Four Horsemen of the Pediatric Apocalypse

In case you missed the story, the United States has embarked on the most unprecedented assault on science and medicine in its history. We will all bear the costs in the coming years, whether in the form of epidemics that could have been prevented; the cancers, heart disease and Alzheimer’s that could have been treated or cured; or the hurricanes, floods, and fires that could have been predicted and prepared for. Medical education is certain to suffer. The number of well-trained physicians is likely to decline. In their place will rise a gang of cranks and snake oil salesmen who traffic in the desperation of the afflicted. The ecosystem of science that took decades to build has been torn apart in a matter of months. Even if the scoundrels are eventually tossed out of the office, the damage to knowledge will have been done, and rebuilding will take years.

As I write this, the barbaric effects of this attack on science are claiming lives of Americans now. In the last four weeks 1,200 new cases of measles, a disease that vaccination had enabled us to declare as conquered in 2000, has returned to 22 States. As misinformation about vaccination is spread in Washington, and American herd immunity against preventable infections falls, the measles outbreak is sure to be followed by a return of the pediatric plagues of whooping cough, diphtheria, tetanus, and polio.

The de facto destruction of the United States Agency for International Development, USAID, the Trump administration has placed on the chopping block 5,800 out of 6,200 contracts to prevent or treat tuberculosis, malaria, Ebola and HIV infections. The US is pulling out of the international vaccine alliance, GAVI, despite the alliance’s record of saving millions of lives. Dr. Atul Gawande, the former Assistant Administrator of Global Health at USAID, has said that this year alone 300,000 children have died from these cuts.

This week the prestigious medical journal, The Lancet, published an international review of the effects of USAID support to 133 countries on mortality over the last 21 years. It was estimated that USAID prevented 92 million deaths of people of all ages, and that steep cuts in its funding were likely to result by the year 2030 in the deaths of 14 million people, including 4.5 million children under the age of five. Dr. Jeremy Faust, an emergency medicine physician at Boston’s Brigham and Women’s Hospital, calls these coming deaths “a mass casualty event.”

Work to prevent an epidemic of bird flu is being halted despite 67 outbreaks recorded in the US this year. A single fatal case has been reported in humans, but once a virus learns to jump from an animal to a human, the chance of spreading among humans is likely to increase. And make no mistake. The world is a small place. An epidemic starting in Africa, China, or South America will not stay there.

In an article packed with data, the physician and researcher Stephen Woolf at the Virginia Commonwealth University writes in his article, How to Wreck the Nation’s Health, by the Numbers, that for years Americans have had shorter life spans than those living in other high income countries, but with changes coming in the administration of Donald Trump, those numbers are going to become more dire, in large measure because of the termination of thousands of research grants for preventing pandemics, studying cancers and chronic diseases, and developing and testing vaccines. Since taking office the president has blocked over nine billion dollars’ worth of medical grants despite them being approved by Congress. The largest cut, 5.8 billion dollars, has been made to the Centers for Disease Control and Prevention which focuses on a range of medical problems including chronic diseases and lead poisoning, drug overdoses, maternal deaths, childhood injuries, and smoking, to say nothing of identifying and preventing the next epidemic. Thousands of grants have been blocked related to cancer, vaccines, and chronic illnesses amounting to 3.2 billion dollars, 0.3% of the defense budget. Drug abuse and mental health services have been cut by 543 million dollars.

Does the administration really think they are saving any money by cutting support for medical care and science? I doubt that. Rather a species of scientific illiteracy is afoot in the land, a failure to understand that the fruits that grace our tables depend on the roots we nurture. It’s a no brainer that the loss of support for medical science will delay new discoveries, but no brains are required if you want to work in the White House. In fact, no brains are preferred.

What are the remedies? First and foremost, impeaching RFK Jr. would be a good start. Having a crackpot at the Secretary of the Department of Health and Human Services is an assault on the foundational pillars of our public health and a danger to every American. The men who cavalierly put him in that position, the Senator (and physician) William Cassidy and President Trump should be held accountable, to say nothing of those who have promoted these crimes against humanity—Marco Rubio, Russell Vought, and Elon Musk. The blood of thousands of women and children are on their hands. The rest of us are victims in waiting.

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