Public Health Predictions for 2025
Three Things Thursday
Three Things Thursday highlights three things I am paying attention to as an epidemiologist each week. The past week(s) has been hard and heartbreaking — filled with the passing of President Carter, who was a champion for public health and health equity, and SO MUCH violence, the murder of UnitedHealthcare CEO Brian Thompson, the act of terror in New Orleans, and the car explosion in Las Vegas.
According to the American Medical Association —
“Violence, overall, has become a public health crisis.”
And please remember —
“Experiencing violence affects people in many ways. It not only causes physical injury or death, but being exposed to it can also cause emotional and psychological trauma. Violence doesn’t just affect the immediate victim, it affects their surrounding community, too.
Violence can affect people throughout their lives: it is associated with worse birth outcomes, childhood developmental delays, physical and mental illness, and premature deaths.”
As we head into the new year, we cannot shy away from advocating for policy & changes to reduce deaths and injuries from violence, especially gun violence. We also need to remember that even though the news cycles will change the emotional and psychological effects of the recent acts of violence will impact our friends, families, and communities for years to come. We cannot belittle or stigmatize these traumas. The impact of these events is real, and it must be addressed.
Despite the news cycle and the heaviness of the week’s events, it is a new year.
This week I’m doing something uncomfortable and something I do not do very often. I’m making predictions for the upcoming year. And while I may not have a crystal ball, I have been paying attention to all things public health and medicine. And I feel like I have a clear sense of what will be making the health headlines in 2025.
NOTE: the only constant is change. Or maybe it is better said that we cannot be surprised by surprises. What is highlighted below is the predictable. The topics I’ve included on my list of predictions for 2025 are those that I am paying attention to as we move into the new year.
Hoping this post helps to educate and empower you
to be healthy and create healthy communities.
H5N1
There are currently 66 human cases of H5N1 in the United States, including one severe case in Louisana.1 While this number is not exceedingly or concerningly high, the case count continues to increase (this is not good) and we are seeing some changes in the virus that concern public health and medical professionals.
On December 26, CDC reported that genetic sequencing of the virus (taken from the severely ill individual in Louisiana) showed several mutations thought to affect the virus’ ability to attach to cells in the upper airways of humans. Specifically, the mutation detected helps H5N1 bind to cell receptors found in the upper respiratory tracts of humans. This is concerning to the public health and medical communities because avian influenzas typically do not bind to human cell receptors.
From a community standpoint, the risk of H5N1 (right now) is still low.
However, there is some writing on the wall (aka warning signs of bad things to come)…
Human case counts continue to increase.
Severe illness is occurring.
The virus is evolving.
As more individuals become sick — potentially for longer periods and with increasing severity — the chances of the virus mutating again and becoming more virulent (able to cause even more severe illness) and more transmissible (potentially from person to person) increases.
It is time for the public health and medical communities to treat H5N1 as a potential (dare I say “probable”) emergency. This means we need to —
Conduct accurate and timely surveillance of human cases.
Conduct wastewater monitoring for H5N1.
Conduct genetic sequencing of human cases to monitor for genetic changes.
Make H5N1 vaccines widely available.
Encourage seasonal flu vaccines for everyone (over 6 months), as a worst-case scenario is H5N1 and seasonal flu co-infecting an individual and creating a new form of the virus that can easily spread from person to person
H5N1 is NOT going away.
The writing is on the wall (so to speak) and we must diligently watch what is happening — at the genetic level and within our communities. While public health officials are on high alert NOW, communities do not need to be concerned YET.
We all need to be aware.
H5N1 will be an unwanted guest in 2025.
Lack of Public Health Leadership at the Federal Level
As I have previously written, President-elect Trump has selected RJK Jr to lead the Department of Health & Human Services. This is the federal agency that oversees CDC, NIH, Medicare, and Medicaid, among others. As I wrote previously —
“RJK Jr and the leadership role he will likely play in the Trump Administration keeps me awake at night. NO JOKE. A recent article in Forbes summarizes why I am so concerned about RFK Jr becoming a federal health leader —
'He has repeatedly made false claims that vaccines cause autism and chaired the Children's Health Defense, an organization that says it wants to end childhood health crises but is a source of vaccine misinformation. He compared vaccine mandates to the Holocaust in 2022, which he apologized for, and was previously banned by YouTube and Instagram for spreading misinformation about the COVID-19 vaccine.’”
Additionally, President-elect Trump has selected Mehmet Oz, aka Dr. Oz, to run the Centers for Medicare & Medicaid Services (CMS). Many of us are concerned because Dr. Oz is known for “promoting medicines and supplements that do not do what Oz says they do.”1 Additionally, Dr. Oz and his wife have significant financial investments in pharmaceutical companies, including AbbVie, Cigna, CVS, Johnson & Johnson, and UnitedHealth Group.
Kedric Payne, VP and senior director of ethics at the Campaign Legal Center said yesterday —
“Dr Oz has held significant stock in health insurance giants including United Healthcare and Cigna and in the pharmaceutical company CVS. If confirmed to this position, Dr Oz will hold sway over how Medicare is administered and could make decisions that make those stocks more valuable while adversely impacting the healthcare of millions of Americans.”
The next four years are going to be hard (see below for some specifics).
I am anticipating we will see — an uptick (epidemic) in vaccine-preventable disease, an increase in cancers that could be prevented with vaccines (Hep B and HPV), a decrease in life expectancy, an increase in health inequalities, increasing healthcare costs, decreases in preventative healthcare, and an uptick in the advertisement and sales of supplements and quick fixes to complicated health problems that cannot be cured with a vitamin or protein shake.
Siloing of Health Problems
If the COVID pandemic taught us anything, it is that when our health is threatened everything is impacted. Financial markets collapse. Schools are closed. Loneliness sets in. Frustration grows. Violence increases. People die. Opportunities are missed. We spent too much time at our desks. We miss visiting with friends and family.
Health is so connected to everything that without health everything else is nothing.
Health cannot be siloed as just an infectious disease, chronic disease, mental health illness, or a disease of old age. It is NOT clear that individuals being appointed by President-elect Trump understand this.
And this is what concerns me about the Make America Healthy Again agenda. According to NPR —
“Its (MAHA) central mandate: Reverse the chronic disease epidemic, which is the leading cause of death in the U.S., and drives massive health care costs…
Kennedy's baseless claims have included that Wi-Fi causes cancer and "leaky brain"; that school shootings are attributable to antidepressants; that chemicals in water can lead to children becoming transgender; and that AIDS may not be caused by HIV. He's also long said that vaccines cause autism and fail to protect people from diseases.”
As I have written previously — the burden of preventable chronic diseases, such as Type II diabetes, heart disease, and lung cancer, is exceptionally high in the US. Where my thinking and that of Trump’s team diverge is what can be done to prevent these diseases.
Years (actually decades) of research, show that the burden of chronic diseases could be reduced by helping individuals stop (or never start) smoking cigarettes/vaping, reducing the amount of alcohol consumed, improving individual diets, allowing individuals the time to (and providing an affordable form of) exercise, and addressing the mental health/loneliness epidemics in our country. We need to take on the tobacco industry/lobby; and Coca-Cola/Pepsi (getting soda out of schools needs to be a priority). We need to turn the Farm Bill on its head and remove subsidies for corn syrup.
Trump’s team has not cited this research or discussed the solutions the public health community has been championing for years. Nor have they talked about providing healthcare for all, sick leave for all, affordable childcare for all, or an increased minimum wage. They have also failed to recognize that we have vaccines that prevent cancers of the cervix, mouth/throat, and liver, with a breast cancer vaccine on the horizon.
Dr. Tom Frieden, former Director of CDC, summarizes it by saying —
"There are some things that RFK Jr. gets right. We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science."
We need to think of health as a system.
We canNOT silo our thinking (or the responsibilities of our federal health agencies) to focus on just one aspect of health. If we focus on just solving the chronic disease problem in America, we will see an uptick in infectious diseases. Children will die. Vaccine-preventable diseases will increase. Quarantines, isolation, and contact tracing will become commonplace. School will be missed; and work, too. And there will be complications and severe adverse effects.
There is no simple solution to the health or healthcare problems in America.
I want (and would argue we all should) to prevent disease before it occurs. I want vaccines that prevent severe illness. I want clean water to prevent the spread of cholera (and other waterborne diseases). I want clean air to prevent asthma attacks from occurring. I want amazing sex education to prevent disease and violence. I want healthcare providers who talk to patients about the dangers of smoking, vaping, drugs, and too much screen time before addiction begins. I want clinics built in communities that lack access to healthcare. I want a healthcare system that values a healthy individual more than it values someone who is sick.
This is what I will be advocating for over the next four years.
That’s what we know right now.
I’m exhausted. Already. And there are four L-O-N-G years ahead of us.
In 2025, I am going to double down on my mission and will work hard and more collaboratively to CREATE HEALTHY COMMUNITIES FOR ALL.
In January 2020, I stepped out of my office and onto TV for the first time to share my knowledge of viruses, pandemics, and epidemiology with my community. I began writing Epi(demiology) Matters in February 2021 (nearly 4 years ago!). And though I am still a professor and researcher, the course of my career has taken off in an unexpected and wonderful direction.
I will be here with you (at least) weekly throughout the next four years.
To create healthy communities for all, I am committing to —
Using data/science to create public health (aka preventative health) programs, policies, and interventions to save lives and decrease suffering.
Fighting misinformation.
Inspiring others to understand the science to make healthy decisions and create healthy communities.
What can you do?
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Happy New Year, friends. Here’s to a healthy 2025…
And please —
Epi(demiology) Matters is written by Dr. Becky Dawson, PhD MPH — an epidemiologist, teacher, mom, wife, and dedicated yogi. She is a tenured professor at Allegheny College, Research Director at a community hospital, and an exclusive contributor (all things health & medicine) at Erie News Now (NBC/CBS). Her goal is to create healthy communities for all. She writes Epi Matters — first & foremost because epidemiology does matter (to all of us) and she hopes that each post will help to educate and empower readers to be healthy and create healthy communities.
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Note — the flu tracker has not been updated in a week due to the holidays. Tracking will resume tomorrow. I expect this number to increase again.
Thanks for all you do! Don’t give up the fight!
Thank you for all you have done. May next year be a year of a nation concerned with public health. Sadly I get the feeling that my statement will be taken as an April Fools joke.