The MAHA movement is all over the news and this month we start off with a first person account of a meeting between the grassroots members of a local MAHA group and four public health leaders. Spoiler alert - what happened isn't necessarily what you would have expected. Following that we are pleased to bring you an interview with an early career professional who went from a childhood in Sub-Saharan Africa...to an Ivy League university...to a career in public health. It's an inspiring story that shows how important U.S. resources are to public health in Africa.
Our look back at Covid continues with articles from our May 2020 issue. The pieces this month address the concerns about the perceived lack of CDC involvement at the time, a look at the Swedish policies, and a modeler's estimate of the deaths we would see during the pandemic.
As always, we continue to provide you with our popular monthly word game feature, Notes on People, an overview of what we are reading from the public media, and a listing of upcoming epidemiology events. Finally, don't miss the Job Bank offerings this month. We have some interesting opportunities.
Did you miss last month’s issue? Read it here: https://tinyurl.com/2vehydww or here: https://tinyurl.com/yuuubpc2
In This Issue
A Meeting with the MAHA Grassroots
What I heard and how I'm approaching this moment
Author: Katelyn Jetelina, PhD, MPH
NOTE: This article was originally published on May 1, 2025 by Your Local Epidemiologist on Substack.
A few weeks ago, I got an invitation that stopped me in my tracks. Leaders and grassroots members* of a local Make America Healthy Again (MAHA) chapter wanted to meet with me, and four public health leaders I deeply admire.**
I sat with it for a long time. Honestly, my gut reaction was no. Not just because I’m busy, not just because it felt risky, but mainly because I’m angry. I’m heartbroken. Watching the world I spent my career in and the people I care about being destroyed—brick by brick and getting taken over by falsehoods and value systems I adamantly disagree with. To me, MAHA has been right at the center of that destruction.
I didn’t know what this meeting would bring. Would it be a political ambush? Would I be able to hold back my grief and rage? Could I trust them not to twist my words and blast them on social media?
But after a lot of wrestling and, frankly, putting on my big girl pants I decided to show up. My goals were simple: 75% listening, 25% speaking my truth.
The meeting was last Friday. And it turned out to be one of the most raw, honest, and important conversations I’ve had in years. At first, we all agreed to keep it private. But afterward, everyone was surprised
pleasantly by how constructive it was. With their permission, I’m sharing a glimpse of it with you.
First: This is a time to listen
As angry as I am, I also know this: if we are truly honest with ourselves, the systems that public health and healthcare built in the 20th century are not keeping up with the needs of Americans today. The world has changed. The information landscape has shifted dramatically. The genuine power of a curiosity-driven public one that expects faster information, more transparency, and more agency has been unleashed.
Those of us in the health world are now at a crossroads. We can either double down on what we know the old systems, the old ways of doing things—or we can listen, learn, and evolve. Both instincts are understandable. Both instincts are necessary. But for me, I’m far more interested in the latter: figuring out better ways to serve Americans where they are now, not where we wish they were.
Listening doesn’t mean agreeing with everything. It doesn’t mean validating falsehoods. It doesn’t mean abandoning evidence or the values that guide me. It simply means understanding truly understanding—what is driving people’s fears, frustrations, questions, and hopes. Because if we don’t listen, we will continue to build systems that overlook the people we are supposed to serve. And if we keep missing them, decisions about public health will continue to be made without our input and we’re already living with the consequences.
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What I heard
I heard three powerful themes emerge from this meeting.
1. First, the health system has failed them.
Everyone in the room had a story with a common thread: heartbreak, betrayal, and thus, mistrust:
A mom caring for an adult child with autism, navigating a system that constantly made things harder, not easier.
A family ripped apart by the opioid epidemic, started by pharmaceutical greed and perpetuated by indifference.
A small business owner who survived pandemic shutdowns, but felt invisible and expendable the entire time.
These weren’t abstract debates about policy. These were lived experiences painful, messy, human. And the message was clear: when it mattered most, the systems built to protect people didn’t show up for them.
2. Our communication isn’t connecting.
Information dissemination, which many in public health and healthcare have been doing, is inherently different from communication, which involves listening. It’s not that people are always rejecting science outright. It’s that, mainly, no one is meeting them where they are—or taking the time to answer their real, everyday questions:
Why does my newborn need the Hepatitis B vaccine if we’re not at high risk?
Why did Covid-19 recommendations change so often?
Why are we beholden to a pharmaceutical industry that fueled an opioid epidemic?
These are good-faith questions. When public health doesn’t show up with clear, empathetic answers, others do Joe Rogan, RFK Jr., wellness influencers. If we stay silent, preach from a moral high ground, or offer one-size-fits-all answers, we leave a vacuum. And that vacuum is getting filled by louder, more relatable, more empathetic, and sometimes more dangerous voices.
3. Grappling with the costs of MAGA alignment.
Something that genuinely surprised me: some acknowledged that hitching their movement to the broader MAGA movement was a risky bet. I heard that they are grappling with the consequences: cuts to public health research on diabetes, food access, maternal health, and more. Cuts that are hurting their ability to make progress.
I heard that much frustration stems from the perception that “the system” should sometimes do more for people, at least where they see it working for them. For example, one mom was saying how much she was concerned about Medicaid being cut because she relies on it for her adult, autistic son. Without it, she would have to use her retirement savings to become a full-time caregiver for him.
While they are fully supportive of Secretary Kennedy’s vision, some believe that blind allegiance to MAGA may be hindering the development of real solutions, rather than facilitating them.
Speaking our truths
The second part of my goal in going to this meeting: I needed MAHA people to hear me, too. I was proud that my colleagues and I were able to accomplish this. We said:
We care deeply, too. We are also parents, partners, grandparents, and active members of communities. And we’ve dedicated our lives to improving the health of Americans. To paint scientists, public health workers, and leaders in public health in a different light is deeply hurtful.
The destruction is real. Friends and colleagues are being fired. Research funding is disappearing before our eyes. Leaders and colleagues are being asked to chase falsehoods, rather than progress. The very foundations of public health are being dismantled. This hurts the most vulnerable in our communities, and it also directly hurts making America healthier. Many of the cuts go directly against MAHA priorities.
When leadership targets those of us in science, it’s dangerous and scary. People show up at our houses. Paul Offit shared a powerful story during this meeting: his childhood experience in a polio ward led him to be a pediatrician and develop vaccines. And, yes, he eventually profited from that which many have criticized him for, including RFK Jr., who accused him of being a pharma shill; but then he asked the group very directly, “Do you still see me as the enemy?” One of them replied, “Of course not.” That moment stayed with me.
Where we go from here
MAHA is not a monolith, and the points of view reflected in these conversations don’t necessarily reflect everyone. For example, in this group, some were up to date on vaccines, some weren’t. Some were Republicans, some Democrats, some Independents. In general, it was clear we have fundamental areas of disagreement on vaccines, data, and even the value of science itself.
Regardless, I want to keep the conversation going, to find slivers of common ground where we can make incremental progress. I believe the only path forward is to reach out to those who lack trust in public health or scientists, instead of meeting skepticism with blind resistance.
We agreed to keep talking and I intend to keep showing up. I’m still approaching this with a healthy dose of skepticism, but I also see cracks in the foundation small, real openings where common ground exists. There are places where we share the same goals: better access to nutritious school lunches, reduced corporate influence on health, longer and healthier lives by targeting chronic diseases, broader access to understandable and helpful information, and substantial support for families. Maybe, just maybe, we can work on some of these solutions together. Because clearly, we both need something from each other.
Today, many people are chasing quick wins. But odd bedfellows coming together doesn’t happen because of a lucky break or a viral post. They happen because of hard, sustained, often invisible work to build relationships. Not transactions. My friend Brinda Adhikari, the former Executive Producer of The Problem with
- MAHA cont'd on page 5
Jon Stewart and now co-host of the Why Should I Trust You? podcast, has spent months, even years, nurturing these relationships and was the one who set up this meeting patiently creating the space for real conversations between public health and the public. I’m honored she trusted me and a few others enough to enter the room. Bottom line
I’m grateful to the MAHA grassroots individuals who showed up to share their stories and to listen to ours. And I look forward to continuing this discussion.
Most people want a healthier America. Most people are also frustrated with the current systems.
So, I’m focusing on three things: Fight for people, not institutions. Meet questions with empathy. Look for opportunity in the rubble because it’s there, if we’re willing to see it. Even when it’s hard. ■
*MAHA members of this meeting: Elizabeth Frost, Nancy Fuller, Daniel DeLuca, Donald Wiggins, and Mark Harris.
**Public health leaders of this meeting: Me, Paul Offit, Megan Ranney, Craig Spencer, and Reed Tuckson
This article was originally printed in Your Local Epidemiologist. To read more content from this source subscribe to Your Local Epidemiologist (YLE): https://tinyurl.com/47494ms4
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Profiles in Public Health
A career sparked in Sub-Saharan Africa and nurtured by academic institutions and public health professionals in the developed world
Interviewer: Staff
Editors note: At their request, to protect their current and future positions, the identity of the individual being interviewed has not been included in this article. All other individuals who are mentioned have consented to have their names included. It is the interviewee's hope that by helping readers in the developing world understand the importance of foreign funding and assistance in Sub-Saharan Africa that they can make at least a small difference in the ongoing discussion regarding the current cuts.
When at immigration, keep quiet, goes the adage. I was traveling by myself - a 16 year old at immigration in Paris. I kept quiet about the petri dishes in my suitcase - bacteria on agar plates, sealed with that stretchy material that you pull on and wrap around the plate to close it. The esteemed Pasteur Institute had decided to help me, a high school student, with my science fair project. When they did, I found out the bacteria on my agar plates was a new species, they called it Bacillus soil1, straight from the dirt in my classmate’s back-yard. The phylogenetic tree showed it was not distantly related to anthrax. Do I need to mention how fortunate I was no one asked me what I had in my suitcase in the airport?
Where did you grow up and how did your education and community trigger your interest in science?
I am really blessed that I can call two different places home. One is where I was born, in the Balkan, Eastern Europe and Caucasus region, and the other where I spent much of my childhood and adolescence, in Sub-Saharan Africa. Our backyard in Africa was home to a multitude of creatures, insects, spiders, and chameleons. This piqued my interest in the natural world. I also was an avid reader.
My story is not particularly uncommon, one of my parents was a refugee and had a break to study in another country. That parent then returned to their homeland, when it was possible to do so, with a spouse and child in tow, and a love of learning. As it was a new country at that time, the spirit of optimism was everywhere. I believe it is still there; we have a great deal left to do.
Was there a special teacher or incident that sparked your interest in taking your petri dishes to Pasteur?
I would not pin it down to one incident per se. But I had noticed there was this major disease claiming the lives of people in the community and that got me interested in microbes. Those were bleak times in my country. I distinctly remember my fourth grade science teacher showing signs of what I would later learn was AIDS. My French high-school teacher passed on shortly after she had become a widow. At that same high school, I had extremely competent teachers, including international ones. The two that come to mind are: my biology teacher (from Canada) and my Chemistry/Physics teacher (from the Philippines) both of whom really pushed
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me to enter the science fair. I am so grateful to them and all the teachers in my school.
When I went to Paris, it was for a scheduled holiday. I just happened to combine it with a trip to the Pasteur Institute, which I did not declare at immigration. At the Pasteur Institute I was fortunate to receive assistance from Professeur Grimont in the Bacteriology department. It was his good will to help a science fair student from a country that had just appeared on the map of Africa after years of colonial rule.
What happened after the science fair?
I did not make it past the national competition, despite my high school being known for producing consecutive Science Fair winners, who would go on to represent the country at the international competition. Part of the reason was I had no control for my experiment (sometimes, we do miss the basics, in search of the exemplary). Nevertheless, I used the entire science fair experience in my applications to universities in the United States. No less than two years later, I had a full-ride to an Ivy League university - a place I had only heard of before, but discovered was a formidable institution while I was attending classes there.
What stands out in your college experience in the USA? Were there professors, lecturers and others who nurtured your interests? Was going to the USA a real culture shock?
I was stunned by the amount that students were doing, at any given time! Back home I remember people being easy-going, not always in a rush driven to accomplish the next thing. That was the major culture shock - the pressure to remain focused and working at high speed
all the time. I can definitely say every single instructor and professor from all departments, not just my own - Molecular Biology, were extremely dedicated to us. I was very impressed by how inspirational they all were. It was not just the Nobel Prize winning tenured professors, but everyone on campus.
However, it was also very grueling, as at the time we had a system known as grade deflation. It meant we competed mostly for the coveted A grades, which only went to those in the top 30% of any class. I remember doing a problem set with a classmate who cried (she is an epidemiologist today and doing well at one of the big pharma companies). Overall, it was an incredibly empowering experience. I went home immediately after graduation and I truly believed I could do whatever I wanted. I was fortunate to find work right after graduation.
After you graduated, what was the next step in your education and career?
When I graduated, the US was in the middle of the Great Recession - one of the worst economic downturns in living memory. I had not been admitted to graduate school. I wanted to study epidemiology, but they required work experience as part of the application process. When I realized I wasn't going to graduate school I was already at the end of my undergraduate career so I did not end up applying for the prestigious fellowships that would have been my alternative as my university had links to many of them.
Returning home, to Africa, felt like let down, noting that I did not know a single fellow African who returned after graduating from university in the United State. But going back to my
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country turned out to be the best decision I could have made. Because of my interest in public health it was the perfect time to return to Namibia. I was driven to address the scourge of HIV and AIDS, which was pervasive in my country at that time. My country was very fortunate because it received one of the largest grants of US aid dollars (when calculated on a per capita basis). These grants fell under the PEPFAR program in Africa. The CDC had been on the ground in Africa since 2004, having benefited from the injection of PEPFAR funds which started the programs and associated surveillance designed to curb the rising tide of infection and abate the deaths we had become so accustomed to in those years.
How did you get a job as part of the program?
I often wondered if it was my degree from an Ivy League university that opened the door for me, but I found a job by merely asking about how the country collected data on HIV prevalence. The Ministry of Health housed a special directorate that was born out of PEPFAR funding to the country. Now, in 2009, they needed staff to work on a census that would map the health facilities in the entire country, and take an inventory of health providers, services, the works! I remember getting the call on a Saturday to attend the training; I visited Friday afternoon. Certainly the team from CDC knew of my university and its reputation. They were not the ones to hire me though, the government was, but I assume they had a say. I only got the offer after completion of 3 weeks training. My role was to manage a team of data clerks, as well as update the Demographic Health Survey Office in the US, which would write the report. I will never know for sure what opened the door for me but I will be forever grateful. This was my first job in public health, my way into the field. Thanks in part to
the US government, one of the key donors to the project.
What happened next to advance your career?
Working on that first job, I met two incredible CDC staffers who shaped the remainder of my career to date. Sadhna Patel, an epidemiologist, worked on everything related to HIV at the time. The epidemiological aspect of that first job entailed field workers going to every single health facility in the country and recording the numbers in the health information system of that facility. I remember perusing handwritten ledgers that documented patient visits and the associated clinical information. I was despondent when I discovered the entire census exercise, meant to be a true census, left out the prison health facilities. How could we leave out a group that were so vulnerable to HIV infection? I didn't have the authority to change the scope of the project, because our Ministry of Prisons would have to sign-off for our access to their facilities before we could investigate prison sick-bays and clinics. Sadhna let me know this would not be the end of the information gathering, as the CDC was planning further projects to look at HIV not only amongst prisoners but also others, such as sex workers and gay, bisexual and other men who have sex with men. Thanks to her mentorship, I eventually did my MPH at an esteemed institution and presented my research on HIV among a vulnerable population at the AIDS Conference in Durban in 2016. Most importantly, this I turned my despondency at returning to Africa into a drive to learn. She has remained my mentor in the years since she left the country.
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After your MPH what did you do next?
In those early years, I started writing about public health and I found support from the CDC. One of the aspects that fascinated me was how our national blood transfusion service dealt with HIV prevention. Unlike the situation in the global North [Europe & North America], there were no restrictions put on GBMSM for donating blood in our country. The HIV epidemic became pervasive very quickly. There was no known trigger, such as a blood transfusion event or an initial outbreak among members of the GBMSM community, that started it all. By the time I had returned to my country, large swathes of people had already succumbed to AIDS in the years before the US government dollars brought antiretroviral therapies to us. There was also no epidemiological data to say the blood transfusion led to the outbreak in my country. As a result there was no need to adopt such measures. Lastly, no one spoke about the GBMSM population, so it was understandable that the blood transfusion service did not mention them on their intake form. There was no such community that had been documented in my country despite the fact that we knew it existed.
I had been a blood donor since I was 16 and I started writing about my experiences remembering that I was barred from donating while I studied in the US. Around the time I met Sadhna, one of the other CDC staffers introduced me to John Pitman. John worked on supporting the blood bank and the issue of transfusion related acquisition of HIV. My country had very little visibility for GBMSM people but I shared the blog I had been writing with him. It was John who encouraged me to continue putting down my experiences as a donor on paper. A few years later, in 2018, I
personally mentored two young activists. I provided them an idea for an HIV prevention intervention for young gay and bisexual men that centered on blood donation. Their submission made it to the shortlist of the contest organised by the US based non-profit MPACT Global Action for Gay Men's Health and Rights. All of this happened thanks to the encouragement I received from John Pitman.
You've accomplished a lot in your life so far, what do you want the reader to understand about it?
I would say it is important to me to share how the presence of the U.S. in my country benefited my career as a person from a SubSaharan African country. I am concerned that the US funding cuts we are hearing about will negatively impact my country and others like me. I want people to understand how important my CDC mentors and others in the developed world have been to my career and how critical funding for these projects are to the future health of Sub-Saharan African countries, and not just the HIV epidemic in Eastern Europe and the Caucasus region which were growing whilst epidemics in our region were contracting. I hope that by spotlighting what I have experienced I have been able to put a personal face on the importance of the support from the developed nations.
By the mid to late 2010s, there were several US government funded public health agencies and universities in my country. With them, came numerous epidemiologists, either hired directly by the US government, or working for different contractors. One of my undergraduate classmates in the US became a fellow for the
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CDC. Another American who had invited me to apply for the project he was leading, an estimation of HIV incidence in the country, could scarcely believe I had attended the same Ivy League university as his colleague, who I had met before he did. “No, I don’t think so,” was what he said, when I mentioned that she and I took a dance class together when we were students. Only later did he realise I was not mistaken, indeed I did attend this prestigious institution, despite having been raised in SubSaharan Africa.
The recruitment agency that processed all the hires for the US government funded public work in the country did not hire me for this project in the end. One could not work on US funded public health jobs without going through that recruitment agency. At the time, I found it annoying, but now I appreciate it. Without an independent recruiter individuals like myself, who were well networked due to our academic backgrounds, would have had the upper hand in applying for these positions. Contrary to the most recent accusations we hear are being leveled against U.S. agencies working in my part of the world, there was actually a great deal of rigor involved both in terms of hiring and spending.
Why didn't you end up working with the CDC?
The closest I came to working with the CDC was in late 2020, when I applied for a role I knew was a stretch for me at the time. At that point I
had not done a field epidemiology training program, but the position was about responding to health incidents, as well as performing ongoing surveillance. I did the interview via Zoom, as was the practice at that time, which was convenient because I wasn't in the US to interview in person. Of the three member panel, I knew one person - Dr Leigh Ann Miller. Leigh Ann had given me work just a few months prior, when I worked with the Ministry of Health on the response to COVID19.
In fact, Leigh Ann was among the few people who took time to guide me in what was clearly my first job, post my MPH, working on a pandemic. Thanks to her, I worked on the situation reports of the capital region of our country, while also offering support in statistical programming. And here she was on my panel. As it turned out, I was not what we call in my country “the successful candidate”. Yet perhaps it was for the best, because little did I know that a mere three years later, the US public health community would be eviscerated by budget cuts.
What are you doing today and what do you hope to do in the years to come?
While I cannot elaborate much on what I do today, suffice it to say I am doing a training program in public health. I hope to work as an epidemiologist in one of my two countries in the years to come. ■
From Our Archives
What We Knew About COVID-19 in May 2020
What it means and why it matters
EDITOR'S NOTE: As we have now reached the 5th anniversary of the initial days of our awareness of COVID19, it seemed appropriate to begin looking back at what we knew, when we knew it and how our thoughts evolved over the early months of the pandemic. Accordingly, we will be reprinting our articles from that period over the next few months. We welcome your comments and suggestions about what you would like to see.
Modeller Estimates Of Cumulative COVID-19 Deaths In The US Now
Projected At 143,357 By August 4, 2020
Author: Roger Bernier, PhD, MPH
The Institute for Health Metrics and Evaluation (IMHE) released an updated estimate for the cumulative number of deaths in the US projected to occur by August 4, 2020. That number is 143,357, a number which has increased over time as the modelling has improved and the realities of the disease have become more apparent.
First Projections
Initially, the Seattle based group had projected approximately 82,000 deaths, a number much lower that the projected number from modellers at the Imperial College in London.
Those numbers were widely reported to have influenced both the US and UK decisions to adopt drastic social distancing measures. They indicated that 2.2 million deaths in the US and 510,000 deaths in the UK could occur without any social distancing measures at all.
Since that scenario was judged unlikely, the Imperial group subsequently revised their estimates downward to 1.1-1.2 million deaths in the US and 250,000 in the UK taking social distancing into account.
Potential Revisions
The IMHE estimate now has almost doubled since the first estimates were released in March. And it is possible the estimates will have to be revised upwards again depending on what happens to the testing, tracing, and isolation strategy that has been recommended across the board by public health professionals. Few areas have created the full infrastructure they will need. According to the IHME, “it is worth noting that the full effects of recent actions to ease social distancing policies, especially if robust containment measures have yet to be fully scaled up, may not be fully known for a few weeks due to the time periods between viral exposure, possible infection, and full disease progression.” In short, the final cumulative number of deaths could grow even larger.
“Ensemble Model”
In what is called a COVID-19 forecast hub, Nicolas Reich and colleagues at the University of Massachusetts have curated 36 models from 20 teams of highly respected infectious disease forecasters. “Forecasting COVID-19 is a
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completely different ballgame because we can’t rely on 20 years of public health surveillance data like we have for flu,” Reich says. The hub has implemented what it calls an “ensemble” forecast which they claim offers a more accurate picture of the future than any single model can project. They estimate that even though the US weekly count of deaths will continue its current downward trend from approximately 10,000 deaths per week now to 7,000 per week by early June, the cumulative number of deaths is projected to exceed 110,000 by June 13.
Country Comparisons
To put these statistics in perspective, it is useful to compare the number of deaths in the US with other countries. We selected the top ten countries with the largest number of confirmed
cases from the WorldoMeter website. The US accounts for approximately 30% of all cases worldwide. The nine other countries account for 39% of cases so that altogether the top ten countries which account for only 5% of the 213 countries being tracked account for just over two thirds of all cases.
While the US is first in the absolute number of cases, its reported case rate per million population (5,058) is lower than that of Spain (6,040). In terms of deaths per million population, which may be a more reliable measure of impact since it is not influenced by level of testing, the US at 299 ranks fifth in the top ten countries with the most reported cases. The rate in Germany at 100 is lower than other comparable European countries.
Dismay That CDC Is Not Front And Center In The Fight Against The Pandemic Is Growing More Intense
Author: Roger Bernier, PhD, MPH
At first, concerns about the absence of the CDC Director and other agency leaders at White House public briefings about the COVID-19 pandemic were shared quietly “within the family” between epidemiologists and other public health professionals. Then, in mid-April, former CDC Director Tom Frieden published an op-ed in the New York Times, stating “Just when American most needs its guidance on the pandemic, the country’s top public health experts do not appear to be guiding, and are certainly not communicating our response.”
Premier Public Health Agency
Also, Ashish Jha, director of the Harvard Global Health Institute, writing this month in STAT
News said “during this pandemic when timely, nationwide information is the lifeblood of our response, the CDC has largely disappeared.” He called CDC “the premier public health agency in the world”, and asserted “Americans are suffering and dying because CDC’s voice is absent.”
Depolitization
Rich Besser, former acting director CDC and now at the Robert Wood Johnson Foundation said it a recent video chat that Americans are not hearing from CDC about best practices in this pandemic. He called for depoliticizing the information provided to the public and agreed that it was “detrimental” to American public health not to be receiving these regular briefings.
Press Briefings
The last CDC press briefing on the pandemic was on March 19 and efforts to restart them have been rebuffed by the White House, according to media reports. Two former CDC employees, Bruce Weniger and Chin-Yih Ou published an essay on Medium saying the lack of CDC direct communication is “denying a worried public straight talk from what has been the world’s premier public-health agency.”
Lancet Editorial
Also, a recent editorial in the Lancet titled “Reviving The US CDC” states the Trump administration's further erosion of the CDC will harm global cooperation in science and public health, as it is trying to do by defunding WHO. A strong CDC is needed to respond to public health threats, both domestic and international, and to help prevent the next inevitable pandemic.
Why Low Profile
One possible explanation for CDC’s absence was the ubiquitous media presence of the NIH’s Anthony Fauci whose knowledge and experience with infectious diseases are widely respected. With a non-partisan reputation and a clear focus on the science, having Fauci in a prominent role communicating with the public was reassuring to many laypersons as well as scientists.
Yet Fauci’s knowledge and experience has come from leading a research institution, and NIH does not have CDC’s relationships with state and local health departments, a tradition of holding regular briefings during evolving outbreaks, and a large cadre of disease detectives with a respected reputation for
responding effectively to outbreaks in all parts of the world.
Points of Tension
However, as time goes on, it becomes clearer that there are multiple points of tension between CDC and the White which might better explain CDC being prevented from playing its rightful role in fighting the pandemic.
Some of these reasons have been described in multiple media accounts, including the following:
1. It seems clear that the leadership in Washington is not interested in developing a coordinated national plan for addressing the different pandemic challenges. This is so despite multiple pleas to do so from leading epidemiologists such as Minnesota’s Michael Osterholm and others. Putting CDC in charge would signify a federal level commitment and obligation.
2. The White House is questioning the validity of the death counts being reported by the Mortality Statistics Branch in CDC’s National Center for Health Statistics. Claims are being made that deaths are being overcounted when expert opinion is that the US is actually underestimating the deaths from COVID-19.
In an interview with the Daily Beast, the chief of that activity at CDC said “The system can always get better. But if we’ve learned anything it’s that we’re seeing some of these individuals who have died of the virus slip through the cracks…It’s not that we’re overcounting.”
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3. Another tension is the limited guidance on reopening different sectors of American society which has been published by the CDC. After early versions of the guidance with specific recommendations were leaked to the press, a revised and much less specific version was published on the CDC website, according to the Washington Post. Now a more detailed guidance document is available, but this document, is nothing like what we are accustomed to seeing from CDC, according to Weniger .
Interviewed on the Rachel Maddow show, he said the new guidance is complicated, inconsistent, and full exceptions to exceptions. In his opinion, CDC personnel must be embarrassed to see it.
4. Criticisms of Robert Redfield, the CDC Director, are also beginning to surface such as those in the Washington Post recently. Redfield is accused of being an ineffective communicator and a weak leader not in control of his agency and not on a par with others in the struggles within the White House environment.
5. There is an ideological struggle according to the former CDC employees between those who believe government has a constitutional role to play in promoting the general welfare and those who place more faith on the private sector. In this category appears to be the recent award of a contract to a Pittsburgh company to collect data from hospitals which is already being reported to the CDC Healthcare Reporting Network.
Richard Jackson, professor emeritus at UCLA and a former CDC Center Director told the Post, “it is unprecedented that you’d set up a competing system separate from CDC."
Painful moment
According to Jha, “this must be a painful time for the many extraordinary career scientists who continue to work at the agency. But it's a painful moment for the American people too and with deadly consequences. Real CDC leadership clear, science based guidance, effective coordination of states, and public transparency of data is absolutely essential for confronting and getting clear of this crisis.” He concludes, “The CDC was once the world’s greatest public health agency. We need that CDC back, and we need it now.”
Scientists Under Duress
An indication of just how painful a time it is for many at CDC, NIH, and other agencies is the recent decision to terminate an NIH grant to the ECO-Health Alliance, a private research organization doing work on coronaviruses. According to our sources at NIH, these researchers are doing the best research on coronaviruses. Yet because of misinformation about the relationship with the research facility in Wuhan and because of unproven theories about the true origins of the virus, the NIH grant was terminated without due process.
The grant cancellation was recently the subject of a special expose report on 60 Minutes. When the best researchers in the world have their work cancelled for political rather than scientific reasons, then you can understand the difficult environment that our government scientists are working in, said the NIH source.
- CDC cont'd on page 15
In a recent op-ed in the NY Times, Seema Yasmin, a former CDC Epidemic Intelligence Service (EIS) Officer concluded by saying, "Given the complex relationship between American public health law, regulations and epidemiology, a complete divorce of politics from public health might not be feasible anytime soon. But week after week, as Covid-19 has killed almost as
many Americans a day as the Sept. 11 attacks, our best response against the pandemic demands unleashing the top disease detectives in the world and fully applying their advice. E.I.S. officers were trained to fight this battle, and no one should stand in their way.” ■
Jury Still Out On Whether Or Not The Swedish “Soft Containment” Strategy Against COVID-19 Is The Right One
Author: Roger Bernier, PhD, MPH
Many countries hard hit with COVID-19 outbreaks have applied harsh social distancing measures to flatten or decrease their epidemic curves. Thousands of lives may have been saved if initial predictions from epidemiologic models were accurate at the time. However, the economic and social consequences have been severe, and some publics are anxious to resume a normal life. In the US, some states are reopening their economies sooner than what public health authorities are recommending.
All Eyes On Sweden
Countries which undertook harsh, mandatory social distancing measures are keen to discover if the significantly less harsh approaches taken in Sweden can offer any guidance about the best way forward from here. Many are looking for the right balance between retaining strict measures to save lives and allowing people to return to more normal lives.
Swedish Strategy
What more specifically has been the Swedish strategy and is it a success story? Does it provide lessons? The following article was
written after reviewing multiple articles and interviews by Swedish and other officials.
The main features of the control measures in Sweden were to encourage social distancing without requiring it. The allowable crowd size was limited, however, restaurants and businesses were allowed to stay open and children below secondary school age were allowed to stay in school. People were encouraged to work from home, and sick persons were advised to stay home from work with pay. Travel was discouraged.
Goals
The economic and social disruption appear to have been significantly less in Sweden than in the US and somewhat less than other European countries. This strategy is often referred to as a “herd immunity” strategy, but in fact is more a byproduct of the Swedish approach than its primary purpose, according to Anders Tegnell, the country’s lead epidemiologist.
Sustainablility
The Swedes understood from the outset that any control measures had to be sustainable,
- Sweden cont'd on page 16
that is, feasible and acceptable over the longer term since no vaccine was considered likely to appear for months or even years. The main goal was to avoid overwhelming the health system, however, this is precisely the risk entailed by their voluntary, soft containment strategy. Without adequate constraints on social interactions, cases could climb dramatically and overwhelm the health care system. Even in the best case scenario, one could expect that Sweden would have to accept a certain number of preventable deaths in the short term that would be avoided in other countries adopting harsher measures. This has not been stated publicly in multiple media accounts reviewed by the Epi Monitor.
Success?
Has the strategy succeeded? The answer is that it is too soon to tell. There are some features of the Swedish situation which suggests that their gamble has paid off for now in that they have avoided social and economic disruption on a large scale. However, the deaths per 100,000 in Sweden are much higher than in neighboring Scandinavian countries. As stated above, some of these excess deaths should have been anticipated as the result of a softer containment strategy. By themselves, they do not point to a failure of the Swedish strategy, at least not yet, but they may reflect a more fatalistic or realistic streak in the Swedish mindset.
Nursing Home Deaths
At least 50% of the deaths in Sweden have been in nursing home residents, according to Tegnell, and there was an admitted failure to prevent introduction and proper management of cases in these facilities. A stricter lockdown strategy might have prevented more COVID-19 infections and reduced the chances of
introductions into a high risk population. Still if the nursing home deaths are excluded, Sweden’s death rate is still several fold higher than neighboring Scandinvavian countries. (See table on page 11).
Epidemic Curve
At present, the epidemic curve or weekly case count is decreasing according to Tegnell from 90 to 70 or less per week. The first reported antibody study on approximately 1000 persons from the Stockholm area found that only 7.3% have antibody, much lower than the 25% Tegnell has estimated might have been produced by their less strict strategy.
The health system in Sweden has not been overwhelmed and the Intensive Care Units have not exceeded 80% of their capacity. Tegnell suggests that Sweden could expect to have a smaller second wave of COVID-19 in the fall and winter if the virus remains endemic or returns later in the year. But now this prediction seems ill-founded if antibody levels in the population remain in single digits.
Sweden As Model?
The big unanswered question is whether the lower death rates in other Scandinavian countries which took drastic measures will eventually rise to catch up with the death rate in Sweden which took a less strict approach. For now, their rates are lower. In theory, other countries with harsh measures may have only postponed some deaths that will come later if population level immunity is truly significantly lower after the first wave of cases.
Feasibility
Is Sweden’s volunteer strategy coupled with
guidance from health officials workable in other countries? The question about the rightness or wrongness of the Swedish strategy may be moot if other countries could not make the Swedish strategy work.
Context Matters
As Tegnell has acknowledged, context is crucial. He states clearly that the Swedish approach would not have been a good idea in countries that were hard hit to begin with or became aware of cases only relatively late after importation.
What about the best strategy going forward when case counts have declined significantly.
The voluntary approach may only be feasible in a country where the level of trust in government and health officials is high. Evidence for this is that “fake news” and misinformation have had little influence on the Swedish population, according to Tegnell. Thus, the Swedes may have had the luxury of taking a longer view because they did not miss as many early cases
and did not have the pressure to do something drastic to prevent an anticipated wave of new cases. It was their intention from the outset to implement what they thought would be sustainable measures acceptable in a trusting population that values personal responsibility and is likely to heed public health guidance.
Collaboration Key For Unity
Also, the Swedes have a history of working together in different segments of the health system, so that achieving a unified strategy was possible even though local jurisdictions make final decisions. Tegnell did not agree that having a decentralized system such as in the US was antithetical to achieving a unified national strategy since that outcome is what Sweden has created beforehand on other topics and it replicated that unity in the present pandemic situation.
Coronavirus cases and deaths in Scandinavian countries and the US Source Worldometer, May 24, 2020 ■
Epi
Named for Our Locations
We know the end of the academic year is incredibly busy for our readers so this month, instead of a long crossword, we are bringing you a short word search. Good luck - don't let the easy words fool you!
For an interactive online version go to: https://tinyurl.com/yrsrbksh
Words to find:
1. Bornholm Disease
2. Nipah Virus
3. Dengue Fever
4. Ross River Fever
5. Ebola
6. Spanish Flu
7. German Measles
8. St Louis Encephalitis
9. Lassa Fever
10. Valley Fever
11. Lyme Disease
12. West Nile Virus
13. Marburg Virus
14. Zika
15. MERS
What We're Reading This Month
Editor's Note: All of us are confronted with more material than we can possibly hope to digest each month. However, that doesn't mean that we should miss some of the articles that appear in the public media on topics of interest to the epi community. The EpiMonitor curates a monthly list of some of the best articles we've encountered in the past month. See something you think others would like to read? Please send us a link at info@epimonitor.net and we'll include it in the next month
Washington DC Chaos
♦ RFK Jr. got rid of an 'alphabet soup' of health agencies. Now, Congress gets a say (NPR) https://tinyurl.com/ykcmhe65
♦ Federal Public Health Funding May Soon Evaporate. Here’s How Philanthropy Should Prepare (Chronicle of Philanthropy)
https://tinyurl.com/22tf88e3
♦ Trump administration has shut down CDC's infection control committee (NBC News) https://tinyurl.com/4h8an6ve
♦ RFK Jr.'s plans for vaccine testing are highly unethical and a danger to your health. Here's why (LA Times via AppleNews)
https://tinyurl.com/mwksw5ph
♦ 7 Ways The FDA Cuts Could Affect You (Forbes via AppleNews) https://tinyurl.com/3cks9tyw
♦ The World Is Wooing U.S. Researchers Shunned by Trump (NYT) https://tinyurl.com/2jx8fzpa
♦ Federal Cuts Become ‘All Consuming’ at Harvard’s Public Health School (NYT) https://tinyurl.com/2m4ku42r
♦ Does the CDC have an Acting Director? (STAT via AppleNews) https://tinyurl.com/yte4633z
♦ WHO vaccine leader on eroding trust in public health (AJC) https://tinyurl.com/bdzeejc8
What We're Reading This Month
[Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Text Box Tools tab to change the formatting of the pull quote text box.]
- con't from page 19
Public Health Topics,
cont.
♦ Scientists Hail This Medical Breakthrough. A Political Storm Could Cripple It. (NYT)
https://tinyurl.com/yxnttesy
♦ Epidemiology team guides national policymakers (UNC)
https://tinyurl.com/54bmrsjc
♦ WHO Director General Shakes Up Agency with Brand New Leadership Team (Health Policy Watch)
https://tinyurl.com/wtn4bj8e
♦ An EPA pivot on PFAS raises alarm over public health protections (Environmental Health News)
https://tinyurl.com/44t73znc
♦ These Three Cities Honored For Their Public Health Achievements (Forbes)
https://tinyurl.com/5xhxvnwm
♦ A Potentially Life-Threatening Disease Caused by Ticks Is Expanding to New Parts of America (Smithsonian Magazine via AppleNews)
♦ Ticks are emerging. Experts warn of rare but deadly vector-borne virus on the rise (MPR News)
https://tinyurl.com/59scsmp3
♦ If You've Noticed More Masks on Planes, You're Not Alone (Travel & Leisure via AppleNews)
https://tinyurl.com/bp6b6ktz
♦ The Texas county where "everybody has somebody in their family" with dementia (The Atlantic via AppleNews)
https://tinyurl.com/3hjp26ev
♦ Their Cows Started Dying Mysteriously. Lawmakers Are Taking Notice. (Texas Monthly via AppleNews)
https://tinyurl.com/48zjsfbv
Notes on People
D
o you have news about yourself, a colleague, or a student?
Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net
Appointed: McGill University is pleased to announce that Dr. Philippe Boileau has been jointly appointed to the Department of Epidemiology, Biostatistics and Occupational Health, as well as the Division of Clinical Epidemiology in the Department of Medicine. He is also a Junior Scientist at the Research Institute of the McGill University Health Centre, where he is a member of the Accelerating Clinical Trials – Clinical Trials Unit and the Centre for Outcomes Research and Evaluation. Prior to joining McGill, Dr. Boileau completed a PhD in Biostatistics at the University of California, Berkeley.
Appointed: Kari North, PhD, an internationally recognized leader in genetic epidemiology and public health genomics, joined UTHealth Houston as the university’s vice president of border health and a professor with UTHealth Houston School of Public Health. North will direct the Border Health Research Center at the School of Public Health in Brownsville. In her combined roles, she will lead collaborative clinical and population research to advance innovation, education, and public health improvement in the U.S.-Mexico border region.
Named: Morehouse College has named public health expert Dr. F. DuBois Bowman, a 1992 graduate of the Atlanta HBCU, as its new president. Bowman, a biostatistician who’s currently the dean of the University of Michigan School of Public Health, will take over as Morehouse’s next president on July 15, the college announced Tuesday. Before his tenure at Michigan, Bowman held faculty and leadership positions at Columbia University and Emory University. He earned a master’s degree in biostatistics from the University of Michigan and a Ph.D. in biostatistics from the University of North Carolina at Chapel Hill.
Named: Stephanie Hicks, an associate professor of biomedical engineering and biostatistics at Johns Hopkins University, has been named a fellow of the American Statistical Association (ASA), the largest community of statisticians in the world. Hicks’ research focuses on computational challenges in single-cell genomics, epigenomics, and spatial transcriptomics. The goal of her research is to better understand human health and disease; specifically, she develops computational methods using statistics and machine learning and implements these methods in open-source software for the analysis of biomedical data.
Notes on People, con’t
Do you have news about yourself, a colleague, or a student?
Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net
Resigned: The University of Minnesota announced that noted public health professor, Rachel Hardeman, has resigned effective May 14, 2025 amid plagiarism allegations. The university has stated that they will close the Center for Antiracism Research for Health Equity, which was headed by Professor Hardeman, on May 30.
Appointed: Annovis Bio Inc. (NYSE: ANVS), a clinical-stage biotech company with a $30.2 million market capitalization focusing on developing treatments for neurodegenerative diseases, announced today the appointment of Hui Liu as Director of Biostatistics. Ms. Liu brings over 19 years of statistical experience in clinical trial design, analysis, and reporting across various therapeutic areas
Honored: Conference USA selected Dr. Noël C. Barengo, Associate Professor of Epidemiology in FIU's Herbert Wertheim College of Medicine, as the 2025 CUSA Professor of the Year, voted on by the member institution's provosts.
A key figure in advancing chronic disease prevention efforts through large-scale research collaborations, Dr. Barengo's research has played a vital role in shaping global public health strategies and policies, particularly in the prevention of chronic diseases.
Honored: Yale School of Public Health Dean Megan L. Ranney, MD, MPH, presented the prestigious C.-E. A. Winslow Medal to Dr. Peter Hotez, MD, PhD, during a ceremony. Dr. Hotez, a Yale College graduate, spent a decade as a postdoctoral fellow and on the YSPH faculty during the 1990s. Dr. Hotez is currently the dean of the National School of Tropical Medicine at Baylor University College of Medicine. He is renowned for his groundbreaking contributions to vaccine development. Dean Ranney introduced him as “a great scientist, an ardent vaccine advocate, and science explainer.”
Notes on People, con’t
from page 22
Do you have news about yourself, a colleague, or a student?
Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net
Named: Nigerian epidemiologist Dr. Chikwe Ihekweazu has been appointed as the Executive Director of the World Health Organisation’s (WHO) Health Emergencies Programme. This appointment marks a significant milestone, placing a Nigerian at the helm of WHO’s largest department responsible for coordinating global responses to health emergencies. Prior to this role, Ihekweazu served as WHO’s Assistant Director-General for Health Emergency Intelligence and Surveillance Systems. He is also widely recognized for his transformative leadership as the founding Director-General of the Nigeria Centre for Disease Control (NCDC), where he led the agency from 2016 to 2021, establishing it as one of Africa’s leading public health institutions.
Passed: Sayan Mukherjee, Duke University research professor of statistical science and mathematics and professor of biostatistics and bioinformatics, died unexpectedly Monday [April 1, 2025] at age 54 in Leipzig, Germany. Mukherjee joined Duke as a professor in 2004, where he worked on developing new statistical and computational tools to analyze complex, high-dimensional data across fields, including mathematics, computer science, biology and medicine. He was particularly interested in understanding data with unusual or intricate structures, including shapes and surfaces. https://tinyurl.com/2y9a4w3u
Passed: Paul Emmett Leaverton, PhD, age 90, passed away on April 25, 2025 in Tampa, Florida. Paul dedicated his life to advancing public health and education. He was a Professor of Biostatistics at the University of Iowa College of Medicine before joining the National Center for Health Statistics in Rockville, Maryland, and the National Institutes of Health in Bethesda, Maryland. Later he founded and chaired the Department of Epidemiology and Biostatistics College of Public Health at the University of South Florida in Tampa. He retired from USF in 2001 with the title of Professor Emeritus. His distinguished academic career earned him the Professorial Excellence Program Award and the USF Health Science Center Distinguished Teaching Award. He coauthored two books and published over 100 scholarly manuscripts on biostatistics and epidemiology. https://tinyurl.com/ss3murrf
Near Term Epidemiology Event Calendar
Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the upcoming year. Thus an online copy exists on our website that is updated regularly. To view the full year please go to: http://www.epimonitor.net/Events The events that we are aware of for the next month follow below.
June 1-30
June 2025
Type: Summer Program Web: https://tinyurl.com/jxms5vue
Sponsor: American Association for Cancer Research (AACR) Location: Philadelphia, PA
July 31 – August 2
Type: Conference
Web: https://tinyurl.com/ydja57yy
Title: Institute of Mathematical Studies - New Researchers Conference
Sponsor: Institute of Mathematical Studies & Vanderbilt University Location: Nashville, TN
July TBD
Type: Summer Program Web: https://tinyurl.com/jubdfaf7
Title: 33rd International Summer School of Epidemiology at Ulm University
Sponsor: Ulm University Location: Ulm, Germany
July TBD Type: Summer Program Web: https://tinyurl.com/5xwkmwdy
Title: 8th Annual Summer Institute in Statistics for Big Data (SISBID)
Sponsor: University of Washington Location: Atlanta, GA
July TBD Type: Summer Program Web: https://tinyurl.com/tbxyha4r
Title: Summer Institute of Advanced Epidemiology & Preventive Medicine
Sponsor: Tel Aviv University Location: Tel Aviv, Israel
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Postdoctoral Research Fellowships in Cancer Prevention and Control
Position Location: St. Louis, MO
Eligibility: PhD, DrPH, MD, or other doctoral degree in a public health related discipline, or a doctoral degree in another discipline with an interest in public health research. T32 applicants are limited to United States citizens, non-citizen nationals, or must be lawfully admitted for permanent residence and possess registration requirements.
Seeking postdoctoral fellowship applicants with an interest in cancer prevention and control to join diverse team of multidisciplinary researchers in the Division of Public Health Sciences and Siteman Cancer Center at Washington University in St. Louis. We welcome applicants from a variety of disciplines. Our multidisciplinary faculty conducts worldleading research on a wide range of health issues and leads community education and outreach to prevent cancer and other diseases, promote population health, and improve quality and access to health care in Missouri and beyond. Engaging community members, addressing key needs in our catchment area, and addressing cancer disparities are priorities in the work we do.
The Division has a diverse range of NIH funded projects and faculty mentors to see the full range, consult our website While we welcome applicants in any relevant research area, these are the highest priorities for the Training Program:
• Cancer Disparities and Access to Care
• Community-based and Community-engaged Research
• Cancer Epidemiology
• Intervention and Implementation Science
• Contextual Drivers of Health and Healthcare
Washington University School of Medicine is an equal opportunity employer. We particularly welcome applications from first generation college graduates and other backgrounds underrepresented in biomedical sciences.
Washington University offers excellent benefits. Support is available for tuition, books, software, conference travel, and research. Postdoctoral positions are partially funded by NCI grants (f32CA190194), with annual stipend starting at $61,428.00 for up to 2-3 years of training. Mentorship and career development are available to our vibrant cohorts of postdoctoral fellows. Our trainees have a strong track record of finding funding and faculty positions after completing their postdoctoral training. You’ll find ample opportunities to collaborate with investigators from a range of disciplines.
Send inquiries to: The T32 Program Coordinator at PHSpostdoc@wustl.edu. You can also contact Dr. Aimee James and Dr. Graham Colditz, Training Directors, at aimeejames@wustl.edu and colditzg@wustl.edu.
To apply: Fill out an application and submit your cover letter, curriculum vitae, and three professional references by visiting https://redcap.link/phs-postdoc.
You can also access the online application by scanning the QR code below.
Please email PHSpostdoc@wustl.edu with any questions. Applications are considered on a rolling basis.
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