Thread by @angie_rasmussen

Out today in @ForeignPolicy: I wrote about what will happen if there is an H5N1 pandemic with Robert F Kennedy, Jr. in charge of safeguarding the health of Americans.

If RFK Jr is leading HHS & H5N1 begins spreading human to human, the deaths will be counted in millions.🧵👇

RFK Jr already has a sizable body count (in every sense of the term, but here I'm talking about counting corpses and not sexual partners).

If he has control over HHS in a flu pandemic, deaths attributable to him will increase by orders of magnitude.

foreignpolicy.com/2025/01/30/rfk…

Independent of RFK, this is why we're dealing with H5N1. We've known about it since 1997, but in 2020 a new strain emerged that has spread among birds globally since 2021. For more than a year, it has been spreading unchecked in US dairy cows. As a virologist, I am very worried.

The cow epizootic is not containable (more on this in a minute). More and more poultry flocks are getting infected. Spillovers from both cows & birds into humans are accelerating & to make things worse, there is growing evidence of undetected human cases.

This is very, very bad.

If H5N1 does "go pandemic," it will like be due to adaptations to a human host that will allow it to transmit efficiently between people. This will occur through mutation or reassortment, which will most likely occur in an infected human or pig.

So we need to detect infections.

I had a conversation with @HelenBranswell about this a while ago that I haven't been able to stop thinking about. If this does go human to human, it will happen FAST. Days to go from "low risk to the general public" to "it's a pandemic."

Speed is essential to containment.

A rapid response depends entirely on the competence and leadership at HHS.

Every thing with COVID that went right was because of urgent actions taken by HHS scientists, public health officials, regulators, administrators, & clinicians.

We won't have that this time around.

Why? Because not only is RFK Jr a predatory grifter who is an enemy of public health, so are all his deputies. They are being vetted by an anti-vax lawyer, presumably for compliance with Kennedy's outrageous and deadly opposition to lifesaving vaccines & public health measures

The CDC Director is an anti-vaxxer who has appeared in Del Bigtree (big time anti-vax media mogul) documentaries with Andrew Wakefield.

The FDA Commissioner is a medical contrarian who previously advised an anti-virology activist group and famously predicted (with almost comical inaccuracy) that we'd have herd immunity to COVID and pandemic over by April 2021.

The NIH Director is also a medical contrarian who authored the Great Barrington Declaration, has made a small fortune off promoting mass infection policies, denigrating vaccines, and spreading conspiracy theories about ivermectin & vaccines. He also really hates virology research

And then there's the CMS Director, a glorified snake oil salesman and failed Senate candidate, who stopped talking about vaccines the second he realized he could make more money selling vitamin D or whatever on social media.

Despite being credentialed physicians, none of these men have any actual experience with virology, vaccinology, outbreak epidemiology, or basic ethics. They have all shown outright hostility to evidence-based public health and they are all profiting from their contrarian stances.

So let's explore what might happen if this clown car pulls up to an emerging pandemic instead of actually competent people.

I said we need to detect cases quickly to contain a human outbreak before it can spread more widely.

We need molecular diagnostic tests (PCR) for that.

During COVID, CDC & FDA did not exactly cover themselves in glory in this regard. Incompetence at designing functional PCR tests in the first Trump administration severely hindered a rapid response. COVID spread undetected for weeks & became entrenched in the US as a result.

The Biden administration repeated these mistakes for H5N1. Fortunately, H5N1 doesn't transmit well between humans...yet.

Hard to overstate the gross incompetence here. My undergrads can design PCR assays that work. I very much doubt this will be rectified under RFK.

Furthermore, what will we do if there is no meaningful research on H5N1 occurring? The US COVID response failed in many ways but also had many successes. All of these were the result of virology, vaccine, & epi research, most of which was funded by NIH.

I remember how happy & relieved I felt when I tweeted this back in January 2021. People I love were going to be protected by safe, effective American-made vaccines.

These vaccines wouldn't be possible without NIH-funded research. Your tax dollars at work.

https://x.com/angie_rasmussen/status/1353197916819582977

But don't count on that from RFK's HHS. Nominated NIH Director Jay Bhattacharya wants to reorganize NIH around his principles of taking medical contrarian positions for money & then declaring himself a free speech martyr when called out that his ideas will kill people.

But the net result of this is that allowing contrarians to set policy involving research and public health responses based on ideology rather than scientific evidence will cripple any kind of functional response to an emerging pandemic.

Let's just go over it all quickly.

Vaccines: the stockpile of H5N1 vaccines might never be authorized by FDA or recommended by CDC. New vaccines won't be developed by NIH. Medicare/Medicaid/insurers won't cover them. No vaccines to stem the tide of death. No vaccines.

Tests: not enough tests & not fast enough thanks to CDC. New tests might not be authorized by FDA. CDC not tracking data or sharing it. CMS again not covering testing costs. No tests, no detection, no ability to contain the outbreak.

Antivirals: the current flu drugs are given after a positive test and they work best when given early. No test, no Tamiflu. Not enough testing, not enough access to antivirals. No insurance coverage, no antivirals. No virus research at NIH, no warning of antiviral resistance.

Containment: no early detection, no epi investigation, no contact tracing, no isolation and quarantine, no containment to an initial cluster of cases. No knowledge of where the virus is spreading, health care systems are at risk of shutting down. No containment.

Public health measures: no public health measures (masking, precautions, air quality, etc). No guidance from any federal public health agency. No public health response. The public will be left to figure it out for themselves. No potential host left uninfected.

And let's do some quick math:

Right now H5N1 has a mortality rate of about 2%. That seems low, right?

At pandemic scale—which is the global population—that is potentially tens or even hundreds of millions of deaths.

In the US, that's about 7-10 million deaths.

We cannot tolerate the devastation Kennedy would wreak in an H5N1 pandemic if he is confirmed. We cannot sacrifice millions of human lives to install an anti-science ideologue as the overseer of American health. The HHS is supposed to save lives, not end them.

Any Senator voting for his confirmation has blood on their hands. If you confirm Robert F. Kennedy, Jr. for Secretary of HHS, his body count is your body count too.

Also I hate doing this but I want the people who need to see this to see it:
@BillCassidy @lisamurkowski @SenatorCollins @MikeCrapo @SenMcConnell @LindseyGrahamSC @HawleyMO @SenWarren @SenBooker @JohnFetterman @SteveDaines @SenRonJohnson @ChuckGrassley @SenatorHassan @PattyMurray @SenSchumer @MariaCantwell @SenCortezMasto @RogerMarshallMD @SenToddYoung @SenTinaSmith @tammybaldwin @RonWyden @MichaelBennet @JohnCornyn @Sen_Alsobrooks @SenMarkey @SenMarkKelly @AndyKimNJ @ChrisMurphyCT @brianschatz @SenMullin @timkaine