• Who decides that you’re dead?

• Who oversees organ procurement?

• Why are more organs now taken after the heart stops?

• What makes circulatory death harder to oversee?

• What did investigators find in Kentucky?

• The 8-year-old on the circulatory death track.

• Can you actually refuse to be an organ donor?

• How do organ procurement organizations make money?

• What is distrust costing the organ transplant system?

• Why aren’t these groups regulated as healthcare?

• What CMS and Congress haven't done.

Who decides that you are dead?

Donna Rhorer was recording her brother’s honor walk at a Kentucky hospital in October 2021 when a supervisor told her to stop. Her brother’s eyes had opened, and they were tracking the people in the room.

Anthony “TJ” Hoover had come in days earlier after cardiac arrest. Rhorer said the family was told within hours that he was brain dead, but he wasn’t. His organs were to be taken after his heart stopped, a track called “donation after circulatory death.” The patient is alive until the heart stops. He was on the national organ donor registry. So when the family moved to withdraw life support, the local organ procurement organization had to be notified. That was Kentucky Organ Donor Affiliates, or KODA.

On the morning his organs were scheduled for recovery, he woke up during a cardiac catheterization, a procedure to assess the health of his heart. A former employee, Nyckoletta Martin, testified to Congress about what happened next. He was paralyzed and sedated right away. His family was never told he’d woken up. KODA’s protocol required an immediate halt if a patient’s neurological status changed. That didn’t happen. House investigators later found a note in the record that hospital staff were “extremely uncomfortable with the amount of reflexes patient is exhibiting.”

Martin told me she was barred from those operating rooms within days of the hearing. It ended her career in organ transplantation, after 20 years.

The supervisor called the eye movement a reflex. Rhorer says the surgeons refused to operate. Hoover lived. Then on August 5, 2026, the federal government finally moved to shut down the organization.

In October 2024, KODA merged with Cincinnati’s LifeCenter Organ Donor Network, and the combined organization is called Network for Hope. It says it will appeal. Network for Hope said it “strongly disagrees” with the decision, in a statement from chief executive Barry Massa. The territory covers 7 million people across 4 states. More than 3,000 of them are on a transplant list.

Who oversees organ procurement?

There are two legal ways to be declared dead. The brain can stop, or the heart can. The organs are recovered by 55 nonprofits called organ procurement organizations (OPOs). Each holds an exclusive territory, handed out in the mid-1980s. One rule underlies the entire system: recovering organs must never cause death.

The Centers for Medicare and Medicaid Services (CMS) oversees them. None lost a federal contract in 40 years until HHS decertified a Miami group on September 18, 2025. That was Life Alliance Organ Recovery Agency, run by the University of Miami Health System. The department said investigators found years of unsafe practices, poor training, chronic underperformance, understaffing, and paperwork errors. One 2024 error led a surgeon to turn down a donated heart. Network for Hope is the second OPO the government has moved to shut down.

Why are more organs now taken after the heart stops?

In 2000, 118 people in the United States donated organs after circulatory death. That was 2% of deceased donors. In 2025, it was 8,129, or 49%. Nearly half of recovered kidneys, and more than 40% of livers, come from this track. So do about a quarter of hearts and lungs. Brain-death donation fell in 2024 for the first time in more than a decade, to 9,705 donors.

Three things drove the rise in “donation after circulatory death,” or DCD. Technology came first. US heart transplants from circulatory-death donors began in December 2019, using a machine that perfuses the organ after removal. Normothermic regional perfusion restores blood flow inside the body after death is declared. It entered US cardiac practice in 2020. The Food and Drug Administration approved machines that keep a liver perfused outside the body in 2021.

Federal pressure came second. In 2020, CMS replaced self-reported performance measures with hard ones. 1 counts donors. The other counts organs actually transplanted. OPOs in the top 25% keep their territories. Groups below the national median lose them. The pressure is on OPOs to convert more deaths into organ donors. The pathway with room to grow is the one that doesn’t require a brain death exam. That year, circulatory death accounted for 26% of deceased donors.

The third is who is dying. More patients now survive an initial resuscitation without recovering brain function. Often that follows an overdose or a cardiac arrest. Their families then face a decision about withdrawing life support. Today’s DCD donors are also older, and more likely to have diabetes, high blood pressure, or hepatitis C.

The result isn’t uniform. Across the 55 service areas, circulatory death accounts for as few as 11% of donors and as many as 73%.

Drs. Kim Olthoff, Peter Abt, and Abraham Shaked are transplant surgeons at Penn. They told me what they’d fix first. “The DCD process should be standardized among all OPOs and hospitals,” they wrote. “Currently there is a wide variation in how potential DCD donors are identified, declaration of death, end of life management prior to donation, etc. The involvement of intensivists in this process is important.” They also wanted it on the record that they think the system works well overall. “It is our impression that the public is quite trusting the system, and this is reflected by the large number of people and families who are willing to donate, more so than any other country except for Spain.”

What makes circulatory death harder to oversee?

Brain death is settled by an exam. A doctor tests for brain function, finds none, and the patient is declared legally dead at that moment. The exam itself asks nothing about other organs. In DCD, the patient is alive through every step of the planning. Clinicians judge that recovery is unlikely. The family agrees to withdraw the ventilator. Everyone waits for the heart to stop. Organs start to fail the moment blood stops moving. The same clock that governs death also governs recovery.

The safeguard is separation. The people caring for the patient are not the people who want the organs. Dr. James Bernat, a neurologist at the Dartmouth Geisel School of Medicine, has spent his career on the ethics of determining death. “There’s probably no way to make it perfectly independent,” he said. He told me that families ask about timing and independence “for very valid reasons.”

Then there’s the waiting period. After the heart stops, clinicians wait to be sure it doesn’t restart before surgery begins. Federal policy requires a wait, but doesn’t say how long. Some hospital protocols specify 2 minutes. A study of 631 patients in 20 intensive care units found hearts resumed beating on their own in 14% of cases. The longest interval was 4 minutes and 20 seconds. In November 2025, federal regulators advised OPOs to reassess any protocol shorter than 5 minutes. That was advice, not a rule.

Comfort medications are the other pressure point. Opioids and sedatives ease real suffering at the end of life. They also slow breathing. Intent is what separates comfort care from hastening a death. Intent is hard to reconstruct later.

Etan Yeshua, an intensive care nurse, told me the process often goes fine. “Sometimes things go very well and run very smoothly,” he said, “but many times a year, I’ve had really unfortunate experiences.” Patients and families, he said, end up “being treated in a way that made them seem like a commodity.”

Circulatory death means the heart has stopped and won’t restart on its own. “Normothermic regional perfusion“ restarts it minutes later. The vessels to the head are clamped so blood doesn’t reach the brain. The American College of Physicians wrote in 2021 that this “appears to violate one of the ethical foundations of organ donation, the ‘dead donor rule’.” It called for the practice to be paused. Transplant surgeons disagree and say it preserves organs without resuscitating anyone. A 2024 JAMA study found 49 of the 55 OPOs had used it. 23 of those had no policy governing it.

OneLegacy, the largest of them, told me the line holds in practice. “The recovery surgeons do not enter an operating room until death has been declared by the treating clinicians,” said Shaan M. Johri, the group’s director of communications. Discussions about donation don’t begin, he said, until a family has independently decided to stop ventilator support.

What did investigators find in Kentucky?

Investigators reviewed 351 Kentucky cases where donation was approved but never done. 103 had concerning features. 73 involved patients showing neurological signs incompatible with donation. At least 28 may not have been dead when the process started. They also found poor neurological exams. They found questionable consent. They found causes of death misclassified, especially overdoses.

Danella Gallegos was 34. An ambulance brought her to Presbyterian Hospital in Albuquerque in September 2022. She was homeless. She had cirrhosis and a history of drug use. Doctors told her family she wouldn’t live.

Within days, she says, New Mexico Donor Services told her mother the kidneys were already matched. “They told my mom I was an organ donor, it was going to be done today, and there wasn’t going to be another option,” Gallegos told me. Her mother signed. “She didn’t know what she was doing and felt forced.”

Her sisters saw her cry and move. They were told those were reflexes. “Whenever they did see me crying again, I picked my whole body up and put my arm out, and then they’re like, no, this is reflex.” Then she opened her eyes and started following commands. The plan changed. She recovered. She has since taken herself off the registry.

The OPO disputes the account. New Mexico Donor Services CEO Sean Van Slyck told me CMS investigated in April 2025 and found the OPO was in “substantial compliance.” He asked me to remove the case from this article. Dr. David Arredondo, Chief Medical Officer at Presbyterian, said its clinicians don’t make donation decisions. New Mexico law, he said, requires the hospital to notify the local OPO when a patient dies, or death is near. Withdrawing life support, he said, is the family’s decision and is “entirely separate from considerations related to organ donation.” If a patient shows “unexpected neurologic responsiveness or improvement, the donation process is stopped, and the care team reassesses the patient.”

Paula Denison was declared brain dead at Anderson Regional Medical Center in Meridian, Mississippi. “My mother on her license was not a donor,” her daughter Brooke Shantelle Denison told me. “She was very adamant about not being an organ donor.” The family consented anyway, and generously. “When I say we donated everything, we were going to donate everything,” Brooke said. “Our intentions were to donate bone, skin, all of it.”

The court record describes what staff found when Denison came in on the afternoon of March 17, 2022. She was drowsy and lethargic. She responded to pain. Her speech was clear. A physician ordered a CT scan and intubated her. After he read the report, he ruled she was brain dead. That was around 4:45 p.m. A nurse called Mississippi Organ Recovery Agency (MORA), the local OPO, at 4:46 p.m.

The family was asked to leave for the apnea test. The ventilator stops delivering breaths while oxygen keeps flowing. Carbon dioxide builds up. That buildup is the strongest signal a brainstem has to trigger a breath. Doctors watch to see whether the patient tries. One breath means the patient is not brain dead.

The curtain was closed. A hospitalist called time of death at 6:51 that evening. Denison was moved by ambulance to an organ recovery center MORA runs in a converted car dealership, 90 minutes away. MORA calls it a donor care unit. OPOs run these centers. They aren’t licensed as hospitals.

The family’s complaint, quoted in the Mississippi Supreme Court opinion, says staff there opened her abdomen and took biopsies of her liver. A placement coordinator found matching recipients for her liver and both kidneys. Notes in MORA’s records document reactive pupils. Then pulling away from pain. Then breathing on her own. Then coughing and gagging. The record puts the first of those signs no later than 7 p.m. on March 18, 2022. MORA told the hospital, but not the family. Denison stayed through the night on rising doses of medication. MORA sent her back at 10:16 a.m. on March 19, having ruled she “did not meet neurologic criteria.” More than 15 hours passed between the first sign she was alive and the ambulance out. “She wasn’t brain dead,” their attorney, Michael Jaques, told me. “She was alive when they began to cut.”

Her daughters learned she was alive two days later, at a funeral home planning her service. Brooke walked into the intensive care unit and found her mother breathing. “There were dried tears down her eyes,” she said. Denison died at the hospital days later.

MORA tells it differently. Trisha Byrd, MORA’s director of community services and relations, told me in writing that hospital physicians pronounced Denison dead under state law. Her family then authorized donation. Denison “unexpectedly began to respond to stimuli about 12 hours after her transfer,” Byrd said. MORA informed the hospital physician immediately, canceled all recovery plans, and returned her the next morning “once it became feasible.” “At no point was the patient either prepped for surgery or operated upon,” Byrd said. She called it “a uniquely rare situation that the Mississippi Organ Recovery Agency (MORA) had not previously experienced in our 30-year history.”

MORA had no protocol for returning a patient to the hospital in these circumstances. CMS made it write one, then approved it. A trial court threw the family’s lawsuit out. State law, it held, makes OPOs immune. The family appealed. At oral argument, a justice asked MORA’s lawyer what duty it owed a patient it knew was still alive. “It may seem harsh to say ‘none’”, counsel answered, “but that would be my response.”

On April 16, 2026, the Mississippi Supreme Court reversed and sent the case back. No Mississippi court has ever ruled on what that immunity covers, the justices wrote, and this record is too thin to be the first. Two of them would have ended the case now, holding that the law shields what MORA did. Brooke lost the other half of the appeal. She had sued in her own name too, for her own distress. Mississippi allows that only if you were close enough to witness the harm. She was 90 minutes away, so that claim stays dismissed.

On May 7, MORA’s medical director asked the trial court to throw out the claims against her. The motion calls Denison “the body” and “the gift.” It lists as undisputed that her body showed “signs that were inconsistent with the prior determination” that all brain function had ceased. It says the statute gave MORA rights “superior to the rights of all others” over her. MORA “exercised its superior, statutory right to maintain possession of the body.” A footnote says there is “no allowance for second-guessing the accuracy of the death determination.” Another says a family’s revocation counts only if the OPO hears it “before an incision has been made.”

Four years in, nobody has been deposed. The family sent written questions in January 2024. They’re still unanswered. MORA’s records, Jaques wrote in May, “do not identify the individuals who determined that Paula Denison should remain at MORA or administered drugs” to her after she was found to be alive. “The defendants do not want us to take any depositions or have any opportunity to find out what happened,” Jaques told me.

The 8-year-old on the circulatory death track.

Cole Hartman was 8 years old. He had Fragile X syndrome. On July 31, 2013, his stepmother found him head down in a top-loading washing machine full of water and clothes. He was resuscitated at Henry Mayo Hospital. The sheriff’s homicide unit was assigned because the injury looked suspicious. The next day he was moved to Ronald Reagan UCLA Medical Center. His pupils became reactive. He was minimally responsive. He did not meet the criteria for brain death. He was placed on the DCD track.

I asked the Los Angeles County medical examiner for its file on the case under the California Public Records Act. The county released it, with redactions, in April 2026.

Denise Bertone was the pediatric death investigator assigned to it. She had conducted more than 2,500 death investigations. On August 4, 2013, Hartman was taken to the operating room. Bertone says his intensive care physician also sat on UCLA’s liver transplant team, and served as the anesthesiologist for the recovery. Those roles are supposed to be held by different people. He was on a continuous morphine drip. When the ventilator came off, he kept breathing. The physician then gave 500 micrograms of fentanyl. Hartman weighed 21 kilograms and had never had opioids. He was pronounced dead at 11:03 a.m.

The dose never went into the medication record. It was handwritten on a slip of paper and scanned into the chart. Bertone subpoenaed the pharmacy logs. One vial of 250 micrograms had been checked out for him. The source of the second was never established.

Then the toxicology, which is the part that makes the case. Blood drawn in the operating room was couriered to the coroner by OneLegacy. It showed morphine and no fentanyl. Bertone asked the pathologist to also draw blood from the body at autopsy. That sample sat untested for 7 months. When it was finally run, in March 2014, it showed morphine and a lethal level of fentanyl.

The case was first closed in October 2013 as the sequelae of a near drowning, with the manner of death undetermined. It was reopened in November 2016. A pediatric toxicologist found the fentanyl inconsistent with a therapeutic dose, and the death certificate was amended to add fentanyl toxicity. In June 2017, the chief of anesthesiology at USC reviewed the records. He found the dose 250 to 300 micrograms above what was safe. The manner of death was changed to homicide.

That is a finding about how a death came about. It says nothing about intent, and it brings no charge on its own. No charge followed. The deputy district attorney assigned to the case never issued the written rejection notice explaining why the prosecution was declined. Bertone says the family was told it was comfort care. UCLA Health declined to comment, citing privacy law. It said that “potential organ and tissue donations are not a consideration in decisions about life-sustaining care.”

Then the money. Bertone sued the county, saying she was pushed out for pursuing the case. Dr. Lakshmanan Sathyavagiswaran, the chief medical examiner, testified at that trial. He said the coroner’s office took in $140,000 to $150,000 a year from OneLegacy, depending on the year. He called it cost recovery, approved in the contract, for organ and tissue procurement and for the time his staff spent on it. He said the office ran on about $40 million a year. He also acknowledged serving on OneLegacy’s board for a period, before he came back as interim chief. He denied that anyone retaliated against Bertone. She says OneLegacy also helped his son-in-law get a job. On December 17, 2021, after 90 minutes of deliberation, the jury found for her.

OneLegacy told me California law requires its agreement with the medical examiner. State law authorizes coroners to enter those agreements. It doesn’t require them. The requirement in Los Angeles is a county ordinance. OneLegacy has the same arrangement in all 7 counties it serves. “The Medical Examiner independently reviews, releases, and/or restricts the recovery of organ, eye, and tissue,” said Shaan M. Johri, director of communications for OneLegacy.

I asked Bertone what changed after the trial. “I was really surprised that after the trial, nothing happened,” she said. “Absolutely nothing.”

Can you actually refuse to be an organ donor?

Rita Hollingsworth and her husband took themselves off the donor list at the California DMV in June 2023. Jeff Hollingsworth told me they did it after reading about investigations into OneLegacy. That organization would have handled both her donation and the kidney transplant she was herself waiting for.

That November she had a brain hemorrhage. The OPO was in the hospital anyway. Jeff says the staff wore scrubs though they weren’t on her medical team. He told the charge nurse he wanted them out of her care. The process kept advancing. He describes her bed kept unusually warm. Rita’s potassium and glucose were checked over and over. Jeff says basic comfort care was neglected. Relatives were turned away. When he got back into her room, he found more than a dozen people around her. A man was performing chest compressions. “Rita was dying,” Jeff told me. “She did not want this.”

OneLegacy sent me a written response to explain the legal position. Registering as a donor in California is called First Person Authorization. It’s legally binding. State law requires OneLegacy to carry it out. The DMV isn’t the controlling registry. You have to contact Donate Life California yourself. “A review of this registrant’s record found no disenrollment,” a OneLegacy spokesperson said. They added that staff are identified by badges and logos. When a family says a patient revoked, they said, the record is re-reviewed. Donation doesn’t proceed until status is confirmed. The registry is now working with the DMV on a way to remove yourself there.

Raven Kinser died in Newport News, Virginia, in January 2025. The 911 call came at 4:30 p.m. She reached the emergency room at 4:48 p.m. Her parents, in Michigan, weren’t called until 7 p.m. By then there were no flights, and they drove 12 hours. “DNR” was written on her right thigh, where first responders would see it.

She had signed a Virginia DMV form marked “Organ Donor: N” on July 16, 2024. A DMV clerk stamped it. Her license said the same thing. Her mother, Jamie Kinser, told me a LifeNet representative said the Michigan registration “was her living will, and we had to abide by it.” The family found the DMV paperwork six weeks later in a box of her belongings that a detective had mailed back. LifeNet had used an older Michigan registration instead. Jamie says nobody told the family that.

Jamie learned the registry only runs one way. You can register “yes,” and your family legally can’t overturn it. The other option is “not at this time,” which your family can still override after you die. There is no binding way to register “no.”

LifeNet Health told me federal and state law bar it from confirming or denying anything about a specific person. Whether she was a donor, whether she was referred to them, whether she was in their system at all. It said it follows the Uniform Anatomical Gift Act. A valid authorization stays legally enforceable, it said, and it trains staff on disputes over donor status.

How do organ procurement organizations make money?

Almost everything else in Medicare is paid a fixed price set in advance. OPOs are not. They spend what they spend, report it, and Medicare reimburses the cost. So the way to earn more is to spend more. Medicare pays the OPO directly for kidneys. For a liver, a heart, or a lung, nobody pays the OPO up front. It sends a bill to the hospital that accepts the organ, and it sets that price itself. So an OPO has two ways to raise money. It can charge hospitals more for the organs it sells them. And it can book its shared overhead against kidneys, with the government reimbursing whatever it spent.

In August 2023, the Department of Health and Human Services inspector general audited that arrangement and said the structure itself invites abuse. Its words were that “opportunities and incentives exist for OPOs to: (1) inflate their [standard acquisition costs] SACs for nonkidney organs, (2) misallocate overhead costs between reimbursable and nonreimbursable costs, and (3) not work actively to recover all available organs.” In plain terms: charge hospitals more, move overhead onto the government’s ledger, and leave organs where they are. A bipartisan Senate Finance letter followed in September 2023. Nothing changed for almost 3 years. On August 4, 2026, CMS finalized a rule requiring Medicare to reconcile what OPOs spend on non-kidney organs. It takes effect for cost reporting periods beginning October 1, 2028. Until then, OPOs still set their own prices, and nobody checks them.

The scorecard has a loophole of its own. It is the pancreas. The 2020 rule credits an OPO only for organs that actually get transplanted. There’s one exception. A pancreas taken for research counts as a donor even when nothing is transplanted. CMS never defined research. Recoveries climbed anyway. Senators Ron Wyden (D-OR), Chuck Grassley (R-IA), Ben Cardin (D-MD), and Todd Young (R-IN) wrote to CMS in June 2024 with the numbers. In 2018, OPOs recovered 169 pancreata for research. In 2022, they recovered 1,606. Over the same four years, the share actually used for islet cell research fell from 88% to 48%. CMS has now proposed a rule to strip those out of the count.

New Jersey is where the alleged mechanics are clearest. The House Ways and Means Committee wrote in November 2025 about a patient at Virtua Our Lady of Lourdes in Camden, New Jersey. The patient “reanimated” after life support was withdrawn. The letter says leadership told staff to continue the recovery until hospital staff intervened. It describes 100 pancreases, processed for research, discarded on a single day in March 2024. In an earlier letter, the committee asked Carolyn Welsh, president and chief executive of the New Jersey Organ and Tissue Sharing Network, about kidneys coded “intent to transplant” that no transplant center would take. Michael Symons, a spokesperson for New Jersey’s attorney general, confirmed to me: “We are investigating these allegations.”

The House Ways and Means Committee went further on the day the government moved against Network for Hope. It charged the group with seeking out organs that couldn’t be transplanted, in order to sell tissue for profit. Chairman Jason Smith (R-MO) called the decertification “a direct result of our investigation.” HHS cites a review its own investigators finished in May. Smith said the committee is still digging into what he called a pattern of misconduct at that group and others like it. Donors and families, he said, “deserve a system they can trust.”

The problem goes beyond any one OPO. Jennifer Erickson, a senior fellow at the Federation of American Scientists, testified that tax filings show OPOs have transferred more than half a billion dollars to “related organizations.” Several hold opaque financial interests in tissue processing companies. Some do business internationally, including in the Middle East.

What is distrust costing the organ transplant system?

The industry has an answer. The number of people who donated organs after death fell in 2025 for the first time in more than a decade. Kidney donors dropped by 4%, and more recovered kidneys were discarded. The Association of Organ Procurement Organizations (AOPO) ties the decline to renewed scrutiny of the system and to people leaving donor registries. “This reversal will cost lives,” it told Axios in January. Fewer donated organs, it said, mean fewer lifesaving transplants.

In Kentucky, more than 2,100 people took their names off the state donor registry between September and December 2024. More than 1,000 of them left in October alone. Massa reported those numbers to Congress himself. Nobody has shown that the news reporting caused the drop. Mark Johnson, the interim CEO of UNOS, which runs the national waiting list, said that the decrease “needs to be better understood.” He added that the system “is built on trust.”

The AOPO also argues the real emergency is elsewhere. Thousands of usable organs are discarded every year. Attention spent on procurement conduct, it says, is attention not spent on that waste. UNOS, the contractor that runs the national waiting list, makes a narrower defense. It answered the December hearing point by point. It says it can’t make clinical decisions or oversee hospitals. Doctors and transplant teams make the clinical calls. CMS and HRSA regulate the hospitals. On retaliation, UNOS says the whistleblowers “are not able to produce evidence of retaliation, because it does not exist.”

In contrast, the American Society of Transplant Surgeons has backed the federal actions and offered to help.

Why aren’t these groups regulated as healthcare?

Almost none of this is about a lack of regulations. KODA’s protocol required an immediate halt if a patient’s neurological status changed. California requires every hospital to keep a protocol for asking a dead patient’s family about donation. The state is supposed to audit for it. Mississippi makes it a misdemeanor to run a hospital without a state license. It has no license category for organ recovery centers.

What was missing was enforcement and penalties for those who didn’t comply with regulations. Martin testified that staff wanted to report the Hoover case. Their access to his records was cut off, and they were told KODA would handle it internally.

Congress left OPOs off Medicare’s list of healthcare providers. The 1986 budget act pays them through a certification condition instead. CMS wrote its own OPO rules in 1996 and rewrote them in 2006. Those rules require only that staff be “qualified”. A license is required of the medical director and nobody else. So the people at a dying patient’s bedside don’t have to hold a clinical license. Whistleblower protections that cover nurses and doctors don’t cover OPO staff. In January 2026, CMS proposed requiring state licenses for OPO staff who do clinical work. It would be the first such rule. The comment period closed March 31. Martin told me her clinical supervisor was hired out of a Jimmy John’s. Greg Segal co-founded Organize, a nonprofit that pushes for reforms to raise the supply of transplantable organs. He told Congress that a Los Angeles Uber driver once mentioned doing organ recoveries for the local group as a side gig.

The consequences fall unevenly. In Alabama, families of men who died in state custody say their bodies came back without a heart or a brain. A state judge let their lawsuit proceed last year. Attorneys general in Kentucky, New Jersey, and New Mexico have all confirmed inquiries of their own. Mississippi declined to comment. California says it’s aware.

What CMS and Congress haven't done.

Some things have. Federal regulators have ordered every OPO to designate a patient safety officer with around-the-clock coverage. The job is to investigate complaints in real time and serve as a contact for families. Regulators also directed the Organ Procurement and Transplantation Network to build a formal way to pause organ recovery. They also ordered a gap closed in the federal data. Records of people authorized as donors whose organs were never recovered had been dropping out. They now have to stay in. In March 2026, CMS issued guidance after reports that some groups had rushed families.

What hasn’t changed is the structure underlying the nation’s organ donation system. Payment stays on cost until 2028. OPOs still sit outside the Medicare category that carries licensing and oversight duties, under a law Congress wrote in 1986.

All 55 federal agreements expire in January 2027, and CMS says it will extend them where a service area needs more time. Decertification actions against the failing tiers start 60 days after CMS publishes its final rule, which it expects late this year. But only the lower tiers face competition. 30 of the 55 were top-tier in the most recent report, up from 15 four years earlier. 10 were in the bottom tier, down from 24. It’s also the wrong lever for these harms. Tier standing rests on 2 measures. How many donors, and how many organs transplanted. Neither asks whether a family was rushed, whether a revocation was honored, or whether a patient was alive. OPOs that push harder score higher. Nothing on that scorecard would have caught a single case in this article. The pancreas exception is part of the same problem. It lets a group add donors whose organs nobody transplanted.

The 2 groups the government did move against were caught differently, through the health and safety rules CMS can enforce at any time. But it took 40 years to use it once.

Congress wrote that classification and can undo it. CMS controls the staffing rules under it, and proposed a licensing requirement in January. Congress can also change the payment structure and the immunity. It hasn’t.

Life Alliance, the Miami OPO, had its Medicare agreement terminated on March 27, 2026. Nevada Donor Network took over South Florida. Network for Hope is appealing, meaning it continues operating while the appeal proceeds.

• The FDA approves Moderna’s mFLUSIVA mRNA vaccine for influenza.

• Why did the FDA say “no” in February?

• How well does mFLUSIVA work?

• What got green-lit, and what got cancelled?

• Will your insurance cover mFLUSIVA?

• The advantage of mRNA vaccine technology.

• Where the decisions get made.

The FDA approves Moderna’s mFLUSIVA mRNA vaccine for influenza.

On Wednesday night, the Food and Drug Administration approved mFLUSIVA, Moderna’s seasonal flu shot and the first flu vaccine built on mRNA.

August 5th was the FDA's target action date, the deadline the agency sets for itself under user-fee law.

Why did the FDA say “no” in February?

On February 10th, the FDA refused to file Moderna’s application. The objection came from Dr. Vinay Prasad, then head of the vaccine division. Moderna had tested its shot against a standard-dose flu vaccine rather than the strongest shot older adults can get.

A refusal to file is rare for a large company with a completed 40,805-person phase III trial. Eight days later, Moderna announced that it had met with the agency and that the FDA had accepted an amended application. On June 18th, the agency’s vaccine advisory committee took 2 votes, one for adults 50 to 64 and one for 65 and older. Both came back 9 to 0 in favor of approval. VRBPAC voted on whether benefits outweigh risks, not on approval. Changed to "in favor."

How well does mFLUSIVA work?

In the pivotal trial, 2.0% of people who got the Moderna flu shot got sick with the flu. Among those getting the standard-dose flu vaccine, 2.8% did. That means that there were about a quarter fewer flu cases among those getting the Moderna flu shot than those getting the standard-dose flu shot.

Side effects were about twice as high as for the standard-dose flu vaccine. Roughly two-thirds reported arm pain, 45% fatigue, and 38% headache. The FDA gave the Moderna flu vaccine full approval for adults 50 to 64. For adults 65 and older, the FDA granted accelerated approval based on immune response, but Moderna still owes the FDA a study showing the vaccine prevents illness, too.

What got green-lit, and what got cancelled?

On May 1, 2025, HHS announced Generation Gold Standard, a $500 million NIH effort to build universal flu and coronavirus vaccines out of whole killed virus. That technology is about 70 years old. The money came from Project NextGen, the Biden-era COVID vaccine program HHS had called wasteful.

Four weeks later, HHS cancelled $766 million in federal funding. That included a $590 million contract signed that January for mRNA vaccines against flu strains that could start a pandemic, including H5N1. Continued investment was "not scientifically or ethically justifiable," HHS communications director Andrew Nixon said.

And then in August, HHS Secretary Robert F. Kennedy Jr. cancelled 22 more mRNA projects at BARDA, worth about $500 million, most of them for flu and COVID. HHS has never documented where that money went. Asked, the department pointed back to Generation Gold Standard.

Will your insurance cover mFLUSIVA?

FDA approval decides whether a vaccine can be sold. Then the Advisory Committee on Immunization Practices (ACIP) determines whether insurers have to cover it for free. The exception is Medicare, for which Congress wrote influenza vaccine directly into the statute.

Under the Affordable Care Act, private plans must cover ACIP-recommended shots with no copay. That kicks in once the CDC director adopts the recommendation. Even then, commercial insurance plans aren’t required to cover the vaccines until at least a year later. The Inflation Reduction Act ties state Medicaid coverage of adult vaccines to ACIP.

ACIP has not voted on mFLUSIVA. Normally, it wouldn’t have to. Its influenza recommendation is for everyone 6 months and older gets an annual shot, using “an age-appropriate influenza vaccine,” with “no preferential recommendation” among licensed options.

On June 9, 2025, Secretary Kennedy removed all 17 sitting ACIP members and named his own. Then on March 16, 2026, Judge Brian Murphy stayed those appointments and the votes the new members had taken. He found the panel was likely seated in violation of the Federal Advisory Committee Act. HHS appealed on April 29th. The committee has had no quorum since, and its June meeting was cancelled.

So there’s no 2026-27 influenza statement. The adult immunization schedule still posted is the 2025 version. Its notes say “any influenza vaccine appropriate for age,” which should include mFLUSIVA, bu its product table lists inactivated, recombinant, and live attenuated vaccines, not mRNA.

Dr. Erica Schwartz was confirmed as CDC director 51 to 44 on August 5th, the same day the Moderna flu vaccine was approved. Adopting a recommendation is her call. A 65-year-old on Medicare Part B pays nothing either way. A 55-year-old with employer coverage or on Medicaid may be waiting on her sign-off.

The advantage of mRNA vaccine technology.

Most flu vaccine is still grown in fertilized chicken eggs. That process takes months, and it forces a strain guess long before the flu season starts. In a pandemic, it would take about 18 months to produce enough egg-based flu vaccine to cover a quarter of the world.

The advantage of mRNA vaccines is that they’re built from genetic sequences. You can redesign them and make them in weeks. That speed matters whether it’s a natural spillover event, lab accident, or bioweapon that leads to an epidemic or pandemic.

No US law requires synthetic biology companies, which make synthetic DNA and mRNA, to screen their orders for dangerous sequences. Under a 2024 White House framework, federally funded researchers can buy only from providers that agree to screen. Providers sign up voluntarily. But anyone without federal money falls outside that framework.

A 2025 study in Science tested the screening software. AI design tools produced 76,080 variants of 72 toxins and viral proteins. The software missed many of them. Developers patched it, and about 3% still get through.

On June 4th, the Foundation for American Innovation and the Institute for Progress organized a letter asking Congress for “mandatory nucleic acid synthesis screening, including recordkeeping, in the United States.” It said Congress “should act this session,” and it applauded “legislative efforts currently underway.”

“AI systems are improving rapidly, and alongside incredible benefits to science and medicine, there is a real possibility that the knowledge barriers which have historically prevented bad actors from obtaining biological weapons will meaningfully erode,” the letter said.

Signatories included Sam Altman of OpenAI, Dario Amodei of Anthropic, Demis Hassabis of Google DeepMind, and Mustafa Suleyman of Microsoft AI. Dozens of life sciences and national security experts signed, along with Eric Horvitz of Microsoft, senior author on that Science paper. Executives at Twist Bioscience and Ansa Biotechnologies signed too. Those are two of the companies the rule would cover.

If someone releases something engineered, you want a countermeasure you can redesign against a sequence in weeks. The FDA just licensed that capability for seasonal flu, but HHS has defunded it for pandemics.

Where the decisions get made.

BARDA's advanced development money is a congressional appropriation. It runs through the Labor-HHS subcommittees, chaired by Rep. Robert Aderholt (R-AL) in the House and Sen. Shelley Moore Capito (R-WV) in the Senate. Sen. Tammy Baldwin (D-WI) is the ranking Democrat there, and Sen. Patty Murray (D-WA) sits on the subcommittee while serving as vice chair of the full Senate committee. In the House, Rep. Tom Cole (R-OK) chairs full Appropriations and Rep. Rosa DeLauro (D-CT) is its ranking Democrat. Aderholt's FY2027 bill adds $105 million for medical countermeasures, but doesn't mention mRNA vaccines.

Insurance coverage depends on the First Circuit Court of Appeals, which is deciding whether Brian Murphy, U.S. District Judge for the District of Massachusetts, was right to block Secretary Kennedy's ACIP appointees. That ruling settles will determine who sits on the committee. The CDC director can then adopt the recommendation or not.

Senators Tom Cotton and Amy Klobuchar introduced the Biosecurity Modernization and Innovation Act on February 4th. It would direct the Commerce Department to require gene synthesis providers to screen their orders and their customers.

• Nine recalls, nine mysteries.

• How big is the lettuce outbreak now?

• Et tu, Salmonella?

• Why is it so hard to trace foods at the center of an outbreak?

Nine recalls, nine mysteries.

Nine recalls this year came after investigators tied a food to people getting sick. Moringa powder, three separate times. Raw cheddar. Soft cheese. Powdered infant formula. Frozen blueberries. Iceberg lettuce. Eggs. Two of those investigations are still growing this morning.

The FDA is running nine more investigations in which no one has identified the food at all. Salmonella, Listeria, E. coli, and five separate Cyclospora clusters. Without a food source, there’s nothing to recall.

Note that many 2026 recalls occurred because a routine test came back positive, and no one got sick. Salmonella in Ghirardelli cocoa mix made with recalled milk powder. Listeria in Atlantic salmon sold at BJ's, caught by a random FDA sample. Listeria in ready-to-eat grilled chicken, caught by a third-party lab. E. coli in nearly 23,000 pounds of ground beef, E. coli O145, caught by USDA testing.

How big is the lettuce outbreak now?

Michigan reported 11,503 cases of cyclosporiasis as of August 4th, and 193 hospitalizations as of July 30th. In a normal year, the state sees about fifty cases.

On August 3rd, Michigan also reported the first two deaths. Both people had serious underlying conditions. Cyclosporiasis almost never kills anyone.

The Washington Post and The New York Times both report that the CDC is expanding the outbreak linked to Taylor Farms lettuce from nine states to fifteen: Arkansas, Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Missouri, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, and West Virginia.

CDC is separately looking at a North Carolina cluster linked to parsley and cilantro.

There is still no positive food sample anywhere in this investigation. The link to Taylor Farms rests on traceback and patient interviews.

Et tu, Salmonella?

On July 22nd, Midwest Poultry Services recalled 1,589,577 dozen shell eggs, about 19 million, sold as Kroger, Simple Truth, Brookshire’s, Country Morning and Sunups. Ninety-eight people across 17 states are confirmed sick with Salmonella Enteritidis, and 26 have been hospitalized. Of 44 people interviewed, 40 reported eating eggs. Samples from the company’s Texas farms matched the outbreak strain by whole-genome sequencing. However, additional sources are still under investigation.

The outbreak strains appear to be resistant to ciprofloxacin and nalidixic acid. Most Salmonella infections don’t need antibiotics at all, but for those that do, the usual first-line option may not work.

Minnesota is now facing a second outbreak of Salmonella. The food source has yet to be identified. The state has reported 110 cases of Salmonella Javiana. Of 84 people interviewed, 75 had eaten at Chipotle. Chipotle found jalapeños from a common lot and pulled them, but no positive product sample has been reported. FDA opened a traceback on July 22nd covering several ingredients, and no supplier, farm, or growing region has been named. People who ate at other Mexican-style restaurants got sick too. That points to an ingredient several operators buy from the same place.

Chipotle has been here before. In 2015, Salmonella Newport sickened 64 people across 22 Minnesota locations. The food turned out to be tomatoes. The company rebuilt its whole food safety program afterward, and that rebuild is why it could find the jalapeño lot in days. Finding a lot fast is containment. Prevention happens out on the farm and in the packing house, and that’s where it keeps failing.

Why is it so hard to trace foods at the center of an outbreak?

A 2022 FDA new rule requires companies that handle foods like lettuce to keep detailed tracking records, so investigators can trace contamination to its source in about a day instead of weeks. The compliance date was originally January 20, 2026.

On March 20, 2025, the FDA announced it intended to push that date back 30 months. Six days later, Taylor Fresh Foods, the parent company of Taylor Farms, gave one million dollars to MAGA Inc., a super PAC supporting President Trump. It’s on line 17 of that committee’s mid-year filing, dated March 26, 2025. (Search the page for “Taylor.”) It was the company’s first gift to any Trump-aligned committee, and twice the largest single donation it had ever made.

Taylor Fresh Foods has written six-figure checks to Republican super PACs across four election cycles, but 2025 was a year of broad escalation. It gave another million dollars to the Congressional Leadership Fund in June, plus two more six-figure gifts. Its federal political giving that year came to $2.2 million, against $950,000 in 2024. Bruce Taylor, the company’s chief executive, is a major Republican donor personally but has never given to a Trump-aligned committee.

I don’t know whether the March donation had anything to do with the delay, and I’m not claiming it did.

In August 2025, the FDA published a proposed rule to move the compliance date to July 20, 2028. It was never finalized. But what’s actually stopping enforcement is money. Section 780 of the appropriations act that ended the shutdown, signed November 12, 2025, says no funds appropriated by that Act “may be used to administer or enforce” the traceability rule “prior to July 20, 2028.”

• What New Mexico's outbreak cost, itemized.

• Where did the $5.4 million go?

• 53% of the cases were adults.

• Who has the power to change things?

What New Mexico's outbreak cost, itemized.

Chasing down a single case of measles in New Mexico last year cost the public health response $32,030. That’s before anyone’s medical bills.

The figure comes from a cost analysis published August 4th in Annals of Internal Medicine by researchers at the Centers for Disease Control and Prevention (CDC) and the New Mexico Department of Health. They added up what the state’s 2025 outbreak cost to society as a whole: 100 cases across nine counties, 7 hospitalizations, 1 death, and $5,352,173. That’s $53,522 per case.

The accounting is unusually granular. Each of the 2,946 identified contacts cost $1,817. Each quarantined adult who never got sick lost $4,341 in wages. The response worked out to $1.51 for every person living in New Mexico.

Where did the $5.4 million go?

Not where you’d guess. Medical care was 5% of the total. All 7 hospitalizations, all 79 outpatient visits, and all the lab work: $290,148.

The biggest line item was the public health response, at $3.2 million. New Mexico stood up an incident command structure, traced 2,946 contacts, and ran 60 mobile vaccination clinics across 11 counties between February 15th and August 24th. It took 133 people and 22,399 hours.

The second biggest line item was lost wages, at $1.9 million. Most of that money was lost by people who never had measles. They were contacts, sent home to wait out the incubation period. Quarantined adults alone accounted for $555,640 of it.

Now look inside the response. Its largest single component, about $2.1 million, was vaccination. Roughly $1.1 million of that bought additional 21,521 doses of MMR. The same vaccine costs $26.35 a dose on the federal contract.

Call it the outbreak surcharge. The vaccine costs what it costs either way. What changes is the van, the overtime, the weekend clinic, and the staffer who drives an hour into Lea County to reach one family that’s finally motivated because somebody in the county died.

53% of the cases were adults.

The picture most people carry is a classroom. The data show something else.

53% of the New Mexico cases were adults, 18 and over. 85% of cases were unvaccinated. When the outbreak began, the state immunization registry showed 92% of New Mexico children with at least one dose of MMR, and 51% of adults. The World Health Organization puts the threshold for stopping community spread at 95% with two doses.

Of the 21,521 extra doses the state pushed out during the response, 17,146 went to adults.

The study can’t say why adult coverage was that low, and the gap matters. Some of it is refusal. Some of it is a records problem, because adults move between states. Some of it is people who got one dose when one dose was the schedule, and have never in fifty years had anyone bring up getting a second shot.

Who has the power to change things?

New Mexico did this about as well as it can be done. The outbreak was declared over on September 26, 2025, at 100 cases. Across the state line, Texas ran past 750 cases and spent more than $10 million. Nationally, researchers put the total economic burden of the 2025 outbreaks at $244.2 million, or $104,629 per case.

One number in the New Mexico accounting is easy to skim past. Of the $3.2 million spent on the public health response, the CDC bore $1.2 million, and federal funds also covered outbreak communications, about two-thirds of the mobile clinics, and vaccine shipping.

In March 2025, HHS moved to cancel roughly $11 billion in public health grants to states, prompting a lawsuit from 23 states and the District of Columbia; a judge blocked the cuts for the states that sued. About $2 billion of it was slated for immunization programs. Section 317, the federal program that buys vaccines for people who fall through the insurance cracks, has been flat for years. A 2023 CDC report to Congress put the need at $1.6 billion. Congress appropriated only $682 million.

Meanwhile the states are moving the other way on vaccination requirements. Nine of them loosened school vaccine exemptions in 2025.

Who has the power to change things? It sits with the Congress, which decides how much to spend on the vaccine safety net, state legislatures writing exemption law, and with the state health departments that could build an adult recall system to boost up vaccination rates among those who’ve fallen through the cracks. An adult with no vaccination record isn’t necessarily vaccine hesitant. In a lot of cases nobody has ever asked.

The United States has already logged more measles cases this year than in all of 2025. Come November, the nation will likely lose its measles elimination status.

• First, what he got right.

• Then Secretary Kennedy named a source.

• What the 2013 IOM review concluded.

• Secretary Kennedy’s science.

• Secretary Kennedy’s history.

• The challenge of real-time fact-checking on TV.

This morning, HHS Secretary Robert F. Kennedy Jr. sat down with Dana Bash on CNN’s State of the Union, and for twenty minutes it went about the way you’d expect. Both of them raised their voices. Each accused the other of attacking them. He told her she’d committed “press malpractice” and that scaring people was “the job of CNN.” She told him he was causing inaccurate information to circulate. By 9:20 a.m. they were calling each other parrots.

The Secretary of Health and Human Services repeatedly demanded proof. Cite me the study. Show me one study. You cannot show me a single study that says that.

First, what he got right.

That’s the right demand. It’s the one I’d make. Most of what goes wrong in TV health coverage goes wrong when somebody says “studies show” and nobody asks which ones or assesses their quality.

Secretary Kennedy said Mexico has about 15 times the US measles rate per capita, Canada about four times, England about two. I checked all three against PAHO’s July situation report and UKHSA’s figures. For 2026 they come out at roughly 14, roughly 4.05, and roughly 2.35.

He said the measles vaccine stops about 97% of cases. That’s CDC’s figure for two doses, exactly.

Sen. Rand Paul released 1,141 pages of Dr. Anthony Fauci’s diary on July 25th. A March 15, 2020 entry reads: “I spoke with Bill de Blasio and convinced him... to close the NYC schools,” and “I went on to tell him he should close the bars and restaurants in NYC.”

Then Secretary Kennedy named a source.

About fourteen minutes in, he stopped asking for citations and produced one. He invoked the Institute of Medicine, now known as the National Academy of Medicine, and called it the ultimate arbiter on vaccine safety. He said according to them, none of the eight vaccines “that are administered during the first six months of life have ever been studied for relationship to autism.”

What the 2013 IOM review concluded.

The 2013 IOM review of the childhood immunization schedule says, in Chapter 5: “The initial literature search identified 32 papers on the relationship between immunizations or vaccines and pervasive developmental disorder.” And: “The evidence of an association between autism and the overall immunization schedule is limited both in quantity and in quality and does not suggest a causal association.” The report brief states the committee’s conclusion in one line: “the IOM committee finds no evidence that the schedule is unsafe.”

The IOM committee wrote that “studies designed to examine the long-term effects of the cumulative number of vaccines or other aspects of the immunization schedule have not been conducted,” and recommended more work on cumulative exposure. That’s about studying the schedule as a single unit rather than one shot at a time.

But that isn’t what Secretary Kennedy said.

On November 21, 2025, the CDC’s page on vaccines and autism was rewritten. Where it had said no links were found between any vaccine ingredient and autism spectrum disorder, it now says: “’Vaccines do not cause autism’ is not an evidence-based claim.” CBS News reported that political appointees at HHS directed the change without consulting the CDC scientists whose subject it is. Secretary Kennedy told The New York Times he ordered it himself.

That page was updated again on July 22nd. It now names seven infant vaccines and asserts there are “still no studies that support the claim that any of the 20 doses of the seven infant vaccines” don’t cause autism. Seven vaccines, 20 doses, the first months of life.

On November 23, 2025, two days after the CDC page changed, the presidents of both the National Academy of Medicine and the National Academy of Sciences issued a joint statement saying that vaccines do not cause autism and that the CDC had cited National Academies work “without sufficient context.”

Secretary Kennedy’s science.

May 2025. The MAHA report came out. NOTUS found that it cited studies that did not exist. Researchers listed as authors said they had not written the papers attributed to them. The report was updated, and then updated again with new errors.

August 2025. HHS cancelled roughly $500 million in BARDA mRNA vaccine contracts. Asked for the scientific basis, it sent STAT News a list of studies. The list had originally been assembled as research for a 2024 book called Toxic Shot: Facing the Dangers of the COVID “Vaccines.”

September and December 2025. CDC staff presented a 2010 paper on hepatitis B vaccination and developmental disability to the vaccine advisory committee, the second time days before that committee voted to change the infant hepatitis B recommendation. The paper rested on 31 autism cases. On May 21st, the paper was retracted, the journal citing “fundamental methodological flaws,” a sample it called “critically small,” and an “overstated conclusion that inappropriately suggests causality.” The vote stands.

January 2026. The childhood immunization schedule was revised. ACIP was not consulted. The revision rested on evidence assembled by two federal health officials and was signed by an acting CDC director. A federal court stayed it in March. The next hearing in AAP v. Kennedy is this month.

And one more example. When a study of 1.2 million Danish children found no association between aluminum-adjuvanted vaccines and autism or 49 other chronic conditions, Secretary Kennedy asked Annals of Internal Medicine to retract it, and the journal declined.

Secretary Kennedy’s history.

On CNN, he said the communities with measles are almost all religious communities that don’t vaccinate, and added: “Even the Mennonites have not vaccinated since 1796, since Edward Jenner invented the smallpox vaccine.”

Mennonites in the Chortitza colony began immunizing their children against smallpox in 1804, within about eight years of Jenner, and colony records show them petitioning Russian officials to obtain cowpox vaccine. The 1809 and 1814 vaccination lists for Chortitza survive and name the families and children, village by village. By 1817, the Molotschna colony had vaccinated 197 of its 311 children.

CDC’s own field investigation of the West Texas outbreak, in a Low German Mennonite community in Gaines County, records no religious prohibition on vaccination. It describes distrust of outside institutions. Mennonite Church USA said: “As a denomination, MC USA does not request vaccine exemptions for our members on behalf of our religious beliefs.”

Secretary Kennedy also said on Sunday that he has never questioned the efficacy of the MMR vaccine. But in an April 2025 CBS News interview, he said: "We're always going to have measles, no matter what happens, as the vaccine wanes very quickly." Two doses of MMR are 97% effective against measles, and the CDC says that protection usually lasts for life.

Two unvaccinated school-aged children died of measles in West Texas last year, along with one unvaccinated adult in New Mexico. There were 2,371 confirmed US cases as of July 30th, a 35-year high and the second record year running, and PAHO’s review of whether the United States still qualifies as having eliminated measles has been pushed to November.

The challenge of real-time fact-checking on TV.

Bash cited more than 40 studies covering 5.6 million people. Secretary Kennedy cited a webpage.

Telling them apart means reading the 2013 IOM report, checking who commissioned it, pulling the revision history on a CDC page, and locating a retraction notice from May, which is a day of work. It can’t happen inside a twenty-minute segment, and he knows that.

Viewers can’t adjudicate in real time, and “do your own research” is the instruction that helped create this problem.

Each item opens with what was actually said. Quotes are from the C-SPAN caption transcript with video and clock timestamps; obvious captioner garbles are corrected in square brackets, and everything in bold is the specific assertion being checked.

• Sen. Ron Johnson’s case, claim by claim.

• The 1.7 million and the 39,000.

• The Rasmussen coincidence.

• What the courts found about NIAID and social media.

• The FDA scientist who warned about hidden signals.

• What Dr. Nath’s 23 patients showed.

• Whether the vaccine caused Dr. Fauci's lung clot.

• The deaths-per-year poster has no denominator.

• Sen. Ernst on Dr. Fauci’s salary, the billion, and the Chinese institute.

• Sen. Hawley on the prizes and the money.

• Did the NIH used subawards to hide Wuhan funding?

• The mouse shipment.

• Did NIAID bribe the Proximal Origin authors?

• Why Bill Gates had a Q clearance.

• What “empiric” means, and whether it is lying.

• What happens next.

Sen. Ron Johnson’s case, claim by claim.

Sen. Johnson · 00:51:43 video / 9:21:24 a.m. ET

“I was warned pretty early on about the dangers of the experimental gene therapy that you called a vaccine, but it really falls under the definition of gene therapy. Were you carefully monitoring the safety surveillance systems that were literally deluged with complaints? Currently worldwide there have been almost 1.7 million adverse events reported to the system. Of those, 39,000 were deaths. Of those deaths, 29% occurred within the date of vaccination. It happens to be the same percentage that a Rasmussen poll pointed out the American public believed they knew someone who died of the experimental gene therapy... When I published it and people had me on their shows, they would be censored by Facebook. They would be deplatformed, largely at the behest of the actions you took to make sure that this information wasn’t spread. This wasn’t disinformation. It was the truth.”

Contradicted. FDA’s gene-therapy guidance explicitly excludes vaccines: “This guidance does not apply to vaccines for infectious disease indications.” EU directive 2001/83/EC defines a gene therapy medicinal product and then states: “Gene therapy medicinal products shall not include vaccines against infectious diseases.” Comirnaty’s approval letter is signed by Marion Gruber, director of FDA’s Office of Vaccines Research and Review, not by the gene-therapy review office. mRNA is translated in the cytoplasm. There is no reverse transcriptase and no integrase.

The kernel. Moderna's own pre-pandemic SEC filing says, "Currently, mRNA is considered a gene therapy product by the FDA." But the next line of the same risk factor reads: "Unlike certain gene therapies that irreversibly alter cell DNA and could act as a source of side effects, mRNA based medicines are designed to not irreversibly change cell DNA." Moderna filed that in November 2018, more than a year before any mRNA vaccine existed, and the risk it was describing to investors was a perception problem. The company's later annual reports carry the parallel line about the European Union characterizing mRNA as a Gene Therapy Medicinal Product, and the EU directive quoted above is the carve-out that line is describing.

mRNA vaccines share a mechanistic family with gene therapy and are excluded from the category by an explicit regulatory carve-out that has a scientific rationale, no integration and transient expression.

The 1.7 million and the 39,000.

Contradicted as evidence of harm.

The figures are VAERS as tabulated by OpenVAERS, current through June 26, 2026: 1,677,227 reports and 39,182 death reports. Sen. Johnson’s numbers match to the digit. VAERS is a United States system rather than a worldwide database, and about half its reports are foreign events forwarded by manufacturers. The actual global total is far larger. VigiAccess, the public window onto the WHO-affiliated Uppsala Monitoring Centre’s global database, lists on the order of 5.8 million.

The United States gave more than 670 million doses between December 14, 2020 and March 1, 2023, skewing heavily toward the oldest and sickest first. American all-cause mortality is roughly 2.7 deaths per 100,000 people per day. Coincidence alone predicts on the order of 55,000 deaths in the three days after a dose, and more than that given the age skew. VAERS captured about 11,300 in that window, a fraction of what chance alone predicts, and that count includes foreign reports, so the American figure is lower.

The Rasmussen coincidence.

Overstated, and the two numbers count different things.

What Rasmussen is. Rasmussen Reports is a private American polling firm. It polls by automated telephone, with a recorded voice reading the questions, and by online panel. FiveThirtyEight dropped it from its polling averages in March 2024, saying it failed the site’s standards for pollsters.

Rasmussen’s December 2022 survey found 28% of American adults saying they know someone personally who died from COVID vaccine side effects, fielded December 28 to 30, 2022, 1,000 adults, margin of error 3 points. Asked again in October 2023, the figure was 24%, from 1,110 adults.

Sen. Johnson presented a VAERS percentage and a polling percentage landing near the same number as two independent measurements converging. They are not independent, and they do not measure the same thing. One is the share of death reports filed within three days of a dose. The other is the share of survey respondents who believe they personally knew someone who died. Public belief about vaccine deaths tracks what people are told, and it is not a second measurement of how many people died. This is evidence, however, of a significant lack of trust in institutions.

What the courts found about NIAID and social media.

Contradicted as to Dr. Fauci. Partly documented as a general phenomenon.

The case is Missouri v. Biden. Two states and a group of individuals sued, arguing federal agencies had pressured social media companies into taking their posts down, and a district judge ordered a long list of agencies to stop. On appeal, the Fifth Circuit took Dr. Fauci and NIAID off that list. The evidence showed “the NIAID did not have regular contact with the platforms or flag content,” and that at most Dr. Fauci and his officials “promoted the government’s scientific and policy views and attempted to discredit opposing ones,” which the court called ordinary government speech rather than a First Amendment violation. The order stood only against the White House, the Surgeon General, CDC, FBI, and CISA.

Then the Supreme Court threw the case out. In Murthy v. Missouri, decided 6 to 3 in June 2024, it held that the people suing had not shown their own posts came down because of anything the government did, so they had no right to bring the case. The justices added that the trial judge’s findings “unfortunately appear to be clearly erroneous.” That is a ruling about who may sue, not about whether the pressure happened. The Fifth Circuit wiped out the order that August.

Mark Zuckerberg’s August 2024 letter, the best single piece of evidence for the general grievance, says “senior officials from the Biden Administration, including the White House, repeatedly pressured our teams for months to censor certain COVID-19 content,” and then: “Ultimately, it was our decision whether or not to take content down, and we own our decisions.” The letter doesn’t mention Dr. Fauci, NIH, or NIAID.

Sen. Johnson’s own suspension was from YouTube, for seven days in June 2021, not from Facebook.

The FDA scientist who warned about hidden signals.

Sen. Johnson · 00:53:03 video / 9:22:44 a.m.:

“My investigation shows that March 1, [Dr. Peter Marks] was warned by Dr. [Ana Szarfman] that the algorithm they were using to analyze the data was going to [mask] safety signals. 26 days later... there were new algorithms that unmasked the safety signals, including sudden cardiac death, cerebral artery occlusion, basal ganglia stroke, Bell’s palsy, and pulmonary infarction.”

Partly verified.

What masking means. VAERS is a pile of reports about problems people had after a shot. To spot a problem you compare: is this event reported more often after this vaccine than after all the others in the pile? In 2021 the pile was mostly COVID vaccine reports, so comparing one COVID vaccine to everything else largely meant comparing it to the other COVID vaccines. If they all had the same problem, no flag appeared. And a flag is not an injury. It means an event is reported more often than the math expected.

Dr. Ana Szarfman worked at FDA’s drug center. VAERS belongs to its biologics center. On March 1, 2021 she told the biologics director, Dr. Peter Marks, that the method in use “is not the state of the art.” She was lead author of the 2002 paper that brought it into FDA, and William DuMouchel, who built the math behind it, agreed with her.

She was right that masking is real. "Signaling COVID-19 Vaccine Adverse Events," in Drug Safety in 2022, found flags "may be undetected or delayed due to masking," and that masking "is much more likely to occur in COVID-19 vaccine signaling." Three caveats. Dr. Szarfman is one of eight authors, so it is not independent confirmation of her own position. Six of the eight work for Oracle Health Sciences, which sells the signal-detection software the paper recommends. And the paper says masking "is rare relative to all possible statistical associations."

Then, CBER’s Dr. Craig Zinderman asked Dr. Szarfman to “hold off on creating and sending data mining reports and analyses using COVID-19 vaccine [adverse event] data,” and Dr. Marks went to her boss warning that her work could “create erroneous conflicts that feed in to anti-vaccination rhetoric.” Separately, the CDC skipped a weekly check its own written procedures required. Those are real failures.

FDA didn't stop at flags. Studies of millions of people on Medicare, 3.4 million after a first round of shots and 6.2 million after a booster, "did not find an increased risk" for heart attack, low platelets, a serious clotting disorder, Bell's palsy or heart inflammation. A study of 99 million people in eight countries confirmed real risks: heart inflammation after all three vaccines it examined, and Guillain-Barré syndrome and a rare brain clot after a first dose of AstraZeneca.

At a separate April 2026 hearing, David Wiseman of Synechion, Inc. and Karl Jablonowski of Children’s Health Defense argued that FDA missed 96% of Pfizer flags and 91% of Moderna flags, that between 763 and 6,765 flags were lost, and that FDA was “completely blind.” Wiseman’s analysis is a ResearchGate posting that has not been peer reviewed, and the “49 examples of extreme masking” figure rests on FDA records that are not public.

To say 96% of flags were missed, you have to know how many there were. Nobody does. The paper compares flag counts from methods run on different slices of the data, differing by country, date range, which products they are measured against, where the cutoff sits, and whether the same event flagged four weeks running counts once or four times. A gap between those counts could be due to masking or just that the settings were different.

“Completely blind” is contradicted by their own data. The same system produced the heart inflammation finding in young men, the clotting finding that got the Johnson & Johnson vaccine pulled, and the Guillain-Barré finding.

What Dr. Nath’s 23 patients showed.

Sen. Johnson · 00:55:01 video / 9:24:42 a.m.:

"That same... month, March of 2021, an employee at NIH, Dr. [Nath], led a team of researchers diagnosing and treating individuals that had never had COVID who were severely injured by the genetic therapy injections. Dr. [Nath] told the individuals to stay quiet... There was a concerted effort. I will enter this in. It appears inside of NIH to quash his publishing of that study. It was finally put on a server, while telling no one, until I think about may of 2022... They didn't want to publish that because... publishing it would create vaccine hesitancy."

Partly verified on the research and the internal resistance. Unsupported on the allegation.

In May 2022, Dr. Avindra Nath of the National Institute of Neurological Disorders and Stroke and his colleagues posted a 23-patient preprint describing new neuropathic symptoms within a month of vaccination. Twelve of the 23, or 52%, had objective evidence of small-fiber neuropathy. Of those given oral corticosteroids, 58% improved completely or nearly completely within two weeks, against 9% of the untreated at twelve weeks. It was never published after peer review.

NIH Director Dr. Francis Collins called the approach “very troubling,” writing that “collecting anecdotes and then trying to build a case isn’t scientifically compelling and will have the main consequence of feeding vaccine hesitancy.” Lawrence Tabak, then NIH’s principal deputy director, wrote to Dr. Collins: “I don’t understand why Walter [Koroshetz, Director of NINDS] does not shut this down.” Dr. Collins was right that a 23-patient uncontrolled series cannot establish causation. Dr. Nath and his co-authors said so themselves: “the lack of a control group precludes attributing a causative role despite the temporal association.”

There are no emails, memos, or witness statements to demonstrate that Dr. Nath told patients to stay quiet.

“Who had never had COVID” is also unsupported. Prior infection was not an exclusion criterion and prior status is not reported.

Whether the vaccine caused Dr. Fauci's lung clot.

Sen. Johnson · 00:51:43:

“Your diary now shows that you actually suffered pulmonary infarction in June of 2021. I was just wondering what went through your mind that maybe that injection and those boosters that you took might have caused that.”

The event is verified. The inference is unsupported.

Dr. Fauci's diary entry for June 19, 2021 (PDF p. 782-783), describes a frightening day. He had chest pain two days earlier, so his doctor ordered a CT scan. A radiologist called to say the scan showed a spot on his right lung that looked like cancer. "I felt like I got hit like by a Mack truck," he wrote. Three more doctors reviewed the images and thought it was more likely inflammation. What they all agreed on was a smaller finding: a pulmonary infarction at the base of the right lung, where a piece of lung tissue had died because its blood supply was cut off. They told him to start Eliquis, a blood thinner, and repeat the scan in three months.

Dr. Fauci was 80. A lung infarction is usually caused by a pulmonary embolism, and the rate of venous clots climbs steeply with age, with embolism accounting for most of that climb. Clots in the veins are "a fairly common disease, particularly in older age."

The timing doesn’t fit a blood clot related to COVID vaccination. Dr. Fauci was vaccinated in December 2020, five to six months earlier. The widest window in which researchers still consider a vaccine a plausible cause is 42 days.

The biology doesn’t fit either. The one clotting problem linked to COVID vaccines is associated with the Johnson & Johnson and AstraZeneca vaccine, which are adenoviral-vector vaccines. They use a modified cold virus to carry the instructions for making COVID Spike protein into cells. Dr. Fauci received the Moderna mRNA COVID vaccine.

The deaths-per-year poster has no denominator.

Sen. Johnson · 02:40:15 video / 11:09:56 a.m. ET

“Let’s put my latest chart. Again, I was tracking adverse events on the experimental injection. I use this chart as comparison. We’ve got ivermectin, hydroxychloroquine. These are [INAUDIBLE], it does not prove causation but there is correlation. So ivermectin over 30 years of reports with 17 deaths per year. Hydroxychloroquine over 38 years of reporting, 142 deaths per year. [Remdesivir] over five and half years, 546 deaths per year. The COVID injection, almost 7000 deaths per year. Which is safest? What did the FDA freak... out about? Ivermectin.”

The poster above compared “deaths per year” for ivermectin, hydroxychloroquine, remdesivir, and “the COVID injection.”

The comparison does not work. Sen. Johnson said out loud that the numbers do not prove causation. Then he used them as if they did.

These numbers are counts of reports, not counts of deaths the drug or vaccine caused. Anyone can file a report. FDA’s guidance on its drug reporting system says the data “should not be used to determine the safety profile of one drug compared to another,” and “cannot be used to calculate the incidence of an adverse event.” VAERS’ data guide says “for any reported event, no cause-and-effect relationship has been established.”

There are no denominators. A count of deaths means nothing until you know how many people took the thing. Ten deaths among a hundred people is a disaster. Ten deaths among a million is ordinary. More than 670 million COVID shots went into American arms, and the oldest and sickest people got them first. Thousands die every week even in the absence of COVID or COVID vaccines.

The counting rules were not the same either. Anyone who gave a COVID shot was required to report a death that followed it. No such rule covered ivermectin or hydroxychloroquine. So one bar on that chart counts nearly everything, and the others count whatever somebody chose to send in.

Remdesivir has its own problem. It went almost only to people already in the hospital with COVID. Deaths after it are mostly deaths from COVID.

Here is the count when it is done properly. Studies that follow a known group of people, so the number who got the shot is known, found nine deaths caused by COVID vaccines. All nine came from clotting with low platelets after the Johnson & Johnson adenoviral-vector vaccine, which uses a modified cold virus to carry its instructions for making COVID Spike protein into cells. That vaccine was restricted and later pulled.

Reports did turn up myocarditis (i.e. heart inflammation) in young men who received the COVID mRNA vaccines. Researchers followed that lead and conducted studies with real denominators, and the risk turned out to be real.

Sen. Ernst on Dr. Fauci’s salary, the billion, and the Chinese institute.

Sen. Ernst (R-IA) · 02:04:05 video / 10:33:46 a.m. ET:

“Dr. Fauci, in 2022, you had a taxpayer-funded salary of $480,000 a year. You were, in fact, the highest paid federal employee in the entire federal government, even making more than the NIH Director and the president of the united states. According to now public documents, that was due in large part to your work on biodefense. Unreported is how NIAID spent the over $1 billion from 2009 to 2026 in biodefense and influenza federal contracts and sub contracts. My office uncovered records on usaspending.gov that show that NIAID paid out $515,418 in sub contracts to the Harbin Veterinary Institute in China, including $100,000 a few days after it opened a biolab in 2018.”

Dr. Fauci was paid $480,654 in 2022, per federal salary records. The president’s salary has been $400,000 since 2001, set by law.

“Highest paid federal employee in the entire federal government” is overstated. It holds only if you leave out the Tennessee Valley Authority, a federally owned corporation whose chief executive is paid several million dollars a year. Dr. Fauci was the highest paid person on the regular federal payroll.

“Due in large part to your work on biodefense” cannot be checked. NIH can pay certain scientists above the normal federal ceiling to recruit and keep them.

The comparison the hearing left out. $480,654 looks large next to other federal employees. CBO’s 2022 analysis found that federal workers with a professional degree or a doctorate earn about 22% less in total compensation than comparable private-sector workers.

Dr. Vivek Murthy’s disclosure shows what that compensation can look like. He filed it in February 2021, when he was nominated for a second term as surgeon general, and it reported at least $2.6 million earned since January 2020: more than $600,000 from Netflix, $410,000 in cash from Airbnb plus stock then worth roughly $402,000, $400,000 from Carnival, $292,500 from Estée Lauder, and $522,650 across about three dozen speeches.

Dr. Murthy earned about five times what Dr. Fauci made in a single year. This is why NIH has the authority to pay above the ceiling in the first place. Without it, the people at the top of a field often take the other offer.

NIH describes its Title 42 hiring authority, which lets it pay some scientists above the normal federal ceiling, as the flexibility “needed to attract and retain scientists with outstanding scientific, technical and clinical skills.”

What he earns now, since the hearing raised the subject. On July 1, 2023 Dr. Fauci started at Georgetown as a distinguished university professor, appointed to the medical school’s infectious disease division and the McCourt School of Public Policy. He also draws a federal pension, takes royalties on the McGraw-Hill internal medicine textbook he has helped edit since the 1980s, and published a memoir with Penguin Random House’s Viking imprint in June 2024. He speaks for a fee, including for the National Association of Chain Drug Stores, the insurance trade group AHIP, the Japan Medical Congress, and the trading firm WorldQuant. Two prizes came with cash: Columbia’s Calderone Prize at $50,000 and the National Academy of Medicine’s Lienhard Award at $40,000. The household's 2023 filing, submitted by his wife Dr. Christine Grady, records five deposits totaling $1.15 million whose sources the forms do not name. No senator asked about it.

Federal contract spending is published on usaspending.gov, including biodefense and influenza federal contracts and sub contracts. NIAID’s budget request to Congress breaks spending down by grant type, not topic. NIAID’s budget was $6.56 billion in fiscal 2025. Sen. Ernst’s figure covers seventeen years. “Over $1 billion” across seventeen years, at an agency spending six billion a year, is a floor. Under the Trump Administration, NIAID’s request for fiscal 2026 was $4.17 billion, a cut of more than a third.

NIAID did indeed pay out $515,418 in subcontracts to the Harbin Veterinary Institute, part of the Chinese Academy of Agricultural Sciences. USASpending shows five subawards totaling exactly $515,418, under NIAID’s influenza surveillance contract, with Emory University as the prime recipient. NIAID did not pay the Harbin Veterinary Institute directly.

The $100,000 is $104,667, and it landed eight days after China announced the Harbin Veterinary Institute biosafety laboratory on August 8, 2018. The Harbin Veterinary Institute was criticized in 2013 for mixing bird flu and human flu viruses, so the institute’s history is a fair thing to raise.

Sen. Hawley on the prizes and the money.

Sen. Hawley (R-MO) 01:45:55 video / 10:15:36 a.m. ET:

“It was a $900,000 cash award. $900,000 cash award. And he got it. Because he used federal employees to get it and this wasn’t the only award, was it, Dr. Fauci? In fact, you applied for and received at least eight other federal cash prizes on federal time using federal employees and federal resources... you used eight separate federal employees on federal time, using federal resources, to solicit cash awards. Isn’t that true?”

Sen. Hawley (R-MO) 01:49:16 video / 10:18:57 a.m. ET:

“...which is north of $12 million. You got over a million dollars in cash awards during COVID, during a 12-month, 24-month span during COVID... Now you’re worth more than $12 million. You’ve got a pension that in its first year paid out north of $400,000 a year. A million people dead, you’re getting rich.”

The numbers mostly hold, but none of the awards Sen. Hawley named is a federal cash prize.

The $900,000 is right. The Dan David Prize is $1 million. Winners give 10% of it to graduate scholarships. That leaves $900,000. The Dan David Prize is awarded by a private Israeli foundation based at Tel Aviv University.

Neither are the others he named. Sen. Hawley listed the Partnership for Public Service, a Smithsonian award, the National Academy of Medicine, and the CDC Foundation. The Partnership for Public Service, the National Academy of Medicine, and the CDC Foundation are private non-profits. The Smithsonian’s Great Americans Medal is not a cash prize.

The staff-time charge is the real one. Whether federal employees spent federal work hours preparing award nominations for their director is a legitimate question about the use of public resources.

The $12 million and the over $400K/year pension. Both figures come from OpenTheBooks, an advocacy group whose founder published the analysis. Federal financial disclosure forms report holdings in broad ranges rather than exact amounts, so any “net worth” built from them is an estimate with wide margins. The Office of Personnel Management has never released Dr. Fauci’s actual annuity. The pension figure that circulates, $414,667, is OpenTheBooks’ calculation from the federal retirement formula.

“A million people dead, you’re getting rich” links two things that are not linked. A retired federal scientist’s portfolio going up during a bull market is not evidence about a pandemic.

Did the NIH used subawards to hide Wuhan funding?

Sen. Ernst · 02:10:08 video / 10:39:49 a.m. ET:

“At my request, the government accountability office helped track down that $1.4 million of US taxpayer money that was sent to the Wuhan Institute of Virology, both by you, Dr. Fauci and through USAID. But first it passed through EcoHealth Alliance, which I helped to get defunded through the NDAA. Dr. Fauci, did you intentionally use subaward funding to obscure NIH funding of Chinese biolabs and coronavirus research?”

The figure is right. The question at the end assumes something the record does not support.

$1.4 million checks out. GAO found three subawards totaling $1,413,720 disbursed to the Wuhan Institute of Virology between 2014 and 2021.

She is right that it came from two places. NIAID’s bat coronavirus grant sent $598,611 to the Wuhan institute. USAID’s PREDICT program sent the rest, and some of that arrived as a subaward of a subaward, a layer further down than the reporting rules require anyone to publish.

A subaward is the ordinary way a federal grant reaches a partner organization. Hundreds of NIH grant holders use one in any given year, and it is written into the grant documents from the start. Nobody invented it for Wuhan.

But there is a real reporting failure inside her question, and it is not the one she asks about. Federal rules require grant holders to post their subawards to a public database. EcoHealth Alliance did not always do it. That is a documented compliance failure by the grant holder, not a concealment scheme by NIH, and it is the reason the money took a GAO inquiry to trace.

The mechanism she is asking about ended more than a year before the hearing. NIH abolished foreign subawards in May 2025 and replaced them that September with a structure that gives each foreign partner its own grant number and its own reporting duty to NIH.

The mouse shipment.

Sen. Ernst · 02:12:38 video / 10:42:19 a.m. ET:

“Dr. Fauci, we have learned that US coronavirus researchers at UNC shipped ‘humanized mice to China’ by around 2017 for use in their dangerous coronavirus work.”

This is correct, but it doesn’t mean what the sentence implies.

The shipment happened. As reported by the MIT Technology Review in 2021, Ralph Baric’s lab at the University of North Carolina sent transgenic mice carrying the human ACE2 receptor to the Wuhan Institute of Virology.

NIH grant documents obtained by The Intercept put the mouse experiments in the grant year running June 2017 to May 2018.

What a humanized mouse is. To get into a cell, a coronavirus has to grab a protein on the cell's surface called ACE2. Think of it as a doorhandle. The mouse version of that doorhandle is shaped differently from the human version, so SARS-like coronaviruses can’t get a grip and infect an ordinary mouse. So researchers breed mice that carry the human doorhandle instead. These animals are standard equipment across virology, used to test vaccines and treatments as much as to test viruses.

And what went into these ones is the real finding. Researchers at Wuhan built hybrid viruses by putting the outer spike of newly found bat coronaviruses onto the body of a virus called WIV1. According to former Principal Deputy Director Lawrence Tabak in October 2021, one hybrid made the mice sicker than the original virus did and killed six of eight of them.

The grant required EcoHealth Alliance to tell NIH right away if a virus grew ten times better than expected. EcoHealth did not.

NIH says the WIV1 family is too far from SARS-CoV-2 for these particular experiments to have started the pandemic, and the published genomes support that. NIH also says the work did not meet its definition of gain-of-function research at the time, because those bat viruses had not been shown to infect people. That second point describes the rules as they stood in 2017. It does not say the experiments were safe. (More on this in Part 2 of my fact-check.)

Did NIAID bribe the Proximal Origin authors?

Sen. Ernst · 02:11:38 video / 10:41:19 a.m. ET:

“NIAID awarded multimillion dollar grants to a number of scientists shortly after they wrote publicly in the origins paper that the COVID virus likely came from nature... In 2023, Representative Jordan insinuated that you basically gave a $9 million bribe in the form of a NIH grant to NIH-funded virologists to say the virus likely was from nature. Dr. Fauci, yes or no, did you reward the Proximal Origin authors by giving them NIAID grants or contracts?”

The grant is real, but the timeline still doesn’t support a bribe.

NIAID award U01AI151812 funds the West African Research Network for Infectious Diseases, about $9 million. Its principal investigators are Kristian Andersen of Scripps, Robert Garry of Tulane, and Pardis Sabeti of the Broad Institute. Andersen and Garry are two of the five authors of Proximal Origin.

Applications were due June 28, 2019. Independent peer reviewers scored it in November 2019. NIAID’s advisory council recommended funding it in January 2020. Every one of those steps came before the February 1, 2020 phone call that the bribery story is built around, and before Proximal Origin was drafted in February 2020 and published March 17, 2020.

The notice of award did not go out until May 21, 2020. Between the council’s recommendation and that notice, the decision sat inside NIAID, and an institute director has some discretion at the margins. The Intercept made this point in 2023, and it is why “the reviewers had already decided” is not a complete answer.

The score and the council recommendation were already on the record before the call. The team is not new: Andersen, Garry, and Sabeti have worked together on Lassa fever in Sierra Leone and Nigeria for more than a decade, through the Viral Hemorrhagic Fever Consortium. And the center’s subject is Lassa fever and disease surveillance across West Africa.

Why Bill Gates had a Q clearance.

Chair Paul · 02:52:35 video / 11:22:16 a.m. ET, in the closing.

“confirms Anthony Fauci’s tenure that Bill Gates was given security clearance from 2014 to 2021.”

The clearance is real, but it’s not an NIH clearance. The letter is from the Department of Energy. It reports a Q access authorization granted June 11, 2014 and terminated December 6, 2021.

A Q authorization is a nuclear credential. DOE’s own explanation describes it as the department’s equivalent of a Top Secret clearance, and it is the level required for access to Restricted Data, meaning nuclear weapons and special nuclear material information. NIAID does not issue one, hold one, or have any say over who gets one.

Reporting on the letter says DOE recorded the clearance as reciprocal, meaning another federal agency had already vetted Mr. Gates and DOE recognized that agency’s decision. DOE policy requires this: a clearance at the same level from any authorized federal agency must be recognized by the others. The letter does not name the original agency.

Mr. Gates founded the nuclear reactor company TerraPower in 2006 and chaired it through the entire clearance period. Whether that is the explanation is not established, and nobody in the room asked.

Dr. Fauci directed NIAID from 1984 to 2022. Any seven-year span between those years falls inside his tenure. “During Fauci’s tenure” is true of the 2014 Winter Olympics too.

DOE asked the committee to keep the letter confidential and marked it not for public release. Chair Paul read it into the public record on July 29, 2026.

What “empiric” means, and whether it is lying.

Sen. Ashley Moody (R-FL) · 02:18:57 video / 10:48:38 a.m. ET

Sen. Moody: “Public has to be able to trust the people giving them instructions. That trust depends on candor. Would you agree with that, Dr. Fauci?”

Dr. Fauci: “On the advice of counsel I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.”

Sen. Moody: “When the evidence is uncertain, officials need to say so. When recommendations are based on assumptions rather than hard data, they need to say so. So when they get something wrong, they need to own it. And when the trust is lost, the consequences extend far beyond any single pandemic. The next time public health officials genuinely need Americans to listen, millions of people may simply ignore them. Or not believe them.”

The candor charge holds on the masks. It is overstated on the six feet.

The masks. On March 8, 2020, on CBS News’ 60 Minutes, Dr. Fauci said “right now in the United States, people should not be walking around with a mask.” On April 3, 2020, CDC recommended cloth face coverings. Four months after that, at a Washington Post event in July 2020, he explained the original advice differently: “Back then, the critical issue was to save the masks for the people who really needed them because it was felt that there was a shortage of masks.”

“When you told the American people there was no reason to wear a mask, what was your principal objective, giving them an honest assessment of the medical evidence or discouraging them from consuming a scarce supply of masks?” asked Sen. Moody.

Two things were true in March 2020. The evidence on community masking was thin, and the supply was short.

In July 2020, he also gave a third reason: officials “didn’t realize at all the extent of asymptomatic spread.” That is a fact about the virus that nobody had in March and most people had by April, and changing advice when something like that lands is what the job requires.

The six feet. In his April 5, 2020 CBS News’ Face the Nation interview, Dr. Fauci urged people to “physically separate six feet away,” which she contrasted with against his January 2024 testimony (p. 183 to 184): “It sort of just appeared. I was not aware of studies that, in fact, that would be a very difficult study to do... Just an empiric decision that wasn’t based on data.”

He didn’t say distancing doesn’t work. The best evidence available at the time, a WHO-commissioned meta-analysis of 172 studies, found lower transmission at a meter or more. The three-versus-six comparison came later, from a Massachusetts cohort of 537,336 students that found no difference where masking was universal. And Dr. Fauci did not issue the six-foot guidance. The CDC did.

What “empiric” means, and whether it is lying. An empiric decision is a judgment made from experience and mechanism when the direct evidence does not exist. Physicians make them all day. You start empiric antibiotics before the cultures come back, because waiting 48 hours for certainty kills the patient. You pick a dose from pharmacology and analogy when no trial has compared 40 mg to 60 mg. Six feet came from droplet-fall experiments done in the 1930s and decades of infection-control convention.

So the answer to “what do you do when the data are imperfect” is to act on the best available reasoning and say that is what you are doing. The obligation is to label it.

Lying means asserting what you believe to be false. Dr. Fauci did not lie about six feet. He believed distance helped, and it does.

Agencies can be required to publish, alongside any guidance, the evidence tier it rests on and what would change it. CDC already does this internally for ACIP recommendations using the GRADE framework. Nothing stops Congress from requiring it on the face of public-facing guidance.

What happens next.

The committee will vote on whether to certify contempt. That vote does not by itself refer anything to a prosecutor: the full Senate has to adopt the resolution and clear a 60-vote threshold first.

Sen. Johnson has separately promised a subpoena for a closed-door deposition. The perjury statute on the May 2021 testimony expired in May 2026.

None of that addresses the question Sen. Moody asked. The fix she was circling, requiring agencies to publish the evidence tier behind any public guidance and what would change it, needs a bill, not a contempt vote. No one has introduced it.

Each item opens with what was actually said. Quotes are from the C-SPAN caption transcript with video and clock timestamps. Everything in bold is the specific assertion being checked.

• The ferret experiment and what Sen. Paul left out.

• What Dr. Fauci wrote about gain-of-function.

• What “gain-of-function” has officially meant, and for how long.

• The three scientists Sen. Paul called as witnesses.

• Why NIH funding was in Wuhan at all.

• DEFUSE was rejected and never funded.

• Was Dr. Fauci’s May 2021 testimony a lie?

• What “the market was the amplifier” actually claims.

• What the Livermore assessment concluded.

• What none of this settled, and who can act.

• And more news coverage…

The ferret experiment and what Sen. Paul left out.

Chair Rand Paul · 00:38:53 video / 9:08:34 a.m. ET

“This might be the most important we get to today, 50% mortality for humans. The good news about animal viruses is that it doesn’t infect humans well. Doesn’t go human to human very well. With the money that you provided to [Ron Fouchier], [they made] purposeful mutations that didn’t just affect birds but also mammals and went ferret to ferret [in] an aerosolized manner. People saw this and were aghast.”

Partly verified.

NIAID money is real: Herfst et al., Science 2012 carries NIAID contract HHSN266200700010C through the Center for Research on Influenza Pathogenesis, on which Fouchier’s Erasmus MC lab was a subcontractor.

Why anyone would do this. H5N1 lives in wild birds and poultry. It infects people who handle infected birds, rarely, and when it does the illness is often severe. What it has never done is pass efficiently from one person to another.

Whether that barrier is permanent or temporary is the question that governs pandemic planning, and surveillance alone doesn't answer it. You can sequence every H5N1 sample on earth and still not know which genetic changes would matter, because you do not know what to look for.

The experiment was built to produce that list, and it did. Find the mutations that let the virus travel through air between mammals, and surveillance labs know which changes to flag in the next poultry outbreak. In an op-ed in The Washington Post, Dr. Fauci made exactly that case: the new data “can inform influenza preparedness and help delineate the principles of virus transmission between species.” Herfst’s group also reported that their transmissible virus stayed sensitive to oseltamivir, sold as Tamiflu, and that the antibodies raised by existing H5N1 vaccines still recognized it. That last test is the standard way to check whether a vaccine would hold: take blood serum from a vaccinated host, which is full of antibodies, and see whether they recognize the new virus. They recognized it twice as well as they did the original, though antibody binding in a dish is not the same as protection in a person. If this virus ever appeared in nature, the antiviral would work on it, and the existing vaccine looked likely to.

"Purposeful mutations" is half right. Three changes were built into the virus deliberately, by rewriting its genes. The rest appeared on their own, over ten rounds of passing the virus from one ferret to the next and letting it adapt. The paper's own summary: "as few as five amino acid substitutions (four in HA and one in PB2) may be sufficient to confer airborne transmission." Four of those five sit in the protein the virus uses to latch onto cells, and one in a protein it uses to copy itself. Airborne transmission happened, and the authors called it "less robust, with less and delayed virus shedding compared with pandemic A/H1N1 virus."

Here is what Sen. Paul left out, and it is the single most important omission in his gain-of-function case. From the paper's abstract: "None of the recipient ferrets died after airborne infection with the mutant A/H5N1 viruses." In the body: "although the airborne-transmissible virus is lethal to ferrets upon intratracheal inoculation at high doses, the virus was not lethal after airborne transmission." The deaths people remember came from squirting a million infectious doses directly into the trachea, a route the authors described as one that does "not represent the natural route of infection."

Paul cited the 50% figure moments before describing the ferret result. The two numbers answer different questions. The 50% is how often people die once infected with H5N1, and those people caught it from birds, not from each other. The experiment asked whether the virus could travel through the air between mammals. It could, and it killed none of the ferrets it reached.

On the 50%. As a reported figure it holds: WHO counts 964 confirmed human H5N1 cases and 466 deaths since 2003, 48.3%. This number has been contested since 2012, because WHO counts only laboratory-confirmed cases, which are overwhelmingly hospitalized severe cases in countries with thin surveillance. The Congressional Research Service concedes this point: “It is widely understood that this reported mortality rate may not reflect the true historical mortality rate in humans.” Of the 46 US cases reported through October 2024, 45 with animal exposure were all mild, none hospitalized, none dead.

Also on the ferret model. Dr. Fauci's op-ed called the ferret "the best animal model for human influenza infection" and that "it is not clear whether this laboratory virus would behave in humans as it does in ferrets." We need better animal models to study human influenza infection and vaccines.

What the experiment settled. Before this work, nobody could say whether H5N1 was capable of airborne spread between mammals, or which genetic changes would get it there. Afterward there were answers to both: it is, and as few as five substitutions will do it. Surveillance could not have produced that. You cannot flag a mutation you have not yet learned to look for. What the experiment did not settle is how dangerous such a virus would be to people, which is the question Sen. Paul's case turns on, and there the ferret result splits: lethal by intratracheal inoculation, but lethal to none of the animals it reached through the air.

What Dr. Fauci wrote about gain-of-function.

Chair Paul · 00:39:08 video / 9:08:49 a.m. ET

“This is when the debate came about and he wrote in support of this in The Washington Post. You said that even if a pandemic should occur, the knowledge is worth the risks.“

Fair as a paraphrase of a different document.

The op-ed is real: Dr. Anthony Fauci, Gary Nabel and Francis Collins, “A flu virus risk worth taking,” The Washington Post, December 30, 2011, but the sentence Sen. Paul read is not in it." Fauci, Nabel, and Collins defended the research, which would later be categorized as gain-of-function: “Given these uncertainties, important information and insights can come from generating a potentially dangerous virus in the laboratory.”

But they also said: “The question is whether benefits of such research outweigh risks. The answer is not simple. A highly pathogenic bird flu virus transmissible in humans could arise in ways not predicted by laboratory studies. And it is not clear whether this laboratory virus would behave in humans as it does in ferrets.” They said: “Safeguarding against the potential accidental release or deliberate misuse of laboratory pathogens is imperative.” The op-ed never contemplated an actual pandemic as an acceptable price.

But ten months later, Dr. Fauci wrote: “In an unlikely but conceivable turn of events, what if that scientist becomes infected with the virus, which leads to an outbreak and ultimately triggers a pandemic? ... Scientists working in this field might say — as indeed I have said — that the benefits of such experiments and the resulting knowledge outweigh the risks.“ He also wrote: “The influenza virus research community is to be commended for implementing a voluntary moratorium on “gain-of-function” experiments related to the transmissibility of highly pathogenic H5N1 influenza virus. As a key funder of influenza virus research, the National Institute of Allergy and Infectious Diseases, a component of the U.S. National Institutes of Health, strongly supports the continuation of this moratorium pending the resolution of critical policy issues related to the rationale for performing and reporting such experiments.”

What “gain-of-function” has officially meant, and for how long.

Chair Paul · 00:08:38 video / 8:38:19 a.m. ET

“That you could define gain of function in one way in which this was not gain of function, in which all of the common sense of the world be thrown out, all of the idea that the mice were dying in the virus was more transmissible did not matter because you had a technical definition that allowed you to fund it.”

Partly verified. A narrow technical definition governed. NIH's position was that it excluded the Wuhan work. The narrow definition came out of a White House policy process and a recommendation from the government’s own biosecurity advisory board, not from NIAID, and that same board asked in 2023 that it be widened.

“Gain of function” in ordinary use means any laboratory change that gives an organism a new or stronger ability. Most of it is routine and harmless. In federal policy the phrase was meant to pick out a much smaller set: experiments that could make a dangerous pathogen more contagious or more deadly.

Whether a safety rule covers a given experiment depends entirely on which words the rule uses. Those words have changed six times in thirteen years.

2011 to 2012: a different name. The Fouchier and Kawaoka ferret experiments were not called gain-of-function at the time. They were called “dual use research of concern,” meaning legitimate research that could also be misused. The 39-scientist pause letter of January 2012 described pausing work that “enhances the transmissibility of highly pathogenic avian influenza viruses in mammals,” and never used the phrase.

Late 2012: the label attaches. NIH applied it retroactively, to the same two experiments, in “A Proposed Framework for Guiding HHS Funding Decisions about Highly Pathogenic Avian Influenza H5N1 Gain-of-Function Research,” November 27, 2012. That document and the HHS framework that followed in February 2013 made “gain-of-function” the governing term. It has not had a stable federal definition since.

October 17, 2014: a pause that doesn’t define what it pauses. After a run of federal laboratory accidents (DC anthrax, forgotten smallpox vials, and an H5N1 cross-contamination), the White House stopped funding a class of experiments. The document was titled a pause on “gain-of-function research,” describing it as research “that reasonably may be anticipated to confer attributes to influenza, MERS, or SARS viruses such that the resulting virus has enhanced pathogenicity and/or transmissibility (via the respiratory route) in mammals.” Work on viruses as they occur in nature was exempt, and agency heads could grant exceptions.

NIH sent 18 letters to 14 universities telling them to stop. Years later the Congressional Research Service reported that it “was unable to identify with certainty which of the 36 initial projects were ultimately paused.”

May 2016: narrowed, still undefined. The National Science Advisory Board for Biosecurity (NSABB), the federal panel that advises on this, created a narrower category instead of defining the broader one. Its first finding: “There are many types of GOF studies and not all of them have the same level of risks. Only a small subset of GOF research, GOF research of concern, entail risks that are potentially significant enough to warrant additional oversight.”

January 2017: the phrase is dropped entirely. New White House guidance, known by the acronym P3CO, for potential pandemic pathogen care and oversight. A “potential pandemic pathogen” was defined as being a germ dangerous enough to start a pandemic. To qualify it had to clear two bars at once: likely to spread easily among people and likely to make them seriously ill or kill them. This definition was “meant to capture the activities that were addressed in the NSABB Recommendations as ‘gain-of-function research of concern.’”

An enhanced potential pandemic pathogen was defined as one that was made that way in a laboratory. The guidance was explicit that a naturally occurring virus never qualified, however dangerous it was: “wild-type pathogens that are circulating in or have been recovered from nature are not enhanced PPPs, regardless of their pandemic potential.” Surveillance work and vaccine manufacturing were exempted on the same reasoning.

December 19, 2017: the pause lifts. HHS issued its version of the framework and NIH restarted funding the same day. HHS was the only federal agency that ever built a review process, and in the seven and a half years it ran, the Government Accountability Office (GAO) found four projects were sent up for department-level review. Three were modified. One was not funded.

December 19, 2017 to May 5, 2025 is seven years and four and a half months.

January 2023: the advisory board says the definition is too tight. In its final report, the same panel called the definitions “too narrow,” warned that requiring a pathogen to be both “highly” transmissible and “highly” virulent “could result in overlooking some research,” and recommended three changes: lower the bar to “moderately or highly,” require only one of the two conditions rather than both, and scrap the blanket exemptions for surveillance and vaccine work.

May 6, 2024: adopted, with a new name. Those changes went into a new policy that replaced the 2012 dual-use policy, the 2014 institutional dual-use policy, and the 2017 framework. It coined a fourth term, “pathogen with enhanced pandemic potential,” covering work that increases spread or severity “or disrupt[s] the effectiveness of pre-existing immunity.” It was written with a year’s lead time, to take effect May 6, 2025.

May 5, 2025: superseded one day early. President Trump’s Executive Order 14292 replaced it the day before it was due to start. The 2024 policy never governed a single grant. The executive order brought back “dangerous gain-of-function research” (DGOF) and defined it as work on an infectious agent or toxin “with the potential to cause disease by enhancing its pathogenicity or increasing its transmissibility.” It suspended that research and ordered a replacement written within 120 days, by September 2, 2025.

July 20, 2026: the replacement. HHS announced it on July 28, the day before this hearing. The policy prohibits federally funded DGOF outright and makes “potential DGOF” fundable only after review by a government-wide Independent Third-Party Review Body. The policy also bars funding any life sciences research involving an “entity of concern,” including research conducted in a country of concern or performed abroad by a designated institution or individual.

Six attempts in thirteen years, using four different technical terms. And for the eight years from January 2017 to May 2025, the phrase at the center of every public argument about this research appeared in no federal regulation.

The three scientists Sen. Paul called as witnesses.

Verified. All three are real, hold the credentials he described, and hold the positions he attributed to them. Two qualifications.

Sen. Paul named three scientists who oppose dangerous gain-of-function research: Dr. David A. Relman, Richard H. Ebright, and Kevin M. Esvelt.

Dr. Relman has said: “I am opposed to high-risk experiments and, in particular, those that seek to create novel, dangerous pathogens that cannot be justified by well-founded expectations of near-term, critical benefits for public health.” Sen. Paul dropped the qualifier that follows: “I want to be clear: I am not opposed to laboratory work on dangerous pathogens, especially if they are known to exist in nature.”

Ebright, in sworn testimony to the same committee’s subcommittee in August 2022: “the risk-benefit ratio for the research almost always is unfavorable and in many cases is extremely unfavorable.”

In an October 7, 2021 Washington Post op-ed, Esvelt wrote: “I implore every scientist, funder and nation working in this field: Please stop. No more trying to discover or make pandemic-capable viruses... No more experiments likely to disseminate blueprints for plagues.”

Esvelt’s worry was that the recipe would get out. He was less worried that a virus would escape a laboratory than that the instructions for building one would get into the wrong hands. Commercial gene synthesis and laboratory reconstruction of viruses were already possible in 2011. What has changed is their accessibility and scale, and the emergence of AI systems that may lower the expertise needed to design or troubleshoot dangerous biological constructs.

Synthetic biology + AI. On June 4, 2026, a letter organized by the Foundation for American Innovation and the Institute for Progress asked Congress for “mandatory nucleic acid synthesis screening, including recordkeeping, in the United States” and said Congress “should act this session,” applauding “legislative efforts currently underway.” “AI systems are improving rapidly, and alongside incredible benefits to science and medicine, there is a real possibility that the knowledge barriers which have historically prevented bad actors from obtaining biological weapons will meaningfully erode,” the letter said. Signatories included Sam Altman of OpenAI, Dario Amodei of Anthropic, Demis Hassabis of Google DeepMind, Eric Horvitz of Microsoft, Mustafa Suleyman of Microsoft AI, dozens of life sciences and national security experts, and executives from two of the companies that would be regulated, Twist Bioscience and Ansa Biotechnologies.

The letter named no specific bill. The vehicle in the Senate is the Biosecurity Modernization and Innovation Act of 2026, S. 3741, introduced in February by Sen. Tom Cotton and Sen. Amy Klobuchar.

Why NIH funding was in Wuhan at all.

Chair Paul · 00:25:48 / 8:55:29 AM:

“The American people would like to understand your reasoning, your rationale for why you chose to fund the research in Wuhan... Can you explain to the committee why you chose to fund this dangerous research in China?”

Partly verified. NIAID money did reach the Wuhan Institute of Virology. "You chose to fund" is an inaccurate description of how it got there.

Start with the size and the direction of the money. The grant was R01AI110964, “Understanding the Risk of Bat Coronavirus Emergence.” NIAID awarded it to EcoHealth Alliance, a nonprofit in New York, with Peter Daszak as principal investigator, and paid out about $3.75 million over five years. An American organization held the grant. It then passed some of the money to partner institutions through what NIH calls a subaward, which is a contract the grant holder signs with a collaborator. HHS’s inspector general itemized each subaward: $598,611 to the Wuhan Institute of Virology (WIV), plus $201,221 to the Wuhan University School of Public Health. About $800,000 over five years, or 21% of the total award.

The reason NIH gave is geography. The grant says the project aimed to “understand what factors increase the risk of the next CoV emerging in people by studying CoV diversity in a critical zoonotic reservoir (bats), at sites of high risk for emergence (wildlife markets) in an emerging disease hotspot (China).” The 2019 renewal explained why a second round of funding was justified: “bats in southern China harbor an extraordinary diversity of SARSr-CoVs, some of which can use human ACE2 to enter cells,” and “at one site diverse SARSr-CoVs exist that contain every genetic element of the SARS-CoV genome.” This site was a single cave complex in Yunnan Province, sampled over years, and described in PLoS Pathogens in 2017: “all of the building blocks of SARS-CoV genome... could be found in the genomes of different SARSr-CoV strains from this single location.” The horseshoe bats carrying the closest known relatives of the 2002 SARS virus live in southern China. Sampling them means field teams, provincial permits, and repeat visits to caves in Yunnan. In EcoHealth’s reporting to NIH, WIV is listed as the “Principal Laboratory for all Research in China”.

The policy rationale for that choice predated NIAID’s grant to EcoHealth Alliance by nearly a decade. The Bush administration’s National Strategy for Pandemic Influenza, issued in November 2005 after SARS, stated: “The most effective way to protect the American population is to contain an outbreak beyond the borders of the U.S.” The revised International Health Regulations, adopted that year, required countries to strengthen their capacity to detect and respond to outbreaks and called for international assistance to help lower-resource countries meet those obligations. USAID’s PREDICT program, which received about $200 million from 2009 to 2020, was created to “pre-empt or combat, at their source, newly emerging diseases of animal origin.” Through EcoHealth Alliance, PREDICT supported bat-coronavirus surveillance involving the Wuhan Institute of Virology for several years before the NIAID grant began.

Arguments for funding such work overseas. The strains in each year’s US flu shot are chosen out of a network of 151 national influenza centers in 127 countries. The two Ebola drugs, Inmazeb and Ebanga, were approved on the strength of a trial NIAID ran with the Congolese health ministry in North Kivu, because that is where the patients were. And the same surveillance model applied in Saudi Arabia found evidence of MERS in a fecal pellet from a bat roost in Bisha, which turned out to carry a fragment identical to the virus in the index patient who lived nearby.

Arguments against funding such work overseas. Edward Holmes, Andrew Rambaut and Kristian Andersen, three of the five authors of the March 2020 Proximal Origin paper, argued in Nature in 2018 that cataloguing wildlife viruses does not work on its own terms. New RNA virus variants “appear every day,” so surveys “would need to be done continuously,” and the exercise would surface thousands of candidates “each with a low probability of causing an outbreak.” They wanted the money spent on “proactive, real-time surveillance of human populations.”

Federal rules assigned primary day-to-day subrecipient monitoring to EcoHealth. The inspector general traced the problem to rules that bind every federal agency, which are “designed to have a prime grant recipient monitor the activities of a subrecipient, rather than requiring the grant-awarding agency, in this case NIH, to conduct active monitoring of subrecipients.” So NIH watched EcoHealth, and EcoHealth was supposed to watch Wuhan. When WIV stopped supplying documents after the outbreak, NIH had no lever. The GAO found that NIH had never asked the State Department for help, because it “does not have a formal process” for that.

Were appropriate biosafety measures in place at the WIV lab? The most repeated safety charge is that the Wuhan chimera work ran at biosafety level 2, roughly what a hospital lab uses for routine specimens, rather than the higher containment used for viruses that grow in human cells. EcoHealth’s grant application, as summarized by the inspector general, described WIV as “an accredited biosafety level 3 (BSL-3) laboratory” with its own biosafety committee and animal care committee.

A chimera is a virus assembled in a lab from parts of two different viruses. You take the backbone of one virus — the bulk of the genome, the machinery it uses to copy itself and build new particles — and swap in the spike protein from another. The spike is the part on the surface that latches onto a human cell and lets the virus in. So you’re asking one question: what can this spike do, with everything else held constant? Researchers do it because you often can’t grow the bat virus itself, and because holding the rest of the genome fixed is the only way to know the spike is what made the difference.

The BSL-2 claim goes back to a MIT Technology Review article from June 2021. No American agency has ever inspected that laboratory. What makes the report hard to wave off is who is quoted in it: Ralph Baric.

Baric runs the coronavirus laboratory at the University of North Carolina at Chapel Hill. He built the reverse-genetics systems that let researchers assemble a coronavirus from its component parts, which is the technique the entire chimera argument rests on, and he co-authored the 2015 SHC014 paper with Shi Zhengli. He is the American end of this collaboration, not a critic of it, which is what makes his answer on containment matter: “I would never argue that WIV1 or SHC014 should be studied at BSL-2, because they can grow in primary human cells.” He has described his own chimera work in Chapel Hill as running at BSL-3, with powered air-purifying respirators, Tyvek suits, aprons, booties and double gloves.

Shi directs the Center for Emerging Infectious Diseases at the Wuhan Institute of Virology, the laboratory that received the EcoHealth subaward. She spent years sampling bats in caves across southern China and was a lead author on the work that traced the 2002 SARS virus back to horseshoe bats, which made her the field’s leading authority on bat coronaviruses and got her nicknamed “bat woman” in the Chinese press. She supplied the SHC014 spike sequence used in the 2015 Chapel Hill experiment and is a co-author on that paper. Asked about containment, Shi said she followed Chinese rules “similar to those in the US,” and that safety requirements “are based on what virus you are studying.” EcoHealth’s answer was that it “must follow the local laws of the countries in which we work.”

NIH’s July 8, 2020 letter, quoted in the audit, says NIH had received reports that WIV “had been conducting research at WIV’s facilities in China that posed serious biosafety concerns and, as a result, created health and welfare threats to the public in China and other countries,” and suspended the grant on that basis. HHS’s memo went further, saying NIH’s conclusion that WIV “likely violated protocols of the NIH regarding biosafety is undisputed.” WIV never produced the records that would dispute it, but there was no inspection to support this.

In January 2025, arguing to HHS that it should keep its federal eligibility, EcoHealth committed to ensuring that “all field and laboratory work is conducted at appropriate biosafety levels in compliance with, or exceeding, U.S. federal regulations.” HHS debarred the organization anyway, for five years, making it ineligible to receive funding through May 14, 2029.

NIH no longer funds foreign subawards. On May 1, 2025 NIH stopped recognizing foreign subawards entirely, and in September 2025 it replaced them with a structure in which the foreign partner gets its own grant number, its own award letter, and reports its own spending directly to NIH. Foreign research continues. NIH Director Dr. Jay Bhattacharya’s August 2025 statement added two tests any overseas site now has to pass: a “clear scientific rationale to be conducted in a foreign country rather than in the United States,” and “direct potential to generate knowledge applicable to... the health of Americans.”

DEFUSE was rejected and never funded.

Chair Paul · 00:08:38:

“In 2018 the same group of scientists and their collaborators submitted the DEFUSE proposal, which involved the insertion of a cleavage site into the coronavirus. DARPA rejected it [as] too dangerous.“

Partly verified.

The proposal was led by EcoHealth Alliance with UNC, Duke-NUS, and the WIV and stated: “We will introduce appropriate human specific cleavage sites and evaluate growth potential.”

DARPA did not say “too dangerous.” Its rejection findings say the proposal “does not mention or assess potential risks of Gain of Function (GoF) research” and “fails to present a DURC risk mitigation plan.” They left the door open to funding parts of it with a mitigation plan attached.

DEFUSE was never funded.

The furin cleavage site, and what it does and does not prove.

Chair Paul · 00:08:38:

“When COVID was sequenced early on in 2020, within days scientists discovered that lo and behold it had a novel cleavage site just as had been proposed in the DEFUSE project. This was either an extraordinary coincidence, or a smoking gun.”

The premise holds, but the inference doesn’t follow. This is an ongoing scientific dispute.

SARS-CoV-2 carries a 12-nucleotide insertion creating a furin site at the S1/S2 junction, and no other known sarbecovirus has one. Sarbecoviruses are the narrow group that includes SARS-CoV-2, the 2002 SARS virus, and the bat viruses in this argument. Across the wider coronavirus family the feature is common.

What does not follow: DEFUSE proposed inserting sites into WIV1, WIV16, and SHC014 backbones. SARS-CoV-2 descends from none of them. The category of modification was proposed. The specific virus, the specific insertion sequence and the specific junction were not.

Against engineering: the site is a suboptimal furin substrate. Furin is a human enzyme that cuts proteins at a specific short sequence, and the closer a virus’s sequence matches furin’s preferred pattern, the more efficiently it gets cut. SARS-CoV-2’s is a mediocre match, which is not what someone inserting a cleavage site on purpose would build.

Furin sites have also arisen independently across many coronaviruses. Bailey Lubinski and Gary Whittaker make the fuller version of this case in The Lancet Microbe, arguing that the site's acquisition and its later fine-tuning both track natural selection, and concluding that it "is no smoking gun."

In support of engineering: the total absence of a furin cleavage site across the subgenus, and the fact that a 2018 American proposal named this class of modification in these viruses.

Was Dr. Fauci’s May 2021 testimony a lie?

Chair Paul · 00:08:38:

“On May 11, [2021] you told the Senate the NIH has never, ever, and does not now fund gain of function research in the Wuhan Institute of Virology. When I gave you the opportunity to correct the record... he responded that you had never before lied to Congress. We were then told that only the government’s narrowest regulation of definition counted here.”

The quotation is verified. The charge of lying is unsupported on this record.

Was gain-of-function research being conducted at the WIV? NIH’s position was that the bat coronaviruses had not been shown to infect people, and that the experiments were not reasonably expected to make them spread more easily or cause worse disease in humans, so no review was triggered based on the policies in place at that time.

That does not mean those viruses cannot infect human cells. When Ralph Baric’s lab put the SHC014 spike protein on a SARS backbone in 2015, the resulting virus grew in human airway cells at levels “equivalent to epidemic strains of SARS-CoV.” That experiment was done at UNC Chapel Hill. A second chimera, built under the EcoHealth grant on a WIV1 backbone, and the two get confused repeatedly.

NIH’s position on that second chimera is laid out in former Principal Deputy Director Lawrence Tabak’s October 20, 2021 letter, which reported that mice infected with it “became sicker than those infected with the WIV1 bat coronavirus,” and said this did not meet NIH’s definition because those bat viruses “had not been shown to infect humans.”

Under the broad scientific meaning of “gain of function,” the experiment produced a gain in phenotype. NIH’s denial relied on the narrower regulatory category governing enhanced potential pandemic pathogens. That definitional conflict makes Fauci’s categorical wording vulnerable, but it does not by itself establish that he knowingly lied to Congress.

And it doesn’t mean nobody was watching. NIH had written a condition into the grant requiring EcoHealth to report immediately if a virus grew ten times better than expected. Tabak’s letter concedes EcoHealth “failed to report this finding right away, as was required by the terms of the grant.” NIH did not receive that notice for about two years.

What “the market was the amplifier” actually claims.

Sen. Lankford · 01:11:19 video / 9:41:00 a.m. ET

“January 26 of 2020, before we had even our first tragic death of coronavirus in the United States, you wrote that it now appears that the genomic data of the first infection was early December and was not connected to the market, the big rumor that was out there. The wet market in China. Market was not the source, the amplifier.“

Sen. Scott · 01:30:51 video / 10:00:32 a.m. ET

“This email [was] sent the same day, the exact same day you write an internal document, ‘now we know the market was not the source, it was the amplifier.’ Would you call the origins of COVID-19 a substantive issue?”

Chair Paul, introducing the video montage · 02:31:11 video / 11:00:52 a.m. ET

“For years, Anthony Fauci has been the public face of saying this but he kept saying it’s the marketplace, it’s the marketplace... In January in private he wrote that it looks like the market was a super spreader event; it didn’t originate there. Then for years and years we got dishonesty.”

Sen. Paul’s claim, that Dr. Fauci said the market publicly while privately knowing better, is contradicted. However, Dr. Fauci’s public certainty may have run ahead of his private deliberation.

Reservoir. The population where a pathogen persists indefinitely on its own. For SARS-related coronaviruses, horseshoe bats. For MERS, dromedary camels.

Intermediate host. The species where the pathogen adapts or through which it reaches people. Palm civets for SARS. Camels for MERS. The intermediate host for SARS-CoV-2 has yet to be identified.

Index case. The first identified human case. Not the first human case, and not the spillover event.

Amplifier. A setting whose density, contact structure and duration turn a handful of introductions into an epidemic. The pathogen does not begin there. It multiplies its reproductive advantage there. Amplification is a property of the venue, not of the virus.

Saying “the wet market was the amplifier, not the source” places the wet market in the fourth category and puts the first three upstream. It says nothing about whether the upstream event was a spillover or a laboratory accident. That is why the next sentence in the same diary entry matters, and neither Sen. Lankford, Sen. Scott, nor Sen. Paul read it into the record: “Having said that, somewhere the virus jumped from animals to humans.”

The Metropole Hotel, Hong Kong, February 2003. A physician from Guangdong stayed one night on the ninth floor. Thirteen cases were tied to the hotel initially, and those seeded Canada, Vietnam and Singapore. The hotel was the amplifier and the global dispersal hub. The source was bats via civets in Guangdong live-animal markets, months earlier.

MERS in hospitals. MERS barely transmits in the community and explodes in healthcare settings. One returning traveler to South Korea in 2015 led to 186 MERS cases, almost entirely through spread in emergency departments and multi-bed wards, generating an epidemic curve that looked like sustained human spread yet was pure amplification. The reservoir was camels in the Arabian Peninsula.

Was Dr. Fauci lying? On November 27, 2021 on Face the Nation, he said: “It may not have originated in the market, but it certainly could have.” That is close to agnostic and it is compatible with his diary. Worobey et al., Science 2022 is titled “the early epicenter of the COVID-19 pandemic,” and its abstract concedes “there is insufficient evidence to define upstream events, and exact circumstances remain obscure.” Meanwhile, Crits-Christoph et al., Cell 2024 claims its findings are “consistent with market emergence” and offers “a shortlist of potential intermediate hosts... to prioritize for serological and viral sampling.” Pekar et al. inferred at least two separate introductions associated with the market, lineages A and B, weeks apart. That pattern fits a venue with recurring animal contact better than it fits a single lab-related release.

The real tension. The gap is between the February 1, 2020 call, where by his own notes most participants thought deliberate insertion was possible and "we could not let this go," and his public statement to National Geographic three months later that the evidence was "very, very strongly leaning toward this could not have been artificially or deliberately manipulated." In between, the Proximal Origin paper was written.

What the Livermore assessment concluded.

Sen. Lankford · 01:13:02 video / 9:42:43 a.m. ET

“The Lawrence Livermore National Laboratory in May of 2020 put out a classified document that has only recently been unclassified that had this statement: we assess all the necessary conditions for the accidental release of a laboratory modified coronavirus that recognizes human cell receptors were present at the Chinese Wuhan Institute of Virology in mid to late 2019. ... My question to you was going to be did you have access.”

Verified, but incomplete.

Dated May 27, 2020, the document was declassified June 18, 2026. Large portions are still redacted. It is the document the Wall Street Journal reported on in June 2021.

What Sen. Lankford did not read. The report concluded nothing about engineering or leakage. It assigned equal weight to three scenarios: natural emergence, laboratory modification then accidental release, and accidental release of a naturally occurring virus.

Sen. Lankford's question was narrower and fairer than his framing: Was Dr. Fauci given unredacted access to it? That is a legitimate question about whether the government's leading public voice on origins was being briefed on the government's own contrary analysis. The document was dated three weeks after Dr. Fauci’s National Geographic interview.

What none of this settled, and who can act.

Every claim discussed here concerns events between 2011 and 2022. The rule governing such work was rewritten on July 20, 2026, and nobody in the hearing room mentioned it.

Executive Order 14292 suspended dangerous gain-of-function research in May 2025 and ordered a replacement policy within 120 days. That deadline was September 2, 2025. HHS announced the new policy on July 28, 2026, the day before Dr. Fauci testified.

The new policy prohibits dangerous gain-of-function research outright rather than reviewing it, and creates a middle tier, “potential DGOF,” permitted only after review by an independent third-party body. That body does not exist yet.

And more news coverage…

“Infectious disease expert on Fauci’s Senate hearing face off with lawmakers,” NPR, July 30, 2026

Each item opens with what was actually said. Quotes are from the C-SPAN caption transcript with video and clock timestamps. Everything in bold is the specific assertion being checked.

• What the record shows about Dr. Fauci and the Proximal Origin paper.

• What the February 2nd email to Dr. Francis Collins actually said.

• The Wuhan wet market’s live mammals were gone before sampling began.

• Why the claim about the pardon isn't settled law.

• Justice declined to prosecute Lois Lerner for contempt.

• And more coverage…

1. What the record shows about Dr. Fauci and the Proximal Origin paper.

Chair Rand Paul (R-KY) · 00:06:27 video / 8:36:08 a.m. ET

“You even cited Proximal Origin from the White House podium. You held it out as evidence that the virus could not have been engineered. [You did] not disclose your role in the discussions that preceded the writing of the paper [“The Proximal Origin of SARS-CoV-2,” Nature Medicine, March 2020]. You did not disclose the author’s original concerns. You did not reveal that you had been part of the paper. That you had read and offered editorial comments on the paper before it was published. Before you began using it as evidence that [it] could not have originated in the lab.”

The record does not support the editing half. Dr. Fauci participated in the February 1, 2020 call, received a copy of the paper after acceptance but before formal publication, and after acceptance wrote back: “Thanks for your note. Nice job on the paper.” That is the whole documented reply, in the emails released to The Intercept. Andersen’s written testimony to the Select Subcommittee stated that “None of this work was influenced by Dr. Fauci,” and that “The only suggested edit was from Dr. Farrar who recommended we change a single instance of ‘unlikely’ with “improbable,’ which we did.” From Andersen’s written testimony:

Andersen also wrote that “Drs. Farrar, Fauci, and Collins all encouraged us to look more closely at the important question of COVID-19 origins, and more specifically, our initial hypothesis that this could have been an engineered or lab-associated virus.” Also from Andersen’s written testimony:

The Republican majority report asserts “undue influence.” The Democratic minority found they “had no role in leading, overseeing, or influencing the drafting.” Overstated. Supported as to Dr. Fauci’s proximity to the paper’s development and as a legitimate criticism of incomplete public disclosure of that involvement.

2. What the February 2nd email to Dr. Francis Collins actually said.

Chair Rand Paul (R-KY) · 00:12:08 video / 8:41:49 a.m. ET

“Your conduct concerning federal records raises further questions. It is a crime to destroy federal records. Yet our investigation reveals your assistant diligently reported that she deleted tons of emails. In 2024 you testified you did not delete federal records. Who is telling the truth, you or your assistant? The committee has obtained repeated instructions from you telling officials to delete communications. On February 2, 2020, one day after [the] origins call, you told Francis Collins ‘please delete this email after you read it.’“

The instruction is genuine, but it concerned Fauci’s criticism of WHO officials inside an origins-related email chain. Presenting it as evidence that he sought to erase scientific discussion of COVID’s origin is misleading. The document, released by Sen. Paul’s own committee, is Dr. Fauci to Dr. Collins, subject “FW: 2019nC-V”: “I agree with you. Mike and Bernhard are good people but they really slow things down, particularly Mike Ryan whose main concern is not offending anyone. Please delete this e-mail after you read it.” The subject is two WHO officials. Verified, misframed.

3. The Wuhan wet market's live mammals were gone before sampling began.

Chair Rand Paul (R-KY) · 02:33:16 video / 11:02:57 a.m. ET

“This is interesting because the first SARS outbreak in 2002 and 2003 was traced to a wet market, animals there. But interestingly, they had evidence [that] the animals had disease and also evidence that the handlers had a disproportionately high number of antibodies to the disease. So there was evidence... So when this came out the same thing happened in the end. They did look at the wet market and tested 80,000 animals and did not find any animals that had COVID-19.“

The “80,000 animals tested at the wet market” line is wrong three ways. At the Huanan Seafood Wholesale Market, the China CDC sampled 457 specimens from from 18 species — strays, pests, frozen merchandise, and fish tanks — all negative [“Surveillance of SARS-CoV-2 at the Huanan Seafood Market,” Nature, April 5, 2023]. The 80,000 figure comes from the WHO-convened joint study, which describes “more than 80 000 wildlife, livestock and poultry samples collected from 31 provinces” — samples, nationwide, mostly routine livestock surveillance. And the mammals being sold in the wet market were removed on January 1, 2020, before sampling began. Contradicted. Reanalysis of China CDC’s own metagenomic data found raccoon dog, masked palm civet, and bamboo rat DNA concentrated in the positive samples. However, testing of these animals from the wet market was not done.

4. Why the claim about the pardon isn't settled law.

Sen. Josh Hawley (R-MO) · 01:43:30 video / 10:13:11 a.m. ET

“Let’s just get one thing straight. You don’t have any rights under the Fifth Amendment because you’ve been pardoned, as you very well know. As [the] Supreme Court has been clear for a century and more, Brown versus Walker, 1896, when he has been pardoned, he may not stand upon his privilege. You know that. Your lawyer sitting behind you now shifting nervously in their chairs, they know it. This isn’t about the Constitution. This isn’t about the law. This is about contempt.”

Immediately preceding, at 01:43:12 and 01:43:19: “What color are you wearing?” and “What color is the carpet in front of you?” Fauci invoked the Fifth to both.

Presented as settled, and it is not. In Brown v. Walker (1896), the Supreme Court said a pardoned witness may not use the Fifth Amendment. Later, in Murphy v. Waterfront Commission (1964), the Court ruled that the Fifth Amendment can protect a witness from prosecution by both state and federal governments. Because Dr. Fauci’s pardon covers only federal crimes, he could still face possible state charges. In addition, the pardon he received from President Biden may not cover accusations of perjury or false statements arising from this sworn testimony in this hearing. Overstated. Sen. Paul conceded it himself in closing: “another legal question that the courts may have to decide.”

5. Justice declined to prosecute Lois Lerner for contempt.

Sen. James Lankford (R-OK), final round · 02:54:59 video / 11:24:40 a.m. ET

“Mr. Chairman, this is really a question for you... clearly, Doctor Fauci’s attorneys are saying that he has a Fifth Amendment right. We have also subpoenaed him to compel his testimony. Lois Lerner came and testified, gave an opening statement, and then took the Fifth Amendment. The committee then held her in contempt for that ... you can’t do both. You can’t both testify and say [you’re] not going to answer questions. So the parliamentary question that we have to deal with is, is [this] consistent with Lois Lerner?”

Chair Paul, in reply, 02:55:59 / 11:25:40 a.m.:

“It’s a very good question. I think we will all examine this over the next week. We will have a vote next week on contempt. I think there’s another legal question that the courts may have to [decide].”

The Lerner episode weakens the proposed waiver theory rather than supporting it. Although the House voted to hold Lerner in contempt, the Department of Justice concluded that her opening claims of innocence did not waive the privilege and declined prosecution. That determination is persuasive and directly relevant, but it was not a binding court ruling resolving Dr. Fauci’s situation. Contradicted.

And more coverage…

Eduardo Cuevas and Erin Mansfield. “A diary, Trump and COVID origins: Watch for these things as Fauci heads to Congress,” USA Today, July 28, 2026

Joseph Choi. “Fauci set for high-profile hearing after Paul released diaries,” The Hill, July 28, 2026

• What Sen. Rand Paul released, and what he didn’t.

• Did Dr. Fauci privately think COVID came from a lab?

• Who’s responsible for closing schools?

• What the diary says about the booster timeline.

• What they agreed to say about the J&J vaccine.

• What being the face of the pandemic did to him.

• Wednesday’s hearing

What Sen. Rand Paul released, and what he didn’t.

Sen. Rand Paul has spent five years trying to get Dr. Anthony Fauci charged with a crime. The criminal referral he’d been pushing since 2021 timed out this May with no indictment. What he released now, four days before Dr. Fauci testifies under subpoena, is his diary.

On Saturday, the Senate Homeland Security Committee posted 1,141 pages of Dr. Anthony Fauci’s personal diary. That drop opened in the middle of a sentence with the first 669 pages cut off. And then this morning Sen. Paul posted a second file, “Tony’s Diary: The Prequel”, 465 pages covering April 2001 to July 2015.1

But still missing are roughly 200 pages between mid-2015 and late December 2019. And Part 5, an entire volume, is missing from the middle of the pandemic release even though Part 6 opens with the header “Continued from Part 5.” That gap runs from December 1, 2021 to May 30, 2022, about six months, covering the Omicron surge.

Sen. Paul's case is that these pages catch Dr. Fauci saying one thing in private and the opposite in public.

Did Dr. Fauci privately think COVID came from a lab?

Sen. Paul’s clearest example of Dr. Fauci saying one thing privately and another publicly is the entry for January 26, 2020 (p. 676):

That was the field’s view at the time. It came from the epidemiological and genomic data available at the time.

On January 31, 2020, Dr. Jeremy Farrar called Dr. Fauci and put Kristian Andersen on the line (p. 681):

Dr. Fauci suggested “we get a larger group of qualified evolutionary biologists/virologists together under the auspices of a convening body and carefully look at this” (p. 681). That call happened the next day. Dr. Fauci’s stated reason for not dropping it:

Dr. Fauci admittedly contradicts himself in his diary about that first call. The contemporaneous February 1, 2020 entry (p. 682) has only Fouchier and Dr. Drosten arguing for natural origin (see screenshot above), but on June 7, 2021 (PDF p. 767), in his retrospective entry sixteen months later:

Then in July 2022, a group of scientists published two papers in Science putting the Huanan market back at the center, as the early epicenter, with at least two separate jumps from animals to people there. The authors included evolutionary biologists and virologists Michael Worobey, Kristian Andersen, Eddie Holmes, Andrew Rambaut and Bob Garry.

Note that Andersen, Holmes, Rambaut, and Garry were all on the February 1, 2020 call telling Dr. Fauci the virus might have been built.

So the sequence is: the scientists said engineering was possible, others told them it wasn’t necessarily, they revised, and two years later they published data moving the origin back to the market.

That’s the scientific process working. Formulate hypotheses, then collect evidence to test them. It’s also why five years of this fight hasn’t moved anyone. Both sides are arguing about what a dozen people said on a phone call in 2020, and the evidence that would settle it isn’t in the diary or in anyone’s inbox. It was in Wuhan. Chinese authorities cleared the live animals out of the Huanan market in the first days of January 2020. Hundreds of environmental samples were taken. The animals themselves mostly weren’t tested, and no serious independent investigation of the market has been permitted since.

Who’s responsible for closing schools?

In a January 2024 transcribed interview with the House, he said “that is the big misperception, when people are out there saying, ‘Fauci closed the schools.’ Fauci did not close the schools.” He later added, “I did not close the schools. And it became the widespread situation where I became a political target.” He also confirmed that he had no authority to decide when schools resumed, that the process “was largely decided at the State and local levels of government,” and that the federal role was “largely an advisory and support function.”

Dr. Fauci ran a research funding institute and had no legal power over classrooms. But in his diary, Dr. Fauci acknowledged that his advice was influential:

March 9, 2020 (p. 712):

March 15, 2020 (p. 724):

But the districts moved even before the governors. By March 18, 2020, the day before Governor Newsom’s statewide stay-at-home order, districts serving more than 99% of California’s 6.2 million public school students had already closed or announced closure on their own.

So if Dr. Fauci didn’t have the power, who did? The authority sat with about 13,349 regular public school districts, their boards, their governors, and in 34 states, their teachers’ unions at the bargaining table. Education is a state function in every state constitution. There is no federal authority to close a classroom, and federal law goes out of its way to bar federal officials from controlling a school’s program of instruction.

By July 2020, President Trump was pushing hard to reopen schools. On July 8, 2020 (p. 909), Dr. Fauci wrote:

On July 8, 2020, CDC Director Dr. Robert Redfield said, “Remember it’s guidance. It’s not requirements.” He added that CDC’s guidance was not meant to provide a rationale for keeping schools closed.

On July 9, 2020 (p. 911), Dr. Fauci wrote:

On July 31, 2020, Dr. Fauci testified under oath before the House. He said, “a default position, despite the fact that we have to have flexibility, would be to try and, as best as we possibly can, in the context of the safety of the children and the teachers, to open the schools… because of the negative consequences on children from a psychological standpoint as well as the downstream unintended consequences on families.”

Later in his diary on August 9, 2020, he wrote:

On November 29, 2020, on ABC Dr. Fauci said, “close the bars and keep the schools open is what we really say.” Then in March 2021, Dr. Fauci endorsed three feet of distancing on CNN days before CDC adopted it. That single change is what made it possible for a lot of districts to physically fit kids back in buildings.

What the diary says about the booster timeline.

On September 2, 2021, regarding the eight-month wait for a COVID booster (PDF p. 866), Dr. Fauci wrote:

He signed the joint statement announcing boosters starting eight months after an individual’s second dose, but five weeks later, the CDC recommended boosters at least six months after their primary series.

Scientists were saying in public at the time that the decisions weren’t evidence-based, and I was one of them. In early August 2021, in The New York Times with Dr. Carlos del Rio and John Moore, I argued that the dosing question was unsettled and that extra shots for the vaccinated shouldn't come out of the supply for the unvaccinated.

Four days after signing, Dr. Fauci logged the pushback in his diary:

A year later, he would name Moore in his diary as the most reasonable of the critics (PDF p. 1046).

On September 23, 2021, after CDC’s advisory committee voted 9 to 6 against boosters for people whose jobs put them at risk, he pushed Dr. Rochelle Walensky to override her own committee (PDF p. 883):

What they agreed to say about the J&J vaccine.

On February 25, 2021 (PDF p. 631), the night before the J&J vaccine went to FDA’s advisory committee, Dr. Fauci and five others agreed to recommend authorizing it only for people under 60:

The committee voted the next day unanimously for an unrestricted authorization.

On February 27, 2021 (PDF p. 634), Dr. Fauci wrote:

But none of what I’ve covered to this point is what led the news coverage of the diary thus far.

What being the face of the pandemic did to him

Fox News led its coverage of the Fauci diary release with the vanity entries, and they’re real. He tracked his own fame closely. Here’s the passage everyone’s quoting:

But many of his diary entries also expressed embarrassment and discomfort with the newfound fame:

On January 29, 2020 (p. 678):

February 8, 2020 (p. 686):

On March 27, 2020, at the relief-bill signing, President Trump said, “I cannot sign this without you being here (p. 742):

April 3, 2020 (p. 752):

The public attention also led to harassments and threats. On April 15, 2020, in the same entry where he logs a Laura Ingraham appearance and a needling text from Jake Tapper about it, Dr. Fauci wrote (p. 781):

On April 17, 2020, after a fabricated sexual-assault allegation went out to reporters from a law firm that turned out not to exist, Dr. Fauci wrote (p. 790):

President Trump ended Dr. Fauci’s federal protection on January 23, 2025. Since then, Dr. Fauci has had to pay for security.

Meanwhile, President Trump’s talk of ratings was constant, and Dr. Fauci described that, too. On March 28, 2020 (p. 743), during the hour in the residence where the team talked President Trump out of quarantining New York, New Jersey and Connecticut, the president broke off between calls to the three governors to phone Sean Hannity:

On March 13, 2020, Dr. Fauci expressed frustration that the media attention was pulling him away from the job at hand (p. 719):

And then, May 23, 2020, Dr. Fauci described doing what he could to protect his working relationship with President Trump (p. 731):

By July 29, 2020 he was writing (p. 932):

Dr. Fauci continued to express uneasiness with the attention for years. At Jonathan Karl’s book party on November 17, 2021 (PDF p. 923):

On December 4, 2022 at the Kennedy Center (PDF p. 1132):

Wednesday’s hearing

Dr. Fauci testifies Wednesday under subpoena. Most of the questions will be about COVID’s origins, which is the fight Sen. Paul has been having since 2020 and the one these pages do the least to settle.

My friend Dr. Craig Spencer spent the past year inside the MAHA movement and published “Public Health Needs MAHA: The field must swallow its pride and admit where the insurgent movement is right,” in The Atlantic today, arguing that public health should stop sneering at MAHA and start listening. We discussed it this morning.

Craig’s argument, in brief

The big picture. Public health has spent every day since RFK Jr. took office fighting fires: the vaccine schedule, peptides, staffing cuts. Craig wants the field to lift its head and ask what comes after this administration, so it can absorb the lessons instead of snapping back to 2019.

There are two MAHAs. A grassroots and what he calls “MAHA Incorporated.” Treating them as one thing is the field’s central mistake. The grassroots is a big tent of groups that, in his words, “don’t even like each other,” held together by decades of frustration.

It isn’t mainly about vaccines. The anti-vaccine wing is loud and litigious but small. And according to KFF polling, only about 1% of adults believe all the common vaccine myths, and among MAHA supporters the top concern is cost, with vaccines far down the list. He describes the anti-vaccine group as having “a small table in the tent, but the best microphone and the best sound system.”

His diagnosis. Public health went timid. It got “more comfortable with p-values than podiums,” and let “the demand for more data become an alibi for inaction.” People trust a movement that visibly fights for them over an institution that quotes stats.

His prescription. Show up and fight, visibly and non-partisan, on the issues that cross the divide: healthcare affordability, food quality, environmental exposures. Put money into state and local public health, where the shortfall is worst. And clean up Big Pharma entanglements because even the appearance of a conflict of interest is a liability.

What he concedes. MAHA-in-power hasn’t delivered on affordability, he grants, and on cost, the public trusts Democrats more. But, he told me, “we are part of the reasons for why MAHA exists,” and unless the field fixes what’s underneath, “there’s going to be another similar movement that comes from its ashes.”

Where I pushed back

The grievances predate the movement. There’s a difference between needing the movement and recognizing the grievances it names. Cost, food, and industry capture are decades-old concerns that most Americans share.

What MAHA hasn’t delivered. MAHA-in-power isn’t delivering on healthcare affordability and access, and Craig notes the public trusts Democrats more on this issue.

Common cause on MAHA’s turf points the field at the wrong target. The movement is loudest where health goes viral: raw milk, fluoride, the vaccine schedule.

The movement in power is doing the opposite of its stated cause. MAHA’s grievance is industry capture of the health agencies, but it has deepened the capture it claims to fight.

The conflict-of-interest scrutiny runs one way. MAHA holds Big Pharma accountable, but not Big Wellness.

You can’t out-feel a movement that isn’t bound by facts. If trust is a feeling and the other side isn’t constrained by evidence, an evidence-bound field loses that contest every time it fights on those terms. The way back is to deliver something people can feel in their household budgets.

The bottom line

The grievances are real, starting with the one thing the whole country already agrees on: the bill. If public health takes that on, MAHA loses its best argument. Skip it, and, in Craig’s words, the next movement is already coming.

Read more here

• Dr. Craig Spencer, “Public Health Needs MAHA: The field must swallow its pride and admit where the insurgent movement is right,” The Atlantic, July 25, 2026.

• Drs. Céline Gounder and Craig Spencer, “The decline in American life expectancy harms more than our health,” The Los Angeles Times, April 16, 2024.

• Gregg Gonsalves, “Public Health Was a Place for Warriors Once. It Needs to Be Again, The Nation, November 6, 2025.

• Ed Yong, “How Public Health Took Part in Its Own Downfall,” The Atlantic, October 23, 2021.

Liam Hammons and Abby Laskey. Their daughter Kasey was almost 6-weeks-old when I interviewed them.

• What measles has already cost this family.

• Vaccination used to spread the cost. Now it doesn’t.

• The official reports only tell part of the story.

• The nation’s measles elimination status is now on the line.

What measles has already cost this family.

Kasey is seven weeks old tomorrow. Her parents keep a running list of the people she hasn’t met: great-grandparents in the Midwest, family in Arizona, relatives who are sick and running out of time to fly. Measles is the reason.

The official story in Utah is that the worst has passed. State guidance on the measles shot recently moved back to the usual 12 months, after a stretch of offering it early because spread had slowed. Utah’s own weekly case count has fallen sharply since its March peak. The national count hasn’t: it passed last year’s full-year total this week and is still climbing.

None of that changes the math in Abby Laskey and Liam Hammons’ apartment in Mill Creek, just outside Salt Lake City. Kasey is too young for the MMR vaccine. The earliest she can get a dose is six months, and with Utah back to standard guidance, more likely a year. Until then she depends on the one thing measles is built to erase: everyone else’s immunity.

So her parents have rearranged their lives around a virus that’s supposedly receding. No museums. No indoor public spaces. No flying. They’re both vaccinated, both careful, both doing everything the system asks of them. And they still can’t introduce their daughter to the people who most want to meet her. “There’s not a guarantee,” Abby told me, “that by the time she’s fully vaccinated they’ll be able to meet her at all.”

Then came the part I keep thinking about. To justify the caution to older relatives, they caught themselves borrowing authority from others. The pediatricians are really cautioning against travel, they’d say, reaching for the white coat to make the case. It made them uneasy. They were, said Liam, “offloading blame and caution onto systems that are already... on the ropes… in the public perception.” You can hear the grandparent’s reply coming: those pediatricians are overreacting; when I was a kid, we all got measles. They didn’t love making every pediatrician in Utah the reason a family stayed home.

Vaccination used to spread the cost. Now it doesn’t.

Vaccination used to spread the cost of protection across everyone. When enough people are immune, a six-week-old who can’t be is covered anyway, for free, by the wall around her. That wall is what’s thinning: national kindergarten MMR coverage has slipped from 95.2% five years ago to 92.5% last year, under the threshold epidemiologists use for herd protection. And when it thins, the cost doesn’t disappear. It moves. It settles on the people with the least protection and the least to do with the problem: the immunocompromised, the newborns, and the parents now playing bouncer on their own maternity leave.

Abby kept circling something they couldn’t quite name: the scary stories, they said, of kids who “die of related things” years later. They’re describing immune amnesia. Measles doesn’t only make a child sick in the moment. It infects the immune cells that remember past infections and erases a chunk of that memory. In work led by the immunologist Dr. Michael Mina, the effect lined up with higher deaths from other infections for about 28 months afterward. A child can recover from measles and stay more vulnerable to everything else for two years. Dr. Paul Offit and New York Times writer David Wallace-Wells call the social version “cultural immune amnesia,” our forgetting of what these diseases actually did. Both kinds are running at once.

The official reports only tell part of the story.

As of July 21st, the US had logged 2,295 confirmed measles cases in 2026, according to the Johns Hopkins University’s measles tracker, surpassing all of 2025’s total of 2,289 and marking the highest count in 35 years, with more than five months still left in the year. (CDC’s own weekly count, released separately on Fridays, stood at 2,260 as of July 16th. Both trackers are counting the same outbreak. They just close their weeks at different times.)

Even short of that line, 2026 is running about 37% ahead of last year’s pace at the same point, and roughly 97% of cases are spreading within US communities. Utah alone has counted 518, spread across 22 of its 29 counties, a share no other state has matched.

Genomic sequencing ties the numbers to one continuous chain: the mutations in Utah’s cases trace back to an outbreak that started in West Texas in January 2025, the same signature now confirmed in at least four other states.

The nation’s measles elimination status is now on the line.

The United States’ measles elimination status, held since 2000, requires no continuous domestic transmission for a full year. The Pan American Health Organization is scheduled to make its formal assessment in November, but based on the data, the U.S. has already lost its measles elimination status.

“This didn’t have to be,” Abby said. They’re not that afraid of the virus itself, they told me; they’re angry it’s forcing the question at all. “If we’re losing the plot on this one,” Liam said, “what’s the next thing we lose the plot on?” He told me that “Trust is going to take a long time to build back up ... a lot of unnecessary suffering and a lot of unnecessary deaths.”

Kasey’s parents will keep her home. They’ll see family at campgrounds and on beaches, outdoors, at a distance, and skip the flights. Her great-grandparents will keep waiting.

• Why a lab test rarely solves a produce outbreak.

• Everyone is still pulling the lettuce.

• FoodNet, the FDA’s lab checks, and the budget.

Last week, the FDA reported that a sample of Taylor Farms shredded iceberg lettuce had tested positive for cyclospora. Then on Sunday, July 19th, it took that back, saying that it had been a false positive test result.

Why a lab test rarely solves a produce outbreak.

Investigators name a source three ways: they interview sick people about what they ate, trace the supply chain back from where they ate, and test the food itself.

Testing the food isn’t usually what solves the case. By the time a produce outbreak is spotted, the lettuce has been eaten or thrown out, and contamination sits in patches, so a clean sample can come from a dirty lot. Most produce outbreaks are solved based on interviews, what we call “shoe leather epidemiology,” public health workers literally wearing out their shoes, going into communities, hospitals, restaurants, farms, food distributors, homes, and more to gather evidence firsthand.

The CDC says the link comes from “epidemiologic and traceback data.” Sick people reported eating at the same restaurants. FDA followed the chain back to one supplier of shredded iceberg from Mexico. Neither finding depended on a positive sample.

Everyone is still pulling the lettuce.

The FDA didn’t withdraw the warning. The same July 19th notice that pulled the sample still tells people not to eat recalled iceberg lettuce from Taylor Farms de Mexico. It says the investigation is ongoing and calls the company’s lettuce “product implicated in this outbreak.” A MedWatch recall notice went out this morning.

Taylor Farms de Mexico, of Guanajuato, is pulling all iceberg lettuce grown in central Mexico from the U.S. market. Taco Bell says it took the lettuce out of every restaurant as of July 17th. Walmart pulled four bagged iceberg products from stores in 26 states, though it says there’s been no sign that its own products were affected. Mexico’s health and agriculture ministries opened a review of the supply chain.

Two lawsuits were filed before the retraction, both on July 17th. Ron Simon & Associates and DiCello Levitt sued Taco Bell and Taylor Farms in Ohio state court for David Ott, a 27-year Army veteran. Marler Clark and Darr Law filed Caruso v. Taco Bell in federal court in northern Ohio, the first case to name Taylor Farms as a defendant. Both claims are based on the government’s traceback.

FoodNet, the FDA’s lab checks, and the budget.

Two systems were cut before this outbreak started.

FoodNet is the country’s only active tracking system for foodborne illness. CDC, USDA, FDA, and ten state health departments run it, covering about 16% of the population. Active means staff stay in touch with more than 700 clinical labs and audit them, instead of waiting for reports to come in. FoodNet isn’t how outbreaks are spotted. It’s how you know what a normal year looks like, so you can tell a real surge from better reporting. On July 1, 2025, it went from tracking eight pathogens to two. Cyclospora had been on that list for 28 years.

The second is the proficiency testing program for the national food testing lab network. It sends labs blind samples to confirm they can find a given hazard, cyclospora among them. In April 2025, after job cuts that took a quality assurance officer, a chemist and two microbiologists, the FDA suspended it, at least through that September. I asked HHS whether it’s running again. The agency wouldn’t say. Proficiency testing exists to catch a wrong lab result before it goes public.

Meanwhile Congress is setting the CDC food safety budget now. FoodNet’s funding is paid out of a single CDC food safety account, funded at $74 million this year. FoodNet’s share has sat at $5 to $6 million a year for a decade while its workload grew, and the CDC dropped from eight pathogens to two last year, saying it needed to conserve resources. Food safety experts, joined by the Meat Institute and the grocery industry, have asked for $111 million, a 50% increase, to turn the other six pathogens back on. The White House asked for $107 million. The House bill offers $79 million, and directs the increase to lab and informatics modernization.

The other two agencies are in a separate bill, and they fare better. FDA’s Human Foods Program, responsible for lettuce, would get $1.279 billion, a $108 million increase and within a rounding error of what the White House asked for. That account had been flat since 2023. USDA’s Food Safety and Inspection Service would get $1.226 billion, up $10.8 million, all of it for state inspection programs. FSIS inspects meat, poultry and eggs. It has no authority over lettuce.

• A poll from the Goldwater Institute.

• The war being waged in American medicine.

• Distrust of mainstream medicine, sold two ways.

• Follow the money into medicine and wellness.

• The American free market in health was a policy choice.

• The people who invented the right to try.

A poll from the Goldwater Institute

On Friday, an advocacy group emailed me a survey. The finding: 90% of Americans say it is important that patients with terminal illnesses or rare diseases reach “the most promising, cutting-edge treatments available, even before those treatments have received full FDA approval.”

The email left out a few things. The pollster, Fabrizio Ward, polls for President Trump. The sample was 1,000 registered voters, not “Americans.” And almost no one says such access is unimportant, which is the answer a question like that always gets.

The group is the Goldwater Institute, and it wants Congress to pass a bill it calls Right to Try 2.0. The survey was conducted to demonstrate popular support for the bill.

Meanwhile, last fall, Hims & Hers, the telehealth company you know from its hair-loss and erectile-dysfunction ads, started selling lab tests straight to consumers, no doctor required. One names the government as standing between you and a cure; the other, your doctor, between you and your data. They are selling the same product, and both are having a very good year.

The war being waged in American medicine.

It is a fight over control. On one side is evidence-based medicine, which says a test or a drug should be filtered by proof before anyone recommends it. On the other is a public that increasingly wants to test, treat, and prevent on its own terms: order the labs, buy the supplement, try the drug, skip the shot.

The public is winning, and not because its customers are fools. It wins for reasons my own profession would rather not say out loud.

Evidence-based medicine, on paper, already takes into account what the patient wants. But in the exam room, it often does not. People meet it as a refusal, a six-week wait, a shrug, a pathway with no time for their story. And sometimes the problem is worse than slowness. The experts are wrong. The opioid epidemic ran on “evidence”: industry-funded trials, paid specialists, and professional-society guidelines that assured doctors that pain was undertreated and the new pills rarely addicted anyone. The mainstream helped kill hundreds of thousands of people. So when someone tells you they have stopped trusting the experts, they are sometimes remembering the last time the experts, footnotes and all, were catastrophically wrong.

The real disconnect is not science versus freedom. Evidence-based medicine asks whether something works for people like you, on average, with proof. A lot of the public is asking a different question: whether they should be free to try it anyway because it fits their values; because they can afford it and what do they have to lose; or because it is the only move they have. Both are legitimate questions.

Distrust of mainstream medicine, sold two ways.

If you think mainstream medicine has grown too synthetic, too corporate, too far from nature, there is a store for you. Raw milk, the supplement stack, the parasite cleanse, castor oil in your belly button, sold as rebellion against a captured system. This is the natural-equals-safe loophole: the product must be good, because mainstream medicine doesn’t want you to have it.

If you think mainstream medicine is too slow and too low-tech, too willing to wait until you are already sick, there is a different store. Function Health will sell you a lab-testing membership, and just raised $298 million doing it. Prenuvo will sell you a $2,499 full-body MRI that doctors say offers reassurance they cannot deliver. A concierge longevity clinic will sell you the whole package. It’s all sold as optimization.

These look like opposites, the naturalist and the biohacker, but they start from the same place: mainstream medicine cannot be trusted. One decides the answer is to minimize the use of biomedical diagnostics and therapeutics, and the other, to maximize their use. Both are selling the same thing: control. One calls it natural. The other calls it data.

“Do your own research” feels like power. Researchers have also found that the more people embrace it, the more likely they are to distrust science. Both of those can be true at once. Ordering your own blood panel feels like power too, especially if the last three times you raised a symptom, a doctor waved you off. When you cannot get an appointment for six weeks, a chatbot that answers at midnight and does not make you feel small is meeting a real need. Doctors are now openly frustrated that patients arrive with results from tests they did not order and cannot easily interpret. The demand is rational. And the market is responding.

Follow the money into medicine and wellness.

The alternative to the wellness market is not clean, disinterested science either. It runs on industry money, and discloses far less of it than it should. In 2020, researchers found that 72% of the leaders of major U.S. medical associations had financial ties to industry. The professional societies that write the guidelines your doctor follows take millions from drug and device companies through conference sponsorships, satellite symposia, and educational grants. When researchers checked the authors of 2020 U.S. clinical guidelines against the federal payments database, about three-quarters had taken money from a drug or device company, though not necessarily from the makers of the drugs in their own guidelines, and only about a third disclosed it. Separately, when guideline writers do have a stake in a product, their recommendations tend to favor it.

Both sides of the wellness market — the naturalists and the biohackers — take industry money, too. Influencers are usually selling the products they’re praising, though they rarely disclose it.

What is left is method and accountability: a doctor’s industry payments are public record, a guideline can be challenged and rewritten, a bad recommendation can be pulled. None of that applies to someone ranking supplements on TikTok. The medical-freedom movement is right that you should follow the money. It just never follows it home, to the supplement seller and the think tank that wrote the bill.

The American free market in health was a policy choice.

Congress exempted supplements from drug-grade proof in 1994. It passed the first Right to Try in 2018, a law used by remarkably few patients, because the thing standing between dying people and experimental drugs was almost never the FDA. The agency already grants the large majority of compassionate-use requests. What actually stands in the way is cost, manufacturing, and whether a company thinks there’s a market for the drug and will make the drug at all.

Other high-income countries have the same distrust, the social media, the same influencers. Germany strictly controls genetic testing. Australia rejects tick-box online prescribing. They looked at the same pressure and chose guardrails. The United States has chosen to run the loosest consumer-health market of its peers.

American medicine is slow, expensive, dismissive, and occasionally captured, sending people to seek control, and there’s a market is waiting to sell it back to them at $2,499 a scan. The system offloads its failures onto the individual, sells that person the freedom to fix it, and calls it empowerment.

The Goldwater email is built the same way. Out front is a real patient, a young man with Duchenne muscular dystrophy whose situation is desperate and whose wish to name his own risk tolerance, when it is his own life, I take seriously. The science he is pointing at is real: individualized gene-based therapies do not fit a system built around large placebo-controlled, randomized clinical trials. But read the bill, and the families still pay for the treatment, the manufacturer still has no obligation to provide it, and no one can be sued if it goes wrong.

The people who invented the right to try

The right-to-try movement didn’t start with the Goldwater Institute. It started with dying gay men.

In the late 1980s, people with AIDS were handed a death sentence and told to wait years for the science to catch up. ACT UP refused, and so did the group that grew out of it, the Treatment Action Group. Activists like Mark Harrington and Peter Staley taught themselves the trial science, forced their way into the FDA and the NIH, and demanded faster access to experimental drugs. They largely won.

But they didn’t ask for a blank check. They demanded a system called parallel track: let people who couldn’t get into a study take the drug anyway, and collect data on every one of them, so the access itself produced answers. Get the drug to the dying and study what happens at the same time. They did not just want the right to try. They wanted the right to know.

They wanted it because they had seen the alternative. One AIDS drug, ddC, was approved after a trial in which twice as many patients taking it alone died in the first year as those on the older drug. Another, ddI, was waved through on a lab value bump with no proof it helped anyone live longer. For desperate people, access without answers was a second way to die. So the same activists who broke down the FDA’s door turned around and forced companies to finish the trials and replace “promising” with “proven.” Access versus answers, they called it, and they took both. That discipline is part of what produced the combination therapy in 1996 that turned HIV from a death sentence into a condition people live with for decades.

That system still exists. It is called expanded access, and the FDA clears about 99% of the requests it gets. The real bottleneck was never the government. It was drug companies that would not supply the drug, and that is the bottleneck Goldwater’s bill leaves standing.

Right to Try 2.0 keeps the access and throws out the right to know: no trial at the end of it, no data, no duty to learn anything, only a shield against being sued. We ran that experiment recently. During COVID, an expanded-access program enrolled more than 100,000 Americans to receive convalescent plasma, and the FDA authorized it based on that observational data. The U.S. largely didn’t run the randomized trials that could have shown whether it worked. We still cannot say for certain that it helped anyone.

That is access without answers, the one thing the people who invented the right to try refused to accept.

• The false claim still on the CDC’s site.

• A lot of deflecting.

• What integrity cost the last CDC director.

• The HHS secretary makes the final call.

• Why a strong CV isn’t enough.

The false claim still on the CDC’s site.

The Centers for Disease Control and Prevention has a page on its website that tells parents that scientists “have not ruled out the possibility that infant vaccines cause autism.” The agency rewrote its own guidance to say that in late 2025. The old heading, “Vaccines do not cause autism,” is still at the top. A footnote explains that the heading survives only because of an agreement with Senator Bill Cassidy. Since 1998, more than 40 studies across seven countries, involving over 5.6 million people, have looked and found no link.

On Wednesday, the physician nominated to run that agency sat before the Senate and was asked, more or less, whether she’d take the page down. Dr. Erica Schwartz said she hadn’t read it. She’d look into it. She’d speak with the Secretary.

That was the hearing, in one exchange.

Dr. Schwartz is a serious pick on paper. She’s a career military physician and clinical epidemiologist who served in the Navy and the Coast Guard and was deputy surgeon general during COVID. She told the committee that public health is in her DNA, that her top priority is to restore trust, that she’ll run the CDC with “radical transparency,” and that she’ll “never betray science.” She came across, by most accounts, as sincere.

Then they got into the specifics.

A lot of deflecting.

Senator Bernie Sanders asked Dr. Schwartz whether the evidence shows that vaccines don’t cause autism. She said she accepted that evidence. So would she commit to removing the claim the CDC itself had posted? She wouldn’t. She hadn’t reviewed the page. She’d talk to the Secretary. She agreed with the science and declined to act on it in the same two minutes.

Then Senator Maggie Hassan pushed harder. If the Secretary ordered her to stop promoting the flu vaccine during a bad flu season, would she refuse? “I don’t speak in hypotheticals,” Schwartz said. Hassan’s answer: it isn’t hypothetical, it happened. Last year HHS ordered the CDC to halt some vaccine advertising.

What integrity cost the last CDC director.

The senators had a specific reason to press her. Schwartz’s predecessor, Susan Monarez, was confirmed as CDC director and lasted about 29 days. She was fired in August 2025 after she refused to promise, in advance, to approve the vaccine committee’s recommendations “regardless of the scientific evidence” and refused to fire career scientists on demand. “I was fired for holding the line on scientific integrity,” Monarez told the Senate. Several senior CDC leaders resigned in protest that week.

Dr. Schwartz insisted that she didn’t believe the President or the Secretary would pressure her to rubber-stamp vaccine policies. She said it 11 months after the Secretary did exactly that to the last CDC director.

being pressured by the Secretary to approve the vaccine committee's recommendations "regardless of the scientific evidence" and to fire career scientists, then getting fired for refusing. So "something like that" = being ordered to carry out an unscientific directive.

The hearing kept returning to the same question, the same one senators ask every nominee: is this a person of integrity? Schwartz kept answering it. “I have lived and led with my integrity.” It’s the wrong question because the job has been rebuilt so that her integrity can’t influence the decisions that matter.

The HHS secretary makes the final call.

Vaccine recommendations become official policy when the CDC director signs them or when the Secretary does. Dr. Schwartz conceded the point herself: the Secretary “ultimately makes the decision.” The Secretary has already reconstituted the Advisory Committee on Immunization Practices (ACIP), the external advisory committee on vaccines, to include vaccine skeptics. He already removed the last CDC director for pushing back. So a sincere director can sit atop the agency and never personally betray science, because the calls she’d object to get made one level up. Her integrity is real and, for the questions the senators care about, beside the point.

The senators trying to pin her down, Cassidy, Sanders, Hassan, Tammy Baldwin, Lisa Blunt Rochester, were all trying to do the same thing, which is to turn a promise about character into a promise she’d be held to. They couldn’t. A confirmation hearing is supposed to be where the public trades a vote for enforceable commitments. This one produced assurances of good character and almost nothing they could enforce.

Why a strong CV isn’t enough.

Trust in the CDC didn’t break because the wrong person held the title. It’s breaking because the people who held it and did the job got pushed out, because a false claim about vaccines and autism went up on the government’s own website, because the recommendations that decide whether childhood vaccinations are covered now run through a committee rebuilt to doubt them. A trustworthy person confirmed into a role stripped of the power to change anything doesn’t fix the problem.

Senators can withhold their votes until her commitments are binding. But the Secretary can sign the vaccine policy either way, whatever the nominee promises.

• How we’re told to handle wildfire smoke now.

• The law that cleaned up the air.

• The people most exposed have the least room to act.

• Wildfire smoke is unregulated under the Clean Air Act.

• Building clean-air infrastructure, not just buying filters.

How we’re told to handle wildfire smoke now.

This week’s public health advice arrived as a shopping list: Close your windows. Buy a box fan and a furnace filter, or a portable air purifier. Wear an N95 if you go out. Check an app before you let the kids outside. Wait for the wind to change.

It’s reasonable advice. I give it myself. It’s also an admission that the thing we built to keep our air clean has stopped protecting us.

The law that cleaned up the air.

The Clean Air Act is one of the most successful public health laws in the country’s history. Since 2000, average fine-particle pollution in the US has fallen about 41%. We treated dirty air as a public problem with a public fix: set standards, cut pollution at the source, and the air over everyone’s house gets cleaner at the same time. Nobody had to shop for it.

This week, the smoke over New York and Minneapolis didn’t come from a local smokestack that can be regulated. It drifted in from forests burning hundreds of miles away, some of them in another country. New York’s air quality index hit 192 Wednesday night, and Minneapolis passed 280. And a heat dome is sitting on top of the country, doing two jobs at once: drying the land so the fires burn bigger, then acting like a lid that traps the smoke close to the ground where we breathe it.

The people most exposed have the least room to act.

“We cleaned the air” becomes “you protect yourself.” And that “you” covers a lot of people who can’t actually follow it.

The shopping list assumes you own your home, or that your landlord cares about your filters. It assumes you have central air, or any air conditioning at all. It assumes you can stay inside, that you don’t frame houses or pave roads or pick crops for a living. It assumes the indoors is a refuge. Harvard’s Joseph Allen pointed out this week that most of the air you breathe on a smoke day is indoors, and older, leakier housing lets more of the smoke in.

The same heat feeding the fires also puts people in a bind. The health department has to warn that overheating can be the more immediate danger. So a person without air conditioning gets two instructions that cancel each other out: close the windows against the smoke, and open the windows so you don’t cook. Pick one.

Who are the people caught in that bind? We call them “sensitive groups.” Children. Older adults. Pregnant women. People with asthma or heart disease. The immunocompromised. The people most exposed usually have the least room to do anything about it.

You've probably seen the apps that turn a smoky day into a cigarette count. It's a real number, from Berkeley Earth: about 22 micrograms of fine particles over a day carries the long-term death risk of one cigarette. But, Allen told me, “The cigarette calcs are easily dismissed (it’s only 1 cigarette!), don’t account for the full range of effects (e.g. everyone’s eyes are itching, headaches), are based on studies of chronic exposure whereas this is acute.” This comparison counts only the slow, decades-off risk, skipping the one that’s actually here this week: the heart attack or asthma attack that hits within hours. “The major and robust stats about short term risks are robust and carry the message (pediatric ER admission risk increases by 5% for every 10 ug/m³ and heart attack risk 2.5% for every 10,” said Allen. A cigarette also sounds like a personal habit you chose, and it averages everyone into one healthy adult. The same air that works out to "a cigarette" for me is an ER visit for a child with asthma. Wildfire smoke is unregulated under the Clean Air Act.

This smoke is climate change handing back the clean air we won by law. Since 2016, wildfire smoke has erased about a quarter of that progress across much of the country and more than half of it in parts of the West. And the law can’t reach it: wildfire smoke is unregulated under the Clean Air Act, which cleaned up everything else. It’s also more harmful than the same amount of ordinary city pollution. And on days that combine extreme heat and heavy particle pollution, exactly what the East is getting this week, the American Heart Association warns that the risk of a fatal heart attack roughly doubles, worst for women and older adults.

Building clean-air infrastructure, not just buying filters.

Something else changed too: who’s on the hook to fix it. A public achievement, clean air by statute, is being swapped for a private chore, a filter and a mask and an app. It’s now about personal responsibility. And the households that can least afford the fix are the ones the smoke reaches first, in neighborhoods that were redlined decades ago and still breathe dirtier air today. The harm isn't spread evenly: a study in the Journal of the American Heart Association found heavy smoke raised the risk of out-of-hospital cardiac arrest by up to 70%, with the biggest jumps in lower-income communities.

None of this makes the box fan wrong. A good filter or a cheap purifier really does help. The American Heart Association says the right one can cut indoor particle pollution by 50 to 60%. But it protects one room in one house for a day. It does nothing about why the smoke is there. You can’t buy your way, one household at a time, back to the air a whole country used to share.

The lever that matters sits upstream. It’s the emissions driving the heat and the fires, which are energy and climate policy. It’s clean-air infrastructure built the way we once built clean-air law: filtration standards for schools and public housing, clean-air shelters that double as cooling centers, protections for outdoor workers, and warning systems that treat heat and smoke as the single combined hazard they’ve become. Cities, employers, landlords, and the EPA hold those levers. A parent with a box fan does not.

For now, the country that once legislated cleaner air is refreshing a smoke map to decide whether it’s safe to send the kids out to play.

• Testing troops over 30 for low testosterone.

• Screening healthy people mostly just finds healthy people.

• What a testosterone test can and can’t tell you.

• Low testosterone is usually a signal, not the problem.

• What the screening costs, and what it can’t buy.

• Waste, fraud, and abuse, by the government’s own definition.

Testing troops over 30 for low testosterone.

On Tuesday, the Secretary of Defense announced that the U.S. military would start drawing blood from hundreds of thousands of men to look for a diagnosis most of them don’t have.

Pete Hegseth’s new policy makes a testosterone test a required part of the annual physical for every service member 30 and older. Younger troops can opt in. Anyone who screens low can be offered testosterone replacement therapy, which Hegseth called entirely voluntary. The stated goal is “maximum psychological and mental readiness” and “the biological foundation required to sustain the fight.”

The logic is simple: Testosterone makes men strong. Strong men win wars. So test the men, fix the low ones, and win more wars.

Screening healthy people mostly just finds healthy people.

There’s a reason no medical body recommends doing this. The Endocrine Society, which writes the guidelines American doctors actually use, recommends against screening the general population for low testosterone. So does the American College of Physicians. They didn’t miss the memo on male vitality. Screen men who feel fine and most of the low readings come back from men who are fine. All the test adds is the label.

What a testosterone test can and can’t tell you.

Start with the test. One low reading doesn’t make a diagnosis, because testosterone rises and falls over the course of a day, drops when you’re sick, stressed, or short on sleep, and declines slowly with age in nearly every man. To actually diagnose the condition Hegseth is screening for, you need two low morning blood draws plus real symptoms. Low readings are common in aging men. In the largest study of the question, only about 2% had a low level together with the symptoms that define the condition. Run the test on everyone over 30 and most of what comes back is ordinary aging that a lab flagged as low.

Then there’s the treatment. The FDA put a warning on the label years ago, spelling out that testosterone is approved for men whose levels are low because of a specific medical problem, and that its benefits and safety have not been established for aging or for performance. In the one large safety trial that tracked men on the therapy, testosterone thickened their blood and raised the rate of blood clots in the lungs. (I’ve had to refer patients taking testosterone for body-building to the Emergency Department for emergency phlebotomy so they didn’t stroke out.) A companion analysis found more fractures in the treated men, which surprised the investigators. And give the hormone to a man whose own levels are normal, and his body responds by shutting down its own production. That can mean shrinking testicles and, for a man who wants children, infertility.

So the readiness policy asks healthy men to take on the risk of clots, fractures, and infertility in exchange for a benefit that, in a man who isn’t deficient, no trial has shown. Even in men who genuinely are low, the honest list of benefits is short. Testosterone reliably helps libido and lifts mood a little. It has not been shown to improve energy, focus, or physical performance. It doesn’t turn a tired 34-year-old into a sharper soldier.

Low testosterone is usually a signal, not the problem.

The announcement leaves out the most useful fact. When a man in his 30s or 40s genuinely does have a low level, it’s usually pointing at something else: extra weight, bad sleep, chronic pain and the opioids prescribed for it, heavy drinking, relentless stress. It’s often pointing to the conditions of military life. Address the weight or the sleep, and the number frequently climbs back on its own. The evidence-based approach is to treat the cause. Screening finds the number and offers a prescription, and the cause stays remains unchanged.

There was already a market waiting for this announcement. Testosterone prescribing in the U.S. climbed steeply through the 2000s, a lot of it going to men who were never properly diagnosed, until the FDA warning cooled it off. The direct-to-consumer “low T” clinics that filled the gap have spent the years since handing out testosterone in ways the guidelines don’t support. A mandatory screening program across the armed forces would be the single biggest source of new testosterone patients anyone has built.

What the screening costs, and what it can’t buy.

Now put a price on it. There are about 1.3 million active-duty troops, and since the average one is nearly 30, the mandate covers something on the order of half a million men, every year. A testosterone test runs around $85 at typical commercial prices. Screen half a million men annually, and you’re into the tens of millions of dollars before anyone is treated. The screen is the cheap part. Every man who flags low needs a second confirmatory draw and a panel of follow-up hormones, and every man who starts therapy needs the drug plus blood and prostate monitoring for as long as he stays on it, which is often the rest of his life. There’s no published cost-effectiveness analysis showing this is worth doing. The Endocrine Society looked at the question and decided it wasn’t.

And ask what that money treats. Picture a trucking company with a crash problem that decides to test every driver’s reflexes and hand stimulants to the slow ones, while leaving the 14-hour routes exactly as they are. The reflex scores come back precise and official. The routes are what’s causing the crashes. A testosterone number works the same way. It’s a real reading, and in a fit man in his 30s it’s usually a downstream signal of sleep, weight, pain, or stress rather than the problem itself. Tens of millions of dollars a year buy a lot of precise readings. It doesn’t buy sleep, weight programs, non-opioid pain care, or a therapist. The military is already short of therapists, and troops seeking care wait for them. Fifty million dollars could buy a few hundred mental health providers in clinics that don’t have enough of them.

Waste, fraud, and abuse, by the government’s own definition.

There’s a phrase this administration is fond of: waste, fraud, and abuse. The policy manages a version of all three. The waste is already here, in the tens of millions spent to screen for a condition the medical field says not to screen for. The fraud risk is the market it feeds. The modern “low T” business was built on a marketing campaign that took ordinary aging and sold it as a disease, and a share of the testosterone men actually receive comes from compounded products that aren’t FDA-approved and often don’t contain the dose printed on the label. The abuse risk is the drug itself. Testosterone is a Schedule III anabolic steroid, the same class that the Navy has begun randomly testing SEALs for. One arm of the military is working to keep steroids out. Another is preparing to hand one out through the pharmacy.

Testosterone therapy is real medicine for a smaller number of men with true hypogonadism, from Klinefelter syndrome to pituitary disease to AIDS to the aftermath of cancer treatment. Those men should get it, and many still don’t. Everyone else in the ranks is now scheduled to be tested for a deficiency the guidelines warn against screening for, and offered a drug whose own label says it won’t sharpen a healthy man. The Secretary of Defense is calling that "readiness.

A July 13th update

On July 11th, I sent HHS a second request for comment, and it was written to be harder to dodge: five questions, each anchored to a specific public record so that a non-answer would be conspicuous. I asked CDC to commit to a defined update cadence and to state its reporting lag; pressed FDA on the GAO finding that it has missed its congressionally mandated inspection targets since 2018; asked why, with mandatory-recall power since 2011, the FDA left the Raw Farm recall voluntary; asked what actually changed to narrow FoodNet from 8 reportable pathogens to 2 when the budget request didn’t move; and asked how much genomic-sequencing capacity states lost when the Advanced Molecular Detection money was rescinded, and how much slower multi-state matches run now.

In their third reply, HHS made two concrete denials that didn’t address my specific questions. “FDA investigators were not impacted by staffing changes or RIFs” is about a job category, investigators, that my question wasn’t flagging. The documented April 2025 cut hit the FERN lab quality-control team, a quality-assurance officer, an analytical chemist, and two microbiologists. Saying investigators were spared neither confirms nor denies that. And “cyclospora tracking never stopped” answers a claim I didn’t make: my point was about the lab check that validates detection and the absence of any testing requirement, not that case-counting halted. Case tracking and lab quality control are different things.

They still didn’t answer my specific questions: no staffing count, no sample results, no yes-or-no on capacity versus 2024, nothing on whether the FERN proficiency-testing program is running, and no named food.

Under the leadership of Secretary Kennedy, FDA is currently investigating Cyclospora outbreaks using established epidemiologic, laboratory, and traceback tools in close coordination with CDC and state and local partners. Protecting the nation’s food supply is a core FDA responsibility, and the agency has the expertise, personnel, and resources necessary to detect, investigate, and respond to foodborne illness outbreaks and take regulatory action when warranted. Additionally, FDA investigators were not impacted by staffing changes or RIFs.

To be clear, cyclospora tracking never stopped. CDC is actively working with 3,000 health departments to gather data.

Emily G. Hilliard
Press Secretary
U.S. Department of Health and Human Services

What I asked, what they said, and what’s still missing

• What a peptide actually is.

• The Ozempic halo effect.

• Not testing the drug is the business model.

• The same trade route that ships fentanyl.

• When the anti-establishment movement becomes the establishment.

• The fix is more scrutiny, not less.

On July 23rd, a federal advisory committee votes on whether to recommend that compounding pharmacies be allowed to make seven peptides, BPC-157, TB-500, and MOTS-c among them, that the FDA has never approved and that carry almost no human trial data. If it goes their way, compounds now sold online in vials stamped “for research only” could move onto pharmacy shelves. They’re up for that vote because they’ve gotten popular and because there’s pressure in Washington to loosen the rules on them. What ties an untested powder to insulin and Ozempic is just the word they share: “peptide.” That’s the marketing. It makes an untested freeze-dried powder in a vial sound like a proven drug.

What a peptide actually is.

A peptide is a short chain of amino acids. A longer chain of amino acids is called a protein. Proteins are long enough to fold into a stable, specific three-dimensional shape, and that shape is usually what does the work: an enzyme’s pocket or an antibody’s binding site. Most peptides are too short to hold a fixed 3D structure. They tend to act as signals or hormones rather than as folded machines.

Short peptides can be built chemically, one amino acid at a time at a lab bench. Proteins are generally too big and too dependent on correct folding to synthesize that way, so you have to grow them in living cells. That’s the whole reason peptides are cheap to make, and antibodies and other biologics need the living-cell factories.

“Peptide” is a description of chemistry, the way “carbohydrate” is. It tells you how a molecule is built, not what it does to you. Insulin is a peptide. So is oxytocin. So is α-amanitin, the toxin in death-cap mushrooms (Amanita phalloides) that can cause fatal liver and kidney failure, and so are the main toxins in bee and scorpion venom. “Carbohydrate” is just as broad: kale and cake are both carbohydrates, and so is laetrile, a sugar compound from apricot pits that was sold for years as a cancer cure and released cyanide in the body. Nobody accepts “it’s a carbohydrate” as a reason to trust something. But “it’s a peptide” has become a reason to inject something, and now a reason to consider selling it at a pharmacy.

The Ozempic halo effect.

So why does “peptide” sell when a word like “oligonucleotide” never could? Ozempic. Semaglutide and other GLP-1 drugs are peptides, and they have become the biggest medical story in a decade. Peptide started to sound like the future, the way "blockchain" did in 2017, when adding the word to a company's name could send its stock up. But that reputation came from a handful of specific drugs, tested for years in real phase III placebo-controlled, randomized clinical trials. It doesn't transfer to a powder in a vial just because it’s a peptide.

Not testing the drug is the business model.

Cheap to make is only half of why this became a business. The other half is that the seller skips the step that costs the most. China is now the world’s peptide manufacturing hub, and U.S. imports of peptide and hormone compounds from there roughly doubled last year, to about $328 million in the first three quarters of 2025, according to customs data reported by The New York Times. The NYT also named the reason drug companies never ran trials on most of these: they’re easy to manufacture and don’t clearly target a disease. There’s no patent to defend and no single illness to run a trial against, so no company spent a decade proving one works. The gray market filled the gap.

A prescription GLP-1 ran more than $1,000 a month until recently. The “research use” version goes for roughly a fifth of that and is still enormously profitable, because bringing a real drug through trials to FDA approval is often estimated in the hundreds of millions of dollars, and by some counts well over a billion once you count the failures. A gray-market peptide skips every bit of that. Not testing the drug is the business model.

Selling it is just as cheap. The “for research only” label is regulatory cosplay. The powders ship from a Chinese factory or a U.S. importer, get promoted by affiliates on TikTok with a discount code, and are often paid for in cryptocurrency because ordinary payment processors flag the sales. None of that needs a sales force, an FDA marketing review, or a single published trial. And the clinics are cashing in too: peptides like BPC-157 have become a booming offering at anti-aging and wellness practices, a business Bloomberg has called a peptide “gold rush.”

The same trade route that ships fentanyl.

Peptides are only the newest product in a trade that China has run for years. The same exporters and the same "research only" labels move selective androgen receptor modulators (SARMs) and raw steroid powder for muscle, compounds like tianeptine that the FDA calls "gas station heroin," and fat-loss chemicals like 2,4-Dinitrophenol (DNP) that have killed people. Some of it gets spiked into "natural" supplements sold on Amazon. At the far end of the same pipeline sit fentanyl and its precursor chemicals, which China ships to the Mexican cartels. The supply chain isn't new. What peptides have that SARMs and DNP never did is a word that sounds like medicine, which is why it may make the jump from the biohacker forums to the pharmacy counter.

When the anti-establishment movement becomes the establishment.

The peptide trade isn’t fringe. It’s the leading edge of a movement, and the movement makes a promise: conventional medicine is captured by profit, so you should be free to route around it. On the facts, the grievance is earned. Drug pricing really is predatory. The company that made OxyContin buried what it knew. Dr. Tom Frieden, the former CDC director, granted as much to STAT News: the Make America Healthy Again movement is right that chronic disease and corporate influence are real problems. A person who concludes the system has lied to them for money isn’t crazy.

The trouble is what the movement sells as the cure. It sells distrust itself as a product. Spend time in the wellness feeds, and the pitch becomes clear: they’re selling products, yes, but also the anxiety that you can’t trust your doctor. And the people making that pitch aren’t neutral. Calley Means, a top adviser to the health secretary, held a financial stake of up to tens of millions of dollars in a wellness-payments company while advising the government, and his sister, Casey, who was nominated for surgeon general, made her name in the wellness industry. The business model isn’t new. Joseph Mercola, one of the most influential anti-vaccine voices online, built a supplement fortune on the audience his misinformation created. At RFK Jr.’s HHS, the industry with the vested interest and the influence muscle is Big Wellness, not Big Pharma.

In 1994, Congress passed the Dietary Supplement Health and Education Act, which allowed supplements to be sold without proving to the FDA that they’re safe or that they work. Peptides are the next product trying to slip through an even wider version of that same opening. Big Wellness, a movement that built its name attacking the establishment, now runs the establishment, and it’s using the FDA’s own machinery to help specific sellers. Kennedy has been candid about the tradeoff. On the alternatives he wants to open up, Kennedy said on a podcast, “You’re going to get a lot of charlatans, and you’re going to get people who have bad results.” He added, “You can’t prevent that either way.”

You can, though, at least some of it. That’s what the FDA and clinical trials are for. What we have on BPC-157, the headliner of the July hearing, is animal and cell studies, as well as testimonials. It was discovered more than 30 years ago, and in all that time, not one controlled human trial of it has been published. Most of the promising research comes from a single lab whose lead scientist holds patents on the compound. It promotes new blood-vessel growth, which is not something to switch on blindly, given how many cancers depend on it.

The fix is more scrutiny, not less.

Call it the “peptide = proven” loophole. The category becomes the proof. Nobody has to show it works, because the word already sounds like it does. And the fix for what Big Pharma gets wrong is not less scrutiny. It’s more: independent trials that aren’t paid for by the company being reviewed and real penalties for hiding data. And drug prices need to be affordable for people not to seek out alternatives on a gray or black market. The peptide market takes a real complaint, that medicine is captured and overpriced, and answers it by selling you something nobody’s checked at all.

• What can go wrong in the aorta.

• The aneurysm nobody saw.

• Why I asked for an autopsy.

• What the autopsy found in his DNA.

• Turning a death into prevention.

• Should you get checked?

Senator Lindsey Graham died on Saturday, July 11th, at 71. The medical examiner’s preliminary finding was an aortic dissection, a tear in the wall of the aorta, the large artery that carries blood out of the heart. The final death certificate is still pending. Most of the coverage called it “sudden.” Aortic disease is usually silent until it tears or bursts.

What can go wrong in the aorta

The aorta is the body’s largest artery, running from the heart down through the chest and abdomen. Three different things can go wrong with it. They’re related but not the same, and they get confused all the time.

An aneurysm is a bulge. A weak spot in the aortic wall stretches and balloons outward. It happens slowly, over years, and usually causes no symptoms, which is why most aneurysms are found by accident on a scan done for something else. An aneurysm is defined by size. The wider it grows, the thinner and more fragile the wall gets, and the higher the odds that it will eventually fail.

A dissection is a tear. Blood breaks through the inner lining and forces its way into the wall itself, splitting the layers apart and carving a false channel. This one is sudden and is a true emergency, usually announced by abrupt, tearing chest or back pain. It doesn’t require an aneurysm first. A dissection can strike an aorta that was never enlarged, which is part of why it gets missed.

A rupture is a burst. The wall gives way completely, and blood pulses out where it shouldn’t, into the chest or the sac around the heart. It’s the usually fatal ending that either an aneurysm or a dissection can lead to, and it can kill in minutes.

Bulge, tear, burst. One can set off another, but they aren’t the same. Dissection skews older, driven by high blood pressure and hardened arteries. An aneurysm in a younger person is more likely to be inherited, caused by a weakness in the connective tissue itself.

That difference is what separated Graham from my husband. Graham's aorta, at 71, tore, a dissection along a wall stiffened by decades of what the medical examiner called arteriosclerotic cardiovascular disease. My husband Grant Wahl's bulged and burst, at an age when this disease usually means something inherited.

Graham’s kind is the common one, driven by age, blood pressure, and hardened arteries. For most people, it isn’t a reason to go hunting for an aneurysm. It’s a reason to treat your blood pressure and for emergency rooms to keep a tear in the aorta on their radar, because it still gets mistaken for a heart attack. There is one proven screening test in this whole area: a one-time ultrasound for men 65 to 75 who have ever smoked, which looks for abdominal aneurysms. Beyond that group, almost no one reading this needs a scan tomorrow.

The version that killed my husband is the other one, and it doesn’t play by those rules. It runs in families, it strikes decades earlier, and it usually gives no warning until the artery fails. A routine checkup won’t find it, and no population screening program looks for it. Most families learn they carry it the way mine did, after someone dies. None of this is a reason for everyone to panic. But if aortic disease runs in your family, it can be caught early, with imaging and sometimes genetic testing, long before it turns dangerous.

The aneurysm nobody saw.

In December 2022, my husband, the soccer journalist Grant Wahl, collapsed in the press box while covering a World Cup quarterfinal in Qatar. He died that night. He was 49.

The aneurysm was in the first stretch of aorta just above his heart, 6.0 cm across, and when it ruptured it filled the sac around his heart with blood. The autopsy found the wall had been thinning from the inside for a long time, its elastic fibers fragmenting. There was almost no hardening of his arteries at all. His was a bulge that burst in a man under 50, without the decades of arterial wear that killed the senator.

Why I asked for an autopsy.

I’m a physician, epidemiologist, and medical journalist. I investigate. I think in terms of mechanisms and evidence, and I don’t accept “he died suddenly” as a stopping point. So I asked the New York City medical examiner for a full autopsy. I wanted to know what had happened, and I wanted an explanation. Had I missed something? Could anything have been done to prevent it or treat it? Could whatever killed him be used to protect the rest of Grant’s family, or help other families? I needed to make sense of it. Grief leaves you turning every ordinary day over, looking for the sign you didn’t catch, and the autopsy gave me answers instead of that loop. It gave me closure. It was therapeutic.

It gave me facts I needed for an uglier reason, too. Within days of Grant’s death, people invested in vaccine disinformation claimed the COVID shot had killed him. The autopsy was unambiguous: he tested negative for the virus, and the report stated that his prior vaccination “neither caused nor contributed” to the rupture. I’ve written about that elsewhere, and I’ll leave it there.

What the autopsy found in his DNA.

The New York City medical examiner’s office runs the only molecular genetics laboratory housed inside a medical examiner’s office in the country. It tests the DNA of people who die suddenly, reviewing about 500 cases a year and finding a genetic cause in roughly 100 of them. In Grant’s heart tissue, the lab found a variant in FBN1, the gene behind Marfan syndrome.

Grant did not have Marfan. He was tall, but he didn’t have the syndrome. What he had was a single change in a gene that helps build the connective tissue holding the aortic wall together, in a spot the labs classify as a “variant of uncertain significance.” We don’t know for certain that this variant caused his aneurysm. It’s the most likely explanation, and inherited connective tissue problems are well-established risk factors for ascending aortic aneurysms in people under 60.

Sorting out which of these variants actually cause disease is real, unfinished work. Dr. Dianna Milewicz’s group at UTHealth Houston has spent years mapping the genes behind thoracic aortic disease. Other teams are chasing the opposite question: why some people carry a Marfan mutation and never get sick, hunting “modifier” genes that seem to shield the aorta. Grant’s variant sits inside that uncertainty.

Turning a death into prevention.

None of that uncertainty changed what came next. Once the lab identified the variant, Grant’s blood relatives could be tested for that exact change. My brother-in-law Eric, Grant’s brother, carries it. His uncle, a niece and a nephew, and other family members have been tested, too. Eric had echocardiograms as well as MRI and CT scans. His aorta is structurally normal. He now gets regular imaging, and if his aorta ever starts to enlarge, his doctors will see it coming, with years to act.

That’s what the autopsy did. It gave the people who share Grant’s DNA something they could act on.

The same disease killed the actor John Ritter. In 2003, at 54, he died of an aortic dissection that was mistaken for a heart attack. His widow, Amy Yasbeck, started the John Ritter Foundation for Aortic Health, which funds Milewicz’s research program and has enrolled more than 1,500 families. Eric now advocates with them. Twenty-three years after Ritter’s death, aortic dissection is still routinely missed in emergency rooms because it mimics a heart attack and most clinicians aren’t thinking about it.

But it’s not just for patients to advocate for themselves. Clinicians should consider a tear in the aorta before sending someone home, and geneticists can test families after a sudden death. The New York City medical examiner recently launched a program called GIFTS that offers free genetic testing to the living relatives of people who died of inherited conditions, the first time a medical examiner’s office has tested living patients. The lab’s director, Dr. Yingying Tang, told me the program was shaped by families like mine.

Should you get checked?

Two questions I get asked a lot:

What should prompt you to get screened? A first-degree relative, a parent, sibling, or child, with a thoracic aortic aneurysm or dissection, or a sudden unexplained death in the family, especially before 60. Physical features of a connective tissue disorder: being very tall with long limbs, a chest that caves in or juts out, severe nearsightedness, or a dislocated lens. The current cardiology guidelines recommend imaging the aorta in the first-degree relatives of anyone with thoracic aortic disease.

One more, and it has nothing to do with family history: men 65 to 75 who have ever smoked should get a one-time abdominal ultrasound to check for an abdominal aortic aneurysm. If that’s you, ask your doctor for it.

Who should get genetic testing? People with a thoracic aortic aneurysm or dissection who also have features of a connective tissue disease, a family history of aortic disease, or disease before 60. When a disease-causing variant turns up, the rest of the family can be tested for that exact variant. That’s how you find the Eric’s, the ones carrying the risk whose aortas are still normal.

And if an aneurysm is found? A known aneurysm is a manageable condition: blood pressure control, regular imaging, and surgery once it reaches a size threshold, around 5.5 cm for the ascending aorta and lower for people with genetic forms. Grant’s was 6.0 cm, well into repair territory. Nobody knew it was there.

I couldn’t have known. He had no symptoms, and nothing in his life would have pointed a doctor to his aorta. But a lot of families can know. If aortic disease has touched your blood relatives, ask your doctor about imaging and ask whether genetic testing makes sense for you.

• Why three million people dropped coverage.

• What the 2027 rate requests mean for you.

• The one state that reversed the trend.

Why three million people dropped coverage.

About three million fewer people are paying for Affordable Care Act coverage than a year ago. Enrollment fell from roughly 22 million to 19 million by February, the first marketplace decline since 2017, and federal data released in June confirmed it across all 50 states. The government points to a crackdown on improper sign-ups. Independent analysts point to the price.

The price change wasn’t subtle. For five years, enhanced tax credits capped what people paid for a marketplace plan, and more than 90% of enrollees got them. Those credits expired on January 1st. The average monthly payment jumped 58%, and deductibles rose about a thousand dollars.

The credits were the central fight in last fall’s 43-day government shutdown, the longest in U.S. history. It ended in November, when lawmakers agreed to reopen the government in exchange for a promised vote on extending them. The credits expired at the end of December. A House vote in January passed the extension, but the Senate didn’t take it up.

Some of the enrollment drop may be due to improper sign-ups being removed. But the federal data can’t cleanly separate cleanup from cost, and the timing is hard to set aside: the coverage cliff arrived the same month the subsidy did. When a premium doubles, a lot of people are going to cancel.

What the 2027 rate requests mean for you.

For 2027, insurers are asking to raise rates again, a second year running. KFF’s analysis for The Wall Street Journal puts the typical request near 14%. In Washington state, the largest marketplace insurer wants 28%, on top of a 35% jump this year. The companies blame rising costs and a shrinking, sicker customer pool, what analysts call a “death spiral”: as healthier people leave over price, the ones who stay cost more, so rates rise, so more people leave.

There’s a second mechanism, less visible. A new verification rule can suspend a person’s tax credit when the details on their application don’t match a government database. Fixing the mismatch can take months, and during that time the enrollee owes the full premium.

The credits were written to be temporary, which means coverage for tens of millions of people was set to expire on a schedule, left to whichever party held Congress in a given year. The verification rule was added on purpose. The death spiral is the predictable output of letting the subsidy lapse.

The one state that reversed the trend.

Which is also why the fix isn’t “shop smarter.” No family re-prices a 58% hike by clipping coupons, and the polling shows they know it: two-thirds of the public, including most independents, say Congress got this wrong. The lever sits with Congress and the states. A Senate proposal from Susan Collins (R-ME) and Bernie Moreno (R-OH) would restore the credits for two years, and it’s drawn interest from both sides of the aisle. What’s blocking it is an unrelated fight over abortion-funding language.

And there’s a working proof of concept. New Mexico was the only state to fully replace the lost federal subsidies with its own money, and the only state where enrollment rose, about 14% in the federal data, while it fell in nearly every other state.

This is the part that gets lost when the story is told as a budget line. The need for a mammogram or an insulin refill or a blood-pressure check doesn’t expire with the tax credit. When people drop coverage, they don’t stop getting sick. They skip the screening, delay the visit, and show up later and sicker, which costs more and helps no one. Even among people who kept their plans, 73% told KFF they were worried about affording a hospital stay.

Open enrollment for next year starts this fall. The credits are still expired, the 2027 requests are still climbing, and the vote that would change either one hasn’t happened. Whether the number of insured Americans keeps falling is a choice, and only a few hundred people in Washington get to make it.