I watched the 1st meeting day of RFK Jr’s handpicked committee of vaccine advisors that encapsulates the proceedings. It was utterly depressing. 1/ Liaisons from medical societies asked repeatedly: what is the reason for the votes to now change children’s routine vaccine schedules when there’s been no signal of harm and clear evidence of great benefit? 2/

STAGGERING: This new study of 133 countries is the first to estimate the impact of all USAID’s work. In 2 decades, it saved *92M* lives.

Current cuts, if not reversed, are forecast to cost *14M* lives thru 2030.
thelancet.com/journals/lance… Higher USAID support was associated w a 15% reduction in overall deaths and 32% reduction in child deaths.

This wasn't just due to its health work but also its development support for economies, people, and institutions that transitioned numerous countries off of aid.

I saw firsthand the impact of stop-work-orders/terminations at USAID & now Harvard.

My new @NewYorker piece is on the serious implications for the lives of millions across the world and the US – including for my own family and very possibly your own. 🧵 newyorker.com/news/the-lede/… These attacks are part of a broader assault on America’s health-and-science infrastructure. >90% of the $9B in federal dollars for Harvard that Trump has threatened supports life sciences – including heart disease research that saved my son’s life and guides his future care.

Yesterday, Rubio terminated 5800 USAID contracts – more than 90% of its foreign aid programs – in defiance of the courts.

Here’s a list of just some of the lifesaving awards that were terminated. Nearly all were Congressional mandated. They've saved millions of lives. 🧵 1. All malaria supplies protecting 53 million people, mostly children, including bed nets, diagnostics, preventive drugs, and treatments – terminated.

Musk is continuing his wildly distorted claims attacking USAID. The last round is debunked below.

And I'll unpack the reality in this 🧵, too. 1/13 wapo.st/3ErHBZM Conservative Andrew Natsios led USAID under the GOP and he masterfully unpacks the lies and slander in this interview. 2/13
politico.com/news/magazine/…

Rubio claims that @USAID lifesaving assistance for health and humanitarian needs will continue. But his team just communicated that the entire agency will be imminently reduced from 14,000 to 294 people. Just 12 in Africa. We already see the shutdown's cost. Kids with drug-resistant TB, turned away from clinics, are not just dying - they're spreading the disease. People around the world w HIV, denied their medicine, will soon start transmitting virus. The damage is global. wbur.org/onpoint/2025/0…

I ran @USAID health programs for the last 3 years. Trump’s 90 day Stop Work Order on foreign assistance does serious damage to the world and the US. Examples:🧵 1. Stops work battling a deadly Marburg outbreak in Tanzania and a wide outbreak of a mpox variant killing children in west Africa before it spreads further.

Wow. On board JetBlue. Attendant just announced that the courts struck down CDC’s 2 week extension of the mask mandate today and JetBlue now dropped its mask requirement. The attendant added he is taking his off.

(Meanwhile: double digit increases in cases in the northeast.) With cases rising, and superspreader events like the Gridiron dinner, I thought CDC’s 2 wk wait to see if hospitalizations climb was sensible. Moreover, it seemed far from an abuse of public health authority. Different courts 2nd guessing seems mainly likely to confuse matters.

As we continue on our grim march to 800K COVID deaths by Xmas, we seem to be deciding to live with 1000+ extra avoidable deaths a day. That puts us on path to exceed 1M deaths in early 2022. The prevailing view seems to be that we must accept that our chances of living past 80 have gone down—even indefinitely, and despite the economic damage—so younger, healthy people can live without having to vaccinate or to test regularly.

This outbreak is vital to understand. It shows what we still face if younger folks go unvaccinated.

47% of health care workers refused vax, while only 10% of residents did.

Result: 1 unvax'd HCW with COVID led to 20 HCWs & 26 residents infected, of whom 3 died (1 vaccinated).

https://twitter.com/nytimes/status/1384980269984370692

Let's unpack the details.

Q: Did the vax (2 doses of Pfizer) work? Absolutely. It was remarkable - but not perfect.

-Of 8 unvax residents, 6 got COVID (75% attack rate), 2 died (33% death rate).
-Of 71 vax residents, 18 got COVID (25%), 1 died (6%).
cdc.gov/mmwr/volumes/7…

US COVID-19 deaths remain upwards of 700 deaths a day. Who are these people who are dying?

🧵 COVID deaths in nursing homes are down massively.

- In Dec 2020, these accounted for 32% of all COVID deaths.
- In Mar 2021, thanks to vaccination, they accounted for just 4%.

So who are the remaining 96%?

data.cms.gov/stories/s/COVI…

Update from listening to the CDC ACIP meeting on the J&J vaccine:

They postponed making any decision, effectively continuing the pause on use of the vaccine.

They will reconvene in 7-10 days to review case reports from the ~4M who received the vax in last two weeks. Why wait for more info? A new case of cerebral sinus venus thrombosis was reported in a 25 year old man who became critically ill from a cerebral hemorrhage.

And for women age 20-50, CSVT occurred in 1 in 13,000, or 4-15X higher than background.

As cases and hospitalizations rise again, we can't count on behavior alone reversing this course.

Therefore, it's time for the Biden admin to delay 2nd vax doses to 12 weeks. Getting as many people as possible a vax dose is now urgent.

https://twitter.com/Atul_Gawande/status/1376888536129998850?s=20

I was on the fence on this. I'm not anymore. Here's why.

1. More contagious strains are now >1/3 of all US cases. And new evidence confirms B117 causes more severe disease, with MUCH higher rates of severe illness and death at younger ages. directorsblog.nih.gov/author/collins…

This is our warning call, America.

Cases are now climbing again in a majority of states--esp across the northeast and midwest.

@CDCDirector Walensky is right to be sounding the alarm. This is how surges start. We are a few weeks behind the pattern of the surges now happening in Europe, Asia, and South America.

I know COVID seems like it is subsiding. But the B117 variant is spreading. What we do now to stop it determines whether it takes over and fills hospitals again in 2 months.

It's going to take more than vaccinations--the supply won't come fast enough. nytimes.com/2021/02/17/opi… 1. We need all Americans to wear a high quality mask. Upgrading to one with a metal nose clip and a snug fit so it doesn't fall when you talk or leak so much out the sides--ideally a medical grade mask--is important. This variant is 30-50% more contagious than what we've faced.

Pfizer's move is indefensible. Yes, squeeze every dose we can. But cutting deliveries from 40M to 33M vials for the same price cannot be justified. Especially when many places lack the special "low dead space" syringes needed to get the "extra" dose. nytimes.com/2021/01/22/hea… "The world’s largest syringe maker does not have the capacity to substantially increase U.S. supplies of specialty syringes needed to squeeze more doses from Pfizer's vaccine vials in the coming weeks, an executive said." reuters.com/article/us-hea…

Key findings from the latest Axios-Ipsos Coronavirus poll.

1. Americans are more worried about COVID's impact on their health, job, and finances than since June. And for most, out of home activity is declining accordingly. axios.com/axios-ipsos-po… 2. Vaccine interest is up, with most now saying they are likely to take a COVID-19 vaccine if it public health officials say it is safe and effective (69%), has a 90%+ effectiveness rate (67%), or has been on the market a few months (65%). ipsos.com/en-us/news-pol…

Spoke to @MarketWatch and here are a few of the points I made:

- Today's election determines who's in charge Jan 20, but what happens with addressing the major surge of COVID19 cases and hospitalizations and with vaccines is being determined now. marketwatch.com/story/dr-gawan… - If we get an effective vaccine, the big problem won't be hesitancy, but lack of supply and distribution resources forcing hard choices among priority groups.

- We will need a mass movement to back mask-wearing, far more testing, and open hospital data.

This week, we at @AriadneLabs and @SurgoFoundation released a Vaccine Allocation Planner for states and cities to plan #COVID19vaccine distribution. As you start working with it, you realize just how wrenching the choices are going to be. covid19vaccineallocation.org .@moderna_tx says it will have 20M doses of its vaccine by Jan; @pfizer 30-40M. It’s unknown if either will work. But if one does, we may have enough for 10-20M people. (Remember, it’s 2 doses per person). qz.com/1924433/the-us…

.@casssunstein lays out the prisoner's dilemma that Democrats find themselves in with the GOP, but doesn't quite lay out what game theory has taught us about the best way to proceed: Generous Tit-for-Tat (or Tit-for-Tat with Forgiveness). 1/9 bloomberg.com/opinion/articl… This @Radiolab episode describes the 1960s tournament with computer programs vying with one another in a version of a Cuban Missile crisis to see if they could avoid escalating to Armageddon. Here were the algorithms. 2/9 wnycstudios.org/podcasts/radio…

Masks work? YES. This is appalling. Atlas offers no explanation for the increasing mountain of evidence in support, and instead offers only a bizarre and incoherent paper. I don't know why the administration wants to die on this hill.

https://twitter.com/SWAtlasHoover/status/1317465173347700740

So, once again, what is the evidence?

In my May article on the regimen hospitals have used to stop spread of COVID19 (hygiene, distancing, masks, and testing at least symptomatic people), I review the copious evidence to then on why masks work. newyorker.com/science/medica…