Great Week for Pandemic Flu Enthusiasts

If you're feeling nostalgic for 2020, don't worry. The next pandemic will be bigger than COVID.

US Department of Health and Human Services Secretary Robert F. Kennedy, Jr.’s had a pretty productive week in terms of destroying public health and preparedness and response capacity. He triumphantly declared on social media that COVID-19 vaccine access would be withheld from children and pregnant people. He went on a wellness influencer’s podcast and declared war on prestigious medical journals on the basis of unsupported allegations that they are “corrupt.” The measles outbreak broke 1000 cases with no signs of slowing. He became a hero to the Canadian freedom ostrich movement for proposing to move a large flock of H5N1-infected birds to Dr. Oz’s estate in Florida. And he stripped Moderna of $766 million in federal contracts to make next-generation mRNA flu vaccines.

If Kennedy thinks something vaccine-related is a great idea, it’s unlikely that I will agree, and that’s especially true when it comes to H5N1 avian influenza. Cancelling Moderna’s contracts is the latest in Kennedy’s relentless efforts to enable a bird flu pandemic. In January, before Kennedy’s confirmation, I wrote about my concerns that if H5N1 gained the ability to transmit person-to-person with Kennedy presiding over the response, we would be unable to respond due to his combined ineptitude and malice. In February, I wrote about how a bird flu pandemic would kill millions of Americans. In April, I was on 60 Minutes talking about how much worse than COVID-19 a bird flu pandemic would be, in large part because of the annihilation of federal response capacity. Developing, manufacturing, and stockpiling vaccines and having a coherent immunization strategy is critical to prevent mass death should H5N1 acquire pandemic capability.

What is the H5N1 situation?

H5N1 actually refers to a lot of different influenza A viruses that are the same subtype (HxNx). The subtype is determined by two proteins on the surface of the virus particle called hemagglutinin (HA/H) and neuraminidase (NA/N). HA binds the receptor on the surface of a host cell, which allows the virus entry so it can infect the cell. NA clips newly made virus particles free from the host cell as they bud from the surface to go on and infect another cell. Both HA and NA are antigens, meaning our immune system targets them when mounting a response against the virus. And within each subtype—like H5N1—there can be a lot of different variants because of their ability to rapidly evolve.

This is an influenza virion (virus particle) seen as if sliced it down the middle. The vRNPs (viral ribonucleoproteins) inside are how the genome segments are packaged. The H5 (HA) and N1 (NA) parts are on the surface sticking outwards.

Influenza viruses are RNA viruses, meaning their genome is made of RNA instead of DNA like ours. A mutation is basically a typo that gets randomly inserted when a genome is being copied. The enzymes that replicate viral RNA lack the ability to proofread the way our DNA replication enzymes do, and so they are more likely to acquire mutations at a faster rate. This means they can adapt very quickly to new hosts. When they do, they might get new traits or characteristics, such as increased fitness (ability to replicate), expanded tropism (ability to infect new cell or tissue types), enhanced transmissibility (ability to spread to new hosts), antigenic escape (ability to evade existing immune responses), and increased pathogenicity (ability to cause disease).

In addition to that, influenza viruses have a segmented genome. The genetic blueprints for the virus are stored in 8 separate pieces, which means that if a host gets infected with 2 viruses at the same time, these segments can get mixed up and create a new hybrid virus. This process is called reassortment and it has preceded every prior flu pandemic that we can investigate using genomic sequencing. Reassortment allows viruses to make huge, rapid evolutionary leaps forward, and could result in an H5N1 reassortant that gains the ability to transmit between people overnight. Many of the viruses circulating right now are reassortants between the many flavors of H5N1 and other avian viruses that are circulating now. Reassortment is frequent, unpredictable, and potentially devastating.

Right now, H5N1 is circulating broadly throughout the US in dairy cows, poultry farms and backyard flocks, and wild animals. As of today, USDA reports 173,107,698 poultry have died in all 50 states and Puerto Rico since bird flu was first detected in the US in 2022. H5N1 can infect a bunch of different hosts, including many species of wild birds, marine mammals, carnivores like wolves, bears, raccoons, foxes, and skunks, cats and dogs, and peridomestic wildlife like mice and rats. H5N1 can infect humans, although there is no evidence that it can spread between them. So far, 70 human cases have been confirmed in the US, although we know there are likely many more. It’s currently unclear how much testing is even occurring, as the CDC’s reported numbers for their targeted testing program have stayed static for months.

H5N1 can infect many different avian and mammalian host species and can be transmitted between them—and potentially humans too. (Figure from Krammer, Hermann, & Rasmussen, Journal of Virology, 2025)

All of this means that a grab bag of diverse H5N1 viruses are circulating unchecked in millions of individual animals, including some unknown number of humans, which increases pandemic risk. Instead of preparing for this or trying to control the outbreak before a human transmissible variant emerges, Kennedy is evidently opting to just ignore it altogether. Every time an H5N1 virus acquires a human-adaptive mutation or undergoes reassortment, it’s buying a lottery ticket for a pandemic. Eventually if we let it buy enough tickets, it’s going to hit the jackpot.

If H5N1 becomes a pandemic virus, we will not have vaccines

Ideally, we would use vaccination to control and contain this virus now. We have flu vaccines and in fact, we have H5N1 flu vaccines that are thought to be well-matched to the clade 2.3.4.4.b H5N1 viruses that are circulating now (clade is another way of categorizing flu viruses within a subtype based on their HA sequence). Last year, the CDC and BARDA partnered with a vaccine manufacturer called CSL-Seqirus to manufacture a stockpile of clade 2.3.4.4.b H5N1 vaccine, eventually acquiring around 10 million doses, as well as shoring up the supplies of adjuvant needed for the vaccine to be maximally effective.

This might seem like a lot, but it’s not going to be useful if this virus does get the ability to transmit from person to person. The US population is 340 million people and the existing stockpile could only be used as part of a targeted vaccination strategy, in which people at the highest exposure risk (veterinarians, dairy workers, poultry workers, backyard flock owners) are prioritized. When an outbreak occurs, these could also be used to vaccinate people who have been exposed, which can stop transmission from expanding. This only works if you can detect cases accurately and, as I noted above, we aren’t doing any targeted testing and our epidemiology and outbreak response capacity is severely impaired. Massive DOGE and Kennedy cuts to state and local public health departments, as well as the illegal punitive defunding of universities and biomedical research means that there is minimal capacity outside the federal government to fill these gaps.

Current flu vaccines are made by growing up a ton of a virus in eggs or cell culture and chemically inactivating it. This works pretty well at reducing disease severity, even if these vaccines don’t completely protect against infection. However, it takes a long time—9 months at minimum—to prepare these vaccines at national scale. If a flu pandemic happened tomorrow, we’d better hope we detect it fast, because 10 million doses won’t be nearly enough.

Furthermore, the H5N1 vaccine stockpile needs to get FDA approval, and I’m not optimistic that would occur in a timely manner since FDA Commissioner Marty Makary and CBER Director Vinay Prasad are both grasping dilettantes with no expertise in immunization (Makary is a GI surgeon, Prasad is an oncologist) and cowards who hide their transactional anti-vax beliefs behind self-righteous handwaving about public trust and unsupported concerns about vaccine safety. Despite Kennedy’s animosity toward the New England Journal of Medicine, Makary and Prasad had no problem publishing their bullshit proposal for a regulatory framework that will strip access to vaccines for millions of people in that esteemed journal.

Next-generation vaccines like what Moderna is developing would greatly augment our preparedness and response capacity. Unlike the traditional inactivated vaccines we currently use for flu, mRNA technology can be modified and adapted for a new variant much more quickly. Manufacturing is faster, too, and considerably safer since it doesn’t involve growing up oceans of virus, or growing any virus at all. mRNA vaccines are designed computationally and can go directly to manufacturing. Having such adaptable immunization technology would be an invaluable addition to the national stockpile. We’d be able to roll out vaccines at population scale much sooner in the event of an H5N1 pandemic, which would translate to millions of lives saved.

However, Kennedy’s groundless antipathy toward vaccination has now prevented that from happening. Moderna is shelving promising vaccines for no reason other than Kennedy’s disqualifying quackery. I’d argue that it’s actually also murderous disqualifying quackery, considering he is blocking access despite knowing about 7 decades of evidence demonstrating that vaccines decrease mortality risk for influenza. We know from preclinical studies and clinical trials that mRNA vaccines work against flu, as well.

Why is Kennedy doing this?

I became a virologist to prevent viruses from making people sick and killing them. Vaccines are one of the greatest medical achievements in human history. For all their talk of "medical freedom,” anti-vaxxers like Kennedy always ignore the fact that vaccines freed us all from the scourge of diseases that used to disable or kill most of us before the age of 40. Most people who feel that valuing and prioritizing human life and civilization understand that we live happier lives when we are healthy and societies are better with less infectious disease. So why does Kennedy blithely continue to take our vaccines away?

I think one explanation is that he’s a real weirdo who never met a conspiratorial wellness rabbit hole he didn’t want to go down. A lifetime of drug abuse, steroids, off-label prescriptions, methylene blue, raw milk, obvious excessive tanning bed use, and occasionally consuming questionably sourced and prepared animals from across the entire tree of vertebrate life has given him the complexion of the dessicated beef liver treats we give to our dogs. Perhaps he thinks that it’s wellness on the inside that counts, because the guy doesn’t exude radiant health. It’s hard for me to buy that he’s walking the path to MAHA when he looks like the picture of Dorian Gray.

Another example of Kennedy’s dishonesty: This pic has to be at least 25 years old.

A more likely explanation for this is less about Kennedy living his best anti-vax life and a lot more about him acquiring power while enriching his bank account. Kennedy has already made millions over the years. The anti-vax nonprofit he founded, Children’s Health Defense, brings in millions of dollars annually through media campaigns and lawsuits against vaccine makers. Kennedy has also personally made $2.5 million in referral fees since 2022 in lawsuits filed against Merck for the Gardasil HPV vaccine and initially refused to divest his 10% stake. Although he later agreed to divest his interest after Senator Elizabeth Warren sharply pointed out that he’d be profiting from lawsuits against companies whose products he would regulate, there’s no evidence that he has. Warren’s concerns were quite valid, considering the actions he’s taken since his confirmation against vaccines and for the benefit of his cause and his fellow travelers. Children’s Health Defense, for example, has been very busy in west Texas, exploiting the grieving families of children who died from measles to make anti-vax propaganda videos selling the services of doctors offering unproven treatments. Kennedy himself has endorsed these alternative treatments, while giving feeble lip service to the MMR vaccine, which is 95% effective at preventing measles in vaccinated people.

If withholding vaccines in favor of snake oil during measles outbreaks is profitable, imagine the moneymaking potential of a flu pandemic. It’s a global market by definition, since pandemics impact the entire world. Unlike with COVID-19, agricultural production would also be heavily affected, causing even more economic turmoil and food shortages. If vaccines were not available, many people would likely resort to alternatives, whether they were proven to work or not. Many more people would, if these alternatives were endorsed by the HHS secretary, approved by the FDA, recommended by the CDC, studied at NIH, and reimbursed by CMS.

There is no question that a great deal of the problems with H5N1 surveillance, control, and public health capacity are not solely Kennedy’s responsibility and not within his control. But vaccines are. I don’t feel great knowing that this leathery charlatan is croaking out decrees to eviscerate vaccine and infectious disease research and public health while simultaneously leveraging his position to promote miracle cures that don’t work and all his anti-vax friends profit from. The shitcanning of Moderna’s contract was not done capriciously; it was done for the profit of a few at the expense of us all.