• Teen suicide risk hit a 10-year low in 2025.

• Guns, sexual violence, and self-harm.

• Where are the 2025 data on transgender teens?

• Missing data changes public health policy.

Teen suicide risk hit a 10-year low in 2025.

CDC asked more than 10,000 high school students over 100 questions in spring 2025. Yesterday, it published a report covering a fraction of them. The report focsed on five areas: diet, physical activity, sleep, digital behaviors, and mental health, reflecting the priorities of the Make America Healthy Again movement.

There was good news. Fewer teens seriously considered suicide in 2025 than in any survey year since 2015: 14%, down from 20% in 2023. Sadness fell.

Sports participation, which dipped to 49% in 2021, is back to its 2015 level of 58%. Daily PE fell from 27% to 20% in two years, while fewer students eat breakfast daily than a decade ago.

Guns, sexual violence, and self-harm.

The questionnaire is public, and it goes well beyond those five areas. Students answered questions about sexual violence, self-harm, and whether they got help when they felt sad or anxious. They said how quickly they could get a loaded gun. They reported whether food ran out at home and whether they felt close to people at school. There were questions about sexual identity, including whether they were transgender.

The report did not publish any of the answers students gave to those questions.

CDC posts the raw survey data online, so anyone can see what the report left out.

The report doesn’t cover the health of sexual minority students. Among students who identified as gay, lesbian, bisexual, questioning, or another non-straight identity, persistent sadness fell from 66% to 57% between 2023 and 2025. Serious thoughts of suicide fell from 41% to 30%. Those drops were bigger than the ones among straight students, although the gap remains wide: 28% of straight students reported persistent sadness, about half the rate of LGBQ+ students.

About 1 in 7 girls reported sexual violence in the past year. One in 6 students hurt themselves on purpose. Among students who needed help for sadness or anxiety, half rarely or never got it. And among students who had seriously considered suicide, 43% said they could get a loaded gun without an adult’s permission.

One protective factor rose sharply. In 2023, 55% of students said they felt close to people at their school; in 2025, 63% did. CDC’s earlier research ties that kind of connection to better mental health.

Where are the 2025 data on transgender teens?

In 2023, CDC's national survey asked high school students, for the first time, whether they were transgender. Their answers are the only nationally representative data on transgender teens, and their mental health is by far the worst of any demographic. That year, 71% of transgender students reported persistent sadness, 54% seriously considered suicide, and 26% attempted it, compared with 38%, 18%, and 8% of cisgender students. But we don’t have 2025 data.

The timing matters because students took the survey in spring 2025, as federal policy toward transgender youth shifted. On January 28th, an executive order directed agencies to end federal support for gender-affirming care for people under 19, and several hospitals paused that care within days. In February, the CDC said it would no longer process transgender identity data. Later in 2025, the Supreme Court upheld Tennessee’s ban on gender-affirming care for minors, and HHS ended the 988 Lifeline’s dedicated line for LGBTQ+ youth.

Researchers disagree about how much state policy shapes trans teens’ mental health. A 2024 Trevor Project study estimated that anti-trans laws increased suicide attempts among trans and nonbinary youth. Critics dispute its methods and its estimates. The 2025 survey could have added national evidence to that fight. CDC collected the data but hasn’t publicly released it.

Missing data changes public health policy.

Surveillance works as a feedback loop. It can show officials whether their policies help or hurt. The CDC didn’t provide data on the students most exposed to transgender policy shifts.

The report kept measures that frame health as personal choice, like fruit, breakfast, and sports. It left out measures that track policy, like gun access, mental healthcare, food at home, and school climate, all of which respond to what legislators and agencies decide.

HHS did not respond to questions that I sent on September 21st.

• Pennsylvania’s measles outbreak, by the numbers.

• What happens if someone gets measles after MMR vaccination?

• Does vitamin A help?

• What vaccines do kids need after measles?

Pennsylvania’s measles outbreak, by the numbers.

Pennsylvania’s measles outbreak began in late April. As of September 9th, the state had confirmed 624 cases in 37 counties, and 109 people had been hospitalized. More than 40% of cases are in Lancaster County, according to the state’s dashboard.

Pennsylvania providers gave more than 46,000 doses of the measles, mumps and rubella (MMR) vaccine in August. A typical month sees about 25,000.

Pennsylvania has also confirmed 4 measles cases in people appropriately vaccinated for their age. Those 4 make up under 1% of the state’s total. More than 99% of cases, and every hospitalized patient, were unvaccinated or under-vaccinated.

Two doses of MMR vaccine are 97% effective. When the virus reaches hundreds of people, a few of the vaccinated will get sick.

What happens if someone gets measles after MMR vaccination?

They usually get a milder illness. A CDC analysis of 4,056 U.S. measles cases from 2001 to 2022 found that 12% were breakthrough infections. Severe disease became less common with each vaccine dose. Vaccinated people also spread it less. A second CDC study estimated that each unvaccinated case infected 0.76 people on average. Each two-dose case infected 0.27.

Newborns are too young to receive the MMR vaccine due to the immaturity of their immune systems and because the mother’s antibodies interfere with vaccine effectiveness. It is those antibodies that cross from mothers to the fetus before birth that protect babies in the first couple of months of life. But because it isn’t safe to give the MMR vaccine during pregnancy, the mother’s immunity has to be in place before she conceives.

The CDC says an MMR dose within 72 hours of exposure may still prevent measles. It may also lessen the severity of disease. In a Cochrane review, a dose after exposure prevented about 74% of cases. Anyone 6 months or older without immunity can get it. It works best after brief contact, such as at school, but for household contacts. Babies under 6 months, pregnant women, and people with very weak immune systems can’t get the MMR vaccine because it’s a live virus vaccine. They can get a shot of donated antibodies, called immune globulin, within 6 days. People who miss the 72-hour window can also get immune globulin.

Does vitamin A help?

HHS Secretary Robert F. Kennedy Jr. has promoted vitamin A for measles, including cod liver oil, since the Texas outbreak in 2025.

Vitamin A is used to treat measles, but it doesn’t prevent infection. The body needs vitamin A for immune function and to maintain the lungs and other organs. Measles lowers vitamin A levels in the blood, even in children who were well nourished. During a 1989 to 1990 outbreak in Milwaukee, 72% of 114 young children with measles had low vitamin A levels, and the sickest children had the lowest. In a South African trial, children given vitamin A recovered from pneumonia in about 6 days, versus 12 days for children given a placebo. The World Health Organization recommends it for all children with measles. So do the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC).

The dose depends on age. According to the AAP, babies under 6 months should receive 50,000 units, babies 6 to 11 months get 100,000, and older children get 200,000. Children are given the first dose at diagnosis and a second the next day. It is not recommended to check a blood test first. A child with signs of vitamin A deficiency, such as night blindness or dry eyes, gets a third dose 2 to 6 weeks later. Trials of this regimen have reported no toxicity. Clinicians still watch for headache, nausea, and blurred vision, which are signs of too much vitamin A. In the hospital, they may also trend liver function tests.

The strongest evidence for vitamin A supplementation comes from low-income countries, where many children be deficient. In a Cochrane review of trials there, two high doses cut the risk of death by about 80% in children under 2. One dose showed no benefit.

During a national shortage in Italy, doctors in Naples couldn’t give vitamin A to every child hospitalized with measles. They gave vitamin A to 36 hospitalized children and standard care to 72 others. The treated children did no better. Both groups had fevers of about the same length, similar lengths of hospital stay, and similar rates of complications.

Too much vitamin A can be toxic to children, because the body stores the extra in the liver. In 2025, Covenant Children’s Hospital in Lubbock, Texas, treated children for measles complications and vitamin A toxicity, including abnormal liver function. Many families had been giving cod liver oil and supplements at home. Poison centers logged 86 vitamin A exposures in children from January through March 2025, up almost 40% from the previous year.

Pennsylvania hasn’t reported how many of its 109 hospitalized measles patients have received vitamin A.

What vaccines do kids need after measles?

Measles keeps causing harm after the rash fades by erasing part of the immune system’s memory of other infections. A 2019 study in Science showed measles wiped out 11% to 73% of the antibodies children already had. An earlier study from England, Wales, the U.S., and Denmark tied measles to higher death rates from other infections for two to three years afterward, particularly bacterial pneumonia and diarrheal illness.

Recovered children still need to complete the recommended childhood vaccine schedule. A child with lab-confirmed measles is immune to measles and doesn’t need another measles dose, but measles infection doesn’t protect against mumps or rubella, so an unvaccinated child still needs MMR vaccination. A child who received immune globulin must wait before MMR vaccination: 6 months after an intramuscular shot, or 8 months after an IV dose.

Pneumococcal and Hib (Haemophilus influenzae type b) vaccines target bacteria that often cause pneumonia after measles. It wouldn’t be unreasonable to repeat those vaccines after a measles infection. No U.S. health agency tells doctors to repeat vaccines a child already got, and a 2025 review in Pediatrics found too little data to support revaccination. In the setting of the current outbreak or future outbreaks, researchers could study whether restarting the childhood vaccination schedule or administering pneumococcal and Hib boosters reduces the risk of bacterial pneumonia in the 2 to 3 years after measles.

Clinicians should educate parents about the increased risk of bacterial pneumonia and diarrheal disease after a measles infection and the need to present promptly if the child develops symptoms. The Pennsylvania Department of Health has a record of every confirmed case and could coordinate with clinicians to provide active follow-up during the 2 to 3 years of higher risk. Pennsylvania has confirmed more than 600 measles cases this year. Those patients may face a higher risk of other infections into 2028.

• What were the five cases?

• Did Anthropic catch a bioweapons program?

• How does an AI answer become real biology?

• Why hasn’t the U.S. government already restricted dangerous gain-of-function work?

• Could AI really help someone build a bioweapon?

• I am very, very worried.

What were the five cases?

Today, Anthropic published a report describing five cases in which scientists used its Claude chatbot for research that could have supported the development of biological weapons. Anthropic caught these, but it also warned: its own safeguards are the only thing standing in the way.

The five cases read like a modern biodefense syllabus:

• A group tied to a military research institute asked Claude to help write a grant application for gain-of-function research, engineering chikungunya to spread more easily or cause more harm. Chikungunya is a virus that causes fever, joint pain, headache, muscle pain, joint swelling, and rash. The joint pain can be severe and last months. Chikungunya outbreaks occur in tropical and subtropical parts of the world.

• A scientist in a country where Claude is blocked spent weeks trying to turn H5N1 bird flu into a strain better suited to spreading between people. Note that Claude use is blocked in countries like China, Russia, Iran, and North Korea.

• Another researcher used Claude to write a funding application to genetically alter orthopoxviruses, the family that includes smallpox and mpox, so they could better dodge immune defenses.

• A scientist with state funding built an atlas of toxin peptides drawn from multiple venomous animal species and a pipeline to optimize them, framed as research toward new painkillers and antidepressants. GLP-1 drugs are derived from Gila monster venom. But some of the same structures are paralytic toxins with potential use as incapacitating agents.

• A researcher redesigned lethal toxins, including bacterial toxins and proteins from hemorrhagic-fever viruses, while requesting deliberately vague identification. This is what your current “optimize lethal toxins” bullet actually describes.

The same information that helps build a weapon can also produce a vaccine or a cure. According to Gregory Koblentz, a biodefense scholar at George Mason University:

"Biological research is not just dual-use like Anthropic said, it is multi-use and can be used for peaceful civilian scientific and commercial purposes, for defensive purposes, and for offense. All of the research discussed by Anthropic was on pathogens that are endemic in different parts of the world and are current public health threats, so studying them is not suspicious on its own. The military affiliation of an institute does not automatically mean that its research is part of an offensive [bioweapons] BW program; for example, the United States military conducts and sponsors research on a range of infectious diseases that pose a potential risk to our troops."

Dr. Tom Inglesby, who directs the Johns Hopkins Center for Health Security, credited Anthropic for catching the attempts and for publishing them:

“The bad news is that those efforts were voluntary. And the more serious bad news is that there is no US government policy requiring frontier models or biological AI models [to] be assessed for major vulnerabilities that could be exploited, or policy requiring any evaluation for potential national security level biological risks.”

No U.S. law required Anthropic to build the classifier that caught these requests. No law required Anthropic to issue this report.

The chikungunya case illustrates additional gaps. When Claude refused to answer, the group routed the request to a different AI model with weaker safeguards. Anthropic didn’t say which model that was or whether it answered.

In a separate 30-day sweep of activity associated with what Anthropic calls “adversarial state institutions,” the company found roughly 35 biological research efforts. Most were ordinary civilian science, Anthropic said, while some had notable multi-use potential. The company did not identify the projects or say how many fell into that category.

Did Anthropic catch a bioweapons program?

Koblentz cautioned:

“it is not possible to determine what, if any, relationship this research had to a state-run biological weapon program.”

He said that judging whether research belongs to a weapons program requires much more context. He would look at the researcher’s publication record and interests, the institution and its affiliations, funding, and other evidence that the country has an active biological weapons program.

The efforts to get around Anthropic’s access controls add another signal. Some researchers used VPNs, dummy accounts or intermediaries to reach models they weren’t supposed to access. Koblentz said that could reflect a desire to keep the work secret, which can be an indicator of a weapons program. It could also reflect something much more ordinary: scientists trying to reach the most powerful tools available for their research and careers. He cautioned that it would be a leap to treat the cases as evidence of a secret biological weapons program.

Another expert in AI and biosecurity, who asked to remain anonymous due to the political sensitivities around these issues, told me that

“these case studies are compatible with legitimate researchers circumventing geoblocks to access the same level of assistance available to their non-geoblocked US/EU counterparts.”

And a military institute’s involvement doesn’t automatically mean an offensive program, because the US military itself funds infectious disease research to protect its troops. In fact, up to $2 billion could move from the National Institutes of Health to the Pentagon under a new biodefense and pandemic-preparedness agreement the two agencies signed this month.

How does an AI answer become real biology?

The other layer of defense doesn’t depend on which chatbot a scientist happens to pick. Synthetic DNA companies ship ordered genetic sequences to labs on request. No federal law requires them to screen those orders for dangerous pathogens. A May 2025 executive order gave the White House Office of Science and Technology Policy 90 days to write nucleic acid synthesis rules.

In February, Senators Tom Cotton (R-AR) and Amy Klobuchar (D-MN) introduced the Biosecurity Modernization and Innovation Act, which would require gene synthesis providers to screen orders and customers. It hasn’t passed.

In July, HHS banned federally funded high-risk gain-of-function research. That rule doesn’t take effect until November, and it only reaches work the federal government pays for. None of it touches what a lab can simply order and receive.

The system that got tested this week belonged to Anthropic. The system Inglesby wants, a government backstop with legal teeth, still doesn’t exist. Anthropic decides what counts as too dangerous to answer. It also decides which countries get access to Claude, and which of its models are safe enough to trust with biology questions at all.

Andrew Weber, a former assistant secretary of defense for nuclear, chemical, and biological programs and now at the Council on Strategic Risks, told CBS News the frontier labs “have been very responsible.” He added that cases like these had never surfaced in public before this week, and it wasn’t the FBI or any regulator that surfaced them.

Weber also wants President Trump to press the issue when he meets President Xi Jinping, because Chinese AI companies, in his words, are “less sensitive about the risks” and aren’t putting comparable guardrails on their open-weight models, which can be downloaded by anyone to their own computer and modified for their specific needs. Asked whether a small group or a lone actor could pull off something similar, Weber said, “unfortunately chillingly realistic.”

Kevin Esvelt, an evolutionary biologist and associate professor at the MIT Media Lab, told me:

“It would seem prudent to give all legitimate researchers trusted user access to the best frontier models — to accelerate our efforts to improve the world within our individual fields — while ensuring that insecure open-weight models know as little as possible about molecular and cellular biology.”

Anthropic’s classifiers, the company says, cannot tell a virus researcher from a weapons developer.

Closing the gap Anthropic’s report describes means acting on both ends of the pipeline:

• Test the most powerful AI and biology tools for serious biological risks before they ship or update, not after a company catches a problem and writes a report about it.

• Build the same detection system Anthropic built — classifiers that can spot and block dangerous biological requests — into what regulators require of every AI model. Congress is now writing rules for the biggest risks AI poses generally, and biological threats belong near the top of that list, not as an afterthought.

• Meanwhile, attempts to regulate gain-of-function research go back well over a decade, across both Democratic and Republican administrations. None of them has closed this particular gap.

Why hasn’t the U.S. government already restricted dangerous gain-of-function work?

This doesn’t necessarily argue for banning gain-of-function research outright. Gain-of-function can mean making a virus easier to study or helping a vaccine work better. Some experiments make a pathogen more dangerous, and those need much tighter oversight, not a ban on the whole category. Governments can restrict funding, raise biosafety standards, or prohibit specific experiments.

And the U.S. can’t ban gain-of-function research outside the U.S. That’s why the answer isn’t just regulation of science. It’s also defense: vaccines, drugs, and a health system that can respond if a bioweapon gets used anyway.

Could AI really help someone build a bioweapon?

The anonymous AI-biosecurity also told me that nobody knows for sure yet. Today’s AI models can already beat most human experts on biology tests, and can help with tricky lab problems and hard biology questions. The real question is whether AI can help people with some lab skills go all the way to building something dangerous.

Esvelt said that an AI model recently disclosed a viable way to build a new category of bioweapon he hadn't known was possible, by combining pieces of information from different fields. "They still aren't innovative," he said. "The pieces were quite obvious once you had all of them. But I'd be surprised if any human scientist did." He's not concerned by the five cases Anthropic just disclosed, he said, "save for the likely intent." None of them "registers on my own ranking of threats." But what worries him is what they represent: AI, in his words, "democratizes competence." We shouldn't assume, he told me, that a lack of knowledge or lab skill will keep someone from causing harm, or that experts can anticipate every threat AI puts within reach.

I am very, very worried.

None of this is evidence of an imminent bioweapons attack. But this is what has experts like me very, very worried: AI systems that can accelerate advanced biology + a drug and vaccine supply chain that sources raw materials overseas + eroding public trust in the institutions (e.g. CDC) that would respond to a natural or engineered biothreat + increasing vaccine skepticism. Together, this describes a country that could find out, in real time, exactly how vulnerable and unprepared it is.

• Shots you can’t biohack

• The numbers behind this fall’s shots.

• Your shots are still covered, but read the fine print.

• How federal law turns medical recommendations into insurance coverage.

• What is an orphaned recommendation?

• Congress. Your state. Your employer.

Shots you can’t biohack

Somewhere on your feed right now, a guy is peptide-maxxing. He’s got a fridge shelf of vials. He’s got a dosing spreadsheet. He’s got a supplier in a group chat. He’s spending a few hundred dollars a month to, he says, train his immune system, but those gray-market peptides don’t have placebo-controlled randomized clinical trials behind them.

He’s willing to inject an at-best experimental compound for some abstract promise of living longer. Meanwhile, a flu shot delivers a concrete one for $0 out of pocket, with proven safety and efficacy.

The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the Infectious Diseases Society of America issued vaccination recommendations for this fall/winter season. Those recommendations are based on evidence-based reviews of the influenza, COVID, and RSV vaccines. The Vaccine Integrity Project (VIP) conducted those reviews, and JAMA published them today. The VIP launched on a $240,000 unrestricted gift from Alumbra, Christy Walton’s foundation. These same medical societies released last year’s fall/winter vaccination recommendations without the federal government, too.

Those three reviews included 299 studies. That’s legit immune-maxxing.

The numbers behind this fall’s shots.

COVID vaccination was 53% effective in preventing hospitalization in adults 65 and older last season. In kids 9 months to 4 years old, it cut COVID-related emergency department visits by 76%.

Across eight seasons of national data, flu shots were 80% effective in preventing lab-confirmed flu deaths in kids and teens. In older adults, the high-dose shot beat the standard dose on hospitalization by 44%.

RSV vaccination was 83% effective in preventing RSV hospitalization in older adults. Nirsevimab, the antibody shot for babies, cut RSV hospitalization somewhere between 64% and 93%.

The VIP also reviewed the data on flu, COVID, and RSV safety. A study of almost 10 million people found no increased risk of serious harms after a flu shot, including Guillain-Barré syndrome. Three randomized trials of the RSV vaccine covered over 130,000 people. None found a case of Guillain-Barré syndrome. But one Scottish study of adults aged 74 to 80 found an increased risk in the 42 days after an RSV shot. Guillain-Barré is rare. Neither result settles the question. The FDA added a Guillain-Barré warning to both RSV vaccine labels in January 2025, but it also says the evidence falls short of establishing cause.

You could skip the vaccines and rawdog flu season. The CDC estimates that flu caused 390,000 to 800,000 hospitalizations and at least 24,000 deaths in the US last season.

Your shots are still covered, but read the fine print.

For most people this fall, the shots are still covered.

Private health insurance still covers your flu, COVID, and RSV shots at $0 in most cases. The insurance lobby AHIP says its member plans will keep them free through the end of 2027. Aetna, Cigna, Humana, Elevance, and Blue Cross Blue Shield plans are all in. Nobody should skip a shot this month because they’re worried the shots aren’t covered. They are.

But read the AHIP pledge more carefully. Member plans will cover “all ACIP-recommended immunizations.” ACIP is the CDC’s vaccine advisory committee, not a medical society.

In September 2025, AHIP promised the shots recommended “as of September 1, 2025,” but then rewrote its pledge in May 2026.

AHIP’s pledge is a trade association commitment rather than a law, so nobody enforces it. The current pledge expires on December 31, 2027. It doesn’t reach self-funded employer plans, Medicaid, CHIP, or Vaccines for Children (VFC). Self-funded plans cover 67% of workers with job-based insurance. That share climbs to 80% at large firms. Employers design those plans.

Kennedy removed all 17 members of ACIP in June 2025 and named his own. In September the new panel voted to drop the combined MMRV shot for children under 4. The AAP still recommends it. For six months, uninsured children and children on Medicaid lost access to it through VFC. Judge Murphy's March order stayed that vote, so it's back, for now, pending HHS's appeal.

Judge Brian Murphy stayed 13 ACIP appointments on March 16, 2026, in AAP v. Kennedy. The same order stayed the panel’s votes back to June 2025. The judge found no quorum in the panel as constituted. HHS Secretary Robert F. Kennedy Jr. says the ruling left ACIP “unable to carry out its core responsibilities.” ACIP hasn’t met since December 2025. HHS rewrote the committee’s charter twice, in April and May 2026. The May version handed Kennedy control over membership and the meeting calendar.

How federal law turns medical recommendations into insurance coverage.

In the US, a vaccine recommendation isn’t just advice. It’s a payment trigger.

The Affordable Care Act lists the shots insurers must cover, including immunizations with an ACIP recommendation “in effect.” The CDC director has to sign off before those vaccines are included on the CDC’s schedule.

Section 1928 of the Social Security Act requires Medicaid and VFC to provide ACIP-recommended pediatric vaccines. VFC buys the shots for more than half of American children.

What is an orphaned recommendation?

Four medical societies just told you what vaccines to get this fall, but every payment mechanism in the country is still based on ACIP recommendations.

Call it an orphaned recommendation: a clinical recommendation with no payment trigger. Doctors know what to do. But no federal law requires insurance companies, Medicaid, or VFC to follow medical societies’ recommendations.

Congress. Your state. Your employer.

Congress can amend Section 2713 of the ACA, which currently names four sources of preventive care recommendations: the ACIP, the US Preventive Services Task Force, the Bright Futures project, and the Women’s Preventive Services Initiative. The AAP writes Bright Futures under an agreement with the Health Resources and Services Administration. ACOG runs the Women’s Preventive Services Initiative under another. Both sets of recommendations already trigger coverage, for well-child visits and for women’s health. Neither covers vaccines.

The states have a lot of power over vaccine coverage, too. KFF’s tracker counts 22 states that now name non-federal groups, such as the AAP and ACOG, as sources of vaccine advice. Thirteen states require state-regulated insurers to cover the vaccines regardless of federal recommendations.

Your employer also has a lot of power here. For two-thirds of workers with employer-sponsored insurance, employers write the rules. Their benefits team answers to employees like you.

Congress. Your state. Your employer.

What Secretary Kennedy leaves out.

HHS Secretary Robert F. Kennedy Jr. has argued that getting measles beats vaccination. Natural infection, he says, provides more durable immunity than the vaccine. Natural measles may confer durable immunity, but two doses of MMR vaccine are 97% effective against measles. The CDC says most people vaccinated with MMR will be protected for life.

What Secretary Kennedy leaves out is the impact of measles infection on your immunity to other infections.

Measles is a factory reset for your immune system, which is why I think of measles as a mini HIV.

Measles gets into cells through a receptor called CD150, which sits on memory B-cells, memory T-cells, and plasma cells in bone marrow. Those cells store the immunity you built from past infections and vaccines. HIV gets in through CD4. CD4 sits on the helper T-cells. Helper T-cells switch on the B-cells that make antibody and the T-cells that destroy infected cells. Both viruses go after the immune system itself. Measles infects 20% to 70% of memory cells in the first 3 to 10 days.

HIV vs Measles

What happens to immune memory after measles.

Dr. Michael Mina and colleagues at Harvard Medical School and Erasmus MC in Rotterdam screened the blood of 77 unvaccinated Dutch children before and after measles infection against thousands of pathogen epitopes, the tiny pieces of a germ that an antibody recognizes. Measles eliminated 11% to 73% of each child’s antibody repertoire. That repertoire is the full set of germs their antibodies could recognize. Total antibody levels didn’t change, but what those antibodies recognized changed enormously.

At the Wellcome Sanger Institute, Velislava Petrova’s group sequenced B-cell receptors before and after infection and found two lasting defects. The supply of naive B-cells rebuilds incompletely. Naive B-cells are the untrained ones, still waiting for a germ they have never encountered. Measles destroys the families of cells that remember germs the child has already met. These same researchers found that in ferrets, a measles-like virus eliminated influenza immunity from vaccination. When animals who’d been infected with the measles-like virus were later infected with influenza, they developed more severe disease.

Children die of pneumonia, sepsis, and diarrhea at rates that track measles cases with a lag of a bit over two years. Dr. Mina’s group found that pattern in England, Wales, the US, and Denmark. Ryoko Sato and Masahiko Haraguchi found the same pattern across 46 African countries. Death certificates record those deaths as pneumonia, sepsis, and diarrhea. Few connect them back to a measles infection two years earlier. Dr. Mina’s group links measles to as much as half of all childhood infectious disease deaths in the pre-vaccine era.

The line between infectious and chronic disease is blurry.

HIV is a chronic infection, while acute measles infection lasts about two weeks. But the immune compromise measles leaves behind can last two to three years.

The line between infectious and chronic diseases is a lot blurrier than most people realize. Some infections, like herpes viruses, are for life. HSV-1 and 2, Epstein-Barr virus, and cytomegalovirus persist for life after the first infection and have long-term consequences. Among 10 million young adults, multiple sclerosis risk rose 32-fold after Epstein-Barr infection. Hepatitis B and C, human papillomavirus, and Helicobacter pylori persist for years and cause cancer. HIV persists too, but antiretroviral therapy turned it from a fatal infection into a chronic condition.

Measles is an acute infection with long-lived or chronic consequences. The virus clears, but the damage stays. Long COVID, post-treatment Lyme disease syndrome, and measles immune amnesia all sit in that second group.

HIV removes the capacity to respond. Measles wipes out immune system memory. Antiretroviral therapy restores CD4 counts and reverses the immunodeficiency. But, there are no drugs to restore an immune repertoire erased by measles. Someone has to reencounter each pathogen, or get another vaccine dose, one at a time. And a child faces each of those germs with less protection than before.

The MMR vaccine provides immunity to measles without immune amnesia to other infections. Dr. Mina’s team ran the same tests on MMR-vaccinated infants and found no loss comparable to what they saw in the children who’d had measles.

What are you supposed to do after measles infection?

There’s no validated protocol to test measles survivors antigen by antigen and re-immunize them. Dr. Mina’s group suggests restarting the routine vaccination schedule, since earlier doses may no longer be protective.

The Advisory Committee on Immunization Practices advises the CDC on the childhood vaccination schedule and could make recommendations for what to do after a measles infection.

Researchers don’t yet know how soon after measles a child can mount an effective response to vaccination. A study in Guinea and Mali is testing that now with a rabies vaccine. One group gets it about 8 weeks after measles infection, the other about 47 weeks.

What happened when I shook my head.

This is a follow-up to my piece on the Fauci texts.

On April 14, 2021, I testified before the Joint Economic Committee at a hearing called “Vaccinations and the Economic Recovery.” Senator Ted Cruz (R-TX) was asking the panel about vaccine passports. He got to who might be shut out of public life, and said, “Right now, women who are pregnant or trying to get pregnant are not recommended to take the vaccine.”

He saw me shake my head.

“Dr. Gounder, I saw you shaking your head when I was asking the question ... And what are the scientific data that back up those views?” he said.

Was he wrong?

Partly.

The Centers for Disease Control and Prevention (CDC) had not told pregnant women to skip the shot. It had not told them to get it, either. The guidance said pregnant people “may choose to receive a COVID-19 vaccine.” Cruz quoted that line back at me in writing after the hearing. But he made it sound like women were being told to stay away from the shot. Nobody was telling them that.

Drugmakers left pregnant women out of the COVID vaccine trials, and this wasn’t a first. Shields and Lyerly looked at late-stage company trials from 2011 and 2012. They found that 348 of 367 excluded pregnant women. By June 29, 2020, before any COVID vaccine existed, 829 of the 1,282 COVID treatment trials that enrolled people of childbearing age had done the same.

What I told him.

I started to answer. He cut in, “Dr. Gounder, if you could do that quickly so we can move on?”

I said COVID in pregnancy acts like flu in pregnancy. It can be severe. It raises the risk of an early delivery. And “women can be safely vaccinated during pregnancy, when they are trying to get pregnant, and when they are breastfeeding.”

Cruz pushed. “Are there any data or empirical studies you can point to on that, that it is safe for pregnant women? I know there are a lot of women who are concerned about that.”

I said I’d send them after the hearing.

“I would ask you to share that with the committee members,” he said. “I think there would be widespread interest.”

The studies I filed with his committee.

Sen. Cruz filed a formal Question for the Record, quoting CDC's careful wording back at me and asking whether I disagreed.

I wrote that I agreed with the CDC and with Dr. Rochelle Walensky, the agency’s director at the time, that no safety problems had been found.

Then I listed what we had. Gray et al. on how pregnant and nursing women responded to the vaccine. Mithal et al. on antibodies in cord blood. Perl et al. on antibodies in breast milk. Prabhu et al. and Rottenstreich et al. on antibodies crossing the placenta, preprints then and published since. Villar et al. and Healy on how dangerous COVID itself is in pregnancy.

I cited one more thing, published the week after the hearing. Researchers at CDC and the Food and Drug Administration published Shimabukuro et al. on April 21, 2021. They used v-safe, the v-safe pregnancy registry, and the Vaccine Adverse Event Reporting System.

So where does 82% come from?

This week Senators Ron Johnson (R-WI) and Rand Paul (R-KY) released texts from Dr. Anthony Fauci’s government phone. Sen. Cruz then promoted a “Verdict” podcast episode called “Bombshell Data: Fauci Covered up that Covid Vaccine Produced 82% Miscarriage Rate.” He wrote, “We now have the receipts: Dr. Fauci and Pfizer knew the second dose of the COVID vaccine carried an 82% risk of miscarriage for women in their first trimester.”

The 82% came from Dr. James Thorp, a maternal-fetal medicine physician who co-wrote a book calling the COVID vaccine the deadliest in history. Science Feedback reviewed his claim that COVID vaccines killed 350,000 to 400,000 Americans and rated it incorrect. That death toll comes from multiplying reports to the federal side-effect database by an unjustified correction factor.

Dr. Thorp laid out his calculation in written testimony to a Senate subcommittee, citing the paper I sent Sen. Cruz. Of the 827 women in the registry who had finished a pregnancy, 104 had miscarried, and 700 of the 712 live births were women who got the shot in their third trimester. Dr. Thorp took those 700 out and divided 104 by the 127 left. That comes to 81.9%.

The healthy pregnancies were still going.

CDC signed up 3,958 pregnant women for the registry. By the March 30, 2021 cutoff, 827 of them had finished a pregnancy. The other 3,131 had not.

That gap is where the 82% comes from.

A miscarriage ends a pregnancy in days or weeks. A healthy pregnancy runs nine months. So early on, the women who have finished are mostly those who lost a pregnancy. The healthy ones are still carrying, and the registry cannot count them until they deliver.

That is why 700 of the 712 live births came from women vaccinated in the third trimester. They were the only healthy pregnancies far enough along to have ended. When Dr. Thorp removed them, he threw out nearly every finished healthy pregnancy in the registry. What was left was 127 women, and 104 of them had miscarried.

The 12.6% has a milder version of the same problem. It divides by 827, only a fifth of the registry.

The paper’s authors said so themselves: “the majority are ongoing, and a direct comparison of outcomes on the basis of timing of vaccination is needed to define the proportion of spontaneous abortions in this cohort.”

CDC waited for the rest of the pregnancies to finish, then measured risk week by week. In September 2021, among the 2,456 women who got vaccinated before they conceived or before 20 weeks, the risk of miscarriage from 6 to under 20 weeks was 14%. Among pregnancies women know about, it’s estimated that 11% to 22% end in miscarriage. A Norwegian registry of 421,201 pregnancies put it at 13%.

In 2025, researchers ran a more rigorous test, with doctors reviewing each miscarriage one by one. The team compared 296 women who miscarried with 592 who gave birth, and found no link between COVID vaccination and miscarriage.

Whose job was it to study COVID vaccination in pregnant women?

Drugmakers excluded pregnant women from vaccine clinical trials, which is why no trial could provide an answer about COVID vaccine safety in April 2021. Congress saw this coming. The 21st Century Cures Act established a task force on research involving pregnant and nursing women. In September 2018, it sent the Secretary of Health and Human Services 15 recommendations, the first of which was to include pregnant and lactating women in research.

Two years later, the COVID vaccine trials left them out anyway.

• The text the senators released.

• The evidence that already existed.

• Who kept pregnant women out of the trials?

• What the data eventually showed.

• Before 20 weeks, after 20 weeks.

• What about next time?

The text the senators released.

On January 25, 2021 at 6:45 p.m., Dr. Anthony Fauci texted the new CDC director and the surgeon general nominee. Drug companies had excluded pregnant women from the COVID vaccine trials. The three of them were trying to work out what advice to give women.

“Since many people have significant cytokines storm and fever after the 2nd dose,” he wrote, “this theoretically could be associated with miscarriage in the 1st trimester.”

Senators Ron Johnson and Rand Paul released that text message on Monday. It came off a government phone that HHS turned over to Sen. Johnson’s investigators on August 5th. On August 6th, the Senate Homeland Security and Governmental Affairs Committee voted along party lines to hold Dr. Fauci in contempt for taking the Fifth.

Dr. Fauci said theoretically. The next day, in the same text thread, he wrote that the benefits outweighed the risks. More than 10,000 pregnant women had already been vaccinated, he said, and no issues had come up.

The evidence that already existed.

More than the text thread suggests.

In 2009, drugmakers made a new H1N1 swine flu vaccine in months. Health systems gave it to pregnant women across Europe and the US. Denmark followed 54,585 pregnancies and found no increase in fetal death or miscarriage. Norway followed 117,347 pregnancies. There, getting the flu raised the risk of fetal death. The vaccine did not.

A Danish study of 24,040 pregnancies found no link between fever in the first 16 weeks of pregnancy and fetal death. That held no matter how high the fever ran, how long it lasted, or when in those 16 weeks it hit.

Pregnant women also get fewer reactions to vaccines than they do outside pregnancy. A randomized trial of Tdap found those reactions in 36% of women vaccinated during pregnancy; in women given the same shot after delivery, 73%.

None of this provided evidence on whether the lipid nanoparticle was safe. That part was new.

Who kept pregnant women out of the trials?

In 2013, a review of industry clinical trials found that 348 of 367 excluded pregnant women. In 2018, a federal task force created by Congress told the Secretary of Health and Human Services to fix it. By June 2020, before any vaccine existed, 829 of 1,282 COVID treatment trials had already excluded pregnant women.

What the data eventually showed.

An analysis of 21 studies and 149,685 women found no rise in miscarriage. France followed 130,338 infants exposed in the first trimester. No rise in birth defects, across all 75 categories they checked. A US case-control study looked specifically at women who’d had both doses and found nothing.

In Scotland, 98% of pregnant women who ended up in critical care with COVID were unvaccinated when they were diagnosed. So were all the women whose babies died.

Dr. Andrea Edlow is a maternal-fetal medicine physician at Massachusetts General Hospital. She runs a lab there on pregnancy and the immune system. She has studied this question since the first COVID shots went into arms. “We have very strong evidence, now longstanding, that the COVID-19 vaccine in pregnancy is not associated with miscarriage,” she told me. “The recirculation of these old anti-vaccination tropes is especially wrong at this point in time when we have the benefit of many years of experience.”

Before 20 weeks, after 20 weeks.

Dr. Vivek Murthy, then Biden's nominee for surgeon general, asked whether it was better to vaccinate early or late in pregnancy. Dr. Fauci answered that there was no data and no theoretical reason to prefer either.

The first half was true. The second half wasn’t, even in 2021. Researchers already knew timing mattered for maternal vaccines. It’s why doctors give Tdap between 27 and 36 weeks, so the antibodies reach the baby.

Babies whose mothers were vaccinated after 20 weeks were 69% less likely to be hospitalized with COVID; before 20 weeks, 38%. Antibodies cross the placenta at different rates depending on when the mother was vaccinated. Dr. Edlow’s lab has since found trimester-specific protein responses in maternal blood.

What about next time?

I asked Dr. Edlow whether pregnant women would be excluded again from the next new vaccine.

“I am concerned we would be in the same position,” she wrote back. “Particularly given the current environment in the country vis a vis vaccination safety in general. I wish that wasn’t the case and that we had learned this lesson from the COVID-19 pandemic. But I worry we have not.”

A group chat is now evidence in a Senate investigation because three federal health officials had to extrapolate from other vaccines instead having clinical trial results to inform their recommendations. In 2018, a federal task force told HHS to fix that. It is 2026.

• What the executive order does.

• Where the real authority sits.

• What splitting the shot would actually take.

• Do vaccines cause autism? No.

• So why are autism diagnoses rising?

• What parental age does and does not explain.

• Nothing has changed at your pediatrician’s office.

What the executive order does.

President Trump signed an executive order on childhood vaccines Monday. At the signing he said it covered “many subjects, but including autism in particular.”

The word autism does not appear in it.

The order sorts childhood vaccines into three tiers. One tier is recommended for every child. A second is only for kids at high risk. The third is called shared clinical decision-making, which means the government takes no position and leaves the call to you and your doctor.

That cuts the recommended list from 18 diseases to 11. Measles, mumps, rubella, polio and the DTaP shots keep their place at the top. Hepatitis A and B, meningococcal, flu and COVID drop to the lower two tiers.

The order also says MMR “should be administered in 3 separate single-disease shots once such products are domestically available.” It says all childhood shots “should be administered at separate medical visits.” It gives HHS 90 days to reassess timing. It orders work to develop alternatives to aluminum. An adjuvant is the ingredient that wakes the immune system up, and each one is matched to the vaccine it goes with. Swap it out and you have a new product. New product, new trials, new approval.

Hepatitis A and hepatitis B each appear twice, once under high-risk and once under shared decision-making. Those two tiers carry different rules for insurance coverage. The order never says which one wins.

Dr. Paul Offit helped invent the RotaTeq rotavirus vaccine and sat on ACIP from 1998 to 2003. “It’s not a gold standard recommendation,” he told me. “It’s a non-science-based recommendation, and it makes no sense.”

Look at the 3 vaccines moved to shared decision-making: rotavirus, COVID and flu. “Those are all short incubation period mucosal infections,” Offit said. They infect the nose, the throat and the gut, and they make you sick fast. “Even if the entire world was vaccinated with those vaccines every year, those viruses would still circulate. You’re never going to eliminate those viruses.” A vaccine you take because the virus is everywhere is a strange candidate for no default.

Before the rotavirus vaccine, every child got it. “You could not find anybody who by 5 years of age had not been infected,” Offit said. That meant 55,000 to 70,000 US hospitalizations a year and 20 to 60 deaths in children under 5, and up to 500,000 deaths a year worldwide.

The American Lung Association singled out flu. The 2024-25 season brought 289 pediatric flu deaths, the most of any non-pandemic season since these deaths became reportable in 2004. Among children old enough to be vaccinated whose status was known, 89% were not fully vaccinated. The shot cuts a child’s risk of dying from flu by 80%. The order, chief executive Harold Wimmer said, “will cause more confusion for parents and healthcare providers, reduce vaccination rates and increase the spread of vaccine-preventable illnesses.”

The high-risk tier has the same problem. “Everyone’s at risk for those diseases,” Offit said of hepatitis A, hepatitis B and RSV. Meningococcal disease is likelier without a spleen, “but everyone’s at risk. I saw a lot of meningococcus in my life in previously healthy people.” (So have I.)

Where the real authority sits.

The Advisory Committee on Immunization Practices makes recommendations and then the CDC director adopts them. That adoption is what triggers private insurance coverage and Vaccines for Children. The president is not part of that chain.

Former CDC Director Dr. Rochelle Walensky once went beyond ACIP on COVID boosters, so a director has some room at the adoption step. She did not skip ACIP.

The EO acknowledges the active lawsuit and tells agencies to proceed “to the fullest extent allowable by law.” Judge Brian Murphy blocked Secretary Kennedy’s January childhood vaccine schedule change in March. ACIP is not meeting. The First Circuit has the appeal.

Almost all the coverage has been about the tiers, which is what the president cannot execute on his own.

But Section 4 is the part the president can act on. It directs newly confirmed Attorney General Todd Blanche to sue states over religious and medical exemptions to school vaccine rules, and it tells Justice, Education and HHS to make their “contractors and grantees, including States and localities” comply. That gives the government a way to squeeze health departments and school districts through their federal grants. A lawsuit takes years.

The legal question is whether a state that allows medical exemptions must also allow religious ones. Every federal appeals court to take it up has said no, including the Fourth Circuit in April. The Supreme Court has held since 1944 that religious freedom “does not include liberty to expose the community or the child to communicable disease.”

What splitting the shot would actually take.

Not now, and not soon. No separate measles, mumps or rubella vaccines are licensed here. Merck stopped making them in 2009 because almost nobody ordered them, and says it would take more than 10 years to win FDA approval for three new products.

“The companies can neither remove aluminum, nor separate the MMR components, and they know that,” Dr. Peter Hotez, who develops vaccines at Texas Children’s Hospital, told me.

Splitting the shot would also mean six appointments instead of two. Researchers in Oregon followed nearly 100,000 children. By nine months, the ones whose parents spread shots out had to make more visits and received fewer vaccines: 4.2 visits and 6.4 shots, against 3.3 and 10.4. More trips, less protection.

Senator Bill Cassidy (R-LA), a physician, made the same point Monday. “Breaking up vaccines will mean children have to get more shots to get the same protection, not fewer shots.”

In 2022 the World Health Organization said one dose was enough for most kids. Britain, Australia, Canada, Ireland and Spain moved, and 93 countries now use a single-dose schedule. We didn’t, and here the critics have a fair point. If the goal were fewer shots that work just as well, that is where you would start.

In January, HHS announced we would. But it skipped ACIP. There is no FDA-licensed one-dose product here. CDC's own webpage still says two or three doses. And Judge Murphy froze the whole package in March, so nothing changed in any exam room.

Do vaccines cause autism? No.

This has been studied in more than 5 million children, in more than 40 studies, across 7 countries.

A Danish study followed 657,461 children and found no increased risk. A study of 95,727 American children included nearly 2,000 with an autistic older sibling, the group where a trigger would show up first. Their risk was no higher. Thimerosal came out of childhood vaccines by 2001, and California diagnoses kept climbing every quarter for 6 more years. A Danish study of 1.2 million children found no risk from aluminum.

So why are autism diagnoses rising?

Trump gave his answer at the signing. “It’s many many times what it used to be years ago,” he said, “and it gets progressively worse and we add progressively more and more vaccines.”

Autism diagnoses have risen. Most of that is a change in how autism is defined, spotted and recorded. CDC’s own surveillance found autism in 9.7 per 1,000 8-year-olds in Laredo, Texas, and 53.1 per 1,000 in California. Same year, same country. Biology does not vary five-fold between two American cities.

Genetics carry most of the rest. Researchers followed 2,001,631 children in Denmark, Finland, Sweden, Israel and Western Australia, 22,156 of whom were diagnosed with autism. About 80% of the differences in autism risk across a whole population trace back to inherited genes. That’s a fact about populations, not about any one child. It does not mean 80% of a given child's autism is genetic and 20% is something else.

There is also a reason the timing fools people. About a third of autistic children lose skills they had already learned, on average around 20 months. MMR is given at 12 to 15 months. A parent who notices that sequence is seeing something real. But regression happens at the same rate whether or not MMR is in the picture. British researchers compared autistic children assessed before and after MMR was introduced and found regression in 16% of the post-MMR group against 18% before it. Eye-tracking studies show infants later diagnosed with autism start diverging from other babies between two and six months, before the shot.

What parental age does and does not explain.

After genetics, the finding that keeps turning up is parental age. Both parents.

Sperm cells keep dividing across a man’s life, and every division is a chance for a new mutation. Each year of a father’s age adds about 1.5 of them to what he passes on. For mothers it is about a quarter of that. Children of fathers 50 and older were ~2x as likely to be autistic as children of fathers under 30. Children of mothers 35 and older were ~1.3 times as likely as children of mothers 25 to 29.

The mutations explain less than you would think. Researchers sequenced families, matched them to Danish health records, and worked out how much autism those extra mutations should cause.

Their math predicted that a father of 45 should have about 1.1x the risk of a father of 25, while health records showed a 1.7x higher risk. The rest comes from somewhere else: genes parents already carry and pass down, who waits to have kids and why, fertility treatment, and what happens during pregnancy.

But how much of the rise in autism diagnoses comes from parents getting older? California researchers looked at the 1990s and put it at about 5%.

Father’s age is on the birth certificate, and it has been in the national birth data since at least 1968. NCHS used to publish tables of births by father’s age. The flagship report, Births: Final Data for 2024, sorts births by the mother’s age a dozen ways but never once by the father’s, and CDC WONDER doesn’t offer paternal age at all.

Father’s age is also missing on 10% to 20% of certificates, depending on the year. Those holes cluster. Father’s age was filled in for 70% of births to Black mothers and 91% of births to White mothers.

Every one of those gaps is a reason to fund the research.

Nothing has changed at your pediatrician’s office.

Nothing has changed at your pediatrician’s office. A judge blocked the January changes back in March, and that order still holds. Kids go back to school on the same schedule as last year.

Michael Osterholm, who runs the Vaccine Integrity Project at the University of Minnesota, said the order “does not change the underlying scientific evidence supporting childhood immunization.” Parents, he said, “deserve clear, evidence-based guidance about how to protect their children, not competing recommendations issued through political processes.”

The American Academy of Pediatrics and twelve other groups published a childhood schedule that twenty-eight states and DC have endorsed. In June, the American College of Obstetricians and Gynecologists (ACOG) issued its first maternal vaccination schedule to depart from the federal one, backed by thirteen medical societies. And on Monday, hours after President Trump signed the EO, New York State and New York City told clinicians to use the ACOG schedule.

• The part that isn’t on camera.

• What are you buying for $12,000?

• Does insurance cover egg freezing?

• Does the father’s age matter?

• Who can change this?

The part that isn’t on camera.

On Saturday night, Alexandria Ocasio-Cortez went live on Instagram and gave herself a fertility shot on camera. She’s 36. She said she’d been weighing it and saving for it for a very long time. The next morning, on ABC’s “This Week,” she said she was talking about it publicly because “this administration is denying reproductive care to women across the country, from abortion rights to the ability to carry out a healthy pregnancy.”

It’s a choice. It’s a choice people should be able to talk about publicly. And it’s also a big purchase.

What are you buying for $12,000?

Egg-freezing technology works. Vitrification, the flash-freezing method used everywhere, stopped being experimental in 2012. About 78% of eggs survive thawing, and about 72% of those fertilize, per a 2024 meta-analysis of 8,750 women. No rise in birth defects has been detected in the children.

What it buys is a probability that drops with each step. 60 Minutes described an inverted pyramid: eggs survive, then fertilize, then become embryos, then healthy embryos, then embryos that implant.

The American Society for Reproductive Medicine 2021 guideline estimates a woman aged 35 to 37 needs about 15 mature eggs for a 70% chance at one live birth, but that’s a projection from one clinic’s thaw data. The same guideline says there’s “insufficient evidence to counsel women of various ages on the absolute number of oocytes necessary to achieve a reasonable probability of a live birth.” No number, in other words, for how many eggs are enough. When NYU followed its own patients through real thaws, clearing 70% took at least 20 mature eggs, frozen before 38.

The costs of egg-freezing are also murky. The most recent peer-reviewed US figure is “around $12,000” per cycle, in 2023 dollars. The last paper to itemize the whole chain priced it in 2014 dollars: $9,261 for the retrieval cycle, $300 a year to store the eggs, $4,416 to thaw and fertilize, $4,169 for the transfer. 60 Minutes put a cycle at $12,000 to $15,000 with medication in May 2025, storage at $500 to $1,000 a year, and about $10,000 to thaw and fertilize later.

About 1 in 10 women comes back for her eggs, at a mean of 3.8 years. NYU followed one cohort 10 to 15 years: 38% used them, 47% were still in storage, 12% were discarded.

Freezing preserves the age of the eggs, nothing else. Young eggs cut the risk of miscarriage and of chromosomal problems in the embryo. They do nothing for the body carrying the pregnancy. The risk of preeclampsia rises about 30% at ages 40 to 44 and more than doubles at 45 and older; gestational diabetes and cesarean delivery climb with age even after controlling for prepregnancy hypertension and diabetes; and stillbirth goes from 6.2 per 1,000 pregnancies under 35 to 12.8 at 40 and older. Those risks fall on the pregnant woman and on the baby, and younger eggs don’t lower them.

60 Minutes asked Dr. Marcelle Cedars whether doctors at firm-owned fertility companies get pushed to run more cycles. She said it “is definitely occurring in some companies,” and that pay is tied to cycles per patient.

Does insurance cover egg freezing?

Twenty-one states and Washington, DC now require insurers to cover fertility preservation, up from 11 in 2021. Nearly all are tied to a medical indication, such as chemotherapy or radiation. None cover freezing because you haven’t met anyone yet. Maryland and New Jersey write into their statutes that the mandate doesn’t cover keeping the eggs in the tank, which is the bill that arrives every year they sit there.

Self-insured employer plans are exempt from state mandates under federal law. That’s 80% of covered workers at firms with 200 or more employees.

Coverage predicts who seeks out egg-freezing. At one New York practice, insurance paid for 0% of egg-freezing cycles in 2012 and 47% in 2022. Over the same period, the average age at freezing fell from 38 to 35 and mature eggs banked per cycle rose from 11 to 13.

What it didn’t change is who the patients were. At an Atlanta practice that added a $25,000 fertility benefit, the racial and ethnic mix of new patients didn’t budge: 42% to 40% non-Hispanic White, 39% to 40% non-Hispanic Black.

Does the father’s age matter?

Men’s fertility declines with age, too. In a British study of 8,515 planned pregnancies, men 40 and older had about half the odds of conceiving within a year as men under 25.

Children of older fathers carry more new mutations. Fathers pass on about 1.5x more of them for every year of their own age, so a 40-year-old transmits roughly 2x as many as a 20-year-old. That’s why older fathers drive rare dominant conditions like achondroplasia. It occurs in about 1 in 26,000 to 28,000 births.

In a study of 17.8 million US births, fathers over 44 had slightly more congenital anomalies in their children.

Older fatherhood is also linked to autism, schizophrenia, and bipolar disorder. The largest study followed 5.8 million children in five countries. Fathers 50 and older had 1.7x the rate of autism in their children as fathers aged 20 to 29.

How big that risk looks depends on what you compare it to. Older fathers differ from younger ones in ways that have nothing to do with sperm. A Swedish cohort of 2.6 million births compared siblings born to the same father at different ages to account for that and still found that age was not only associated with increased risk of neurodevelopmental disorders, but more strongly so. Compared with fathers aged 20 to 24, fathers 45 and older had children with 4x the rate of autism, 2x psychosis, 13x ADHD, and 25x bipolar disorder. The authors interpret this as evidence that new sperm mutations may be driving the risk.

Delayed childbearing accounted for 5% of the rise in autism diagnoses in California across the 1990s, and 3% in New York City over a similar stretch. Paternal age is one of the few biological contributions to autism risk that researchers take seriously, but it’s been drowned out by arguments about vaccines, which don’t cause autism.

The joint American Urological Association and ASRM male infertility guideline was amended in 2024. Its 7th statement says clinicians “should advise couples with advanced paternal age (≥40) that there is an increased risk of adverse health outcomes for their offspring.” Blood panels for a couple dozen paternal-age genes exist and aren’t standard care. Those work because each of those conditions traces to one known gene. The autism and schizophrenia risk comes from many random mutations scattered across the whole genome. No prenatal test looks for that.

Who can change this?

State legislatures can widen the mandates past medical indications. Congress wrote the preemption that lets self-insured plans ignore them, and it can close it. Employers decide whether a benefit covers the thaw as well as the freeze, and whether it survives a job change. Ask HR both questions before you start the process.

The federal government has used that power once. Starting with plan year 2023, the Office of Personnel Management required every carrier in the federal employee health program to cover egg and sperm freezing. It covers people facing infertility caused by medical treatment. For 2026, it added a year of storage.

The White House fertility plan announced in October 2025 didn’t mention OPM. It promised three other things: an EMD Serono deal cutting fertility drug prices by about 84%; guidance allowing employers to offer a standalone fertility benefit; and an FDA priority voucher for a cheaper gonadotropin, a program that advertises a 1-to-2-month review instead of 6 months or more.

Ten months on, one of the three works, narrowly. TrumpRx launched in February 2026, and the discounts are real. Gonal-f went from $966 to $168. But the site issues a coupon, and you’re ineligible if you use your insurance. Drugs are about a fifth of the cost of a cycle. The employer benefit is still a proposed rule. It’s voluntary and can’t start before January 2027, and KFF found the original guidance created no new coverage at all. The gonadotropin still isn't approved. It's not on the FDA's list of drugs cleared under that voucher program, which has cleared others since December 2025. The CDC team that tracked assisted reproduction outcomes was cut in April 2025, so there's no federal data on whether a cycle got cheaper.

• 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.