This Sunday morning, we begin with a video recorded as I make my way to Camp Kotok. In the video, recorded on Friday around noon, I responded to what turned out to be a dismal jobs report:
We round out this Sunday’s missive with a collaboratively produced update on health-related matters. I would like to thank Elizabeth Sweet for partnering with me in compiling this piece.
We know, having studied such things, that healthy people contribute to healthy economies, whereas health shocks or heavy disease or disability burdens erode economic productivity. There is no unseeing that connection, whether in Ancient Greece or Rome or today — thus our periodic updates on health matters and their economic implications.
Links are embedded in our text, but a full reading list follows.
Childhood Vaccinations Down
Vaccinations for US children entering kindergarten slipped downward again this past school year, according to the CDC. In the climate of vaccine skepticism now shaping policy under RFK, Jr., the American Association of Pediatrics has pushed back against the weakening of vaccination requirements for schoolchildren, calling for an end to nonmedical exemptions now available in 45 states. The debate continues. Consequences of vaccine avoidance are already emerging.
Meanwhile, the cutbacks in vaccination programs previously funded by USAID will ensure the resurgence of infectious diseases globally, with implications for economies. You can’t screen a pathogen at a border. Malaria and chikungunya are both rebounding. The WHO predicts that malaria will claim more than 100,000 lives this year. Deaths have already tripled in Zimbabwe.
Measles Cases Up
To prevent measles outbreaks, 95% of a population has to be vaccinated. Where the vaccination rate is lower, outbreaks begin to occur. Nationwide in school year 2024–2025, only 92.5% of kindergarteners received the MMR vaccine protecting against measles, mumps, and rubella. Measles outbreaks, once largely eradicated in the US, are on the rise, with 29 outbreaks and 1333 cases across 40 states at last report. Canada, however, has seen more than triple that number, with 4206. Alberta is currently seeing a rise in cases. With no immunization requirements for schoolchildren in that province, only 70% have been vaccinated. We see epidemiological math in action.
HIV/AIDS and PEPFAR
A stunning number of people are still dying of HIV/AIDS globally: The WHO estimates 630,000 deaths of HIV-related causes for 2024. That’s 70% fewer than died in 2004, though, at the peak of the AIDS pandemic. By the end of 2022, the pandemic had killed some 36 million people globally. But millions have also been saved, and it was the President’s Emergency Plan for AIDS Relief (PEPFAR) spearheaded by the George W. Bush administration that made the difference, saving some 25 million lives. The budget proposed by the Trump administration cut that funding; Congress insisted on restoring it; and the administration by some reports is still trying to find ways to overhaul and essentially wind down the assistance.
H5N1 Bird Flu
The US bird flu emergency has been declared over by the CDC, as confirmed animal and human infections have declined, though a resurgence is possible in fall, when migratory birds take to their flyways. Meanwhile, the USDA has distributed $230 million in emergency assistance to dairy farmers in California alone, where more than 75% of dairy cattle herds were affected. (A new form of economic damage looms, however, with ICE raids on dairy farms.)
Erin Sorrell, a senior scholar at the Johns Hopkins Bloomberg School of Public Health Center for Health Security, explains the summer lull and relevant changes in surveillance practices with regard to H5N1 bird flu:
Migratory birds have gone south, so we are going to have fewer cases reported right now, both in avian species and dairy cattle. As a result, we’ll likely have less chances of exposure in humans and other mammalian species. We’ve seen cases in South American countries where the birds have migrated. Those birds will come back north, but we do have some time now to plan and prepare.
But as of July 7, CDC has changed from weekly reporting to monthly, so it will be much harder to track when there’s an uptick in potential exposures. It is less likely that we’ll be able to see it quickly.
And CDC is not tracking animal cases anymore. It used to be that on the same page, you’d see on a weekly basis the number of human cases along with how many cases have been reported in different animal species, and that was all linked to USDA databases. Now CDC is just linking to USDA sites and not putting that information together.
That’s a disadvantage because we need a more integrated response. I think we need a one-stop shop for H5 in terms of all the species that it can be impacting.
The US has confirmed 70 cases of H5N1 in humans and seen one death, according to the CDC. Forty-one cases resulted from exposure to infected dairy cattle herds, 24 from exposure to infected poultry, and 2 from exposure to other infected animals, with the exposure sources unknown in the remaining 3 cases. (We note that mild infections may occur under the radar, especially if those infected are immigrants afraid of deportation and thus unlikely to seek care.) In the week of July 20–26, wastewater surveillance identified H5 influenza (Flu A, not specifically H5N1) at only 4 of 395 testing sites that collected samples.
Across the globe, however, Cambodia’s experience this year precludes complacency about the potential severity of the virus in humans. Cambodia’s health ministry has confirmed the country’s 14th H5N1 case this year. Seven cases thus far have been fatal — a 50% fatality rate for 2025. The strain responsible in many of the most recent cases is a reassortment between an older clade circulating in Cambodia and a newer one. All infections have resulted from exposure to infected poultry, without evidence that the virus is spreading between one person and another. That remains good news for Homo sapiens.
NIH Funding
Katelyn Jetelina and Elisabeth Marnick at Your Local Epidemiologist have written a terrific explainer about the work of the National Institutes of Health (NIH) and the vital importance of the research it funds. Please do take time to read their Substack post, “NIH: The quiet engine of science is being dismantled.” A study recently published at JAMA examines the impacts of slashing NIH funding and the research it makes possible (cancer research, for instance). “Slower scientific progress” and an “erosion of scientific talent” are sure bets, its authors conclude. The study finds that “At the national level, in 2024, NIH funding is estimated to generate $94.58 billion in new economic output, with a $2.56 return per dollar awarded, and support 407,782 jobs.” The Senate Appropriations Committee has balked at the 40% cuts planned by the White House and has put forward a bill with funding increases in some areas — $100 million for Alzheimer’s research, $150 million for cancer, and $30 million for women’s health. Perhaps most significant was the vote from this bipartisan committee: 26 to 3.
A Healthcare Patchwork Unraveling
In The Fed and the Flu, we characterized US healthcare this way:
US healthcare is an expensive, fragmented layering of healthcare providers, insurers, and programs. Patchwork may arguably be too generous a word to describe it, because the word implies that the pieces are coordinated and stitched together according to a design in some sort of continuous pattern. We think, perhaps, of a patchwork quilt that covers us from head to toe and keeps us warm. But the patchwork of American healthcare is full of holes where many Americans are concerned. System is another overly generous word.
(The Fed and the Flu: Parsing Pandemic Economic Shocks, p. 390.)
Holes in the US healthcare patchwork are growing larger, and with them the burden of health conditions for which many Americans lack adequate care. Medicaid cuts will, according to the Congressional Budget Office, lead to 7.8 million Americans losing health insurance. Estimates rise to more than 17 million additional uninsured Americans as ACA health insurance subsidies are ended. When people lack insurance, their health outcomes are poorer because preventive care tends to fall by the wayside; ER visits rise; hospitals face higher costs and some close; healthcare workers lose jobs; and health insurance costs raise care costs such that fewer Americans can afford the premiums. Federal funding cuts affect state and local health departments and the services they offer. Cuts to SNAP will end SNAP-Ed, the program’s nutrition education program, this fiscal year. More responsibility for healthcare will fall on the states, which are unequally prepared to shoulder this and other new burdens, though wealthier states may take on challenges that the federal government is stepping back from.
A patchwork quilt with more holes wraps around fewer people — with economic implications. The US saw COVID pandemic outcomes worse than many other nations did, though it staged an impressively fast economic recovery, in part by facilitating immigration again. The growing holes in the US healthcare patchwork spell heightened economic vulnerability to future pandemic shocks, along with an ongoing health-related drag on productivity and a healthcare-cost drag on consumption.
Reading List (Sources listed in order of appearance)
Childhood Vaccinations Down
“Fewer kindergarteners are being vaccinated, CDC data shows” | News Channel 8 Tampa,
https://www.wfla.com/news/national/fewer-kindergarteners-are-being-vaccinated-cdc-data-shows/
“AAP calls for end to nonmedical vaccine exemptions for school attendance” | CIDRAP,
https://www.cidrap.umn.edu/childhood-vaccines/aap-calls-end-nonmedical-vaccine-exemptions-school-attendance
“Malaria’s Rebound” | Global Health Now
https://mailchi.mp/4982490c09f2/global-health-now-malarias-rebound-how-do-the-amish-avoid-allergies-and-swinging-toward-mobility?e=d4595330b0
“Chikungunya Outbreak Spreads from Indian Ocean Islands, Posing Global Risk” | Health Policy Watch,
https://healthpolicy-watch.news/who-warns-of-global-risk-of-mosquito-borne-chikungunya/
“WHO Warning: Over 100,000 Malaria Deaths Expected in 2025” | IMArabic,
https://en.imarabic.com/who-warning-over-100000-malaria-deaths-expected-in-2025/
“Malaria ‘back with a vengeance’ in Zimbabwe as number of deaths from the disease triple” | Guardian,
https://www.theguardian.com/global-development/2025/jul/19/health-malaria-mosquito-deaths-zimbabwe-trump-usaid-cuts-disease-control
Measles Cases Up
“Fewer kindergarteners are being vaccinated, CDC data shows” | News Channel 8 Tampa,
https://www.wfla.com/news/national/fewer-kindergarteners-are-being-vaccinated-cdc-data-shows/
“Measles Cases and Outbreaks” | CDC,
https://www.cdc.gov/measles/data-research/index.html
“More measles cases in US as infections in Canada balloon” | CIDRAP,
https://www.cidrap.umn.edu/measles/more-measles-cases-us-infections-canada-balloon
HIV/AIDS and PEPFAR
“HIV – Number of people dying from HIV-related causes,” | World Health Organization,
https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-deaths-due-to-hiv-aids
“A global HIV/AIDS program that saved millions of lives faces cuts under the Trump administration” | NBC News,
https://www.nbcnews.com/politics/trump-administration/global-hivaids-program-saved-millions-lives-faces-cuts-trump-administr-rcna221025
“Republicans Scrap Plan to Cut $400 Million From PEPFAR Anti-AIDS Program” | TIME,
https://time.com/7302545/pepfar-aids-congress-republicans/
“U.S. Quietly Drafts Plan to End Program That Saved Millions From AIDS” | New York Times,
https://www.nytimes.com/2025/07/23/health/pepfar-shutdown.html
H5N1 Bird Flu
“CDC declares bird flu emergency over as experts warn of possible fall resurgence” | Fox News,
https://www.foxnews.com/health/cdc-declares-bird-flu-emergency-over-experts-warn-possible-fall-resurgence
“USDA Pays Millions to California Dairies Amid Bird Flu Milk Losses” | AgNet West,
https://agnetwest.com/usda-pays-millions-to-california-dairies-amid-bird-flu-milk-losses/
“Worries Mount as ICE Raids Ramp Up On Dairy Farms” | Dairy Herd Management,
https://www.dairyherd.com/news/business/worries-mount-ice-immigration-raids-ramp
“Is Bird Flu Gone for Good?” | Bloomberg School of Public Health,
https://publichealth.jhu.edu/2025/whats-the-status-of-the-h5n1-flu-outbreak
“H5 Bird Flu: Current Situation” | CDC,
https://www.cdc.gov/bird-flu/situation-summary/index.html
“Wastewater Data for Avian Influenza A(H5)” | CDC,
https://www.cdc.gov/nwss/rv/wwd-h5.html
“H5N1 avian flu hospitalizes Cambodian man” | CIDRAP,
https://www.cidrap.umn.edu/avian-influenza-bird-flu/h5n1-avian-flu-hospitalizes-cambodian-man
NIH Funding
“NIH: The quiet engine of science is being dismantled” | Your Local Epidemiologist,
https://yourlocalepidemiologist.substack.com/p/nih-the-quiet-engine-of-science-is
“Potential Trade-Offs of Proposed Cuts to the US National Institutes of Health” | JAMA Health Forum,
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2836433
“Senate panel rejects Trump cuts to NIH, other health agencies” | The Hill,
https://thehill.com/homenews/senate/5430915-senate-rejects-trump-nih-cuts/
A Healthcare Patchwork Unraveling
David R. Kotok, Michael R. Englund, Tristan J. Erwin, and Elizabeth Sweet, The Fed and the Flu: Parsing Pandemic Economic Shocks, 2025
“Higher Premiums and Packed ERs: 6 Ways Medicaid Cuts Will Affect You, Even If You’re Not on Medicaid” | Investopedia,
https://www.investopedia.com/higher-premiums-and-packed-ers-6-ways-medicaid-cuts-will-affect-you-even-if-you-re-not-on-medicaid-11770935
“How 17 million Americans enrolled in Medicaid and ACA plans could lose their health insurance by 2034” | WANE.com, reprinted from The Conversation,
https://www.wane.com/news/how-17-million-americans-enrolled-in-medicaid-and-aca-plans-could-lose-their-health-insurance-by-2034/
“State, local public health officials grapple with fallout from funding, job cuts” | CIDRAP,
https://www.cidrap.umn.edu/public-health/state-local-public-health-officials-grapple-fallout-funding-job-cuts
“Budget cuts knock down a ‘pillar of public health,’ ending nutrition education” | STAT News,
https://www.statnews.com/2025/07/30/budget-cuts-end-snap-public-health-education-program-for-food-stamp-beneficiaries/
“Can States Reinvent U.S. Healthcare? This Expert Thinks So.” | Institute for New Economic Thinking,
https://www.ineteconomics.org/perspectives/blog/can-states-reinvent-u-s-healthcare-this-expert-thinks-so
“Immigration is ‘taking pressure off’ the job market and U.S. economy, expert says” | CNBC,
https://www.cnbc.com/2024/03/02/immigration-taking-pressure-off-the-job-market-us-economy-expert.html
