How Trump is remaking US public health, with NY Times reporter Apoorva Mandavilli

Transcript: How Trump is remaking US public health, with NY Times reporter Apoorva Mandavilli

Ian Bremmer:

Hello and welcome to the GZERO World Podcast. This is where you'll find extended versions of my interviews on public television. I'm Ian Bremmer, and today we are talking about the future of healthcare under President Trump and what it could mean not just for the United States, but for the rest of the world. The Trump administration has made it clear it wants to slash government spending and remake institutions like the CDC, the NIH, and the FDA. Trump has had a whirlwind first few weeks in office. Among his many changes in executive orders, he pulled the US out of the World Health Organization and froze all foreign aid, which includes a wide range of support for global health programs.

Meanwhile, the Senate is debating RFK Jr'.s nomination to lead Health and Human Services. He's an alternative medicine advocate, noted vaccine skeptic, and the cultural force behind the Trump administration's "Make America Healthy Again" agenda, a movement united by skepticism toward mainstream health institutions, big pharma, and government mandates. What will Trump's executive orders mean for medical research and public health programs? Should we be worried about the spread of bird flu and potential new pandemics? Will the CDC endorse RFK's ideas about raw milk and unflouridated water?

To break it all down, I'm joined by New York Times Science and global health reporter Apoorva Mandavilli. Let's get to it.

Apoorva Mandavilli, welcome to GZERO World.

Apoorva Mandavilli:

My pleasure.

Ian Bremmer:

So we've now seen, you've been reporting quite closely on the RFK Jr. Senate confirmations. Tell me what you've made of that, any surprises as you've seen it?

Apoorva Mandavilli:

Well, I expected them to be heated because he has made a lot of controversial statements and I expected that at least some of the senators would really hold him to those and ask him. But it really went way beyond my expectations, it was just so dramatic at times. We had Senator Maggie Hassan breaking down in tears talking about her adult son with cerebral palsy and saying, "How dare you say things like Democratic senators don't care about what causes autism." You had Bernie Sanders and RFK Jr. yelling at each other. You had-

Ian Bremmer:

Over pharma funding, as it turned out.

Apoorva Mandavilli:

Exactly, saying, "You get money from them. You get money from them."

Ian Bremmer:

The one thing we should all agree on is that everyone in politics gets money, right?

Apoorva Mandavilli:

Is there anybody who is entirely honest? I don't know. And you also saw, I think, some really meaty conversations about the science, about whether vaccines cause autism, which RFK Jr. has maintained that there is a link. And you saw very clearly, Dr. Cassidy, Senator Cassidy saying, "No, the studies have shown that that is not the case. Convince me that you now believe that there's not anything there." And then you saw Rand Paul, another GOP doctor, directly arguing with Senator Cassidy, so that was very unusual. It just had a lot of very dramatic moments. So there were a lot of surprises, but not a surprise that he was confirmed.

Ian Bremmer:

Lots of places where the Trump administration, where President Trump is focusing on things that are indeed problems, but a lot of disagreements on how one would go about fixing them. Where do you think RFK is getting it right that something is truly out of whack with the US health system today?

Apoorva Mandavilli:

I think it's very, very clear that we do have a problem with chronic diseases in this country. That's something he talks about a lot. He doesn't always get his numbers right. He said things like 48% of America's teenagers are diabetic when the real number is 0.35%.

Ian Bremmer:

Those numbers are not exactly close.

Apoorva Mandavilli:

No, they're astronomically different. But what he does get right is that those numbers have been going up. They've been going up for decades and they have been especially going up in kids who are obese. And even that has been a huge problem, now there are more and more kids who are obese. And-

Ian Bremmer:

To be fair, those numbers are mostly going down in other wealthy economies around the world.

Apoorva Mandavilli:

We are much worse off. We're not the only ones, but we are much worse off than a lot of other countries. And we also have just a lot of cancers and they're rising in young people and in women. So there's clearly something in our food, in our environment, whatever it is that is driving these very unhealthy trends, and I think he's right about that. And also that we don't think enough, spend enough money on prevention as we do on treating it after there already is a problem.

Ian Bremmer:

Is it fair to say that he has a fundamental mistrust about corporate interests in this area?

Apoorva Mandavilli:

I think he does. And obviously he takes it too far in some arenas, like with vaccines for example, where he is convinced that all the pharma companies are out to poison all the kids and they don't care how many have died. He has said things like that. He has said that about CDC scientists as well. So he does seem to have this very innate mistrust in large organizations, whether they're corporate or even government. Interesting that he's going to go be a very big government person.

But he's not wrong about that, he does say... The thing about RFK's statements is if you really look at them, there is always a grain of truth in there somewhere. He'll say pharma companies are really corrupt and manipulative and they will take data to make a profit. And he's right about that if you look at things like Vioxx, the drug that caused heart attacks, and we didn't know about it until it was really a big problem. So there are-

Ian Bremmer:

And they did? The pharma companies that were putting that out did actually know?

Apoorva Mandavilli:

They did actually obfuscate the data. And there are instances, we know that pharma companies are driven by the profit margins. That's not a surprise. But I think where he starts to go wrong is when he takes those things and really runs with them, as with the comparing 0.35% to 48%. He takes the very real statement he has on his hands and he exaggerates it to a point where it is no longer true.

Ian Bremmer:

So let's get into the vaccine point because I certainly have heard a lot of vaccine skepticism from RFK. In fact, it's how he first got on my screen well before he was running for president. Has he moderated that now that he's in a position where he has to say nice things to senators to get his job? Do you buy any of that moderation? Because one could make the argument, "Oh, he just wants to get in." One could also make the argument, "Oh, he was saying a lot of this before because it's the way that he gets himself known." Where do you fall on that spectrum?

Apoorva Mandavilli:

He has said a lot of things, and I don't actually think he has walked them back enough. In the hearings, for example, he kept making the point that there are all these studies that he knows of showing that vaccines cause autism, for example, even though there were people on the committee, Bernie Sanders, Dr. Cassidy saying, "Look, the studies are out there and that is not what they're showing." He could not budge from his status on that, from his stance on that.

But he did take back some other things. He has said things like no vaccine is safe and effective, for example. And he did go back on that-

Ian Bremmer:

Like the polio vaccine, for example.

Apoorva Mandavilli:

Like the polio vaccine.

Ian Bremmer:

Things that we need children to take because otherwise we're going to have big problems.

Apoorva Mandavilli:

Yes, exactly. But the-

Ian Bremmer:

And he's now okay with that. You're saying that this is something that as head of Health and Human Services, you would expect that he's not going to be a problem on those baseline continued vaccine programs for kids?

Apoorva Mandavilli:

I wouldn't go that far.

Ian Bremmer:

You wouldn't go that far?

Apoorva Mandavilli:

No. I think he said that in the hearing. I think he said in the hearings of vaccines have saved many lives, but I don't actually believe that he has changed his mind on that. And I don't think we can be certain that if as the head of HHS, that he's not going to do things that actually undermine vaccines. I don't know if you noticed, but the CDC's pages, the vaccine information sheets on all kinds of vaccines were down, and this is even before he's running HHS.

Ian Bremmer:

They took the pages down.

Apoorva Mandavilli:

They took the pages down.

Ian Bremmer:

So that American citizens can no longer access that information if they go to the CDC.

Apoorva Mandavilli:

More importantly, doctors cannot vaccinate anybody unless they give the patients a copy of these vaccine information sheets, and those are currently down. So they may come back up, they probably will. They're being cleansed, a lot of the CDC website is being cleansed, so they may come up. But the point is that I don't think we can assume that vaccines are sacred and will not be touched.

Ian Bremmer:

Now, I remember during the pandemic in Brazil when Jair Bolsonaro was in charge, he was quite skeptical on vaccines, yet the country has had very strong healthcare programs. And as a consequence, you had enormous amounts of basic trust in doctors and science. Where's the United States compared to that?

Apoorva Mandavilli:

I think we have a huge problem with trust in this country and that predates RFK Jr. I don't think that he's going to create that problem, but we already are going into it. If you talk about Bolsonaro, COVID was a very big part of when he was really making a lot of misstatements about COVID and about the vaccines, right? We did not come out of that entire era with a great deal of trust in the public health establishment. So now when you have somebody who has made those comments very openly about the CDC not being trustworthy or the FDA not being trustworthy, and that's who's leading the health department, I think we are in real danger of having people say even more. I don't trust anything that was said previously about any of these things, I'm just going to go with what that guy is saying.

Ian Bremmer:

What does vaccine skepticism look like in the United States right now? How much of a present day problem is it?

Apoorva Mandavilli:

It's a growing problem. So during the pandemic, the vaccination rates started to slip for other reasons, logistical reasons, but they haven't come back up.

Ian Bremmer:

From what to what? Give us a sense of what it looks like.

Apoorva Mandavilli:

So we say for herd immunity, which is the rate at which the population, a community is protected, you need 95% of kids to be vaccinated for polio or for measles. And we fell to 93%, which doesn't seem like a lot-

Ian Bremmer:

Across the country?

Apoorva Mandavilli:

Across the country. And that doesn't seem like a lot, two percentage points, but that's hundreds of thousands of children. And if you look state by state, because it's the states that set the vaccination policies, there are states where the rates of exemptions have really gone up quite a lot. And now you've got states like Louisiana saying, "We're not going to promote vaccines. If people want to go get them, that's fine. We're not going to provide the information." And I think we're going to see a lot more of that.

Ian Bremmer:

What's driving vaccine skepticism in the United States right now? Again, I understand that trust in institutions generally is going down, but again, people that are growing up in the United States have seen disfigurement with polio, have seen a history of these horrible diseases, and response to them have been really effective. Is a lot of this the pandemic or are there other issues that we really should be focusing on?

Apoorva Mandavilli:

Well, some of it predates the pandemic. The anti-vaccine movement was there and quite strong even before the pandemic and a lot of it centered around autism. You said we've seen in this country people getting disfigured. Well, people more recently have also been seeing kids get diagnosed with autism, and there are a lot of reasons for that.

Number one, actually, the diagnostic criteria are a lot wider than they used to be, and a lot of milder cases are now being diagnosed. But people do hear the numbers, and I think they think, "Well, there's got to be an explanation." And vaccines coincide very much with when somebody starts to notice signs of autism in their kids. Around the time that they get the MMR vaccine, for example, is when symptoms start to show up. So it becomes very easy to confuse the two. And you've got lots of anti-vax people waiting in the wings, ready to provide that as a very simple explanation.

The truth is complicated, but saying, "Oh, it's the vaccine. Your kid got the vaccine and that's why they got autism," that's simple. And it takes away any guilt the parents might have about their own genetics, maybe being involved. There are lots of reasons it's an attractive explanation.

Ian Bremmer:

And to be clear, for all of our viewers, there is no scientific evidence that links autism to vaccines.

Apoorva Mandavilli:

That's correct, it's been looked at over and over and over. There are large studies that have looked at it and concluded there's no link, but that has never been enough to satisfy the people who suggest that those two things are connected.

And then at the same time, you also have this backlash against mandates. People don't want to be told what to do. And that did get a lot worse during COVID, just the idea of it's my body, I'll do what I want. And then when you don't see things like polio, when you don't see things like measles be a big problem, you forget. You forget that's why you take vaccines.

Ian Bremmer:

And to be fair, the fact that the Biden administration decided they were going to run this study, the investigation into the origins of COVID, and suddenly the CIA is saying, "Yeah, actually we think the most plausible evidence is that it came from a lab in Wuhan as opposed to a wet market, as opposed to sort of natural leaping from bats or pangolins or whatnot." You're doing a lot of damage to undermine trust in the same scientific voices that are telling you these vaccines are safe. So from that perspective, I think we can understand more why there would be more skepticism today.

Apoorva Mandavilli:

I think you can understand why there's skepticism any time people have a big question like what's causing autism and there isn't an answer, and the scientific authorities, for whatever reason, because it's just complicated or because they're not taking those concerns seriously enough, have not done enough to fill the gap and say, "Here's what's going on," in simple and clear enough terms that people can grab onto. And that just leaves a vacuum for other theories to come in.

Ian Bremmer:

Let me ask you about another issue that's come up recently, which is the World Health Organization. Trump, in his first term, briefly pulled the US out of the WHO. Now that seems to be made permanent, one of the first steps he's taken. World Health Organization originally established by the United States and allies, part of the UN system. US has been principal donor to the WHO. What are the implications of withdrawal?

Apoorva Mandavilli:

Huge.

Ian Bremmer:

How so?

Apoorva Mandavilli:

The WHO does a lot of things that I think we don't really think about a lot in this country. Let's talk about the rest of the world for a second, but it does also matter to Americans, and I'll explain why. But in many parts of the world, they don't have their own CDC, they don't have their own FDA, and the WHO essentially plays that role. It provides health guidelines just like the CDC does for us. It approves drugs just like the FDA does for us. So when the WHO loses its money, it's funding, and the US is its biggest donor, so when they pull out, the WHO is a lot poorer, those things are really going to hurt.

We Americans, we also benefit from the WHO. So the WHO comes up with the diagnostic code system that we use here, the ICD it's called. Every doctor, every insurer uses this. It also comes up with chemical names for drugs, antibiotics. You might know it as amoxicillin, might be sold as something else in another country, but as long as you know that's what it is, you can get it anywhere.

And one of the big things that it does is every Fall, we get a flu vaccine. And that is based entirely on information that's collected by the WHO-

Ian Bremmer:

Globally. Yeah.

Apoorva Mandavilli:

Globally, through its massive surveillance network. Now, we might still be able to find out what that information is, but we would essentially be freeloading and not actually contributing to the conversation. So we would have no say in it, and we would be bystanders in this process.

Ian Bremmer:

Private sector corporations benefit from that.

Apoorva Mandavilli:

They do.

Ian Bremmer:

Should they be loudly on the side of you've got to stay in the World Health Organization? Because I haven't seen much of that.

Apoorva Mandavilli:

I think they're doing more quiet lobbying. There are organizations that help the WHO and those organizations are talking to these companies because you're right, the companies that want to sell their products in these other countries, they are reliant on the WHO to tell the health ministries that it's okay to buy this product, and so that's very important for American businesses.

But I think at the moment, in general, you're not seeing a lot of conversation from companies or even from large organizations like the Bill and Melinda Gates Foundation, the Bill Gates Foundation now. They're not saying a lot about what the Trump administration is doing, whether it's correct or not. Everybody's pretty silent.

Ian Bremmer:

And they've been a huge donor to the WHO.

Apoorva Mandavilli:

They are a huge donor to the WHO and they have not really spoken up about any of it, about the suspension of foreign aid, about the withdrawal from the WHO. These are things that really the Gates Foundation plays a big part in, but they have been quite silent.

Ian Bremmer:

And WHO is not directly under the authority of the UN, even though it is a part of the broader umbrella. It has been a fairly weak organization, there has been a lot of legitimate criticism that they're unwilling to call out the Chinese on transparency, for example, because the Chinese are major donors. What sort of reform would you need for the WHO to feel more comfortable about how it operates? And again, I'm not trying to cast aspersions that doesn't do important work, but there are criticisms that need to be addressed.

Apoorva Mandavilli:

Absolutely. It's in great need of reform. And actually, the biggest problem is that it's so reliant on member states, it can't actually criticize member states because it depends on them for money. So ironically, the fix is for them to have more money and to not have it so tied to member countries just giving these dues and wanting their say. One expert I talked to said it's every country, even the tiniest of country can throw a wrench into the proceedings. That's sort of how it's structured, and I think that really needs to change.

Ian Bremmer:

And then suspension of support, USAID, I see PEPFAR, for example, South Africa right now, a big part of the HIV prevention and fighting budget around the world. Suddenly, programs that were being supported aren't necessarily going to have money going forward. Some of this I'm sure is not efficient, and maybe some of it's corrupt, but some of it obviously matters to people that don't have means. What do you think the implications are of all this? Where do you think rubber hits the road?

Apoorva Mandavilli:

USAID is basically dead. That's what it's looking like. It's subsumed into the State Department. The office has been shut down. People-

Ian Bremmer:

Well, subsumed into the State Department isn't dead, right? That the money still gets potentially spent, right? Since Congress-

Apoorva Mandavilli:

Potentially.

Ian Bremmer:

Right.

Apoorva Mandavilli:

A lot of it-

Ian Bremmer:

But I'm saying we don't know that yet.

Apoorva Mandavilli:

The USAID is dead in its current form. Let's put it that way. It's going to look very different, whatever it is.

Ian Bremmer:

What does that mean though? What does different mean?

Apoorva Mandavilli:

I think they're seen as giving money away to all kinds of things that are unimportant. And Elon Musk, for example, has said they're criminals. And a lot of the top leaders in the organization have been let go, have been fired. There are people who can't even access their own email accounts. There's a lot going on there that I think really has been quite disruptive, and they're not allowed to talk to any of their partners in various countries.

Again, there's this perception that everything that USAID does is for the benefit of other people and not Americans. But some of what USAID does is very important to us. So there have been at least about a dozen Ebola outbreaks in Africa in the last few years. There have been something like-

Ian Bremmer:

Including one right now.

Apoorva Mandavilli:

Including one right now in Uganda, yeah. And there've been about 20 swine flu outbreaks and USAID helped contain those. And those, if they come here, could decimate our agricultural industry. Ebola, if it comes here, would be a huge public health disaster. There's Marburg, another infectious disease that's very similar to Ebola, another hemorrhagic fever going on in Tanzania. And USAID is often on the ground in those situations helping to contain those outbreaks, and that's something that could very directly affect us.

Ian Bremmer:

I'm seeing more concern about bird flu these days, including here in the United States. You've said that we need to take it more seriously. Why is that?

Apoorva Mandavilli:

So a lot has changed in the last few months with bird flu. As you may know, there's been this virus, H5N1, one of the bird flu viruses circulating in the US since early 2024. It's been in dairy cattle, it's been in wild birds, but it's spilled into dairy cattle at some point, and now it's in herds all over the country. So that was already a big problem.

Ian Bremmer:

There have been a couple of human cases that we know about, right?

Apoorva Mandavilli:

67.

Ian Bremmer:

Yeah.

Apoorva Mandavilli:

Yeah. So that's one of the big things that has changed is that in June, we had three cases, now we've had 67, so there's been a big increase in that. And now there are two versions of this virus that are circulating and one of them is pretty new, and it's already in wild birds all over the country. So that-

Ian Bremmer:

Is this a potentially likely fatal disease in humans?

Apoorva Mandavilli:

We don't actually know. That's one of the problems. It has been fatal elsewhere in the world. It's been fatal. And here, we've had one case so far, but we don't know exactly what the death rate would be, for example, because, A, there haven't been enough cases for us to know that, and B, surveillance has been just really, really poor. So we don't actually know what this virus is doing, how it's evolving, how widely it has spread. We have a vague sense.

But that first death was quite a wake-up call. It was in a person in Louisiana who was over 65 and had some underlying conditions. But then there was also a teenager in Canada who was 13. She was very obese, but beyond that, no risk factors. And she was ill and hospitalized with organ failure for weeks. So this virus could actually be quite bad for a lot of people, but we don't have a very good lens on what it's doing.

So that's one of the reasons I think that scientists are quite worried that now you have this virus that's clearly changing. And having two versions run around is never a good thing because flu viruses are very good at what we call reassortment, mixing and matching and picking up new mutations. And also, we have seasonal flu going on. So if you had a person who became infected with bird flu and became infected with the seasonal flu, bird flu could pick up the ease with which seasonal flu spreads and then off we go, spreading among people.

So the idea that it's now in cows and it's been in cows and it's not going anywhere. That means we are probably looking at a permanent scenario of farm workers being exposed to this virus and for that virus to then have a lot of opportunities to mutate and become adapted to people.

Ian Bremmer:

Now, we've just gone through an unprecedented pandemic. It's been the most disruptive episode for our lives for pretty much almost everyone around the world. Surely, the United States is in a better position coming out of that to respond to another pandemic were it to occur. Tell me that's true.

Apoorva Mandavilli:

It's not true.

Ian Bremmer:

It's not true. Well, how is that not true? How is that not true coming after like three years of pandemic in this country?

Apoorva Mandavilli:

Well, you saw it play out. You saw exactly what people were willing to do and what they were not. And it's not that scientifically were not able to do it, but from a policy perspective, whether states and even the federal government's willing to do the things it needs to do and whether citizens are willing to do the things they need to do, I think that's where the response is really going to fall down.

Ian Bremmer:

What would you say needs to do, what do you really mean? Because you're not saying, oh, we've got to lock everyone down. You're not saying we've got to have mandates that all the schools are closed. Clearly, there were lots of overstatements on some of those issues.

Apoorva Mandavilli:

Absolutely. And the schools were shut down for too long and all of that. But I think that number one, we needed to test. And the reason we know 67 people have had it is not because CDC went in and tested everybody who needed to be tested. Those were people, we just happened to find out that they are sick and they ended up getting tested. There's been no mandatory testing of people, and we only started testing bulk milk for it to see which herds are infected in December. And even now, we're not doing it for the whole country.

So we've been very slow to do all the testing, the kind of surveillance we need. And the entire time, this whole year plus that we've been hearing about this, the federal agencies have been very, very clear to say, and every call with reporters, "This isn't mandatory. We're not making anybody do anything." So that seems to be their main focus is to reassure everybody that they're not actually forcing anyone to do anything, instead of saying, "We're actually doing everything that should be done."

And there's a lot of the same kind of thing we saw during COVID where the main goal seems to be to stop panic rather than to actually give us all the information. So it becomes very difficult. Again, as with COVID, it's been reporters who've had to find out information and say, "This is actually what's happening," and then confront the agencies with it.

For example, I found out that there are herds in Idaho that are reinfected for a second time. That's really bad news because that means that the virus could potentially circulate forever among cows. And the USDA told me, "No, no, no. There's been no cows that have been infected in Idaho since October." These reinfections happened in November, and Idaho state officials have talked about it very publicly, but we're not hearing about it from the feds.

Ian Bremmer:

So given that there has been a lot of political opposition to the way COVID was handled by many of the officials that are coming in, what do you think that might mean for a bird flu epidemic were we to see one?

Apoorva Mandavilli:

I think it actually could be quite tricky. RFK Jr. really is a proponent of raw milk, which is full of virus actually at this point, bird flu virus. And health officials say that raw milk is dangerous to drink, but he has continued to support it, for example.

We have bird flu vaccines that are in the federal stockpile, and he has said those are dangerous. Asked about it in the hearing, he did say that he would support whatever vaccine, but again, he's been so anti-vaccine so many times over the years, it's really fully hard to believe that. He's definitely opposed to mRNA, which would be our fastest, most efficient way to get to a vaccine.

And even the other nominees, Jay Bhattacharya, who's supposed to head the NIH, Marty Makary, who's supposed to head the FDA, they have been at times huge critics of how COVID was handled. Not always without basis, but certainly they're not big fans of the big public health measures that were taken. So it's really quite an open question what would happen if we had to have a big bird flu epidemic or a pandemic, how they would actually deal with it and whether they would support the things needed to contain something like that.

Ian Bremmer:

I understand why lots of people would have problems trusting the media, trusting their political leaders, trusting corporate leaders. Trusting doctors seems to be kind of fundamental. If something goes wrong, you talk to a doctor, you get a second opinion, it's usually from another doctor. Right? So it does feel like in the United States right now, when we talk about the CDC, we talk about Dr. Fauci, we talk about the politicization has gone into an area that heretofore really was off limits for that, or at least it felt that way. Am I right about that?

Apoorva Mandavilli:

You're partly right. And here, I actually get to say something positive. I don't think the trust in doctors is as bad as you might think. I think surveys have actually shown that even now, even with all of the partisanship and all of the negativity, people do trust their own doctors. That has not really gone away. They may have feelings about Dr. Fauci, but their own doctor, generally, people do trust them. And it might surprise you to hear that in a recent survey, Americans actually said that they don't think we're doing enough to prepare for pandemics. So who knows? They might still surprise us all.

Ian Bremmer:

And when Americans are saying that, does that hold true across the political spectrum?

Apoorva Mandavilli:

Probably not. But as a group, as a country, I think they do still want precautions. They do still want investments in pandemic preparedness. And at least some portion of the country will be ready to wear masks again if they need to.

Ian Bremmer:

Apoorva Mandavilli, thanks for joining us today.

Apoorva Mandavilli:

It's my pleasure.

Ian Bremmer:

That's it for today's edition of the GZERO World Podcast. Do you like what you heard? Of course you do. Why not make it official? Why don't you rate and review GZERO World five stars, only five stars, otherwise don't do it, on Apple, Spotify, or wherever you get your podcasts. Tell your friends.