeddah, Istanbul, Singapore. Every extra stop is another chance for a temperature problem — and with cancer drugs, a temperature slip can destroy the product.

There’s also a sleeper problem: MRI machines need liquid helium to cool their magnets. Qatar supplies about a third of the world’s helium. Strikes hit a major gas plant there, and QatarEnergy cut helium exports 14%. Helium containers stuck near the Strait evaporate around the six-week mark. That product isn’t delayed. It’s gone.

Would a ceasefire fix this?

Not quickly. The ceasefire is close to expiring. Even if shipping lanes opened tomorrow, it would take months to clear the backlog. Shipping companies say they need a week and a half to catch up for every week of paused shipments. Damage to chemical plants could take years to fix. And once shipping resumes, distributors will rush to stock up — panic buying that creates its own pressure, especially in countries that can’t afford a bidding war. That hoarding pattern is already playing out with energy: wealthy nations are scrambling to lock up oil and gas supplies, outbidding poorer countries and driving up the cost of the very raw materials that drugmakers need.

What should people do?

Most pharmacies still have 30 to 60 days of supply on hand. This isn’t an empty-shelves moment — yet. Shortages, if they come, will likely surface in June or July.

If you take a daily generic, make sure your prescription is current and filled. If you’re on something that needs refrigeration — an injectable, a biologic, an insulin — talk with your doctor now about a plan in case of delays.

The system hasn’t broken yet. But it’s burning through its buffer. The United States built the cheapest generic drug supply in the developed world by sending production overseas and never really thinking about what happens when the route breaks. Now we’re about to find out.