Suffer The Children: The Cost of the Worldwide Assault on Public Health is Unacceptable
Image: January 19, 2025: Protesters gathered in Washington Square Park, speaking out against funding cuts to science and the firing of federal workers in Lower Manhattan.
Originally Published in The Hill, April 12, 2025
By Jonathan Fielding, Peter Katona and Seth Freeman
The only thing worse than the painful death of a child is the painful death of a child that could easily have been prevented.
Already, as a result of the Trump administration’s attack on the public health community, which includes defunding the U.S. Agency for International Development (USAID), Gavi, the Vaccine Alliance, and PEPFAR (for AIDS relief) many, especially children, are dying. Unnecessarily. Per the New York Times, "… the loss of U.S. support may mean 75 million children do not receive routine vaccinations in the next five years, with more than 1.2 million children dying as a result."
In a memo leaked to the Times, a USAID insider projected that the defunding would likely cause:
rising maternal and child mortality in 48 countries;
up to 18 million additional cases of malaria per year (166,000 additional deaths);
hundreds of millions of polio infections (200,000 children paralyzed), just when we are close to eradicating this disease;
1 million children to be untreated for severe acute, often fatal, malnutrition each year;
28,000 new cases of Ebola and Marburg annually, increasing healthcare spending (in a 2014 case, one Ebola patient cost New York’s Health Department $4.3 million);
increased cost from treating patients with multidrug-resistant TB (treating one patient costs more than $154,000, and there will be a 30 percent increase in drug-resistant TB); and
uncontrolled outbreaks of Mpox and bird flu, perhaps 105 million cases in the U.S. alone.
The “savings” from cutting USAID funding quickly turns into excessive spending on preventable conditions. Even more costly is the loss of soft power which enhances U.S. security around the world. This thoughtless cost-cutting is not only immoral and needlessly cruel, it is extremely bad business. For example, a study showed that for every $1 spent on USAID agriculture research, the U.S. earned a return of $8.52 in new jobs, exports, and further economic growth.
Defunding USAID is not the only case of recent penny wise/pound foolish U.S. government actions with deeply serious consequences for public health. After withdrawing from WHO (the World Health Organization), we have no say in where and how the organization directs its vital resources, while cutting ourselves off from WHO’s critical early warning intelligence on potential epidemics and other health dangers. Likewise, in cutting funding for Gavi, which has saved the lives of 19 million children, we are raising the eventual budget burden while increasing human suffering. By defunding PEPFAR, the program nurtured by George W. Bush, an estimated 500,00 children could die from AIDS-related conditions in the next five years.
Additionally, the HHS Secretary cancelled the FDA meeting to update next year’s flu vaccine, which may presage a less effective flu shot for the fall 2025 flu season. The government is slashing the CDC staff, cutting HIV and other critical research programs, prohibiting it from dispensing vital information and even from contacting WHO. Stupidly, we are spending tax-payer dollars re-studying a vaccine/autism connection after exhaustive investigations showed no relationship. We are wasting time and resources with conspiracy theories speculating that HIV does not cause AIDS (it does), and an irresponsible linking of SSRIs to mass shootings (there is no link). Studies of vaccine hesitancy, a major cause of the loss of protective herd immunity, have been cancelled.
We have decimated NIH’s $4 billion research budget, leaving important studies unfinished, losing critical medical talent and putting a chill on future cancer, heart disease and infectious diseases research. Patients in the middle of studies are left hanging. Cutbacks have further undermined public health information systems, disease surveillance and tracking with effective tools like wastewater testing, the upgrading of research and testing labs, and programs to curb infections in nursing homes.
In the midst of a deadly expanding measles outbreak the HHS secretary pushes good nutrition, cod liver oil, and Vitamin A as the solution (they will not cure the disease) while the highly effective vaccine is reduced to “parent’s choice” in an environment where overall vaccination rates are dropping precipitously. Fourteen states reported rates below 90% for the 2023-2024 school year, compared to only three states in the 2019-2020 school year. In the last year over 30 states experienced declines in the rates of all state required vaccines, including MMR, DTaP, polio, and varicella – with more states apparently joining the trend. Meanwhile, an avian flu strain, shown to be transmissible between mammals, lurks in the background with pandemic possibilities.
All of these actions, individually and collectively, represent an aggressive assault on public health, eroding trust in reliable sources of information, compromising understanding of current threats to the health of everyone on the planet. It took centuries to build public trust in real, solid science from the ignorant and disease-plagued Dark Ages. Suddenly, all that careful work of thousands of smart, caring scientists and physicians is being overthrown in an instant while many – either because they have been bullied or misinformed or are just cowardly – remain silent.
What’s clear is that we cannot, must not, wait to speak out, or many people, including millions of children, will unnecessarily die.
Jonathan Fielding, MD, MPH, MA, MBA, is a Distinguished Professor of Health Policy and Management and of Pediatrics in the Schools of Public Health and Medicine at UCLA. He served as Massachusetts Commissioner of Public Health and for 16 years as Public Health Director and Health Officer for Los Angeles County. The UCLA Fielding School of Public Health is named for Jonathan and his wife Karin.
Peter Katona, MD, has been clinical professor of medicine at the UCLA David Geffen School of Medicine in Infectious Diseases, and adjunct professor of Public Health at the UCLA Fielding School of Public Health in Epidemiology. He helped design UCLA’s campus covid policy.
Seth Freeman, MPH, is an Emmy-winning writer/producer for television, a playwright and a journalist, who writes about technology, education, policy and public health.
The views and opinions expressed here are those of the author(s) and do not necessarily reflect the official policy or position of the Pacific Council.
