Novavax confusion, food dyes, measles, dengue, and a new backup plan for vaccines
The Dose (April 29)
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Measles cases are still rising fast, dengue season is heating up early, and food dyes may be on their way out. Plus, a lot of confusion around Novavax Covid-19 vaccine approval and a new backup plan for vaccine policy.
Here’s the much-needed context and what it may mean to you.
Infectious disease alerts
Measles: We’re now at 923 cases nationwide. It’s hard to determine whether we’re at the beginning or middle of these outbreaks, given significant underreporting, but we’re quickly approaching the highest number of cases recorded in the past 25 years.
For the big Texas outbreak, I’m keeping a close eye on:
El Paso: 29 cases in just 18 days.
Chihuahua, Mexico: Outbreak is surging, with 605 cases reported.
New Mexico: Signs of slowing, with fewer new cases each week.
A new KFF poll shows a stark divide in public concern: 76% of Democrats say they’re worried about the measles outbreak, compared to just 28% of Republicans.
For a deeper dive, check out the SITREP report:
Dengue (also known as breakbone fever), traditionally considered a neglected tropical disease, is creeping northward due to a warming Earth, resulting in more locally acquired cases and an increase in cases from international travel. Last year, Puerto Rico declared a state of emergency. Most infections are asymptomatic, but 1 in 4 infections cause flu-like symptoms and can occasionally (1 in 20 infections) cause more severe disease like hemorrhagic fever.
This year, CDC has reported 1,568 cases—mostly from international travel and mostly in Puerto Rico. But Hawaii made news last week as they already reported 7 travel-related cases—higher than expected for this time of year:
2024: 14 total cases
Previous years: 4 cases on average
We will likely see more cases in the U.S., but for now, it remains a rare occurrence.
What does this mean to you? Risk is very low and not uniform across the States. TX, CA, FL, and PR typically see the most locally acquired cases. Prevention is simple: EPA-recommended insect repellents, especially those with DEET. They really do work. Here is a YLE deep dive on mosquito-borne illnesses in the U.S. if you’re looking for more context.
FDA moves to phase out all petroleum-based food dyes
Red dye #3 is already out the door, and the new HHS administration is trying to phase out the rest. Last Tuesday, HHS announced the initiative.
What actually happened:
Only two rarely-used colors—Citrus Red 2 and Orange B—were officially revoked.
For the remaining six, which are more widely used, it will be entirely up to the food industry under a voluntary “understanding”—not a formal ban. Response from industry members so far has been mixed; some have pledged support, while others are maintaining their safety.
Some key context:
Contrary to popular belief, five of these six colors are allowed in Europe whose regulatory body follows a more cautionary hazard-based approach to food safety. They just use different names on their food labels. Dr. Andrea Love created a great table (see below).
Possible tradeoffs: Natural colors are generally less vibrant and may help reduce the appeal of unhealthy foods to kids. It will be interesting to see the impact on consumers. But natural colors are also more expensive to make, less consistent (affected by pH, cooking and processing) and less shelf-stable—which means higher food costs and potentially more food waste. Some natural colors may also pose a risk to individuals with food allergies, making transparency in ingredient labeling critical.
What does this mean for you? It’s unclear at this point. The impact on you as a consumer will depend on how—and whether—the industry chooses to shift. But again, let’s not lose the forest for the trees. For real progress to make America healthier, we need a number of systematic changes that tackle root causes.
What’s happening with Novavax? This is a good question.
Unlike Pfizer and Moderna’s mRNA Covid-19 vaccines, Novavax uses a more traditional protein-based platform. It has been available under emergency use authorization while working toward full FDA approval—the gold standard for maintaining market access. Manufacturing delays have slowed that process. But a lot has changed in just the past month.
Here’s what I know:
Full approval was originally scheduled for April 1, but that decision was paused—eerily, just after Dr. Peter Marks was forced to resign—sparking speculation of political interference.
Last week, Novavax announced it’s back on track for full approval.
Then, over the weekend, the FDA said that it is requiring a clinical trial to reevaluate the effectiveness of Novavax.
And now, more recent comments suggest that the same bar might be applied to Moderna and Pfizer vaccines as well.
This is… not normal. A new clinical trial could cost millions of dollars—which isn’t my main concern, given the financial position of these companies—but it would also take time, and that is a concern. Fall is around the corner, and designing, recruiting, conducting trials, and manufacturing doses typically take years—unless we’re in a declared emergency.
Since the original Covid-19 vaccine trials, we have shifted to a model similar to flu vaccines: anticipate the virus mutating quickly and test a small number of people’s blood to confirm an immune response. The strain changes in the vaccine formula are minor—more like tweaking a few letters in a Word doc than changing the document’s content, length, or format. Meanwhile, real-world data from CDC continues to show that updated Covid vaccines offer additional protection, especially for those over 65.
Here’s what I don’t know: Are these just FDA talking points to the media, or will this actually become policy for fall approval? What kind of trial is being required—tens of thousands of participants? And why are Covid-19 vaccines now being treated so differently than flu?
There’s a lot we still don’t know. And until we get clarity, it’s unclear whether updated Covid vaccines will be available this fall—or if they’ll be delayed by shifting expectations and new rules.
The Vaccine Integrity Project: a new backup plan?
There are concerns that Secretary Kennedy will politically influence or change ACIP—the external committee for vaccine policy in the United States—which means the possibility of changing eligibility or access to vaccines. If this happens, it will be a mess. States will be on their own, insurance companies will be looking for third-party validation, and there would be a whole lot of confusion.
So, a shadow group was stood up University of Minnesota (called the Vaccine Integrity Project) backed by a philanthropic gift. This will be an eight-member committee to advise on vaccine protection, effectiveness, and recommendations outside of government.
What does it mean for you? The Vaccine Integrity Project won’t have formal authority. However, if ACIP’s role becomes politicized, it could serve as an important alternative. It’s another sign that public health groups are mobilizing to stay ahead of potential disruptions.
Bottom line
You’re all caught up! Have a great week.
Love, the YLE Team
Your Local Epidemiologist (YLE) is a public health newsletter with one goal: to “translate” the ever-evolving public health science so that people feel well-equipped to make evidence-based decisions. This newsletter is owned and operated by Dr. Katelyn Jetelina— an epidemiologist and mom. This is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:
So glad groups are mobilizing to stay ahead of the confusion and caos.
I continue to admire you more than I can say. And I remember Winston Churchill's, "If you've going through hell, keep going."