A National Institutes of Health Pediatric Oncology Branch POB researcher's lab jacket. The NIH consists of 27 different centers and institutes that each focus on health challenges facing Americans. President-elect Donald Trump announced Tuesday he would nominate Stanford University researcher Dr. Jay Bhattacharya to lead the wide-ranging agency. (Photo credit: NIH)

WASHINGTON — President-elect Donald Trump said Tuesday he has selected a Stanford University professor of health policy and skeptic of COVID-19 precautions to run the National Institutes of Health, the sweeping federal agency tasked with solving many of the country’s biggest health challenges.

Dr. Jay Bhattacharya will require Senate confirmation before taking over the role officially, but assuming he can secure the votes next year when the chamber is controlled by Republicans, he’ll have significant sway over where the federal government directs billions in research dollars.

“Dr. Bhattacharya will work in cooperation with Robert F. Kennedy Jr. to direct the Nation’s Medical Research, and to make important discoveries that will improve Health, and save lives,” Trump wrote in the announcement. Kennedy is Trump’s pick to lead the Department of Health and Human Services.

Bhattacharya posted on social media that he was “honored and humbled” by the nomination and pledged to “reform American scientific institutions so that they are worthy of trust again and will deploy the fruits of excellent science to make America healthy again!”

In addition to Kennedy, other Trump nominees for health-related positions include former TV personality and onetime Pennsylvania U.S. Senate candidate Mehmet Oz to lead the Centers for Medicare and Medicaid Services, former Florida Congressman Dave Weldon to run the Centers for Disease Control and Prevention, Dr. Marty Makary for commissioner of the Food and Drug Administration and Fox News medical contributor Dr. Janette Nesheiwat as the next surgeon general.

“Together, Jay and RFK Jr. will restore the NIH to a Gold Standard of Medical Research as they examine the underlying causes of, and solutions to, America’s biggest Health challenges, including our Crisis of Chronic Illness and Disease,” Trump wrote in his announcement.

Health economist

Bhattacharya received his undergraduate degree from Stanford University in 1990 before earning his medical degree from its School of Medicine in 1997 and a Ph.D. from the university’s Economics Department in 2000.

He focuses his research on health economics and outcomes, according to his curriculum vitae, the academic version of a resume.

Bhattacharya’s biography on Stanford’s website says that in addition to being a professor of health policy, he runs its Center for Demography and Economics of Health and Aging, in addition to working as a research associate at the National Bureau of Economics Research.

“Dr. Bhattacharya’s research focuses on the health and well-being of vulnerable populations, with a particular emphasis on the role of government programs, biomedical innovation, and economics,” according to the biography. 

Among his research areas is the “epidemiology of COVID-19 as well as an evaluation of policy responses to the epidemic.”

‘A fringe component’

Bhattacharya testified before the U.S. House Oversight Committee’s Select Subcommittee on the Coronavirus Pandemic in February 2023 that he believed there was “near universal agreement that what we did failed.”

“Official counts attribute more than one million deaths in the United States and seven million worldwide,” he said.

Bhattacharya was one of three authors of The Great Barrington Declaration in October 2020, arguing that younger, healthy people should have gone about their normal lives in an effort to contract COVID-19, since they were somewhat less likely to die than at-risk populations. 

The brief declaration says that “(a)dopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19.” But it doesn’t list what those measures should include and never brings up masking, physical distancing, or vaccination.

Several public health officials and researchers rejected the declaration, noting that it didn’t cite any research, data or peer-reviewed articles.

Former NIH Director Francis S. Collins, who ran the agency from 2009 through 2021, told The Washington Post in October 2020 that the Barrington Declaration authors’ beliefs were not held “by large numbers of experts in the scientific community.”

“This is a fringe component of epidemiology. This is not mainstream science. It’s dangerous. It fits into the political views of certain parts of our confused political establishment,” Collins said in the Post interview. “I’m sure it will be an idea that someone can wrap themselves in as a justification for skipping wearing masks or social distancing and just doing whatever they damn well please.”

One of the many reasons public health experts recommended masking, working from home and physical distancing before there was a COVID-19 vaccine was to prevent patients from overwhelming the country’s health care system.

There were concerns during some of the spikes in COVID-19 infections that the country would have so many ill people at one time there wouldn’t be enough space, health care professionals or equipment to provide treatment.

Wide-ranging agency

The NIH is made up of 27 different centers and institutes that each focus on health challenges facing Americans.

The National Institute of Allergy and Infectious Diseases, formerly run by Dr. Anthony Fauci, became one of the more well known institutes during the COVID-19 pandemic, especially when he would regularly appear beside Trump at press briefings.

Other components at NIH include the National Cancer Institute, National Institute on Aging, National Institute of Neurological Disorders and Stroke, and the NIH Clinical Center that’s also referred to as America’s research hospital.

Congress approved $48 billion in discretionary spending for NIH during the last fiscal year, continuing a broadly bipartisan push that for years has increased funding to the agency to provide grants to research some of the most challenging diseases and illnesses facing Americans.

The current NIH director, Monica M. Bertagnolli, testified before Congress in early November about how the agency was working to rebuild trust following the pandemic.

Bertagnolli told U.S. House lawmakers the NIH was focusing some of its research on finding cures for rare diseases, since for-profit companies often don’t have the financial incentive to do so.

She also rejected the notion that NIH leaders have allowed politics to interfere with the agency’s mission.

“First and foremost, NIH concentrates on science, not on politics,” Bertagnolli said. “We actually have an integrity mandate against political interference in our work. That is the law for us and we abide by that completely.”

Pediatric Oncology Branch researchers observe samples in a microscope in the National Institutes of Health Clinical Center. NIH Director Monica M. Bertagnolli testified at a U.S. House Appropriations hearing Tuesday. (Photo credit: NIH)

WASHINGTON — The director of the National Institutes of Health testified before Congress on Tuesday the agency is looking to rebuild trust following the COVID-19 pandemic by solving some of the biggest health challenges facing the country.

Monica M. Bertagnolli told the House panel in charge of the agency’s funding that one of those focus areas is rare diseases, since private, for-profit companies often won’t take on the financial risk of developing gene therapies. 

“What if you’re a parent of a child who has this rare disease?” Bertagnolli said. “We know if we work hard, our technology will be able to cure that child.”

Bertagnolli said during the two-hour hearing that NIH plans to soon begin “delivering more out of our pipeline for gene therapies for rare disease” and is collaborating with the U.S. Food and Drug Administration to ensure a smooth process.

“We will manufacture and test them within the clinical center at NIH. And then when they are ready for marketing and production — at that point after everything is completely de-risked — we will hand them over to the for-profit sector with the absolute requirements that the people who need them are able to access them,” Bertagnolli said.

The NIH, she told lawmakers, is responsible for the health of all Americans and will partner with the private sector on projects, but “can’t abandon these patients and these families.”

Bertagnolli told the House Labor-HHS-Education Appropriations Subcommittee that working to solve health challenges is one of several ways the NIH is working to rebuild trust with Americans following the global pandemic.

“We do not get people’s trust by putting out public service announcements. We do not gain people’s trust by saying ‘We’re smart, we know what to do, we’re the scientists,’” Bertagnolli testified. “We get people’s trust by solving the problems they need to have solved.”

Science, not politics

Bertagnolli also sought to reinforce basic scientific understanding about public health during the hearing, pressing back against political notions of researching infectious diseases.

“First and foremost, NIH concentrates on science, not on politics,” Bertagnolli said. “We actually have an integrity mandate against political interference in our work. That is the law for us and we abide by that completely.”

Bertagnolli noted that if NIH ceased research into diseases, death rates would rise.

“We are facing some serious threats. I mean, look in the news today, H5N1 is scary for us and we are all over risk assessment, mitigation, working with our other federal agencies to make sure that we can protect and mitigate anything that happens with that virus doing something evil,” Bertagnolli said. “We cannot afford to let down on that, people will die.”

H5N1, also known as highly pathogenic avian influenza, has caused significant disruptions to U.S. poultry farms for years, but showed up in dairy herds this March, raising alarm bells for public health experts.

Fifty-three people have been diagnosed with the virus so far, though the risk to the general public is low.

NIH duties

The NIH is made up of 27 different centers and institutes, including the National Cancer Institute, National Institute on Aging, National Institute of Neurological Disorders and Stroke, and the NIH Clinical Center that’s also referred to as America’s research hospital.

Congress approved $48 billion in discretionary funding for NIH in March as part of a full-year spending package.

The NIH writes on its budget website that 84% of its funding goes to “extramural research, largely through almost 50,000 competitive grants to more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every state.”

“In addition, approximately 11% of the NIH’s budget supports projects conducted by nearly 6,000 scientists in its own laboratories, most of which are on the NIH campus in Bethesda, Maryland,” it states. “The remaining 6% covers research support, administrative, and facility construction, maintenance, or operational costs.”

Bipartisan support for funding

The NIH has long had broad bipartisan support in Congress, especially from members of the Appropriations committees.

That continued Tuesday with the majority of Democratic and Republican lawmakers on the panel asking genuine questions about NIH research, funding and future plans.

Alabama Republican Rep. Robert Aderholt, chairman of the subcommittee, said there was “no doubt every life is touched by the discoveries made by the investments at NIH.”

Aderholt encouraged Bertagnolli to make it a top priority to rebuild “confidence in the NIH as a leader in unbiased, nonpartisan, objective, basic science.”

A Pew Research Center survey published earlier this month showed 76% of Americans held a fair amount or a great deal of “confidence in scientists to act in the public’s best interests.” That represents a slight rebound for public faith in scientists after a steady decline since the start of the pandemic, according to Pew surveys.

Eighty-nine percent of those surveyed said research scientists were intelligent, while 65% said they were focused on solving real problems.

Connecticut Democratic Rep. Rosa DeLauro, ranking member on the panel, applauded Bertagnolli for “ensuring NIH’s life-saving research reaches more places and more patients, especially in rural communities.”

“And she understands that health policy must be first and foremost based on science and data,” DeLauro said.

NIH funding, she said, was going toward better understanding numerous diseases facing Americans, including ALS, Alzheimer’s, cancer, diabetes and mental illness.

The agency is also dedicating research dollars to address several health challenges facing women, including maternal mortality, as well as other areas that historically have been ignored or underfunded.

“NIH supported research has us on the cusp of curing endometriosis and they are ramping up investments for menopause, which will ultimately impact half of our country’s population,” DeLauro said. “But there is still a long way to go.”  

A case of bird flu in a Missouri resident is the only diagnosis in the United States this year where the person did not have contact with infected dairy cattle or poultry. (Photo by Stephen Ausmus/Animal Research Services, USDA)

WASHINGTON — The Centers for Disease Control and Prevention should have results later this month that provide more insight into how a Missouri resident, who hadn’t had any contact with infected animals or food, contracted a case of highly pathogenic avian influenza.

Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC, said on a call with reporters Friday the agency is working through its investigation of that bird flu case, while providing several more details.

“As we previously reported, CDC would be able to perform partial sequencing of the avian influenza H5 virus from the case in Missouri, despite a nearly undetectable level of viral RNA in the patient sample,” Daskalakis said.

That process is complex and time-consuming, in part because the patient had rather small amounts of the virus in their system when the test was taken.

Another contributing factor, he said, is “that the virus has two potentially important mutations, meaning two amino acid differences, in comparison with the viruses previously characterized during this event that could affect antigenicity.”

Daskalakis explained that antigenicity is when someone is able to produce “a specific immune response, such as creation of specific antibodies.”

Both the mutations and small sample size have presented challenges for the CDC, but the agency expects to announce results of the test later this month after completing the complicated lab process, he said.

Two cases in California

The Missouri case is the only bird flu diagnosis in the United States this year where the person hadn’t had direct contact with infected poultry or dairy cattle.

The remainder of the 16 people diagnosed with H5N1 during this calendar year had direct contact with farm animals, with nine of those cases linked to poultry and six related to dairy cows.

One of those cases was diagnosed in Texas, two in Michigan, two in California just this week and 10 in Colorado.

Public health officials on the call emphasized that the risk to the general public remains low and that several studies undertaken by the Food and Drug Administration show pasteurized dairy products as well as other foods remain safe to eat.

Since February, the CDC has tested more than 50,000 samples that would have “detected Influenza A, H5 or other novel influenza viruses,” Daskalakis said.

The Missouri case was the first case of bird flu detected through that influenza surveillance system, he said.

Public health officials at the state and federal level have been trying to determine how the Missouri patient, who officials are not identifying for their privacy, contracted the virus through a series of “intense interviews,” Daskalakis said.

That is how they learned someone living in the same house had been symptomatic with various gastrointestinal issues at the same time the patient had been ill.

That simultaneous onset of symptoms implied “a common exposure, rather than human-to-human transmission,” Daskalakis said, before reinforcing that the second person never tested positive for the virus and isn’t considered a case of bird flu.

“At the time of the interview, the household contact had also completely recovered and had not been tested for influenza while they were sick,” he said. “To be clear, there is only one case of H5N1 influenza detected in Missouri.”

Because the person living in the same house as the Missouri patient had been symptom-free for more than 10 days when they were interviewed by public health officials, Daskalakis said there was “no utility in testing the contact for acute influenza.”

Instead, officials in Missouri took blood samples from the two people so the CDC could test for “antibodies against H5 to assess for possible infection with this virus,” he said.

A separate investigation was taken at the hospital where the Missouri patient had been diagnosed to see if any health care workers had contracted H5N1.

Out of 118 health care workers who interacted with the patient in some way, 18 had higher-risk interactions before the patient was diagnosed and began using what Daskalakis referred to as “droplet precautions.”

Six of those health care workers later developed respiratory symptoms, though only one of them had symptoms by the time the public health investigation had begun retroactively, he said.

That one person’s PCR test for acute influenza came back negative and the other five health care workers, who had recovered, did not require a PCR test, he said.

“Since exposures could only be assessed retrospectively, Missouri has also obtained blood specimens from these individuals for antibody or serology testing at CDC to search for any evidence to support the unlikely possibility that their symptoms were related to H5 infection resulting from their interaction with the patient,” Daskalakis said. “Despite the low risk, this testing is important to complete the public health investigation of this case.”

The CDC began working on that serology testing in mid-September when it received the samples from Missouri, though the complicated process likely won’t conclude until later in October.

“For serology testing to be conclusive, it needs to be done using a virus that is genetically identical to the one obtained from the human case from Missouri or there is a risk of a false negative test,” Daskalakis said. “Since this H5 virus was not recoverable, we could not grow it because there was not enough for the Missouri specimen.”

The CDC, he explained, has to “create the right virus for the test using reverse genetics to match the one from Missouri, so that we can use it in these serology tests.”

“We realize people, including all of us at CDC, are anxious to see results from this testing,” he said. “CDC is moving at a very accelerated pace while conducting rigorous science to assure the validity of these results.”

Poultry, dairy cases

In addition to human cases, bird flu continues to infect poultry flocks and dairy herds within the United States.

While the poultry industry has had years of experience supplying its workers with personal protective equipment and culling affected farms, the dairy industry has had to figure out how to address the virus this year.

Eric Deeble, deputy under secretary for marketing and regulatory programs at USDA, said on the call Friday that Colorado’s mandatory testing program of bulk milk tanks, which began in July, offered a hopeful case study for ridding farms throughout the country of H5N1.

“Initially, this revealed a significant local prevalence, about 72% of dairies, centered in Weld County,” Deeble said.

But following months of hard work by farmers and public health officials, Colorado has just one dairy herd that’s currently affected by H5N1 out of 86 dairy herds within the state, he said.

“Mandatory surveillance in the state allows for continuous monitoring of herds and helps detect any instances of non-negative results early on, ensuring timely intervention,” Deeble said. “This decrease in Colorado cases, even in the absence of a vaccine, gives us further confidence that H5N1 can be eliminated in the national herd, even in places where we have seen an initial rapid increase in cases.”

Data from the USDA show that during the past month, three dairy herds in Idaho and 53 in California have tested positive for H5N1.

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Scott Faber of the Environmental Working Group speaks Tuesday, Sept. 17, at a Capitol Hill briefing urging the EPA to ban the use of the herbicide paraquat dichloride to protect farmworkers. (Ariana Figueroa/States Newsroom.)

WASHINGTON — Public health advocates and farmworkers called for a federal ban on a toxic herbicide they say led to their Parkinson’s disease during a Tuesday briefing for congressional staffers.

The U.S. Environmental Protection Agency will determine next year if the herbicide, paraquat dichloride, should have its license renewed for another 15 years. The herbicide is used for controlling weeds in agriculture settings. It’s currently banned in more than 70 countries and has several serious health conditions it’s linked to, such as cancer and increases the likelihood of developing Parkinson’s disease.

Nora Jackson, a former farmworker of Indiana, said that her cousin, whose job it was to spray paraquat on farms, developed Parkinson’s at 55 years old. Signs of Parkinson’s usually appear around 60 years old.

“Farmworkers often have to do extremely risky jobs … but it doesn’t have to be that way,” Jackson said. “It is possible to have an agriculture system that does not depend so heavily on paraquat and it does not have to be a pesticide that puts so many people’s lives at risk.”

The disease has drastically affected his life, Jackson added.

“He now relies heavily on medication and uses a walking stick to be able to walk every day,” she said.

The briefing on the health risks of paraquat was hosted by the Michael J. Fox Foundation for Parkinson’s Research, Alianza Nacional de Campesinas, which is an alliance for farmworker women, and the Environmental Working Group, a nonprofit that produces research and advocates for public health.

The Michael J. Fox Foundation for Parkinson’s Research was established by the actor who starred in blockbusters Back to the Future, Doc Hollywood and Teen Wolf. Fox was diagnosed with early onset Parkinson’s at the age of 29.

Ban necessary

The EPA has until Jan. 17 to make a decision on paraquat’s future availability.

Advocates at Tuesday’s event called for the agency to deny paraquat’s license renewal, saying other regulations to reduce exposure to the herbicide have come up short.

“Keep in mind that people have been using this chemical as directed, and are still developing Parkinson’s disease,” Scott Faber, Environmental Working Group’s senior vice president of government affairs, said. “So putting more restrictions on how it’s used, when it’s used, what equipment you use, and so on, is not the answer.”

Parkinson’s disease affects the nervous system and causes unintended shakiness, trouble with balance and stiffness. There is no cure.

The California Legislature is moving to ban the herbicide. 

David Jilbert, of Valley City, Ohio, a former farmworker with a background in engineering, was diagnosed with Parkinson’s in 2021.

“As a longtime environmental engineer, I understood the importance of personal protection equipment, and I particularly followed all safety protocols,” he said.

He sold his vineyard in 2019 because he wasn’t feeling well and his hands were beginning to move slowly.

“My diagnosis changed everything, affecting every aspect of my life, from physical capabilities to emotional wellbeing, financial stability,” he said. “There is no cure for Parkinson’s. It is degenerative and it will only get worse, not better.”

Charlene Tenbrink of Winters, California, was diagnosed with Parkinson’s in 2020. She worked on her family farm from 1993 to 2000 where she would mix, load and spray paraquat.

Tenbrink said she felt let down by the federal government because she was unaware of the health risks that paraquat could pose.

“We’ve been trying to change this for a long time,” she said.

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