COVID, Vax, RFK Jr.—What’s Next?
Public health policy changes have enormous implications, including economic ones.
As we have watched over the last few months the cancelling of research grants and health-related programs and the firing of people with deep expertise in epidemiology and vaccine science, we are reminded of the immense contributions of Maurice Hilleman, chief of the Dept. of Virus Diseases at Walter Reed Army Medical Center from 1948 to 1957. Hilleman and his team developed eight of the vaccines on today’s vaccine schedule and saved countless lives. In our book, The Fed and the Flu: Parsing Pandemic Economic Shocks, we recall a moment in Hilleman’s career that points to the extraordinary value of infectious disease surveillance and research:
On April 17, 1957, microbiologist Maurice Hilleman was perusing the New York Times. On page three, his eye was likely drawn first to the photo of Marines landing on a beach in Turkey, but he must have also been interested to read the article at the top left, about a possible link between radiation exposure from hydrogen bomb tests and bone cancer. The slim article titled “Hong Kong Battling Influenza Epidemic,” though, was just four inches of copy — a mere eight sentences — sandwiched just above the ads for Brooks Brothers worsted suits, Macy’s shoes, men’s ties, a lacy nylon blouse, and a beauty treatment for blackheads. The article reported “thousands of cases” of influenza in Hong Kong and mothers standing in long lines seeking treatment for their “glassy-eyed children, tied to their backs.” Maurice Hilleman immediately recognized a possible flu pandemic in the making.
At the time, Hilleman was working at the Walter Reed Institute of Army Research, where he had identified changes that could happen when a virus mutated. The next day, he sent a message to the Army Medical General Laboratory in Japan, asking them to investigate the outbreak. They were able to send him a saliva sample from a U.S. servicemember who had caught the virus. Studying the new influenza virus in the sample, he quickly identified two key changes that rendered most people susceptible to the new strain. He verified that U.S. soldiers had no antibodies to fight the new flu. Only elderly survivors of the Russian Flu pandemic of 1889–1890 would have any immunity. (That epidemic infected 4 million people in Britain and killed at least 125,000 of them.) Once other labs confirmed his findings, Dr. Hilleman announced that an influenza epidemic was coming, and he set out to ensure that a vaccine would be available by the time schools reopened in September. Because of his timely realization and quick action, 40 million doses of vaccine were produced in the United States by fall.
– The Fed and the Flu: Parsing Pandemic Economic Shocks, 263
As Hilleman worked to lessen the impact of the 1957 flu pandemic, he enjoyed the support of Republican President Dwight D. Eisenhower, who ordered vaccination for the military (though not for the entire country).
In today’s commentary, we touch on several key health issues capable of driving sizable economic impacts, offer a book excerpt we think vitally relevant to this moment, draw some conclusions, and make readers an offer we hope you will take us up on.
Long COVID persists and persists
Long COVID studies continue to reveal the lasting damage COVID infections can do to human bodies and minds. Long COVID erodes quality of life and productivity, drives costs, and impacts spending.
A short reading list highlighting recent research findings follows:
Of those infected with Omicron, 4.5% developed Long COVID, according to one 2022 study, vs. 10.8% in the case of those infected with the Delta variant. Note, however, that the number of Omicron infections has far exceeded the number of Delta infections.
“Omicron less likely to lead to long COVID, study finds,” | CIDRAP,
https://www.cidrap.umn.edu/omicron-less-likely-lead-long-covid-study-finds
In addition to physical symptoms, COVID causes long-term neurological damage, impacting sleep, cognition, mood, and more.
“Is Covid Rewriting the Rules of Aging? Brain Decline Alarms Doctors” | WSJ,
https://www.wsj.com/health/wellness/is-covid-rewriting-the-rules-of-aging-brain-decline-alarms-doctors-6ed3dfaa“Long-term neurological and cognitive impact of COVID-19: a systematic review and meta-analysis in over 4 million patients” | BMC Neurology,
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04174-9“Insights on the neurocognitive mechanisms underlying hippocampus-dependent memory impairment in COVID-19” | Nature,
https://www.nature.com/articles/s41598-025-04166-2
Long COVID symptoms look different in very young children than they do in older children and adolescents.
“Characterizing Long COVID Symptoms During Early Childhood,”
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2834480
Since vaccination significantly reduces the risk of developing Long COVID, limiting access to COVID vaccines for a broad swath of the population spells a higher incidence of Long COVID, with associated healthcare and productivity costs. Repeated infections raise risk. Repeated infections sans vaccinations raise more risk.
Please note that Long COVID research has been defunded, though the condition impacts 23 million people in the United States alone.
“US Government cuts funding for long COVID research” | Lancet,
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(25)00094-1/fulltext
COVID lull lingers, but for how long?
Currently, wastewater data indicates that COVID infection levels remain “very low” That’s good news, though with a new variant on the prowl the lull is not likely to last. A new Omicron variant, NB.1.8.1, appears to be gaining ground as a percentage of confirmed infections. The caveat? Genomic sequencing data is now too sparse to ensure accuracy.
We’ve checked out NB.1.8.1, nicknamed “Nimbus,” and it does not sound like a good time.
“A new COVID variant is spreading in the US: What are the symptoms?” | USA Today,
https://www.usatoday.com/story/news/health/2025/06/23/new-covid-variant-2025-symptoms/84317260007/
The Latest on US Vaccine Policy
At an ACIP meeting riddled with misinformation from some, RSV and flu shots were approved for fall. The committee voted to ban thimerosal from flu vaccines (not an evidence-based decision) but did not address Covid vaccine policy because RFK Jr had already decided it — though the CDC maintains its recommendation that pregnant women get the vaccine to protect themselves and their babies. Infants are otherwise as vulnerable to serious illness from COVID from one to six months of age as senior citizens are.
Vaccine misinformation and resulting policies
= lower vaccination rates
= more preventable illness
= more absenteeism as a result of illness or caregiving + higher mortality rates
= an erosion of productivity + higher costs
This equation figures globally as the US withdraws funding for global vaccination programs, a strategy which has served to protect lives abroad and at home (because we live in an interconnected world) and the health of the global economy.
“Vaccine policy meeting: The essentials” | Your Local Epidemiologist
“RFK Jr. says US won’t donate to global vaccine effort” | POLITICO,
“CDC vaccine advisory committee to review long-approved immunizations” | STAT News,
https://www.statnews.com/2025/06/25/cdc-vaccines-advisory-committee-meeting-day-1/“AAP will continue to publish its own vaccine recommendations after CDC advisers sow distrust” | AAP News,
https://publications.aap.org/aapnews/news/32529/AAP-will-continue-to-publish-its-own-vaccine“COVID Vaccines and Boosters: What’s Changing in 2025” | US News and World Report,
https://health.usnews.com/wellness/articles/covid-vaccines-and-boosters-whats-changing
A personal note (from co-author Elizabeth Sweet)
As RFK Jr. questions settled science, rolls back funding for childhood vaccinations around the world, and encourages disinformation and doubt and confusion about vaccines, I remember little Jimmy and my grandmother.
When we flew to Pennsylvania in 1993 to lay my grandmother to rest beside my grandfather, my father wanted very much to relocate his brother Jimmy’s remains to the family plot to be near his mother. At two years old, Jimmy had fallen ill with diphtheria, a bacterial infection that has now long been readily prevented by childhood vaccinations. He died two days later and was buried in a simple wooden coffin as hastily as possible to prevent the spread of the infection. My grandmother never got over the loss of her first son, the brother my father never met.
When my father asked about moving his brother’s remains, the answer was succinct and jarring, “There would be nothing left to move.”
Jimmy was born in the days before childhood vaccinations steeply reduced child mortality rates.
On turning the clock back in public health
In The Fed and the Flu, we traced the evolution of modern medical science from a time when people lacked efficacious means of fighting infectious diseases and could not stem the enormous toll that they took. We concisely traced the period between the Black Death and the 20th century in a chapter titled “The Modern Era Dawns.”
Everything we now see unfolding that impacts the quality of science we do and the quality or reach of care, we understand in the context of the history that short chapter depicts, a history that many appear to have forgotten, along with children like Jimmy, whose untimely deaths should speak to us now about the imperative of protecting our children — and everyone else — today.
We have made Chapter 9, “The Modern Era Dawns,” available to read at the link below.
We invite readers to consider with us the earlier time it depicts in light of the crossroads we face now, as the Trump administration pulls support for the United States’ leadership role in medical science (and science in general) and weighs vaccine-related policies using, as Katelyn Jetelina characterizes it, “policy-based evidence” that is supplanting “evidence-based policy” (Inside Medicine podcast with Jeremy Faust, MD, June 26).
Of ignoring infectious disease threats and abandoning or partially abandoning the tools we have to fight them, we must say this. If we lack adequate surveillance, if we have no Maurice Hillemans to lead the charge because they’ve been fired and replaced with ideologically aligned people who lack expertise, public health outcomes will be worse and not better because we cannot respond quickly to new or existing disease threats.
If we abandon proven mitigations against infectious diseases, such as vaccination, rhetoric around that choice cannot forestall economic impacts that have always been driven by the erosion of public health or by disease-driven shocks. Talk doesn’t sculpt hard realities, whether we map those realities accurately or not.
Those who govern cannot say, through policy, “the health trajectories and lives of those who will fall victim to our policies are sacrifices we are willing to make,” without also saying, “the enormous economic losses driven by disability and untimely death are also sacrifices we are prepared to incur.” Human health and economics are inextricably intertwined and ever pertinent to investors and to all who navigate an economic landscape shaped by policy. And where public health and its economic ramifications are concerned, bulldozers are already at work reshaping the world.
Over the past several years, we spent many hours painstakingly tracing the relationship between disease outbreaks and their economic impacts across history. Our claims about these linkages are evidence-based as far back as history offers us a record.
We invite you to retrace what we found and draw your own conclusions about potential short- and long-term economic implications of shifting national health policy. Today, readers of the Kotok Report can purchase The Fed and the Flu: Parsing Pandemic Economic Shocks at a discounted price of $30 for the paperback. That is just a penny short of 40% off the list price. Please order using the link below:
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