Will Humble Disease Control, Wills Blog

How Do Influenza Pandemics Usually Start?

Last week I wrote about Secretary Kennedy’s actions to gut infectious disease research and public health practice funding are the man-made risk that will greatly impair our ability to detect and respond to future outbreaks and pandemics.

The Real H5N1 Threat: Kennedy’s Assault on Our Public Health System

This week I thought I’d give a short summary of how influenza pandemics typically get started.

See: Bird flu’s dangerous leap – Arizona PBS

Influenza pandemics usually begin when a new strain of the influenza virus emerges that can infect humans and spread easily from person to person. It usually starts with an antigenic shift when there’s a significant change in the virus’s genetic makeup creates a novel subtype that most people have little or no immunity to.

  • The natural reservoir for influenza A viruses is wild aquatic birds, like ducks, geese, and swans. These birds often carry the virus in their intestines and shed it in feces (usually without showing symptoms).
  • Poultry farms can also become infected, and when kept in close quarters with pigs, can serve as intermediate hosts.
  • Pigs are usually the lynchpin species because they can be infected by both bird and human influenza viruses. This makes pigs effective “mixing vessels” where genetic material from different influenza viruses can reassort to create new combinations when they have a concurrent infection.
  • Influenza viruses have an RNA genome. If a pig is infected simultaneously with an avian and a human strain, the RNA can reassort, leading to a new virus that has a mixture of genes from both sources. If this reassorted virus gains the ability to infect humans and transmit efficiently between them, it can spark a human pandemic.
  • The first human infections often occur in regions where humans live in close proximity to livestock and wild birds—especially in parts of Asia with informal & traditional farming practices where birds, pigs and humans live in close proximity to each other.
  • Once human-to-human transmission becomes efficient (via respiratory droplets), the virus can spread rapidly across the globe, leading to a pandemic.

Historical Examples

  • 1918 “Spanish Flu“: Likely originated from birds, potentially with swine involvement. It caused the deadliest pandemic in recorded history.
  • 1957 “Asian Flu” and 1968 “Hong Kong Flu”: Resulted from reassortment involving avian influenza viruses and existing human strains likely in pigs.
  • 2009 “Swine Flu” (H1N1): Originated from pigs, involving a complex reassortment of avian, swine, and human influenza viruses.
Will Humble Public Health, Wills Blog

The Most Important Staffer in Congress You’ve Probably Never Heard Of

The Senate Parliamentarian plays an important but mostly overlooked role in the legislative process of the United States Senate. This ‘nonpartisan’ official acts as the chief interpreter of the Senate’s complex rules and procedures, advising the presiding officer on how to apply them during debates, votes, and other proceedings.

The current Senate Parliamentarian is Elizabeth MacDonough, who has been in the job since 2012. She’s not affiliated with any political party as neutrality is supposed to be a requirement of the role. Like a referee.

The Parliamentarian is appointed by the Senate Majority Leader (John Thune of SD).  The person’s main job is to provide guidance on the Senate’s complex procedural rules. Things like advising the presiding officer during debates, deciding the proper referral of legislation to committees, and making sure legislative actions follow established Senate procedures.

While MacDonough is appointed by the Senate Majority Leader (Thune) they don’t “report” to any one Senator or party. Instead, they serve the institution of the Senate itself.

One of the Parliamentarian’s most important jobs has to do with the development of the federal budget – which is underway right now. The Parliamentarian decides what legislative provisions qualify for inclusion in budget reconciliation bills. Essentially, she decides what policy measures get to bypass the standard 60-vote filibuster threshold and instead pass with a simple majority (51 votes).

According to Senate rules budget reconciliations just need 51 votes vs. the 60 votes needed for other measures.

To make the determinations, the Parliamentarian is supposed to apply something called the Byrd Rule, which limits budget reconciliation to things that directly affect federal revenues or expenditures.

The Parliamentarian is supposed to assess whether each part of a bill adheres to this rule. If a provision is believed not related to the budget, it’s supposed to be removed unless 60 Senators vote to override the ruling—effectively reinstating the filibuster barrier for that section.

For example, in 2021, MacDonough ruled that a proposed minimum wage increase could not be included in a COVID-19 relief package passed via reconciliation, saying it did not have a direct budgetary impact. In 2017, she advised that several provisions in a Republican-backed healthcare bill (the ‘skinny repeal’) didn’t meet reconciliation rules, forcing their removal or requiring 60 votes for passage.

While the Parliamentarian’s decisions are advisory, they historically have carried weight. Senate Majority Leaders have historically followed the Parliamentarian’s guidance. Deviations have been rare and politically sensitive.

But – as you know – these aren’t normal times.

Parliamentarian of the United States Senate – Wikipedia

Will Humble Public Health, Wills Blog

President Releases Budget Proposal – It’s Not Good for Public health

Last Friday the White House released the President’s ‘discretionary’ budget proposal for next federal fiscal year. The proposal presents top-level requests for each federal agency and doesn’t include funding tables that are usually part of the executive’s proposal.

Congress can approve, reject, or modify the Administration’s budget recommendations. A complete budget request with additional details such as congressional justifications and mandatory funding proposals is expected to be released by the White House in the coming weeks.

Here are some of the key federal agency proposals:

CDC

  • Decreases CDC’s budget by 48% going from $7.6B to just $4B.
  • Eliminates the:
    • National Center for Chronic Disease Prevention & Health Promotion
    • National Center for Environmental Health
    • National Center for Injury Prevention and Control
    • Global Health Center
    • Public Health Preparedness and Response
    • Preventive Health and Human Services Block Grant

HRSA

  • The budget decreases HRSA from $7.6B to just $6B. 
  • The budget includes a:
    • $74M decrease in funding for Ryan White HIV/AIDS program activities that do not focus on core health care and support services directly to patients, such as education and training.
    • $274M decrease in funding for MCH.
    • $1B decrease in funding for health workforce programs that provide scholarships and support for individuals to enter “high-paying medical careers.”
    • $286M decrease in funding for Title X Family Planning programs.

ASPR

  • Decreases funding by $240 million for ASPR.
  • Eliminates funding for ASPR’s Hospital Preparedness Program.

Other HHS Programs

  • Eliminates the Sexual Risk Avoidance Program.
  • Eliminates the Teen Pregnancy Prevention program.
  • Reduces funding levels for the HHS Office of Minority Health and Office on Women’s Health. 

For more information view the FY26 budget proposal.

Will Humble Public Health, State Legislature, Wills Blog

Senate Confirmation Circus Forces Out Heredia & Cunico: Will the Senate Majority Ever Choose Governance Over Grandstanding?

Governor Katie Hobbs has once again been inappropriately hamstrung by the hyper-partisan Senator Jake Hoffman – the Chair of the Senate’s Director Nominations Committee.

This week, his ongoing political theater forced the resignation of two important health directors: AHCCCS Director Carmen Heredia & ADHS Director Jennifer Cunico.

The Arizona Republic and AZ Capitol Times both reported that the directors resigned ahead of expected rejections by the Senate committee, which has repeatedly used its power (mostly Mr. Hoffman) not to vet nominees in good faith – but to publicly humiliate and undermine the governor’s choices.

AHCCCS & ADHS Directors Resign | Arizona Capitol Times
AHCCCS, Health services directors resign before Senate confirmation

It would be one thing if Hoffman were looking at the statutory requirements of the jobs and vetting the nominees based on whether their experience meets the statutory requirements – but that’s not what he’s doing.

Rather than perform his legitimate constitutional duty to evaluate and confirm nominees, Hoffman is focused on sabotaging the executive branch when it’s not held by his party. Ducey nominees wouldn’t be getting this treatment regardless of how unqualified were.

See: View ARS 36-102 Statutory Qualifications for the ADHS Director

This behavior isn’t new — my op-ed published two years ago highlighted how Hoffman’s treatment of nominees hasn’t been about qualifications but about political ideology and partisan sabotage.

Senate committee doesn’t ‘vet’ nominees. It sabotages them

Heredia and Cunico weren’t ‘fringe figures with radical ideologues’ as suggested by Hoffman. Both were respected inside and outside their agencies. All the information I have suggests they were driven to resign not because of a scandal or mismanagement, but because Mr. Hoffman disagrees with their opinions.

Hoffman’s behavior—grilling nominees on partisan talking points, delaying hearings, or simply refusing to confirm them is basically sabotage – not legitimate legislative oversight of the executive branch.

Who will want to serve in Arizona government and leave jobs they like knowing their reputation will be dragged through the mud for political theater?  

Per ARS §38-211(B), Hobbs must now “promptly” nominate new directors for both ADHS and AHCCCS. While the statute doesn’t define “promptly,” the need to name at least interim directors is immediate because state agencies can’t execute administrative or regulatory decisions without directors at the helms.

38-211 – Nominations by governor; consent of senate; appointment

Will the Senate majority ever choose governance and accountability over grandstanding?

Not until President Petersen changes who is chair of the DINO Committee or scraps it all together and goes back to the old way of vetting through normal standing committees.

 

Will Humble Public Health, Wills Blog

Kennedy’s Sweeping HHS Cuts Continue to Assault Public Health & Research Infrastructure

A leaked Office of Management and Budget document reveals drastic plans by Kennedy to slash $40 billion from the department’s budget, a reduction of nearly one-third.

The cuts, outlined in a 64-page internal document, fundamentally restructure HHS and dismantle major agencies and programs vital to public health and scientific research.

Leaked HHS budget projects $40B in cuts, ACA subsidies expire

Key casualties include the HRSA, SAMHSA, AHRQ, NIH, CMS, CDC and FDA. The National Institutes of Health faces an added 40% budget cut, shrinking from $47 billion to $27 billion, severely undermining biomedical research. 

Scoop: Leaked PDF outlines major HHS restructuring proposal (authenticity now confirmed). “The safety nets are being blown up right and left.”

HHS has already eliminated 10,000 positions and announced that was just the beginning of a planned reduction, saying in a press release, “The current 82,000 full-time employees will be reduced to 62,000.”

  • The FDA will decrease its workforce by approximately 3,500 full-time employees.
  • The CDC will decrease its workforce by approximately 2,400 employees.
  • The NIH will decrease its workforce by approximately 1,200 employees.
  • CMS will decrease its workforce by approximately 300 employees.
  • Ten regional offices will become five, a tool to get people to quit rather than move.

Kennedy also proposes to no longer subsidize Affordable Care Act Marketplace premiums – effectively ending insurance coverage for an estimated 4 million people and significant revenue losses for hospitals, especially in rural communities.

The implications are stark: the U.S. risks reversing decades of progress in disease prevention, health equity, and medical innovation.

Vulnerable The only real hope for the US’ public health system rests with the Judicial branch of government.

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