The Dose (December 13)

Healthcare policy debate, finally H5N1 milk testing, cancer death progress, and RSV vaccine flops.

Good morning! Happy Friday the 13th. Respiratory season is here, but health policy has dominated this week’s national conversation. Also, while we are making progress on cancer, the RSV vaccine for infants flopped in clinical trials.

Here’s the latest.

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First, a correction

In the excitement of introducing a nutrition section of YLE, I left out an important disclosure. Ms. Maisano—who co-wrote the post earlier this week—works by day as Director of Nutrition and Regulatory Affairs at the National Dairy Council, a non-profit, non-lobbying organization founded by dairy farmers. She will not write on dairy-related matters for YLE, but transparency is my core value. This information has been added to her bio.

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Fall respiratory weather report: A slow murmur is growing

The number of people with a fever, cough, and stuffy nose has officially crossed the epidemic threshold in the United States. In other words, we are officially in respiratory season. While traveling, I wear a mask now; I don’t have time to get sick.

To epidemiologists’ surprise, the “big three”—Covid-19, flu, and RSV—have had an incredibly sluggish start to the season. The number of people testing positive for flu and RSV, especially in the Southeast, is increasing but still at “low” or “moderate” levels. Covid-19 is still very low.

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Groundswell frustration with the healthcare industry

There’s been a remarkable conversation about the U.S. healthcare industry this week sparked by three big pieces of news: the tragic murder of UnitedHealth Group’s CEO, Brian Thompson; Anthem’s withdrawal of its proposal to pay less for anesthesia; and RFK Jr. rethinking of how physicians get paid.

Here’s my 30,000-foot take:

• Americans have complicated feelings about their health insurance. The U.S. is an outlier among developed countries in terms of in poor health system performance, health care spending, and life expectancy. (We rank #49.) This is unacceptable and has devastating consequences. Despite this, 80% of Americans rate their healthcare insurance positively. (Ratings drop 16 points once people get sick, though.) Reconciling these conflicting realities with solutions is hard.

• In an environment with growing distrust, listen. This week’s public outcry isn’t nothing—it was a loud, public groundswell of frustration. But the major players—insurance companies, hospital systems, Wall Street, pharmaceutical giants, and lobbying groups—are locked in a cycle of finger-pointing, consistently overlooking the core issue: Americans’ health is not the most important voice in the conversation when it should be.

• Real change in the U.S. is slow. Americans have deeply divided values and, thus, often competing priorities and solutions. This results in a slow crawl of national reckoning, with big problems chipped away in small chunks from multiple angles. We’ve seen this with tobacco, motor vehicle safety, gun violence, and, yes, health care. Change is possible but comes from relentless advocates, legislators, innovators, and even people from the inside—not from murdering someone in the street.

Hear more first-draft reactions on the podcast I co-host called America Dissected. (Yes, I even agreed with RFK Jr. on his solution for physician pay.)

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We finally have a national approach to testing H5N1 in milk. Why did it take so long?

We’ve been flying blind for almost a year on the H5N1 outbreak—we still don’t know how many herds, in how many states, or how many humans have “truly” been infected. One reason is suboptimal testing due to pushback from workers and dairy operators.

One workaround is testing the raw milk batches to understand the extent of the spread (and thus, the risk for a pandemic). However, USDA faces strong agricultural lobbying. So some local jurisdictions, like Santa Clara, CA, started testing raw milk without a federal order.

The tides have now turned: USDA has ordered bulk milk testing nationally starting next week. Why now?

• H5N1 isn’t burning out like the USDA had hoped.

• Several raw milk batches sold to the public have tested positive for H5N1.

• The election is over, and so are political sensitivities. This order may attempt to establish processes before the next administration, which would ideally be harder to unwind.

Photo by Wolfgang Hasselmann on Unsplash

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Moderna’s first RSV vaccine for babies flops, but our vaccine safety systems shines

VRBPAC—the FDA's external advisory committee—met this week to discuss vaccines. One topic was Moderna’s failed mRNA RSV vaccine clinical trial for children.

Back up: why do kids need a vaccine? While there is already an RSV vaccine for pregnancy and a monoclonal antibody for infants, the antibodies provide only temporary protection. So multiple vaccines are being evaluated for use in young children, one of which is Moderna’s.

Unfortunately, during Moderna’s phase I clinical trial, infants who received the vaccine developed more severe RSV disease than those who received the placebo. Moderna stopped the trial when the signal appeared and informed the FDA. This safety signal may be a coincidence because so few children were involved, but it’s best to assume it is real, given the long road of RSV vaccine failures among kids.

Why is it so hard to get babies’ immune systems to protect them from RSV? One hypothesis is that young kids’ T cells are to blame. Babies’ immune systems have a specific quirk that makes it hard for them to make certain immune responses to viruses like RSV until they mature. There are potential approaches to get around this, but these are many years away.

For now, the best defense against RSV disease is what is already on the market: a maternal vaccination and monoclonal antibodies.

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Good news: Millions of cancer deaths averted over 45 years

A new study estimates that 5.94 million deaths from breast, cervical, colorectal, lung, and prostate cancers have been averted since 1975. This is attributed to prevention and screening (80% of deaths prevented) and treatment advances.

Cancer is still the second leading cause of death, so we have work to do, but progress is a reason to celebrate.

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Question grab bag

YLE hosted its first webinar for paid subscribers this week, and it actually went smoothly! (The recording will be available soon.) The conversation stirred up many brilliant questions, including the following, which we didn’t get to answer live.

“I am really struggling with identifying effective strategies to communicate . . . toward collaboratively making effective change with incoming leaders who appear uninterested in the totality of the current scientific knowledge and have a track record of cherry-picking (sometimes poorly designed) studies that support a predetermined narrative.” So, how do we advocate for the importance of data, regardless of the specific topic/issue?

This is a significant challenge, but I’ve found it not insurmountable. Here’s what I do:

1. Recognize your goal. There is a difference between being right vs. moving someone towards thinking differently. Changing someone’s mind right away rarely happens, but showing them why science (and scientists) is something they can trust is a successful conversation, even if they don't fully accept the data.

2. Meet them where they are. Identify your audience’s priorities, concerns, and the outcomes that matter most to them. Frame data as a tool to advance their goals. For example, RFK Jr.’s underlying want is transparency. Data can help with that.

3. People don’t need more facts; they need educators and storytellers. Humanize numbers by pairing data with narratives that resonate emotionally. Stories can make data feel more relevant and harder to dismiss.

4. Shift the frame: Data should act as a compass, not a weapon. Rather than directly challenging their preferred studies, frame the conversation as exploring all available evidence to strengthen decision-making.

5. Call out cherry-picking tactfully by focusing on methods, not motives. When addressing poorly designed studies, emphasize scientific rigor without attacking intentions.

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Bottom line

You’re all caught up for the week! Have a wonderful weekend.

Love, YLE

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. During the day, Dr. Jetelina runs this newsletter and consults with several nonprofit and federal agencies, including CDC. YLE reaches more than 290,000 people in over 132 countries with one goal: “translate” the ever-evolving public health science so that people feel well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: