Bird Flu Outbreak Raises Readiness Concerns for Trump HHS

An increase in human cases of bird flu is sparking concerns that the incoming Trump administration won’t be ready to respond to a potential public health emergency from avian influenza.

Over 60 human cases of H5N1 bird flu have been detected in the US since April, and California recently declared a state of emergency around the outbreak among dairy cows. But while people working with animals are at higher risk of infection, public health experts warn that should the virus evolve to spread from human to human, the impact would be catastrophic.

The Biden administration’s response has drawn warnings from health experts worried the US Department of Health and Human Services is moving too slowly to adequately prepare for a public health emergency.

“For years we’ve had major outbreaks and deaths with avian influenza throughout the world,” said Lawrence Gostin, faculty director of Georgetown University’s O’Neill Institute for National and Global Health Law. “And it’s only one genetic leap away from becoming very, very serious.”

The World Health Organization pegs the case fatality rate from bird flu as over 50%. The HHS’s Administration for Strategic Preparedness and Response (ASPR) ranks the public health risk as low, though the agency is monitoring the situation and ready with personal protective equipment, antiviral drugs, and millions of vaccine doses should they be needed.

“It would be far worse than Covid because the death rate would likely be higher,” said Gostin, who advises the WHO and has been putting together a plan to advise the US government on bird flu. “‘We don’t want to wait until a breakout moment for this virus, because by then it’ll be too late.”

With Donald Trump’s administration set to take control of the HHS in a few weeks, the views and priorities of his nominees also are drawing notice.

Trump’s pick to lead the HHS, Robert F. Kennedy Jr., has vowed to end the Food and Drug Administration’s “aggressive suppression” of raw milk. Officials have detected bird flu in raw milk for sale, though it’s unclear whether that can cause infection.

Kennedy has also made attacking chronic diseases a staple of his candidacy, prompting fear those goals could come at the cost of combating communicable diseases like bird flu.

“Non-communicable diseases are a major problem, and health agencies have been working on it. But sacrificing preparedness for communicable diseases for that would be a real threat,” said Dorit Reiss, professor of law at University of California College of the Law San Francisco.

Quick Response

David Boucher, director of infectious disease preparedness and response at ASPR, said the government has four approved antivirals it expects would be useful, with tens of millions of courses of Tamiflu, which the Centers for Disease Control and Prevention recommends for treating H5N1 infection.

Also in the stockpile is PPE, much of which was accumulated during the Covid-19 pandemic.

The government has two vaccine candidates, with around 5 million doses in hand and 5 million more that will be ready in spring 2025. Boucher said the government has made the investments and taken the steps needed to develop and produce an mRNA vaccine candidate for a human-to-human bird flu should it be needed.

At present, the government doesn’t know what a mutated virus would look like, Boucher said, “so manufacturing right now 660 million doses of a vaccine that ultimately might not be matched just wouldn’t be the right way to go.”

Some health experts are concerned the administration isn’t moving faster.

“We want an Operation Warp Speed or Manhattan Project to develop better and more accessible H5 vaccines,” Gostin said.

Robert Kadlec, who led ASPR as an assistant HHS secretary in the first Trump term and helped launch Operation Warp Speed, said he was “‘a little bit perplexed” by the Biden administration’s “slow reaction” to bird flu.

A lack of testing for humans and animals means “we really don’t have a good idea what’s happening,” Kadlec said, while the sporadic clinical cases of people getting it with unknown or undefined exposure heighten concerns. Surveillance should be further along, he said.

Also important, Kadlec noted, is developing a rapid antigen test to broadly test specifically for H5N1, as well as antiviral drugs.

“‘If there is an outbreak, even with a limited supply of vaccine, you’re not going to have enough vaccine for several months before you can actually employ it broadly,” Kadlec said.

Kennedy Factor

How much the incoming administration plans to focus on health emergency preparation remains unclear.

Kennedy has said he wants to replace National Institutes of Health staff and focus on chronic rather than infectious diseases.

Switching focus will mean less preparation, Reiss said, adding that “there’s only so much funding to move around.”

“Politically and financially, we don’t have an appetite for pandemic preparedness and response. We’re fatigued by Covid-19. The new administration can’t run away faster from the pandemic,” Gostin said.

Responding to a potential health emergency like bird flu is a multi-agency effort, requiring ASPR to work alongside offices like the CDC and FDA.

Asked whether the change in administrations would affect its approach, an agency spokesperson said that “throughout its more than 115-year history, the FDA has continually upheld its mission to protect and promote public health across numerous administrations.”

“The FDA is regarded globally as the gold standard public health regulatory agency and its more than 20,000 career staff include leading experts in their fields. The agency remains guided by science and the law for products within its oversight,” the spokesperson said.

ASPR’s Boucher likewise said “the things that we’re doing and we’ve been doing for past years, we’re going to continue to do.”

“There’s no differences based on administration. The work we’re doing is really following a trajectory of the outbreak, pulling in all of the data we have, and then making best decisions on path forward. So that hasn’t changed as a result of the election,” Boucher said.