The cadre of elite disease detectives at the Centers for Disease Control and Prevention is expected to be left in ruin today as the Trump administration continues to slash the federal workforce.
Many members of the CDC’s Epidemic Intelligence Service, EIS—a globally revered public health training program—were informed earlier Friday that they were about to be fired, according to reporting from Stat News. Multiple sources told CBS News that half of EIS officers are among the ongoing cuts.
The Trump administration is ousting thousands of probationary federal workers in a wide-scale effort to dramatically slim agencies.
The EIS is a two-year program filled with competitively selected, highly educated and trained experts. EIS officers are the ones deployed in critical public health situations, such as deadly outbreaks or bioterror attacks. The program has a long, rich history since its establishment in 1951, which includes contributing to the eradication of smallpox, among other achievements.
The deep cuts to the program have horrified those in the public health sphere.
“The country is less safe,” Dr. Anne Schuchat, a former top-ranking CDC official and alumna of the program, told CBS News. “These are the deployable assets critical for investigating new threats, from anthrax to Zika.”
“It’s almost beyond belief,” former CDC director Bill Foege told Stat. He noted that the EIS trainees were critical to stopping the spread of the disastrous West Africa Ebola outbreak of 2014–2016.
The cuts to EIS are just some of those that CDC is facing. CBS News reports that around 1,270 are being cut from the agency, which is around 10 percent of its staff.
On January 23, WHO Director-General Tedros Adhanom Ghebreyesus sent a memo to staff announcing the cost-cutting measures. Reuters obtained a copy of the memo.
“This announcement has made our financial situation more acute,” Tedros wrote, referring to the US withdrawal plans. WHO’s budget mainly comes from dues and voluntary contributions from member states. The dues are a percentage of each member state’s gross domestic product, and the percentage is set by the UN General Assembly. US contributions account for about 18 percent of WHO’s overall funding, and its two-year 2024-2025 budget was $6.8 billion, according to Reuters.
To prepare for the budget cut, WHO is halting recruitment, significantly curtailing travel expenditures, making all meetings virtual, limiting IT equipment updates, and suspending office refurbishment.
“This set of measures is not comprehensive, and more will be announced in due course,” Tedros wrote, adding that the agency would do everything it could to protect and support staff.
The country’s pending withdrawal has been heavily criticized by global health leaders and US experts, who say it will make the world less safe and weaken America. In a CBS/KFF Health News report examining the global health implications of the US withdrawal, Kenneth Bernard, a visiting fellow at the Hoover Institution at Stanford University who served as a top biodefense official during the George W. Bush administration, did not mince words:
“It’s just stupid,” Bernard said. “Withdrawing from the WHO leaves a gap in global health leadership that will be filled by China,” he said, “which is clearly not in America’s best interests.”
70 percent of studies included in the meta-analysis had a high risk of bias.
Federal toxicology researchers on Monday finally published a long-controversial analysis that claims to find a link between high levels of fluoride exposure and slightly lower IQs in children living in areas outside the US, mostly in China and India. As expected, it immediately drew yet more controversy.
The study, published in JAMA Pediatrics, is a meta-analysis, a type of study that combines data from many different studies—in this case, mostly low-quality studies—to come up with new results. None of the data included in the analysis is from the US, and the fluoride levels examined are at least double the level recommended for municipal water in the US. In some places in the world, fluoride is naturally present in water, such as parts of China, and can reach concentrations several-fold higher than fluoridated water in the US.
The authors of the analysis are researchers at the National Toxicology Program at the National Institute of Environmental Health Sciences. For context, this is the same federal research program that published a dubious analysis in 2016 suggesting that cell phones cause cancer in rats. The study underwent a suspicious peer-review process and contained questionable methods and statistics.
The new fluoride analysis shares similarities. NTP researchers have been working on the fluoride study since 2015 and submitted two drafts for peer review to an independent panel of experts at the National Academies of Sciences, Engineering, and Medicine in 2020 and 2021. The study failed its review both times. The National Academies’ reviews found fault with the methods and statistical rigor of the analysis. Specifically, the reviews noted potential bias in the selection of the studies included in the analysis, inconsistent application of risk-of-bias criteria, lack of data transparency, insufficient evaluations of potential confounding, and flawed measures of neurodevelopmental outcomes, among other problems.
After the failing reviews, the NTP selected its own reviewers and self-published the study as a monograph in August.
High risk of bias
The related analysis published Monday looked at data from 74 human studies, 45 of which were conducted in China and 12 in India. Of the 74, 52 were rated as having a high risk of bias, meaning they had designs, study methods, or statistical approaches that could skew the results.
The study’s primary meta-analysis only included 59 of the studies: 47 with a high risk of bias and 12 with a low risk. This analysis looked at standardized mean differences in children’s IQ between higher and lower fluoride exposure groups. Of the 59 studies, 41 were from China.
Among the 47 studies with a high risk of bias, the pooled difference in mean IQ scores between the higher-exposure groups and lower-exposure groups was -0.52, suggesting that higher fluoride exposure lowered IQs. But, among the 12 studies at low risk for bias, the difference was slight overall, only -0.19. And of those 12 studies, eight found no link between fluoride exposure and IQ at all.
Among 31 studies that reported fluoride levels in water, the NTP authors looked at possible IQ associations at three fluoride-level cutoffs: less than 4 mg/L, less than 2 mg/L, and less than 1.5 mg/L. Among all 31 studies, the researchers found that fluoride exposure levels of less than 4 mg/L and less than 2 mg/L were linked to statistically significant decreases in IQ. However, there was no statistically significant link at 1.5 mg/L. For context, 1.5 mg/L is a little over twice the level of fluoride recommended by the US Environmental Protection Agency for US community water, which is 0.7 mg/L. When the NTP authors looked at just the studies that had a low risk of bias—seven studies—they saw the same lack of association with the 1.5 mg/L cutoff.
The NTP authors also looked at IQ associations in 20 studies that reported urine fluoride levels and again split the analysis using the same fluoride cutoffs as before. While there did appear to be a link with lower IQ at the highest fluoride level, the two lower fluoride levels had borderline statistical significance. Ten of the 20 studies were assessed as having a low risk of bias, and for just those 10, the results were similar to the larger group.
Criticism
The inclusion of urinary fluoride measurements is sure to spark criticism. For years, experts have noted that these measurements are not standardized, can vary by day and time, and are not reflective of a person’s overall fluoride exposure.
In an editorial published alongside the NTP study today, Steven Levy, a public health dentist at the University of Iowa, blasted the new analysis, including the urinary sample measurements.
“There is scientific consensus that the urinary sample collection approaches used in almost all included studies (ie, spot urinary fluoride or a few 24-hour samples, many not adjusted for dilution) are not valid measures of individuals’ long-term fluoride exposure, since fluoride has a short half-life and there is substantial variation within days and from day to day,” Levy wrote.
Overall, Levy reiterated much of the same concerns from the National Academies’ reviews, noting the study’s lack of transparency, the reliance on highly biased studies, questionable statistics, and questionable exclusion of newer, higher-quality studies, which have found no link between water fluoridation and children’s IQ. For instance, one exclusion was a 2023 study out of Australia that found “Exposure to fluoridated water during the first 5 [years] of life was not associated with altered measures of child emotional and behavioral development and executive functioning.” A 2022 study out of Spain similarly found no risk of prenatal exposure.
“Taking these many important concerns together, readers are advised to be very cautious in drawing conclusions about possible associations of fluoride exposures with lower IQ,” Levy concluded. “This is especially true for lower water fluoride levels.”
Another controversial study
But, the debate on water fluoridation is unlikely to recede anytime soon. In a second editorial published alongside the NTP study, other researchers praised the analysis, calling for health organizations and regulators to reassess fluoridation.
“The absence of a statistically significant association of water fluoride less than 1.5 mg/L and children’s IQ scores in the dose-response meta-analysis does not exonerate fluoride as a potential risk for lower IQ scores at levels found in fluoridated communities,” the authors argue, noting there are additional sources of fluoride, such as toothpaste and foods.
The EPA estimates that 40 to 70 percent of people’s fluoride exposure comes from water.
Two of the three authors of the second editorial—Christine Till and Bruce Lanphear—were authors of a highly controversial 2019 study out of Canada suggesting that fluoride intake during pregnancy could reduce children’s IQ. The authors even suggested that pregnant people should reduce their fluoride intake. But, the study, also published in JAMA Pediatrics, only found a link between maternal fluoride levels and IQ in male children. There was no association in females.
The study drew heavy backlash, with blistering responses published in JAMA Pediatrics. In one response, UK researchers essentially accused Till and colleagues of a statistical fishing expedition to find a link.
“[T]here was no significant IQ difference between children from fluoridated and nonfluoridated communities and no overall association with maternal urinary fluoride (MUFSG). The authors did not mention this and instead emphasized the significant sex interaction, where the association appeared for boys but not girls. No theoretical rationale for this test was provided; in the absence of a study preregistration, we cannot know whether it was planned a priori. If not, the false-positive probability increases because there are many potential subgroups that might show the result by chance.”
Beth is Ars Technica’s Senior Health Reporter. Beth has a Ph.D. in microbiology from the University of North Carolina at Chapel Hill and attended the Science Communication program at the University of California, Santa Cruz. She specializes in covering infectious diseases, public health, and microbes.
Their investigative report—based on interviews with multiple health department employees who spoke on the condition of anonymity for fear of retaliation—revealed that employees were told of the startling policy change in meetings in October and November and that the policy would be implemented quietly and not put into writing.
Ars Technica has contacted the health department for comment and will update this post with any new information.
The health department provided a statement to NPR saying that it has been “reevaluating both the state’s public health priorities as well as our messaging around vaccine promotion, especially for COVID-19 and influenza.” The statement described the change as a move “away from one-size-fits-all paternalistic guidance” to a stance in which “immunization for any vaccine, along with practices like mask wearing and social distancing, are an individual’s personal choice.”
According to employees, the new policy cancelled standard fall flu vaccination events this year and affects every other aspect of the health department’s work, as NPR explained:
“Employees could not send out press releases, give interviews, hold vaccine events, give presentations or create social media posts encouraging the public to get the vaccines. They also could not put up signs at the department’s clinics that COVID, flu or mpox vaccines were available on site.”
“We’re really talking about deaths”
The change comes amid a dangerous swell of anti-vaccine sentiment and misinformation in Louisiana and across the country. President-elect Trump has picked Robert F. Kennedy Jr.—a high-profile anti-vaccine advocate and one of the most prolific spreaders of vaccine misinformation—to head the US Department of Health and Human Services.
Once infectious material gets into the water, disinfection systems that aren’t working properly or are inadequate can allow pathogens to gush from every nozzle. Splash pads aren’t unique in having to handle sick children in poopy swim diapers—but they are unique in how they are regulated. That is, in some places, they’re not regulated at all. Splash pads are designed to not have standing water, therefore reducing the risk of young children drowning. But, because they lack standing water, they are sometimes deemed exempt from local health regulations. Before 2000, only 13 states regulated splash pads. Though many states have since added regulations, some did so only after splash pad-linked outbreaks were reported.
Downpour of disease
The primary method for keeping recreational water free of infectious viruses and bacteria is chlorinating it. However, maintaining germ-killing chlorine concentration is especially difficult for splash pads because the jets and sprays aerosolize chlorine, lowering the concentration.
Still, in most splash-pad linked outbreaks, standard chlorine concentrations aren’t enough anyway. The most common pathogen to cause an outbreak at splash pads is the parasite Cryptosporidium, aka Crypto. The parasite’s hardy spores, called oocysts, are extremely tolerant of chlorine, surviving in water with the standard chlorine concentration (1 ppm free chlorine) for over seven days. (Other germs die in minutes.) In splash pads that might not even have that standard chlorine concentration, Crypto flourishes and can cause massive outbreaks.
In 2023, the CDC recommended new health codes that call for “secondary disinfection” methods to keep Crypto at bay, including disinfection systems using ozone or ultraviolet light. Another possible solution is to have “single-pass” splash pads that don’t recirculate water.
In all, to keep splash pads from being geysers of gastrointestinal parasites and pathogens, various changes have to happen, the CDC experts say.
“Prevention of waterborne disease outbreaks at splash pads requires changes in user behavior; recreational venue code updates; and improved venue design, construction, operation, and management of facilities,” they conclude. But it should all start with keeping kids from sitting on jets and drinking the water.
Earlier this week, Robert F. Kennedy, Jr. used a Zoom call to tell his supporters that Donald Trump had promised him “control” of the Department of Health and Human Services (HHS), the federal agency that includes the Centers for Disease Control, Food and Drug Administration, National Institutes of Health, as well as the Department of Agriculture. Given Kennedy’s support for debunked anti-vaccine nonsense, this represents a potential public health nightmare.
A few days after, Howard Lutnick, a co-chair of Trump’s transition team, appeared on CNN to deny that RFK Jr. would be put in charge of HHS. But he followed that with a long rant in which he echoed Kennedy’s spurious claims about vaccines. This provides yet another indication of how anti-vaccine activism has become deeply enmeshed with Republican politics, to the point where it may be just as bad even if Kennedy isn’t appointed.
Trump as Kennedy’s route to power
Kennedy has a long history of misinformation regarding health, with a special focus on vaccines. This includes the extensively debunked suggestion that there is a correlation between vaccinations and autism incidence, and it extends to a general skepticism about vaccine safety. That’s mixed with conspiracy theories regarding collusion between federal regulators and pharmaceutical companies.
While there is no evidence for any of this, and some of it is clearly wrong, the conspiracies have real-world consequences. An anti-vaccine activist in Samoa, aided by a visit from RFK Jr., helped pave the way for a measles outbreak that shut down the government and ultimately led to over 80 deaths.
Kennedy has long been interested in getting access to the agencies that regulate vaccines and other interests of his, such as food safety, under the assumption they are hiding the data that would vindicate his views. And, long before his recent presidential run, he viewed Trump as the route to that access. Shortly before Trump’s inauguration in 2017, Kennedy claimed that he would be appointed to head a vaccine safety commission that Trump would supposedly create once in office. Nothing ever came of that, and it was never clear whether that was due to Trump lying to him, Kennedy exaggerating his significance, or Trump simply telling him what he wanted to hear at the time and never following up.
The North Carolina State Senate on Wednesday voted 30–15, along party lines, in favor of a Republican bill that would make it illegal for people in the state to wear a mask in public for health reasons. The bill is now moving to the House, where it could potentially see changes.
The proposed ban on health-based masking is part of a larger bill otherwise aimed at increasing penalties for people wearing masks to conceal their identity while committing a crime or impeding traffic. The bill was largely spurred by recent protests on university and college campuses across the country, including North Carolina-based schools, against the war in Gaza. In recent months, there have been demonstrations in Raleigh and Durham that have blocked roadways, as well as clashes on the nearby campus of the University of North Carolina at Chapel Hill. Some demonstrators were seen wearing masks in those events.
But the bill, House Bill 237, goes a step further by making it illegal to wear a mask in public for health and safety reasons, either to protect the wearer, those around them, or both. Specifically, the bill repeals a 2020 legal exemption enacted amid the COVID-19 pandemic, which allowed for public health-based masking for the first time in decades.
Prior to 2020, laws dating back to 1953 largely prohibited public masking. The prohibition was part of a crackdown on “secret societies” at the time, or more specifically, an attempt to curtail the activities of the Ku Klux Clan in the state. Exemptions only existed for things like holiday costumes, theater productions, gas masks, and members of public parades or ceremonies that had obtained permits.
On Wednesday, North Carolina residents with compromised immune systems spoke—while masked—during a public comment section. Simone Hetherington told lawmakers that masking was the only way to protect herself in public from illness and feared passage of the bill would prevent her from doing so, according to reporting by the Associated Press.
But, according to The News & Observer, Republicans were dismissive of that possibility, arguing that in the decades prior to the pandemic, when public masking was largely illegal, they couldn’t recall anyone being prosecuted for wearing a mask for health reasons.
Raleigh-based news outlet WRAL quoted Sen. Sydney Batch, a Democrat from Wake, who criticized the bill along with fellow Democratic colleagues. Batch, a cancer survivor, spoke of how her husband and children wore masks to protect her while she underwent cancer treatments that weakened her immune system. “This bill criminalizes their behavior and mine,” she said. “We talk a lot about freedoms in this chamber. I hear it all the time. I should have the freedom—my children and my husband should have the freedom—to wear masks in order to protect and save my life, without fear of being arrested and charged.”
Most of us want to stay on this planet as long as possible. While there are still differences depending on sex and region, we are now living longer as a species—and it seems life spans will only continue to grow longer.
Researcher David Atance of Universidad de Alcalá, Spain, and his team gathered data on the trends of the past. They then used their findings to project what we can expect to see in the future. Some groups have had it harder than others because of factors such as war, poverty, natural disasters, or disease, but the researchers found that morality and longevity trends are becoming more similar regardless of disparities between sexes and locations.
“The male-female gap is decreasing among the [clusters],” they said in a study recently published in PLOS One.
Remembering the past
The research team used specific mortality indicators—such as life expectancy at birth and most common age at death–to identify five global clusters that reflect the average life expectancy in different parts of the world. The countries in these clusters changed slightly from 1990 to 2010 and are projected to change further by 2030 (though 2030 projections are obviously tentative). Data for both males and females was considered when deciding which countries belonged in which cluster during each period. Sometimes, one sex thrived while the other struggled within a cluster—or even within the same country.
Clusters that included mostly wealthier countries had the best chance at longevity in 1990 and 2010. Low-income countries predictably had the worst mortality rate. In 1990, these countries, many of which are in Africa, suffered from war, political upheaval, and the lethal spread of HIV/AIDS. Rwanda endured a bloody civil war during this period. Around the same time, Uganda had tensions with Rwanda, as well as Sudan and Zaire. In the Middle East, the Gulf War and its aftermath inevitably affected 1990 male and female populations.
Along with a weak health care system, the factors that gave most African countries a high mortality rate were still just as problematic in 2010. In all clusters, male life spans tended to differ slightly less between countries than female life spans. However, in some regions, there were differences between how long males lived compared to females. Mortality significantly increased in 1990 male populations from former Soviet countries after the dissolution of the Soviet Union, and this trend continued in 2010. Deaths in those countries were attributed to violence, accidents, cardiovascular disease, alcohol, an inadequate healthcare system, poverty, and psychosocial stress.
Glimpsing the future
2030 predictions must be taken with caution. Though past trends can be good indicators of what is to come, trends do not always continue. While things may change between now and 2030 (and those changes could be drastic), these estimates project what would happen if past and current trends continue into the relatively near future.
Some countries might be worse off in 2030. The lowest-income, highest-mortality cluster will include several African countries that have been hit hard with wars as well as political and socioeconomic challenges. The second low-income, high-mortality cluster, also with mostly African countries, will now add some Eastern European and Asian countries that suffer from political and socioeconomic issues most have recently been involved in conflicts and wars or still are, such as Ukraine.
The highest-income, lowest-mortality cluster will gain some countries. These include Chile, which has made strides in development that are helping people live longer.
Former Soviet countries will probably continue to face the same issues they did in 1990 and 2010. They fall into one of the middle-income, mid-longevity clusters and will most likely be joined by some Latin American countries that were once in a higher bracket but presently face high levels of homicide, suicide, and accidents among middle-aged males. Meanwhile, there are some other countries in Latin America that the research team foresees as moving toward a higher income and lower mortality rate.
Appearances can be deceiving
The study places the US in the first or second high-income, low-mortality bracket, depending on the timeline. This could make it look like it is doing well on a global scale. While the study doesn’t look at the US specifically, there are certain local issues that say otherwise.
A 2022 study by the Centers for Disease Control and Prevention suggests that pregnancy and maternal care in the US is abysmal, with a surprisingly high (and still worsening) maternal death rate of about 33 deaths per 100,000 live births. This is more than double what it was two decades ago. In states like Texas, which banned abortion after the overturn of Roe v. Wade, infant deaths have also spiked. The US also has the most expensive health care system among high-income countries, which was only worsened by the pandemic.
The CDC also reports that life expectancy in the US keeps plummeting. Cancer, heart disease, stroke, drug overdose, and accidents are the culprits, especially in middle-aged Americans. There has also been an increase in gun violence and suicides. Guns have become the No. 1 killer of children and teens, which used to be car accidents.
Whether the US will stay in that top longevity bracket is also unsure, especially if maternal death rates keep rising and there aren’t significant improvements made to the health care system. There and elsewhere, there’s no way of telling what will actually happen between now and 2030, but Atance and his team want to revisit their study then and compare their estimates to actual data. The team is also planning to further analyze the factors that contribute to longevity and mortality, as well as conduct surveys that could support their predictions. We will hopefully live to see the results.
