• Click here to hear Boden on “Central Valley Daily”
• Read Boden’s “House Cats With Bird Flu Could Pose a Risk to Public Health”

KFF Health News South Carolina correspondent Lauren Sausser juxtaposed the increasing trendiness of rural health care and the lack of Medicaid expansion in the South on America’s Heroes Group on Feb. 12.

• Click here to watch Sausser on America’s Heroes Group
• Read Sausser’s “Across the South, Rural Health Care Has Become ‘Trendy.’ Medicaid Expansion Has Not.”

KFF Health News contributor Rebecca Grapevine, of Healthbeat, discussed the barriers to lifesaving HIV drugs in Georgia on America’s Heroes Group on Feb. 12.

• Click here to watch Grapevine on America’s Heroes Group
• Read “Biden Rule Cleared Hurdles to Lifesaving HIV Drug, but in Georgia Barriers Remain”

KFF Health News Southern correspondent Sam Whitehead discussed childhood vaccination rates on WUGA’s “The Georgia Health Report” on Feb. 7.

• Click here to hear Whitehead on “The Georgia Health Report”
• Read Whitehead’s “Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping,” co-reported with Daniel Chang

KFF Health News public health local editor and correspondent Amy Maxmen discussed the U.S.’ pulling out of the World Health Organization on America’s Heroes Group on Feb. 5.

• Click here to watch Maxmen on America’s Heroes Group
• Read Maxmen’s “What a US Exit From the WHO Means for Global Health”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But there’s actually some ambivalence about the parade’s absence in Kansas City. The celebration of the Chiefs’ win last year ended with a mass shooting that killed one person and injured at least 24 more. 

I’ve been talking to the survivors since then with my colleague Peggy Lowe at KCUR for a series we call “The Injured.” They’ve told us all about their lives since the shooting: about being left off the official list of victims, about doctors leaving bullets in their bodies, about the financial hardship of surviving, about the mental toll on the children who were shot, and about their efforts to restore a sense of safety in a society where gun violence is rampant. 

This week we published one last story about what therapists call the “thawing” of survivors. Many people who experience trauma emotionally freeze as a coping mechanism. But with time, that freeze melts, and the intensity of what happened to them can be suddenly overpowering. 

“Trauma pulls us into the past,” Gary Behrman told me. He’s a therapist who worked with witnesses of the 9/11 attacks in New York. 

Sights, smells, sounds, tastes, and touches can all trigger flashbacks that shut down the brain like an overloaded circuit breaker. The survivors in Kansas City told us about being triggered by loud noises, large crowds, and seeing police officers who remind them of the first responders at the shooting. 

And the shooting happened at a cultural institution, Union Station, so many survivors found themselves back there unexpectedly. Kids had field trips to a science center inside. Follow-up doctor visits were often on nearby Hospital Hill. An October dinner organized for survivors was less than a mile away, prompting one young survivor to decline the invitation. 

One survivor told me about a date she went on in December in downtown Kansas City. She doesn’t know the city well — she lives in Leavenworth, Kansas — so she was shocked to look up and see the intersection where a bullet ripped through her leg. 

“Oh f—,” she told her date, fighting tears and a panic attack until the station was out of view. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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She’s desperate for information, but the Centers for Disease Control and Prevention, a critical source of urgent analyses of the flu and other public health threats, has gone quiet in the weeks since President Donald Trump took office.

“Without more information, we are blind,” she said.

Flu has been brutal this season. The CDC estimates at least 24 million illnesses, 310,000 hospitalizations, and 13,000 deaths from the flu since the start of October. At the same time, the bird flu outbreak continues to infect cattle and farmworkers. But CDC analyses that would inform people about these situations are delayed, and the CDC has cut off communication with doctors, researchers, and the World Health Organization, say doctors and public health experts.

“CDC right now is not reporting influenza data through the WHO global platforms, FluNet [and] FluID, that they’ve been providing information [on] for many, many years,” Maria Van Kerkhove, interim director of epidemic and pandemic preparedness at the WHO, said at a Feb. 12 press briefing.

“We are communicating with them,” she added, “but we haven’t heard anything back.”

On his first day in office, President Donald Trump announced the U.S. would withdraw from the WHO.

A critical analysis of the seasonal flu selected for distribution through the CDC’s Health Alert Network has stalled, according to people close to the CDC. They asked not to be identified because of fears of retaliation. The network, abbreviated as HAN, is the CDC’s main method of sharing urgent public health information with health officials, doctors, and, sometimes, the public.

A chart from that analysis, reviewed by KFF Health News, suggests that flu may be at a record high. About 7.7% of patients who visited clinics and hospitals without being admitted had flu-like symptoms in early February, a ratio higher than in four other flu seasons depicted in the graph. That includes 2003-04, when an atypical strain of flu fueled a particularly treacherous season that killed at least 153 children.

Without a complete analysis, however, it’s unclear whether this tidal wave of sickness foreshadows a spike in hospitalizations and deaths that hospitals, pharmacies, and schools must prepare for. Specifically, other data could relay how many of the flu-like illnesses are caused by flu viruses — or which flu strain is infecting people. A deeper report might also reveal whether the flu is more severe or contagious than usual.

“I need to know if we are dealing with a more virulent strain or a coinfection with another virus that is making my patients sicker, and what to look for so that I know if my patients are in danger,” Stokes said. “Delays in data create dangerous situations on the front line.”

Although the CDC’s flu dashboard shows a surge of influenza, it doesn’t include all data needed to interpret the situation. Nor does it offer the tailored advice found in HAN alerts that tells health care workers how to protect patients and the public. In 2023, for example, a report urged clinics to test patients with respiratory symptoms rather than assume cases are the flu, since other viruses were causing similar issues that year.

“This is incredibly disturbing,” said Rachel Hardeman, a member of the Advisory Committee to the Director of the CDC. On Feb. 10, Hardeman and other committee members wrote to acting CDC Director Susan Monarez asking the agency to explain missing data, delayed studies, and potentially severe staff cuts. “The CDC is vital to our nation’s security,” the letter said.

Several studies have also been delayed or remain missing from the CDC’s preeminent scientific publication, the Morbidity and Mortality Weekly Report. Anne Schuchat, a former principal deputy director at the CDC, said she would be concerned if there was political oversight of scientific material: “Suppressing information is potentially confusing, possibly dangerous, and it can backfire.”

CDC spokesperson Melissa Dibble declined to comment on delayed or missing analyses. “It is not unexpected to see flu activity elevated and increasing at this time of the year,” she said.

A draft of one unpublished study, reviewed by KFF Health News, that has been withheld from the MMWR for three weeks describes how a milk hauler and a dairy worker in Michigan may have spread bird flu to their pet cats. The indoor cats became severely sick and died. Although the workers weren’t tested, the study says that one of them had irritated eyes before the cat fell ill — a common bird flu symptom. That person told researchers that the pet “would roll in their work clothes.”

After one cat became sick, the investigation reports, an adolescent in the household developed a cough. But the report says this young person tested negative for the flu, and positive for a cold-causing virus.

Corresponding CDC documents summarizing the cat study and another as-yet unpublished bird flu analysis said the reports were scheduled to be published Jan. 23. These were reviewed by KFF Health News. The briefing on cats advises dairy farmworkers to “remove clothing and footwear, and rinse off any animal biproduct residue before entering the household to protect others in the household, including potentially indoor-only cats.”

The second summary refers to “the most comprehensive” analysis of bird flu virus detected in wastewater in the United States.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, said delays of bird flu reports are upsetting because they’re needed to inform the public about a worsening situation with many unknown elements. Citing “insufficient data” and “high uncertainty,” the United Kingdom raised its assessment of the risk posed by the U.S. outbreak on dairies.

“Missing and delayed data causes uncertainty,” Nuzzo said. “It also potentially makes us react in ways that are counterproductive.”

Another bird flu study slated for January publication showed up in the MMWR on Feb. 13, three weeks after it was expected. It revealed that three cattle veterinarians had been unknowingly infected last year, based on the discovery of antibodies against the bird flu virus in their blood. One of the veterinarians worked in Georgia and South Carolina, states that haven’t reported outbreaks on dairy farms.

The study provides further evidence that the United States is not adequately detecting cases in cows and people. Nuzzo said it also highlights how data can supply reassuring news. Only three of 150 cattle veterinarians had signs of prior infections, suggesting that the virus doesn’t easily spread from the animals into people. More than 40 dairy workers have been infected, but they generally have had more sustained contact with sick cattle and their virus-laden milk than veterinarians.

Instead, recently released reports have been about wildfires in California and Hawaii.

“Interesting but not urgent,” Nuzzo said, considering the acute fire emergencies have ended. The bird flu outbreak, she said, is an ongoing “urgent health threat for which we need up-to-the-minute information to know how to protect people.”

“The American public is at greater risk when we don’t have information on a timely basis,” Schuchat said.

This week, a federal judge ordered the CDC and other health agencies to “restore” datasets and websites that the organization Doctors for America had identified in a lawsuit as having been altered. Further, the judge ordered the agencies to “identify any other resources that DFA members rely on to provide medical care” and restore them by Feb. 14.

In their letter, CDC advisory committee members requested an investigation into missing data and delayed reports. Hardeman, an adviser who is a health policy expert at the University of Minnesota, said the group didn’t know why data and scientific findings were being withheld or removed. Still, she added, “I hold accountable the acting director of the CDC, the head of HHS, and the White House.”

Hardeman said the Trump administration has the power to disband the advisory committee. She said the group expects that to happen but proceeded with its demands regardless.

“We want to safeguard the rigor of the work at the CDC because we care deeply about public health,” she said. “We aren’t here to be silent.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Congress has mostly stood by as the Trump administration — spurred by Elon Musk and his Department of Government Efficiency, named and created by President Donald Trump  — takes a chainsaw to a broad array of government programs. But now the courts are stepping in to slow or stop some efforts that critics claim are illegal, unconstitutional, or both.

Funding freezes and contract cancellations are already having a chilling effect on health programs, such as biomedical research grants for the National Institutes of Health, humanitarian and health aid provided overseas by the U.S. Agency for International Development, and federal funding owed to community health centers and other domestic agencies.

This week’s panelists are Julie Rovner of KFF Health News, Jessie Hellmann of CQ Roll Call, Shefali Luthra of The 19th, and Maya Goldman of Axios.

Panelists

Among the takeaways from this week’s episode:

• Universities are reconsidering hiring and other forward-looking actions after the Trump administration imposed an abrupt, immediate cap on indirect costs, which help cover overhead and related expenses that aren’t included in federal research grants. A slowdown at research institutions could undermine the prospects for innovation generally — and the nation’s economy specifically, as the United States relies quite a bit on those jobs and the developments they produce.
• The Trump administration’s decision to apply the cap on indirect costs to not only future but also current federal grants specifically violates the terms of spending legislation passed by Congress. Meanwhile, the health impacts of the sudden shuttering of USAID are becoming clear, including concerns about how unprepared the nation could be for a health threat that emerges abroad.
• Congress still hasn’t approved a full funding package for this year, and Republicans don’t seem to be in a hurry to do more than extend the current extension — and pass a budget resolution to fund Trump’s priorities and defund his chosen targets.
• The House GOP budget resolution package released this week includes a call for $880 billion in spending cuts that is expected to hit Medicaid hard. House Republican leaders say they’re weighing imposing work requirements, but only a small percentage of Medicaid beneficiaries would be subject to that change, as most would be exempt due to disability or other reasons — or are already working. Cuts to Medicaid could have cascading consequences, including for the national problem of maternal mortality.

Also this week, Rovner interviews Mark McClellan — director of the Duke-Margolis Institute for Health Policy who led the FDA and the Centers for Medicare & Medicaid Services during the George W. Bush administration — about the impact of cutting funding to research universities. And Rovner reads the winner of the annual KFF Health News’ “health policy valentines” contest.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: Axios’ “Nonprofit Hospital Draws Backlash for Super Bowl Ad,” by Maya Goldman. 

Shefali Luthra: Politico’s “‘Americans Can and Will Die From This’: USAID Worker Details Dangers, Chaos,” by Jonathan Martin. 

Maya Goldman: KFF Health News’ “Doctor Wanted: Small Town in Florida Offers Big Perks To Attract a Physician,” by Daniel Chang.

Jessie Hellmann: NPR’s “Trump’s Ban on Gender-Affirming Care for Young People Puts Hospitals in a Bind,” by Selena Simmons-Duffin. 

Also mentioned in this week’s podcast:

• Reuters’ “USAID Families Have Their Lives Upended by Trump Move To Shut Agency,” by Jonathan Landay and Humeyra Pamuk.
• Newsweek’s “First USAID Death as Freeze Sees Oxygen Supplies Cut Off for Refugee,” by Theo Burman.

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Feb. 13, at 10 a.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today we are joined via videoconference by Shefali Luthra of The 19th. 

Shefali Luthra: Hello. 

Rovner: Jessie Hellmann of CQ Roll Call. 

Jessie Hellmann: Hi. 

Rovner: And we welcome to the podcast our first of two new panelists you’ll be hearing in the coming weeks, Maya Goldman of Axios news. 

Maya Goldman: Hi, great to be here. 

Rovner: Later in this episode we’ll have my interview with doctor and economist Mark McClellan, former commissioner of the Food and Drug Administration and administrator of the Centers for Medicare & Medicaid Services under President George W. Bush — though not at the same time. Mark now heads a research institute at Duke University, and he will try to explain what’s happening with NIH [National Institutes of Health] grants. We also have the winner of our annual KFF Health News Health Policy Valentine Contest, but first this week’s health news. 

So by the time you hear this, Robert F. Kennedy Jr. is almost certain to have been confirmed by the Senate as the next secretary of health and human services. But even before he gets sworn in, as we have been chronicling these past few weeks, things are changing fast and furious over at HHS [the Department of Health and Human Services], and, increasingly, courts are trying to stop or at least slow some of those changes. 

The thread running through all of these, which we will talk about, is growing doubt about whether this administration will comply with those court orders or touch off a constitutional crisis. So I admit I had to make myself a chart to keep track of all of these lawsuits challenging all of the actions the administration has taken just in its first three weeks. We’ll start with what’s going on — or not — at the National Institutes of Health, where last Friday night the agency announced that, henceforth, indirect costs as part of agency grants would be capped at 15%, including for current grants. We’ll have more on this and what it might mean in my chat with Mark McClellan later in this episode. But suffice it to say that I am old enough to remember when NIH was an untouchable jewel for both Republicans and Democrats. What the heck happened here? 

Hellmann: I think Elon Musk, in his crusade to find government waste, decided to hone in on NIH next. And this has been something that the conservative think tanks have been talking about for a little bit, that they think some of these universities are just ripping off the government with these indirect costs on NIH grants. Some of the universities get up to 60% or higher on their NIH grants to cover administrative costs, staffing, stuff like that. But it’s just become a target. [President Donald] Trump also tried to do something similar in 2017, but Congress said, No, we do not want to do that, and actually put a rider in appropriations bills to stop it. And that was kind of the end of it. But it seems like the strategy in this version of the Trump administration is to do something anyway and then take it through the courts. 

Rovner: Don’t skip over that too fast. There’s actual language in the spending bill that says you can’t do this. 

Hellmann: Yeah, there just doesn’t seem to be a lot of concern about this, even from people who have historically supported NIH, and Republicans are just kind of going along with what Elon Musk has been saying about, This is wasteful. We think 15% is fair. So it’s definitely been a big shift. 

Goldman: There have been some Republicans that have spoken out, though. I think Sen. Katie Britt from Alabama was one of the first voices to — I don’t know if you could necessarily say she spoke out against it so strongly, but she said, I value the research that the universities in my state do, and I’m talking to RFK Jr. I think, well, it’s not the same kind of response that we might’ve seen seven, eight years ago. There is a little bit of pushback, which is I think different than some other health changes that we’ve seen. 

Rovner: I did notice that [Sen.] Susan Collins had a strongly worded statement in which she buried the news that she was going to vote for RFK Jr., too, as HHS secretary but also saying that Jackson Labs, big biomedical research facility in Maine, thinks this is really important. I have sort of a broader question. This usually comes up in the context of Medicare. We talk about whether or not the federal government is a good or a bad business partner. Because if they keep changing the rules, you don’t want to rely on their word if it can change. I mean it’s one thing to say, Yes, going forward we’re going to cap indirect costs of 15% and you can decide whether to take it or leave it, but they’re doing this for current grant. They’re just saying: OK, that’s it. We’re not going to pay you this money that we gave you a grant and agreed to pay you for five years. One would think that could have longer-term consequences even if this is eventually reversed. And as I just said, there is language in the spending bill that says they can’t do this. 

Luthra: The other thing that I think is worth noting is that there is this sort of uncertainty that it has created at a lot of universities, similar to what we’re seeing in basically any institution that’s been touched by some sort of very sudden funding freeze or funding cut. A lot of universities really rely on these funds, and they don’t know whether they will come back, whether they’ll be losing tens of millions of dollars each year. And they’re trying to plan their budgets, and that means in some cases I’ve heard about universities canceling existing hiring cycles because they don’t think they can necessarily afford to pay for employees that two weeks ago they thought they’d be able to. And what we have seen in other institutions, which we’ll talk about later in the podcast, is coming up here in academia as well, and this will just have vast ripple effects throughout our country and our economy, given what a big role universities play. 

Rovner: And also, in the young scientist pipeline, that’s always been a concern that, who’s going to be the next generation. If graduate students and even undergraduate students see all of this uncertainty and people being suddenly laid off, are they going to think, Well, maybe I should go learn coding or do something else? Maya, you’re nodding. 

Goldman: Yeah, I talked to somebody yesterday who said she’s hearing from students that she mentors — she’s a professor — she’s hearing from students that she mentors that they’re, like, Maybe I should just go to the private sector and make some money. Which I think is actually maybe one of the underlying goals of DOGE [the Department of Government Efficiency] and Elon Musk, to get people to go to the private sector. 

Rovner: Although as we discover, and we will talk more about this, the private sector gets a lot of money from the federal government. 

Goldman: Absolutely. 

Rovner: That’s been kind of the Republican mantra for many generations, of Let’s partner more with the private sectors. Therefore, there’s a lot of partnerships between the public and private sectors. 

Hellmann: It’s also interesting because there’s been a lot of distrust from RFK Jr. about health research done in the private sector by pharmaceutical companies. So if you’re not doing this research or funding it through NIH and you don’t trust pharmaceutical companies to do it, either, then where does that leave you? 

Rovner: Well, moving on to the broader funding freeze that the Office of Management and Budget tried to impose, then tried to rescind, but apparently didn’t in many cases. A U.S. district judge ordered the administration to resume payments, and when officials didn’t, another judge in a second lawsuit ordered the resumption in much angrier terms and led Elon Musk and Vice President JD Vance, the latter of whom is a graduate of Yale Law School, to question whether judges even have the authority to tell the executive branch what it can and can’t do. I have not been to law school, but, I don’t know, I’ve been doing this for a long time, and my perception has always been that’s courts’ jobs, to tell the executive branch and Congress what it can and can’t do. Is it not? 

Luthra: It is, and any of us who has taken civics or American history could tell you that. But I do think it’s worth noting that this actually isn’t a new talking point for, in particular, the vice president, who frequently references Andrew Jackson, the president who famously said: “The courts have made their order. Let’s see them enforce it.” And to what you alluded to earlier, Julie, that is the question about whether we find ourselves hurtling toward some kind of very serious constitutional, if not crisis, then very serious concern about whether the separation of equal powers remains tantamount. 

Rovner: I think you can call it a constitutional crisis. I mean we’re not there yet— 

Luthra: Yes, but we could be hurtling toward one. 

Rovner: Yes. I think that’s very, very fair. 

Luthra: Excellent. 

Rovner: Well, also among the early Trump actions getting shot down by federal judges are the removal of various webpages and datasets at HHS, including a two-week delay of the release of the CDC’s [Centers for Disease Control and Prevention’s] Morbidity and Mortality Weekly Report, with a couple of key studies of bird flu, which by the way continues to spread from birds to cows to people in a growing number of states, most lately Nevada. In a case filed by the liberal groups Doctors for America and Public Citizen, a judge has given HHS until this Friday to restore the websites to the state they were in before they were taken down. I checked this morning, and the CDC website still says it’s being, quote, “modified” to comply with the president’s executive orders. Is this another of those judicial orders the administration considers optional to obey? 

Goldman: I am very curious to see that. I think it’s also hard to wrap my head around exactly what was taken down and changed, because there’s just so much information on the CDC’s website, on federal health websites. So I think it’ll be really hard to know unless you’re looking on a case-by-case basis to see if something has been restored or changed. 

Rovner: I did see, I think this was in The Washington Post, a researcher who said she had a paper on using mobile vans to distribute fruit and vegetables and healthier foods in remote areas and it was taken down because it had the word “diverse” populations in it. I can’t remember whether it was back up or not. But I mean, yes, the president gets to say, We’re not going to do DEI [diversity, equality, and inclusion] again, but this is like the NIH grant. It’s one thing to say we’re not going to do this going forward, and it’s another thing to say everybody who’s ever said this is now fired, which basically they’re saying in a lot of departments. 

Luthra: And that words have very vast meanings. You mentioned diverse populations. “Biodiversity,” a scientific term that may not be used in a lot of these papers anymore, just sort of creates a real chilling effect and makes it in some cases impossible to do accurate science. 

Rovner: Yes. And if you missed it in last week’s episode, I read out part of the list of the words that can no longer be used in federally funded research. Well, outside of HHS, but still inside of health care, the fight continues over the fate of the U.S. Agency for International Development, which Elon Musk has all but obliterated. This may be an example of court relief coming too late. We’re getting stories of rotting food in warehouses with no one to deliver it, a 71-year-old refugee from Myanmar dying because the hospital that had been providing her oxygen in Thailand closed suddenly, and pregnant USAID workers suddenly finding themselves ordered to change continents while in their third trimester of pregnancy. Is there a point to this? There’s so far been no real evidence of fraud in the program. It’s only spending that the new administration doesn’t agree with. 

Luthra: I think we could go even further than spending they don’t agree with. It’s hard to see that they’ve even reviewed it. A lot of the reporting coming out shows that people who work at USAID haven’t gotten any questions from the administration about, What work are you doing? There’s been process initiated to review all the grants that they have frozen, which suggests that maybe they won’t actually do that. This seems very arbitrary, very broad, and to your point, Julie, the health implications will be and are very immediate and very sweeping and risk setting Americans, but also people across the globe, back in terms of health progress by I don’t even know how much. 

Rovner: One presumes that USAID is a target because Americans in general don’t like foreign aid. This is foreign aid. Most people haven’t heard of it. It’s an easy target, if you will, and they can sort of, like, If we can do this with USAID, then we can go on and do it with things that might be a little more politically sensitive. Is that a fair interpretation? Maya, you’re nodding. 

Goldman: Yeah. I mean I think so, but it’s also a matter of national security in a lot of ways, and foreign aid, at least global health foreign aid, is a pretty small fraction of the federal budget. But I’ve been talking to some virologists who are really worried that the collapse of U.S. involvement in global health efforts, there’s going to be viruses that mutate and then come back to the U.S., and who knows if we’ll have the public health infrastructure in our country to fight them anymore. But it’s also just a good investment to fight these viruses, prevent these viruses abroad before they even get to the U.S. 

Rovner: Yeah, it’s better to control Ebola in Africa before somebody with it gets on an airplane. 

Goldman: Exactly, yeah. And there’s also the question that we’ve been talking about on my team of the collapse of U.S. soft power in some ways. You’re leaving a vacuum for another country like China, perhaps, to come in and exert influence in other countries. And I think that you could also see that in biomedical research if NIH funding continues to be cut. 

Rovner: So moving over to Capitol Hill, we’ll talk about efforts to launch the fiscal 2026 budget process and legislate President Trump’s agenda in a moment. But first, our weekly reminder that Congress hasn’t yet finished the fiscal 2025 spending bills, even though the fiscal year began last Oct. 1. And the temporary funding that Congress passed in December runs out March 14. So the new Congress must be about to get that all tied up in a bow, right? 

Hellmann: Yeah, it doesn’t seem to be a lot of urgency about that right now. House Republicans are now pushing for a full-year CR [continuing resolution]. Some Democrats are talking about potentially using a potential shutdown as leverage as they fight back against some of these unilateral spending cuts by Elon Musk. But yeah, most of the focus right now seems to be on the budget reconciliation package that Donald Trump wants to extend his tax cuts and do border spending and things like that. And the government doesn’t shut down for a month, which is a million years in Congress time. So— 

Rovner: It’s like the opposite of dog years. But still, when you say a, quote-unquote, “full-year CR,” that’s really a seven-month CR. That’s really just, Let’s continue what we’ve been doing and move on to fight the next battle. 

Hellmann: Yeah. 

Rovner: Which of course they could have done in December, but they didn’t want to, because I think they were going to come in and do exciting things for the rest of fiscal 2025. But Congress being Congress, they’re going to kick the can down the road. And while we’re on news from Congress, as I mentioned at the top, RFK Jr. will become the next health and human services secretary any minute, if it hasn’t already happened. They are literally voting as we tape this morning. This was a huge controversy — until it wasn’t. What happened to Republicans who were so worried about his anti-vax and potentially pro-abortion-rights views? It just all kind of melted away? 

Luthra: I think what happened is what’s happened with every Cabinet nominee with the exception of Matt Gaetz, which is that the resistance from Senate Republicans is simply not there anymore. I’ve been pretty surprised personally to see some of the lawmakers who are typically considered more moderate, the Susan Collinses of the world, Lisa Murkowskis, who in Trump 1 would vote against some of these types of picks but appear to have changed their perspective this time around. There was so much attention on [Sen.] Bill Cassidy during last week’s hearings, and he made a very public conversation about whether RFK Jr.’s views on vaccines would be deeply detrimental. 

And then he came back and said, I have gotten real reassurances that everything will be fine. And all of these lawmakers are citing these private conversations they’ve had and these commitments that they say they received, and at the same time you have Democrats like [Sen.] Patty Murray saying they have never had more disturbing conversations with a nominee than they had with this particular one. And it just really shows how stark the contrast is. You have the Republican Party largely saying yes to everything Donald Trump is proposing, and Democrats may be critical in cases like this one, but without really the power to stop it. 

Rovner: As we pointed out on the podcast, Kennedy showed an almost alarming lack of knowledge about the programs that he’s going to be overseeing as secretary. I mean, not just didn’t know but apparently just didn’t bother to do the basic homework that one would assume that a Cabinet nominee would do before coming before the Senate. Perhaps he knew that it didn’t matter, that Republicans are going to basically fall in line for whoever Trump wants, because that seems to be what’s going on right now. 

Hellmann: Yeah, he was asked about Medicare and Medicaid in his first hearing and didn’t have a very good answer, and then was asked about it in his second hearing and I think somehow gave a worse answer. So it’s like he didn’t go home and do any studying on it. And maybe he has since. 

Rovner: Yeah, we will see. 

Hellmann: Hopefully. 

Rovner: All right. Well, now onto next year’s budget. It’s not hard to see why President Trump is trying to do so much using his executive power, because the Republican Congress is so far looking unlikely to do anything approaching the president’s, quote, “big, beautiful bill” anytime soon. Just a reminder that in 2017 the Republican Congress just barely got its big tax bill over the finish line before Christmas, so it took them an entire year back then. Jessie, I know you’re following this, or trying to. First, why are the House and the Senate seemingly on different tracks? If they’re going to plunge ahead with the president’s agenda, shouldn’t they be trying to do the same thing at the same time? 

Hellmann: I think Trump just wants to let both sides go at it and see who gets it done fastest and who comes up with the best outcome, kind of like pitting them against each other a little bit. But I think Senate Republicans have a lot of doubt about how quickly the House can get this done. There’s been a lot of pushback on the House side from members of the Freedom Caucus, the really conservative members who would like to see deeper spending cuts. And I think House leadership knows that that’s going to necessitate some cuts that are going to be really unpopular for some moderate Republicans in competitive districts. So I think the Senate sees a sense of urgency. Ross Vought, the OMB director, was on the Hill today basically saying they’re running out of money to do some of these immigration things that they want to do, and [Sen.] Lindsey Graham is saying: We need to be more urgent about this. We need to get this done quickly. So I think that that’s why they’re trying to move. 

Rovner: Just to be clear: The Senate is trying to do a smaller bill first with a single budget resolution, and then they’ll do the tax bill later, and the House is trying to do all of it together. Is that basically where we are in the 15-second wrap-up? 

Hellmann: Yes. 

Rovner: Well, President Trump rather famously on the campaign trail said he would not cut Social Security or Medicare benefits, and just two weeks ago he said he wouldn’t cut Medicaid, either, except for fraud and abuse. How on Earth is either chamber going to pay for $4 trillion in tax cuts without cutting Medicare, Medicaid, or Social Security? 

Goldman: I think it’s important to note that Trump said that he’s going to love and cherish Medicaid and only make changes in fraud, waste, and abuse categories. But what does that mean? We don’t really know. There are a lot of ways that that could be interpreted. So I definitely don’t think that Medicaid and, possibly, I haven’t heard chatter about Medicare, but if you apply the same logic, possibly Medicare and Social Security as well are on the table. 

Rovner: Yeah. And Medicaid, I know that certainly everybody seems to be getting all excited about Medicaid work requirements. They seem to have forgotten what we learned before, which is that most people on Medicaid already work, and if they don’t, it’s because they can’t. They’re either disabled themselves, caring for someone who’s disabled, or for other legitimate reasons cannot work. And that when you do work requirements, generally what we discovered in Arkansas is that you knock eligible people off the rolls, not because they’re not working but because they’ve not been able to properly report that they are working. So we saw lots of people who were eligible and working who were still cut — which maybe that’s the idea of how you cut Medicaid and call it waste, fraud, and abuse? 

Goldman: Definitely possible. 

Rovner: Shefali, what’s the impact of a really big cut to Medicaid, besides the fact that it would save a lot of money? 

Luthra: I think it’s something that we don’t talk about enough, because Medicaid is such a tremendous payer for so many people’s health insurance. We’ve seen really meaningful efforts to expand Medicaid’s reach in the past. Even just a few years, I’m thinking about its role in covering pregnancy, in particular. About half of all pregnancies are paid for through Medicaid. A lot of people qualify for the program specifically when they become pregnant, because the income threshold is different. And we’ve seen a lot of states extend eligibility so that you can hold on to your Medicaid for six months postpartum, the period when you’re most vulnerable, in an effort to reduce pregnancy-related mortality. And obviously insurance is not the sole silver bullet toward improving health, but it makes a very big difference. And so when we talk about cuts toward Medicaid, we talk about cuts toward very vulnerable people. We also do talk about backtracking in an effort to undo one of our most significant reproductive health problems, which is that we really trail other wealthy nations when it comes to maternal mortality, and jeopardizing Medicaid means that we could continue to do that. 

Rovner: An administration that pushes not just the pro-life position, but the pro-family position and the pro-natal, the Let’s have more children position, that seems to be something that gets lost, I think, in a lot of this fiscal discussion of, Let’s cut Medicaid to save money so we can have tax cuts. But obviously we will be talking more about this, because this is just the very beginning of it. 

All right. That is the news this week, or at least as much as we have time for. Now we will play my interview with Mark McClellan, and then we will come back and do our extra credits. 

I am so pleased to welcome to the podcast health economist and doctor Mark McClellan, who is the only person to have led both the Food and Drug Administration and the Centers for Medicare & Medicaid Services, both in the George W. Bush administration. Mark now leads the Duke-Margolis Institute for Health [Policy], which conducts interdisciplinary health policy research across Duke University and its affiliated health care system. Mark, welcome to “What the Health?” 

Mark McClellan: Julie, great to be with you. That was a mouthful and nice to be talking about. There’s so much to discuss on these kinds of topics right now. 

Rovner: I know. You’re really in the right place. So I listened to a podcast that you taped all the way back in January talking about some of the policy changes you were expecting in a second Trump administration. Is it safe to say that what’s happening now over at HHS is not what you were expecting? 

McClellan: Well, maybe it’s a matter of degree and timing, but I think the Trump Version 2 here is, they said themselves, it’s different than Version 1. There are some common themes — tax cuts, deregulation — and some new themes, though, as well — “Make America Healthy Again,” bigger emphasis on finding ways to prevent chronic disease and reduce disease burden than deal frankly with a big frustration of Americans. The first Trump administration was more about repealing the ACA [Affordable Care Act]. This is a different approach here. And also the president promised not to cut Medicare benefits. But then, Julie, I think you’re referring to the third part, which may be the DOGE part, which is a more aggressive approach. As President Trump said, “I’ve learned a lot” over the last eight years. I think he and the people who are advising him have come away from that thinking they can be more aggressive if they want to get more changes done in the direction that they feel like they were elected to pursue. 

Rovner: Well, my main reason in asking you to join us today was to explain this big fight going on at the National Institutes of Health, one of the few major agencies at HHS that you have not led, at least not yet. I assume that many of the researchers you work with have NIH grants, right? 

McClellan: Yeah. So at Duke University, very heavily dependent on federal function, a big federal grant support for its research functions, lots of programs, from gene therapies to cutting-edge AI. All of the efforts to translate that from basic science to impacts on making Americans healthier depends on the NIH. 

Rovner: So how’s the grant process supposed to work? I live near NIH, and I think most people think, Oh, it all goes on there. It’s like the vast majority of it does not go on there. 

McClellan: No, the vast majority is grants that go out to academic institutions and other researchers. And that goes back to the post-World War II era when the United States was trying to figure out what kind of biomedical science policy would work best. And the decision then was we’re not going to have just government institutes run and executed under direct government oversight. We’re going to do this as a public-private partnership with the federal government providing a lot of support, especially for the basic research, what us economists call a public good. Something that benefits everybody is therefore kind of harder for an individual company to support by itself. We’re going to support private academic institutions, nonprofits, sometimes state-affiliated, and we’re going to do that through the grants themselves and also for the infrastructure that’s needed to sustain that research base and grow it out and strengthen it over time. 

Rovner: And that’s what these indirect costs are, right? 

McClellan: Yeah, the indirect costs also date back to the early days, and over time, just like everything else that where federal funding is involved, you’ve got to be careful about how to do it. So in order to do research, you not only need cutting-edge technology and equipment, the funding for the researchers who are the best trained in the world and have the most promising ideas out there, but also funding for increasingly advanced and sophisticated medical equipment, gene sequencers, advanced microscopes. 

And not only the equipment themselves, but maintaining all of this. I work with a lot of these labs and researchers in them. They are also having to spend a lot of resources and time and effort making sure that they’re handling data and samples securely and appropriately, that they’re maintaining all this equipment and the buildings and the other infrastructure supports that they need. And also making sure they’re documenting and complying with all the requirements for what you can and can’t do with federal grant money. That’s where all the overhead goes, and there’ve been, over years, a lot of agreements worked out that have a whole process for figuring out what’s an appropriate cost and what’s not that factors into the resulting overhead rates that academic institutions get for their grants. 

Rovner: So the Trump administration says that, Why should the federal government be paying these indirect costs, particularly to big institutions like Duke that have big endowments? Why can’t Duke just use its endowment to pay for these indirect costs? 

McClellan: Well, Duke does have an endowment, but most of the organizations that are conducting research don’t have an endowment that would cover the kinds of costs that we’re talking about here. We’re talking about, like, biosecure materials, sensitive patient information, very complex equipment put together at scale for major research projects. And that’s something that historically has been part of what governments do best, just like paying for the development of the good research ideas to see if they really pan out and can be advanced to be used effectively in humans. Also, the supports for those increasingly complex research projects that are needed. And the private foundations, Julie, that pay for some additional projects and things, they’re really operating off of this base publicly supported infrastructure that’s had tremendous contributions — you look at the data — tremendous contributions in terms of value for money for the research spending, including the overhead spending that goes into it. 

I should say that that’s not to say that we’ve got all this right. These programs get established and you need to keep looking at them. So do we really need as many NIH institutes as we have today? We’ve learned that a lot of underlying biological processes work across different diseases, not only different types of cancer, but say, as we’ve seen with some of the obesity drugs, obesity and cardiometabolic diseases also have implications for heart and kidney disease, maybe even cancer. Are we doing enough big moonshots on these, kind of understanding fundamental biologic processes? Are we set up to do that? And are these really the most efficient ways to set overhead to support modern technology and research where AI and cloud-based data infrastructure are a much more important part? So it’s important to keep looking at these questions, but they are important issues to deal with if you want to have effective research infrastructure. 

Rovner: What happens, though? At the moment, this is on hold. Judges ordered it stopped. I believe NIH had said they will go back to issuing grants. But if this were to happen — I mean, you’re an economist, also — this would have an enormous economic effect, and in addition to the impact that it would have just on— 

McClellan: Yeah. And I’ll leave it to the universities and the research advocates who have made a very clear case about — these are billions of dollars in funding, collectively. It would have a big impact on the biomedical research infrastructure. And I think, Julie, that’s why you’ve seen two things have happened since this proposal went out. The first was the proposals faced judicial restrictions, temporary restraining orders, both on the ground. This was a very broad decision that might not be consistent with the congressional requirements to spend money on these research priorities. But second, what they call in government regulatory speak an arbitrary and capricious government decision, one that wasn’t tied to a look at. And the NIH does have the authority to set and adjust rates, but it has a well-established set of processes for figuring out what is an appropriate rate. It can update those processes, but it has to go through the effort, essentially what the temporary restraining orders on these cases have put in place. So those are not moving forward right now. 

The other thing that’s happened has been a lot of these research advocates and others, patient groups, affected cancer patients, etc., have talked to their members of Congress, and you’ve seen a bipartisan swell of concern about this. This is not a new thing under the sun. The Trump administration in 2018 actually proposed in its legislative budget proposals to limit overhead costs. The response to that in Congress was not only continuing the NIH budget where it was, but restricting reductions in overhead rates without a due-process approach. So we’re seeing some of the same thing playing out here. 

Rovner: Last question. This is really for you. You’ve worked as a high-level HHS official in a Republican administration. What advice would you give those who are about to walk into the jobs that you once had? 

McClellan: Well, I would advise them to, and I hope would advise the administration, to help those people get there soon. So these kinds of policy approaches, some further proposals for NIH and, for that matter, FDA and CDC reforms, are on the books, but we don’t have confirmed leaders in any of those agencies right now, and also some very thin staff. Julie, often in addition to the Senate-confirmed leader of the organization, there’ll be some other senior leaders who can carry out the administration’s policy agenda, but also have a lot of experience with the agency or with the organizations that the agency is dealing with. 

And the NIH, the FDA are pretty thin on those people right now. I’d contrast that with CMS, where my other successor, Dr. [Mehmet] Oz, is not there yet. He hasn’t been confirmed, but he has a whole team of seasoned political appointees and actually some really good career appointees who have come back who are trying to implement policies effectively there. That’s what I’d really encourage, getting a team on board so we can look at these issues, find ways to do research more efficiently and effectively. Those are the kinds of goals that I think a lot of people would share. 

Rovner: Well, we will all be watching. Mark McClellan, thank you so much. 

McClellan: Great to talk with you. 

Rovner: OK, we’re back. It’s time for our extra-credit segment. That’s where we each recognize the story we read this week we think you should read, too. Don’t worry if you miss it. We will put the links in our show notes on your phone or other mobile device. Jessie, why don’t you go first this week? 

Hellmann: My story is from NPR. It’s called “Trump’s ban on gender-affirming care for young people puts hospitals in a bind.” It’s about an executive order basically ordering hospitals not to provide gender-affirming care if they want to continue receiving Medicare and Medicaid funding and other kinds of federal funding. Obviously, Medicare and Medicaid are huge revenue sources for hospitals, and so they really feel like they have no other option but to comply with his executive order. And the story looks at the impact that that has. Hospitals have been canceling appointments that people have already made to receive this care. And then on the other hand, you have states telling hospitals that they can’t stop providing this care if they’ve been doing it already. And it just really shows how there’s no playbook for this and hospitals and patients are left in a really tenuous position. 

Rovner: Shefali. 

Luthra: My piece is from Politico, by Jonathan Martin. The headline is “‘Americans Can and Will Die from This’: USAID Worker Details Dangers, Chaos.” And it’s a really great Q&A that he’s done with a longtime USAID worker whose name he withholds for privacy concerns. And they talk about how this employee feels and how he’s processed the past several days of USAID being virtually abandoned by the federal government. What I love about this is how frank the conversation is and how I think it does a really important job of putting a very human face on the kind of people that we have heard really criticized by Elon Musk and by Donald Trump, described as fraudsters and disloyal and criminals. 

And what we see in this piece is that the people who work for USAID and work in this industry, they could be making more money elsewhere, but they are risking their lives and often facing threats of kidnapping, of violence in their work because they think it means something and they really care about doing this work. I just hope that more people read pieces like this to understand who exactly is being hurt, workers and also the people whom they help, the lives they save every day, when we talk about the decimation of USAID that we are currently experiencing. 

Rovner: Yeah, it’s quite a moving piece. Maya. 

Goldman: My extra credit is a story published by KFF Health News on CBS’ website called “Doctor Wanted: Small town in Florida offers big perks to attract a physician.” And I think it’s important for a couple reasons. One, it’s a good reminder that while there is so much chaos happening in Washington, there are other issues that have been going on since long before the election, like health care worker shortages and primary care shortages that are still really important to pay attention to. But I also love that this takes a really big issue, provider shortages in rural areas, and humanizes it, like Shefali said, and shows a really poignant example. There’s this small town. They had one doctor for many years, and that doctor retired. And now, what do you do? It’s just, I think, a good look at that problem. 

Rovner: It is. Right, my extra credit is actually by Maya, and it’s called “Nonprofit hospital draws backlash for Super Bowl ad.” So between those ads for movies and Dunkin’ Donuts and new cars and beer was one for NYU Langone Health, a giant academic medical center in New York City. It’s not the first hospital ad to air during the Super Bowl, and it’s not even NYU’s first. But a supposedly nonprofit system dropping a cool $8 million while the long knives are out for health spending, as we’ve been discussing for the last half an hour, is maybe not the best look. I don’t know. I personally prefer the Budweiser Clydesdales. 

OK, so before we go, as promised, I am honored to announce the winner of this year’s KFF Health News Health Policy Valentine Contest. It’s from Sally Nix of North Carolina, and it goes like this. “Roses are red, our system is flawed. Surprise bills and denials leave us all feeling odd. They promise us care, yet profits come first, leaving patients to suffer and wallets to burst. But know that voices stand by your side, doctors and advocates who won’t let this slide. Love should mean coverage that’s honest and kind, not loopholes and jargon designed to blind. This Valentine’s Day, let’s champion care, and demand a system that’s honest and fair.” 

Congratulations, Sally. I hope the rest of you also have a very happy Valentine’s Day. OK, that is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Thanks as always, to our producer and editor, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can still find me occasionally at X, @jrovner, and increasingly at Bluesky, @julierovner. Where are you guys hanging on social media these days? Maya? 

Goldman: I’m on Twitter [X] and Bluesky, @Maya_Goldman_, I believe. And been a little more active on LinkedIn recently, so find me there. 

Rovner: I’m hearing that a lot. Shefali, where are you? 

Luthra: I am on Bluesky, at @shefali.bsky.social, and that’s about it. 

Rovner: Jessie? 

Hellmann: I am at X and Bluesky, @jessiehellmann. 

Rovner: Great. We will be back in your feed next week. Until then, be healthy. 

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“Oh, c…”, dijo Tavis, desconcertando a su cita.

Tavis vive a 35 millas de distancia, en Leavenworth, Kansas, y todavía no había vuelto a Union Station, donde ocurrió el tiroteo masivo. Sintió ganas de llorar. O tal vez fue un ataque de pánico. Levantó un dedo para indicarle a su cita que necesitaba un momento. Fue entonces cuando él entendió lo que estaba pasando.

“Oh, ni siquiera me di cuenta”, dijo, y siguió conduciendo en silencio.

Tavis contuvo las lágrimas hasta que la estación desapareció de su vista.

“Ok…”, dijo en voz alta, mientras pensaba para sí misma, “bien. Ataque de pánico, primera cita”.

Un año después del tiroteo del 14 de febrero que mató a una persona e hirió al menos a 24, los sobrevivientes y sus familias todavía están conmocionados.

Las relaciones se han tensionado. Los padres están preocupados por sus hijos. El generoso apoyo financiero y los buenos deseos que recibieron en los primeros días ya se han agotado. Y tienen sentimientos encontrados sobre el equipo al que siguen vitoreando: mientras los Chiefs avanzaban hacia otro Super Bowl, muchos se preguntaban por qué su amado equipo parecía ni haber advertido lo que todos estaban pasando.

“No puedo creer que los Chiefs no hayan hecho nada por nosotros”, dijo Jacob Gooch Sr., quien recibió un disparo en el pie. El equipo, la fundación de la familia propietaria y la Liga Nacional de Fútbol Americano (NFL) donaron un total de $200.000 a un fondo para sobrevivientes, pero Gooch dijo que nadie de la organización se acercó a su familia, tres de los cuales recibieron disparos.

Lo que les está sucediendo a estas familias no es nada inusual. Muchos sobrevivientes se “paralizan” emocionalmente como un mecanismo de afrontamiento para evitar sentir por completo el trauma que sufrieron. Pero, con el tiempo, experimentan lo que los terapeutas llaman “descongelamiento”, y la intensidad de lo que sucedió puede volver a dominarlos de repente como le pasó a Tavis.

“El trauma nos lleva al pasado”, dijo Gary Behrman, terapeuta que publicó un modelo de intervención en crisis basado en su trabajo con testigos de los ataques del 11 de septiembre en Nueva York.

Las imágenes, los olores, los sonidos, los sabores y el tacto pueden desencadenar flashbacks que apagan el cerebro como un disyuntor sobrecargado. Es una respuesta de supervivencia, el cerebro es un amigo, dijo Behrman.

La clave para la recuperación es ayudar a los sobrevivientes a encontrar formas saludables de manejar esos desencadenantes, cuando estén listos.

Los sobrevivientes se “descongelan” a su propio ritmo. Recuperar el control después de un evento potencialmente mortal es un proceso que puede llevar semanas, meses o años.

Puede ser fácil sentirse olvidado cuando la vida continúa alrededor. Mientras los fanáticos se juntaban en torno a los Chiefs esta temporada, a los sobrevivientes les resultó difícil ver los juegos. Los Chiefs perdieron ante los Philadelphia Eagles en el Super Bowl del domingo 9 de febrero. Philadelphia celebra su propio desfile el viernes 14, exactamente un año después del tiroteo.

“Es una lástima porque todos los demás siguieron adelante”, dijo Jason Barton.

Barton le practicó resucitación a un hombre que ahora cree que era uno de los presuntos tiradores, su esposa encontró un proyectil de bala en su mochila y su hijastra se quemó con las chispas de una bala que rebotó.

“Si hubiéramos estado al otro lado de ese lugar”, dijo. “No nos habría afectado”.

Viaje de regreso a Union Station

Tavis no es la única sobreviviente que se encontró sin querer en Union Station un año después del tiroteo.

Los niños hicieron excursiones a Science City, ubicado dentro de la estación. Las visitas médicas de seguimiento se realizaban a menudo en vecino Hospital Hill. Una cena de octubre organizada para sobrevivientes por un grupo religioso local estaba a menos de una milla de distancia: una joven sobreviviente rechazó la invitación.

Tavis había planeado regresar a Union Station como parte de su proceso de curación. Pensó que iría cuando se cumpliera un año para tener un momento a solas y sentir las emociones que la invadieran.

Tal vez Dios le estaba mostrando que estaba lista al colocarla allí inesperadamente, le dijo su terapeuta. Tal vez. Pero ella no se sentía lista en ese momento. Quiso ver a un terapeuta justo después del tiroteo. Pero no buscó uno hasta julio, después que la United Way local distribuyera la asistencia financiera a los sobrevivientes y aliviara la tensión económica de meses de trabajo perdido y facturas médicas.

Tavis y su pareja en ese momento habían sacado una tarjeta de crédito adicional para cubrir los gastos mientras esperaban la ayuda prometida.

Después de dos meses de visitas, su terapeuta comenzó a preparar a Tavis para la desensibilización y reprocesamiento del movimiento ocular, una técnica para ayudar a los sobrevivientes de traumas. Ahora, sesión por medio, revisa una hoja de recuerdos del desfile, visualizándolos y reprocesándolos uno por uno.

Está nerviosa porque se acerca el año de aniversario. Es el día de San Valentín y le preocupa que sea deprimente.

Decidió invitar a Gooch, su ex pareja, a que la acompañara a Union Station ese día. Con todo lo que han pasado, él entiende. Estaban en el desfile junto con su hijo y los dos hijos mayores de Jacob. Gooch Sr. y su hijo mayor, Jacob Gooch Jr., recibieron disparos.

El trauma cambia quiénes somos

Gooch Sr. no ha trabajado desde el desfile. Su trabajo requería estar de pie durante turnos de 10 horas cuatro días a la semana, pero no pudo caminar durante meses después de que una bala le destrozara un hueso del pie y se le volviera a fusionar lentamente.

Esperaba volver a trabajar en julio, pero su pie no sanó correctamente y tuvo que operarse en agosto, a lo que siguieron semanas de recuperación.

La cobertura por discapacidad se agotó, al igual que su seguro médico a través del trabajo. Su empleador mantuvo su trabajo durante un tiempo antes de despedirlo en agosto. Ha buscado otros empleos en Leavenworth y sus alrededores: producción, agencias de personal, reparación de automóviles. No ha conseguido nada.

“Todos hemos pasado por problemas, no solo yo”, dijo Gooch Sr. “Me dispararon en el pie y no he trabajado durante un año. Hay gente que ha pasado por cosas mucho peores durante el último año”.

Ahora se siente bien al caminar y puede correr distancias cortas sin dolor. Pero no sabe si alguna vez volverá a jugar al fútbol americano, un pilar de su vida desde que tiene memoria. Jugó como safety para los Kansas City Reapers, un equipo semi profesional, y, antes del desfile, el jugador de 38 años estaba considerando que la de 2024 fuera su última temporada como jugador.

“Me han robado mucho más que el fútbol americano en este último año. Como si me hubieran robado toda mi vida”, dijo Gooch Sr. “Realmente odio esa parte”.

Y esas emociones son dolorosamente reales. El trauma amenaza nuestras creencias sobre nosotros mismos, dijo el terapeuta Behrman. Cada persona carga su propia historia a un evento traumático, una identidad diferente que corre el riesgo de ser destrozada. El trabajo de sanación que viene después a menudo implica dar vuelta la página, y construir algo nuevo.

Recientemente, Gooch Sr. comenzó a ir a una nueva iglesia, dirigida por el esposo de alguien con quien cantó en un coro cuando era niño. En un servicio dominical de este mes, el pastor habló sobre encontrar un camino cuando uno está perdido.

“Estoy buscando el camino. Estoy en el campo ahora mismo”, dijo Gooch Sr. en su casa más tarde esa noche.

“Obviamente estoy en un camino, pero no sé hacia dónde voy”.

“Hice lo mejor que pude”

Todos los días antes de que Jason Barton se vaya a trabajar, le pregunta a su esposa, Bridget, si debería quedarse en casa con ella.

Ella ha dicho que sí lo suficiente como para que se le acabara el tiempo libre remunerado. Jason, que ha sobrevivido al cáncer y a un ataque cardíaco, tuvo que tomarse una licencia sin goce de sueldo en enero cuando un caso grave de gripe lo llevó al hospital. Eso es amor verdadero, dijo Bridget con lágrimas en los ojos, sentada con Jason y su hija de 14 años, Gabriella, en su casa en Osawatomie, Kansas.

Bridget se ha conectado con la madre de otra niña herida en el tiroteo. Han intercambiado mensajes de texto y de voz durante todo el año. Bridget dijo que es bueno tener a alguien con quien hablar que entienda. Tienen la esperanza de reunir a las niñas para que también construyan una conexión.

Con excepción de ir a terapia una vez por semana, Bridget ya no sale mucho de casa. Puede sentirse como una prisión, dijo, pero tiene demasiado miedo de salir. “Es mi propio infierno interno”, dijo. No deja de pensar en esa bala que se alojó en su mochila. ¿Qué hubiera pasado si hubiera estado parada de otra manera? ¿Qué hubiera pasado si se hubieran ido 10 segundos antes? ¿Las cosas serían diferentes?

Una nota adhesiva en su cocina le recuerda: “Estoy a salvo. Gabriella está a salvo. Hice lo mejor que pude”.

Siente mucha culpa. Por Jason quedándose en casa. Por no salir de casa, ni siquiera para ver a sus nietos. Por querer que la familia fuera al desfile en primer lugar. Al mismo tiempo, sabe que de alguna manera prosperó en el caos después del tiroteo, haciéndose cargo de su hija, hablando con la policía. Todo es confuso.

La familia ha sobrellevado el trauma de manera diferente.

En los seis meses posteriores al desfile, Jason vio reality shows que lo mantenían distraído: 23 temporadas de “Deadliest Catch” y 21 temporadas de “Gold Rush”, incluidos los spin-offs, según calculó.

Últimamente ha mantenido su mente ocupada con un nuevo pasatiempo: construir modelos de autos y aviones. Acaba de terminar un Shelby Mustang negro de 1968, y lo próximo es un avión F4U-4 Corsair que Bridget le regaló.

Gabriella pudo regresar a Union Station para una excursión escolar a Science City, pero se sobresaltó cuando vio a un grupo de policías dentro de la estación. Su madre veía en dónde estaba por el celular, y le envió mensajes de texto durante todo el día.

Después del desfile, Gabriella comenzó a practicar boxeo, luego se pasó a la lucha libre. Le había ido bien, incluso se sentía empoderada. Pero dejó de ir, y Bridget cree que se debe en parte a la emoción del aniversario: el primero siempre es el más difícil, dijo su terapeuta. Gabriella insistió en que la lucha libre la estaba agotando.

Como no les dispararon, la familia no se benefició de los recursos disponibles para otros sobrevivientes. Entienden que otras familias se están recuperando de heridas de bala o incluso están de luto por una muerte.

Aun así, sería bueno que se reconociera de alguna manera su trauma emocional. Sus nombres han estado en las noticias. Uno pensaría que los Chiefs al menos habrían enviado una carta.

Jason dijo: “Lamentamos que esto te haya pasado”.

Jason le propuso matrimonio a Bridget en un partido de los Chiefs. Ahora, ver los partidos por televisión desencadena recuerdos.

“Quiero volver a ser parte del Reino de los Chiefs”, dijo Bridget, “pero no puedo. Y ese es un sentimiento enorme y muy solitario”.

“Hay una palabra llamada ‘resiliencia’”

Una noche del pasado octubre, los sobrevivientes se reunieron con sus familias en un restaurante mexicano en el centro de Kansas City.

Algunos vinieron vestidos con sus mejores galas, otros con camisetas rojas de fútbol americano. De todas las edades, desde niños pequeños hasta personas de 70 y tantos años, algunos de Missouri, algunos de Kansas. Algunos hablaban solo español, algunos solo inglés. La mayoría de las dos docenas de personas nunca se habían visto antes. Pero mientras hablaban, descubrieron que el tiroteo que los une también les dio un lenguaje común.

Dos niños pequeños se dieron cuenta de que habían lanzado una pelota de fútbol durante el jubileo antes de que estallara la violencia. Una mujer de unos 70 años llamada Sarai Holguín recordó haberlos visto jugar en ese cálido día de febrero. Después de una bendición y una cena, Holguín, que recibió un disparo en la rodilla y ha sido sometida a cuatro cirugías, se puso de pie para dirigirse a la sala.

“Fui la primera víctima que llevaron a la carpa médica”, dijo en español, sus palabras traducidas por un familiar de otro sobreviviente. Ella vio todo, explicó, mientras, uno por uno, más sobrevivientes eran trasladados a la carpa para recibir tratamiento, incluida Lisa López-Galván, una madre de 43 años que fue asesinada ese día.

Sin embargo, en esa tragedia, Holguín vio la belleza de la gente que se ayuda entre sí.

“Esto nos mostró que la humanidad todavía está viva, que el amor todavía está vivo. Hay una palabra que se llama ‘resiliencia’”, dijo Holguín. Mientras el traductor se esforzaba por entender la última palabra, la gente del público la captó y la gritó: “Resiliencia”.

“Esta palabra nos ayuda a superar los problemas que enfrentamos”, dijo Holguín. “Para tratar de dejar atrás el momento trágico que todos vivimos y seguir adelante, debemos recordar los momentos hermosos”.

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Emily Tavis was on a first date in December when she looked up and realized they were driving past the downtown Kansas City, Missouri, intersection where a bullet ripped through her leg at last year’s Super Bowl victory parade.

“Oh f—,” Tavis said, bewildering her date.

She lives 35 miles away in Leavenworth, Kansas, and hadn’t yet returned to Union Station, where the mass shooting happened. She felt like crying. Or maybe it was a panic attack. She held up a finger signaling to her date that she needed a moment. That’s when it hit him, too.

“Oh crap, I didn’t even realize,” he said, and kept driving in silence.

Tavis sucked in her tears until the station was out of view.

“So anyway,” she said aloud, while thinking to herself, “way to go. Panic attack, first date.”

A year after the Feb. 14 shooting that killed one and injured at least 24 people, the survivors and their families are still reeling. Relationships have strained. Parents are anxious about their children. The generous financial support and well wishes that poured through in early days have now dried up. And they’re ambivalent about the team they all root for; as the Chiefs moved on to another Super Bowl, many wondered why their beloved team hasn’t acknowledged what they have all been going through.

“I can’t believe the Chiefs didn’t do anything for us,” said Jacob Gooch Sr., who was shot in the foot. The team, the owner family’s foundation, and the National Football League gave a combined $200,000 to a fund for survivors, but Gooch said no one from the organization reached out to his family, three members of whom were shot.

What’s happening to these families is far from unusual. Many survivors emotionally freeze as a coping mechanism to avoid fully feeling the trauma they suffered. But with time, survivors experience what therapists call “thawing,” and the intensity of what happened can suddenly overpower them like it did Tavis.

“Trauma pulls us into the past,” said Gary Behrman, a therapist who published a model of crisis intervention based on his work with witnesses of the 9/11 attacks in New York.

Sights, smells, sounds, tastes, and touches can all trigger flashbacks that shut down the brain like an overloaded circuit breaker. It’s a survival response, Behrman said; the brain is a friend.

The key to recovery is to help survivors find healthy ways to manage those triggers — when they are ready.

Survivors thaw at their own pace. Regaining control after a life-threatening event is a process that can take weeks, months, or years.

It can be hard not to feel forgotten when life carries on around them. As fans rallied around the Chiefs this season, survivors found it hard to watch the games. The Chiefs lost to the Philadelphia Eagles in Sunday’s Super Bowl. Philadelphia will hold its own parade on Friday, exactly one year after the shooting.

“It sucks because everybody else went on,” Jason Barton said. He performed CPR on a man he now thinks was one of the alleged shooters, his wife found a bullet slug in her backpack, and his stepdaughter was burned by sparks from a ricocheted bullet.

“If we were on the other side of that place, we would too,” he said. “It wouldn’t have affected us.”

A Trip Back to Union Station

Tavis isn’t the only survivor to have found herself unintentionally back at Union Station in the year since the shooting. Kids had field trips to Science City, located inside the station. Follow-up doctor visits were often on nearby Hospital Hill. An October dinner organized for survivors by a local faith-based group was less than a mile away, prompting one young survivor to decline the invitation.

Tavis had planned to return to Union Station as part of her healing process. She thought she would go on the one-year mark to have a moment alone to feel whatever emotions swept over her there.

Maybe God was showing her she was ready by placing her back there unexpectedly, her therapist told her. Maybe. But she didn’t feel ready in that moment.

Tavis wanted to see a therapist right after the shooting. But she didn’t seek one out until July, after the local United Way distributed financial assistance to survivors and relieved the months-long financial strain of lost work and medical bills incurred by many. Tavis and her partner at the time had taken out an extra credit card to cover expenses while they waited for the promised help.

After two months of visits, her therapist started prepping Tavis for eye movement desensitization and reprocessing, a technique to help trauma survivors. She now spends every other session making her way through a spreadsheet of memories from the parade, visualizing and reprocessing them one by one.

She’s nervous as the one-year mark approaches. It’s on Valentine’s Day, and she worries it’ll be depressing.

She decided to invite Gooch, her former partner, to come to Union Station with her that day. Despite everything, he’s the one who understands. They were at the parade together with their son and Jacob’s two older kids. Both Gooch Sr. and his older son, Jacob Gooch Jr., were also shot.

Trauma Changes Who We Are

Gooch Sr. hasn’t worked since the parade. His job required standing for 10-hour shifts four days a week, but he couldn’t walk for months after a bullet shattered a bone in his foot and it slowly fused back together. He hoped to go back to work in July. But his foot didn’t heal correctly and he had surgery in August, followed by weeks of recovery.

His short-term disability ran out, as did his health insurance through work. His employer held his job for a while before releasing him in August. He’s applied for other jobs in and around Leavenworth: production, staffing agencies, auto repair. Nothing’s come through.

“We’ve all gone through problems, not just me,” Gooch Sr. said. “I got shot in my foot and haven’t worked for a year. There are people that have been through much worse stuff over the past year.”

He feels good walking now and can run short distances without pain. But he doesn’t know if he’ll ever play football again, a mainstay of his life since he can remember. He played safety for the semiprofessional Kansas City Reapers and, before the parade, the 38-year-old was considering making the 2024 season his last as a player.

“A lot more than football has been stolen from me in this last year. Like my whole life has been stolen from me,” Gooch Sr. said. “I really hate that part of it.”

And those emotions are painfully real. Trauma threatens our beliefs about ourselves, said Behrman, the therapist. Every person brings their own history to a traumatic event, a different identity that risks being shattered. The healing work that comes later often involves letting go and building something new.

Recently Gooch Sr. started going to a new church, led by the husband of someone he sang with in a children’s choir growing up. At a Sunday service this month, the pastor spoke about finding a path when you’re lost.

“I’m looking for the path. I’m in the grass right now,” Gooch Sr. said at his home later that evening.

“I’m obviously on a path, but I don’t know where I’m headed.”

‘I Did the Best I Could’

Every day before Jason Barton goes to work, he asks his wife, Bridget, if he should stay home with her.

She’s said yes enough that he’s out of paid time off. Jason, who’s survived cancer and a heart attack, had to take unpaid leave in January when a bad case of the flu put him in the hospital. That’s real love, Bridget said with tearful eyes, sitting with Jason and her 14-year-old daughter, Gabriella, in their home in Osawatomie, Kansas.

Bridget has connected with the mother of another girl injured in the shooting. They’ve exchanged texts and voicemails throughout the year. It’s nice to have someone to talk to who gets it, Bridget said. They’re hoping to get the girls together to build a connection as well.

Except for a trip to therapy once a week, Bridget doesn’t leave the house much anymore. It can feel like a prison, she said, but she’s too scared to leave. “It’s my own internal hell,” she said. She keeps thinking about that bullet slug that lodged in her backpack. What if she’d been standing differently? What if they’d left 10 seconds earlier? Would things be different?

A Post-it note in her kitchen reminds her: “I’m safe. Gabriella is safe. I did the best I could.”

She carries a lot of guilt. About Jason staying home. About not leaving the house, even to see her grandkids. About wanting the family to go to the parade in the first place. At the same time, she knows she kind of thrived in the chaos after the shooting, taking charge of her daughter, talking to the police. It’s confusing.

The family has carried the trauma differently. In the six months after the parade, Jason watched reality TV shows that kept him out of his head — 23 seasons of “Deadliest Catch” and 21 seasons of “Gold Rush,” including spinoffs, he estimated. Lately he’s kept his mind occupied with a new hobby: building model cars and planes. He just finished a black 1968 Shelby Mustang, and next is an F4U-4 Corsair plane that Bridget got him.

Gabriella was unfazed about returning to Union Station for a class field trip to Science City, but she was startled when she saw a group of police officers inside the station. Her mom watched her location on her phone and texted her all day.

Gabriella took up boxing after the parade, then switched to wrestling. It had been going well, even felt empowering. But she’s stopped going, and Bridget thinks it’s partly due to the emotion of the anniversary — the first is always the hardest, her therapist said. Gabriella insisted that wrestling was just exhausting her.

Because they weren’t shot, the family didn’t benefit from resources available to other survivors. They understand that other families are recovering from bullet wounds or even mourning a death.

Still, it would be nice to have some acknowledgment of their emotional trauma. Their names have been in the news. You’d think the Chiefs would have at least sent a letter saying, “We’re sorry this happened to you,” Jason said.

Jason proposed to Bridget at a Chiefs game. Now watching games on TV triggers flashbacks.

“I want to be a part of Chiefs Kingdom again,” Bridget said, “but I just can’t. And that is a huge, really lonely feeling.”

‘There Is a Word Called “Resilience”’

One evening last October, survivors gathered with their families at a Mexican restaurant in downtown Kansas City.

Some came dressed in their Sunday best, some in red football jerseys. All ages, toddlers to 70-somethings, some from Missouri, some from Kansas. Some spoke only Spanish, some only English. Most of the two dozen people had never met before. But as they talked, they discovered the shooting that binds them also gave them a common language.

Two young boys realized they’d tossed a football during the jubilation before the violence erupted. A woman in her early 70s named Sarai Holguin remembered watching them play on that warm February day. After a blessing and dinner, Holguin, who was shot in the knee and has had four surgeries, stood to address the room.

“I was the first victim taken to the medical tent,” she said in Spanish, her words translated by a relative of another survivor. She saw everything, she explained, as, one by one, more survivors were brought to the tent for treatment, including Lisa Lopez-Galvan, a 43-year-old mother who was killed that day.

Yet in that tragedy, Holguin saw the beauty of people helping one another.

“This showed us that humanity is still alive, that love is still alive. There is a word called ‘resilience,’” Holguin said, the translator stumbling to understand the last word, as people in the audience caught it and shouted it out. “Resilience.”

“This word helps us overcome the problems we face,” Holguin said. “To try to put the tragic moment we all lived behind us and move on, we must remember the beautiful moments.”

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Now, a small but growing number of house cats have gotten sick from H5N1, the bird flu strain driving the current U.S. outbreak, after eating raw food or drinking unpasteurized milk. Some of those cats died.

The strain of bird flu currently circulating has not adapted to efficiently spread among people. And there have been no known cases of cat-to-human transmission during the current outbreak of H5N1.

Still, there’s always been the risk that cats, which are arguably only semi-domesticated, could bring home a disease from a midnight prowl.

“Companion animals, and especially cats, are 100% a public health risk in terms of the risk of zoonotic transmission to people,” said virologist Angela Rasmussen, who studies disease progression in emerging viruses at the University of Saskatchewan’s Vaccine and Infectious Disease Organization.

This is because we snuggle with and sleep in bed with our cats. When we’re not looking, cats drink from our water glasses and walk on kitchen counters. So, cat owners should be aware of the ongoing spread of bird flu. “By reducing the risk to your cats, you reduce the risk to yourself,” Rasmussen said.

Rasmussen doesn’t think pet owners should be afraid their cats will give them bird flu but said taking precautions is good for pets, and for public health.

Signs of bird flu in cats include runny nose and discharge around the eyes, explained Michael Q. Bailey, president-elect of the American Veterinary Medical Association.

H5N1 also causes neurological problems like dizziness and seizures, which are symptoms of rabies, too. Rabies is almost always fatal, and it poses a threat to human health, so any animal suspected of having the viral disease must be euthanized. Bailey encourages people to ensure pets are up-to-date on their vaccinations.

Veterinarian Jane Sykes, who specializes in infectious diseases in cats and dogs at the University of California-Davis School of Veterinary Medicine, said people should not assume it’s bird flu if their cat is sick — even if their animal spends time outdoors or eats a raw diet. Upper-respiratory illnesses are common in cats, while H5N1 is “still pretty rare.”

Sykes gives her indoor cat, Freckles, regular kibble exclusively. She told NPR and KFF Health News she has no concerns about Freckles getting H5N1 because the heating process of making dry or canned pet food kills viruses.

More Cases in Cats, More Risk to Humans

Some people feed their pets raw meat or unpasteurized milk because they think it’s a more nutritious or natural diet. The American Veterinary Medical Association’s website discourages this due to foodborne pathogens like salmonella and listeria, and now the highly pathogenic H5N1.

By keeping pets healthy, veterinarians play an essential role in protecting humans from zoonotic diseases. The American Veterinary Medical Association says the risk of H5N1 spilling over from a pet to a person is “considered extremely low, but not zero.”

State and local public health agencies, including those in Los Angeles County and Washington state, have issued similar warnings against raw food diets for pets.

Concerns for human health are partly why the FDA announced last month it is now requiring cat and dog food companies to update their safety plans to protect against bird flu.

This came after the Oregon Department of Agriculture discovered a cat that was “strictly an indoor cat” had contracted H5N1 and died after consuming a frozen turkey product made by the raw pet food brand Northwest Naturals. It stated that “tests confirmed a genetic match between the virus in the raw and frozen pet food and the infected cat.”

Northwest Naturals voluntarily recalled that batch of its frozen turkey-based product. The company told KFF Health News and NPR that the recall involved “a small product run” and that it has concerns about the accuracy of the Oregon Agriculture Department’s testing.

Los Angeles County’s public health department said five cats from two households tested positive for bird flu after drinking unpasteurized raw milk from the Raw Farm dairy in California’s Central Valley.

Raw Farm voluntarily recalled its milk and cream after retail products tested positive for H5N1, but it denies any food safety issues, calling the concern “a political issue.”

Veterinarians also warn pet owners not to allow cats unsupervised time outside as there’s the risk of them getting H5N1 by interacting with other animals that might carry the disease.

“This is a very scary virus, given that it can infect so many different host species,” said Bruce Kornreich, director of Cornell University’s Feline Health Center.

At least one instance of a cat infecting a person with bird flu occurred in 2016. As NPR reported, a veterinarian in New York City caught the virus after having close contact with infected cats. The vet experienced mild symptoms and quickly recovered.

In that case, the strain of bird flu was H7N2, not the H5N1 that is now circulating in the U.S.

H7N2 is a very different type of virus, Sykes explained. But she said it shows that cat-to-human transmission of avian influenza is theoretically possible.

There isn’t a lot of research on transmission of bird flu from companion animals like cats or dogs to humans, though Rasmussen agreed it’s definitely a concern: The more infections you have in animals, “the more your luck is potentially going to run out.”

Most people who have caught H5N1 are agricultural workers who had direct contact with infected poultry or cattle. Of at least 67 confirmed human cases of H5N1 in the U.S., there’s been one fatality in an immunocompromised person who had contact with birds.

In general, zoonotic disease researchers want more H5N1 surveillance in companion animals of all types. Even if the human death toll of H5N1 remains relatively low, it remains a public health risk.

Chances for Mutation

Part of the concern with this H5N1 outbreak is that bird flu viruses change. Just a few mutations could make this strain adept at spreading between people. And the more people who catch H5N1, the more likely it would adapt to be more efficient, said Suresh Kuchipudi, a virologist at the University of Pittsburgh School of Public Health, where he researches zoonotic diseases. Kuchipudi has studied H5N1 in cats.

Another concern is something called reassortment. If an animal or person is infected with two viruses at once, the viruses can trade genetic material, creating something new. This is common in influenza, so virologists are on the lookout for a case in which the bird flu reassorts to make a virus that’s far more contagious, and potentially more virulent.

Virologist Rasmussen is way more worried about this happening in pigs. Human respiratory physiology is more like that of swines than felines. So far, the current outbreak of H5N1 has not reached commercial hog operations. Rasmussen hopes it stays that way.

Kuchipudi said that reassortments are relatively rare events, but the outcome is completely unpredictable. Sometimes the results are benign, though it was likely a reassortment that involved an avian virus that led to the 1918 flu pandemic, which killed an estimated 50 million people. In the century since, virologists have established a global surveillance network to monitor influenza viruses. Scientists say continued investment in this network is key to preparing for and hopefully preventing another pandemic.

Winter is “reassortment season” because of all the influenza viruses circulating, Rasmussen said. A reassortment in cats could technically be possible since these pets occasionally get seasonal flu, but it’s highly unlikely. Rather, Rasmussen said, it’s more likely that a cat would pass H5N1 to a human who already has seasonal flu, and then a reassortment happens in the sick person. While the risk isn’t zero, Rasmussen doubts this will happen. It would depend on how ill the human was, and how much virus they’re exposed to from their cat.

“Unless the cat is really shedding a ton of virus, and you’re kind of making out with the cat, I think it would be hard,” she said.

Rasmussen and Kuchipudi caution there isn’t enough research to know for sure how much virus cats shed, or even how they shed the virus.

The Centers for Disease Control and Prevention was poised to release a new study about H5N1 in cats, but that was delayed when the Trump administration paused the Morbidity and Mortality Weekly Report. That investigation, revealed through emails obtained by KFF Health News in a public records request, found that house cats likely got bird flu from dairy workers.

Scientists and public health agencies should question previously held assumptions about bird flu, Kuchipudi urged. He noted that 20 years ago nobody would have predicted that bird flu would infect dairy cattle the way it is now.

Dogs Seem To Fare Better

The FDA says other domesticated animals, including dogs, can get bird flu infections. There are no confirmed cases of H5N1 among dogs in the U.S., though in other countries they have died from the virus.

There’s some disagreement and an overall lack of research on whether cat biology makes them more susceptible to H5N1 than other mammals, including humans, pigs, or dogs.

But cat behaviors, such as their love of dairy and predation of wild birds, put them at higher risk, Kuchipudi said. Also, living in groups might play a role as there are more feral cat colonies in the U.S. than packs of stray dogs.

There’s very little people can do about the H5N1 circulating in wild birds. As Rasmussen explained, “It’s flying around in the skies. It’s migrating north and south with the seasons.”

But she said there’s a lot people can do to keep the virus out of their homes.

That includes limiting a pet’s exposure to H5N1 by not feeding them raw food or unpasteurized milk, and trying to keep them from interacting with animals like rodents and wild birds that could be infected with the virus.

This article is from a partnership that includes NPR and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Ahora, un pequeño pero creciente número de gatos domésticos se han enfermado con H5N1, la cepa de gripe aviar protagonista del brote actual en el país, después de comer alimentos crudos o beber leche sin pasteurizar. Algunos de ellos murieron.

La cepa de gripe aviar que circula actualmente no se ha adaptado para propagarse de manera eficiente entre las personas. Y no se han conocido casos de transmisión de gato a humano durante el brote actual de H5N1.

Aun así, siempre ha existido el riesgo de que los gatos, que posiblemente solo estén semi domesticados, puedan traer a casa una enfermedad al acecho nocturno.

“Los animales de compañía, y especialmente los gatos, son un riesgo para la salud pública en un 100% en términos de riesgo de transmisión zoonótica a las personas”, dijo la viróloga Angela Rasmussen, que estudia la progresión de la enfermedad en virus emergentes en la Vaccines and Infectious Disease Organization de la Universidad de Saskatchewan.

Las personas duermen con sus gatos. Los gatos beben de los vasos de agua humanos y caminan sobre la mesada de la cocina. Por eso, los dueños de gatos deben ser conscientes de la propagación continua de la gripe aviar. “Al reducir el riesgo para sus gatos, se reduce el riesgo para tí mismo”, dijo Rasmussen.

Rasmussen no cree que los dueños de mascotas deban tener miedo de que sus gatos les transmitan la gripe aviar, pero dijo que tomar precauciones es bueno para las mascotas y para la salud pública.

Los síntomas de la gripe aviar en los gatos incluyen secreción nasal y alrededor de los ojos, explicó Michael Q. Bailey, presidente electo de la American Veterinary Medical Association.

El H5N1 también causa problemas neurológicos como mareos y convulsiones, que comparte con los síntomas de la rabia. La rabia es casi siempre mortal y supone una amenaza para la salud humana, por lo que cualquier animal sospechoso de tener esta enfermedad viral debe ser sacrificado. Bailey anima a las personas a asegurarse de que sus mascotas estén al día con sus vacunas.

La veterinaria Jane Sykes, que se especializa en enfermedades infecciosas en gatos y perros en la Facultad de Medicina Veterinaria de la Universidad de California-Davis, dijo que las personas no deben asumir que se trata de gripe aviar si su gato está enfermo, incluso si su animal pasa tiempo al aire libre o come una dieta cruda. Las enfermedades de las vías respiratorias superiores son comunes en los gatos, mientras que el H5N1 es “todavía bastante raro”.

Sykes le da a su gato, Freckles, alimento para mascotas. Dijo a NPR y KFF Health News que no le preocupa que Freckles contraiga el H5N1 porque el proceso de calentamiento para hacer alimentos secos o enlatados para mascotas mata los virus.

Más casos en gatos, más riesgo para los humanos

Algunas personas alimentan a sus mascotas con carne cruda o leche no pasteurizada porque creen que es una dieta más nutritiva o natural. El sitio web de la American Veterinary Medical Association desaconseja esta práctica debido a los patógenos transmitidos por los alimentos, como la salmonella y la listeria, y ahora el altamente patógeno H5N1.

Al mantener sanas a las mascotas, los veterinarios desempeñan un papel esencial en la protección de los humanos contra las enfermedades zoonóticas. La asociación afirma que el riesgo que el H5N1 se transmita de una mascota a una persona se considera “extremadamente bajo, pero no cero”.

Las agencias de salud pública estatales y locales, incluidas las del condado de Los Ángeles y del estado de Washington, han emitido advertencias similares sobre alimentar a las mascotas con alimentos crudos.

Las preocupaciones por la salud humana son en parte la razón por la que la Administración de Drogas y Alimentos (FDA) anunció el mes pasado que ahora exige a las empresas de alimentos para perros y gatos que actualicen sus planes de seguridad para protegerse contra la gripe aviar.

Esto se produjo después que el Departamento de Agricultura de Oregon descubriera que un gato que era “estrictamente de interior” había contraído H5N1 y había muerto después de consumir un producto de pavo congelado elaborado por la marca de comida cruda para mascotas Northwest Naturals. Afirmó que “las pruebas confirmaron una coincidencia genética entre el virus en la comida cruda y congelada para mascotas y el gato infectado”.

Northwest Naturals retiró voluntariamente ese lote de su producto a base de pavo congelado. La empresa dijo a KFF Health News y NPR que el retiro del mercado involucraba “una pequeña producción de producto” y que tenía inquietudes sobre la precisión de las pruebas del Departamento de Agricultura de Oregón.

El departamento de salud pública del condado de Los Ángeles dijo que cinco gatos de dos hogares dieron positivo en la prueba de gripe aviar después de beber leche cruda no pasteurizada de la lechería Raw Farm en el Valle Central de California.

Raw Farm retiró voluntariamente su leche y crema después que los productos minoristas dieran positivo en la prueba de H5N1, pero niega cualquier problema de seguridad alimentaria, calificando la preocupación como “un problema político”.

Los veterinarios también advierten a los dueños de mascotas que no permitan que los gatos pasen tiempo sin supervisión al aire libre, ya que existe el riesgo de que contraigan el H5N1 al interactuar con otros animales que podrían transmitir la enfermedad.

“Este es un virus muy aterrador, dado que puede infectar a muchas especies diferentes de huéspedes”, dijo Bruce Kornreich, director del Centro de Salud Felina de la Universidad Cornell.

Al menos un caso de un gato que infectó a una persona con gripe aviar ocurrió en 2016. Como informó NPR, un veterinario de la ciudad de Nueva York contrajo el virus después de tener contacto cercano con gatos infectados. El veterinario experimentó síntomas leves y se recuperó rápidamente.

En ese caso, la cepa de gripe aviar era H7N2, no el H5N1 que ahora circula en el país.

La mayoría de las personas que han contraído el H5N1 son trabajadores agrícolas que tuvieron contacto directo con aves de corral o ganado infectados. De al menos 67 casos humanos confirmados de H5N1, ha habido una muerte en una persona inmunodeprimida que tuvo contacto con aves.

En general, los investigadores de enfermedades zoonóticas quieren una mayor vigilancia del H5N1 en animales de compañía de todo tipo. Incluso si el número de muertes humanas por H5N1 todavía es relativamente bajo, sigue siendo un riesgo para la salud pública.

Posibles mutaciones

Parte de la preocupación con este brote de H5N1 es que los virus de la gripe aviar cambian. Sólo unas pocas mutaciones podrían hacer que esta cepa sea capaz de propagarse entre personas. Y cuantas más personas se contagien del H5N1, más probable es que se adapte y se vuelva más eficiente, dijo Suresh Kuchipudi, virólogo de la Facultad de Salud Pública de la Universidad de Pittsburgh, donde investiga enfermedades zoonóticas. Kuchipudi ha estudiado el H5N1 en gatos.

Otro motivo de preocupación es algo llamado recombinación. Si un animal o una persona se infecta con dos virus a la vez, los virus pueden intercambiar material genético y crear algo nuevo. Esto es común en la gripe, por lo que los virólogos están atentos a un caso en el que la gripe aviar se recombine para crear un virus mucho más contagioso y potencialmente más virulento.

El virólogo Rasmussen está mucho más preocupado por que esto suceda en los cerdos. La fisiología respiratoria humana se parece más a la de los cerdos que a la de los felinos. Hasta ahora, el brote actual de H5N1 no ha llegado a las explotaciones porcinas comerciales. Rasmussen espera que siga así.

Kuchipudi dijo que las recombinaciones son eventos relativamente raros, pero el resultado es completamente impredecible. A veces los resultados son benignos. Aunque es probable que haya sido una recombinación que involucrara un virus aviar lo que condujera a la pandemia de gripe de 1918, que mató a unos 50 millones de personas. En el siglo transcurrido desde entonces, los virólogos han establecido una red de vigilancia mundial para controlar los virus de la gripe. Los científicos dicen que la inversión continua en esta red es clave para prepararse y, con suerte, prevenir otra pandemia.

El invierno es la “temporada de redistribución” debido a todos los virus de la gripe que circulan, dijo Rasmussen. Una redistribución en gatos podría ser técnicamente posible ya que estas mascotas ocasionalmente contraen gripe estacional, pero es muy poco probable. En cambio, dijo Rasmussen, es más probable que un gato transmita el H5N1 a un humano que ya tiene gripe estacional, y luego se produzca una redistribución en la persona enferma. Si bien el riesgo no es cero, Rasmussen duda que esto suceda. Dependería de qué tan enfermo esté el humano y a qué cantidad de virus esté expuesto a través de su gato.

“A menos que el gato esté realmente eliminando una tonelada de virus y la persona se esté besando con el gato, creo que sería difícil”, dijo.

Rasmussen y Kuchipudi advierten que no hay suficiente investigación para saber con certeza cuánto virus eliminan los gatos, o incluso cómo lo eliminan.

Los Centros para el Control y la Prevención de Enfermedades (CDC) estaban a punto de publicar un nuevo estudio sobre el H5N1 en gatos, pero eso se retrasó cuando la administración Trump detuvo el Informe Semanal de Morbilidad y Mortalidad.

Esa investigación, revelada a través de correos electrónicos obtenidos por KFF Health News en una solicitud de registros públicos, encontró que los gatos domésticos probablemente contrajeron la gripe aviar de los trabajadores de las lecherías.

Los científicos y las agencias de salud pública deberían cuestionar las suposiciones previas sobre la gripe aviar, instó Kuchipudi. Señaló que hace 20 años nadie habría predicho que la gripe aviar infectaría al ganado lechero de la forma en que lo hace ahora.

Los perros parecen tener mejor suerte

La FDA dice que otros animales domésticos, incluidos los perros, pueden contraer infecciones de gripe aviar. No hay casos confirmados de H5N1 entre perros en los EE. UU., aunque en otros países han muerto a causa del virus.

Hay cierto desacuerdo y una falta general de investigación sobre si la biología de los gatos los vuelve más susceptibles al H5N1 que otros mamíferos, incluidos los humanos, los cerdos o los perros.

Pero los comportamientos de los gatos, como su amor por los productos lácteos y la depredación de aves silvestres, los ponen en mayor riesgo, dijo Kuchipudi. Además, vivir en grupos podría desempeñar un papel, ya que hay más colonias de gatos salvajes en los que grupos de perros callejeros.

Hay muy poco que la gente pueda hacer sobre el H5N1 que circula en las aves silvestres. Como explicó Rasmussen, “Está volando por los cielos. “Está migrando de norte a sur con las estaciones”.

Pero dijo que hay muchas cosas que la gente puede hacer para mantener el virus fuera de sus hogares.

Eso incluye limitar la exposición de una mascota al H5N1 no alimentándola con alimentos crudos o leche no pasteurizada, y tratar de evitar que interactúe con animales como roedores y aves silvestres que podrían estar infectados con el virus.

Este artículo es parte de una asociación que incluye a NPR y KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But the CEO of Herbruck’s Poultry Ranch wasn’t sure how the family egg producer (one of the largest in the U.S., in business for over three generations) was going to get through it, financially or emotionally. One staffer broke down in Herbruck’s office in tears.

“The mental toll on our team of dealing with that many dead chickens is just, I mean, you can’t imagine it,” Herbruck said. “I didn’t sleep. Our team didn’t sleep.”

The stress of watching tens of thousands of sick birds die of avian flu each day, while millions of others waited to be euthanized, kept everyone awake.

In April 2024, as his first hens tested positive for the highly pathogenic avian influenza H5N1 virus, Herbruck turned to the tried-and-true U.S. Department of Agriculture playbook, the “stamping-out” strategy that helped end the 2014-15 bird flu outbreak, which was the largest in the U.S. until now.

Within 24 to 48 hours of the first detection of the virus, state and federal animal health officials work with farms to cull infected flocks to reduce the risk of transmission. That’s followed by extensive disinfection and months of surveillance and testing to make sure the virus isn’t still lurking somewhere on-site.

Since then, egg farms have had to invest millions of dollars into biosecurity. For instance, employees shower in and shower out, before they start working and after their shifts end, to prevent spreading any virus. But their efforts have not been enough to contain the outbreak that started three years ago.

This time, the risk to human health is only growing, experts say. Sixty-six of the 67 total human cases in the United States have been just since March, including the nation’s first human death, reported last month.

“The last six months have accelerated my concern, which was already high,” said Nahid Bhadelia, an infectious diseases physician and the founding director of Boston University’s Center on Emerging Infectious Diseases.

Controlling this virus has become more challenging, precisely because it’s so entrenched in the global environment, spilling into mammals such as dairy cows, and affecting roughly 150 million birds in commercial and backyard flocks in the U.S.

Because laying hens are so susceptible to the H5N1 virus, which can wipe out entire flocks within days of the first infection, egg producers have been on the front lines in the fight against various bird flu strains for years. But this moment feels different. Egg producers and the American Egg Board, an industry group, are begging for a new prevention strategy.

Many infectious disease experts agree that the risks to human health of continuing current protocols are unsustainable, because of the strain of bird flu driving this outbreak.

“The one we’re battling today is unique,” said David Swayne, former director of the Southeast Poultry Research Laboratory at the USDA’s Agricultural Research Service and a leading national expert in avian influenza.

“It’s not saying for sure there’s gonna be a pandemic” of H5N1, Swayne said, “but it’s saying the more human infections, the spreading into multiple mammal species is concerning.”

For Herbruck, it feels like war. Ten months after Herbruck’s Poultry Ranch was hit, the company is still rebuilding its flocks and rehired most of the 400 workers it laid off.

Still, he and his counterparts in the industry live in fear, watching other farms get hit two, even three times in the past few years.

“I call this virus a terrorist,” he said. “And we are in a battle and losing, at the moment.”

When Biosecurity Isn’t Working … or Just Isn’t Happening

So far, none of the 23 people who contracted the disease from commercial poultry have experienced severe cases, but the risks are still very real. The first human death was a Louisiana patient who had contact with both wild birds and backyard poultry. The person was over age 65 and reportedly had underlying medical conditions.

And the official message to both backyard farm enthusiasts and mega-farms has been broadly the same: Biosecurity is your best weapon against the spread of disease.

But there’s a range of opinions among backyard flock owners about how seriously to take bird flu, said Katie Ockert, a Michigan State University Extension educator who specializes in biosecurity communications.

Skeptics think that “we’re making a mountain out of a molehill,” Ockert said, or that “the media is maybe blowing it out of proportion.” This means there are two types of backyard poultry enthusiasts, Ockert said: those doing great biosecurity, and those who aren’t even trying.

“I see both,” she said. “I don’t feel like there’s really any middle ground there for people.”

And the challenges of biosecurity are completely different for backyard coops than massive commercial barns: How are hobbyists with limited time and budgets supposed to create impenetrable fortresses for their flocks, when any standing water or trees on the property could draw wild birds carrying the virus?

Rosemary Reams, an 82-year-old retired educator in Ionia, Michigan, grew up farming and has been helping the local 4-H poultry program for years, teaching kids how to raise poultry. Now, with the bird flu outbreak, “I just don’t let people go out to my barn,” she said.

Reams even swapped real birds with fake ones for kids to use while being assessed by judges at recent 4-H competitions, she said.

“We made changes to the fair last year, which I got questioned about a lot. And I said, ‘No, I gotta think about the safety of the kids.’”

Reams was shocked by the news of the death of the Louisiana backyard flock owner. She even has questioned whether she should continue to keep her own flock of 20 to 30 chickens and a pair of turkeys.

“But I love ’em. At my age, I need to be doing it. I need to be outside,” Reams said. “That’s what life is about.” She said she’ll do her best to protect herself and her 4-H kids from bird flu.

Even “the best biosecurity in the world” hasn’t been enough to save large commercial farms from infection, said Emily Metz, president and CEO of the American Egg Board.

The egg industry thought it learned how to outsmart this virus after the 2014-15 outbreak. Back then, “we were spreading it amongst ourselves between egg farms, with people, with trucks,” Metz said. So egg producers went into lockdown, she said, developing intensive biosecurity measures to try to block the routes of transmission from wild birds or other farms.

Metz said the measures egg producers are taking now are extensive.

“They have invested hundreds of millions of dollars in improvements, everything from truck washing stations — which is washing every truck from the FedEx man to the feed truck — and everything in between: busing in workers so that there’s less foot traffic, laser light systems to prevent waterfowl from landing.”

Lateral spread, when the virus is transmitted from farm to farm, has dropped dramatically, down from 70% of cases in the last outbreak to just 15% as of April 2023, according to the USDA.

And yet, Metz said, “all the measures we’re doing are still getting beat by this virus.”

The Fight Over Vaccinating Birds

Perhaps the most contentious debate about bird flu in the poultry industry right now is whether to vaccinate flocks.

Given the mounting death toll for animals and the increasing risk to humans, there’s a growing push to vaccinate certain poultry against avian influenza, which countries like China, Egypt, and France are already doing.

In 2023, the World Organization for Animal Health urged nations to consider vaccination “as part of a broader disease prevention and control strategy.”

Swayne, the avian influenza expert and poultry veterinarian, works with WOAH and said most of his colleagues in the animal and public health world “see vaccination of poultry as a positive tool in controlling this panzootic in animals,” but also as a tool that reduces chances for human infection, and chances for additional mutations of the virus to become more human-adapted.

But vaccination could put poultry meat exporters (whose birds are genetically less susceptible to H5N1 than laying hens) at risk of losing billions of dollars in international trade deals. That’s because of concerns that vaccination, which lowers the severity of disease in poultry, could mask infections and bring the virus across borders, according to John Clifford, a former chief veterinary officer of the USDA. Clifford is currently an adviser to the USA Poultry and Egg Export Council.

“If we vaccinate, we not only lose $6 billion potentially in exports a year,” Clifford said. “If they shut us off, that product comes back on the U.S. market. Our economists looked at this and said we would lose $18 billion domestically.”

Clifford added that would also mean the loss of “over 200,000 agricultural jobs.”

Even if those trade rules changed to allow meat and eggs to be harvested from vaccinated birds, logistical hurdles remain.

“Vaccination possibly could be on the horizon in the future, but it’s not going to be tomorrow or the next day, next year, or whatever,” Clifford said.

Considering just one obstacle: No current HPAI vaccine is a perfect match for the current strain, according to the USDA. But if the virus evolves to be able to transmit efficiently from human to human, he said, “that would be a game changer for everybody, which would probably force vaccination.”

Last month, the USDA announced it would “pursue a stockpile that matches current outbreak strains” in poultry.

“While deploying a vaccine for poultry would be difficult in practice and may have trade implications, in addition to uncertainty about its effectiveness, USDA has continued to support research and development in avian vaccines,” the agency said.

At this point, Metz argued, the industry can’t afford not to try vaccination, which has helped eradicate diseases in poultry before.

“We’re desperate, and we need every possible tool,” she said. “And right now, we’re fighting this virus with at least one, if not two, arms tied behind our back. And the vaccine can be a huge hammer in our toolbox.”

But unless the federal government acts, that tool won’t be used.

Industry concerns aside, infectious diseases physician Bhadelia said there’s an urgent need to focus on reducing the risk to humans of getting infected in the first place. And that means reducing “chances of infections in animals that are around humans, which include cows and chickens. Which is why I think vaccination to me sounds like a great plan.”

The lesson “that we keep learning every single time is that if we’d acted earlier, it would have been a smaller problem,” she said.

This article is from a partnership that includes Michigan Public, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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In late January, two school-age children from Gaines County were hospitalized with measles. Since an estimated 1 in 5 people with the disease end up in the hospital, the two cases suggested a larger outbreak.

As of Feb. 12, there were 24 cases, mainly among children, with at least 14 hospitalizations, said Zach Holbrooks, executive director of the South Plains Public Health District, which includes Gaines. A few cases are in surrounding counties. The department is investigating many other potential cases in hopes of treating people quickly and curbing the spread of the virus. “There may be active cases out there and the individual has chosen not to seek medical attention,” Holbrooks said.

Public health practitioners warn such outbreaks will become more common because of scores of laws around the U.S. — pending and passed — that ultimately lower vaccine rates. Many of the measures allow parents to more easily exempt their children from school vaccine requirements, and a swell of vaccine misinformation has led to record rates of exemptions.

As Robert F. Kennedy Jr., one of the most influential purveyors of dangerous vaccine misinformation, prepares to take the helm of the Department of Health and Human Services, researchers say such bills have a higher chance of passing and that more parents will refuse vaccines because of false information spread at the highest levels of government.

“Mr. Kennedy has been an opponent of many health-protecting and life-saving vaccines, such as those that prevent measles and polio,” scores of Nobel Prize laureates wrote in a letter to the Senate. Having him head HHS, they wrote, “would put the public’s health in jeopardy.”

Most people who aren’t protected by vaccination will get measles if exposed. Gaines County has one of the lowest rates of childhood vaccination in Texas. At a local public school district in the community of Loop, only 46% of kindergarten students have gotten vaccines against measles, mumps, and rubella. Vaccination rates may be even lower at private schools and within homeschool groups, which don’t always report the information.

Holbrooks’ team is scrambling to track transmission, ensure that kids and babies seek prompt care, and offer measles vaccines to anyone who hasn’t yet gotten them.

“We are going to see more kids infected. We will see more families taking time off from work. More kids in the hospital,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit that advocates for vaccine access. “This is the tip of the iceberg.”

As a rule, at least 95% of people need to be vaccinated against measles for a community to be well protected. That threshold is high enough to protect infants too young for the vaccine, people who can’t take the vaccine for medical reasons, and anyone who doesn’t mount a strong, lasting immune response to it.

Measles is extremely contagious, so health workers preemptively treated infants too young to be vaccinated who had shared the emergency room with children later diagnosed with the virus, said Katherine Wells, public health director in Lubbock, Texas. Some children from Gaines were hospitalized in that county. The disease can cause severe complications, and about one of every thousand children with measles die.

An outbreak among a largely unvaccinated population in Samoa in 2019 and 2020 caused 83 deaths, mainly among children, and more than 5,700 cases. Kennedy, who peddles misinformation about measles vaccines, had visited the island earlier on a trip arranged by a Samoan anti-vaccine influencer, according to a 2021 blog post by Kennedy.

Without evidence, Kennedy cast doubt on the fact that measles caused the tragedy in Samoa. “We don’t know what was killing them,” he said at his first confirmation hearing. Samoa’s top health official denounced this evasion as “a complete lie,” in an interview with The Associated Press.

Last school year, the number of kindergartners exempted from a vaccine requirement — 3.3% — was higher than ever reported before, according to the Centers for Disease Control and Prevention. Numbers were far higher than that in Gaines County, where nearly 1 in 5 children in kindergarten had a vaccine exemption for philosophical or religious reasons in 2023-24.

Over the past couple of years, several states have allowed more parents to obtain exemptions. Already, about 25 bills have been filed in the 2025 Texas legislative session that could limit vaccination in various ways.

“We’re seeing a level of momentum this legislative session that we’ve never seen in the past,” Lakshaman said. Changes are afoot at the local level, too. For example, a school board in the Houston area voted to remove references to vaccines in its curriculum. “There is a top-down and bottom-up assault on these protections,” Lakshaman said.

About 80% of the public believes that the benefits of the measles, mumps, and rubella vaccines outweigh the risks, according to a 2025 KFF poll.

“Lawmakers who put forth dangerous policies need to know the people they hear from don’t represent the majority,” Lakshaman said. Her group offers resources on its website to help people influence decisions on vaccination policies.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).