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Yesterday โ€” 24 December 2024Main stream

Holiday cheer in shorter supply for Dems: poll

By: Tina Reed
24 December 2024 at 03:00

Spending the holidays with family and friends may be more of an emotional wringer this year if you're a Democrat or independent, according to the latest Axios-Ipsos American Health Index.

Why it matters: While an overwhelming majority of Americans say their emotional well-being is good, our first polling since the elections shows those who didn't vote for President-elect Trump appear to be bracing for added strife.


Driving the news: In the poll of 1,002 adults taken between Dec. 6 and Dec. 9, roughly half of all respondents said spending time with friends or family at the holidays didn't affect how stressed they felt, echoing prior polls.

  • But dig a little deeper and there's a big split in those answers: More than 61% of Democrats said spending time with family or friends during the holidays makes them more stressed out. Independents are right behind them at 60%.
  • Meanwhile, 39% of Republicans said the same.

Democrats appear likelier to be searching for holiday cheer after a fractious election and GOP trifecta.

  • Nearly 1 in 5 Democrats (17%) said their emotional health was poor whereas 7% of Republicans said the same.

But overall, more than 8 in 10 respondents (84%) said their emotional well-being was very or somewhat good โ€” a sign that election anxiety, too many, may have been temporary, or hasn't left lasting scars.

  • "For all the gnashing of teeth since the election, people are rating their mental health virtually the same as earlier this year," Ipsos pollster and senior vice president Chris Jackson told Axios.
  • "There may have been high anxiety in the electoral context but generally there has not been any change."

The big picture: A recent Harris Poll of more than 2,000 adults conducted for the American Psychological Association found more than 2 out of 5 adults aged 44 and younger are skipping holiday gatherings because of political differences.

  • Three quarters of all adults (72%) said they hoped to avoid discussing politics with family this holiday season.
  • 83% of respondents said they saw the holidays as a time to put political differences aside โ€” although among those whose candidate lost, that figure was slightly lower (82%.)

The bottom line: Pass the potatoes โ€” and pass on the political talk โ€” this year.

Methodology: This Axios/Ipsos Poll was conducted Dec. 6-9 by Ipsos' KnowledgePanelยฎ. This poll is based on a nationally representative probability sample of 1,002 general population adults age 18 or older.

  • The margin of sampling error is ยฑ3.3 percentage points at the 95% confidence level, for results based on the entire sample of adults.

Before yesterdayMain stream

Moderate drinking may be healthier than teetotaling

By: Tina Reed
19 December 2024 at 01:50

One or two alcoholic drinks a day may reduce the risk of dying more than completely abstaining, according to a review of existing research by the National Academies of Science, Engineering and Medicine.

Why it matters: The findings help inform Health and Human Services and the Department of Agriculture in developing guidance on alcohol consumption in the next Dietary Guidelines for Americans, expected in late 2025.


  • Current guidelines come down on the side of temperance, saying it's a choice between not at all or moderation and that "drinking less is better for health."

What they found: The review, which was ordered up by Congress, looked at multiple studies of light to moderate drinking, defined as two drinks a day for men and one for women.

  • When it came to cardiovascular health, the moderate use of alcohol was associated with a lower risk of nonfatal heart attacks and strokes, as well as a lower overall risk of death.
  • There was some increased risk for breast and colorectal cancer, but no broader conclusion could be made for most other cancers.

Between the lines: The findings appear to contradict studies and a World Health Organization position that "no amount of alcohol" appears to be safe, largely based on increased cancer risk.

The bottom line: One thing everyone seems to agree on: heavy drinking โ€” defined as more than three or four drinks a day โ€” should be avoided.

  • While most doctors won't be prescribing booze like the old days, those people who do imbibe could derive some benefit if they keep their consumption levels in check.

The political lens on food is changing

By: Tina Reed
18 December 2024 at 02:30

After years of dire warnings about Americans' diet, the political winds appear to be shifting to a more critical view of what we eat.

Why it matters: The concerns were evident at a Senate health committee hearing this month as lawmakers on both sides of the aisle dug into the connection between ultra-processed foods and obesity and chronic illness.


  • Committee Chair Bernie Sanders (I-Vt.) assailed the way Congress and the Food and Drug Administration allowed big corporations to profit off enticing children and adults to consume ultra-processed foods and beverages.
  • Some lawmakers were also surprised that the FDA hasn't reviewed the safety of a food dye called Red 40 in more than a decade, and asked about its potential effects on behavioral health.

What they're saying: "This is the first time that I've heard anybody at that level talk about issues related to the food system in general and chronic disease in particular in a very, very long time," Marion Nestle, an emerita professor of nutrition at New York University, told Axios.

The big picture: The connection between food and chronic disease has been central to HHS Secretary-designate Robert F. Kennedy, whose Make America Healthy Again agenda has targeted everything from dyes to seed oils.

  • But it's tapped into a deeper public distrust of corporate influences in public health and the belief that obesity is the top overall health threat, ahead of poor mental health, opioids and gun violence.
  • Last week, a Pennsylvania teenager sued Coca-Cola and 10 other big food companies, accusing them of "engineering" ultra-processed products to be addictive and marketing them to kids.
  • The surging popularity of GLP-1 drugs also reflects a belief that being overweight or having poor metabolic health is a medical condition, not a lifestyle choice.

Yes, but: There may be limited policy options short of mandates, more spending and the specter of the government dictating what we eat.

  • One option could be "food as medicine" โ€” the idea that doctors can prescribe certain foods the way they do medicines to improve patients' health. While a handful of states have tried to tap Medicaid funds for pilot programs, measuring data and getting insurers on board are obstacles, Axios Pro reported.
  • Jerold Mande, former deputy undersecretary at the Department of Agriculture, told Axios policies like changing the SNAP program, regulating ultra-processed foods and investing in nutrition and prevention are finally getting attention.
  • "We've been waiting for this to be a political priority, and it finally is," Mande said, adding "the messenger is imperfect here," in reference to Kennedy and MAHA.

Zoom in: In a recent op-ed in the Wall Street Journal, former Centers for Disease Control and Prevention director Tom Frieden and former New York City and Philadelphia health commissioner Thomas Farley agreed with Kennedy "that food is driving epidemics of chronic disease."

  • "If Kennedy were to ask us for advice, we'd tell him this: Americans eat unhealthy food because the food system is designed to feed it to them. Changes to the system will be fought bitterly by food and agricultural companies, but the fight is worth it," they wrote.

Between the lines: At the Senate hearing, FDA officials, facing sometimes sharp questioning, confirmed they are eyeing a potential ban on Red No. 3, a food dye commonly used in candy and snack foods that has raised concerns about whether it causes behavioral problems in children.

  • The FDA is also eyeing front-of-package labeling on processed foods, and intends to issue a rule updating when food makers can claim a product is "healthy," commissioner Robert Califf testified.
  • He pointed to the agency's recent reorganization of its human foods program, which included creating a center to review nutrition and conduct post-market reviews of chemicals used in the nation's food supply.
  • In July, the FDA moved to remove an additive that had long been used in certain sodas.

But Califf said the agency is decades behind Europe in this effort and has been limited by existing science, legal hurdles and "powerful industry forces."

  • "There is good reason to be concerned about the chemicals that are routinely included in much of our food," he testified earlier this month. "The FDA has limited resources to deal with this issue."

Zoom in: Experts are critical of the lack of regulation around ultra-processed foods.

  • With industry pressure from snack foods, beverages and other groceries, the current focus in most nutritional guidance in the U.S. is personal responsibility for healthier eating, experts tell Axios.
  • Efforts to make ultra-processed foods pricier than healthier options or to beef up FDA scrutiny of additives and how corporations market their products would be far more effective, they say.
  • "There's no question that the food that's being sold to us is injurious to health," Mande said. "And yet they don't do anything. So why don't they do anything? And it's really is because they just aren't funded to do that."

Reality check: Congress is highly unlikely to make significant moves in light of the power of the food industry, Barry Popkin, nutrition professor at the University of North Carolina, told Axios.

  • "Think of the size of these companies. They dwarf the old tobacco companies," he said.
  • Even as Nestle said she's been encouraged by the recent attention to processed foods, it's unclear what might happen to that effort if Kennedy isn't confirmed โ€”ย or even if he does get the job.
  • "Eating healthfully is very bad for business and there are huge economic forces that mitigate against trying to do anything about chronic disease," Nestle said.
  • "If Kennedy wants to take on ultra-processed foods in schools, he's taking on the ultra-processed food industry. If he wants to take mercury out of fish ... that's coal-burning power plants. If he wants to get chemicals out of the food supply, he's taking on polluters," she said. "That's a lot to take on."

Polio vax petition could preview more challenges

By: Tina Reed
16 December 2024 at 02:30

Efforts to revoke Food and Drug Administration approval of the polio vaccine could provide a preview of how vaccine skeptics plan to challenge decades of federal health policy during a second Trump administration, experts say.

Why it matters: By asserting that the agency didn't do enough safety studies, groups like the Informed Consent Action Network are implying that the risks are greater than the benefits, even though vaccines are more thoroughly tracked than virtually any other medical product, the experts say.


Driving the news: The concerns have amped up in recent days following a report that an ally of Health and Human Services Secretary-designate Robert F. Kennedy Jr. filed a citizen petition in 2022 to revoke the approval of polio vaccines for infants and children.

  • Attorney Aaron Siri has also joined Kennedy in questioning and choosing candidates for top health positions, the New York Times reported, citing an unnamed source who witnessed the interactions.

State of play: Siri and others successfully challenged COVID vaccine mandates, sued federal agencies for vaccine approval records and put prominent vaccine scientists through lengthy videotaped depositions, the Times wrote.

  • In the case of polio, critics are zeroing in on a vaccine using inactivated, or killed, virus that causes the body to produce its own antibodies against the virus that causes polio and stop it from spreading to the central nervous system.
  • The virus can still multiply inside the intestines and be shed in the stool. But the risk of continued circulation is low in the U.S. because of vaccination efforts.

The petition asks the FDA to suspend the vaccine's approval for infants and toddlers "until a properly controlled and properly powered double-blind trial of sufficient duration is conducted."

  • It claims that the studies FDA cited in its 1990 approval of updated polio vaccine don't properly investigate the vaccine's long-term safety.
  • And it calls for a warning label stating the vaccine "does not prevent intestinal infection and therefore does not prevent poliovirus transmission."

Between the lines: Public health experts say vaccine skeptics, including Kennedy, have repeatedly questioned the safety and efficacy of the shots while insisting they're not anti-vaccine.

  • "There is much more behind this than just rhetoric," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota told Axios.
  • "They say 'We just want more studies. We're only concerned about vaccine safety.' The real objective to get vaccines off the market," said Angela Rasmussen, a virologist at the University of Saskatchewan's Vaccine and Infectious Disease Organization.
  • She said she expects Kennedy would follow a similar path of calling for more clinical trials and research as a pretext for removing vaccines from federal schedules of recommended shots.

Between the lines: Beyond direct challenges like citizen petitions, vaccines could be undermined by outside committees of advisers, whose recommendations determine the jabs' availability and how they are paid for.

  • Kennedy and Siri's vetting of key health positions in the incoming administration also indicates anyone who gets a top job should ascribe to vaccine skepticism, the experts say.
  • "Having Siri be the gatekeeper of who gets these positions or not is a worst-case scenario," Rasmussen said. "These picks are all the picks I would pick if I were trying to destroy the U.S. vaccine program."

The other side: In a statement posted online, Siri called the Times report a "hit piece" and said the petition challenging the polio vaccine was filed on behalf of the Informed Consent Action Network and not himself.

  • He also said the vaccine in question, IPOL, "is not the polio vaccine of old," saying there are "clear safety gaps in licensing this particular product."
  • In 2000, the U.S. stopped using the oral polio vaccine, which blocks the spread of the virus by inducing immunity in the gut but can result in vaccine-derived poliovirus due to its use of a weakened strain of polio.
  • Vaccine-derived polio virus can cause outbreaks where vaccine coverage is low, per the Centers for Disease Control and Prevention.

"Vaccines have been so effective we don't appreciate what it was like prior to the vaccines when, during the summer, sending your kid to the swimming pool might result in them living in an iron lung the rest of their life," Rasmussen said.

Reality check: It still will difficult to upend the regulatory system that's in place to vet vaccines for safety and efficacy, Osterholm said.

  • "I don't think there's this imminent danger that sometime in January where, all of a sudden, we won't see vaccines available," Osterholm said.
  • That's particularly true now that the Supreme Court has scrapped a decades-old legal doctrine that gave the FDA, Centers for Medicare and Medicaid Services and other health agencies the discretion to interpret vague or ill-defined laws. Legal challenges to any vaccine rollback are likely.
  • There is also the question of popular opinion. Americans have expressed mistrust of Kennedy on health, with a majority disagreeing with his views about vaccine requirements in schools, per the latest Axios-Ipsos American Health Index.

Americans worried about vaccine safety should be aware the shots are among the most scrutinized medical products, Joshua Sharfstein, a former FDA deputy commissioner and public health professor at Johns Hopkins University, told Axios.

  • That doesn't mean safety discussions should be off the table, but that "we don't want to have a conversation about vaccine safety led by people who have irresponsibly called for the removal of vaccines," he added.

What to watch: Kennedy is expected to spend this week on the Hill meeting with senators.

  • The New York Times report of Kennedy's collaboration with Siri generated a strong rebuke on Friday from Senate Minority Leader Mitch McConnell, who had polio as a child and is an important vote for Trump's nominees to win over.

Trump's immigration crackdown could reduce caregiving workforce

By: Tina Reed
4 December 2024 at 02:30

Some of the earliest and lasting effects from President-elect Trump's promised immigration crackdowns would be in home health and long-term care, both of which rely on a substantial number of immigrants and undocumented workers.

Why it matters: Reducing an already thin labor market could have serious ramifications for aging adults or those with disabilities โ€” and potentially put more stress on family caregivers.


What they're saying: "Immigration policy is long-term care policy," said David Grabowski, a Harvard Medical School professor who's chronicled how foreign-born workers filled key nursing home roles early in the pandemic.

  • He found nursing homes in regions with a higher share of foreign-born nursing assistants provided more direct care and better quality.
  • "If you were to tighten up immigration or begin deporting individuals, it's going to lower the available workforce, and this is only going to add to an already challenging labor situation," he said.

By the numbers: Between 2021 and 2031, the long-term care sector will need to fill 9.3 million direct care job openings as demand grows and workers exit the field, according to PHI, a research group that studies care workers.

  • With the fast-growing senior baby boomer population, many of the gaps have been filled by immigrants.
  • The American Immigration Council estimates more than a third of home health aids in the U.S. are immigrants. In states like California, New York and New Jersey, it's estimated at least 40% of the caregiving workforce is foreign-born.

Trump's proposals call for mass deportations of undocumented workers and would also curb legal immigration and limit asylum.

  • Trump transition spokesperson Karoline Leavitt said in a statement that the deportation of criminals, drug dealers and human traffickers would lower costs for families and strengthen the workforce.
  • Experts say the effects of tighter immigration policies would be felt beyond communal settings, and especially in home care, where workers, predominantly women, earn around $16 an hour, according to government data.
  • Undocumented workers made up an estimated 6.9% of home health aides and 4.4% of personal care aides, according to the American Immigration Council.

Zoom in: There is particular concern about the impact on what's considered the "gray" market of caregivers in which individuals are not working for an accredited agency but directly for an individual or family, said Nicole Howell, director of workforce policy at aging services provider association LeadingAge.

  • It's hard to quantify the size of that market, but studies have found families in rural markets are five times more likely to reach for care on the gray market where supply through companies may be limited, Howell said.

The big picture: The effects of mass deportations or other crackdowns on caregiving would not just come from the loss of undocumented workers, Howell said.

  • Aggressive immigration enforcement could cause home care workers who might have otherwise legally entered the U.S. to move to countries with friendlier polices. Canada, for instance, announced a permanent residence program earlier this year specifically aimed at incentivizing foreign-born caregivers.
  • Many caregivers who are documented immigrants may live in mixed-status households, and deportation โ€” or the threat of deportation โ€” may destabilize those households and force them to go work in other sectors.
  • The concern is "this could put our industry under increased strain, that foreign-born workers might just decide the sector is not for them broadly. And clearly, we have so much data that says that they are the lifeblood," Howell said.

Biden administration pushes anti-obesity drug pressure to Trump

By: Tina Reed
27 November 2024 at 02:00

The Biden administration's eleventh hour move to expand Medicare coverage for anti-obesity drugs is likely to be popular among seniors, putting the Trump administration โ€” which would ultimately decide whether to carry out the expansion โ€” in the hot seat.

Why it matters: The buzzy class of drugs known as GLP-1 agonists have been hailed as game changers amid an obesity crisis tied to chronic diseases.


  • But the drugs are pricey, and insurers, advocacy groups and policymakers warn that opening up coverage for them could be a recipe for runaway costs in an already financially taxed system.

Driving the news: Under current law, Medicare is barred by Congress from covering drugs for weight loss. They're covered only as an optional benefit on state Medicaid plans, and coverage varies by state.

  • Biden administration officials say they're reinterpreting the statute by addressing obesity as a chronic condition rather than weight loss.
  • "I have heard from countless people about how this coverage exclusion is a barrier preventing people from treating obesity and living healthier lives," Centers for Medicare and Medicaid Services administrator Chiquita Brooks-LaSure said in a call with reporters.

By the numbers: The Biden administration's move, which would take effect in 2026, would expand access to drugs like Novo Nordisk's Ozempic or Wegovy for 3.4 million Americans on Medicare and another 4 million on Medicaid who are obese, per the White House. Officials said they do not expect this would raise seniors' premiums.

  • Officials estimated the cost to the federal government of the proposed coverage over 10 years would be roughly $25 billion for Medicare and $11 billion for Medicaid. Biden administration officials estimate states would shoulder roughly $3.8 billion in additional spending during that time.
  • Medicare opening coverage to anti-obesity drugs would likely have a much broader impact on access to the drugs via employer coverage, said Kathy Hempstead, a health insurance expert at the Robert Wood Johnson Foundation.
  • "The fact that there is such a patchwork of access to this drug is something that strikes a lot of Americans as being unfair. You just sort of randomly might or might not have access to this medication, depending on where you work or what state you live in," she said, adding the current proposal from the White House could be a path to universal coverage.

The other side: It's unclear how the Trump administration will view Medicare coverage of GLP-1s. Health and Human Services secretary nominee Robert F. Kennedy Jr. has slammed use of the drugs while CMS administrator nominee Mehmet Oz has sung their praises.

  • The cost is expected to be a key sticking point, particularly as the administration promises to cut back federal spending, Capstone's Hunter Hammond wrote in a note.
  • The Trump transition team did not respond to a request for comment.

Between the lines: Generally, rules proposed late in one administration are put on hold or set aside by incoming administrations in favor of their own policy priorities.

  • But expanding coverage to the drugs is likely to be popular among seniors who make up a core part of Trump's base.

"We view this more as a parting shot from the outgoing administration, particularly given the likely cost of adding GLP-1 coverage," Evercore ISI analyst Elizabeth Anderson said in note.

  • "It's more likely that the proposed ruling may not get finalized (at least not in its current form) given the timing, but helps to raise the profile of this issue further."
  • "We have some cautious optimism," Joe Nadglowski, CEO of the Obesity Action Coalition, told Axios. "We've gotten some mixed messages from members of the Trump administration and his team around these therapies. But I think the reality is that obesity is going to be a major issue for the administration."

Between the lines: While a Trump administration might be reticent to put its stamp of approval on a Biden proposal, it may also be a political win to allow this proposal or something like it to cross the finish line, Larry Levitt, executive vice president for policy at KFF, told Axios in an email.

  • And members of Congress on "the Hill would be happy to have this done by regulation so they don't have to pay for it."

Friction point: The Alliance of Community Health Plans said the proposal would have "enormous cost consequences for consumers, taxpayers and employers."

  • "The proposed expansion is irresponsible without further analysis and stakeholder engagement. It's high time policymakers focus on exorbitant costs and appropriate utilization," it said in a statement.

What to watch: It's unclear whether the proposal would make it through the courts.

  • "Even if finalized, legal challenges overturning the rule are highly likely to be successful," Chris Meekins, an analyst at Raymond James who worked at HHS in the first Trump administration, wrote in a note.

Medicare and Medicaid would cover Ozempic, Wegovy under new Biden rule

26 November 2024 at 08:18

The Biden administration on Tuesday proposed requiring Medicare and Medicaid to cover anti-obesity drugs.

Why it matters: The rule would expand access to medications known as GLP-1 agonists for millions of Americans struggling with obesity, who are at higher risk of diabetes, stroke and cardiovascular disease, according to a White House fact sheet.


  • The proposal could set up a conflict between pharmaceutical companies and Robert F. Kennedy Jr., President-elect Trump's nominee for secretary of the Health and Human Services Department, who is an Ozempic critic.

Driving the news: Under current law, Medicare is barred from covering drugs for weight loss. That also makes it optional for state Medicaid plans, officials said.

  • The new rule proposes a "reinterpretation" of the law, expanding access to the drugs like Novo Nordisk's Ozempic or Wegovy for 3.4 million Americans on Medicare and another 4 million on Medicaid who are obese, per the fact sheet.
  • "The medical consensus has evolved. The medical community today agrees that obesity is a chronic disease, it is a serious condition that increases the risk of premature death and can lead to other serious health issues such as heart disease, stroke and diabetes," said Chiquita Brooks-LaSure, administrator for the Centers for Medicare and Medicaid Services, in a call with reporters.
  • The proposal could cost taxpayers roughly $40 billion over the next decade, officials said.

State of play: About 40% of American adults are considered obese and therefore at risk of further health complications, according to the Centers for Disease Control and Prevention.

  • 22% of people with Medicare had a diagnosis of obesity in 2022, which is more than double the number from a decade earlier and it's believed many more people suffer from obesity without an official diagnosis, CMS administrator Brooks-LaSure said.
  • High price tags and insurance restrictions made the drugs difficult to access for many Americans, especially those on Medicare and Medicaid.
  • "Without insurance coverage, these drugs can cost someone as much as $1,000 a month," the fact sheet stated.

The big picture: Demand for the drugs has surged in recent years.

  • While the drugs were originally approved to treat diabetes, they were later approved for use in obesity as well as heart disease.
  • The popularity of Ozempic among celebrities and TikTokers has also contributed to shortages for patients in need.

Go deeper: United States of Ozempic: Where anti-obesity drugs are taking off

Editor's note: This story was updated with additional details.

How RFK Jr. could use levers of HHS to shape vaccine and drug outcomes

26 November 2024 at 01:30

Robert F. Kennedy Jr. could use Health and Human Services' vast bureaucracy to put a distinct stamp on vaccine policy, drug approvals and food regulation if he's confirmed. But with so many legal requirements and bureaucratic layers baked into the process, it's hardly a foregone conclusion he will.

Why it matters: Experts say RFK Jr.'s public calls for more transparency and vows to shore up the trustworthiness of federal health agencies may translate into more requests for vaccine safety data and into appointing like-minded individuals to advisory panels that could influence coverage of drugs, services and devices.


  • They also say it could result in shifting public health funding to chronic disease or environmental health and away from infectious disease, or a diversion of federal investment to study unproven health issues instead of known risks.
  • And they're expecting attempts to remove job protections from career federal employees who work in policymaking roles and reduce the ranks of officials who don't align with RFK Jr.'s goals.

Between the lines: In the near term, he's likely to focus on how much influence he might exert on negotiations between the Food and Drug Administration and the health industries it regulates over user fees for companies, which fund a significant portion of the FDA's operations.

  • Talks to reauthorize programs for prescription drugs, medical devices and generics are due to start next year and could provide a crucible for Trump appointees to take aim at what they describe as regulators' coziness with industries they police.
  • The spotlight could fall especially hard on vaccines, based on Kennedy's criticisms of the federal pandemic response, his calls to revoke emergency use authorizations for COVID shots and his advocacy of hydroxychloroquine and ivermectin, both of which were found ineffective for treating the virus.

The general thinking is RFK Jr. could have more openings to exert his influence through the Centers for Disease Control and Prevention than the FDA, which is tightly bound by the Food, Drug and Cosmetic Act.

  • He also stack outside advisory panels like the CDC's Advisory Committee on Immunization Practices, or ACIP, with fellow vaccine skeptics.
  • ACIP recommendations influence whether Medicare covers a vaccine at no cost to patients. State Medicaid programs have to cover recommended adult vaccines.
  • "They have the ability to change the bylaws or the charters under which those committees run, and essentially have the ability to ignore the committees or disband it entirely if they felt like they needed to," Joshua Michaud, associate director of global health and HIV policy at KFF.

Zoom in: RFK Jr., with the help of Congress, could also seek to make changes to the National Vaccine Injury Compensation Program, which dates to the 1980s and gives vaccine makers legal immunity for any injuries caused by their products, in exchange for a 75-cent tax on each dose sold.

  • The program drew criticism from the right during the pandemic, when makers of COVID-19 vaccines were not required to pay the tax because the shots were designated as "countermeasures."
  • "We've never had an HHS secretary who wants to blow up the nation's immunization system. So there are questions here that haven't come up before," said Sara Rosenbaum, who served on ACIP between 2009 and 2013.

Zoom out: The HHS secretary still has a great deal of authority at the FDA.

  • "The Secretary's role doesn't have to be just routinely sign off on things," said Richard Besser, former acting director for the CDC from January to June 2009 and current CEO of the Robert Wood Johnson Foundation.

Flashback: In the Obama administration, HHS Secretary Kathleen Sebelius made an unprecedented decision to override an FDA decision that would have made emergency contraceptives available over the counter, Besser pointed out. (The decision was later reversed in 2013.)

  • "And Mr. Kennedy as the secretary has some strong feelings about what drugs are effective and which ones are not, and what things should be used to promote health," Besser said.

Reality check: HHS's budget and legal mandates are determined by Congress and have limits. Any major regulatory changes must go through public comment periods and comprehensive legal review.

  • They would also certainly be subject to lawsuits, particularly after the fall of the Chevron doctrine.

What to watch: There's a question about whether HHS could usurp school vaccine requirements using section 361 of the Public Health Service Act of 1944, which gives it the authority to "control communicable diseases."

  • "The answer is not entirely straightforward and would set off legal challenges," Richard Hughes of Epstein Becker Green wrote.

Regardless, experts say some of the most significant effects of an RFK-led HHS may be how health guidance and evidence-based information, including about vaccines, are communicated.

  • "If the CDC and the HHS secretary are out there saying we have doubts about the safety of this vaccine ... that might have some downstream effects at the state and local level, which is where those vaccine requirement decisions are actually made," Michaud said.

Patients rush to get reproductive care before Trump takes office

By: Tina Reed
25 November 2024 at 01:30

Patients are flooding doctors offices and pharmacies seeking IUD replacements, backup contraception and abortion pills before the Trump administration takes office and Republicans control Congress.

Why it matters: Republicans have vowed to restrict abortion care and experts say access to reproductive health care more broadly could erode, especially under a conservative Supreme Court.


  • Millions of women of reproductive age could be impacted if the cost of care increases or access to contraceptives is limited.

Driving the news: Google searches for contraception spiked in the wake of the election, and Planned Parenthood North Central States has seen a 150% increase in scheduled appointments for long-acting reversible contraception such as IUDs.

  • In Kentucky, health clinic appointments for contraceptives increased by 66%. There's also been an uptick in demand for permanent surgical sterilization, including tubal ligation, the Lexington Herald-Leader reported.
  • In Massachusetts, patients with contraceptive implants and IUDs, which can remain in the body for three to 10 years, are asking Boston-area clinics if they can replace the devices early, Axios' Steph Solis reports.

"I think that this is going to continue over the next few months and even years down the line, as people try to take some control over their bodies," Brittany Cline, an OB-GYN at Northwestern Medicine in Chicago, told ABC News, adding she'd used all the IUDs she had in her office in the days following the election.

Between the lines: People have also been rushing to delete their digital footprints, including menstrual cycle tracking apps, out of fear the data might be used by law enforcement in states with abortion bans.

  • Women have begun stocking up on emergency contraception, also often referred to as the morning-after pill.
  • Telehealth company Wisp saw orders for the drug, which doesn't need a prescription, double the week after the election, the New York Times reports. The bulk of those orders came from new patients and were for multipacks of the pills, the company told the Times.
  • Some states, such as Oregon, have recently begun stockpiling the drugs used for medication abortion, joining others that created their own reserves in the aftermath of the Dobbs decision.

Flashback: There was also a rush for IUDs in advance of the first Trump presidency, years before the overturn of Roe v. Wade. There was another surge just before the Dobbs decision was handed down.

The big picture: Experts say the next administration is likely to restrict access to medication used for abortion by applying a 19th century anti-obscenity law known as the Comstock Act to prevent mailing drugs used for abortion.

  • Congress could also attempt to pass a national abortion ban.

Meanwhile, contraception is expected to become more expensive and more difficult to get.

  • Access to contraception could erode if Congress targets expanded Medicaid coverage as well as the Affordable Care Act itself, which requires plans to make no-cost birth control available.
  • That could put pricier methods, including IUDs or emergency birth control, out of reach for many women, Liz Taylor, senior federal policy counsel at the Center for Reproductive Rights, told Axios.

There is also an ongoing challenge over a provision in the ACA that requires employers to cover certain preventative services, including contraception, points out Zachary Baron, director of the Health Policy and the Law Initiative at Georgetown University's O'Neill Institute.

  • The Biden administration asked the Supreme Court to weigh in, but the Trump administration could petition the court to withdraw the case, leaving a lower court decision that the federal government does not need to enforce the ACA's preventative service coverage requirement.
  • Broader religious and moral exemptions could also be granted to employers, who could opt out of paying for birth control, and to health providers, who could then refuse to prescribe or dispense the medicine.

Reality check: All of these restrictions and changes could be challenged in the courts.

  • "All that would be subject to litigation, and there are other obstacles to actually accomplishing" these scenarios, Baron said.

What to watch: The future of fertility care is unclear. Trump said on the campaign trail that he not only supported IVF, but would back government coverage for it.

  • But Republicans may not be aligned with him: GOP members of the House sent a letter to the Armed Services Committee on Friday questioning the ethics of the procedure and calling for coverage of it to be stripped from military benefits.
  • Fertility care is "the big test of if we could trust any of the rhetoric from the campaign versus what the true policy actions are going to be," Taylor said.

What to know about RFK Jr.'s positions on vaccines, drugs and health care

By: Tina Reed
14 November 2024 at 14:10

Robert F. Kennedy Jr. has fanned the flames of vaccine misinformation and elevated unfounded claims about corruption within the FDA.

Why it matters: Now, he's President-elect Trump's pick to lead America's health agencies โ€” including the ones he has lambasted for years.


  • Some of the concerns Kennedy has raised are relatively mainstream, such as the prevalence of chronic disease and issues with the U.S. food supply.
  • But his past comments also include outlandish theories like blaming school shootings on antidepressant use.

Make America Healthy Again movement

State of play: Since suspending his presidential campaign and endorsing Trump, RFK Jr. has been pushing an agenda called Make American Healthy Again, or MAHA.

  • It calls for policing food additives and expanding health savings accounts, and it's advanced more conspiracy-tinged ideas about corruption within the Food and Drug Administration, fluoride in water and vaccine recommendations.
  • The overriding concern, he says, is children's health. "We must stop poisoning our kids," he recently tweeted in response to conservative activist Charlie Kirk's comments about additives allowed in the American food system.

RFK's positions: Anti-fluorinated water, pro-psychedelics

When it comes to health care, RFK Jr. balks at what he calls "aggressive suppression" by the FDA on "psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can't be patented by Pharma."

  • He has called for the end of the public health practice of putting fluoride in water, calling it "an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease."
  • Health experts have called fluoridation one of public health's greatest achievements and said claims it is unsafe are unsupported by science.

"We see what can only be described as extraordinary proposals coming out of Kennedy," Sara Rosenbaum at George Washington University's Milken School of Public Health told Axios.

Vaccine skepticism

Public health experts are particularly alarmed by Kennedy's vaccine skepticism.

  • He is chair of the anti-vaccine group Children's Health Defense. However, Kennedy rejects claims that he's anti-vaccine and told NBC News after Trump was elected that he won't "take away anybody's vaccines."
  • However, he also repeated a debunked claim that ties vaccinations to autism, making comments on a June 15ย episodeย of the "Joe Rogan Experience" podcast inferring that autism has become more common due to modern vaccinations.
  • Researchers called the statements inaccurate and misleading. CDC director Mandy Cohen recently warned that Kennedy's views on vaccines could cost lives, Modern Healthcare reported.
  • He has suggested a flu vaccine may be to blame for a condition called spasmodic dysphonia, a rare neurological disorder that has impacted his voice, per an NBC report. That's not backed up by the research.

Kennedy's next fights

Between the lines: RFK Jr. could face a tricky nomination battle, but the pick is setting off alarm bells across the scientific community.

  • FDA commissioner Robert Califf this week warned about the lines between politics and science being blurred.
  • Yes, but: RFK Jr. has also promised to tackle chronic disease, which some experts say could be a good thing if he addresses evidence-backed contributors to poor health in America.

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