As America gears up for the year's end and a change in administration, the topic of public health has dominated many conversations throughout the election season, but one facet has been noticeably absent: bird flu. Human infections of the H5N1 virus have sharply risen in the last few weeks, alarming many public health experts are wondering — and worried — what this means for another possible pandemic like COVID-19.
This week, public health officials detected bird flu in a sample of raw milk sold in California. According to a press release by the California Department of Public Health, the public is being advised to avoid consuming “one batch of cream top, whole raw milk” produced by the brand Raw Farm. The news comes after public health experts have warned that drinking or accidentally inhaling raw milk containing the bird flu virus may lead to illness.
It also comes at a time as the country’s incoming Secretary of the Department of Health and Human Services Robert F. Kennedy Jr. continues to promote the consumption of raw milk. Just this past summer, Kennedy bragged to an audience at an event that he only drinks raw milk, and more recently, claimed the Food and Drug Administration’s so-called “war on public health” includes “suppression” of raw milk.
The bird flu crisis began several years ago but ramped up last April when dairy cows started becoming infected. Since then, 55 human cases have been reported across several states, according to the Centers for Disease Control and Prevention. Most of these infections occurred in farmworkers who came into contact with infected cows or poultry, with the exception of three cases that are mystifying health officials. The first is a case in Missouri in which health officials have yet to track the origins of the infection. The second is a Canadian teenager who has remained hospitalized in critical condition with bird flu, again with unknown exposure and stark in its severity. (No other bird flu infections in this crisis have required hospitalization.) The third is a case of a child in California, also with an unknown source of the infection.
Since last spring, public health officials have publicly criticized the Biden administration for not properly handling and monitoring the situation, but they don’t have faith that the situation will improve under a Trump administration, either. In fact, they imagine things will only intensify, just like how the Trump admin botched the response to COVID.
“If the Biden administration is not doing a good job, you can only imagine when you have certain individuals who are much more hostile towards these types of government action, it will get worse,” Dr. Amesh Adalja, an infectious disease and senior scholar at Johns Hopkins Center for Health Security, told Salon in a phone interview. “It would be important for the Trump administration, as it's rolling out its team that's going to be heading CDC, HHS, USDA, that they talk about bird flu and how their plan may differ, and how they're going to correct the deficiencies that are occurring currently.”
Adalja added that the new Secretary of Agriculture is going to have to address bird flu, given that it spreads so much in factory farmed animals. Recently, news broke that Trump picked Brooke Rollins as his agriculture secretary, who has been influential in two right-leaning think tanks. "Brooke’s commitment to support the American Farmer, defense of American Food Self-Sufficiency, and the restoration of Agriculture-dependent American Small Towns is second to none," Trump said in the statement.
But part of the problem in managing H5N1, Adalja said, has been the conflict between public health and the farm economy. Currently, the approach to monitoring bird flu in dairy cows is fragmented and depends on each state's cooperation. The CDC only mandates testing for herds if they’re traveling from one state to another.
“What I think has constrained this entire outbreak response from the beginning is the fact that dairy cattle farmers do not want anything to impact their short-term economic interests,” Adalja said. “But they’re sacrificing the long-term for the short-term because they're not understanding that, if this [virus] becomes endemic in cattle, that's a major [financial] problem. And if it continues to affect humans and threaten their workforce, that's a major problem.”
Dr. Rajendram Rajnarayanan, of the New York Institute of Technology campus in Jonesboro, Arkansas, told Salon he’s concerned about proposed cuts to staff at various government agencies and how that will affect the future of bird flu monitoring. For example, Kennedy has claimed that he will gut the FDA once in power. Elon Musk, co-head of the Department of Government Efficiency — which is not an official government agency but acts as an advisory group to the Trump admin — has said they will recommend reducing headcounts to cut costs at federal departments.
“Cuts to these agencies could severely diminish their capacity to monitor and respond to emerging infectious diseases,” Rajnarayanan said. “The ability to conduct epidemiological studies and implement public health measures relies heavily on its workforce, reducing capacity may lead to significantly slower response times and create unnecessary gaps in surveillance thereby increasing the risk of a disease spreading undetected among both animal and human populations.”
One of the biggest fears regarding this outbreak of H5N1 is if human-to-human transmission is occurring. Rajnarayanan said one primary indicator of human-to-human transmission will be “the occurrence of clusters of cases where individuals have not had direct contact with infected animals.” He pointed to the recent California case as an example. Notably, the CDC states its risk assessment for the general public is low.
“The CDC, FDA and USDA must work together seamlessly to manage outbreaks,” Rajnarayanan said. “Staff reductions could disrupt this collaboration, as seen during the current H5N1 outbreak where farmers and local officials have expressed reluctance to cooperate with federal health officials due to concerns over jurisdiction and trust.”
A “weakened CDC,” Rajnarayanan added, could exacerbate current tensions between the farm and public health sector, making it “harder to implement necessary biosecurity measures on farms.”
Regarding an ideal response from the next administration, Rajnarayanan said he’d like to see more biosecurity measures, comprehensive surveillance, and investments in research, as well as the development of rapid testing, therapeutics and vaccines.
Adalja said he’d like to see the next administration be much more “aggressive” with active cases.
“Instead of being reactive, being very proactive, and saying we're going to assume that this is widespread, that it's not just in the 600 plus herds that have been identified,” he told Salon. “And encourage states to do testing of asymptomatic cows that are not meant for interstate travel.”
The previous Trump administration, Adalja said, was “destroyed by the COVID-19 pandemic.” Infectious disease should be top of mind.
“They should have this realization about how important infectious disease emergency response is,” Adalja said. “This is something that the HHS and CDC nominees need to be asked about, this is one of the pressing infectious disease threats right now — even if this doesn't cause a pandemic, they need to get this right, put systems in place.”
