We thank readers for their feedback on the January 26 Sunday Kotok Report, “Trump 2.0 and Healthcare?” (https://kotokreport.com/trump-2-0-healthcare/).
And, yes, the book — The Fed and the Flu: Parsing Pandemic Economic Shocks — is finished and will be released on February 12. Details regarding preorders are updated at https://www.thefedandtheflu.com. Two recent reviews are out, at Kirkus Reviews and Readers’ Favorite.
Flu pandemics are among the pandemic economic shocks examined in the book. Yes, we have a bird flu outbreak in the United States right now, in wild animals, poultry, and dairy cows. No, we haven’t had a human-to-human transmission cluster. Yes, there has been a surveillance system in place, but surveillance is not robust, and the recent Trump administration pause in communications from HHS agencies, including the CDC, has slowed reporting to a trickle.
The current economic shock because of bird flu is visible, even though the H5N1 virus is not yet a human pandemic but one in birds and some mammals. Think broadly and focus on price shocks like eggs. Or contemplate costs for mammal protection in dairies or the reconstruction of chicken houses with rigorous HEPA air filtration.
This is a price chart BEFORE any tariff increases:
Chart source: BLS (https://www.bls.gov/charts/consumer-price-index/consumer-price-index-average-price-data.htm)
All these impacts are occurring as and when mutations have not led to verified clusters or cases of human-to-human transmission, though troubling mutations have popped up in individual cases — the fatal case in Louisiana and the very serious case in a teen in British Columbia, for example. Mutation to a human-to-human transmission cluster can happen tomorrow or never. There is no way to predict a mutation outcome.
Pandemics, epidemics and plagues are shocks in economic terms, as we demonstrate in The Fed and the Flu: Parsing Pandemic Economic Shocks. Below is a brief reading list of existing economic shock reports for agricultural output and food prices.
“Bird Flu, U.S. Cows, and Economic Consequences,” https://www.thinkglobalhealth.org/article/bird-flu-us-cows-and-economic-consequences
“Avian flu outbreak devastates Michigan dairy: Nathan Brearley’s dairy herd is still recovering six months after an infection,” https://www.farmprogress.com/animal-health/avian-flu-outbreak-devastates-michigan-dairy
“Where poultry’s king, bird flu is a crisis,” https://saportareport.com/where-poultrys-king-bird-flu-is-a-crisis/columnists/tom/
“Eggs may be expensive forever,” https://www.businessinsider.com/egg-prices-expensive-avian-bird-flu-changing-tastes-cage-free-2025-1
“The effect of avian influenza outbreaks on retail price premiums in the United States poultry market,” https://www.sciencedirect.com/science/article/pii/S0032579124006813
“On the frontline against bird flu, egg farmers fear they’re losing the battle,” https://www.npr.org/sections/shots-health-news/2025/02/02/nx-s1-5282389/avian-bird-flu-eggs-prices-cull-usda-michigan-poultry-influenza-farmer-vaccination-h5n1
“USDA Egg Markets Overview,” https://www.ams.usda.gov/mnreports/ams_3725.pdf
The greater the prevalence of H5N1 in our environment and the animals that make up part of our food chain, the greater the chances of a human pandemic. Intensified surveillance is an urgent priority since any human H5N1 infection may provide the opportunity for final key mutations that will enable the virus to spread readily from one person to another.
“CDC Advises Expedited Influenza Subtyping in Hospitalized Patients to Help Identify Bird Flu Cases Sooner,” https://jamanetwork.com/journals/jama/fullarticle/2829941#google_vignette
“Will bird flu spark a human pandemic? Scientists say the risk is rising,” https://www.nature.com/articles/d41586-025-00245-6
“The global H5N1 influenza panzootic in mammals,” https://www.nature.com/articles/s41586-024-08054-z
Reports of new outbreaks affecting thousands or millions of birds and more and more herds of dairy cattle keep rolling in. Between the time this commentary is written and the time it is formatted and sent, there will be more. Keeping up is hard to do, so this list is no more than a sampling of recent reports.
“Avian flu strikes second biggest US egg producer,” https://www.cidrap.umn.edu/avian-influenza-bird-flu/avian-flu-strikes-second-biggest-us-egg-producer
“Ohio leads nation in bird flu cases among commercial poultry operations,” https://www.daytondailynews.com/local/ohio-leads-nation-in-bird-flu-cases-among-commercial-poultry-operations/6W6SJ3SYNFE3DB7D4HTEYPC33Y/
“Long Island’s last duck farm weighs closure after outbreak leads to killing of entire flock,” https://apnews.com/article/duck-farm-long-island-bird-flu-outbreak-05de4befe20499595d52ad1e223dad06
“H5N1 avian flu strikes more poultry in 4 states,” https://www.cidrap.umn.edu/avian-influenza-bird-flu/h5n1-avian-flu-strikes-more-poultry-4-states
“Rare bird flu strain found in California raises potential of wider spread,” https://www.washingtonpost.com/health/2025/01/28/new-bird-flu-strain-h5n9-california/
In the meantime, the new administration has quickly rolled out policies that reshape humanity’s battle against infectious diseases. For however long the pauses imposed last, the Trump Administration has called a unilateral ceasefire in the ongoing war against infectious disease. Readers will have to consider the potential long-term economic impacts of erosions in human health and human lifespans, should public health initiatives and research and fact-based guidance be stymied. What public health policies will emerge once the pause ends and cabinet appointments are complete are not yet known. We do know from history that insofar as policies impact the trajectory of human health on a national and global basis, they will have economic impacts, too, both within the healthcare sector and well beyond it.
“Trump administration freezes many health agency reports and online posts,” https://apnews.com/article/trump-health-communications-cdc-hhs-fda-1eeca64c1ccc324b31b779a86d3999a4
“Trump order set to halt supply of HIV, malaria drugs to poor countries, sources say,” https://www.reuters.com/business/healthcare-pharmaceuticals/trump-order-set-halt-supply-hiv-malaria-drugs-poor-countries-sources-say-2025-01-28/
“CDC ordered to stop working with WHO immediately, upending expectations of an extended withdrawal,” https://apnews.com/article/cdc-who-trump-548cf18b1c409c7d22e17311ccdfe1f6
“Aid groups get blanket order to pause U.S.-funded programs as payments dry up,” https://www.reuters.com/world/us/aid-groups-get-blanket-order-pause-us-funded-programs-payments-dry-up-2025-01-30/
“US foreign aid freeze is upending global aid and the work of contractors,” https://www.cnn.com/2025/01/30/world/us-foreign-aid-freeze-intl-latam/index.html
The future of US public health policy regarding vaccines that dramatically lowered childhood mortality and extended human lifespans remains uncertain, but the nomination of Robert F. Kennedy Jr, a long-time purveyor of vaccine-related misinformation, as head of HHS has raised concerns. We must consider the risks of a (policy-enabled) rising burden of infectious, vaccine-preventable diseases and resulting mortality, particularly among children, and for associated costs that extend from healthcare to lost productivity. Nations and economies are not stronger than their people are healthy and able to be productive and to earn and spend.
“How Measles, Whooping Cough, and Worse Could Roar Back on RFK Jr’s Watch,” https://kffhealthnews.org/news/article/rfk-jr-hhs-vaccine-policy-preventable-infectious-diseases-resurge/
On measles and RFK Jr see also this thread from Peter Hotez on X: https://x.com/peterhotez/status/1885307126702367204?s=12&t=LFKFffCQXRqJrDrqt0OO9Q
“With little fanfare, Biden administration stacked vaccine advisory committee with new members,” https://www.statnews.com/2025/01/31/vaccine-policy-acip-members-appointees-hhs/
Newly announced tariffs will affect affordability and quality of healthcare in the US. Here are two impacts, as reported by Becker’s Hospital Review:
The tariffs are expected to affect a significant portion of U.S. medical devices, as about 69% of U.S.-marketed medical devices are manufactured entirely outside of the U.S., according to Medical Device Network. In 2023, medical equipment was among the 10 top U.S. imports from Mexico, accounting for $13.6 billion in goods, according to Census Bureau data cited by AP. Additionally, about 13.6% of U.S.-marketed medical devices are manufactured in China. As a result, the healthcare sector could experience medical device price increases and supply disruptions.
In addition, generic drugs could face further supply challenges. The U.S. imports a substantial amount of active pharmaceutical ingredients from China and any tariffs on these imports could increase drug costs and exacerbate shortages.
“White House unveils tariff plan: 7 healthcare takeaways,” https://www.beckershospitalreview.com/supply-chain/white-house-unveils-tariff-plan-7-healthcare-takeaways.html
For healthcare and DT 2.0, all we know is that more will be revealed.
