You’d be hard-pressed to find many public health experts who have positive things to say about Donald Trump’s handling of the Covid-19 pandemic in the United States. Alongside his numerous policy failures, one Cornell University study found that he was the biggest source of Covid-19 misinformation. But if there’s one redeeming feature to Trump’s pandemic record, it has to be his leadership on Operation Warp Speed – a massive, government-funded initiative that played a pivotal role in fast-tracking Covid-19 vaccines.
“Operation Warp Speed stands as one of the most remarkable scientific and humanitarian achievements of the past half-century,” the former US surgeon general Jerome Adams said. It directed billions of dollars into vaccine development and manufacturing, particularly into the mRNA platform, which became the backbone of the Moderna and Pfizer/BioNTech vaccines.
Vaccines work by preparing the body’s immune system to identify and successfully attack foreign agents entering the body. Traditional vaccines use weakened or inactivated viruses to offer a baby version for the body to fight and learn from. These vaccines are often produced by growing the virus in hen’s eggs, which means production is slow and can take months to scale up. In contrast, the mRNA platform functions like a plug-and-play video game console: you just “plug in” the genetic code of a particular virus or pathogen. The vaccine provides instructions to our bodies to make parts of the virus in our own cells, which then prompts an immune response.
The process of creating and manufacturing these vaccines is much faster and more flexible than their traditional counterparts. This is especially important for a disease such as avian flu, which has an up to 100% mortality rate in chickens. But despite the speed in which they come together, there is still a considerable time-lag before mass rollout to allow for clinical trials to ensure human safety, test for side-effects and figure out optimal dosing. During the Covid pandemic, the Moderna and Pfizer vaccines were created within weeks of research teams receiving the genetic sequencing of SARS-CoV-2 from China in January 2020. What took a year was the testing and regulatory approval processes to ensure there was trust in their safety.
Given Trump’s success with Operation Warp Speed, it’s particularly bizarre that Robert F Kennedy Jr, his health and human services secretary, has announced $500m in cuts to the mRNA vaccine investment portfolio. These include cancelling funding for Moderna’s development into a late-stage H5N1 avian flu vaccine. I asked Prof Rebecca Katz, a global health security expert and former US State Department adviser, for her assessment of the damage. She called it: “A self-inflicted wound to a vital organ.”
On its own, RFK Jr’s decision isn’t surprising, considering his longstanding anti-vax advocacy and cult-like following. He has built a whole identity on anti-science rhetoric and he is especially vocal about the supposed dangers of mRNA technology. But being an anti-vaxxer is also a tricky road to navigate: RFK Jr upset his base when, under considerable political pressure, he finally endorsed MMR vaccinations during the Texas measles outbreak.
But putting one personality aside, what do these cuts mean for the health of people living in the US and the wider world? It’s bad news. Take the example of H5N1 avian flu. This virus has shown concerning step-changes including becoming endemic in wild birds, infecting a number of poultry farms, and now has sufficient mutations to enable cow-to-cow (mammal to mammal) transmission in the US among dairy cattle. With its circulation in certain herds of dairy cattle has come a rise in human infections (cow-to-human). The virus is now one mutation away from easier transmission among humans. That’s the nightmare scenario: an influenza pandemic, possibly more lethal than Covid-19.
If a human-to-human transmissible H5N1 strain appears, the existing mRNA infrastructure could be used to rapidly develop a targeted vaccine. Many countries, including the UK, have been stockpiling vaccine components or ramping up surveillance. Under the Biden administration, the US had been among the leaders in this effort. By shelving investment and halting further development, the US is essentially gambling that we won’t need quick medical countermeasures. It’s a dangerous bet. When the next pandemic happens, the cost in human lives could be much higher than we witnessed in 2020.
Can other countries simply pick up the slack with mRNA production? Not easily. After the Covid pandemic led to huge disparities in which places in the world had access to vaccine supply, many countries starting planning for their own vaccine and mRNA hubs. They didn’t want to be dependent on the charity of the US or UK to donate them doses: they wanted to independently respond effectively. On a National Academies project that I was vice-chair of on the global coordination of vaccines for pandemic influenza, we looked closely into regional production, including in Africa. What I learned from experts across the world is that vaccine production, especially mRNA-based vaccines, requires a high degree of technical expertise, quality control and highly specialised supply chains. It will happen in other places, but not quickly enough to shoulder the impact of the US decision.
Unlike foreign aid cuts, where the effect is felt immediately in the shutting down of food programmes or health clinics, cuts to research funding have a slower, deeper impact, especially in terms of expertise and knowledge generation. Research programmes that were working on pandemic preparedness are closing. Postdoctoral researchers aren’t finding jobs, without the necessary soft money to support them. PhD programmes have been frozen or cancelled. Universities, highly dependent on government funding, are scaling back their research activities in health, especially in areas that money is being cut from. Perhaps most devastating of all: smart, ambitious young scientists have fewer opportunities to develop careers in public health research and vaccine development. They’ll look elsewhere – into AI, tech, finance. Where will the expertise come from in the next 15 to 20 years if the career pipeline is being shut down?
RFK Jr may position himself as Making America Healthy Again, but in reality, his policies make the entire world more vulnerable. He may, in fact, be the most dangerous person in the Trump administration – not because he’s loud or erratic, but because he’s steadily eroding the foundation of public health research and infrastructure. This isn’t just bad policy. It’s a generational setback. In that light, RFK Jr stands not merely as a controversial figure but as a serious risk to national and global health security.