President’s Letter from Bill Steinbach – Current Landscape of Pediatric ID

We’re not in Kansas anymore. Or perhaps we’re all about to “be” there as the state has joined 21 others to report measles cases this year. We’ve reached at least 634 cases (already more than doubling the total for all 2024) nationwide, two children in Texas have tragically died, and it’s only April. It is precisely at a time like this that the country should look to our world-class public health agencies for information and guidance – provided by experienced, knowledgeable, transparent scientists – in support of the demonstrably safe and effective MMR vaccine.

We have been swept far away from that place. Instead, we are revising our MMR recommendations as the country is most certainly to lose its measles elimination status earned in 2000. Unfortunately, incidences of measles aren’t happening in a vacuum; we’ve also experienced two children in Louisiana dying from whooping cough. It is all part of a larger undermining of vaccine-preventable diseases, specifically, and healthcare, more broadly.

My 25-year-old daughter, who has no formal training in medicine and is in fact a second-year law student, grew up in Durham, NC, and for two decades came to know my friend and colleague Dr. Sam Katz as a wonderful grandfather-like figure. Sam was, of course, the co-inventor of the measles vaccine, a life-long advocate for access to it, and a PIDS member. She told me the other day, “Dad, I am glad Sam is not around to see this.” 

This past month has ushered in decimating “efficiency” cuts to our public health agencies, their budgets, personnel and emphases. A brief, partial recap of how infectious diseases and public health have been affected by leadership’s actions:

• Eliminated grants studying vaccine hesitancy and strategies for improvement.
• Terminated grants to Gavi for vaccine programs internationally.
• Shuttered departments focusing on matters such as HIV, health disparities, and LGBTQ health.
• Rescinded billions of dollars already approved for immunization programs.
• Scrapped studies into possible future pandemics.
• Canceled meetings by independent approval boards.
• Reassigned or forced resignations of staff and leadership, including the heads of NIAID, NICHD, and FDA’s top vaccine regulator.

As a result, we have fewer resources to face greater threats. Decades of institutional and practical knowledge have been shoved out the door with zero succession plans ready to carry us through the transition period. The understandable response from the scientific community to these unprecedented, abrupt, capricious actions has been nearly uniform: they are detrimental to our abilities to function properly in the short term and threaten to inflict generational damage to public health long-term. This has nothing to do with Red or Blue, this has to do with science and medicine and preparedness.

Like you, I worry what this all portends for the future of our specialty and our patients. Will the funding cuts lead to gut-wrenching decisions by young researchers to abandon clinical research? Will only politically favorable results be permitted to be pursued or published when science is by definition apolitical? What will reductions to agency staff mean for things such as inspections? Will the prescriptions we recommend for patients remain safe? How much needless suffering will be inflicted on children by these baffling cuts and reemerging diseases?

I don’t know if there are satisfying answers to these questions yet. Some of the cuts are being challenged in court, some government staff are being quickly rehired, and the HHS secretary has recently made a tepid endorsement of the measles vaccine. Whether any of these moves will lead to us regaining the resources and expertise needed to adequately protect children and fund essential research we’ll have to wait and see. In the meantime our Society is partnering now more than ever with countless other medical groups and working hard to provide leadership and encouragement to students and fellows, wherever possible, to persevere. This is the time for your voice to be heard and for us to be stronger together.