I have had a mama bear living inside me for as long as I can remember, long before I had children of my own. My mother and I were the kind of animal lovers who could not walk past a creature in trouble, and we rescued our way through my childhood. We bottle-fed baby birds who had lost their mothers. Heck, we even kept a little terrarium for snails with cracked shells (humid and stocked with a calcium source like crushed eggshells or cuttlebone) to help them gradually repair the shell by secreting new shell material from their mantle. We pulled a kitten out of a car’s tailpipe, and I spent the whole night with him tucked into a papoose against my chest, rocking back and forth without anyone teaching me how. The rocking came from some deep, evolutionary place, an instinct rooted in me long before I understood it. Nurturing was and is in my blood. (Thanks, Mom. ♥)

When my OB placed my son on my chest in December of 2016, that quiet, lifelong instinct moved to center stage. I heard him cry and it took me over completely. Mama bear Jess found her cub in the same breath my son took his first.

The scientist in me loves this part, because none of what I felt was only poetry. There is real, measurable biology behind it. Pregnancy and the months after it actually reshape the maternal brain. Gray matter reorganizes. The regions that handle empathy and vigilance and the pull toward the baby get more active. The amygdala, that little almond of a structure that runs fear and protection, grows more sensitive, soaked in oxytocin, wired to pull a mother toward this one small person above everyone else. Researchers who study this describe new motherhood as looking, in the brain, a lot like falling in love. They also describe something I recognized instantly. The constant looping thoughts. Is the baby breathing? Is he warm enough? Is he okay? A protective circuit running on a hair trigger.

That instinct is biology doing what it evolved to do. But biology can cut both ways...and that same instinct that made me a mother would, years later, nearly talk me out of the very thing my son needed.

My son’s name is Dylan, and I am in total awe of his brain. He is a sponge. Inquisitive. A steel trap who only has to hear something once before he files it away and pulls it back out whenever he wants, which is humbling for a woman who tears the house apart looking for the glasses sitting on top of her head. He asks questions and pontificates about the universe and about humankind, and I just listen, half-marveling and half-lost– fumbling my way through my responses. Bright beyond words. Yes, I am a mama’s-boy mama. Guilty. A million times over.

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There is something else about Dylan. If I let my focus go soft, the way you have to unfocus your eyes to see one of those 3D stereogram illusions, I sometimes feel like my late father is in the room. I try to keep my daddy issues from crowding my mommy ones, but I will not pretend it is not a gift to catch my father’s wit, his brilliance, his sharp tongue, alive again in his grandson. For a second at a time, a man I lost comes back to me in the shape of this boy.

They are alike in another way, too. My father could have been the poster child for a certain kind of restless, motor-always-running mind. ADHD shows up in different presentations. Some people mostly drift and lose track. Others mostly fidget and act before they think. Plenty land in between, a foot in each. That is my dad, and that is Dylan, with the restless end turned up loudest. Genetics sure isn’t subtle.

Dylan had been showing signs for a while, and we grew more aware of them the longer we watched. He could not make it through even part of a family dinner in his seat. He moved as if a motor ran him, his body and his beautiful mind chasing each other, neither one quite able to slow down and let the other catch up. Other times he would be right in front of us and somehow not really there, physically present but unable to focus on what we were saying, so that we often felt like he was talking past us. His teachers noticed it, too. At one point they asked, carefully, whether he might have a hearing problem. (He does not. We checked.) The notes that came home were all gentle versions of the same observation: how hard it was for him to sit still and stay focused, a mind that would not quite settle. Interestingly, none of it touched his schoolwork. He was bright and he excelled. But I could see it somewhere else, in the flickers of frustration from the people around him, in the way it was starting to wear on his friendships. So we raised it at one of his pediatric well visits. His teachers filled out questionnaires. We filled out ours. A formal diagnosis followed. Our pediatrician walked us through the medication options, and together we settled on the one that seemed best for him. The prescription went to our local pharmacy. I picked it up and brought it home.

Yet the medication sat in our cabinet for months, collecting dust. Two parents. One of us a physician, one of us a public health scientist (who had, years earlier, even done pre-clinical research on this class of medication). A real diagnosis from a real evaluation… and we hesitated to give our son the thing that might help him.

Why? I have turned this over and over because I surprised even myself. Part of it was fear of touching the magic. What if the very thing that makes him him got suppressed? Part of it, if I am being honest, was that the traits I would be treating are the same ones that sound like my late father. Quieting them might feel like losing my father a second time. Part of it, plainer still, was that I was not yet convinced it was necessary. I did not want to reach for something Dylan did not actually need. So, I watched. Was this a disorder, or was it just a bright, busy boy being a bright, busy boy? I did not want to medicate a personality, I wanted to be sure.

In this case, I think my mama bear instinct might have protected Dylan right past the point of actually helping him.

Watching him gave me my answer. This was not a phase, and it was not just ‘little-boy energy.’ I could see how much it cost Dylan to be unable to slow himself down. He was not thriving inside the chaos, he was fighting it. Waiting had stopped being caution and started being its own kind of harm. Holding the tools back from him was not protecting him, it was failing him. If I really wanted to be his mama bear, the fierce thing to do was to use those tools.

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So we gave him the pill. This was not a casual decision, and it was not a reflex. I do not leap at every intervention that gets waved in front of me, I weigh the costs against the benefits every single time. I watched my own kid with my own eyes. I listened to the clinicians whose job is to help families through exactly this, and I let what they knew guide me past what I feared. My instinct did its job, which was to make me look closely. The deciding part, I left to the evidence and the people trained to read it. Helping him meant acting, not dismissing. It meant listening to the experts.

And then my son told me what it felt like when he took his medication. He said he could finally slow his thoughts and his body. He said he noticed his own heartbeat for the first time. He said he could pull his thoughts apart from one another instead of having them all at once. And then, in words I am not embellishing even slightly, he said, “I feel like I’m finally in control of my brain.”

So no, I do not doubt my mama bear. I trust her more than ever. But I have learned that trusting her is not the same as obeying her on the spot. Her job is to love Dylan fiercely and to sound the alarm. Mine is to make sure that love leads me toward what actually helps him. Protecting Dylan meant seeing the real threat clearly, and it was never the pill.

I am not the only one who freezes like this. I have heard pediatricians, the people who recommend and give vaccines every single day, describe the exact same flicker when it is their own child’s arm in front of the needle. The evidence is screaming in support. They have given that shot a thousand times. And still, for half a second, their heart flutters and some ancient part of them pauses. They go through with it anyway, every single time, because they know it is the best way to protect the child they love. That evolutionary seed is planted in all of us. So I am not alone in this, and neither are you.

If there is one thing I want you to take from my fumbling, it is this. I am a scientist and a science communicator, and I would never tell you to suppress that instinct. It is one of the truest, most protective things about you, and it is often the first to sense that something is wrong. But the instinct is old. It evolved to guard children from predators and cliffs and cold, not to weigh evidence from a clinical trial. Sometimes it points you exactly right. Sometimes it has not caught up to the medicine, and it aims your fear at the wrong target. Mine did. It told me the threat was the pill, when the real threat was the thing the pill treats. So listen to the instinct, always. Then carry it to the people whose job is to help you make sense of it, and let the evidence carry real weight, especially in the moments when love and fear have clouded your view, the way they clouded mine. The instinct knows that something matters. It does not always know what to do. That part we borrow from the experts.

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For us, the answer turned out to be a small pill that had been gathering dust on a shelf. And the thing I was most afraid of never happened. It did not dim him, and it did not take anything away. If anything, it gave him more of himself. It sharpened the parts of Dylan that will serve him best and turned down the static that had been drowning them out. His spark didn’t come from his restlessness. And on the other side of my fear, my son finally got to feel like himself.

And I think about my father. His ADHD went untreated his entire life, in a time without the language or the tools we have now. He was brilliant and electric, and that same boundless energy and fervor left him misunderstood more often than he deserved, with people frustrated in the wake of it, never quite seeing the man underneath the motor. I cannot help but think how grateful he would be that his grandson does not have to power through without the tools we now have at the ready. Treating Dylan was never going to erase my father. It honors him.

The medicine has made a world of difference for him. Family dinners have gotten longer. He still asks impossible questions about the universe, but now he can sit still long enough to hear the answer, usually from ‘Alexa,’ since I am still mostly winging mine. I am so grateful. There is some guilt mixed in too, because I wish I had not made him wait while I worked through my own fear. But I am trying to give myself the same grace I would offer any of you reading this. The hesitation was never neglect. It was love that had not yet found the evidence standing right beside it.

Stay Curious,

Unbiased Science

Myasthenia gravis (MG) translates, roughly, to “grave muscle weakness.” The name is no exaggeration, but the disease doesn’t always announce itself that way. It can start with signs that are easy to wave off, and that are sometimes waved off by others too: a drooping eyelid, double vision that blinking won’t clear, an arm that gives out halfway through holding your kid. But they share a common origin. The immune system has turned against the tiny junction where nerves tell muscles what to do, a process that can spread until it affects swallowing, speech, even breathing. For the next entry in our autoimmune series, our collaborator Nicole, an epidemiologist living with MG, starts us off in her own words.

I (Nicole) was going about my life in late 2021, with no indication that I was sick, when I woke up one morning with blurry vision. Blinking wouldn’t make it go away. By the next day, I was also seeing double. As an epidemiologist, I immediately went into research mode, trying to figure out what was wrong while I waited for an appointment. I had heard of myasthenia gravis because I assist with investigations of botulism, which can present with similar symptoms. I shared my suspicions with my doctor (along with a few other conditions I thought it could be), and after a blood test, it was confirmed – I had ocular myasthenia gravis.

After several months of standard treatments and a thymectomy, we wanted to expand our family while I was stable. I was able to get pregnant quickly but, unfortunately, while I was pregnant with my second child, my MG progressed from ocular (affecting only the eyes) to generalized, with weakness developing in the muscles of the face, throat, and neck, as well as the arms, hands, legs, and chest. My neurologist took a conservative approach, limiting treatment to options considered safe in pregnancy. The focus was to just make it through with a healthy baby.

Looking back, I wish I had planned more carefully for life after she arrived. After my daughter was born, I really went downhill both physically and emotionally. I didn’t have the arm strength to hold my newborn, and I spiraled into postpartum depression. I eventually found a different neurologist, one who really listened and supported my decisions as a patient, but I wish I had made that change sooner. The right doctor makes an enormous difference, and so does learning when and how to advocate for yourself.

Many new targeted therapies have come on the market in the last five years or so, and while they don’t work for everyone, I was able to find one that has brought me back to “normal.” I started one of the new complement inhibitors about 18 months ago, and it has been a game changer. I do daily injections and have to manage my energy levels, but it’s such a difference.

A few weeks ago, I was on a Disney cruise with my family. One day, coming back from an excursion, I realized it was exactly three years since my worst MG exacerbation. I had just been swimming in the ocean, fighting the waves, snorkeling, and carrying my children around. Three years earlier, that would have been unthinkable. I was overwhelmed with gratitude.

One thing I have taken away from my experience is a deeper appreciation for the small things I once couldn’t do and never thought I’d do again. I don’t take any of it for granted. And I’m using my voice now, from a better place, to share my story and encourage others the way I wish someone had encouraged me when I was first diagnosed.

What is Myasthenia Gravis (MG)?

Myasthenia gravis is a chronic autoimmune disease in which the immune system mistakenly disrupts communication between nerves and muscles, causing weakness in specific muscle groups. The degree of muscle weakness can vary considerably between individuals. MG can affect men and women across all racial and ethnic groups. It is most common in women under 40 and men over 60 but can occur at any age, including during childhood. It is estimated to affect 150-200 people per million worldwide, though rates vary considerably by region and have been rising in recent decades.

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When the immune system mistakenly targets the neuromuscular junction

Normally, nerves release the chemical acetylcholine, which binds to receptors on muscle cells, to trigger contraction. In MG, B cells (guided by helper T cells) produce autoantibodies that bind to key proteins at the neuromuscular junction (the communication point between nerves and muscles). The most common target is the acetylcholine receptor (AChR), but autoantibodies can also attack proteins such as MuSK (muscle-specific kinase, a receptor tyrosine kinase) or LRP4 (low-density lipoprotein receptor-related protein 4), both of which play important roles in helping nerve signals reach the muscle.

These antibodies interfere with signaling in several ways: they can physically block acetylcholine from binding, or cause receptors to be removed and destroyed. In AChR-positive disease, they can also activate the complement system, a cascade of immune proteins that damages the muscle side of the neuromuscular junction. The result is a reduced number of functional acetylcholine receptors, so the nerve’s signal becomes weaker with repeated use, producing the hallmark fluctuating muscle weakness and fatigue.

This immune misfiring is often linked to abnormalities of the thymus, an immune organ involved in T cell development. The thymus normally grows until puberty, then begins to shrink and is eventually replaced by fat tissue in adulthood. In people with MG, however, the thymus can fail to shrink, and may remain active in ways that drive the autoimmune response.

In some people, clusters of immune cells form within the thymus, and in a small percentage, tumors called thymomas may develop, which range in severity and require monitoring or treatment. MG’s links to immune dysregulation extend beyond the thymus. About 5-10% of people with MG have another autoimmune disease, such as thyroid disease, rheumatoid arthritis, or systemic lupus erythematosus.

What causes Myasthenia Gravis?

The exact causes of MG are not fully understood, though genetic susceptibility and environmental triggers both appear to play a role.

Genetics

MG is rarely an inherited condition, with only 3.8-7.1% of patients reporting a family history of disease. While some autoimmune conditions have specific genes associated with their diagnosis, MG does not appear to be highly heritable. In the context of all autoimmune diseases, what is commonly passed down is a predisposition to autoimmunity itself, not necessarily a specific autoimmune disease. Those with this predisposition inherit immune systems that are prone to turn against the body. In some people, the target is the insulin-producing beta cells in the pancreas (like type 1 diabetes); in others, the myelin surrounding nerves in the brain (like MS); in others, the cells lining the small intestine (like celiac disease). In other words, what’s inherited is a tendency toward autoimmunity itself, not which tissue the immune system attacks.

In the context of MG, some specific genetic susceptibility markers have been identified. Examples include some forms of human leukocyte antigen (HLA) genes, the methylation status of cytotoxic T lymphocyte associated protein 4 (CTLA4) gene,tumor necrosis factor receptor superfamily member 11a (TNFRSF11A), and NFkB activator genes — all of which vary with early and/or late onset disease. Each plays a role in the immune response: HLA genes govern how antigens are displayed to T cells, CTLA4 and TNFR are involved in cell-to-cell signaling, and NFkB drives the activation of immune-specific genes.

Environment

Several environmental factors have been associated with the development and flares of MG:

• Relapse in disease has been associated with both stress and depression.

• Viral infection, including hepatitis C, herpes simplex virus, Epstein-Barr virus, cytomegalovirus, human T-lymphotropic virus, West Nile Virus, and more recently SARS-CoV-2, have been associated with MG, though results are mixed and no clear causal relationship has been established.

• Several studies have shown a potential association between pesticide exposure and MG, but again no causal relationship has been established.

What Myasthenia Gravis looks and feels like

The most common presenting symptoms for MG are ocular (eye-related) weakness and general muscle weakness, both of which tend to improve with rest.

Common symptoms of myasthenia gravis include:

• Weakness of the eye muscles, including drooping eyelids, and blurred or double vision

• Facial expression changes

• Difficulty swallowing

• Shortness of breath

• Impaired speech

• Weakness in the arms, hands, fingers, legs and neck

Muscles required for breathing can weaken to the point that a ventilator is required. This is called a “myasthenic crisis” and requires emergency medical attention. Around 15-20% of those with MG experience at least one myasthenic crisis in their lifetime after diagnosis.

Piecing together a diagnosis

Medical teams

A diagnosis for MG is usually made by a neurologist upon referral by a primary care doctor or an eye doctor.

Diagnostic evaluation

• Physical and neurological exams assess muscle strength and tone, coordination, sense of touch and eye movements.

• Electrodiagnostic tests, including nerve stimulation tests and single-fiber electromyography (EMG), assess how well nerves and muscles are communicating. EMG is considered the most sensitive test for MG and can detect impaired nerve-to-muscle transmission.

• Blood tests can detect autoantibodies directed against specific proteins, including acetylcholine receptors (AChR), muscle-specific kinase (MuSK), and low-density lipoprotein receptor-related protein 4 (LRP4). Some people with MG test negative for all known autoantibodies — a subtype known as seronegative MG.

The subtype of MG (whether defined by clinical presentation or antibody profile) can influence how the disease manifests and help guide treatment decisions.

Disease subtypes:

• Generalized MG: involves muscle weakness beyond the eyes, affecting the face, throat, limbs, and breathing muscles. It tends to be more severe.

• Ocular MG: generally confined to weakness of the eye muscles.

• Pediatric MG:

  • Transient neonatal MG: occurs in infants born to mothers with MG and tends to resolve as mother’s antibodies disappear from the infant’s bloodstream.

  • Juvenile MG: a rare form that develops before the age of 18, causing systemic muscle weakness that can interfere with everyday activities.

Antibody-based subtypes:

• Acetylcholine receptor antibody-positive MG (AChR): the most common subtype.

• Muscle-specific kinase antibody positive MG (MuSK): more common in women, generally affects the face and head more than the limbs.

• Low density lipoprotein receptor related protein 4 antibody positive MG (LRP4): involves antibodies against a different receptor.

• Triple seronegative MG: presents with similar symptoms but no autoantibodies are detected.

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How is Myasthenia Gravis treated?

Current treatments

Treatments for MG target different steps in the immune process driving the disease. There are treatments that promote the activity of acetylcholine to enhance signaling and transmission at the neuromuscular junctions. Surgical approaches can “reset” the immune system. Other treatments focus on inhibition of pathways that contribute to pathology, block production of autoantibodies or directly degrade or remove autoantibodies from circulation.

• Anti-cholinesterase medications: pyridostigmine (brand names Mestinon and Regonol) can slow the breakdown of acetylcholine at the neuromuscular junction, improving transmission and increasing muscle strength.

• Thymectomy: operation to remove the thymus; can rebalance the immune system and decrease symptoms. This approach can provide complete remission in about 50% of people who undergo the treatment.

• Complement inhibition: complement is a collection of proteins that are part of the immune system and can contribute to the pathology of MG. There are FDA-approved medications like eculizumab that can inhibit key complement proteins known to contribute to neuromuscular junction damage in MG.

• Immunosuppressants: some immunosuppressants can also improve muscle strength by suppressing the production of abnormal antibodies. These medications may include prednisone, azathioprine, mycophenolate mofetil, and tacrolimus, but these all come with side effects that require careful monitoring by a physician.

• Plasmapheresis and IVIG: these therapies are used in severe cases to remove destructive antibodies that attack the neuromuscular junctions. They usually help for a few weeks to months.

• Neonatal Fc Receptor Blockers (FcRn): these medications are targeted biologic therapies given by injection that intercept and degrade the specific autoantibodies that destroy neuromuscular junctions. Examples include Imaavy, Vyvgart, and Rystiggo.

• Lifestyle: regular exercise can be helpful in some cases of MG.

Innovative treatments

The treatment landscape for MG has expanded rapidly in recent years, with several new targeted therapies approved and more in development.

• CAR T-cell therapy: several approaches using CAR T-cell therapy are in development to help reprogram the immune system to destroy the B cells that produce the damaging autoantibodies driving disease.

• B-cell depleting antibodies: currently in phase 3 trials, these therapies aim to selectively eliminate B cells responsible for producing MG autoantibodies.

• Oral targeted therapies: researchers are developing oral drugs to inhibit complement proteins and BTK, a signaling molecule inside B cells that drives autoantibody production. If approved, these would offer a pill-based alternative to IV infusions or injections.

Final Thoughts

Three years separated Nicole’s worst days from that cruise. The distance between those two points used to be much harder to cross. MG is now one of the more treatable autoimmune diseases, and the last few years have brought a wave of targeted therapies that didn’t exist before. They don’t work for everyone, but for a lot of people they’ve been the difference between getting by and getting their life back.

For anyone at the start of this journey, Nicole’s experience offers a few guiding lessons: push for answers when something feels off, find a doctor who treats you like a partner and not a chart, and remember that you are not navigating this alone.

Stay Curious,

Unbiased Science

Resources for MG support

Support resources:

https://www.mg-united.com/

https://myasthenia.org/understanding-mg/overview-mg/

https://www.mgteam.com/

General MG resources:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/myasthenia-gravis

https://www.mda.org/disease/myasthenia-gravis#causes

Past Substacks in our Immunology Explained/AAI Collaboration

• Celiac Disease

• Sjögren’s

• Multiple Sclerosis (MS)

• Rheumatoid Arthritis (RA)

• Lupus

I tried my best to unplug, though I’ll admit I checked the news in the quiet early mornings before the kids woke up. Here are some things that caught my attention. Let’s discuss…

1. No, a new study did not show that kids’ flu shots are a “complete failure”

We say all the time that we try to avoid debunks, but every so often a claim comes along that is wrong enough, and spreading fast enough, that staying quiet starts to feel worse than wading in. This particular one cleared that bar, so we put together a full breakdown of it.

The post, written by Nicolas Hulscher on Peter McCullough’s Substack, claims that a new Catalan study proves childhood flu shots are a complete failure, but the study shows nothing of the kind. What it tracked was flu across a region of 400,000 people in Catalonia before and after they extended the flu vaccine recommendation to young kids. That’s a question about whether flu rates fell across the whole region, not about whether vaccinated kids got sick less than unvaccinated ones. The authors themselves say plainly that their data can’t judge how well the shot protects an individual child, and the habit of treating a population-level result as if it settles the individual-level question even has a name: the ecological fallacy.

Coverage was also far too low for any community-wide signal to show up in the first place. Only about 19% of young kids got the shot in the first season and 27% in the second, while researchers estimate you need at least 50 to 60% before that kind of effect becomes visible. For a sense of what higher uptake looks like, when the UK reached 56% coverage, flu hospitalizations in schoolchildren fell by 93%.

A recent study that set out to test individual protection directly is a Harvard research letter in JAMA Pediatrics, which found that for every 100 kids ages 2 to 5 who got the flu shot, 9 to 14 fewer caught the flu, and the American Academy of Pediatrics (AAP) continues to recommend flu vaccines for every child over 6 months. The citation on the original graphic also appears to be fabricated, pointing to a DOI that leads nowhere and a paper that does not appear to exist, even though the numbers underneath it come from a real study. (Ruh-roh!)

For any clinicians who have these conversations all day, we also make free virtual escape rooms to take some of the friction out of them, including one on pediatric flu vaccines, which you can find here.

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2. Obesity is dropping, and the credit is going to the wrong place

RFK Jr. posted that obesity has fallen 2.5%, calling it the first drop in 50 years and crediting the administration’s food agenda, which is once again confusing correlation with causation in a way that has become something of a pattern for him.

The number he’s citing comes from Gallup’s self-reported survey data, where people give their own height and weight, and that tends to run a little lower than what a clinical scale would show. The system most people treat as the gold standard here, NHANES, physically measures people instead, and because it runs on multi-year cycles, the data that would capture this stretch of time isn’t out yet. Once it is, we’ll have a much cleaner picture of what’s really happening.

To be fair, he may well be right that obesity is coming down, and if he is, that’s good news for public health. The trouble starts with slapping a ‘cause’ on it without proper assessment. For one thing, the decline was already well underway before his food agenda existed. Obesity peaked at 39.9% in 2022 and has eased every year since, to 38.4% in 2023, 37.5% in 2024, and 37.0% in 2025, a steady slide that began long before he was confirmed as HHS secretary and well before any of his initiatives rolled out in 2025. The same Gallup data that show the decline also point to the most likely reason for it: the use of GLP-1 medications for weight loss roughly doubled in about a year and a half, climbing from under 6% to over 12% of adults. The decline in obesity has been steepest in exactly the age groups using these drugs the most, adults between 40 and 64, where rates dropped by 4 to 5 points, and Gallup itself draws the line between the two.

The food-policy changes he keeps pointing to don’t really bear on any of this. Yes, we’ve all seen the “dye-free” versions lining the shelves now, but food coloring has no bearing on a product’s calories or nutritional value, so swapping it out was never going to move the needle on weight. The one structural move of the bunch, the restriction on buying soda and candy through SNAP, was blocked in court last week. Meanwhile, the programs that actually help low-income families afford fresh produce, SNAP and WIC, have faced significant cuts to their fruit and vegetable benefits under this same administration. If we really are past peak obesity, that’s worth celebrating, but the thing driving it looks far more like a class of medications than anything happening to the food supply.

3. The cancer-preventing vaccine keeps proving itself

I’ve been talking about the HPV vaccine for a while now, including in a recent CIDRAP op-ed about the shot I wish I could have given my younger self. There was no HPV vaccine when I was a teenager, and by the time it existed I was already in my twenties and a candidate without realizing I was one. I caught HPV in my early twenties, and a routine pap smear during grad school came back precancerous. If I’d gotten the shot as a kid, I most likely would have avoided that scare altogether.

This month brought new data worth celebrating. A new study in The Lancet looked at cervical cancer deaths in England from 2001 to 2024, and among women aged 20 to 24, the group with around 90% vaccination coverage at age 12 or 13, there were no deaths from cervical cancer at all across the five years from 2020 to 2024, against the roughly 23 deaths that past rates would have predicted. The researchers are careful to note that zero almost certainly reflects how low the underlying death rate has become rather than a true eradication, and they wouldn’t be surprised to see a death or two in a future year. Even so, the scale of the drop is remarkable, and they estimate the program has prevented close to 200 cervical cancer deaths in England so far, with that number expected to keep climbing as vaccinated girls grow older. England achieved this with about 90% vaccine coverage. The US is well short of that, and the gaps fall hardest on rural, uninsured, and lower-income kids, so if we want results like England's, we have some work to do. National Geographic and the BBC both have very readable write-ups if you want the plain-language version.

My nine-year-old son is scheduled for his first dose in a couple of weeks, and my daughter will get hers next year once she’s eligible. He has some needle anxiety, so we sat down together and talked through what the shot actually does and all the cancers it heads off down the road, and he is excited about it now. Yes, really.

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A brief mention of Roundup, with more to come

We couldn’t run a roundup this week without at least a nod to Roundup (see what we did there?), which is back in the news. The Supreme Court handed Monsanto a win this week in the long-running glyphosate litigation, but the ruling was about federal pesticide labeling and whether a state failure-to-warn claim can stand, not about whether glyphosate causes cancer. That gap between the legal question and the scientific one tends to get lost in the headlines, which is most of why this topic stays so muddled.

Rather than rehash everything here, I’ll point you to our full post from February, but will highlight a few key takeaways:

1. The cancer worry traces back to IARC’s 2015 “probably carcinogenic” classification. That was a hazard assessment, which asks whether something can cause cancer under some set of conditions, at any dose, in a lab or otherwise. It is a different question from risk, which asks whether it actually does at the levels people are exposed to in real life. Coffee and aloe vera sit in the same IARC hazard category, which gives you a sense of what the label does and doesn’t tell you.

2. The agencies that take that next step and weigh real-world exposure, including the EPA, the FAO/WHO joint meeting, and the European Food Safety Authority, have repeatedly concluded glyphosate is not likely to cause cancer at typical use. They aren’t contradicting IARC so much as answering that second question.

3. The enormous settlements are their own story, one about corporate conduct and legal risk rather than the science, since a company can decide to settle cases it thinks it would win rather than gamble in front of a jury.

To be clear, we're not defending Monsanto, and nobody is paying us to say this. There are still open questions, especially around heavy occupational exposure and the documented industry interference in the research. The evidence we have right now doesn't justify the certainty coming from either side. More soon.

Back to unpacking…

Stay Curious,

Unbiased Science

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If you’ve seen The Good Place, you likely remember the stretch of episodes in Season 2 where Michael keeps resetting his fake “Good Place” neighborhood.

Over and over and over.

Each reset is a fresh attempt to make the same arrangement work. Needing another one each time is a reminder that the last version didn’t hold up.

The American Academy of Pediatrics (AAP) v Kennedy case has followed a similar rhythm. Since District Judge Brian Murphy’s March 16th stay left the Advisory Committee on Immunization Practices (ACIP) without a quorum, the government has tried rewriting the ACIP charter (April), rewriting it again (May), and issuing an Executive Order in late May. Then last week, a request to fast-track the related appeal arrived—88 days after the original stay was issued.

There is still no quorum, and that’s a gap that both sides agree needs to be filled. After all, fall respiratory vaccine recommendations have to come from somewhere. Let’s discuss…

Hurry Up and Wait (Then Hurry Up Again)

Since we last wrote, the Department of Health and Human Services (HHS) asked the court to expedite its appeal of the stay and set a shorter briefing schedule, arguing the ACIP wouldn’t be able to act in time for fall respiratory season otherwise. AAP opposed the motion, and the court resolved it by setting a briefing schedule. However, in this context, “expedited” means the response brief is due July 16th, with another reply to follow after that. That is still too late to matter for fall vaccine ordering timelines that they purport to be racing against.

But the concern is manufactured, because there’s nothing inherently stopping the ACIP from meeting if fall immunizations were truly the motive here. The stay blocks the current ACIP appointees, specifically. If new, qualified members were appointed through the standard vetting process, the ACIP could reconvene and issue recommendations while the broader litigation continues.

It took the government 44 days to file its initial Notice of Appeal after the stay. It took another 44 days to request that the appeal be expedited. None of the deadlines driving the urgency were a surprise. The fall respiratory season arrives around the same time every year. The ACIP itself had a meeting on the books for June 24th through 26th since the beginning of the year, which has since been canceled due to ongoing litigation. Insurers have already committed to covering vaccines that were ACIP-recommended as of September 1, 2025, with no cost-sharing through the end of 2027, regardless of how this case turns out. None of it was unpredictable. So, why did it take nearly three months to call it urgent?

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Approved COVID-19 Vaccine Formulation Stuck in ACIP Limbo

On May 28th, the U.S. Food and Drug Administration’s (FDA’s) Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted to recommend that the fall 2026-27 COVID-19 vaccine target the XFG strain. The FDA adopted the recommendation the following day. Normally, the next stop would be the ACIP, which would make the official recommendation on who should receive the vaccine and how the costs would be covered. With no functioning ACIP, that hasn’t happened.

Beyond the expedited appeal, federal procurement records show that in early June, the Centers for Disease Control and Prevention (CDC) invested roughly $1.24 billion in COVID-19 vaccine contracts with Pfizer for both pediatric and adult vaccines for fiscal years 2026 and 2027, as well as separate agreements with Moderna and Sanofi. HHS Secretary Robert F. Kennedy Jr. has denied the framing of these contracts, saying that they are indefinite delivery agreements that “ensure availability if needed” but aren’t representative of a completed purchase.

Aaron Siri, the vaccine injury lawyer and Kennedy ally that we’ve covered before, sent a letter last week demanding that the contracts be canceled, arguing that the vaccines cannot be administered through the Vaccines for Children (VFC) program without an ACIP recommendation. But the ACIP already approved the inclusion of COVID-19 vaccines in the VFC program in 2022, so it does not need to reaffirm its recommendation.

A Rare Hand of Flu Vaccine Wild Cards

If February’s flu vaccine debacle was a double-reverse card, then VRBPAC’s vote on June 18th was the rarest hand in the deck consisting of all wild cards.

The committee voted unanimously (9-0) to recommend Moderna’s mRNA influenza vaccine (mFlusiva) for adults aged 50 through 64 through the traditional approval pathway, and for adults 65 and older under an accelerated approval process requiring an additional post-marketing safety study. This was VRBPAC’s first review of a new vaccine application since 2023, and a memorable turnaround for a product that the FDA had previously refused to even review back in February, reversing course just a few days later. The FDA’s ultimate decision to adopt VRBPAC’s recommendation is due by August 5th.

If the right pieces fall into place, the vaccine could be available for the upcoming respiratory viral season. But Mamma Mia, here we go again. VRBPAC makes recommendations for FDA licensure. But the ACIP ultimately decides who gets the vaccine and whether insurers should cover it.

The importance of the flu vaccine cannot be overstated. Two months after Defense Secretary Pete Hegseth lifted the flu vaccine requirement for U.S. troops, a flu outbreak has infected at least 275 recruits in basic training at the Lackland Air Force Base in Texas, where quarters are close and therefore infectious diseases thrive. Recruits receive vaccines (including flu) on a rolling basis when they enter basic training, regardless of the season. However, reports suggest that only about 40% of new recruits received their flu vaccine once it became optional, compared to nearly 100% before the mandate was lifted. Already, the flu vaccine mandate is back in place.

Spotlight on the Sudden Infant Death Playbook

In this session for state legislators, beneath the overt anti-vaccine legislation we covered here (vaccine exemptions, schedule changes), ran a quieter campaign: bills introduced across many states built on a debunked link between vaccines and sudden infant and child deaths.

A quick terminology, note because these bills use a lot of acronyms: Sudden unexpected infant death (SUID) is the umbrella category for any sudden, unexpected death in an infant under 1 year of age. Under that umbrella term, sudden infant death syndrome (SIDS) is a diagnosis of exclusion that is assigned after other causes of death have been ruled out. For deaths that occur after age 1, the parallel term is sudden unexplained death in childhood (SUDC), under the umbrella term of sudden death in the young (SDY). We will refer to SUID from now on for simplicity, but these bills actually use all of these acronyms.

Using recycled language from state to state, the bills would require coroners to record a child’s recent vaccination history on any autopsy reports for sudden or unexplained infant and child deaths. It was signed into law in Oklahoma in May and in Louisiana in June. Similar bills were introduced in states such as Mississippi, Iowa, Florida, and South Carolina, but stalled. One such bill made it to the governor’s desk in Arizona before it was vetoed last week.

Collecting as much information as possible when a child dies is a no-brainer, and, for grieving parents and caregivers, no policy could touch what it means to cope with the loss of a child. But behind the facade of empathy and emotion, these bills are explicitly built around a claim unsupported by scientific evidence that SUID is caused by vaccination.

Another aside: Studies have shown either no association between vaccines and SUID, or a slightly lower risk of SUID among vaccinated children. Nobody is claiming that vaccines directly prevent SUID, but families who vaccinate their children on schedule tend to also follow other health recommendations.

Most infant deaths occur within the first few months of life. This is also when most infants receive several routine vaccines. The overlap is coincidental, but in a way that makes it easy to exploit. Requiring that vaccines be noted on autopsy reports does not add scientific rigor, because, by timing alone, most sudden infant deaths will occur near a vaccination.

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The unfounded claims about a causal relationship between vaccines and SUID hinge on the Vaccine Adverse Event Reporting System (VAERS), a passive database in which anyone can report a health event after receiving a vaccine. The system is valuable for detecting safety signals, but frequently misused, because a report shows only that an event occurred after a vaccine, not that the vaccine caused it. In fact, this is the same error that was made in a recently removed journal article by Neil Z. Miller, who has largely been the face of the push for SUID legislation. Recently, Kennedy wrote to the journal demanding a full explanation for its removal.

The legislative push applies the same flawed logic at scale, creating an even larger passive surveillance source in which correlations will be cited as evidence. Compiling results from each state in which the legislation passes could create an even larger dataset that is difficult to push back against, despite its manufactured nature. And while most legislative sessions have wrapped up, this plan of attack will likely continue into subsequent years.

What Else We’re Watching

• COVID-19 vaccines still work. A CDC study showing the effectiveness of updated COVID vaccines was published in JAMA Network Open with the same methods that caused the publication to be blocked from publication in the CDC’s Morbidity and Mortality Weekly Report this spring by Acting CDC Director Jay Bhattacharya due to “methodological concerns.” The analysis found that the updated COVID vaccine halved the odds of an emergency department visit or hospitalization among healthy adults, consistent with results from previous seasons.

• Another new name floated for FDA head. The permanent commissioner position for the FDA has been vacant since last month following Marty Makary’s departure. Bloomberg reports that Dr. Heidi Overton is now a finalist to run the agency, though nothing has been officially decided. Overton holds a medical degree and doctorate in clinical investigation from Johns Hopkins, and is currently a presidential adviser on domestic policy.

• An inquiry was opened into HHS’s vaccine policy. Senate Finance Committee Democrats sent Kennedy a letter urging HHS to provide documentation about how the ACIP was overhauled, including details like who signed off, which risks were considered, and the process for new member screening. As the minority party, Democrats cannot force the agency to respond, but the letter likely lays groundwork for more stringent oversight in the future, depending on how midterm elections shape up.

• The Office of Management and Budget (OMB) proposed a sweeping rework of federal grant oversight. The proposed rule would significantly affect how research is both funded and conducted across the National Institutes of Health and other agencies. Individual comments carry more weight than form letters, and comments don’t need to be long or technical. The public comment period is open until July 13 if you would like to submit something.

Michael kept resetting the neighborhood because each version collapsed the moment anyone looked closely. The reset button works only until people stop forgetting. We’re not forgetting; and neither, it seems, are the courts, the insurers, or the manufacturers already making this year’s shots.

As a reminder, we have a dedicated inbox for reader questions about vaccines and vaccine policy. Whether it’s something you saw in the news or a question you just can’t find the answer to, send it to vaccines@unbiasedscience.com. Your questions directly shape the content that we cover.

Stay Curious,

Unbiased Science

This piece is cross-posted with CIDRAP.

We’re headed out for a family adventure, so I’ll keep the news quick. A new flu vaccine cleared a major hurdle, and the technology behind it deserves way more attention than it got. More parents are turning down a routine newborn shot, and pediatricians are alarmed. And two baby products got pulled from shelves, one for bacteria in wipes, the other for botulism in the formula. Let’s discuss…

1. Moderna’s mRNA flu shot just cleared a major hurdle

Last Thursday, the FDA’s vaccine advisory committee voted 9 to 0 to back Moderna’s new mRNA flu vaccine, mFlusiva, for adults 50 and older. It’s built on the same technology as the COVID vaccines, and it’s the first mRNA flu shot to make it this far in the US. The FDA’s final decision is expected by August 5.

The real story is speed. Most flu shots are still grown in eggs over about six months, which forces manufacturers to lock in their strain guesses early in the year, and when that guess misses the strains that actually circulate, the shot works less well. Egg-free flu vaccines already exist, like the cell-based and recombinant shots that have been around for years, so that part isn’t new. What sets mRNA apart is the timeline. It can go from strain selection to finished doses in two to three months, late enough to track what’s actually spreading. In the trial, people who got mFlusiva were about 27 percent less likely to catch the flu than those who got a standard shot, and the gap grew for the more serious outcomes, like ER and hospital visits. For adults 65 and older, it produced a stronger immune response than the high-dose shot many of them get now.

The tradeoff is that side effects are a bit more common. People reported more sore arms, fatigue, and low-grade fever in the day or two after the shot, though the reactions were mostly mild and passed quickly. And to be clear, every flu shot is worth getting, and the best one is the one you’ll actually roll up your sleeve for. We’re not hyping a new option at the expense of the proven ones, but we won’t pretend we aren’t excited about this one.

But here’s the rub… even if the FDA signs off in August, a vaccine doesn’t reach most people until the CDC’s advisory committee recommends it, which is also what unlocks insurance coverage. That committee has been tangled in legal challenges and largely unable to meet, and HHS leadership has been openly skeptical of mRNA, to the point of pulling back roughly half a billion dollars in mRNA vaccine funding last year. So a vaccine that looks strong on the evidence may still be hard to get this fall.

This is also a good moment to push back on “it’s just the flu,” a phrase that makes every public health person I know want to scream. I recently sat down with Dr. Sarah Nosal of the American Academy of Family Physicians to talk through the adult vaccine schedule, and that exact framing came up as one of our shared frustrations. Flu is not a minor illness. It hospitalizes and kills tens of thousands of Americans in an ordinary year.

This past week brought a hard reminder: an outbreak hit a basic training facility at Lackland Air Force Base in Texas, where young, fit recruits, about as healthy a group as you’ll find anywhere, sleep in open bays of bunk beds and eat at shared tables. Around 160 trainees got sick, two were hospitalized, and a recruit in his sixth week of training died after a medical emergency, with the cause still under investigation.

All of this followed a policy change in April, when the Pentagon made the flu shot optional for service members, framed as a matter of individual freedom. At Lackland, the vaccination rate among recruits fell from nearly 100 percent to about 40 percent. Personal choice is a real value, but in a crowded barracks, one unvaccinated person becomes everyone’s exposure. Recruits are normally vaccinated the moment they arrive, whatever the season, because they live packed together; drop the requirement and you have unprotected people in close quarters year-round. Facing the outbreak, the base secured an exception and began requiring the shot again, and the Pentagon has since granted similar carve-outs to several other branches.

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2. The vitamin K shot, and why more parents are turning it down

More parents are turning down the newborn vitamin K shot, and the numbers aren’t small. A national study of more than 5 million births, published in JAMA, found that the share of US newborns not getting it rose from about 3 percent in 2017 to just over 5 percent in 2024. This spring, ProPublica documented the human cost: infants suffering catastrophic brain bleeds, and deaths that doctors believe could have been prevented with the shot.

Talk to any pediatrician right now and the frustration is palpable. My best friend, a pediatrician, texted me the other day about the third family she’s seen this year decline the shot, this time over frightening claims circulating in an online mom group. What makes these fears so painful is that they often point at the wrong culprit. It’s vitamin K deficiency, not the shot meant to prevent it, that can cause catastrophic brain bleeds in a newborn, bleeds that can show up as seizures.

The vitamin K shot is not a vaccine. It’s a vitamin, the same one in spinach and kale, given because every newborn starts life low in it. Very little crosses the placenta before birth, and breast milk carries almost none.

One argument circulating online is that babies must be “meant” to be low in vitamin K, so why intervene? But that low level isn’t the body working as intended, it’s the very reason newborns are vulnerable to this bleeding, and it used to kill them. Before routine prophylaxis, vitamin-K-related bleeding into the brain was far more common; one large surveillance program recorded it in roughly 1 in 3,500 babies, and prophylaxis cut that close to twentyfold.

Without enough vitamin K, a newborn’s blood can’t clot properly, and the bleeding can start without warning in the first six months of life, including in the brain. Babies who don’t get the shot are far more likely to bleed this way, and among the infants who do develop vitamin K deficiency bleeding, roughly one in five die, by the CDC’s count. The only reason most of us have never heard of this is that the shot has been routine since 1961 and has quietly prevented it for decades. We forgot the danger because the fix worked.

One of the more common challenges pediatricians hear is that other countries use oral vitamin K drops, so why push an injection? It’s a fair thing to ask, and the country data turns out to be the best argument for the shot. Australia offers the cleanest comparison: rather than comparing bleeding rates across countries with different healthcare systems, it is one country with a single continuous national surveillance system, tracking both regimens side by side from 1993 to 2017. Babies who got the shot had about 0.56 cases of bleeding per 100,000, versus 2.46 with three oral doses, roughly four to five times more bleeding on oral. The reason is absorption. Vitamin K is fat-soluble, so taking it by mouth depends on a mature gut and good bile flow, and oral dosing has to be repeated correctly over weeks, where a spit-up or a missed dose chips away at protection. The injection sidesteps all of that by parking a slow-release reserve in the muscle, so a single dose covers the whole danger window.

The instinct behind all of this is a good one. New parents understandably question anything that looks like an unnecessary intervention on a brand new baby, and that protective reflex is exactly what you want. This is just one of the rare cases where the simplest option, one shot, one time, is also far and away the safest.

3. Two recalls worth knowing about

Two baby products got pulled from shelves this month. Let’s start with baby wipes.

Earlier this month, Target recalled several of its Up & Up baby wipes, both the fragrance-free and cucumber-scented lines, after customers reported discoloration and after FDA testing found two bacteria, Burkholderia cepacia and Burkholderia gladioli. For most healthy people, these cause little more than mild skin or eye irritation. The concern is for newborns, infants, and people with weakened immune systems, for whom an infection can occasionally become serious.

Our team member Kelly Dobos, a cosmetic chemist, walked us through why wipes are so prone to this. A wipe is mostly water sitting on a soft, porous material that gets opened and handled over and over, and water is the single hardest ingredient to keep microbially clean in manufacturing. Bacteria like Burkholderia will happily set up shop in the pumps and tubing of a production line if cleaning slips. So a problem like this usually traces back to something going wrong on the production line, not to anything inherent in the wipes you bought.

Let’s turn to the formula recall, which takes a bit more unpacking. In June, Nara Organics recalled all of its Whole Milk Organic powdered infant formula after three infants in California, Pennsylvania, and Washington were hospitalized with botulism. All three are accounted for and no deaths were reported, but botulism in a baby is about as serious as it gets. It came barely six months after a similar outbreak tied to ByHeart formula, the first of its kind documented in the U.S. Two brands, two recalls, the same rare illness in half a year, which raises the obvious question: why is this suddenly happening to baby formula?

Part of the answer is powder itself. Ready-to-feed liquid formula is sterilized in the can, but powdered formula is not sterile and can’t be easily made sterile without destroying its nutrients. The culprit, Clostridium botulinum, survives as hardy, heat-resistant spores that live in soil and dust and can ride in on an ingredient or a surface. The maddening part is that infant formula is one of the most heavily regulated foods in the country, inspected at least once a year, and the failures still get through. One reason is a testing gap. As the FDA notes, the spore-forming bacteria behind these cases behave very differently from the Salmonella and Cronobacter that formula makers are routinely required to screen for, and botulinum spores aren’t part of that standard testing. Pressure is building to change that.

The most telling detail is the ingredient trail. When investigators traced the earlier ByHeart cases, the contamination came from the whole milk powder itself, a supplied ingredient, not a slip on the factory floor. Both ByHeart and Nara are small, premium brands sold as the wholesome alternative to the big manufacturers, but a clean, organic-sounding label tells you about the branding, not about whether the milk powder upstream was clean.

By the way, this isn’t only a uniquely American issue. Over the past several months, Danone and Nestle have recalled infant formula across more than 60 countries over a different toxin, traced to one contaminated ingredient from a third-party supplier.

The reassuring part is that a recall is mostly the safety system doing its job, catching a problem and pulling the product off shelves. The contamination shouldn’t happen, and that part is worth fixing, but the catching and the pulling are the parts working as intended.

If you have these products at home, match the lot and date codes against the recall notices, stop using anything that matches, and return it for a refund. For most families, the risk is low, but for the babies and medically vulnerable people these products are made for, it’s two minutes well spent. And if you need to switch brands, resist the urge to flee to an imported or boutique formula, which can carry its own risks, such as counterfeits and tampering. The AAP suggests sticking to a comparable standard or store brand and checking in with your pediatrician.

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The World Cup… but with a public health spin

Before we go, a quick shoutout to our very own Izzy Brandstetter Figueroa, MPH, PhD(c), who’s been doing something we love this summer. Group by group, as the World Cup plays out, she’s pairing every country on the pitch with a public health win from its history, the kind that never makes the highlight reel. Egypt cutting one of the world’s highest hepatitis C rates to near zero in a decade. Scotland’s HPV program producing zero cervical cancers in the first generation of vaccinated girls. Dozens more, from the discovery of insulin to the elimination of malaria. It’s a lovely way to pick up some global health history between matches! Today’s post will tackle Group H… GAME ON!

Stay Curious,

Unbiased Science

P.S. For anyone else missing their dad today, this is the poem I keep close: Diana Der-Hovanessian’s “Shifting the Sun.” It moves through what cultures around the world say when a father dies. Proud to walk in my father’s light.

The thing is, debunking is exhausting, because the falsehoods start comin’ and they don’t stop comin’. So, we shifted gears toward more of a prebunk approach, helping people spot the red flags themselves so they’re less susceptible to misinformation, whatever the topic happens to be (because honestly, who can predict what the next one will be). But every now and then, something crops up that does warrant a direct response.

Here’s a round-up of three recent ones worth flagging.

Strawberries covered in pesticides?

A wellness blog called Mamavation had a lab test two containers of Driscoll’s from a single store on a single day, found trace residues of 12 pesticides in the conventional box (and none in the organic one), and framed them as “PFAS pesticides.” That one shopping trip became worldwide headlines claiming strawberries cause cancer. People were tossing fruit. So, we sat down with a toxicologist (the amazing Dr. Joe Zagorski) and ran the actual numbers.

Take indoxacarb, one of the residues on that list, as an example. To reach its safety threshold, which already bakes in a 100-fold buffer, a 154-pound adult would have to eat 123 pounds of strawberries every single day for the rest of their life. The “PFAS pesticide” label doing all the scaring isn’t a recognized scientific category, and even the blog’s own reviewer conceded the EPA disputes that classification. The organic box showing nothing wasn’t the damning contrast it looked like either. Organic farms use their own approved pesticides, which a synthetic-focused residue panel can miss, so a non-detect there says less than it seems.

The fear underneath most of this is also the most reasonable one, that even trace amounts add up over the years and never leave your body. It’s a fair thing to wonder. The “forever” in “forever chemicals” is about how slowly these break down in the environment, not about your body being unable to clear them. Even PFOA and PFOS, the legacy chemicals that started the whole worry, are eliminated by the body over time, and population blood levels have dropped by something like 80% since they were phased out. Pesticides like the ones found here are metabolized and cleared faster still. And the safety thresholds toxicologists use already assume a lifetime of daily exposure, so the “it adds up over decades” part is built into the number. Joe’s take on the bigger version of this, the whole cocktail of residues over time, is honest and measured. It’s a real and active area of research, but the trace levels on food are unlikely to rise to a level of concern.

The part that actually worries us isn’t the trace residue. It’s that a scare like this pushes people to eat less produce, a genuine health cost, in exchange for a risk the numbers don’t support. And USDA’s pesticide monitoring finds residues across produce sitting well below safety limits year after year.

Strawberries get this treatment on a schedule, too, because they top the EWG’s Dirty Dozen list almost every year. We write about that list a lot, because it ranks produce by how many pesticide residues turn up, not by whether any of them come close to a harmful level, and even its own authors concede it doesn’t assess actual risk. The main thing it reliably does is make people anxious about some of the healthiest food they can buy. We covered the strawberry case in full here, and the broader Dirty Dozen problem in our pesticide Q&A (here’s part one and part two of our series, and there are more posts coming!).

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CeraVe’s cancer lawsuit

The viral version was that CeraVe is being sued because its products cause cancer. But nobody is actually suing because they got cancer. The real cases are consumer claims arguing buyers wouldn’t have paid what they did if they’d known about possible benzene, and even if the plaintiffs win, the result is refunds or new labeling, not a court ruling that the products cause cancer.

The frightening test numbers came from a lab that heated the products to hot-car temperatures to generate them, and whose leaders hold a patent on a more stable version of the ingredient, so it stands to gain from the alarm. The FDA called that lab’s testing method unvalidated, then ran its own tests under normal conditions and found the vast majority of products had little or no benzene. CeraVe wasn’t among the few that were recalled, and the agency’s conclusion was that even decades of daily use carries very low risk.

The people actually using these products back that up. They don’t carry more benzene in their blood than non-users, and they don’t have higher cancer rates. That tracks with what we know about benzene, which is a carcinogen at the high, repeated doses you get from gasoline and cigarette smoke, not from trace amounts in a face wash. The honest caveat we make in the post is that benzoyl peroxide can form benzene when it gets hot, so don’t leave acne products baking in a hot car. The jump from that to “your cleanser causes cancer” is where it tips into fearmongering.

Peptides everywhere we look

The wellness craze of the moment. Peptides themselves are just short chains of amino acids, the same building blocks that make up proteins, and the science on how they work is well established. The problem is a distinction the industry is counting on you missing, which is what Part one of our ongoing peptide series digs into. The FDA-approved peptide drugs like insulin and GLP-1s, backed by decades of trials, are not the same thing as the unregulated wellness peptides (BPC-157, TB-500, and friends) sold for recovery and anti-aging. Most of those have little or no human data, some were built as research tools and never meant for people at all, and stacking several at once just multiplies the unknowns.

So, why are peptides suddenly everywhere? Every single time I open social media, another celeb is touting them as a panacea. Mostly that’s because someone is paying for you to hear about it. The wellness industry is enormous, influencer marketing is its engine, and there’s usually a discount code attached. There’s also a genuine reason people reach for them, though. Conventional medicine has real gaps, and people dealing with chronic pain, fatigue, and aging are often told nothing can be done, so a confident promise of control lands even when the evidence hasn’t caught up. Our bottom line is uncomfortable and not very satisfying. We just don’t know yet, and that’s true whether you’re hyping these or fearing them.

Part two is coming, and a preview of where it lands. It follows the patents and the regulation. The popular line that “pharma can’t patent these, so they’re hiding the cure” isn’t true, because peptides can absolutely be patented. The real reason industry hasn’t chased most of them is that the data isn’t there (though the biological reasons for caution are), and the majority of compounds that look good in mice fail in people. And while the FDA is reviewing whether to let compounding pharmacies prepare some of these, moving a peptide into a new regulatory category isn’t approval and isn’t new evidence. What’s changing is access, not the science.

Huge thanks to Unbiased Scientist Dr. Leigh Baxt for so much of the work behind these peptide posts. Her page is full of great videos if you want to go deeper.

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The pattern

Look across all three and the same shapes keep showing up. There’s usually a scary-sounding label or a single study doing far more work than it should, a tiny or cherry-picked sample, a financial incentive sitting just off camera, and headlines sprinting way ahead of the evidence. That pattern is the whole reason we lean toward prebunking now. We can’t write a post for every panic (again, the falsehoods don’t stop comin’), but we can help you recognize the moves, so the next one lands a little softer. And when something genuinely new and worrying does come up, we’ll be here for that too. In the meantime, eat the strawberries, and most importantly, stay curious.

One of the best parts of this work is the people I get to do it alongside. A lot of the Unbiased Science team are science communicators in their own right, and their recent stuff is all worth your time. Here are a few I’ve been reading and recommending lately:

• Aimee Bernard, PhD gave a TEDx talk, “Confessions of a Scientist,” on a gap I think about constantly, which is that we train scientists for years to make discoveries and never teach them how to talk about the work.

• David Higgins, MD, MPH wrote “Trust Me, AI Recommend You Vaccinate Your Children,” built around a real exam-room moment with a family who’d changed their mind about vaccinating their newborn. It’s a thoughtful case that even as AI gets eerily good at delivering vaccine facts and mimicking empathy, the hardest conversations still come down to human trust.

• Sarah Berg, MD wrote “STIs Don’t Check IDs,” an OB-GYN’s case that sexual health is a lifespan conversation, including why STI rates are climbing among older adults.

• Deanna Altomara, MPH wrote “Oh, Rats! From Plague to Hantavirus,” which takes you from a plague tour beneath Edinburgh to a cruise-ship hantavirus outbreak and lands on why prevention does so much of its work invisibly.

• Katie Schenk, MSc, PhD wrote “Service, Trust, and the People Inside Public Health,” a Memorial Day reflection on service, moral injury, and institutional trust in the public health workforce.

I watch every single one.

My algorithm has me figured out. It serves up the cottage videos, the bread made from scratch, the women in linen aprons pulling carrots out of dark soil. I am mesmerized by all of it.

What you might not guess, watching me watch her, is that I’m a public health scientist. I have a doctorate in public health and I’ve spent my career in vaccines, in data, in the unglamorous machinery of evidence. And I watch her anyway, because the appeal is real.

The pendulum

I did not grow up crunchy. I grew up in South Brooklyn with parents who took me to Atlantic City on weekends to scratch my father’s gambling itch, and I don’t remember the room service being organic. We ate out four or five nights a week, and when we didn’t, dinner was a TV dinner or a Happy Meal handed through a car window that let the cigarette smoke out when it rolled down. Nobody was checking labels, because checking labels wasn’t really a thing yet.

Then I got into public health, and the pendulum swung hard the other way. I remember a school project where I measured out the actual sugar in sodas, spooning it into little mounds, and feeling something close to betrayal. I married a California boy with deeply crunchy roots, and my mother-in-law taught me the “Dirty Dozen” (more on this soon) and the long list of things to avoid while pregnant. She once went through my cupboards and was genuinely aghast. The bleach in my cleaning supplies. The carrageenan in the almond milk in my fridge. The aluminum in my deodorant. Monster.

These days I’ve landed somewhere in the middle: a public health scientist with a few crunchy-ish habits. We keep a vegetable garden. We compost. I occasionally make my own oat milk, though I should be honest about why. It’s to dodge the price tag, not the gums and additives.

That little distinction, the reason I make the oat milk, is the whole point of this piece.

Two ideas wearing one apron

When I watch the woman in the cottage, or the sourdough videos, what pulls me in is the making. It is genuinely wonderful to bake bread with your own hands and then eat the thing you created. To grow food and pick it. To know how to do things. What I don’t believe is that the loaf at the grocery store is hurting me.

Those are two different ideas, and nearly all the trouble in the wellness world comes from quietly fusing them.

The first idea is additive (it adds to your life). Grow things. Make things. Slow down. Dry herbs on the windowsill, learn what lemon balm smells like when you crush it, feed the compost, knead the dough. All of it is good for you in the way that hobbies and rituals and beauty are. You can keep every bit of it. No scientist anywhere wants to take your garden.

The second idea is subtractive (it takes things away from your life), and it usually slips in wearing the first idea’s clothes. Skip the vaccine, because natural immunity is better. Skip the antibiotics, take the elderberry. Skip the sunscreen, because the sun is natural. (So is melanoma.) Pay double for anything labeled clean or non-toxic, as if the unlabeled version were dirty and toxic, which, legally and chemically, it is not allowed to be.

Earth, balms, gardens, healing. Hands in soil. It evokes an image that feels like the opposite of factories and labs, and if you carry any mistrust of industry, and most of us carry some, a fair amount of it earned, then the cottage starts to feel not just lovely but safe. Safer than the pharmacy. That’s the leap I want to gently take apart, because the lovely part is true and the safer part is not.

Ingredients you can pronounce

The strange part is that you never have to go looking for any of this. The vocabulary comes to you. The podcasts I put on to let my brain unplug (the pop culture ones, the celebrity interviews, the true crime) all run the same ads. Without fail, once I hit play I hear the same laundry list of buzzy terms: non-toxic, clean, all natural, no artificial ingredients, organic, non-GMO, no aluminum, pesticide-free, raw, ingredients you can pronounce. Those words are drilled into our subconscious every time we consume content in 2026.

Nobody ever sits you down and argues that natural means safe. There’s no lecture to push back on. You just absorb it, passively, until the framing feels like common sense, until “I can’t pronounce it” starts to sound like a reason to be afraid of something.

For the record, I can’t pronounce cyanocobalamin on the first try either. It’s vitamin B12. Meanwhile, arsenic and hemlock roll right off the tongue. Everything has a chemical name, because everything is made of chemicals. A banana contains phylloquinone and 3-methylbutyl ethanoate. Water is dihydrogen monoxide. The lemon balm in the cottage garden is, chemically speaking, a long list of terpenes.

When I say this, people tend to roll their eyes. You know what I mean, they say. The “bad” chemicals. And I do know what they mean, that’s the thing. There really is a difference between something that helps you and something that hurts you. It’s just not the difference between a hard word and an easy one, or between a lab and a leaf. It’s the dose. So let’s talk about the dose.

Toxic at what dose?

The other word doing heavy lifting in those ads is toxic, and toxic is a measurement pretending to be a category. Everything is toxic at some dose, water included, but for most of what gets called toxic in a wellness ad, almost nothing is toxic at the dose you actually encounter it. So when a product is sold as free of toxic aspartame or toxic aluminum, the questions that actually matter never get asked. Toxic at what amount? And how much would I have to consume to get there?

Take aspartame. To reach the acceptable daily intake the FDA has set, an adult would need to drink something like 75 packets’ worth, or well over a dozen cans of diet soda, every single day, and that threshold already sits far below where any harm appears. Or aluminum, the most abundant metal in the earth’s crust. It’s in the soil of that cottage garden and in nearly everything that grows from it, which means the trace amounts in an antiperspirant or a vaccine are a rounding error next to what you take in from an ordinary week of meals.

The pesticide panic runs on the same missing number. Take the Dirty Dozen, the annual list of produce ranked by pesticide residue. What the ranking measures is whether a residue was detected, not whether the amount detected comes anywhere near a level that could harm you. So a fruit can top the scary list while carrying a quantity thousands of times below any threshold of concern. It’s a list of “we found a trace,” dressed up as a list of “this will hurt you.” Strawberries are the perennial villain. So, we ran the math: to reach the EPA’s chronic safety threshold for the residue in question, a 154-pound adult would have to eat roughly 123 pounds of strawberries a day, every day, for life, and that threshold already carries a hundredfold safety margin. You would make yourself sick on the sheer volume long before the pesticide could do a thing. Eat that many strawberries and it’s the strawberries that get you, not what’s on them.

What worries me about the strawberry panic isn’t the strawberries, it’s that it scares people off produce entirely, when not eating enough fruits and vegetables is a far more certain harm than any trace residue. I want my kids eating greens. I don’t track whether they’re organic or conventional, because I have a finite amount of worry to spend, and the food supply is not where I’m spending it. People whose entire job is setting these limits have already done it, with margins built in by the hundredfold, and I’d rather trust that and use my attention on things that are actually up to me.

And plenty of the vilified ingredients aren’t just failing to harm us, they’re doing a job. Preservatives are in food because the alternative isn’t purity, it’s mold and botulism, and we put them there on purpose after a long history of people dying from food that spoiled. Pesticides, used within regulated limits, are a large part of why food is abundant and affordable, and organic farms use them too, just from a different approved list. Organic doesn’t mean pesticide-free, and an organic pesticide isn’t automatically safer or gentler on the environment than a synthetic one. There are many of each, and what matters is the specific compound and the dose, not which list it came from. And the appeal of aspartame is that it isn’t sugar: sweetness with almost no calories and no blood sugar spike. Most of the nutrition scientists on my feed will tell you that for the many people who are going to drink soda regardless, the diet version is the better choice, not the dangerous one. “Not natural” tells you nothing about which side of the ledger an ingredient sits on. Sometimes the unpronounceable thing is the reason the food is safe.

Genetically modified food triggers the same reflex, and it might be the clearest case of fear attaching to an aesthetic rather than a fact. GM crops are among the most studied foods on the planet, examined across decades and thousands of studies, and the scientific consensus that they’re safe to eat is about as settled as the consensus on vaccines. Some were built to resist insects so the field gets sprayed less, which means the very technology people fear as unnatural is part of why there’s less pesticide on the food they’re trying to avoid. What the label sells is a feeling about origin. Frankenfood, something foreign and lab-made standing in for something grown, when the lab and the field were never the opposites the word wants them to be. (By the way, the technology is already in the medicine cabinet of people who’d never think twice about it. The insulin that keeps a diabetic alive is made by genetically engineered microbes, bacteria or yeast given the human insulin gene and set to produce it, which is purer and steadier than the older version scraped from pig and cattle pancreases. The same tool behind the “scary” GM crops is behind a drug nobody calls frankenfood.)

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A petition to rename natural immunity

So let’s talk prevention, because this is where the stakes climb. The phrase “natural immunity” makes it sound like Mother Nature bops Snow White on the nose and grants her protection from future illness. A more honest name would be survivor immunity, or infection immunity, as my colleague Dr. Aimee Bernard calls it, because you have to survive the infection to gain protection, and you take on every risk it carries along the way.

And those risks are not small, with death only the most final of them. Measles can erase your immune system’s memory of other diseases it already learned to fight, and in some children it swells the brain. Mumps can cause permanent hearing loss. Chickenpox never fully leaves; it hides in your nerves and can return decades later as shingles. HPV causes cancers that take years to announce themselves. Flu kills tens of thousands of Americans in a bad season, most of whom assumed they’d shake it off, and hospitalizes far more.

A vaccine offers your immune system the same protection with the dangerous parts removed. Nothing about it bypasses nature. It works through the most natural equipment you own, your own immune system, the same cells and antibodies and memory. The only thing it skips is the part where you might get seriously ill, or worse.

Medicine and nature were never the opposites the marketing implies. Aspirin began as willow bark, penicillin is a mold, and the lab didn’t replace the garden so much as learn from it, then add what the garden never had: precise doses, purity, and proof.

About the supplements

If you love your vitamins and your elderberry syrup, I’m not coming for them. But there are a few things to consider before the next repurchase.

For most people who aren’t actually deficient in something, most supplements do very little, which means that you’re mostly paying for a feeling. Feelings have value, so that can be fine, as long as you know what you’re buying. And supplements are not held to the same standards as medications. A drug has to prove it is safe and effective before it can be sold. A supplement does not. There’s no required testing before it reaches the shelf, and studies that check bottles against their labels keep finding doses that don’t match and ingredients that were never listed. The pharma-versus-natural framing has it backward here: the synthetic pill is the one somebody had to prove something about. There’s a strange asymmetry in who gets the skepticism. People distrust the FDA and CDC while giving the supplement and wellness industry a pass, even though it’s a multi-billion-dollar business selling peptides and powders and proprietary blends with a fraction of the oversight. The doubt is sometimes earned. It just rarely gets pointed at the people actually profiting from the fear.

The benefits get inflated on the way to you, too. A cottage video tells you a spice or a berry is a powerful anti-inflammatory, and underneath that claim is usually a study where the compound did something interesting to cells in a dish, or to mice at a dose no human could eat. The clip keeps the impressive verb and quietly drops the context: how much you’d actually need, whether your body absorbs it, whether it does anything in a person at all. A modest finding in a lab becomes a miracle in your cupboard, and the part that got cut is almost always the part that mattered.

Natural also doesn’t mean gentle. St. John’s wort can interfere with birth control and antidepressants. Turmeric has been linked to liver injury at high doses. Megadoses of certain vitamins cause real harm. These compounds follow the same rule as their synthetic counterparts: harmless at one dose, harmful at another. “Herbal” describes where something came from, not what it will do to you.

And none of it is a substitute for medicine. Enjoy the herbal tea because you like it, because it’s warm and it tastes like something and the ritual is its own reward. Just not in place of the antibiotics your doctor prescribed. The tea is lovely. The tea was never the medicine.

The pull of the simpler past

I live in western Massachusetts now, surrounded by dairy farms, and plenty of them have raw milk signs out front. I understand the pull completely. And I should admit something: I’m a city girl who landed in a pretty rural part of the country on purpose. I came for the calm, the farmstands, the Saturday markets, the quiet simplicity of it. So I’m not standing outside this feeling. I’m in it.

Raw milk is the purest version of the fantasy. Milk warm from the cow, nothing done to it, no factory and no lab between the animal and the glass. It isn’t really about milk. It’s about wanting the thing closest to the origin, before anyone in a white coat got their hands on it, because surely that’s how it was meant to be. And underneath that is the bigger romance, the one this whole essay keeps circling: yesteryear. The sense that people once lived closer to the land and were better for it, that somewhere back there was a simpler, cleaner way we’ve since lost.

Will everyone who drinks raw milk get sick? No, and that’s exactly what makes it persuasive. Most people who skip a single vaccine in a given year are fine too, but only because nearly everyone around them didn’t skip it; the protection they’re enjoying was paid for by the people who showed up. Raw milk works similarly in reverse. It’s a reliable carrier of Listeria, E. coli, and Salmonella, and the people who pay for that gamble most often are the ones least able to absorb it: the children it gets poured for, pregnant women, the elderly, anyone immunocompromised. And the danger isn’t filed away in some distant past. As I write this, Idaho is investigating an outbreak that has sickened nearly 60 people since mid-May, traced mostly to raw milk from two dairies, at least 45 of them testing positive for Campylobacter. All pasteurization does is heat the milk enough to kill those bacteria. It doesn’t touch the nutrition. The sign out front is rejecting the one step that would have kept those people out of the doctor’s office.

That’s the trap in the simpler past. It looks simpler partly because the harm gets edited out of the picture. We keep the cow in the field and the warm glass of milk, and quietly crop out the part where it puts real people, this month, in a real place, in the hospital.

Keep the garden

I’m going to keep watching the woman in the cottage. I’m growing mint in my garden right now to dry for tea, and over the weekend my husband and I got our raised garden beds ready for the season and talked about how good it felt to have our hands in the dirt.

Here’s the line I’ve landed on, for myself and my kids. Natural is wonderful right up until it starts costing you the things that actually keep you alive. The vaccine. The antibiotic. The preservative that’s standing between you and a foodborne illness. It turns sour when it tips into constant worry about what’s in everything, into anxiety around food and your own body, into a forced choice between the garden and the doctor’s office. The fallacy isn’t loving lemon balm. It’s the dichotomy, the belief that to have one good thing you must refuse the other.

You don’t. We can love nature and also love the modern marvels that science has built on top of it.

And it helps to be honest about the fantasy because, for almost all of us, it is one. We don’t live in cottages in mountain towns or on small farms with a cow out back. We live in towns and cities and buy our food at grocery stores, and that food has to be grown at a scale that requires pesticides, kept shelf-stable with additives, and protected, along with the rest of us, by vaccines that are the reason children no longer routinely die at twelve of things that used to be ordinary. Our minds live in the past. Our bodies live in the present. We are being sold a picture of a life that almost none of us actually lead.

But you can keep the real parts. The garden, the sourdough, the herbs drying upside down in the kitchen, the candles, the tea you grew yourself, the whole gorgeous slow world of making things by hand. None of it conflicts with a flu shot. None of it is threatened by an antibiotic. Keep all of it. Just keep it as your hobby, in your kitchen, and for your hour of calm at the end of the day, but not as your immune system’s entire plan. Because Mother Nature, whatever the cottage videos suggest, was never really taking sides. She made the lemon balm.

She also made the measles.

Stay Curious,

Unbiased Science

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Minneapolis was hit with severe thunderstorms a couple nights ago, so I (Izzy) spent a good chunk of the evening with my dog, swaddled in a blanket, trying to convince her the world wasn’t ending while her teeth chattered through every house-shaking rumble. She knew the storm was coming before I did. She just couldn’t see it on the radar.

I’m still running on very little sleep, and it stuck with me this morning that she sensed the storm before any of us could see it on the radar. That’s not a bad description of how a lot of us are feeling about vaccine policy right now. And I don’t think the unease is unfounded.

Policies and procedures we never could have dreamed could be overturned seem to compound and complicate every time we sit down to write these updates. The American Academy of Pediatrics (AAP) v Kennedy litigation is quiet for now, and most state legislatures have wrapped up—and yet we still don’t feel calm. It is this exact “calm before the storm” window where the administration continues to thrive.

Consider this issue our attempt to show you what’s on that radar as well as we can. But, as with any weather report, it’s subject to change without warning. Let’s discuss…

A Head-Scratching Executive Order

Publicly, the AAP v Kennedy litigation has settled into a waiting game, though there’s plenty happening behind the scenes. Briefing schedules are set and the next hearing isn’t until August. But the administration continues to pursue other options.

We’ve previously covered the back-to-back Advisory Committee on Immunization Practices (ACIP) charter revisions (two in just over a month!) and the pattern this suggests. The second charter, signed by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. on May 19th, removed some of the language from April’s version while keeping other language broad enough to ensure he retains full authority over the committee’s membership and meeting schedules.

Ten days later, on May 29th, President Donald Trump signed an executive order (EO) directing the Centers for Disease Control and Prevention (CDC) and ACIP to treat the December 2025 HHS scientific assessment as a “guiding resource” and to take steps necessary to realign the childhood vaccine schedule with what it calls “best practices from peer-developed countries.” Jess covered this in depth in her CIDRAP op-ed last week, so we won’t rehash it here, but here’s the short version: the “peer-developed countries” framing is not a valid comparative framework for vaccine policy.

The sequencing of these events is hard to ignore: a newly flexible charter lays the groundwork for new committee appointments followed by an EO that essentially provides marching orders for that committee. Technically speaking, neither move violates Judge Brian Murphy’s March 16th stay, but they were dramatic enough that AAP’s legal team will keep a close watch to ensure they are prepared to respond to any actions that track the same path as before.

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Maternal Vaccine Guidelines

This week, the American College of Obstetricians and Gynecologists (ACOG) published its own vaccine schedule for pregnancy, endorsed by 13 medical societies and health organizations. ACOG, as you may remember, is the same organization that withdrew from the ACIP liaison roster in February.

The schedule recommends four vaccines be routinely administered during pregnancy: tetanus, diphtheria, and acellular pertussis (Tdap), respiratory syncytial virus (RSV), influenza, and COVID-19. Additional vaccines are recommended for higher-risk individuals or those who previously missed vaccines.

The CDC’s recommendations for flu and COVID-19 vaccines during pregnancy were withdrawn under Kennedy in December 2025, which means ACOG now directly diverges from the CDC. As Laura Riley of Weill Cornell Medicine noted, vaccination during pregnancy doesn’t just protect the mother, but also newborns who cannot yet be vaccinated. Removing vaccine recommendations from federal guidelines doesn’t erase the biology.

Two years ago, we could have never expected that a major professional society would have to correct rampant vaccine misinformation coming from federal guidance. Today, it’s sadly routine.

What ‘Decoupling from the CDC’ Actually Means

This was the top comment we received from last issue’s survey, so here’s our plain-language explainer.

Over the past several decades, most U.S. vaccine policy has operated as though it’s a well-oiled machine. The ACIP reviewed evidence and issued recommendations. Under the Affordable Care Act, insurance coverage was tied to those recommendations, which meant any vaccine on the recommended schedule had to be covered. The CDC schedule served as the universal foundation from which states could build, adding their own school-entry requirements.

You’ve already seen what it looks like when that machine starts to rust. At the professional society level, ACOG is issuing its own guidance, because it no longer trusts the federal body to act in a pregnant woman’s best interest. As we’ve covered in our state roundups, at least a dozen states are now tying their recommendations to organizations like the AAP, or their own state health officer’s judgment, rather than the federal schedule. And finally, at the federal level, the ACIP is in legal limbo, and in any practical sense there is no functional recommending body at this time.

The way that decoupling acts in practice is, for lack of a better term, chaos. A pregnant woman in Maryland seeing an OB-GYN affiliated with a major academic medical center will likely receive flu and COVID-19 vaccine recommendations this fall. A pregnant woman in Texas, where there is no decoupling legislation, who sees a provider that only follows CDC guidance may not. A teenager in Iowa who wants to receive the HPV vaccine now needs parental consent to receive it. Meanwhile, a child in Maine can receive it at a pharmacy without a prescription.

Decoupling recommendations from the CDC is currently the best option for operating within a system that previously has never seen such fragmentation. The patchwork system that we now find ourselves operating in maps closely onto political geography, so it’s not random, per se. And while this is seemingly the best option for now, the complexity is affecting real clinical decisions and disease risk differentially across different demographic groups nationwide.

State Round-Up

The wave of vaccine-related bills we’ve been tracking has slowed considerably. Louisiana SB 29 was signed into law on June 2 (now Act 732, effective August 1), requiring coroners to include a child’s immunization history in autopsy reports for sudden child deaths, a framing that implies a vaccine link that the evidence doesn’t support.

In Arizona, HB 2248, the “Arizona Medical Freedom Act,” heads to the governor’s desk; it would bar schools, businesses, employers, and government from requiring “medical interventions,” a term defined broadly enough to cover vaccines. Coupled with Arizona’s HB 2048, which is also advancing to the governor’s desk, this could remove school vaccine requirements entirely. And Illinois adopted two symbolic resolutions, HR 810 and HR 803, declaring Vaccine Awareness Day and Hepatitis B Awareness Day.

On Religious Exemptions

While the legislative push to weaken vaccines has had mixed outcomes in state houses this session, the legal strategy is a different story. According to a Washington Post analysis published this week, the next page in the so-called “anti-vaccine movement” playbook to ensure a national win through the courts will likely operate through claims on First Amendment religious freedoms.

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The central case in question is Miller v. McDonald (filed in 2023), in which Amish parents are challenging the state of New York’s refusal to recognize religious vaccine exemptions. The Supreme Court sent the case back to the 2nd Circuit in December, and if the 2nd Circuit still rejects a religious exemption, the case would likely make it back to the Supreme Court. Here, a ruling in the plaintiffs’ favor could essentially require religious exemptions across the country. Cases in West Virginia and California are also advancing. Aaron Siri has been the driving force behind much of this litigation.

Lawrence Gostin of Georgetown University called a potential court win “the worst nightmare for public health,” warning that it could function as a blanket opt-out system for anyone, given current levels of vaccine misinformation and distrust.

Importantly, legislative and legal strategies don’t require the same conditions to succeed. The legislative push started slowly because it was polling as a liability heading into the midterms. Litigation, however, doesn’t answer to voters. These cases will move ahead regardless of November midterm election results, and the Court’s more recent posture on religious liberties suggests that the current legal environment may be the most favorable it’s been to these challenges in decades.

Fall Vaccine Composition: COVID-19 and Flu

The U.S. Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on May 28th and recommended that the fall 2026-2027 COVID-19 vaccine target the XFG strain. While this differs from the World Health Organization’s (WHO) strain selection of LP.8.1, it’s not unusual for these recommendations to diverge. The WHO’s guidance is intended to cover all member countries, while VRBPAC focuses just on what’s circulating or expected to circulate in the U.S. The FDA will make the final determination.

VRBPAC will meet again on June 18th to make recommendations on Moderna’s new mRNA influenza vaccine for individuals 50 years of age and older.

Aside from the actual vaccine composition, the next steps get a little more complicated. As Katherine J. Wu explains in The Atlantic, after VRBPAC decides on the composition of the vaccines, the ACIP would usually convene to recommend who should receive these vaccines. This guidance directly affects the Vaccines for Children (VFC) program, which covers more than half of American kids.

There’s currently no functioning CDC. Last fall, the delayed COVID-19 vaccine guidance issued by the ACIP caused confusion for pharmacies, clinicians, and those in charge of ordering the vaccines across multiple states. As it stands, experts are warning that a similar situation is very possible this fall.

What Else We’re Watching

• Trust in the CDC is falling, but support for childhood vaccines is holding. A new poll from the de Beaumont Foundation and Harvard T.H. Chan School of Public Health found that only 50% of adults said they could rely on the CDC for health recommendations (down from 77% last year). Yet, more than three-quarters of the public still supports school vaccination requirements.

• RFK Jr. is seeking access to Americans’ medical records to revisit the vaccine-autism question. HHS is pursuing data from state health information exchanges—which let hospitals and clinics share detailed, identifiable patient records—to research a vaccine-autism link the medical establishment has long rejected. Some public health leaders objected in private meetings, doubting it’s legal or useful, and HHS has offered no detail on how it would protect the information. Maryland declined to share data, while a Nebraska nonprofit cooperated as millions in federal dollars flowed to the effort.

• Merck settled the bulk of its Gardasil lawsuits for approximately $50 million. Though it may seem like an admission of liability, it’s not. Settlements are driven by many factors including litigation cost and risk management. The scientific consensus on human papillomavirus (HPV) vaccine safety has not changed.

• The U.S. signaled it will re-engage with Gavi, the Vaccine Alliance. Secretary of State Marco Rubio told the Senate Foreign Relations Committee on June 2 that the U.S. would re-engage with Gavi amid the Ebola outbreak in several African countries. Kennedy had been holding up $600 million that Congress appropriated for fiscal 2025 and 2026, in part because Gavi declined to phase out the preservative thimerosal. The funds expire September 30 if the administration doesn’t release them. The reversal is notable, given that Kennedy framed the original cutoff around vaccine-safety claims he never substantiated.

• The Office of Management and Budget (OMB) proposed a sweeping rework of federal grant oversight. The proposed rule would significantly affect how research is both funded and conducted across the National Institutes of Health and other agencies. Individual comments carry more weight than form letters, and comments don’t need to be long or technical. The public comment period is open until July 13 if you would like to submit something.

This issue has been a bit dreary, but we do have some exciting news to share! We’re launching a dedicated inbox for reader questions about vaccines and vaccine policy. Whether it’s something you’ve seen in the news, a claim a family member shared, or a policy question you can’t find a straight answer to, send it to vaccines@unbiasedscience.com. We can’t promise we’ll answer every question individually, but we will use those questions to shape future newsletter and social media content. We can’t wait to hear from you! (And as always, you’re welcome to leave your comments and questions right here on our Substack, too.)

Stay curious,

Unbiased Science

This piece is cross-posted with CIDRAP.

Plenty of young men get vaccinated, ask thoughtful questions, and take their health seriously. But the population-level trends suggest that whatever we are doing to reach them is not working at the scale it needs to, and the gap shows up most clearly in the audience public health communicators least often design for.

Most of our science communication infrastructure is built around the audiences who already show up: women, parents, and caregivers. They are the household decision-makers for vaccines, the ones reading the newsletters and watching the Instagram explainers, the ones who write in with questions about their kids, their pregnancies, and their aging parents. Young men, particularly those past pediatric care and not yet parents themselves, sit outside that frame, and the uptake data reflects it.

Take HPV. According to the most recent national data, from the 2022 NHIS, coverage among adults aged 18 to 26 was 57.2% for women and 37.3% for men. The gap has narrowed since the early years of the male recommendation, but it has not closed, and the overall rate has stagnated since 2019, well below the Healthy People 2030 goal of 80%. The HPV vaccine prevents cancers affecting both sexes, including the oropharyngeal cancers that disproportionately affect men, and yet the messaging around it has, for two decades, been overwhelmingly oriented toward girls and the people raising them.

The men’s flu vaccination data are harder to explain. A PLOS Global Public Health study, covered by CIDRAP last summer, found that self-reported flu vaccination among U.S. adult men dropped from 65% in May 2020 to 51% in October 2024, a 13-percentage-point decline, while uptake among women remained essentially flat. Within that four-year window, men went from above women to below them. The COVID-era data complicate the picture: early in the pandemic, men actually reported higher intent to vaccinate than women, even though actual uptake eventually skewed slightly higher among women. So the simple story, the one where men are uniformly more hesitant than women, does not really hold. But the openness men expressed in 2020 has not translated into sustained vaccination behavior, and somewhere between intent and follow-through, we are losing them.

Is this primarily a young man’s problem? Yes, but not exclusively. The dramatic sex gaps in flu and HPV vaccination are concentrated in adults under 65, and they widen among the youngest cohorts. After 65, the picture is more mixed. Flu vaccination rates are similar between men and women, though men trail women in pneumococcal vaccination. But the consistent, population-level pattern of men lagging behind is most evident among adults under 65.

That tracks with what we know about how young men move through the world. They have less routine contact with the health system. They are heavily targeted by the wellness-influencer economy. And compared to older men, they are at substantially lower direct risk of severe outcomes from the diseases these vaccines prevent, which leaves them more susceptible to the argument that the vaccine itself is the thing to worry about, not the disease. Older men get reminded of their actual risk in their actual bodies, often in the same conversation in which their doctor offers them the shot.

Psychologist Ryon McDermott at the University of South Alabama has spent years studying this directly, and his framing of the underlying question is the one we should be asking: how do we make vaccines manly? His research finds that men who endorse traditional masculinity norms are less likely to engage in preventive health behaviors because those behaviors get coded as feminine, deferential, or evidence of weakness, with the strongest correlates clustering in white, evangelical, and politically conservative populations. A 2024 systematic review and meta-analysis found the same pattern across 11 studies: stronger adherence to masculine norms correlated with lower uptake of COVID-protective behaviors, including vaccination. Recognizing this is not the same as mocking it or lecturing anyone out of it. It is the basic work of designing messaging around the people we are trying to reach.

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The information environment that has grown up around this audience makes the problem far worse. The health education of a 22-year-old man in 2026 does not come from his pediatrician. It comes from Joe Rogan, the most listened-to podcaster in the country, who co-founded the supplement company Onnit and platforms guests ranging from credentialed scientists to alpha-male wellness entrepreneurs. It comes from Andrew Huberman, whose Stanford credentials and “protocol” framing lend scientific gloss to a podcast that, in his episode on colds and flu, told listeners he does not get the flu vaccine. It comes from a constellation of carnivore-diet evangelists, peptide stackers, biohackers, and testosterone optimizers whose commercial model depends on selling the premise that the right combination of supplements, sleep protocols, sauna sessions, and cold exposure can render external medical interventions unnecessary or even suspect.

And increasingly, it comes from the federal government. In February, RFK Jr. posted a 90-second workout video with Kid Rock, the two of them shirtless on exercise bikes, doing push-ups in a sauna, plunging into cold pools, playing pickleball, and toasting glasses of whole milk under the caption GET ACTIVE + EAT REAL FOOD. The video is bro-coded to a degree that would be funny if the man producing it did not also run the federal apparatus responsible for the country’s vaccine policy. Conspicuously absent from his prescription for American health: any mention of vaccines.

This manosphere-meets-biohacking ecosystem is not anti-health, exactly. It is voraciously pro-health, just a parallel version of health that runs on different premises. The men public health is failing to reach are spending hundreds of dollars a month on AG1 (formerly Athletic Greens), creatine, and continuous glucose monitors, tracking their HRV (heart rate variability), and reading study abstracts in pursuit of what they understand as optimization. In that universe, vaccines are conspicuously absent from the protocol, sometimes treated as actively suspect, and almost always framed as something the speaker has personally opted out of in favor of a more sophisticated approach.

Threading through much of this content is a particular nostalgia for the primal: eat as our ancestors did, sleep as our ancestors did, lift heavy things, walk barefoot, and expose yourself to the elements like our ancestors did. (Extreme versions of this include drinking your own urine and sunning your perineum. Trust me, do not Google it.) It is a worldview built around the idea that modern life has corrupted us and that the way back to health runs through pre-modern practice. The fact that those ancestors died young, frequently from the exact infectious diseases we now prevent with vaccines, does not appear to factor into the protocol.

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The values underneath this worldview, that you are the steward of your own body and that institutions should earn rather than assume your trust, are not on their face unreasonable. They are also not unique to young men or to libertarian politics, though young men and libertarians are heavily represented among those who embrace them. The problem is that vaccines, as currently framed by public health, hit none of the notes this audience responds to. They are often presented as community responsibility rather than individual benefit, when in fact they are both. They are framed as routine and parental rather than as something a young man might actively choose to maximize his long-term odds against a preventable cancer or a season of lost training time.

What would taking this seriously look like?

• Recruiting credible male voices in their twenties and thirties into evidence-based science communication, because almost every trusted public-facing vaccine voice in the country right now is a woman.

• Meeting young men in the formats they actually consume, which are long-form podcasts and video, where vaccine skeptics currently do the talking.

• Using sovereignty-compatible framing where it is honest, because protecting a man’s future fertility, his future children, his performance, and his time are good reasons to vaccinate that are often absent from the conversation.

• Dropping the assumption that what we are seeing in the data is a hesitancy problem when much of it is a reach problem.

So, who gets to be that voice? I would love it to be me. But as an aging millennial mom whose recent Google history runs heavily to vaginal estradiol and elementary school PTA threads, I am almost certainly not the right match. Like listens to like, and as much as I tried in my youth to figure out how young men think, I am no closer to that answer at forty than I was at seventeen. What I can do, and what I think many of us in this field can do, is support the people who are willing to venture into that space. Arm them with the science, the communication strategies, the receipts. Help them anticipate the bad-faith arguments. Make it easier for them to show up well, in formats their audiences actually trust, in language those audiences actually use. The boys are listening, all the time, to whoever is willing to talk to them in language that respects how they think about their bodies. The least the rest of us can do is build the runway.

Stay Curious,

Unbiased Science

Which is why, when it comes to comms, canned messages do not work.

I have been doing this in the public eye via social media for about six years now, and in that time, I have encountered a lot of characters, a lot of questions, and a lot of pushback. What I love about our platform is that we work painstakingly hard to create a place where all folks can come and be heard. This includes skeptics, the uncertain, and the simply curious, who have questions about vaccines, antibiotics, fluoride, or whatever it happens to be that day. While we love our loyal readers who understand the value of what we do, we’re not interested in only speaking to people who get it. That feels like preaching to the choir, and that’s not where the work is.

So instead, we spend most of our time behind the scenes of social media, constantly listening, conducting surveys, doing interviews, and running sentiment and thematic qualitative analyses of our messages, comments, and DMs, all in service of understanding the patterns beneath what people are actually saying.

A huge focus for us (obviously) is vaccines.

One thing to say upfront: most people are not vaccine-hesitant. The large majority still vaccinate themselves and their kids. This is not a piece about a country that has turned against vaccines, because it has not. It is about the smaller set of conversations that are harder, and how to have them better.

For some of our vaccine-focused work, my team and I have begun to map out personas of vaccine hesitancy, drawing on the CDC-funded PANDEMIC project, the WHO SAGE 3C/5C antecedents work, and the Surgo Ventures persona scale, layered against what we are actually seeing and hearing from real people in 2026.

We are not the first to map this terrain. Researchers like Matthew Hornsey and Kelly Fielding have identified the “attitude roots” underlying vaccine hesitancy, and Stephan Lewandowsky’s group has gone further by identifying distinct profiles of hesitancy. Where that research maps the psychology, often in controlled European samples, our aim is to translate it for the US in its current moment, built from what we hear from real people every day, and simple enough to use in the first thirty seconds of a real conversation, whether you are a pharmacist or someone’s sister.

This framework is aimed at anyone having these conversations: clinicians, pharmacists, and science communicators, but also parents, family members, and anyone who has found themselves at a dinner table (or a bar!) trying to explain why they chose to vaccinate. And if you find yourself recognizing your own thinking in one of these personas, that is useful too. Understanding where your own hesitancy or uncertainty comes from is the first step toward working through it. For each persona, we have tried to distill not just who they are, but also what tends to work in conversation. Here is where we have landed so far.

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The seven personas

1. The Naturalist. You probably know a Naturalist. They may say things like, “My body doesn’t need vaccines, I prefer natural protection.” They see “clean” living and “food is medicine” as real prevention, and view vaccines as meddling with a system that is already working. The Naturalist also frequently has concerns about ingredients, additives, and what is “really” in the shot, and often turns first to herbal remedies, supplements, or integrative medicine traditions before reaching for anything pharmaceutical. Listen for words like “natural” and “clean,” and frequent questions about ingredients. What works: engage the worldview rather than dismiss it. Reframe vaccines as something that supports the immune system rather than overrides it, and answer ingredient questions honestly and directly.

2. The Worried Well. This group is not outright opposed to vaccines, but may be anxious about side effects, feeling sick after vaccines, or getting “too many at once.” This is often a parent, and someone who wants to do the right thing, but is paralyzed by the fear of doing the wrong thing. Listen for questions about side effects, fevers, and dose spacing. What works: validate the worry, then reframe post-vaccine symptoms as signs the immune system is working, not signs of illness. Naming what to expect in concrete terms takes the fear out of the unknown.

3. The Skeptic. The Skeptic does not necessarily doubt the science. The doubt is aimed at the institutions delivering it (the CDC, pharma, and federal guidance) and at the motives behind the recommendation. They tend to assume a profit motive is driving it. To be clear, pharma is for-profit, and pretending otherwise does not build trust. The Skeptic’s wariness of institutions is not always misplaced, and that is part of why the conversation requires care rather than dismissal. Listen for mentions of CDC, pharma, “follow the money,” and “profit.” What works: transfer trust from the institution to the relationship in front of them, whether that is their pharmacist, their clinician, or someone in their community who knows them.

4. The Conspiratorial. This group is certain that vaccines are poison, a scam, or that someone is hiding something. This is the persona most associated with escalation risk in clinical settings, and the one where rational conversations or scientific evidence are often dismissed. Listen for “poison,” “scam,” “they’re hiding it,” and language that signals the conversation is not happening in good faith. What works: stay respectful, focus on building trust, and leave the door open for a future conversation rather than burning the bridge with a debate that will not change the outcome. You never know what seeds you may plant, even if it doesn’t seem like you got through. (A note on this term. We went back and forth on it, because the last thing we want is for someone who recognizes themselves here to feel dismissed, which defeats the whole point of this piece. We kept “Conspiratorial” not for the content of the belief, since plenty of personas hold mistaken ones, but for its shape: it assumes deliberate, hidden harm. We use the word with care and without contempt.)

5. The Confused. These people are victims of all the noise, and they are looking for a clear answer. There is no emotion behind their confusion; they are genuinely unsure given shifting guidance and schedule changes. In 2026, this might be the fastest-growing segment, and frankly, who can blame them? Listen for “wait, do I still need this?” questions about the current schedule, and questions about what changed. What works: Be the trusted source. Give a clear, direct answer about where things stand right now, without overloading them with the history of every guideline change that got us here.

6. The Unimpressed. As far as the Unimpressed is concerned, the experiment has already been run. They, or someone close to them, got vaccinated and "still got sick"; they "already had the disease" and figure they don't need the shot; or they simply heard the vaccine "doesn't really work" (the flu shot is the usual example). Either way, the verdict is the same: what's the point? The Unimpressed needs a reframe of what "working" actually means, since reducing severity is not the same as preventing every infection. Listen for "still got sick," "already had it," "doesn't work," and "what's the point." What works: reset the goalposts. Vaccines are not a force field; they are a way to make the version of illness you do get less severe, shorter, and less likely to result in hospitalization or death.

7. The Deferrer. The Deferrer is not opposed to vaccines. They just have not gotten around to it yet, held up by friction like time, cost, coverage, or wanting to check with their doctor first. The Deferrer is often the lowest-hanging fruit, and we miss them constantly because we assume they are a no when they are actually a not-yet. Listen for “not today,” “my doctor,” “cost,” and “next time.” What works: remove the friction, whatever friction you can remove. For a clinician or pharmacist, that means walk-ins, no appointment, and a coverage check on the spot: “We can do it right now while you are here.” For everyone else, it is making the path obvious: tell them it is walk-in and covered, send the booking link, or offer to go together. The move is the same either way; take the next step off their plate.

This is our 1.0 version of the persona list, and we have been thinking about it for a very long time.

A few things to keep in mind

These personas are not clean buckets, and most real people are a blend. A common pattern right now is a Confused patient with a Skeptic streak who says something like, “I don’t know what to listen to anymore, and honestly, I’m not sure I trust the people changing the rules.” Someone can be a Worried Well parent who is also a bit of a Naturalist, or a Deferrer who tips into Unimpressed after their third bout of COVID. The personas are a starting point for the conversation, not a label to slap on someone.

It is also important to be realistic about what success looks like. We are not trying to “win” conversations or shift anyone’s entire worldview in a single conversation. Success is often partial, and that’s ok. Someone can swear by herbal supplements and still roll up their sleeve. I’d argue that a Naturalist who decides to vaccinate while still buying her elderberry gummies is a win.

A lot of people in this space talk about the “movable middle,” meaning the segment of folks who can actually be reached with the right conversation. I would not try to map these personas cleanly onto that idea, but my honest read is that some are more reachable than others. The Confused, the Deferrer, the Worried Well, and even a lot of Naturalists are very much in the movable middle. The Conspiratorial persona, generally, is not, and a clinician or pharmacist trying to win that conversation in a five-minute window is going to burn time that would be better spent with the patient behind them in line. That is not a judgment of the patient; it is just an honest accounting of where a clinician’s limited bandwidth is best spent.

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This works for more than vaccines

This framework can be applied to almost any health topic where there is tension between the evidence and the public conversation, whether that is fluoride, seed oils, sunscreen, GLP-1s, or microplastics. We all see the world through our own lenses, we consume information differently, and we place emphasis on different priorities.

So why would I, or a clinician or pharmacist with an extremely limited window of time with patients, spend that time talking to a Goop/Gwyneth/crunchy type about the extreme rigor of pharma regulation if her hesitancy lies in the belief that infection immunity is superior? While we are on the subject, can we retire “natural immunity”? My team has been pushing for “infection immunity” or “survivor immunity” because you have to first survive infection to get the good stuff.

One evidence base. Many topics. And for each topic, seven different conversations.

Why we think this approach works

A reasonable question at this point is whether any of this works. We have not yet formally tested the seven-persona framework against patient outcomes, and that work is in progress. But we have a fair amount of evidence that the underlying listen-first, meet-people-where-they-are approach is doing something.

Our 2026 audience survey of more than 1,500 respondents found that 65% use our content to make health-related decisions, and more than half share it with family and friends. We also see actual behavior change: On Instagram, 17% of followers say our content significantly changed their perspective, and 34% stopped following a harmful health trend after seeing our content. On Facebook, 15% of followers took a vaccine-related action after engaging with our content. None of this is a controlled trial, but real behavior change is rare in this space, and these numbers are a positive indication.

More specifically, within the persona framework, we have built virtual escape rooms that use these personas to train clinicians to navigate real conversations with hesitant patients. After completing the training, clinicians report gaining substantial clinical confidence on tough topics, including a 67-point jump in confidence when discussing vaccine ingredients (the kind of question a Naturalist tends to bring) and a 44-point jump in confidence when addressing medical mistrust (the kind of question a Skeptic tends to bring). Whether that confidence translates into more effective conversations with actual patients is the next thing we need to study, and we are working on it.

A caveat about scale

In a one-on-one conversation (a pharmacist and a patient, a clinician and a parent, you and your hesitant brother-in-law at Thanksgiving), tailoring to a specific persona is realistic and probably essential. In a mass campaign in communities or on social media, we cannot tailor to one person, because audiences are mixed and exposed to everything at once.

What this means for mass communication is slightly different. Instead of tailoring a single message, we put out a varied portfolio of messages that address different personas and concerns over time. One post addresses ingredient questions, another addresses shifting federal guidance, and another addresses the “I already had it” reframe. Over weeks and months, the audience gets exposed to the message that speaks to where they actually are, even if we never knew which persona they belonged to.

What is next?

This is a work in progress. We are still testing and refining these personas against new pulse survey data, feedback from clinicians and pharmacists on the front lines, and our ongoing listening across social media. The labels will probably shift, the triage cues will sharpen, and there may be more (or fewer) than seven. I wanted to give you a sneak peek at where our thinking is right now, and at the approach we keep coming back to, because the alternative (which is to keep blasting canned “vaccines save lives” messages at audiences who have already tuned them out) is not working for anyone. If something here resonates, or if you read a persona and thought “you’re missing one,” we would love to hear it, because that is exactly the kind of input that gets us to a 2.0.

Stay Curious,

Unbiased Science

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This will be the first time since we started this series that we don’t have a major update on the American Academy of Pediatrics (AAP) v Kennedy case. In our last issue, we mentioned we didn’t expect much movement on the litigation front for a while. Over the past two weeks, there have been routine procedural activities (scheduling orders). Also, a joint status report is due tomorrow.

Summer is nearly here, and the rhythm of vaccine policy is shifting with the season. Most state legislative sessions have wrapped up or are about to, so the flood of bills we’ve been tracking is slowing to a trickle. That doesn’t mean things are quiet, though. Federal leadership keeps reshuffling, the Advisory Committee on Immunization Practices (ACIP) charter is back (again), and the global picture is anything but calm. Let’s discuss…

Take 2 on the ACIP Charter (Sort Of…)

On April 6th, the Department of Health and Human Services (HHS) published a revised ACIP charter that rewrote eligibility requirements, added vaccine-skeptical liaison organizations, and expanded the committee’s scope of revisiting existing vaccine recommendations (we covered these changes in depth in our April issue). These changes became the subject of legal scrutiny right away, since Judge Brian Murphy’s March 16th stay in the AAP v. Kennedy litigation remains active.

HHS has formally re-established ACIP’s charter (again)—the April 6th Federal Register notice was withdrawn, and replaced with a new charter signed by HHS Secretary Robert F. Kennedy Jr. on May 19th. The revised charter removed some of the “controversial” language from the April iteration. It no longer explicitly calls out mRNA vaccines as a focus for vaccine safety reviews (which was arguably a challenge on COVID-19 vaccines in not-so-subtle disguise). It also removed the specific requirements for a toxicologist, data scientist, and other disciplines, replacing the text with something a bit more flexible in requiring “a balanced range of scientific, clinical, and public health expertise.”

The flexibility piece is significant. As law professor Dorit Reiss, who has closely tracked this litigation, notes, the new language acknowledges the court’s injunction and that previous ACIP members likely wouldn’t have met the requirements anyway. However, the new language also remains vague enough that it doesn’t explicitly prevent Kennedy from trying again with new appointments. Under the newest charter language, Kennedy retains ultimate authority over ACIP membership, and there is no language specifying how often the committee should convene.

Of note, the June 24-26 ACIP meeting is still listed on the Centers for Disease Control and Prevention (CDC) website, despite the stay, which prohibits the committee from taking action. We’re keeping a close eye on this to see whether the meeting will still happen and, if it does, what it would and could look like.

More Personnel Shakeups

If you’ve been following our HHS org chart, it’s time for another update.

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Dr. Katherine Szarama served less than three weeks as the acting director of the Center for Biologics Evaluation and Research (CBER), the U.S. Food and Drug Administration (FDA) division that oversees vaccine approvals. She had stepped into the role on May 1st following Vinay Prasad’s March departure. Karim Mikhail, a former pharmaceutical executive who joined the FDA in 2025 as a senior adviser, will now take that role.

Dr. Tracy Beth Høeg is out as acting director of the Center for Drug Evaluation and Research (CDER). Per the New York Times, she says she was fired on May 15th after refusing to resign and that she doesn’t know who ordered her removal. Her departure came just days after FDA Commissioner Marty Makary resigned as part of a broader leadership shake-up at the agency. Høeg was a key figure in the administration’s effort to revisit the childhood vaccine schedule, an effort Judge Murphy later blocked. Dr. Michael Davis, CDER’s previous deputy director, will now serve as acting director in her stead.

Acting head of the National Institute of Health (NIH)’s National Institute of Allergy and Infectious Diseases (NIAID), Dr. Jeffery Taubenberger, has stepped down after serving in the role since April 2025. The exact timing of or reasoning for his departure remains unclear.

Finally, while Nicole Saphier awaits Senate confirmation to become the next U.S. surgeon general, HHS has appointed Stephanie Haridopolos as the interim surgeon general.

State Round-Up

Despite the wave of Make America Healthy Again (MAHA)-backed legislation this legislative session aimed at weakening school vaccine requirements, most of those bills failed to become law. Lobbying efforts from groups like the AAP and American Families for Vaccines helped reverse the course of several of these bills. Legislative sessions in Alaska, Arizona, Illinois, Louisiana, Minnesota, Missouri, Oklahoma, and South Carolina have all ended since our last issue (or will end this week).

On May 19th, Iowa Governor Kim Reynolds signed SF 304, which will limit teenagers from receiving the human papillomavirus (HPV) or hepatitis B vaccines without parental permission. The law will take effect on July 1st.

In Illinois, SB 3487 would amend the Hospital Licensing Act and require hospitals to identify and offer eligible patients influenza and pneumococcal vaccines in accordance with ACIP and the state public health director. The bill passed the House last week but is still awaiting the governor’s signature.

West Virginia remains one of only a handful of states without a religious exemption for school vaccination, and that’s being challenged in court. For full details on the briefs filed by the families and the governor, see our last issue. Otherwise, we’ll keep an eye on this; the school board’s reply brief is due on June 1st.

Finally, the solicitor general weighed in on a case about New York healthcare workers who were fired for refusing the COVID-19 vaccine on religious grounds. The Department of Justice argued that the Supreme Court shouldn’t take the case, a move that drew sharp criticism from supporters of the Trump administration, such as Aaron Siri, who felt betrayed by the decision.

Global Round-Up

After early success in animal models, scientists in Chile were close to moving a vaccine for the Andes hantavirus (the one in the news right now following the MV Hondius outbreak) to human testing, but they ran out of money.

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This week, Gavi, the Vaccine Alliance, provided HHS with a formal timeline to phase out thimerosal-containing vaccines. It’s important to note that this transition was already in the works for reasons unrelated to the Trump administration’s recent decision to freeze $600 million in congressionally appropriated funding to the organization. It is unclear whether Kennedy will release the funds in response to the timeline.

The Ebola outbreak in the Democratic Republic of the Congo and neighboring countries continues to grow. Experts are weighing in on whether to use the existing Ebola vaccine (Ervebo) as cases increase. The World Health Organization (WHO) says the vaccine, which is unlikely to provide much cross-protection against the Bundibugyo virus that’s causing the current Ebola outbreak, should be administered only under a research protocol. Meanwhile, two Bundibugyo virus-specific vaccines are being prioritized for development.

A new piece in The Atlantic takes a broader look at how U.S. funding cuts and political pressure are affecting global relationships with multilateral health bodies, and the long-term implications for global vaccine infrastructure. It’s well worth your read, but suffice to say the ripple effects of these cuts extend far beyond U.S. borders.

What Else We’re Watching

• COVID-19 Vaccine Formulation: The Vaccines and Related Biologic Products Advisory Committee (VRBPAC) meets today to recommend which variant(s) the fall COVID-19 vaccine should include. The committee is considering XFG, which differs from the WHO’s guidance earlier this month recommending LP.8.1. However, the FDA’s briefing document acknowledges that either variant could be appropriate, so we’ll report back next time.

• Retracted Studies: Two prominently circulating vaccine-skeptical papers have been formally retracted: “Hepatitis B Vaccination of Male Neonates and Autism Diagnosis, NHIS 1997–2002“ and “Vaccines and sudden infant death: An analysis of the Vaccine Adverse Event Reporting System (VAERS) database 1990–2019 and review of the medical literature.” Both have been frequently cited to support claims about vaccine safety that lack scientific evidence or consensus.

• COVID-19 Vaccine Injuries: Children’s Health Defense is actively recruiting plaintiffs for a potential lawsuit over COVID-19 vaccine injuries in children. This comes on the heels of a new report from the FDA stating that no pediatric deaths were definitively tied to COVID-19 vaccines. No new adverse event data have been published to spark this latest lawsuit, but we’re flagging it because this type of lawsuit can generate a lot of hype and headlines that will carry more weight than the ultimate legal outcome, and we want to get ahead of that.

• Insurance Coverage for Vaccines: AHIP (formerly America’s Health Insurance Plans) issued a statement this week confirming that member plans will continue to cover ACIP-recommended vaccines without cost-sharing through the end of 2027. This covers all pre-2025 ACIP vaccine recommendations (these are the recommendations in place right now while the AAP v Kennedy litigation continues).

With many state legislatures adjourning and the AAP v Kennedy litigation slowly moving in the background, we’d love to hear what you want us to dig into next.

Stay Curious,

Unbiased Science

This piece is cross-posted with CIDRAP.

When my son was a newborn, I was sent home with a piece of paper (and as many diapers as I could stuff in my overnight bag). It was a schedule. Two months, four months, six months. Hepatitis B, DTaP, Hib, polio, pneumococcal, and rotavirus. The pediatrician’s office called to remind me. The chart followed him from visit to visit. The nurse pulled it up on her screen before she even said hello. There were so many safeguards and reminders. (All of which, of course, assumed I had a pediatrician and access to care in the first place.)

I don’t remember most of those first months after my kids were born. I remember the fog, the blowouts, my son waiting until I opened his diaper to pee in my face, and nursing at 3 a.m. without knowing what day it was. And truthfully, I remember showing up to those well visits because someone else was holding the schedule for me. The system was doing the remembering.

That’s how pediatric vaccination works in this country, when it works. There’s scaffolding around it. Well-child visits are billed and tracked, schools require records, and doctors are trained to bring vaccines up at every visit. There’s a chart, a registry, a workflow.

Then your kid grows up. And so do you. And nobody hands you the adult version of that paper, because there isn’t one.

I’ve written a lot about specific adult vaccines lately. I wrote about HPV, the vaccine that didn’t exist when I was a teenager and that I would go back in time to give my younger self if I could, to spare myself the diagnosis and the colposcopy that came with it. I wrote about RSV, the middle child of respiratory season, and my mother standing in a CVS aisle calling to ask what the vaccine was for. My mother is in her seventies and has a daughter with a doctorate in public health, so she had someone to call. Most people don’t. Most people are standing in that aisle alone, reading the back of a pamphlet, and deciding it’s easier to just not. We’ve published content on COVID, on shingles, on pneumococcal disease, on hepatitis B, on the updated flu vaccine, and on Tdap in pregnancy. A whole library of pieces, and each case is good on its own. But the thing that ties them together is what nobody writes. Adult vaccines exist inside a system that isn’t designed to deliver them. Let’s discuss…

The schedule, briefly

The AAFP adult immunization schedule for 2026 fits all of this on a single page, which is a real feat. Reading it cold, though, is hard. There isn’t one timing rule. There are several, layered on top of each other:

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For most adults, year after year: flu vaccine (annually, every fall) and COVID shot (at least once a year for most adults, twice for adults 65 and up). These aren’t “boosters” in the way people often think of them. Their formulations are updated to match the viruses circulating that season, because flu and SARS-CoV-2 viruses evolve quickly enough that last year’s vaccine may not be a great match for this year’s strain. For viruses like flu and SARS-CoV-2, repeated exposure doesn’t confer lasting immunity, and vaccines generally follow the same logic. An annual vaccine for an annually circulating, rapidly evolving virus isn’t a sign that something is broken. It’s a sign that science is keeping up.

On a longer interval: Td or Tdap, every ten years (not just when you step on a rusty nail!). And after certain wounds, if it’s been over five years since your last dose. Easy to forget about, easy to be overdue without realizing it.

When you hit a certain age: shingles vaccine at 50, pneumococcal at 50, RSV at 75.

If you’re pregnant: Tdap with each pregnancy, flu vaccine during flu season, and RSV shot during the seasonal window, all timed to protect the baby in those vulnerable first months before they can be vaccinated themselves. If you’re planning a pregnancy, it’s also worth checking whether you’re up to date on live vaccines like MMR and varicella beforehand, since those can’t be given during pregnancy.

If you have a specific risk factor: an immunocompromising condition, a job that exposes you to bloodborne pathogens or sick patients, a household member at higher risk, or international travel to places where vaccine-preventable diseases are more common. The schedule accounts for all of it.

If you’re catching up: HPV is on the adult list for catch-up through age 26, with shared decision-making through age 45. MMR, hepatitis B, varicella, and others may also be worth revisiting if you were never vaccinated, incompletely vaccinated, or simply don’t know your history.

Four or five different timing rules on one schedule, none of which map onto a yearly rhythm the way a child’s well visits do.

Why this is so much harder than it sounds

Adult primary care isn’t built around immunization the way pediatric care is. There’s no analog to the well-child visit. There’s no school requirement reminding you. Some employers require some vaccines, especially in healthcare, the military, and certain travel-heavy jobs, but that’s a far cry from the universal school-entry infrastructure that scaffolds childhood immunization. Your insurance might cover the vaccine, but it doesn’t call you.

There are pieces of a system. Medicare offers an annual wellness visit at no cost, but it isn’t required, and most people don’t know to ask for it. My pharmacy sends me reasonably timed vaccine reminders. My primary care physician’s (PCP) patient portal pings me when something is due. These are useful, and I use them (when my inbox isn’t being slammed by some competing work emergency). But they’re partial, and they don’t talk to each other. My shingles shot might live in one pharmacy’s record, my flu shot in another because I was traveling that week, my travel vaccines somewhere else entirely, and my PCP’s chart catching whichever ones I remembered to mention at my last visit. None of it adds up to a single place that knows what I’ve had and what I’m due for, the way my son’s pediatric chart does for him.

And then there’s the mental load. I can barely remember to eat lunch. I have alarms set for when to stand up from my computer and when to shower. I’m juggling thirty different school projects, wear-this-color-shirt day, dental cleanings, dog groomings, kids’ birthday parties on Saturday mornings that I find out about on Friday nights. Knowing when to schedule which vaccine is another tab my brain has to keep open, and most days, there’s no more room on the bar.

My PCP visit got bumped twice last year, once because something came up at the kids’ school and once because of work. Both legitimate. Both the kind of thing that doesn’t happen to a four-month-old, because a four-month-old doesn’t have a calendar. The four-month-old has a parent whose job, in that specific window, is to keep the appointment. And a system that makes sure they do.

Adult life doesn’t give you that. Adult life gives you a calendar that’s constantly being interrupted by other people’s calendars, and a body that’s quietly accumulating risk in the background while you reschedule.

And the risk is bigger than people often realize. The “I never get the flu shot, the flu isn’t that bad for me“ mindset misses that flu infection has been linked to elevated risk of heart attacks and stroke in the weeks afterward, especially in older adults. Shingles vaccination has been linked to a meaningful reduction in dementia risk. The evidence on these downstream effects is still developing, but it’s pointing in a consistent direction: adult vaccines are doing more than preventing the infections they were designed to prevent. The stakes of the system not working aren’t just “you might catch the flu.” They’re heart attacks, strokes, hospitalizations, and cognitive decline.

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My own example

The HPV vaccine sits weirdly in my own history because of this. It was brand new when I was 20. There was real evidence behind it, but also real wiggle room in how it was being recommended, especially for women already in their early twenties, already sexually active, already past the textbook target window. The shared decision-making lane on the schedule today exists precisely because that wiggle room is real. The problem wasn’t that the science was unclear. The problem was that the decision was entirely on me, a 20-year-old grad student, with nobody in the system whose job it was to walk me through it. So I did what most adults do when nobody helps them weigh a decision: I did nothing. And then I had a colposcopy to investigate abnormal cells on my cervix, the kind of changes caused by HPV that the vaccine exists to prevent.

The workaround

The gap between pediatric and adult vaccination in this country isn’t a willpower problem; it’s a design problem. Vaccines for kids are a default, and vaccines for adults are an opt-in. Defaults beat opt-ins every single time, in every domain of human behavior we have ever studied. That isn’t your fault. That’s how the system is built.

So what do you do inside a system that isn’t built to help you?

You don’t need to figure out the entire schedule, or memorize ACIP recommendations, or come in with a printout. You need one question, asked once a year, of one person who knows your history.

The question is: am I up to date on the vaccines recommended for me?

That question shifts the cognitive load from you to the system, where it belongs. Your family physician can consider your age, health history, job, whether you are pregnant or planning to become pregnant, whether you travel, what you may have missed, and what’s new since your last visit. They can tell you which bucket you’re in right now, and what to prioritize if you’re due for more than one thing.

“Up to date” is also a moving target, which is part of why this question is worth asking more than once. The schedule changes. You age into new recommendations. New vaccines get added. Your own risk factors shift over time. Being up to date last year doesn’t mean you’re up to date this year. It also doesn’t help that our federal health infrastructure has felt a bit unsteady lately. January’s HPV schedule change, made outside the standard process and later struck down on procedural grounds, gave a lot of us whiplash. The recommendations themselves are still grounded in evidence, but the process has gotten noisier, which makes the family physician who actually knows you more important, not less.

Adult vaccines aren’t one-size-fits-all, and they aren’t supposed to be. The recommendations bend around your age, your health, your work, and your life. That’s the point. What we haven’t built yet is the system around them, the part that should make it easy to know what you need and when.

Until we do, the workaround is small and doable. You don’t have to become a vaccine expert to navigate it.

None of the adult vaccines that have mattered in my life were on a piece of paper anyone handed me. Not the HPV vaccine, not the flu shot I’ll get again this fall, not the Tdap I made sure I had before my niece was born. I had to find my way to each of them myself.

Am I up to date on the vaccines recommended for me?

You don’t have to know the answer. You just have to ask the question.

Stay Curious,

Unbiased Science

Every time I grab a bite with one of my dear friends, she lets the server know she has celiac disease. And every time, she apologizes for being “that person.” And every time, I remind her she isn’t being that person. This is a medical condition. An autoimmune disease, actually. Telling a server you can’t eat gluten isn’t a preference or a quirk, it’s the same as telling them about a serious allergy.

She’s told me what it feels like to get “glutened” (she uses it as a verb, and once you know someone with celiac, you will too). Even trace amounts can wreck her for days. A fryer that cooked something breaded earlier in the day and then fried her french fries is enough. Cross-contamination isn’t a fussy preference. It’s the difference between a normal evening and being in pain for the next week.

For a long time, celiac disease was thought of as a rare childhood condition: the kind where a sick kid couldn’t gain weight and had chronic diarrhea, and once you figured out the cause, the diagnosis was almost surprising in its simplicity. Stop eating gluten. Problem solved.

Except it isn’t that simple. And it isn’t that rare.

Celiac disease affects roughly 1 in 100 people worldwide, but around 80% of those people don’t know they have it. It doesn’t always look like a gut problem. And because its symptoms overlap with so many other conditions, the average time from symptom onset to diagnosis has historically stretched across years, sometimes more than a decade.

This is the latest installment in our ongoing autoimmune series, following rheumatoid arthritis, lupus, multiple sclerosis, and Sjögren’s disease. As with each condition we’ve covered, the story of celiac is one of a disease hiding in plain sight: common, underdiagnosed, and one that medicine has been slow to take seriously.

We asked Dr. Padget Skogman, a board-certified pediatrician who lives with the diagnosis herself, to help us tell this story. Let’s discuss…

“I (Padget) was diagnosed with type one diabetes at the age of 5, but back then, celiac disease was barely heard of, let alone tested for yearly like it is today. It was my mom’s diagnosis of celiac disease in 2008 that prompted me to get screened with an endomysial antibody test. I was 24 years old and had a history of microcytic anemia, but had no obvious GI discomfort. I was shocked when my test came back positive. I had an endoscopy about a month later and was diagnosed with celiac disease (like my mom).

The diagnosis was an adjustment, to say the least. Hardest initially was finding restaurants that could truly cook celiac-style, gluten-free food without cross-contamination, and finding replacements for my favorite things, like bagels. I remember how nervous I felt going on my first date with my now-husband, wondering if he would be annoyed by all the places I couldn’t safely eat. [Clearly he was not ;)]

Since the initial diagnosis, things have changed a lot as there is more awareness and more products. I find myself grateful for all the gluten-free products and for the fact that I eat a healthy, mostly plant-based diet, since almost all plants are naturally gluten-free.

As a pediatrician and a parent, I think about the mental health implications and risk for disordered eating for the kiddos who have to deal with a restrictive diet while growing up with celiac disease. I hear this from kids and families who are missing out on eating the “normal” birthday cake at parties or on donuts after church. There’s no one right way to address this, but it’s important to recognize signs, encourage your child to discuss them with you, and seek professional help if needed.”

When the immune system goes wrong

In celiac disease, the immune system mistakes gluten, a protein found in wheat, barley, and rye, for a serious threat and launches an attack. The problem isn’t just that it targets gluten. It’s that in doing so, it damages the body’s own tissues, particularly the lining of the small intestine, where food is digested and nutrients are absorbed. Over time, this attack destroys the tiny, finger-like projections called villi that enable nutrient absorption. The visible result is intestinal injury and malabsorption, but the deeper issue is the immune misfire driving it.

When gluten is present, immune cells become activated and they stimulate the production of specific autoantibodies (such as antibodies that target tissue transglutaminase, an enzyme that modifies proteins including gluten). Together, these immune responses fuel chronic inflammation and tissue destruction in the gut and can affect other parts of the body, contributing to symptoms such as anemia, bone loss, skin rashes, neurological changes, and fatigue.

Like most autoimmune conditions, celiac disease develops from a combination of factors:

Genetics: Almost everyone with celiac disease carries a specific genetic variant that affects how their immune system identifies threats. These variants, known as HLA-DQ2 and HLA-DQ8, influence how the immune system reads and responds to proteins like gluten. In people who carry them, fragments of gluten are more likely to be displayed to immune cells in a way that triggers an attack. Think of it as repeatedly showing the immune system a harmless object but labeling it “dangerous.”

Environmental triggers: Gluten exposure is necessary but not sufficient on its own. Certain infections, particularly gastrointestinal infections early in life, changes in the gut microbiome, or events that disrupt intestinal barrier function, may help trigger the disease in genetically susceptible people, setting the stage for the immune system to overreact when gluten is encountered.

Developmental and physiological factors: Celiac disease can appear at any age, but often emerges during periods of immune or physiological change, such as early childhood, puberty, pregnancy, or after major illness or stress. These shifts may influence immune regulation, tipping a balanced system into autoimmunity in people already at risk.

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What celiac disease looks and feels like

One of the reasons celiac disease goes undiagnosed so often is that its symptoms are easy to explain away, and they don’t always look like a classic “gut problem.” Fatigue? Stress. Iron deficiency? Diet. Bloating? Food intolerance. Brain fog? Lack of sleep.

The most recognizable symptoms involve the digestive system: chronic diarrhea or constipation, bloating, abdominal pain, nausea, and unintentional weight loss. But plenty of people with celiac disease never have obvious digestive symptoms at all. Instead, they may notice persistent fatigue, anemia that doesn’t respond to iron supplements, or unexplained nutrient deficiencies.

Celiac disease doesn’t stay in the gut. For many people, the most noticeable symptoms occur outside the digestive system:

• Blood: iron-deficiency anemia or deficiencies in B12 or folate

• Bones: reduced bone density (osteopenia or osteoporosis) and increased fracture risk

• Skin: an intensely itchy, blistering rash called dermatitis herpetiformis

• Nervous system: headaches, brain fog, peripheral neuropathy, or balance problems

• Reproductive system: infertility or pregnancy complications

• Growth and development (in children): delayed growth or puberty

• General: fatigue, often severe enough to disrupt work and daily routines

In some cases, these are the only clues that something is wrong. The result is a condition that can look entirely different from one person to the next, ranging from severe gastrointestinal illness to subtle, system‑wide symptoms, making it easy to overlook, misattribute, or dismiss until the underlying cause is finally identified.

Left undiagnosed and untreated, celiac disease can cause lasting damage, including malnutrition, weakened immunity, liver disease, and an elevated risk of certain cancers.

Piecing together a diagnosis

As with many autoimmune conditions, no single test confirms celiac disease in every case. Diagnosis is based on a combination of symptoms, blood tests, and intestinal biopsy findings. It can take time and can involve multiple specialists, particularly when symptoms are subtle or don’t point clearly to a gastrointestinal condition.

Part of what makes diagnosis difficult is how widely symptoms can vary and how much they overlap with other conditions, from irritable bowel syndrome to iron‑deficiency anemia to chronic fatigue. Some patients have few or no digestive symptoms. Others may have negative or borderline test results early in the disease. Many people live with unexplained symptoms for years before receiving a diagnosis. When clinicians are piecing it together, they typically look at several key elements:

• Blood tests for celiac‑associated antibodies, especially tissue transglutaminase IgA (tTG‑IgA), the preferred initial screening test, along with endomysial antibodies (EMA) or deamidated gliadin peptide (DGP) antibodies.

• Total IgA levels, since IgA deficiency can cause false‑negative results and requires a different testing approach.

• Small intestinal biopsy (via endoscopy) to confirm damage to the intestinal lining (villous atrophy), which remains the gold standard for diagnosis in most adults.

• Genetic testing for HLA‑DQ2 or HLA‑DQ8, which can help rule out celiac disease when absent, but cannot confirm it on its own.

For some women, reproductive difficulties are the first sign that something is wrong. Undiagnosed celiac disease has been associated with infertility, recurrent pregnancy loss, and complications during pregnancy, and women experiencing these issues without a clear explanation are reasonable candidates for celiac screening.

One important wrinkle: for testing to be accurate, patients must still be eating gluten. Cutting it out too early can normalize blood tests and make diagnosis much harder. This is one of the more frustrating aspects of the process, since people who are already feeling sick are asked to keep eating the thing that may be making them sick, at least until testing is complete.

For many people, getting a clear diagnosis is a turning point. A diagnosis doesn’t eliminate the disease, but it provides something equally important: an explanation and a path forward. Celiac disease is one of the few autoimmune conditions with a clear, effective treatment. Remove the trigger, and the immune attack stops.

How is celiac disease treated?

The good news is that there is an effective treatment for celiac disease: a lifelong, strictly gluten-free diet. The harder news is that “lifelong” and “strictly” mean exactly what they say.

Dietary disease management

A gluten-free diet means eliminating wheat, barley, rye, and all their derivatives: bulgur, durum, farina, graham flour, malt, semolina, spelt, and triticale, among others.

Gluten also hides in unexpected places, including food starch, preservatives, some over-the-counter medications, supplements, certain cosmetics, and even toothpaste and envelope glue. Label reading becomes essential.

Dietary changes can resolve inflammation in the small intestine and, in many cases, lead to meaningful symptom relief relatively quickly. Children tend to respond faster than adults, and the speed of symptom improvement largely depends on the extent of intestinal damage that has already occurred.

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Nutritional support

Because celiac disease impairs nutrient absorption, many people are deficient at the time of diagnosis. Depending on what’s been affected, a care team may recommend supplements including copper, folic acid, iron, vitamin B12, vitamin D, vitamin K, or zinc.

Skin involvement

Some people with celiac disease develop dermatitis herpetiformis, an intensely itchy blistering rash caused by gluten intolerance. It typically resolves with a gluten-free diet, but prescription medications like dapsone, which has both antibiotic and anti-inflammatory properties, can help manage it in the meantime.

When the intestine needs more support

If the small intestine is severely damaged, steroids such as budesonide or immunosuppressants such as azathioprine may be recommended to control inflammation.

Mental health and quality of life

Managing a lifelong restrictive diet carries a psychological burden that doesn’t always get enough attention, particularly for children and adolescents. Missing the birthday cake at a classmate’s party or the donuts after church may sound small, but these moments add up. Kids with celiac disease are at higher risk for anxiety, social isolation, and disordered eating, and families navigating the diagnosis benefit from knowing that these struggles are real and worth addressing. If a child is showing signs of distress around food or eating, it’s worth raising with their care team.

Refractory celiac disease (RCD)

In rare cases (about 1-2% of celiac patients), the small intestine does not heal with dietary interventions within 6-12 months. This is called refractory celiac disease (RCD), and it comes in two forms. RCD Type I responds reasonably well to steroids, which extend survival significantly. Type II is more severe, with a five-year survival rate below 50%. In these cases, treatment may include a liquid-only diet or parenteral nutrition delivered intravenously. Clinical trials are ongoing, exploring anti-inflammatory drugs and immunomodulators as potential options.

Future treatments

A strict gluten-free diet remains the only proven treatment for celiac disease, but that may not always be the case. Several approaches are being tested, most targeting the immune cascade rather than just its downstream damage.

One area of research focuses on oral enzymes that can degrade gluten peptides before they trigger an immune response, potentially protecting against accidental exposure. Latiglutenase and TAK-062 are among the candidates in this category, though results so far have been mixed.

Other therapies in development include:

• ZED1227 is a small-molecule inhibitor of an enzyme that blocks the enzyme responsible for modifying gluten peptides into the form that activates T cells,

• Amlitelimab is a monoclonal antibody that prevents inflammation and damage caused by T cells, currently in Phase II development for patients who don’t respond to dietary treatment alone.

• Ritlecitinib is a small molecule inhibitor of enzymes involved in T-cell activation, designed to protect the intestine even with some gluten exposure.

• VTP-1000 is an immunotherapy composed of nanoparticles that deliver an immunomodulator alongside gluten peptides, with the goal of training the immune system to tolerate gluten.

• TEV-53408 is a monoclonal antibody that blocks IL-15, a key driver of the immune response that damages the small intestine.

Final Thoughts

Celiac disease has spent a long time being missed and misunderstood. It’s common, it’s complex, and for many people it looks nothing like what they expect a “digestive disease” to be. Too often, people cycle through years of unexplained symptoms like fatigue, anemia, and brain fog without realizing there could be a single, unifying cause.

But there is real progress to point to. Diagnostic tools have improved significantly, with sensitive antibody tests and clearer clinical guidelines helping identify patients earlier and more accurately. Research into the immune mechanisms behind celiac disease is deepening our understanding of how and why it develops, opening the door to new therapeutic strategies beyond diet alone.

And while those future therapies are still in development, celiac disease already has something powerful going for it: a treatment that works. A strict gluten‑free diet can halt the immune response, allow the small intestine to heal, and dramatically improve symptoms for many patients. That’s not nothing. For a condition that took so long to be taken seriously, it’s actually quite a lot.

Avoiding gluten requires constant vigilance that includes reading labels, navigating cross‑contamination, and asking questions at restaurants. It can feel isolating. But as awareness has grown, so has the availability of gluten‑free products and restaurant options, making it easier than it once was to eat safely without giving up variety or enjoyment.

Progress in medicine rarely arrives all at once. It builds through better recognition, clearer definitions, and a deeper understanding of the biology underneath. That work is happening in celiac disease, and it’s accelerating.

Stay Curious,

Unbiased Science

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Resources for Celiac support

Support resources:

https://celiac.org/celiac-disease-awareness-month/

https://gikids.org/celiac-disease/resources/

General Celiac resources:

https://celiac.org/

https://nationalceliac.org/

https://www.beyondceliac.org/

https://medlineplus.gov/ency/article/002194.htm

Past Substacks in our Immunology Explained/AAI Collaboration

• Sjögren’s

• Multiple Sclerosis (MS)

• Rheumatoid Arthritis (RA)

• Lupus

I expected my kids might lose interest after the first minute or so, but they were locked in. This was mommy in action, and it was such a cool feeling to see them engaged.

Dylan, my almost-ten-year-old, told me he was “so proud” that I am his mama. Sophia, who is eight, wished she could come and hear me speak. When I finished, Dylan took the speech out of my hands, spaghetti sauce on the corner of his lips, and read it aloud himself. He said he wanted to feel what it felt like. Then they took turns writing little inspirational notes at the top of the page. Keep going. I am proud of you.

I am a homebody. I hate leaving my family. And the Jewish-mom guilt I carry is real, especially in the days leading up to a trip when I am packing in one room and the kids are drawing or playing in another. This time, the guilt was tangled up with anxiety about the speech itself, and the whole week felt heavy. I was honored beyond words to give the keynote, even as I was dreading the part where I had to leave them to do it.

But sitting at that table watching my kids really listen helped. Being a working mom comes with sacrifice, but it also comes with this. They were watching me prepare to do something that mattered to me, and they wanted in.

In the morning, before I left for the Amtrak, a half-sleeping Ethan gave me a good luck hug, wrote a note of his own on the last page of the speech, loaded my luggage into the trunk, and I was off to give the keynote address for NYU’s School of Global Public Health. NO BIG DEAL.

Months earlier, my former biostatistics professor, Dr. Melody Goodman, now the dean of the school, had reached out to gauge my interest in delivering the keynote. I nearly fell off my chair. Dr. Goodman was the kind of professor who is so smart it is intimidating, and I still keep the class binder she put together for us in 2008, the one that taught me probability and odds and the early scaffolding of Bayesian thinking. She has since turned that binder into a textbook, and I now have a signed copy.

I was sure my nerves were going to make me lose my voice. Like I would open my mouth and nothing would come out. Isn’t it strange how we can have hundreds of thousands of followers online but never actually see their faces staring back at us? So when I walked out and saw a few thousand real, living humans in the audience, it felt like a lot.

But the second I got on stage, it all melted away. I felt laser-focused. Excited, even.

Excited because of who was sitting in front of me. The graduates were walking into a field that does not look anything like the one I was promised. Trust in science has been gutted. Vaccines, fluoride, even vegetables… all political now. So I did not write them a “wear sunscreen” list of gentle truths. I wrote them a hype talk. The kind you give people who are running toward a burning building.

So if you are one of them, or if you are anywhere in this field right now, this piece is for you.

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Three things I want you to carry with you.

One. Never lose sight of your north star.

You have every right to be angry, disappointed, and even scared about the landscape ahead of you. You are fighting an uphill battle, and you already know that. So please, please never lose sight of why you got into this in the first place. That is your north star, and you will need it.

My favorite question to ask people in public health is, “What is your origin story?” The answers never disappoint, and they always come back to the same underlying driver. I want to help people. Whatever got you there, whether it was witnessing the injustice of health disparities, watching a family member suffer from a preventable disease, or something far more personal that you hold close, you ended up here for a reason.

For me, it was watching my father fight and ultimately lose his battle with emphysema and bladder cancer after a decades-long smoking addiction. When I feel myself getting disheartened, I can hear him in my ear. They just authorized flavored vapes, Jessy. Don’t you dare stop now.

Two. Lead with humanity.

Remember that the mother who chooses not to vaccinate her child thinks she is making the right decision for her child. The same is true for any public health intervention you can name.

We are all products of our information ecosystems, our friends and families, our cultures, and our social media algorithms. We are living in a world that delivers a thousand competing messages every time we open our phones. So please remember that it isn’t usually the person who is at fault; it is the information they have been exposed to. Public health does not only apply to the people who do what we think they should do. Help that mom make a decision based on the best available evidence, and do it by leading with your humanity.

Three. Public health is not conditional.

I recently learned about a term called disenfranchised grief from a documentary that followed the families of three unvaccinated people who died from COVID-19. The families spoke about the shame and judgment they were met with when people learned that their loved ones were not vaccinated. As if they were not worthy of being grieved.

But we in public health know that the decisions people make are shaped by forces far outside their control. By their communities, by their access, by what they have been told, and by whom. That doesn’t change when someone makes a choice we wouldn’t have made. If anything, it is the whole reason we exist.

Our work belongs to everyone. The person who refused the vaccine. The person who didn’t show up for the screening. The person whose family was told their grief did not count. They are still ours to serve.

Unconditional care is not a soft skill. It is the whole job.

To the graduating class of 2026, and to anyone reading this who has wondered whether to stay in this field or whether to enter it at all: please. We need you more than ever.

I am in awe of these students. They lived through a global pandemic. They watched trust in science get stripped to the studs. They saw the field they were about to enter become a target. And they chose it anyway. They ran toward the building.

Public health just got its latest set of avengers. We are in good hands.

The world you are walking into is not the one I was promised when I sat where you sat. It is harder. It is louder. But it is also full of helpers. And now, it is full of you.

Welcome to public health. We have been waiting for you.

You can watch the full speech here:

Stay Curious,

Unbiased Science

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Some of us are breathing easier. Some of us are frustrated with how the rest of us are talking about this. We are arguing with each other, and this is the story we think is worth telling this week.

What we’re seeing in real time:

1. The public is uncomfortable with uncertainty, especially when it comes from trusted sources. When experts disagree in public, and there’s no federal voice to anchor the conversation, people interpret that disagreement as chaos or a cover-up rather than normal science.

2. Staying measured in a post-COVID environment reads as complicity. People who lived through false reassurance in 2020 are now demanding alarm as the price of credibility. But a false alarm is also bad communication; it just does different damage.

3. The federal communication void forces individual communicators to be everything at once. We’re asked to weigh in on pandemic preparedness, airborne transmission, masking policy, and 42-day quarantine windows, when what we actually need is a coordinated federal voice to ground the conversation.

Two pieces, two different approaches

If you’ve been following coverage closely, you may have noticed two pieces this week that are emblematic of the different approaches science communicators are taking to this outbreak.

Michael Osterholm, in a CIDRAP Q&A, makes an empirical case grounded in the available data. Person-to-person spread of Andes hantavirus is rare. He notes that a woman who flew from Argentina to Delaware while infected exposed 51 people, and none of them got sick, and that the median incubation is 18 days rather than 42, which means we are already well past the window when most additional ship-linked cases would be expected to appear. His read is that this outbreak will fade in 10 to 14 days, and that the framing that treats every quarantined passenger as a high-transmission risk is overstating what the evidence supports. (We very much appreciated this approach.)

Apoorva Mandavilli, in the New York Times, makes a precautionary case grounded in what we don’t yet know. Officials, she writes, may be downplaying the risks of this outbreak. She points to the Epuyén outbreak in Argentina in 2018-2019, where she reports that six of 34 cases had no direct contact with those who were ill, including a person infected after sharing a hospital room (with no physical contact, per her reporting) and another who, in her words, “seems to have become infected after simply saying hello as they crossed paths.” Linsey Marr at Virginia Tech and Steven Bradfute at the University of New Mexico push back on the close-contact-only framing. WHO Director-General Tedros Adhanom Ghebreyesus acknowledges to the Times that the WHO has emphasized close contact partly to avoid panicking people about rarer transmission scenarios. Mandavilli’s read is that the airborne route is being dismissed too quickly, and that the credibility cost of that dismissal will compound over time.

These two arguments are not actually diametrically opposed. Osterholm is reading the epidemiology of the current outbreak and concluding it will be self-limited, while Mandavilli is reading the gaps in what we know about the virus and arguing that messaging should not outpace evidence. Both can be true at the same time. The outbreak may be on track to fade, and the question of airborne transmission deserves more honest acknowledgment than it has been getting. These two camps represent different approaches to communicating under uncertainty. Osterholm leans risk-based by reading the epidemiology and weighing the likelihood. Mandavilli leans precautionary, emphasizing what we don’t know. At Unbiased Science, we discuss the knowns and unknowns, but we tend to lean into risk based on likelihood. We could come up with examples of when each approach proved ‘right’ or ‘wrong,’ but hindsight is 20/20. These different frameworks are not the problem. The problem is that there is no trusted, consistent federal voice for either of them to work alongside, push back on, or be accountable to.

What the audience hears versus what we’re saying

When we say “U.S. risk is low,” some readers hear “do nothing,” when what they want to hear is “low risk and public health is working hard to keep it that way.” A week of reading comments has reinforced how often that small distinction makes the difference. When Osterholm says this will be over in two weeks, some readers hear reassurance and others hear dismissal. When Mandavilli’s piece runs with a headline about officials downplaying, some readers hear vindication of their COVID-era doubts, while others hear fear-mongering.

Our followers’ responses make sense. They are the predictable outcome of asking too much of a public without the context for how scientific disagreement works. These are people who lived through COVID, watched mask guidance change three times, and were told ‘low risk’ before in ways that did not age well. Most fields disagree internally. That is how knowledge gets built. The disagreement itself is not the threat to science communication, but the absence of a trusted infrastructure to help the public make sense of it is.

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Science writers like Tanya Lewis at Scientific American are trying to thread the same needle, writing carefully about what we don’t know regarding airborne transmission without triggering either false reassurance or false alarm. And still, the uncertainty itself becomes the story for some readers, while others read it as confirmation that officials are hiding something.

A pop culture example (because you know we love these): in The Office’s “Stress Relief” episode, Dwight stages a fake fire drill to test the staff’s preparedness. The fire itself is contained to a trash can, but the panic it triggers spirals quickly, and by the time Dwight reveals it was just a drill, Stanley has had a heart attack. (Can you hear it now? “SAVE BANDIT!” “The fire is shooting at us!” Pure chaos.) The damage came from the response, not the fire. We have a real outbreak with real deaths, but the broader panic is spiraling faster than the evidence warrants, because staying calm about a contained situation has become controversial in itself.

And then there’s our inbox

Some of what has come in this week, more or less verbatim:

“Why are you not saying this is airborne?!”

“Why aren’t you telling people to stop all travel and to mask 24/7?!”

“Why are you okay with ONLY a 42-day quarantine?!”

“YOU ARE CALMMONGERING.”

Calmmongering. We hadn’t encountered that one before. (And the anxiety-sized ulcer in my gut would like a word.)

Most of these messages are not coming from anti-science accounts. They are coming from people who believe they accept evidence and follow expert guidance. They are not asking us to ignore what the data shows. They are asking us to lead with the worst-case scenario every time, and they are framing our failure to do so as a kind of public health malpractice.

The accusation is that staying measured itself constitutes harm, that if we are not sounding the alarm every six hours, we are part of the problem, and that calm in the post-COVID environment reads as complicity. We understand where it comes from. People who lived through 2020 watched authorities use the language of calm to delay action that, in retrospect, should have happened sooner. The pattern recognition is doing exactly what it’s supposed to do.

But the right response to having been failed by false reassurance in 2020 is not to demand the opposite failure now. Treating a low-probability scenario as if it were the most likely scenario is not vigilance. It is a different kind of bad communication, and it does its own damage to people’s nervous systems, to their ability to make decisions based on actual risk, and to the long-term credibility of those sounding the alarms.

Public health is as much an art as a science. We interpret incomplete data, make decisions under uncertainty, and balance how we communicate risk against other real-world factors, such as cooperation, trust, mental health, economic stability, and the long-term credibility of the institutions providing the guidance. The 42-day quarantine is a good example. It is not an exact number handed down by nature; it is a judgment call. It sits at more than twice the median incubation period of 18 days, and it is broadly consistent with how monitoring windows are set for other emerging pathogens—using median incubation periods, outer bounds, and the full range of reported cases to determine where to draw the line. It is the same window being used by the UK, EU, and U.S. health agencies, not a U.S.-specific choice. (Canada is taking a different approach with a 21-day quarantine and a plan to reassess, which is a reasonable judgment call in the other direction; reasonable people can land in different places on this.)

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Some have asked whether 42 is “enough,” citing rare reports of cases appearing up to 8 weeks after exposure, but those outlier cases are usually hard to interpret because exposure timing is often based on retrospective recall. The issue is that what appears to be an 8-week incubation is more likely ambiguity about when exposure occurred than evidence of an extended incubation period. The vast majority of cases appear well within 42 days, and there is a real cost to going further than the evidence supports. We saw a version of this with COVID. By the time some masking and stay-home measures extended past what the evidence at that moment warranted, large parts of the public had stopped engaging, and that loss of trust is still showing up in how people respond to public health guidance now, hantavirus included. If we tell everyone on the MV Hondius to quarantine for eight weeks and then nobody gets sick, the next time something similar happens fewer people will cooperate at all. Stretching the window further would catch very few additional cases while straining the cooperation and trust we will need if something more transmissible ever comes along.

We know hantavirus reaches humans from rodents through inhalation of aerosolized particles, so that route is biologically plausible for human-to-human spread as well. What we don’t yet know is whether infected humans shed enough virus in their respiratory fluids for long enough to efficiently transmit it to others. “We’re not yet comfortable calling it airborne” isn’t the same as “it definitely isn’t airborne.” Researchers like Linsey Marr are right to keep pressing on this question. We are not telling you to stop flying because the data on this outbreak does not support that recommendation. And on the masking question, we have written before about why absolutist masking messaging often fails the very people it is meant to protect. Individual decisions to mask, especially for people who are immunocompromised or live with someone who is, are valid and evidence-based, and we will never tell anyone not to. What we are unwilling to do is issue a universal call for 24/7 masking against a virus for which we have no current evidence of person-to-person spread in the United States, because that kind of decoupled-from-evidence recommendation is how public health loses people. Masking is a tool; it fits some risks better than others, and applying it to every risk, regardless of context, is what stops it from working.

And we are not calmmongering. We are trying to communicate proportionate risk in a moment when proportion itself has become controversial.

The federal voice that’s missing

We wrote last week about how the federal communication apparatus is essentially missing in action on this outbreak, and a week later, that remains the case. The CDC didn’t hold a briefing until nearly a month after the first passenger died, the State Department is reportedly running the U.S. response, and the U.S. withdrawal from WHO in January severed the formal channels the CDC would normally use to coordinate its response to an international outbreak.

The people doing the actual work are extraordinary, and they do not need another pile-on. The Nebraska quarantine team, the Emory clinicians, the state epidemiologists in Maryland and Connecticut and New York and at least seven other states monitoring exposed residents, the CIDRAP team putting out daily updates, the career CDC scientists who answered questions clearly at briefings on Thursday and Friday when given the chance to do so, the WHO communicators who have been the most consistent and substantive voices in this outbreak from day one—they are all doing the job well.

What they don’t have is a unified federal backbone behind them, or a clear evidence-based answer when officials are asked how the virus spreads or why some Americans are in the National Quarantine Unit while others are taking their temperatures at home. And when there is no clear federal voice, the void fills itself with cable news segments, cruise ship anxiety, and suspected hantavirus cases in states where Sin Nombre virus has quietly circulated for decades with no person-to-person spread, all treated as sudden new developments. Hantavirus has even primed people to notice every norovirus outbreak, suddenly treating routine reports as breaking news.

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We’re also getting questions from people who understand the current risk is low but are thinking about longer-term vulnerabilities — viral recombination, coinfection dynamics, and what happens when people stop taking basic precautions. These are systems-level concerns that deserve to be taken seriously. But the fact that people are asking us to weigh in on pandemic preparedness while we’re writing about this week’s outbreak is itself a symptom of the void. When there’s no coordinated federal voice, people turn to whoever is in front of them and ask them to be everything at once.

Where we land this week

We went back to the formula we used in last week’s piece. Risk perception is roughly outrage multiplied by hazard. The population-level hazard here is low, and the outrage is high, which means the product will be uncomfortable no matter what we say, and pretending otherwise is what got science communication into trouble in the first place.

A question we are getting a lot is whether this could spread beyond the people on the ship. Based on what we know about previous Andes hantavirus outbreaks, we can be cautiously optimistic. Not everyone who is infected transmits it to others; in fact, most do not. Previous outbreaks in Argentina have been self-limited, meaning they did not spiral into widespread community transmission, and the pattern of cases on the MV Hondius so far is consistent with that history. That does not mean there is nothing to watch. It does mean the current response, which includes quarantine, close monitoring, and a wide net of contact tracing, is working as intended, and the historical record gives us reason to believe this outbreak can be contained.

As Dr. Abdirahman Mahamud emphasized in the WHO briefing on Friday morning, transmission here depends on the infectiousness of the infected person, the environment they are in, and whether PPE is being used. While there is still more to learn about an infected person’s infectiousness and how the environment affects it, not everyone has an equal probability of being infected. The current WHO precautions intentionally assume any infected person could be a super-spreader, so all exposed people are managed as high risk , reflecting the most conservative approach as more evidence accumulates. But that’s exactly the point — this isn’t a failure of caution, it’s caution being applied while the evidence accumulates.

The empirical case on this specific outbreak is, in our view, the more persuasive one right now. The attack rate is low, the timing is on our side, and the pattern of cases is consistent with what Andes virus has done in past outbreaks rather than something new and more dangerous.

The published NEJM analysis of the Epuyén outbreak, the largest documented person-to-person transmission of Andes virus, supports this. Documented transmission events centered on prolonged contact during social gatherings, not brief encounters. The authors identify ‘prolonged or close contact with symptomatic persons’ as the established risk factor and conclude that social and ecological factors, not fleeting exposure, drove the super-spreading. That is the pattern we are seeing on the MV Hondius.

We think this will fade. That does not make the precautionary read wrong, because the questions Marr and Bradfute are raising about airborne transmission are open scientific questions, and they will still be open when this outbreak is over. We can be honest about the limits of what we know without changing the risk assessment for the U.S. public this week, which remains low.

What we are taking from this week is that the discipline is working. People like Osterholm, Mandavilli, Marr, Bradfute, and our Evidence Collective colleagues are reading the evidence, disagreeing about what it means, and, yes, occasionally being public about that disagreement.

But the discipline can only carry so much weight on its own. Science communicators are not a substitute for a functioning public health communication infrastructure. We can clarify, contextualize, and translate, but we cannot replace the credibility that a coordinated federal voice would bring to all of this, and we are stretching ourselves thin trying to.

In the meantime, the people on the MV Hondius are in the hardest stretch of this. Three families are grieving, and that loss is real. The remaining passengers and crew are still inside their monitoring windows, watching for symptoms that may or may not come, and the noise around this outbreak is hardest on the people actually living inside it. The epidemiology suggests the outbreak is winding down, and Dr. Kornfeld is okay. That’s the update. The people at the center of this story deserve more from the rest of us than what they’ve been getting: less spectacle, more patience, and a willingness to let them go through this without being turned into a headline every day. If you read last week’s piece and wanted an update, this is it. If you have been watching the comments fight unfold and wondering whether the people you trust have lost the thread, we don’t think we have. We think we are doing the job with each other, in front of a public that deserves better infrastructure than we can build on our own.

Stay Curious,

Unbiased Science

This week has been a lot. With hantavirus in the headlines and public health teams responding quickly without a permanent CDC director (Dr. Erica Schwartz is still awaiting Senate confirmation), and with many other key vacancies, it would be easy for vaccine policy updates to be pushed aside. But the landscape is still moving—and moving fast. Let’s discuss…

AAP v Kennedy

The American Academy of Pediatrics (AAP) v Kennedy litigation is now running on two parallel tracks. Legal actions are under way both regarding the stay issued on March 16th

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and the trial itself. There are a lot of steps along the way, so you may not hear about either in the news for a while, but that doesn’t mean work isn’t happening behind the scenes. Richard Hughes IV, the attorney representing AAP, doesn’t expect any official rulings on either until late summer or early fall.

The first track concerns the March 16th stay, which is the order that paused the major vaccine policy changes, including the revised childhood immunization schedule, while the case proceeds. The AAP argues that the government had only 10 days to appeal. On May 7th (52 days later…), the government finally filed a notice of appeal and is now preparing its brief. The brief is due at the end of June, AAP has 30 days to respond, and then the government gets another round. Oral arguments before the appeals court are expected in early fall, and it’s not unreasonable to expect the case could ultimately reach the Supreme Court.

The second track is at the trial court level, where the focus has shifted to the administrative record (the paper trail documenting the government’s vaccine policy decisions, including conflicts of interest among members of the Advisory Committee on Immunization Practices). The AAP wants those documents handed over. Most recently, the government asked the court to issue a stay

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, pausing that process entirely—a federal judge denied the motion within an hour.

Behind the Scenes, Kennedy Hasn’t Pumped the Brakes

We’ve previously covered how vaccine skepticism has become a political liability heading into the midterms, and the notable quiet from the administration about vaccines. However, a new investigation by the New York Times suggests that the public silence is a strategy rather than a change of heart.

According to people close to the effort, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. is spearheading a large research initiative across HHS agencies to find evidence linking vaccines to chronic disease, autism, and other neurological conditions—all topics that have been extensively studied, with no causal link established. The effort is estimated to cost between $40 million and $50 million. Dr. Sara Brenner (whom we discuss below) is expected to help move the studies forward.

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No Shortage of Personnel News

U.S. Surgeon General: After Janette Nesheiwat’s nomination was withdrawn and Casey Means was never formally nominated, President Donald Trump has nominated his third pick—Dr. Nicole Saphier, a radiologist and former Fox News medical contributor. She has overall positioned herself as pro-vaccine, but has also questioned parts of the childhood vaccine schedule and criticized school vaccine mandates. She still needs to be confirmed by the Senate.

FDA Commissioner: Marty Makary is out after 13 months. His tenure was marked by staff turnover and layoffs and fights over vaccines, abortion pills, and rare disease drugs. Kyle Diamantas, the U.S. Food and Drug Administration’s (FDA) top food regulator and a former corporate lawyer, is serving as acting commissioner. The White House is reportedly considering former FDA Commissioner Stephen Hahn and former Assistant Secretary for Health Brett Giroir for the permanent role. This also requires Senate confirmation.

FDA’s Center for Biologics Evaluation and Research (CBER): Katherine Szarama has been named acting director, replacing Vinay Prasad, who left at the end of April. She was previously Prasad’s deputy, and her background is primarily regulatory and administrative. As a reminder, CBER regulates vaccines, gene therapies, and blood supply. It’s not clear yet whether she will stay in the role permanently.

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RFK Jr.’s new inside ally: President Trump appointed Dr. Sara Brenner—a preventive medicine physician, FDA deputy commissioner and self-described “MAHA mom”—as Kennedy’s senior counselor for public health. The role sits at the intersection of HHS, the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health, but, notably, it does not require Senate confirmation. Brenner has expressed concerns about COVID-19 vaccination during pregnancy and questioned whether the COVID-19 vaccine benefits for children outweigh the risks.

State Round-Up

New Hampshire’s two biggest anti-vaccine bills stalled out this session. HB 1719, which would have removed hepatitis B from the state’s required childhood immunizations, was shelved until at least next year. HB 1811, which would have ended nearly all school vaccine requirements in the state, was killed by a bipartisan House vote in February.

In Illinois, SB 3487 advanced out of the House Public Health Committee. If passed, the bill would update hospital vaccination policies for flu and pneumococcal vaccines, and decouple the state from federal vaccine guidance.

West Virginia remains the site of one of the bigger vaccine policy battles to watch. Governor Patrick Morrisey has asked the state Supreme Court to uphold a lower court ruling that would allow religious exemptions to school vaccine requirements under the state’s Equal Protection for Religion Act. Schools will continue to reject religious exemptions while the case moves forward.

What else we’re watching:

• RFK Jr. is reportedly holding up $600 million in congressionally appropriated funds for Gavi, the Vaccine Alliance, which provides vaccines to 30 low-income countries around the world. The sticking point appears to be thimerosal, a preservative used in some vaccines distributed in countries that lack adequate refrigeration. Thimerosal is the preservative that Kennedy has falsely linked to the development of autism, and that he has been pressuring Gavi to phase out since January. Lawmakers are demanding answers, as the funds will expire at the end of September if they aren’t used.

• HHS launched moms.gov on Mother’s Day, intended to be a one-stop resource for expecting mothers. However, the resource notably leaves out any mention of maternal immunization, even though vaccines during pregnancy are an evidence-backed way to protect both mother and baby.

• The FDA blocked publication of several studies supporting the safety of COVID-19 and shingles vaccines. Both studies, conducted with public funds, analyzed millions of patient records and found serious side effects to be very rare. This comes on top of the acting CDC director blocking a separate study demonstrating the effectiveness of COVID-19 vaccines last winter. In addition to the studies themselves, it’s the pattern that signals alarm for us. When agencies suppress findings showing that vaccines are safe and effective, it slows down the science, but it also shapes what people in decision-making roles like policymakers and insurers believe is true.

• A Danish researcher who co-authored CDC-funded studies finding no link between vaccines and autism was recently arraigned on wire fraud and money laundering charges. His charges are for financial crimes and not research misconduct.

It’s so hard to know where to look when the headlines are this crowded: hantavirus on a cruise ship, a landmark lawsuit moving through two courts simultaneously, a secretive research initiative, ongoing leadership vacancies, and state legislatures making decisions that will affect families for years. But the quieter stories (and all the work going on behind the scenes) are often what matters most, and that’s exactly why we’re trying to keep up with them.

Stay curious,

Unbiased Science

This piece is cross-posted with CIDRAP.

Our family tradition has settled into something simple. No cut flowers. I love flowers, but I like them most when they’re still in the ground, so we plant something in the garden instead. Ethan makes eggs Benedict and fresh-squeezed orange juice. No fancy restaurants, no babysitters. We go outside and do something together. Last year, we rode our bikes over a bridge across the Connecticut River and stopped for hot dogs and refreshments along the way. Perfection.

The thing about my Mother’s Day is that none of it is really about Mother’s Day. It’s about Ethan and me both having jobs that let us be home together. Ethan runs an ER and works plenty of holidays, but he does his best to protect this one; I run my own company and can choose to step away. It’s about a garden to plant in, all of us being well enough to ride bikes together, having bikes in the first place, and having the stability to enjoy a carefree day as a family. For most mothers in this country, the gap between what Mother’s Day promises and what their actual lives allow is enormous, and it’s not a gap that flowers fix. My friend and colleague Katie Schenk, an epidemiologist, wrote something this week that captures this better than I have. I’m handing the rest of the article over to her…

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It’s framed as the hardest job in the world, and we celebrate it for one day a year: Happy Mother’s Day.

One way to think about this day is not only as recognition, but as an opportunity to consider the systems that shape family health and well-being. Evidence consistently links maternal and child outcomes to access to healthcare, paid leave, childcare availability, reproductive healthcare services, and workplace protections, all of which are shaped by policy decisions. When policy underinvests in these areas, families bear the consequences in predictable and inequitable ways.

That apostrophe in Mother’s Day is doing ideological work. This is not only about celebrating an individual mother in isolation; it also reflects mothers as a population group and the systems that affect them. The singular framing obscures the collective realities of caregiving and the policy environments that shape them. Reframing it as Mothers’ Day shifts attention from the individual to the population, and from sentiment to the policy environments that shape the lives of mothers and all those in caregiving roles.

When symbolism and systems diverge

Mother’s Day can highlight the gap between symbolic recognition and the policy supports that shape day-to-day experiences of motherhood in the United States. Too often, it functions as a commercial and cultural distraction from the structural conditions that actually determine family well-being. Symbolic gestures are common (cue the flowers, cards, and brunches), while structural supports such as paid family leave, affordable childcare, and workplace flexibility remain unevenly available.

From a public health perspective, current approaches to supporting families are often described as reactive and fragmented. Resources are concentrated on addressing outcomes only after they emerge (for example, responding to maternal mental health challenges or pregnancy-related complications), instead of being invested in upstream factors that reduce risk and prevent the poor outcomes in the first place. These patterns are not evenly distributed. Caregiving burden varies by income, race, geography, and employment status, contributing to persistent disparities in maternal and child health outcomes.

A meaningful framing of Mothers’ Day must also reflect that motherhood is not universally experienced. For some it is joyful, for others it is marked by grief, infertility, pregnancy loss, estrangement, or barriers to parenting. Messaging that presents a single celebratory narrative can miss these differences in lived experience and can unintentionally exclude those whose experiences fall outside dominant cultural expectations.

When a stranger in a store or clinic addresses me as ‘mom,’ it may seem like harmless shorthand. But the assumption behind it, that any woman accompanying a child must be her mother, collapses a complex relationship into a generic placeholder. The shoe salesperson does not know whether I am a parent, a foster parent, a guardian, or simply someone accompanying a child who needs support. This reflects a broader pattern in how caregiving is treated as invisible, interchangeable labor, particularly for women. The same flattening happens at the policy level, where caregiving is treated as an individual responsibility rather than a collective one supported by public infrastructure.

Commercial messaging can further widen the gap between symbolic gestures and real support, offering mothers special deals on wellness products and novelty gifts marketed as self-care, rather than the sustained investments that would actually make a difference. Consumer recognition is being substituted for structural support.

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What evidence supports

Research consistently identifies a set of interventions associated with improved outcomes for families. These include policies such as paid family leave, access to affordable childcare, comprehensive healthcare (including reproductive healthcare services), workplace flexibility, and community-level safety initiatives. These supports are associated with improvements in maternal mental health, reductions in infant mortality, increased workforce participation, and greater economic stability. They are also linked to reductions in disparities by improving access to resources across populations.

This is where framing matters. If Mothers’ Day is to mean anything beyond flowers and brunch, it could function as a public health reminder of what evidence already shows. Caregiving outcomes are policy outcomes, and the conditions in which families live and work are shaped by political and economic decisions, not individual effort alone.

The evidence points to a persistent gap between what we know works and what we actually invest in. Short-term gestures continue to substitute for long-term infrastructure, and the burden of filling that gap falls on individual families rather than being addressed through the collective systems that could reduce it, particularly for the most vulnerable. We continue to celebrate caregiving symbolically while underinvesting in the conditions that make caregiving sustainable.

If we are serious about maternal and family well-being, we should stop treating Mothers’ Day as an endpoint, and start using it as an entry point to a broader policy conversation about what it actually takes, based on evidence, to support caregiving in a modern society. Anything less is sentiment without systems. And the evidence gives us every reason to do better.

Honestly, I’d happily give up any hope of receiving flowers altogether if they’re being used as proof that “we’ve done something for mothers today.” We haven’t. But we still could.

Katie D Schenk MSc PhD is a mother, an epidemiologist, and a health informatics specialist based in Washington, DC. She is the author of The Public Health Workforce is Not OK.

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I had been doing science communication for years before the COVID pandemic, but only in classrooms, at conferences, and on private social media accounts where my audience was friends and colleagues. In March 2020, I started doing it for the general public, and in August 2020, I formally launched Unbiased Science as an LLC and podcast. Which means I came up professionally as a public-facing science communicator in the most fraught communication environment of my lifetime (so far). The post-COVID critique of public health communication is loud, sustained, and not entirely wrong. People felt whiplashed by mask guidance. They felt patronized by “two weeks to flatten the curve.” They felt lied to when “low risk” gave way to “everyone is going to get it.” Some of those critiques are legitimate. Some are bad-faith revisionism. Most are somewhere in between, but the nuance adds up.

Those of us who work in the scientific communication space are now navigating conversations about an emerging outbreak in an environment where trust in institutions, information, and each other has taken a major hit in the wake of COVID. As we continue to build a new landscape of trust, the context shapes everything about how we communicate about hantavirus. What is happening this week is a real-time test case in what we have actually learned and where we are still not gaining the trust of people who want answers.

A status check as of May 7 (around 2 p.m. EST)

The MV Hondius, an adventure expedition cruise ship, left Argentina on April 1st. This expedition cruise is the site of a hantavirus cluster confirmed by the WHO to be caused by Andes virus, a specific species of hantavirus (we’ll circle back later on why this matters). As of yesterday evening, there are 5 confirmed and 3 suspected cases, including 3 deaths, and one patient in the ICU. None of the cases are U.S. citizens. The ship is en route to Tenerife in the Canary Islands, where non-Spanish passengers will be repatriated, and Spanish nationals will be quarantined at a military hospital in Madrid.

Expedition cruises are very different than a wild Disney cruise, where you bring the whole family on. The purpose of these cruises is to take people to hard-to-reach places, which requires a smaller ship, and thus there are fewer passengers. On a traditional cruise, you’re likely there for the on-ship amenities—the pools, the activities, the food. On expedition cruises, getting off the ship to explore the places you travel to is the amenity.

There were 149 people on board in total, 7 of whom were American. Twenty-six passengers disembarked at St. Helena on April 24th as part of planned departures, including the Americans who returned to the U.S. Public health departments in California, Arizona, Virginia, Texas, and Georgia have publicly confirmed they are monitoring those individuals; none have been reported ill. The CDC has activated its Emergency Operations Center and is coordinating with state and local jurisdictions through EpiX. WHO held a media briefing yesterday morning, emphasizing that this situation is being actively contained and, in their words, “very, very different to COVID and very different to influenza.” The European Centre for Disease Prevention and Control (ECDC) also activated a Task Force on May 6th—their threat assessment continues to remain low to the general public.

For a fuller picture, my colleagues and I at The Evidence Collective are publishing a detailed brief (coming soon) on Substack.

Why this is not COVID

Andes virus is not novel. We have known about it since the 1990s. There have been documented outbreaks before, most notably in Argentina in 2018-2019, and they were contained with conventional public health tools. It is the only hantavirus with documented person-to-person transmission, but that transmission is inefficient and requires prolonged, close contact with someone who is symptomatic: sharing a cabin, sharing food, caregiving (hours of physical proximity). There is no evidence of asymptomatic or presymptomatic transmission. The incubation period is long, typically 2 to 4 weeks, with a median of around 18 days for Andes virus specifically. In an outbreak with a defined exposed cohort, like this cruise, those features make contact tracing and containment tractable in ways they were not with COVID.

Compare that to early SARS-CoV-2: a novel coronavirus we had no tools or immunity against, with efficient airborne transmission and contagiousness before symptoms appeared. By the time anyone knew they were sick, they had been spreading the virus for days and had already seeded it across the global travel network. The pandemic potential of COVID was high precisely because the things that made it impossible to contain are the things hantavirus does not have.

None of which is to say hantavirus is mild. It is a serious illness with a high case fatality rate, and early recognition matters enormously for the individuals who contract it. A high case fatality rate actually makes pathogens like hantavirus less likely to cause a pandemic. When many people are hospitalized, severely ill, or die, they are less likely to be out exposing others. The argument here is about population-level pandemic potential, not individual severity.

Not all viruses are the same. They have wildly different characteristics, and it’s those unique characteristics that dictate our public health response. Treating every emerging outbreak as if it has the same potential as COVID is an oversimplification. When people say “the U.S. risk is low,” they are not handwaving. They are interpreting the known biology of the virus.

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The harder problem

You can be technically correct and still communicate poorly. Several of my Evidence Collective colleagues have posted careful, evidence-based content this week, saying the risk to the general public is low and there is no need to panic. The pushback in the comments has been intense, and a meaningful share of it comes from people who would normally consider themselves aligned with the science.

Part of what is happening is a misreading of what we are actually saying. “Don’t panic” is not the same as “We are not worried at all.” “The U.S. risk is low” is not the same as “This does not matter.” It is possible to be measured and concerned simultaneously, and that is what a calibrated public health response looks like. For some readers, “low risk” reads as “do nothing”; what they actually want to hear is “low risk and public health is working hard to keep it that way.” A small distinction that turns out to be the whole game.

But the pushback is not just a misread. There are real reasons people are reaching for it.

First, COVID. People who lived through 2019-20 watched authorities declare the virus “low risk” even as a pandemic was already quietly brewing. That memory is doing a lot of work right now, even when it is not consciously articulated. “Low risk” lands differently in 2026 than it did in 2019. You cannot say those words and not invoke the ghost of every reassurance that turned out to be premature. And it is not just the reassurances. The old ghosts have all come back this week. Ivermectin is making the rounds again as a hantavirus “treatment.” Vitamin D and zinc are right behind it. The same misinformation playbook from 2020, dusted off and redeployed for a virus most people had barely thought about until seventy-two hours ago. To be crystal clear, none of these are known to treat hantavirus.

Second, the federal trust environment is in tatters. The current administration has done significant damage to federal public health infrastructure, and many people have lost faith that the institutions designed to handle such crises are still capable of doing so. There are legitimate reasons to be concerned: leading infectious disease experts have publicly noted that the CDC has not deployed a team to the outbreak area, has not issued a Health Alert Network message to the medical community, and has been notably absent from public-facing communication about this outbreak. The U.S. withdrew from the WHO in January, severing the formal channels through which the CDC would normally be looped into an international outbreak response. The State Department, not the CDC, is reportedly leading the U.S. response. That is not normal.

An important caveat: The absence of public-facing communication is not the same as the absence of work. Even with the political demolition at the CDC’s leadership level, there are still extraordinary people working at every level of government, federal included, who are taking this seriously. State epidemiologists, public health labs, the frontline staff doing contact tracing for the disembarked passengers, and the career scientists who activated the Emergency Operations Center. The dysfunction at the top is real, and so is the work being done underneath it. The communication gap is one of the most visible casualties of the political demolition; much of the work itself continues quietly in the background. One side effect of that gap is that falsehoods fill it. A clear example this week: claims that the CDC’s Vessel Sanitation Program (VSP) was “gutted” to 12 officers. Per the CDC, VSP was designed to have only 12 staff, and the one or two civilian employees who were lost have since been reinstated (in June 2025). They are responsible for cruise ships that dock in the U.S., so this isn’t even relevant to the current discussion since the MV Hondius has not been in U.S. waters. All of this is to say that the vacuum at the top is real; the conclusions people draw about what that vacuum means are sometimes wrong.

On the what-ifs

I see this whole moment as a test. Did we actually learn from the COVID communication problem? Can we stay true to the nuance, to the evolving nature of an outbreak, while acknowledging the worst-case scenarios but staying grounded in the reality that this is nowhere near pandemic potential—all while rebuilding public trust?

Because here is the thing people seem to assume we are not doing: walking through the what-ifs. We are. Painstakingly. The Evidence Collective group chat over the past 48 hours has been a constant exercise in pressure-testing every assumption, every new piece of data, every plausible alternative scenario. What if the asymptomatic transmission data turns out to be wrong? What if the incubation period is longer than reported? What if a passenger we have not tracked yet seeds a secondary cluster? We are running those scenarios. We are reading the case reports. We are reading the NEJM literature on the 2018 outbreak. We are watching for the data that would change our assessment. And we are open to changing our assessment if the data warrant a change.

What we are also doing, because we are pragmatists, is weighing those scenarios by likelihood. That is the part that often gets lost in public-facing communication. Considering a worst case is not the same as predicting one. The question is never “is X possible?” It is “given what this virus actually does, how probable is X?” If we treated every theoretically possible scenario as equally probable, we would never leave the house. That is not vigilance, it’s fear-mongering—and that is immobilizing.

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Not everyone needs to or should be present for every worst-case scenario we run. In fact, walking through every doomsday possibility in public communication or on social media doesn’t build trust; it just generates panic. But people do need to know that those with skill and expertise are rigorously pressure-testing those scenarios on their behalf. That is the trust signal that is missing for some people right now. Good communication in a crisis is not a tour of everything that could possibly go wrong. It says, “Here’s how seriously we are taking this, here is what we are doing about it, here is your risk today, and here is what you should watch for that would tell you the situation has changed.” Giving people clear criteria for reassessment is what makes “low risk” messaging resonate without feeling dismissed.

The actual tightrope

I keep coming back to a formula from the risk communication literature: risk perception is roughly outrage multiplied by hazard. Even when the hazard is really low, if outrage is high, communication has to be careful, generous, and mindful of why people are feeling what they are. The outrage exists for a reason, and dismissing it as irrational does not reduce it, but it severs the opportunity to build trust and connection.

That is the tightrope. Be honest about how bounded the risk is, without sounding like you are dismissing the fear. Validate that this feels eerily familiar, without conceding ground that the situations are actually analogous. Push back on misinformation, without becoming the person who lectures and loses the audience entirely. And continue to acknowledge that the situation is happening in real time, and new information can change how we continue to communicate.

I am so grateful that I am not navigating it alone. My Unbiased Science team members, and colleagues at The Evidence Collective, have been on group chats and Google Docs and live WHO briefings together for the past 48 hours, working out in real time how to balance nuance against detail, calm against urgency, technical accuracy against the very real and very valid fears people are bringing to the conversation. None of us are getting it perfectly right. All of us are trying. Watching these groups work is the most hopeful thing I have to point to right now.

Where I land

The current outbreak is serious for the people on that ship and their families. It is being contained through standard public health measures that have worked in prior Andes virus outbreaks and that are working now. At this time, the U.S. risk is low, and that assessment is not in tension with the fact that public health officials are working hard to keep it that way. Both things are true.

This is not a pandemic. It is a contained outbreak being managed in real time, under conditions of broken trust, fresh trauma, and institutional uncertainty. That is the actual challenge, and the work is in being honest about it rather than pretending the science alone is enough. But it is also a moment when science communication has the chance to do something it is often blamed for not doing: meet the public where they are. We have seen what oversimplified, top-down messaging does to trust. We have lived through the consequences. This time, with this outbreak, we know what is at stake—and we know what the alternative looks like.

I will keep updating as the situation evolves. In the meantime, give the people doing this work some grace. We are all reading the same data, taking the same hits in the comments, and trying very hard to land in the right place at the right time.

Stay Curious,

Then everyone claps or nods, and goes back to a system that does not fund this work, does not count it toward promotion, does not train people to do it well, and treats anyone who does it full-time as a kind of charming eccentric operating outside the “real” work of science. To be clear, I am not writing about scientists or clinicians who communicate publicly alongside their day jobs — that work matters and faces its own challenges. I am writing about the people who do this full-time, as a discipline, and help those same scientists, clinicians, and leaders communicate better with the people they serve. The ones whose entire job is the public-facing translation work, and who currently have no reliable way to fund it.

What follows is a map of what I see from inside that funding gap. Science communication, as a field, is struggling with three interlocking problems:

1. It is not treated as a discipline.

2. It is not funded like one, and we have treated funding it as something that cheapens or discredits the work.

3. We are making its funding dependent on metrics that don’t measure what success actually looks like.

Problem one: Science Communication is not treated as a discipline

Most people, including most scientists, think of science communication as a soft skill — something you pick up because you are personable, because you are a good public speaker, or because you got an A in your college writing courses. It gets treated as a style layered over real content rather than as its own body of knowledge with methods, failure modes, and an actual evidence base.

But communicating scientific evidence well — to a skeptical parent, a policymaker, or a clinician who needs clear, actionable information to bring back to patients — is not the same as slapping some science on a slide or making a Canva infographic. It requires knowing why certain framings backfire, why corrections sometimes entrench the beliefs you’re trying to correct, how trust actually builds over time, and how the platforms we work on reshape our messages in ways we don’t control. Science communication is a discipline.

The consequence of the soft-skill framing is that too many institutions don’t staff for this work, don’t budget for it, and don’t build career ladders around it. They assume it will get done by someone, somewhere, on the side. So, when they do spend real money on public-facing science and health communication, they tend to route it to large general-purpose marketing and PR agencies — firms staffed by skilled communicators, most of whom have no scientific or public health background. They can produce a beautiful campaign. What they often cannot do is catch the nuance that matters: the shortcut that slides into something technically wrong, the oversimplification that papers over tradeoffs the audience deserved to weigh (which, by the way, sets us up for a credibility hit later), the punchy headline that lands fine with the general public and detonates with clinicians.

When institutions pour budgets into firms with the comms expertise but not the science literacy, they shouldn’t be surprised when the message gets lost in translation — or worse, when it quietly erodes the trust they were trying to build.

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Problem two: Nobody wants to fund it

Before getting into who pays, the premise: being compensated for science communication does not cheapen it, compromise it, or make it less rigorous. The opposite is closer to true— sustainable funding is what makes this work possible at all. Until we accept that, every funding conversation starts from a defensive crouch. So, who should pay?

There is a strong case for a range of potential funders from across the health ecosystem. Insurance companies and health systems have a direct financial stake; every patient who falls for a supplement scam or skips a vaccine becomes a downstream cost. Foundations and medical societies have a mission stake; their target communities are the same audiences being misled, and effective communication amplifies the work they are already doing. Public health agencies have a public-interest stake; accurate and actionable information is, in theory, the entire point of their existence.

Yet very little of this is being funded at scale, and the investment opportunity remains largely untapped. Foundations could move beyond one-off project grants to fund the communications infrastructure that makes all their other health investments more effective. Health systems and medical societies are laden with trusted platforms and credentialed voices - resources that rarely get deployed at the scale or with the strategy the moment demands. Insurers, with perhaps the most direct financial stake in whether people make good health decisions, have the potential to lead here in novel ways. And then there is industry (gasp!), the loudest and most contested option, which I will come back to.

This problem is even worse for those of us who are science communication generalists. A cancer foundation might fund a communicator who only covers cancer. A vaccine group might fund one who only covers vaccines. But public health funding tends to flow vertically, by disease, by population, by issue area, while misinformation moves horizontally. The patterns are the same whether the topic is cancer, vaccines, microplastics, or supplements: the same logical fallacies, the same rhetorical traps, the same predatory marketing tactics. A generalist communicator who has built audience trust can deploy that trust across topics as new misinformation emerges. A topic-specific campaign cannot. If we want public health dollars to stretch further, funding science communication as a discipline rather than as a series of one-off campaigns is one of the highest-leverage moves available. Yet the funding ecosystem is built around silos, and generalists fall between them.

In the absence of reliable and flexible funding, many science communicators turn to sponsored campaigns, where a foundation or company pays us to independently review the available research on a specific topic and then skillfully present the best available evidence to an audience that needs it. But disclosed sponsorship is treated as more suspect than the undisclosed alignments and unstated incentives that quietly shape every other voice in the space.

So, given all of that, here is what searching for funding has actually looked like for me over the last six or so years. I have explored every available avenue, and yet the infrastructure to sustain this work for experts like me in the long term just isn’t there. Grants? We submit multiple proposals a month, knowing that the pool of grants actually designed for science communication is tiny, and most of what we apply for is research funding with a communication line item bolted on. Federal funding? We had CDC money for vaccine communication work, but lost it last year because “vaccine equity” was in the title. Philanthropy? Getting a reply to an email can feel like pulling teeth (and also makes me feel a bit like Oliver Twist- “Please, sir…”). Public support through a Substack paid tier? Yes, and I’m grateful for every single subscriber, but it barely covers overhead. Back in 2020, when I launched Unbiased Science, I chose Instagram as my primary outlet. It was where the audiences were, and where misinformation was spreading fastest. Years and several hundred thousand followers later, that platform pays a couple of hundred dollars a month. It isn’t built to sustain the people doing the work.

So now, as a late-Substack-bloomer, I am asking people who have followed me for years on Instagram to please also find me on a platform that can.

The foundations and partners who have funded our work are the reason we are still here, and I am so very grateful. My frustration is with the structural reality that good funders are scarce, and most organizations that claim to value this work never actually write a check for it.

The collapse of trust in scientific institutions has created a vacuum, and vacuums get filled. Independent science communicators are working to fill the vacuum faster and more accurately than those whose business models depend on being wrong, but doing so is nearly impossible without proper support.

The people pushing misinformation have a clear and lucrative funding model: engagement revenue, supplement sales, and donor bases motivated by the feeling of fighting the establishment. They seem to face none of the constraints we impose on ourselves. They are replicating like gremlins exposed to water while we are still debating whether it is acceptable for evidence-based communicators to be paid for their expertise and labor.

Science communicators need to stop bragging about doing this work for free. The “I’m not getting paid for this” badge of honor signals that compensation somehow cheapens the work, the message, or the integrity behind it. It doesn’t, and we are reinforcing a norm that is actively killing the field. We had better start thinking creatively about how to fund this work, and fast.

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Problem two, continued: When transparency gets punished

Let’s start with the facts about “neutrality.” No funding source is neutral. Government funding comes with messaging constraints and political priorities. Foundation funding reflects the ideological commitments of the donors. Institutional funding reflects the agendas of the institutions. Even “independent” funding from high-net-worth individuals or anonymous donors carries the biases of the people writing the checks. The honest question is not whether a communicator has ever taken money from a compromising source; it is whether they disclose their funding, maintain editorial independence, and only say things the evidence supports.

A recent example from our own work. We published a piece on microplastics, co-authored with a chemist, reviewed by a medical editor, and vetted by an immunotoxicologist with an academic appointment. We had covered the topic before without any funding and reached the same balanced conclusion. The industry sponsorship was fully disclosed. We maintained complete editorial and scientific control, and the sponsor had no input on the content — we were asked to summarize the best available evidence, so that is what we did.

Honestly, this is the most painstaking and time-consuming work I do. Paid partnerships are the projects where I scrutinize every line, double-check every citation, and pressure-test every claim with experts before publication. The standard is higher, not lower, because I know exactly the kind of scrutiny the work will get. I am not naive about why people are suspicious of paid partnerships— plenty are done without integrity, with creators handed scripts and a sponsor’s preferred angle baked in. That is exactly why the markers of rigorous work (visible sources, expert review, full editorial independence) matter. They are how you tell the difference.

I have turned down hundreds of thousands of dollars from wellness companies asking me to endorse detoxes and supplements. I understand why some people find that money too good to pass up. Misinformation and wellness grift are extremely well-funded. Sci comm? Purity tests and pennies.

And still, a few vocal critics took to social media to publicly shame the microplastics piece, taking issue not with the science but with the fact that we were paid for our work. One wrote that they were “as red angry as my hair” over the sponsorship. Another called it a “public health education miss” on the same grounds. Neither engaged with the actual evidence. The fact of compensation alone was enough to trigger the pile-on.

Many of the people who criticize our work this way hold positions at universities, with institutional salaries, infrastructure, and the built-in support that comes with academic appointments. They are not surviving on Substack subscriptions and consulting contracts, and they are using that backing to shame people who are doing rigorous, transparent work without it.

Negative reactions are loud and tend to stand out in memory, but I was elated that the overwhelming majority of responses to the microplastics piece were positive. Readers engaged with the substance, asked thoughtful questions, and told us the piece helped them sort through coverage that had left them confused. The trust-building did what it was supposed to do.

Still, this is about optics. All of the work—the chemist co-author, the toxicologist review, the editorial control, the disclosed sponsorship—was canceled out, in some readers’ eyes, by a single phrase identifying who paid for the project. The transparency that purity culture claims to want became the very thing that got us attacked.

This is not to say our work should be immune to criticism. We welcome civil scientific discourse; that’s the whole point of science. The standard being applied is just the wrong one. It is not “did this person disclose their funding, maintain editorial independence, and only say things the evidence supports.” It is “did this person ever, at any point, receive a dollar from a source someone could make look bad in a LinkedIn post.” One is about integrity. The other is about purity. I care about the first. I have run out of patience for the second.

Problem three: We are tethering funding to the wrong things

Funding decisions are tied to engagement metrics. When a foundation officer or a sponsor evaluates whether your work is worth supporting, the first thing they look at is the dashboard — likes, shares, follower counts, reach, and impressions. The implicit message is: optimize for engagement or watch your funding evaporate. Which means the system is effectively asking science communicators to produce clickbait that collapses nuance and plays to the already science-minded crowd rather than reaching anyone new. That is not good science communication. Good science communication is two-way. It listens. It takes the questions people are actually asking and answers them directly, rather than broadcasting past them. It is patient, balanced, often emotionally restrained, and aimed at people who are not already on the team.

Maybe the question isn’t how many people our work reaches. Maybe the question is what happens when it does reach someone. Whether they came away clearer than they were before. Whether they trusted the source enough to come back. Whether anything actually shifted.

Good science communication is a slow trust-building exercise. It is seeds planted that may not sprout for months or years. It is the worried parent who reads your post at two in the morning and does not share it, because sharing would mean admitting to their extended family that they were wobbling on vaccines. It is the clinician who saw your explainer and now uses a version of it with patients. It is the policy staffer who cited your piece in a briefing memo nobody outside that office will ever see. The best communicators I know are not chasing virality — they are trying to become the voice a specific person trusts on a specific topic over a long period of time, and the algorithm does not reward that.

I have made this tradeoff myself, deliberately, for years. I have prioritized building trust over building follower counts, which means I am not raking in the kind of engagement money that creators with seven-figure followings pull down. A few communicators have managed to do both, but they are rarer than the field’s success stories suggest. For most of us, the choice between scale and depth is real, and the field has not figured out how to recognize, let alone reward, the people who choose depth.

When our work breaks through to the audiences we most want to reach, those audiences often do not like or share it. The people most likely to hit the share button are already on our side, broadcasting to communities that share their beliefs. The people we most want to reach (the ones quietly rethinking a position) rarely signal anything publicly. If I write something that lands with a vaccine-hesitant parent, the win is that they quietly process it. Maybe they think twice before sharing the next post claiming vaccines turn you into a lizard. Maybe, eventually, they get their kid vaccinated. That’s the goal, but it doesn’t happen overnight, and it doesn’t happen in a way the dashboard can track.

We need different standards. It is pie in the sky to expect the average science communicator to run randomized controlled trials on whether an Instagram caption shifted behavior — a handful of research groups can do that work, and they should. For the rest of us, the path forward is developing better proxies: trust, depth of engagement, reach into hard-to-access audiences, longitudinal return readership, qualitative signals from the people we are actually trying to reach. None is perfect, but all measure something closer to what we actually care about than likes do.

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What I actually want

Three things.

One, treat science communication as a discipline. That means training that goes beyond a half-day workshop. It means ending the idea that this is a soft skill anyone with good vibes can pick up on the side of their real job.

Two, fund it. Actually fund it. Staff lines, not honoraria. Contracts, not grant applications. Career ladders, not gig work. Advancement criteria (in academia, industry, and nonprofits) that count a well-done explainer or a trusted newsletter the way they count a peer-reviewed paper or a successful campaign. And while we are at it, stop shaming the communicators who have figured out how to survive in a broken system. Instead, help us change the system.

Three, measure what actually matters. Trust, depth, return readership, reach into skeptical audiences— not likes or superficial algorithm engagement.

Until that changes, science communication will remain an afterthought, and, as a result, the potential gains in understanding, behavior change, and better health outcomes for patients and communities will go entirely unrealized. The next time someone at a podium tells you science communication has never been more important, ask them what their organization is doing about it. Not in the abstract. In the budget. In the job postings. In the contracts they signed this quarter. That is the question. Everything else is applause.

Stay Curious,

Unbiased Science

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Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. just wrapped up a busy two-week tour of Congress. During that time, he made seven different appearances on four separate days, racking up nearly 20 hours of testimony before the House Ways and Means Committee, House Appropriations health subcommittee, House Education and Workforce Committee, and Senate Finance Committee. If you followed along, you already know what we mean when we say it was a lot to absorb.

(Transparently, I [Izzy] only made it through about three hours before I needed to reset with a dog walk. To those of you who watched all 20 hours: first of all, kudos. Second, thank you for the summaries. We cannot emphasize enough how grateful we are for you!)

So, what actually happened over the course of these 20 hours? Kennedy acknowledged that the measles, mumps, and rubella (MMR) vaccine is safe and effective “for most people.” He went on to say that HHS promotes and recommends the vaccine for every child. The moment that got us the most, though, was when he conceded under direct questioning that vaccination could possibly have saved a child’s life during the Texas measles outbreak. The tone didn’t match the anti-MMR mantra we’ve grown so accustomed to hearing from him. We’ll admit it… we cautiously exhaled a little.

But then, he refused to commit to implementing vaccine guidance from the new Centers for Disease Control and Prevention (CDC) director nominee, Erica Schwartz, without interference. He denied responsibility for the country’s declining vaccination rates. Cue the head scratching.

If these past two weeks reinforced anything for us, it’s that the chasm between what gets said on Capitol Hill and what actually ends up playing out in policy has never been wider, and that gap is what today’s issue is all about. Let’s discuss…

AAP v Kennedy

If you’ve been reading this series, you won’t be surprised that we’re starting here. At this point, American Academy of Pediatrics (AAP) v Kennedy has a standing reservation in every issue.

The government asked Judge Brian Murphy to pause the case at the district court level while it decides whether to appeal his March 16th preliminary injunction. What’s odd, though, is that the government didn’t actually signal that it plans to appeal. Plaintiffs’ lawyers say the 10-day window to appeal is closed, meaning the government is asking to freeze a case it may not have legal standing to challenge in the first place.

The timing is notable because both sides had been negotiating the production of the administrative record, which is essentially all the documents and communications related to the government’s vaccine and decisions by the CDC’s Advisory Committee on Immunization Practices (ACIP) over the past year. Thus far, the documentation has been incomplete, suggesting the government may be shifting tactics rather than producing materials that would shed light on how these decisions were actually made.

Guarded but Hopeful?

President Donald Trump nominated Erica Schwartz as the next CDC director on April 16th, just as our last issue was going out. Since we only had time for a brief mention then, consider this a proper introduction.

Schwartz is a retired Rear Admiral in the U.S. Public Health Service Commissioned Corps, a board-certified preventive medicine physician, and a former deputy surgeon general who served during President Trump’s first term. She has no public record opposing vaccines. That said, her predecessor, Susan Monarez, was fired after a vaccine policy disagreement with Kennedy, and Kennedy has already, on the record, refused to commit to implementing Schwartz’s vaccine guidance without interference. As one CDC employee put it, the mood since her nomination has been “guarded but hopeful.” Some have raised concerns that the optimism may be premature, wondering whether the nomination is designed to carry the administration through the midterms rather than an actual U-turn in vaccine policy. No Senate hearing date has been set yet, but she will go before the Senate Health, Education, Labor and Pensions Committee—the same committee that still has yet to vote on Casey Means for surgeon general. Jay Bhattacharya remains the acting CDC director and can continue to issue vaccine recommendations in the interim.

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Meanwhile, Kristine Blanche—an integrative medicine physician and wife of acting Attorney General Todd Blanche—was appointed to the National Institutes of Health (NIH) Advisory Council to the National Center for Complementary and Integrative Medicine, which makes funding recommendations to NIH. While this isn’t directly related to vaccines, the membership of a funding advisory committee is important, particularly as the boundaries of what counts as evidence-based medicine face growing political pressure.

President Trump also fired all members of the National Science Board—the governing body of the National Science Foundation, which funds a large portion of the basic research that informs vaccine development and public health infrastructure. This is another page from the playbook we’ve been tracking all year. Quietly dismantling the infrastructure meant to protect scientific decision-making from external political pressures means you don’t have to touch a single vaccine policy directly to undermine the science behind it. You just have to keep removing the people whose job it is to protect scientific rigor and integrity.

Meet the New IACC

Today, the Interagency Autism Coordinating Committee (IACC) is holding its first meeting with a new membership composition appointed by Kennedy. The committee is a federal body that coordinates autism-related research priorities and helps direct over $300 million in annual funding. We looked through the membership biographies released ahead of the meeting, and the results were telling:

• John Gilmore, founder of the Autism Action Network, co-founded American Values 2024—a political action committee that sought to elect Kennedy as president. Katie Sweeney, another member, served as the director of scheduling on that campaign.

• Elizabeth Mumper is a senior fellow at the Independent Medical Alliance—the organization that was added as the new non-voting ACIP liaison in the revised charter we covered in our last issue.

• Ginger Taylor’s biography describes her as a “parent advocate and former family therapist” with a focus on “parental rights, informed consent, and access to health care services.” What her bio doesn’t mention is that she is actually one of the most prolific anti-vaccine content creators in the movement, known for maintaining a list of studies linking vaccines to autism—studies that have been repeatedly and thoroughly debunked (we debunked many of them here).

None of the new members, including the chair, has previously served on the committee. A separate, parallel group, the Independent Autism Coordinating Committee (I-ACC) formed in March in direct response to the IACC’s reconstitution. The I-ACC consists of former IACC chairs, NIH directors, and leading autism scientists, with the goal of ensuring that “science, not misinformation, guides autism research.”

State Roundup

State legislatures have been busy, and they aren’t all moving in the same direction. Here’s what we’ve been monitoring over the past few weeks:

Connecticut Governor Ned Lamont signed HB 5044 into law this week after several weeks of heated debate. The bill expands the state health commissioner’s authority to issue vaccine recommendations independent of federal guidance. It also includes a provision clarifying the state’s Religious Freedom Restoration Act (RFRA), which is what sparked the disagreement and controversy. Connecticut eliminated religious exemptions from school vaccination requirements in 2021, but some families found a legal workaround by invoking the state’s 1993 Religious Freedom Restoration Act. The new law clarifies that the RFRA doesn’t apply to school vaccine requirements, closing the door for workarounds. Critics say the law is rewriting the rules in the middle of an active lawsuit, while supporters say it clarifies what they intended all along.

In New York, A 10711 passed through both chambers on April 21st and awaits Governor Kathy Hochul’s signature. As in Connecticut, the bill decouples the state’s vaccine requirements from federal guidance, anchoring them to AAP and other trusted medical bodies. Just before Tennessee’s legislature adjourned, SB 2070 (the SHIELD Act) was signed by Governor Bill Lee. The law prevents insurance companies from penalizing clinicians who treat patients who decline vaccines. In essence, clinicians can’t be dropped from an insurance network because some of their patients choose not to vaccinate. HB 2569 is still sitting on the governor’s desk after passing both chambers, and we expect to have an update by our next issue. The bill would expand the requirements for what flu and pneumococcal vaccines the state’s hospitals must offer, meaning more patients would be routinely offered these vaccines before leaving the hospital. Public health experts consider this a key way to reach adults who may otherwise miss these vaccines.

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We’re keeping an eye on three other states. Florida’s special session opened today and will run through May 1st. The Medical Freedom Act was of particular interest, as it would create a new conscience-based exemption from school vaccine requirements, making it even easier for Florida families to opt their children out of school-required vaccines. However, breaking just before we hit “publish,” Senate Rules Chair Kathleen Passidomo announced she will postpone its consideration during the special session. In Missouri, SB 878 is scheduled for an executive session on April 30th. The bill would update which vaccines pharmacists are allowed to order and administer, potentially restricting pharmacies from administering updated COVID-19 or flu shots. The impact would be most severe in rural areas where pharmacies are often the most accessible point of care. Finally, SB 2856 is scheduled for a Senate health committee hearing on April 30th in Rhode Island. The bill would allow pharmacists to administer the full range of routine, recommended childhood vaccines (not just flu and COVID-19) to children ages 3 to 18, bringing those shots under the same parental consent, reporting, and provider‑notification requirements that already apply when pharmacies vaccinate kids.

What else we’re watching:

• CDC blocked publication of a COVID-19 vaccine efficacy report. A study showing the updated vaccine cut emergency department visits and hospitalizations among healthy adults by roughly half this past season was stopped from publication in MMWR after passing the agency’s full scientific review process. You can read the full manuscript here.

• The military flu vaccine mandate was removed. Defense Secretary Pete Hegseth announced that flu vaccines are no longer required for U.S. troops. The policy had been in place since 1945, largely as a result of the 1918 influenza pandemic that killed more American troops than combat.

• VRBPAC meeting is scheduled for May 28th. The Vaccines and Related Biological Products Advisory Committee will meet to discuss the composition of next year’s COVID-19 vaccine. However, with the ACIP still in limbo under the court stay, any updated vaccines may lack insurance coverage even after approval.

• Bird flu trial launches; Moderna’s combination vaccine approved in the EU. Moderna launched a large bird flu vaccine trial months behind schedule after HHS canceled previously committed funding. Separately, a joint flu/COVID-19 vaccine received European Union (EU) approval. The company withdrew its U.S. application last May amid reported difficulties navigating the Food and Drug Administration’s current regulatory environment.

If reading this made you want to call your state legislator, look up your child’s vaccination records, or just go on a long walk with your dog, those are all completely reasonable responses…

Stay curious,

Unbiased Science

This piece is cross-posted with CIDRAP.