Alarms raised over bird flu response under Trump

• Those concerns have grown as Trump stocks his health agencies with a host of controversial picks, including National Institutes of Health director-designate Jay Bhattacharya and former Rep. Dave Weldon, a vaccine skeptic in line to head the Centers for Disease Control and Prevention.
• "There's this lack of situational awareness that we've got some big threats looming and and there's not going to be any time to waste with the transition," Peter Hotez, a vaccine researcher at the Baylor College of Medicine, pointing to vows of sweeping reforms, including firing career employees, at federal health agencies.

Even Trump first-term FDA commissioner Scott Gottlieb has sounded alarms about the reemergence of long-vanquished diseases if overall vaccination rates keep falling.

• "What I worry about is that we're at a tipping point where we're going to start seeing epidemics of diseases that've long been vanquished. And God forbid we see polio reemerge in this country," Gottlieb said on CNBC last week.

What they're saying: "President Trump will deliver on the promise of implementing principles that allow for more choice in the marketplace and efficiency as tools for better, more affordable healthcare," spokesperson Brian Hughes said in an emailed statement.

• Hughes added that Trump "will slash wasteful spending in our broken healthcare system that cripples our nation's budget, return healthcare to the Gold Standard, ensure Americans have better access to healthcare."

State of play: The already-limited testing and tracking of bird flu is stoking fears of what's to come for the current outbreak and any future ones, even though the H5N1 virus has been slow to transmit easily to and between humans.

• The Biden administration CDC only last month recommended expanded testing of farm workers after new evidence showed previously undetected cases of H5N1 in humans.
• The U.S, has already stockpiled vaccines for H5N1, but the Biden administration has been reluctant to recommend vaccinations or take other steps to prevent the outbreak from becoming a crisis, they warn.

Between the lines: Experts say decisions still need to be made about whether to ramp up stockpiles of vaccines developed for prior flu strains or to develop additional options.

• There's also the question of whether to increase surveillance and diagnostic testing of farm workers, and laying out a roadmap for deploying antivirals and other steps if the virus becomes widespread.

Public health officials worry the next administration will give surveillance of disease spread short shrift while pursuing alternative cures and questioning vaccine safety. In Trump's first term, he proposed deep cuts to global infectious disease surveillance funding and disbanded a National Security Council unit charged with pandemic preparedness.

• Another concern is that the nominees, if confirmed, will deemphasize and reduce funding for infectious disease, as well as testing and therapeutics.

• Experts also worry that a newly empowered Department of Government Efficiency or the Office of Management and Budget could reclassify or fire career scientists, leading to a brain drain.
• "In an emergency, you have to listen to science, follow the scientific evidence and communicate that evidence honestly to the public," Lawrence Gostin, a global health law expert at Georgetown University, told Axios. "Those basic minimum core requirements of an effective response I don't see in the current leadership."

The big picture: Concerns about infectious diseases dovetail with significant cuts to Medicaid and potentially the Affordable Care Act, Angela Rasmussen, a virologist at the University of Saskatchewan's Vaccine and Infectious Disease Organization, told Axios.

• That could cut off access to interventions like vaccinations and timely treatments at a time when they are most needed.
• "What frustrates me is there's this idea that we need to burn the entire public health infrastructure to the ground to shake things up," Rasmussen told Axios.
• That approach will cost lives, she said.

What to watch: Whether the Trump administration decides to keep or dismantle the White House Office of Pandemic Preparedness and Response Policy will be an indicator of his infectious disease policy.

• It will be telling who ends up in the role of leading the Administration for Strategic Preparedness and Response, as well as the leadership of the Department of Agriculture, which is critical to coordinating the response to bird flu with health agencies.
• Other areas to watch include whether infectious disease research funding is reduced, career scientists are fired or whether the incoming administration is "kowtowing to the meat packing industry in relation to keeping farmworkers safe," Gostin said.