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Amina Srna: It's The Brian Lehrer Show on WNYC. I'm producer Amina Srna filling in for Brian today. Welcome back, everyone. We now turn to our Health and climate stories of the week. As some listeners know, The Brian Lehrer Show is building on its Climate Story of the Week series from past years. It's an effort to keep stories about the environment and public health from getting lost in the shuffle during Trump's first 100 days in office. We'll start now on health.

Health Secretary Robert F. Kennedy, Jr. recently completed his so-called Make America Healthy Again tour, designed to highlight his plan to fight chronic disease and promote a healthy diet. The tour took place amid massive cuts to the Department of Health and Human Services. Brian covered them last week with NPR health reporter Selena Simmons-Duffin. As the week has gone on, the scope of cutbacks to vital public health programs has become clear.

Kennedy has claimed since his Senate confirmation hearings, that infectious diseases receive far more federal funding than chronic diseases. Yet Kennedy's purge of federal workers has halted the very programs that track public health problems. Joining us now with a roundup of all the news coming out of HHS is Julie Rovner, chief Washington correspondent at KFF Health News and host of the What the Health? podcast. Julie, welcome back to WNYC.

Julie Rovner: Thanks for having me.

Amina Srna: In your weekly What the Health? podcast episode, you referred to the health secretary's cuts to HHS as the great dismantling. For listeners that missed the story or missed Brian's segment last week, can you refresh our memories? What happened earlier this month?

Julie Rovner: Yes. Well, first, when the Trump administration came in, even before RFK Jr. had been confirmed, they offered this big buyout to, basically, all federal workers. You had a number of people, I think as many as 10,000, either taking the buyout or retiring early or simply leaving because they could see the handwriting on the wall. Then, in February and again in April, there were these enormous cuts. In February, they basically eliminated all the probationary workers, everybody who hadn't been in their job more than a certain amount of time, which includes not just junior workers, but senior workers who'd been promoted into new jobs. A lot of people were basically eliminated at that point.

Then finally, they had this huge reduction in force, which took out big swaths at the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration, primarily also across HHS. HHS, remember, is just an enormous organization. We think about it in pieces, but it oversees, basically, food and drugs for everyone through the FDA healthcare for about half the population through Medicare and Medicaid and the Affordable Care Act, all of the important biomedical research through the NIH, and everything about infectious disease through the CDC. It is literally an agency that touches every single American pretty much every single day.

Amina Srna: Kennedy has said that since that he'd rehire some of the employees who were mistakenly fired, though it's unclear if any of that has happened. I'll add that The Hill reported recently HHS officials during a closed-door briefing on Friday could not give a full accounting of the number of people who have been fired from the agency. They cite a Democratic aide for the House Energy and Commerce Committee as their source. What is your understanding of these cuts? Do they appear to be permanent for now, or does it seem like we don't know?

Julie Rovner: I think it's mass confusion. I think that's the best way to describe it. Obviously, I live in the Washington, D.C. area, so I know people who work at all these organizations, and they describe what's going on as nobody really knows, including the people who were supposed to be running it. We're not sure. There are various judges who are ordering the return of some of these workers. There are various efforts to get some of these workers back.

For instance, in the FDA Tobacco Control office, they apparently let everybody go, and now they have no capacity to enforce the rules about selling tobacco products to minors, which is deemed a problem, even by this administration. It's truly confusing. Nobody knows what's permanent, who's really laid off, who might come back, and when.

Amina Srna: Listeners, we can take some of your questions or comments on RFK Jr.'s recent moves at HHS. Give us a call now at 212-433-WNYC. That's 212-433-9692. You can also text that number. What are your biggest concerns about what Secretary Kennedy will do at HSS, might do at HSS, or these recent cuts in particular? Do you know anybody who has been impacted? Maybe you even agree with some of his previous public stances? What do you hope he'll push through during his time as secretary of HHS? 212-433-WNYC. That's 212-433-9692. You can also text that number.

Last Wednesday, Kennedy sat down with CBS News Chief Medical Correspondent Dr. Jon LaPook to discuss the cuts. Let's take a listen to a clip of that. Dr. LaPook speaks first.

Dr. Jon LaPook: You proposed more than $11 billion in cuts to local and state programs addressing things like infectious disease, mental health, addiction, and childhood vaccination. Did you personally approve those cuts?

Robert F. Kennedy, Jr.: I'm not familiar with those cuts. We'd have to go. We'd have to go.

Dr. Jon LaPook: There's more than 50 pages of cuts that I actually went through.

Robert F. Kennedy, Jr.: The cuts were mainly DEI cuts, which the president approved.

Dr. Jon LaPook: They were a lot, but I'll give you-- For example, about $750,000 of a University of Michigan grant into adolescent diabetes was cut. Did you know that?

Robert F. Kennedy, Jr.: I didn't know that. That's something that we'll look at.

Amina Srna: Julie, that clip is getting a little bit of play in the media that I have seen. Have you heard that clip before, or what is your reaction to it?

Julie Rovner: Yes, I have heard that clip before. The secretary keeps saying that all of these cuts are things that aimed at advancing his agenda to make America healthy again, to concentrate more on chronic disease. In fact, a lot of the money, a lot of the things that are being cut do focus on chronic disease. There's been a lot of cancer research cut. The money that Dr. LaPook was actually referencing is money that was rescinded by the department because it had been originally designated for COVID, for fighting COVID. They said, "COVID is over. We want this money back."

Well, that was a lot of money that a lot of agencies were using for basic public health outreach. In Texas, they were using it to address the measles outbreak that they're having. This is really putting a lot of state and local health departments in really untenable position because they simply don't have the money to do their regular operations.

Amina Srna: You started to allude to this in your answer, but we've talked a lot on this program about the termination of NIH-funded research grants. I think their significance can't be overstated, but it can be hard to conceptualize for people like me who aren't science researchers. We can speculate, but we won't necessarily know the immediate impact of some of these studies being stopped in their tracks. Maybe a more tangible consequence happening right now is that the HHS has cut the federal teams that are in charge of data collections. You were speaking about monitoring the measles outbreak, for example.

Politico reported over the weekend that Kennedy's purge has "halted efforts to collect data on everything from cancer rates in firefighters to mother-to-baby transmission of HIV and syphilis outbreak outbreaks to outbreaks of drug-resistant gonorrhea and cases of carbon monoxide poisoning." That's a lot of different stories there, but have you been following any of them? Where do you want to weigh in on the specific data collection cuts?

Julie Rovner: I have, and I think it's important to think about this in different buckets. There's the laying off of the workers who actually do this work for the federal government, who collect this data, make it usable to other researchers. That's actually the point of collecting it, is to collect it and make sure that people can see it. There's the HHS internal workforce. There are the grants that are given to states and universities either for operations or for, in the case of community health centers, to actually provide services, or in the case of the NIH, to help pay for research.

Then there are contractors. There are people who do work for the agency that get paid to do that work, often that support kind of work. HHS hasn't even cut the contractors yet. There's apparently a 35% contractor cut coming. You've got three different ways that HHS is retrenching, if you will, from everything that it has been providing to the nation's healthcare system. Obviously, the data is one big important piece of that.

Another thing that we at KFF Health News broke over the weekend is that they've fired all of the people who put together the poverty statistics at the Department of Health and Human Services. If we don't have the poverty statistics, you can't determine who's eligible for things like food stamps, and Medicaid, and welfare. All of the means-tested program depend on those statistics. It's unclear what's going to happen. Is that something that will be contracted out? Who will do that? There is just a lot that's trying to make the agency not function. They're doing a pretty good job in a pretty short time of making this enormous agency not function.

Amina Srna: Thanks for laying it out for us like that. Listeners, if you're just joining us, I'm Amina Srna, producer here at The Brian Lehrer Show, filling in for Brian today. My guest is Julie Rovner, chief Washington correspondent for KFF Health News. We can take some of your calls now at 212-433-WNYC. That's 212-433-9692.

Julie, for the listeners who didn't catch the story, what were some of the headlines coming out of Kennedy's Make America Healthy Again tour? I'll ask you specifically about his stop in West Texas where there is a measles outbreak. The tour itself, how does his visits line up with what's shaping up to be his agenda?

Julie Rovner: Well, obviously, one of the places he went, we'll get to Texas in a minute. One of the places he went was Utah, which is the first state that has now banned localities from adding fluoride to their drinking water, which has, obviously, been shown over several generations to lower the rate of dental cavities and other problems. It has been controversial over the years. They have, obviously, found fluoride in excess amounts can hurt brain development. Although most localities that add fluoride to their water take into account the fact that many people are getting fluoride from other sources.

Then obviously in Texas, he went to the funeral of one of the children who've died in the measles outbreak there, basically endorsed the measles vaccine, but then reiterated that the government isn't going to mandate it. Has been saying things that are not true about measles and about the vaccine, including the fact that the vaccine wears off, which it doesn't. It's one of the most effective vaccines that we have. There's been no link found between the measles vaccine and autism in many, many studies, although he's commissioning yet another study. I'll stop and take a breath here.

Amina Srna: [chuckles] That leads me perfectly into the next question. On his tour, as you were saying, Kennedy made a stop in Texas on April 6th to attend that funeral of the second child to die of measles in that state. After the visit, Kennedy posted on X that the measles mumps rubella vaccine, also known as the MMR vaccine, is "the most effective way to prevent the spread of measles." Listeners may be familiar with Kennedy's complicated history with that vaccine, in particular, having previously said it causes autism in children. Is this an about phase? What do you make of it?

Julie Rovner: It is and it isn't. I mean, he did say that, but in his long interview on CBS with Dr. LaPook, he rolled that back a little bit. He's trying to play both sides. Some of his anti-vaccine supporters are now unhappy with him for suggesting that anyone should get the vaccine. He's walking a delicate line, and he's trying to have it both ways.

Amina Srna: You started to talk about his commission or his vow to discover what causes autism by September. I gather he made that statement at a cabinet meeting on April 10th. That's following that funeral of the child in Texas. Can you tell us more about his plans? Some scientists are already pushing back and saying that's just not how science works. You can't-- Yes, go ahead.

Julie Rovner: Yes, that is not how science works. Science would love to know exactly what causes autism and how to cure it. Most of the research that we've seen thus far, and there's been a lot of research because everyone is concerned about rising rates of autism. Is it really more prevalent, or are we just better able to diagnose it? Is it related to the environment, to climate change, to genetics, to what children eat? We're fairly confident that it's not caused by vaccines. That's the one thing that has really been studied.

On the other hand, Kennedy has hired a vaccine skeptic to lead yet another study of vaccines and autism. In fact, this vaccine skeptic has been disciplined by the state of Maryland for practicing medicine without a license. It does suggest what that new study is going to find. There are people who are very concerned about this. We'll have to see, but it does seem there are a lot of scientists who say we are not going to know exactly what the cause and the cure for autism is by September, even though that would be a wonderful thing.

Amina Srna: Staying on the measles vaccine for just one more moment, let's go to Leslie in Rockville Centre on Long Island. I believe this is a little bit in the weeds, but I have heard it talked about on other media outlets. Maybe we can answer her question. Leslie, you're on WNYC.

Leslie: Hi. No, I don't really have a question. It is a very unpublicized fact or little-known statistic about the measles vaccine that there is a cohort of people who were born between 1957 and 1968 who did not receive the live virus. They received a different vaccine, and their immunity does wane over time. A case in point, my sister, just a couple of years ago, she's within that cohort, went to Africa and she needed to be tested, and her measles titers were non-existent. She needed to be revaccinated.

I don't think many people are aware of that, that they should have their titer levels tested if they were vaccinated between those years. In a way, some people, yes, their immunity does abate, but it's because they received a different vaccine.

Amina Srna: Leslie, thank you so much for your call. Julie, I don't know if you can weigh in on that in particular. That's a pretty narrow slice of--

Julie Rovner: I can, because I'm also a member of that cohort born in those years. My internist told me, I think the last time we had a measles outbreak, "I actually did get my titers checked and they were okay." Yes, that is true, that there are these people in their 50s and 60s, who-- Presumably, everybody born before 1957 was exposed to measles at some point because we know it is so contagious and it's around. It's just the people who got the first iteration of the measles vaccine. People who have good primary care should know that because their doctors should tell them that. That is true. That's not what Secretary Kennedy was talking about, though.

Amina Srna: Julie, last month, the Food and Drug Administration's top vaccine regulator, Dr. Peter Marks, was forced to resign. Forced to resign as some media outlets-- I think that's how NPR put it. For listeners who might have missed that story, what happened there? There's also some recent news about his departure.

Julie Rovner: Yes, Peter Marks now has begun to speak out. We've heard several interviews with him. He was, in fact, forced out. This is not only the FDA official who was in charge of all vaccines, but he was pretty much the person who led Operation Warp Speed and got us the COVID vaccine in such a short period of time. It was clear in his resignation letter, his forced resignation letter, and in subsequent interviews that he's done that he does not believe that the secretary is interested in real scientific inquiry, that he's just interested in people who will reassure him of his pre-existing beliefs.

Amina Srna: Here's a text. "My husband just retired from the FDA in the nick of time before being in operation. However, he has had many colleagues who have been let go, some of whom are the director of vaccine, the director of clinical research, and the director of tobacco. Many of his colleagues are in quandaries as to whether they will be cut. Some have been given four months severance package. In the interim, the entire agency has been truly put into a state of disarray where so many things like research on drugs and tobacco vaccines are just being affected in terms of researching and staffing. It's been an absolute internal nightmare, and it's just a disgrace."

Moving on, I wanted to take another caller. Let's go to Matthew in the Bronx. Hi, Matthew. You're on WNYC.

Matthew: Hi, thanks for taking my call.

Amina Srna: Thanks for calling in.

Matthew: This is a wonderful segment. Thank you for doing it. I wanted to say a couple of things about RFK. I agree with him that we should probably be eating better. We should have better quality food and stuff, better options in supermarkets that are more affordable. I think otherwise, he is an absolute disaster. The fact that he's cutting so many people and firing so many people just to save money for the ultra-wealthy to become even more ultra-wealthy and the poor to become even poorer is, I think, antithetical to the American system. I'm really angry at what's happening.

Amina Srna: Thank you so much for sharing, Matthew. Julie, we did talk earlier about the broad scope of HHS. I know that some of the things that Robert F. Kennedy Jr.'s eyeing don't even fall under the purview of HHS. They are under maybe USDA or other agencies. Do you want to talk maybe more about what he can and can't do to make America healthy again?

Julie Rovner: Yes, that's right. Most of the environmental issues that he has been most associated with throughout his career fall under the purview of the Environmental Protection Agency. Most of the food issues fall under the purview, as you said, of the USDA. There are a lot of things. He's talked about should we be paying for the health care of people who smoke or drink or eat badly. One of the ways to facilitate that would be through food stamps, but that's not an HHS program. That's USDA program. There are lots of things that he can't do.

As we said earlier, a lot of things that he said that he does want to do, focus on chronic disease. These cuts have been so sweeping and so broad that one of the things that was eliminated was the office at NIH that coordinates research on long COVID. That's one of the most chronic of chronic diseases right now. Things that he says are his priorities are also getting cut in all of this.

Amina Srna: Here's a question via text. "Can your guest discuss the issue with development of the flu vaccine for the 2025/2026 season? I understand that the FDA made a decision without going through its normal process."

Julie Rovner: They did. Actually, interestingly, the Advisory Committee on Immunization Practices is meeting today. It was supposed to meet in February after it was much delayed. There is going to be a flu vaccine for this fall that was somehow managed to get taken care of. Obviously, I am talking here, so I'm not watching that advisory committee, but a lot of my colleagues are to see whether-- These are independent researchers who are on this committee but to see if they're feeling constrained by the new leadership at HHS.

Amina Srna: Well, we appreciate you being here with us instead of watching that. Definitely. Let's go to another caller. Adrienne in Brooklyn. Hi, Adrienne. You're on WNYC.

Adrienne: Hi. Thanks for taking my call. I just wanted to share a little bit of an anomalous situation. It was similar to a caller a couple of calls ago. I'm 50. I grew up overseas. I received my MMR vaccinations. In 2008, when my son was eight months, we traveled to the UK, England and Scotland, and we both contracted measles. He contracted it because he was too young for the vaccine at that time. I did, too, even though I was vaccinated. I don't really have a point. I'm totally pro-vaccines. I just think-- I don't know. I don't even really know what my conclusion is other than it's an interesting story.

Amina Srna: Yes. Adrienne, thank you so much for your call. I think, Julie, a lot of what we saw coming out of COVID, especially, was a misunderstanding of or people thinking that COVID vaccines don't work because you can still contract COVID itself. I don't know where you want to weigh in on Adrienne's call, but something that a lot of people think about, right?

Julie Rovner: Yes, no vaccine is 100%, but the measles vaccine is very, very good. As I said, except for that cohort that the caller mentioned, which is good to remind people, people who are born after 1957, I believe before 1968, should either get a second vaccination or get their titers checked to see if they still have immunity. Most people who are vaccinated after 1968 will not get measles. That doesn't mean that everybody won't.

This is not to say that there are not, occasionally, complications from the vaccine. No vaccine is also 100% safe. There is a federal program that actually helps people who've been injured by these vaccines because there are-- It's a very, very tiny, tiny percentage, fractions of 1%. There are, in fact, injuries associated with vaccines, and there are ways to address those. There is a cost-benefit to everything. Certainly, in the case of measles, it is considered much, much, much, much better to get the vaccine than to not, which is not to say you won't get measles. As with COVID, you're likely to get a much more mild case. In most cases, you won't get it if you're vaccinated.

Amina Srna: Another question via text. "Is there a time period or metric that RFK points to as a time when Americans were healthier? Are we just accepting the Maha frame?" I don't know if you can answer this, Julie. I don't know if you know--

Julie Rovner: I think he talks about when he was a kid, which I guess was in the '50s because he's 70. Obviously, if you look at the statistics, we were healthier in some ways and we were way less healthy in lots of other ways. Medical science has come a very long way for an awful lot of things. Much of that funded by the National Institutes of Health research.

Amina Srna: Which is being cut.

Julie Rovner: Yes, which is being cut. Do we have problems? Is our health system a huge mess? Yes, our health system is a huge mess. There's lots of ways in which it doesn't work, but there was never a golden age when everything was great.

Amina Srna: Let's take one more call. Let's go to Bill in Yorkville. Hi, Bill. You're on WNYC.

Bill: Hi. Thanks so much for taking my call. Awesome job filling in for Brian. I love the show. I wanted to make two very quick points. I think one of them quickly goes to the credibility of RFK Jr. and the recent statements about fluoride. Yes, fluoride, in certain doses, is a neurotoxin. People should remember that it is the dose that makes the poison. Water is fatal. Glucose, simple sugar is fatal in the right dose. The credibility issue, I believe, comes from-- there's a lot of evidence, but people should remember that RFK, under his leadership, has now gutted the group that is tasked with ensuring safe levels of lead in drinking water.

I think they have no leg to stand on if they want to claim fluorides and neurotoxin. Well, so is lead, and you're doing nothing to reduce concentrations in water. We still have children growing up with lead poisoning in this country today. The other thing, I guess, about this larger issue of vaccine-preventable disease, I come down politically and scientifically as a physician, firmly against everything that this administration stands for. However, if people want to question the efficacy of vaccines, the safety of vaccines, I think they do well to talk to older generations and ask about what it was like in the time that polio was rampant in our society.

If you ask your parents and grandparents, depending on how old you are, they will have tale after tale after tale of children who became paralyzed, children who just disappeared from school and they never saw them again, summers where they could not go swimming because polio can be transmitted through stool. It can be transmitted from the stool into water. People can get it in pools.

This is the world we lived in not long ago, and we no longer live in that world specifically because of vaccines. If you want to have your doubts, that's fine. I believe they are incorrect. Talk to people about what it was like before we had widespread vaccination and decide if that's the world you want to go back to.

Amina Srna: Doctor, thank you so much for your call and insight there. Julie, as I was listening to the caller, I was thinking about some of the pushback from Republicans during RFK's Senate confirmation hearing because a few of them had survived or had grown up during the time of polio and had seen its devastating effects on their peers. I don't know, what were you thinking about as you were hearing that call?

Julie Rovner: That I have nothing to add to what the doctor said. [chuckles]

Amina Srna: Perfect call. Perfect call. That's where we will leave it. I guess it's a great place to end. Wait, actually, Julie, one last thing. As we were speaking, we were getting a bunch of people texting in asking some very specific questions about, "I've contracted measles when I was a child in the '50s. Am I still immune?" or, "I was born in '56, got measles when I was seven. Am I permanently immune?" I don't want to put you on the spot there, but I do want to ask if there are any specific resources now.

My understanding is the CDC website is not giving broad guidance. I think it's giving very specific statewide guidance, especially in the case of Texas. Where would you go if you don't maybe have a primary care physician that you can talk to?

Julie Rovner: The American Public Health Association is trying to make available a lot of the CDC databases that are in some question right now. That would be a good place to start. There are a number of places that are looking for that. Also, some of the medical organizations, American College of Physicians, the American Medical Association, are trying to fill in some of the gaps that are being created.

Amina Srna: Thank you. That's super helpful. That's where we will actually leave it for today. I've been speaking with Julie Rovner, chief Washington correspondent at KFF Health News and the host of the What the Health? podcast. Julie, thank you so much for your time today. We really appreciate it.

Julie Rovner: My pleasure.

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