Maryn McKenna talks bird flu, Covid, and cycles of ‘panic and neglect’ in our public health system

By Brent Cunningham

In “Bird Flu in Cows Is a Slow-Motion Disaster,” FERN’s latest publishing partnership with The New York Times opinion section, science journalist and FERN contributor Maryn McKenna describes the frustrating limits on what the government is doing — and could be doing — to stop the spread of bird flu in cattle:

Public health responders need to adopt a more granular understanding of the vulnerabilities of all types of farmers. Agriculture needs to recognize that its cherished flocks and herds can serve as the source of devastating diseases.

The goal should be to develop response plans that can be modified for a range of pathogens, rather than responding to one disease in one species at a time. This means building better surveillance programs for emerging diseases, making big investments in rapid diagnostics and funding the research that could forecast where disease threats might surface next.

Unfortunately, such policies seem unlikely, given that the Trump administration has signaled its intent to soften its focus on infectious disease. The recent announcement by the U.S.D.A. that a second form of bird flu has surfaced in cattle underscores how diseases are already behaving in ways we can scarcely anticipate — and why repairing the relationship between public health and agriculture is so critical.

With the Trump administration in control of the levers of government, and intent on reducing its size, concerns over the nation’s readiness for the spread of disease from animals are rising. FERN Executive Editor Brent Cunningham spoke with McKenna about her article. 

This interview has been edited for clarity and length.

Given that we’ve known about the threat of crossover viruses for decades. Why wasn’t the U.S. public health system better prepared for Covid-19, and now bird flu?

People in public health talk often about a cycle of “panic and neglect”: A disease rears up, we throw a lot of money at it, the disease subsides, and then the concern and the money subside too. That cycle occurs because we haven’t put in the work and investment before the disease arrives, and it keeps occurring because we don’t put in the work and investment afterward — and before the next time. That we’re caught in this cycle for Covid and avian flu is especially exasperating, because we’ve had either experience with or extensive planning for them. For Covid, there was the SARS crisis in 2003, which was also caused by a coronavirus and which the U.S. health agencies, particularly the Centers for Disease Control and Prevention, were very involved in. For bird flu, there was a massive outbreak in the Midwest in 2014-15 that was the United States’ largest animal health outbreak in history to that point. 

So there is a failure to learn lessons — but also, I think, a failure of imagination. People will argue that no one could have foreseen bird flu moving into cattle. But in fact, since 2022, H5  viruses have infected at least 48 mammal species, including farmed mammals such as foxes and minks. So maybe we should have thought a little harder about what other production species might be vulnerable.

What, if anything, has been done in the wake of Covid to improve preparedness for these kinds of outbreaks?

As public health scholars have written in medical journals, the post-Covid situation is messy. Experiencing that pandemic demonstrated that there were places where US preparations were surprisingly weak — yet those discoveries haven’t necessarily been capitalized on. For instance: In the early days of Covid, there was a fair amount of confusion regarding how the federal health and defense agencies ought to divide up authority for pandemic response. I think you can see an echo of that now, with avian flu in cows: If the ultimate threat is to humans, then that is the business of the CDC — but while the virus remains primarily in animals, it is a  responsibility of USDA. Agencies can’t walk into each other’s jurisdictions, and the CDC and USDA have different ideas (and legal justifications) for conducting disease control. 

That’s not even mentioning the role played by state agencies for human health and animal health. A lot of what we think of as “public health” is actually empowered at the state level, and therefore is affected by the politics of individual states. We’ve seen that play out in post-Covid state restrictions on masking, public gatherings and school closures in conservative states, and it is reasonable to think that might affect flu plans also.

When Robert F. Kennedy Jr. was running for president, he said that if elected he would tell the National Institutes of Health to “take a break” from studying infectious diseases. If he follows through on this idea as Trump’s secretary of the Department of Health and Human Services, what kinds of things would likely happen to current bird-flu efforts?

Nothing would happen to attempts to track and control avian flu in cows or poultry, since those are the province of USDA, which is not under HHS. But it’s an open question what might happen if H5 flu began to infect more humans — or, in the worst-case scenario, developed the ability to pass from humans to human, rather than from cow to human as is happening occasionally now.

If that happened, there would be increased pressure to roll out H5N1 flu vaccine for the workers and farmers who have the most close contact with cows, and potentially more broadly. At the moment, the CDC is recommending only seasonal flu vaccine for dairy workers, but the FDA has approved and HHS has stockpiled three H5N1 flu vaccines. The unanswered question is what influence Kennedy would exert over those possible actions, given his past record criticizing vaccines and his contradictory messaging on his role just this week.

In January, the outgoing Biden administration granted Moderna $590 million to develop mRNA vaccines for pandemic influenza strains, including H5N1. In the current political climate, how quickly could we realistically ramp up production to a level that provided broad public protection if a bird flu epidemic/pandemic erupted? Or is it a fantasy to even suggest this?

I think it is realistic to wonder whether the kind of rapid vaccine development we saw during Covid, the public-private and multi-agency project called Operation Warp Speed, can ever happen again, because both the response to the Covid pandemic, and also vaccines more broadly, have become so demonized in the past few years. There would certainly be vaccines available. Companies would be incentivized to develop them, by other governments if not by the U.S.; in fact, Canada, the UK and the EU have all made advance purchases of the versions available now. But would the U.S. make a Covid-style effort to get that protection to its own population? I don’t think it is possible to answer that question yet.