Experts fear a resurgence of infections in low-income countries if the ban were to continue. The waiver remains in place, while officials review foreign aid programs.The Trump administration on Tuesday issued a waiver for lifesaving medicines and medical services, offering a reprieve for a worldwide H.I.V. treatment program that was halted last week.The waiver, announced by Secretary of State Marco Rubio, seemed to allow for the distribution of H.I.V. medications, but whether the waiver extended to preventive drugs or other services offered by the program, the President’s Emergency Plan for AIDS Relief, was not immediately clear.Still, PEPFAR’s future remains in jeopardy, with potential consequences for more than 20 million people — including 500,000 children — who could lose access to lifesaving medications. Without treatment, millions of people with H.I.V. in low-income countries would be at risk of full-blown AIDS and of premature death.“We can very rapidly return to where the pandemic is exploding, like it was back in the 1980s,” said Dr. Steve Deeks, an H.I.V. expert at the University of California, San Francisco.“This really cannot happen,” he said.On Monday, the Trump administration ordered health organizations in other countries to immediately stop distributing H.I.V. medications purchased with U.S. aid. The directive stemmed from a freeze — which may become permanent — in the activities of PEPFAR, a $7.5 billion program overseen by the State Department.Since it started in 2003, PEPFAR is estimated to have saved more than 25 million lives; more than 5.5 million children have been born free of H.I.V. who otherwise would have been infected.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

2 hours agoNiall McCrackenBBC News NI Mid Ulster Reporter

Representatives of groups that administer the Supplemental Nutrition Program for Women, Infants, and Children, a $7 billion effort funded entirely by the federal government, did not know on Tuesday whether the federal funding pause would affect the program.W.I.C., as it’s usually called, provides vouchers for healthy foods to low-income pregnant and postpartum women, infants and children.Trump administration officials said that programs that provide direct assistance to individuals are supposed to be exempt from the freeze. But W.I.C. support does not come directly from the federal government — like with Medicaid, the federal government sends money to states, which administer the program locally.Like many other organizations that rely on federal dollars for charity work and other forms of aid, the uncertainty around the order left W.I.C. officials unclear on how their funding would be affected.“Millions of people, moms and babies, rely on W.I.C. every day to get the healthy food they need and infant formula, breastfeeding support, and breast pumps they need,” said Alison Hard, director of public policy at the National W.I.C. Association. “Any policy that would put this program at risk would be catastrophic.”Ms. Hard said the organization was seeking assurances from the Trump administration that W.I.C. was excluded from the freeze in funding. Fortunately, she added, states receive W.I.C. funds on a quarterly basis, so the programs should continue to operate.“For now, we encourage families to continue to come in to W.I.C. as normal until we know more,” she said.During the first Trump administration, many immigrant families or mixed-status families feared taking advantage of public benefits programs like W.I.C., even if they were eligible, out of concern that doing so could jeopardize their legal status or ability to get a green card. A 2021 poll by the Protecting Immigrant Families coalition found that 46 percent of respondents in immigrant families that needed help during the Covid-19 pandemic didn’t seek it because of immigration concerns. A more recent 2024 Urban Institute survey found that 17 percent of individuals from immigrant families avoided safety net programs because of immigration concerns.

Gov. Josh Green battled a measles outbreak that killed 83 people, mostly children. President Trump wants Robert F. Kennedy, Jr., a vaccine skeptic, as his health policy chief.It was a spasm of tragedy on a remote Pacific island that only a few months later was overshadowed by a global pandemic. But to Gov. Josh Green of Hawaii, the measles outbreak on neighboring Samoa that killed 83 people, mostly babies and children, was a preventable catastrophe wrought by the man President Trump now wants to steer American health policy.In December of 2019 Dr. Green, an emergency medical physician and Hawaii’s Democratic lieutenant governor at the time, rounded up a medical team and thousands of vaccine doses and flew to Samoa to help. Last month he flew to Washington aiming to alert lawmakers from both parties about the role Robert F. Kennedy Jr., Mr. Trump’s nominee for health and human services secretary and a longtime vaccine skeptic, played in the Samoa outbreak.Mr. Kennedy’s confirmation hearings are on Wednesday and Thursday before two Senate committees, which will then vote on whether his nomination advances to the full Senate.Democrats are attempting to leverage Mr. Kennedy’s connection to the Samoa outbreak to build opposition to his nomination. Dr. Green recently appeared in an ad by a liberal advocacy group, 314 Action, saying, “R.F.K. Jr. had spread so much misinformation that the country stopped vaccinating, and that caused a tragic and fatal spread of the measles.”In an interview on Monday, Dr. Green said that based on his conversations so far, if the full Senate vote was taken anonymously, “R.F.K. Jr. would be defeated 70-30 or worse.” At the same time, he said, “the political climate has everyone under great pressure to go with the president, or be labeled disloyal.”A spokeswoman for Mr. Kennedy did not respond to requests for comment on Tuesday. In the past he has blamed Samoa’s measles outbreak on “an Indian-manufactured MMR vaccine,” referring to the measles, mumps and rubella vaccine.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Robert F. Kennedy Jr., President Trump’s nominee for health secretary, doesn’t just hold fringe views on vaccines. We fact-checked five recent statements.At Robert F. Kennedy Jr.’s confirmation hearings, beginning on Wednesday, senators are expected to question him closely about his controversial views on vaccines.For years Mr. Kennedy has questioned the safety of vaccines, including those for polio and measles, two diseases that continue to harm children. More recently, he has said that he’s not planning to take vaccines away from Americans but wants to release safety data to the public — even though nearly all of the data is already publicly available.Mr. Kennedy’s contrarian views extend well beyond vaccines. And as secretary of health and human services, he would have enormous influence on health policy, even on issues typically under state control, by cutting funding for certain programs or elevating others.Here’s a fact check of some of his claims.What was saidThis is false. Mr. Kennedy’s number is off by orders of magnitude.The National Diabetes Statistics Report estimated that in 2021, about 35 per 10,000 children and adolescents younger than 20 — that is, 0.35 percent — had a diagnosis of diabetes. Another study found that 0.1 percent of young people 10 to 19 had diabetes in 2017.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Caroline Kennedy wrote a letter to key senators on Tuesday, calling her cousin, Robert F. Kennedy Jr., a “predator” who is addicted to the attention he gets from airing dangerous views on vaccinations.She called on lawmakers, who will be questioning Mr. Kennedy at his confirmation hearings to become the nation’s health secretary on Wednesday and Thursday, to reject his nomination. She cited his lack of experience, misinformed views on vaccines and personal attributes. In the letter, she described how he led other families members “down the path of drug addiction.”“His basement, his garage, and his dorm room were the centers of the action where drugs were available, and he enjoyed showing off how he put baby chickens and mice in the blender to feed his hawks,” Ms. Kennedy wrote. “It was often a perverse scene of despair and violence.”Her letter was first reported in The Washington Post.She gave him credit for overcoming his drug addiction, which Mr. Kennedy has discussed extensively, but she said that the collateral damage was extensive.“But siblings and cousins who Bobby encouraged down the path of substance abuse suffered addiction, illness and death while Bobby has gone on to misrepresent, lie and cheat his way through life,” Ms. Kennedy wrote.She criticized his advocacy against vaccines, describing it as part of an addiction to attention and power.“Bobby preys on the desperation of parents of sick children — vaccinating his own children while building a following by hypocritically discouraging other parents from vaccinating theirs,” she wrote.

Based on an ARIC cohort analysis, supine hypertension may be more predictive of cardiovascular events than seated hypertension. (JAMA Cardiology)
Blood pressure (BP) readings in public, noisy environments were still fairly accurate. (Annals of Internal Medicine)
One lot of Provepharm’s phenylephrine hydrochloride is under voluntary recall by the manufacturer due to “visible black particulate matter,” according to an FDA alert.
Racial minorities and people on Medicaid were still taking baby aspirin in 2021-2023 despite guideline warnings. (JAMA)
For patients with stable chest pain, management guided by coronary CT angiography was still associated with a sustained reduction in coronary heart disease death or myocardial infarction 10 years into the SCOT-HEART trial. (The Lancet)
Taken from the same blood sample, high-sensitivity cardiac troponin I had a slightly higher diagnostic accuracy for heart attacks, while high-sensitivity cardiac troponin T had higher prognostic accuracy for all-cause and cardiovascular death. (Journal of the American College of Cardiology)
Left atrial appendage (LAA) closure appeared promising for people with atrial fibrillation on hemodialysis, based on an international registry. (JACC: Clinical Electrophysiology)
Imperative Care announced FDA 510(k) clearance of the Zoom stroke thrombectomy system, including its large-bore .088″ catheter.
It’s not just cigarettes: Users of cigars, pipes, and smokeless tobacco displayed subclinical markers of inflammation and atherosclerosis in a cross-sectional study. (Circulation)
Central adiposity, or a high waist-to-height ratio, was prevalent in almost every patient with heart failure with preserved ejection fraction in the PARAGON-HF trial. (European Heart Journal)
The Society of Thoracic Surgeons Intermacs Risk Model was unveiled as a tool to predict 90-day mortality risk from durable left ventricular assist device implantation. (Annals of Thoracic Surgery)
Modeling showed the best performing clinical decision rule regarding when to terminate resuscitation efforts for in-hospital cardiac arrest: when the patient had an unwitnessed, unmonitored cardiac arrest, an initial rhythm of asystole, and resuscitation duration of at least 10 minutes. (JAMA Internal Medicine)
Traditional risk factors were unable to predict exercise-related sudden cardiac death in those with hypertrophic cardiomyopathy. (Heart)
And in young people who died from sudden cardiac death due to coronary artery disease, there was no evidence that screening for carotid or aortic plaque would have flagged the event. (European Journal of Preventive Cardiology)
Among toddlers with congenital heart disease, those who received cardiac inpatient neurodevelopmental interventions wound up having reduced delirium and higher cognitive scores, one hospital found. (JAMA Network Open)
The anti-PCKS9 adnectin drug lerodalcibep failed to meet noninferiority criteria against evolocumab (Repatha) for reducing LDL cholesterol in a homozygous familial hypercholesterolemia population. (Lancet Diabetes & Endocrinology)

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

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England’s chief medical officer Prof Sir Chris Whitty has urged MPs to not overly complicate assisted dying laws if they are to introduce it.

President Trump said he would take health agencies in a new direction on the campaign trail and has chosen some controversial nominees to help him achieve his goal, including Robert F. Kennedy Jr., Trump’s pick for HHS secretary.
However, it remains unclear how much could actually change if Kennedy were to be confirmed. To answer that question, MedPage Today spoke with legal experts, former CMS and White House officials, and others who worked alongside health agencies to gauge the potential for substantial reforms across HHS and its sub-agencies.
Can Kennedy Terminate Employees at FDA, Other Agencies?
In October, Kennedy posted on X that “FDA’s war on public health is about to end.” He criticized the agency’s “aggressive suppression” of a number of unproven therapies, including ivermectin and hydroxychloroquine, and warned, “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”
If confirmed as HHS secretary, would Kennedy have the authority to overhaul the FDA and clear out “entire departments,” as he said he planned to do? Lawrence Gostin, JD, a professor at Georgetown Law School in Washington, D.C., said Kennedy has “extensive power” to reorganize the federal workforce, but it isn’t unlimited.
He may get some help from Trump, who issued an executive order to reclassify certain federal employee positions in a way that would make it easier to fire them at will, Gostin said. This order seeks to restore a 2020 executive order, which Biden rescinded in January 2021.
Public servants do have civil service and whistleblower protections, Gostin noted. “They can complain publicly about malevolent intentions,” and would likely have a “valid legal challenge” if they sued that could at least delay the reclassification process.
In April, the Office of Personnel Management under President Biden issued a final rule to prohibit this type of reclassification. If the president was to “follow the letter of the law,” he would need to revoke the prior rule, which includes issuing a notice, holding a hearing, and having “good reasons” for that revocation that could withstand court challenges, Gostin said. “I think [Trump] may succeed, ultimately, if he perseveres,” but he also might drop these efforts if enough civil servants retire or quit on their own.
Steven Balla, PhD, an associate professor of political science at George Washington University in Washington, D.C., told MedPage Today, “I’m convinced that a lot of this is rhetoric that’s designed to demoralize and shrink the federal workforce through ‘voluntary’ resignations.”
Gostin said that the only “real check” on Trump’s authority relates to centers or divisions having statutory functions — meaning their funding or authorities come directly from Congress. In those cases, Trump and Kennedy would need Congress’s help to undo or eliminate those functions. “But if it’s simply a matter of reorganizing how an agency is constituted, [Kennedy] has quite extensive power to do that, and that’s alarming,” he added.
Ashish Jha, MD, dean of the Brown University School of Public Health in Providence, Rhode Island, and former White House COVID-19 Response Coordinator under Biden, agreed with Gostin. “He can definitely reorganize … but it’s going to be hard to shut entire agencies down,” he said.
Tom Scully, JD, who served as CMS administrator under President George W. Bush, noted that it wouldn’t hurt to trim down at least one of the agencies a bit. “I went through the [CMS org chart] and there are offices I never heard of when I was there 20 years ago,” he told MedPage Today.
Scully, who sees himself as a “pretty moderate Republican,” said if he was in government now he would probably eliminate 25% of the offices he saw on the org chart.
On the other hand, the Trump administration’s effort to require all federal employees to go to their offices 5 days a week could have unintended consequences as it potentially forces a lot of early retirements, he added.
“Some people will say, ‘Great.’ I would say, ‘It depends,'” said Scully, who is now a principal at Federal Health Policy Strategies, a Washington consulting firm. “If you lose the good people, you’re in trouble.”
Can Kennedy Pause Research on Infectious Diseases, Direct Half of NIH Funding to Holistic Health?
At an anti-vaccine conference in 2023, Kennedy, who was still running as an independent candidate for president, said he would tell NIH scientists, “Thank you for [your] public service. We’re going to give infectious disease a break for about 8 years.” Later, in a September 2024 editorial for the Wall Street Journal, in which he endorsed Trump for president, Kennedy suggested that half of the NIH’s budget should be directed to “preventative, alternative, and holistic approaches to health.”
Gostin said, as HHS secretary, Kennedy will have “certain flexibility” to allocate where research dollars are spent, but at NIH in particular, Congress funds certain centers and programs. So, “without congressional action to readjust those financial flows, he’s going to have relatively limited ability to make the kind of radical changes that he wants to see,” he noted.
Also, given the number of Republicans in Congress with a vested interest in research on childhood cancers, heart disease, diabetes, and even infectious diseases, it would be “very, very difficult,” although “not impossible” to change that, he added.
Can Kennedy Reverse Vaccine Approvals, Overhaul Vaccine Advisory Committees?
FDA approvals are granted at the center director level, which is not currently a political appointment, but the HHS secretary does make the final decision, Gostin said.
Paul Offit, MD, a former member of the Advisory Committee on Immunization Practices (ACIP) at CDC and a current member of the FDA’s Vaccines and Related Biological Products Advisory Committee, noted that if the FDA’s vaccine advisory committee recommends a vaccine be licensed and the FDA agrees, the HHS secretary could disagree. “He can say, ‘I think this vaccine hasn’t been tested well enough,'” or even that existing vaccines have not been tested enough.
Kennedy has previously made such arguments. In 2021, he lobbied the FDA to revoke the authorization of the COVID vaccines, even while thousands of people were dying weekly from the virus. In recent months, however, Kennedy has appeared to moderate his stance, telling Republican senators that he won’t take away vaccines and that he just wants to make safety and efficacy data more readily available.
But Offit noted that Kennedy still believes vaccines cause autism despite “abundant evidence” that they do not. “When he says … ‘I just care about vaccine safety,’ what he really means is he wants to see studies done to confirm his immutable, fixed, science-resistant beliefs,” he said.
Donald Berwick, MD, president emeritus of the nonprofit Institute for Healthcare Improvement in Boston and a former CMS administrator under President Obama, noted that to change vaccination policies reflected in CDC regulations, an HHS secretary would have to follow the rule-making process and provide a 30- or 60-day comment period under the Administrative Procedure Act.
“You can always ignore the law, but when you’re a public official … you’ve taken an oath, and violating that oath has consequences,” Berwick said, adding that there needs to be enforcement of those consequences.
Jha noted that as HHS secretary, Kennedy would yield “soft power” over the heads of other agencies, including CMS, FDA, NIH, and CDC. “They’re not going to want to make decisions that are going to upset him,” he said.
Gostin argued that making vaccine bans the “holy grail” of an anti-vaccine agenda is flawed, given the many ways Kennedy, as HHS secretary, could potentially undermine trust in immunizations. Although he has the power to reverse an approval, Kennedy might hesitate to do so given the “enormous” backlash he could face, and likely would instead undermine vaccines in other ways — such as by appointing vaccine skeptics to advisory committees such as ACIP, he said.
Balla pointed out that there are stipulations in the Federal Advisory Committee Act (FACA) that govern how these committees are constituted and operate. When there’s an opening, usually a call is issued in the Federal Register and an open application process follows. Balla also noted that a share of seats are reserved for certain stakeholders to ensure committees are balanced.
In the “bad old days” before FACA, Balla said, committees would hold non-public meetings and be stacked with certain types of stakeholders. The balance and solicitation requirements seek to prevent that. “So, that makes it harder to, just by fiat, change the composition of the advisory committee,” he noted.
Still, as Gostin pointed out, the CDC director makes nominations for the advisory committees, and appointments are ultimately determined by the HHS secretary. And Kennedy, by leveraging anti-vaccine allies on these committees, could ensure that even approved vaccines would not receive coverage under the Affordable Care Act.
“Even more insidiously,” he added, “he could cherry-pick data, [and] use misleading health communications to foment doubt and distrust in certain vaccines,” and “a number of red states” would likely change their school immunization requirements as a result.
Additional Checks and Balances
Other forces could limit Kennedy’s plans, but for Offit, Congress is unlikely to be one of them. “The mere fact that they might confirm him tells you that you should worry about them ever pushing back” on his actions, he said.
Kennedy’s confirmation hearing with the Senate Finance Committee is scheduled for Wednesday, and he has a hearing with the Senate Committee on Health, Education, Labor, and Pensions on Thursday.
For Jha, one check on Kennedy’s power is the sheer number of rules that government officials have to follow. “It’s hard to make reform inside government … You can do window dressing, but substantive reform is very, very hard, and I don’t know that [Kennedy has] got the team or the capability or the patience to do it,” he said. Plus, if he’s not careful, lawsuits will inevitably follow, he added.
“The truth is that I think the biggest bulwark against really egregious behavior is likely to come from the courts,” Jha said. “I think at least for the next 2 years … if anybody is doing anything, it’s going to be the courts.”

Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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Allan-Blitz is a pediatrician and adult medicine specialist. Klausner is a professor of population and public health sciences.

Sexually transmitted infections (STIs) have a major impact on the heath of people every day — from diseases like AIDS and syphilis to drug-resistant gonorrhea and herpes. But few know that chlamydia, one of the most common STIs, is a major cause of infertility when left untreated. Too many people are unaware of the long-term complications of chlamydia and how a simple test and cheap treatment can save fertility.
Few schools provide in-depth education about STIs. These infections remain highly stigmatized in most communities and are rarely talked about — even by healthcare professionals. Aside from ob/gyns and other sexual health experts, there is a serious lack of knowledge in this area. The ongoing silence and lack of awareness pose barriers to testing and treatment.
We urgently need new federal and state efforts to reduce stigma and provide STI testing and treatment to prevent infertility. Infertility prevention can improve the health of all women and families.
The Impact of Undetected and Untreated Chlamydia
In 2023 there were 1.6 million reported cases of chlamydia in the U.S., and likely twice that many went undetected and unreported. One in 10 women with chlamydia will develop long-term infection of the reproductive organs (pelvic inflammatory disease), often without any symptoms. Over time, chronic infection will rob women of their fertility. It is estimated that for every 150 untreated chlamydial infections in the U.S., there will be at least one case of permanent sterility.
Infertility can be a very difficult issue for people who want to have children. Infertility is a common cause of anxiety and depression, and can also contribute to relationship stress and divorce. Infertility is also very difficult and expensive to treat. The costs of infertility treatment are borne by everyone — families, employers, and taxpayers. Cases of infertility caused by chlamydia cost about $135 million in medical expenses every year.
Testing and Treating Chlamydia
Chlamydia, however, is easily detectable through testing and can be treated with a single course of antibiotics. What makes treatment challenging is that most women with chlamydia do not know they have it. In 70-75% of cases, the infection in women has no symptoms, which is why it’s known as the “silent STI.” The only way to know if you or your patient has chlamydia is through testing. The CDC recommends that all sexually active women get tested every year until the age of 25. Women 25 and older should get tested if they have new sex partners or a partner with an STI. Even with those recommendations, however, only about half of women who should get tested, get tested regularly.
We need a unified program to increase awareness about chlamydia and infertility among policy makers, medical providers, and young women. While insurance companies generally reimburse for STI testing, we need to make testing and treatment easier for women to access.
Newer FDA-approved tests allow women to collect swabs for testing in their own home and mail the swabs to nearby testing laboratories. Meanwhile, the CDC is working on a cheap, 15-minute test that people could buy in a store, or doctors could use in their office, without the need to involve a testing lab. Very accurate, more expensive, 30-minute chlamydia tests do exist, but many doctors don’t use these tests because most insurers don’t reimburse enough to cover the cost of testing; instead doctor’s offices use standard testing, which can take 1-to-2 days or more for results.
For 20 years, from 1993 to 2013, Congress supported the National Infertility Prevention Project. That program paid states and organizations to test for and treat chlamydia as well as other STIs, specifically in women. A similar program today could help millions of American women and restore the health and fertility of our nation.
Research shows that public funding for STI prevention works. For every 1% increase in federal funding for prevention, rates of chlamydia decrease by 0.17%. In 2023, the CDC received only about $110 million for STI prevention, or approximately 35 cents per U.S. resident. Doubling current federal funding might prevent over 2,200 cases of infertility caused by chlamydia in a single year, and only use a very small amount of the overall federal budget. That means hundreds or thousands more women would be able to have children, and more families would avoid the challenges and stigma of infertility.
Given the importance that we all place on healthy pregnancies and families, addressing preventable infertility must become a well-funded national priority.
Lao-Tzu Allan-Blitz, MD, MPH, is a pediatrician and adult medicine specialist at Brigham and Women’s Hospital and Harvard Medical School in Boston. Jeffrey D. Klausner, MD, MPH, is a professor of population and public health sciences at the University of Southern California Keck School of Medicine in Los Angeles, and a former CDC medical officer.

Disclosures
Klausner has received consulting fees from Visby Medical, a producer of a point-of-care STI test for women, and bioMerieux, a maker of infectious disease tests.

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