Opinion | APHA Sounds the Alarm on Trump’s Targeting of Public Health

In this Instagram Live discussion, MedPage Today editor-in-chief Jeremy Faust, MD, talks with Georges Benjamin, MD, executive director of the American Public Health Association (APHA), about the sweeping public health changes enacted by President Trump in the first weeks of his second term. Faust and Benjamin break down the administration’s executive orders affecting federal health agencies, scientific research, and global health policy.

Following is a partial transcript of the video (note that errors are possible):

Faust: Thank you so much for joining us.

Benjamin: Glad to be here.

Faust: Well, we just got breaking news that RFK Jr. got a vote — at least it seems like will get a vote — from Sen. Bill Cassidy of Louisiana, who’s a physician and who had been very public in his grappling with that nomination. What’s your reaction to that?

Benjamin: Yeah, well, obviously very disappointed with Dr. Cassidy’s vote. I don’t think there’s a lot to grapple with. I understand he’s trading off the politics versus the medical thing, the right thing to do as a physician. And I think that I disagree with the decision that he made, and we will continue to try to convince him that when it comes to the full committee vote, a full Senate vote, that he change his vote and vote no. But I think it’s a terrible precedent and obviously RFK is absolutely the wrong guy for this job.

Faust: It’s interesting. I am old enough to remember when a lot of confirmations would go pretty much 100 to zero or it was basically an up/down on whether somebody was prepared or not. And then at some point there became political lines, especially with the Supreme Court, Robert Bork being sort of the famous example of when people said, “Oh, this guy’s too political in one way. It’s not a matter of preparation, it’s a matter of philosophy.” And the same thing kind of began to happen with nominees, but I’ve never seen… I can’t remember a public health-related confirmation that really hinged on a guy who doesn’t seem to know the difference between Medicare and Medicaid. Is that right?

Benjamin: That’s right. This is someone who [is] not prepared by training or experience, has never run anything that’s complicated, and quite frankly does not know his craft. And you cannot wrap enough people around him to make him satisfactory for the job. Ideologically he’s wrong on so many things. He’s anti-science. And so this was clearly a partisan vote, at least on the part of the Republicans. I think the Democrats are voting the principle, and that sounds like it is a partisan statement, but I think it’s a fact, and I’m very disappointed. I’m disappointed in the members of the Senate committee that are Republicans. I think that they’re voting the bad health outcomes for their own family members and their constituents.

Faust: Someone asked me — actually this is a former White House official — asked me last night if we could somehow track the health outcomes of the fork in the road that we’re at now. And the question was: When are we going to start to see, and in what ways, the effects of the choices that are being made right now?

Benjamin: Well, from an immunization perspective, we’ve already seen the impact of Mr. Kennedy’s public stances on vaccines. And we’re already seeing the impact of the administration’s holding back on money through the grants debacle that we’ve had. And we’ve already seen the disregard for human life through the actions and with USAID [U.S. Agency for International Development] and the holding back of foreign assistance. So people are going to die based on the actions that they’ve done in the last few days. And I think that’s the real tragedy here. Literally, they’ve pulled the rug from under healthcare and a range of services for people who desperately need them.

Faust: And I meant to start this conversation and really center it around the work that APHA does. But obviously with this news, you have to start here, but let’s kind of reset and talk about the past 2 years. I mean 2 weeks, it feels like it’s been 2 years with everything that’s happened. The APHA was one of the first organizations in this country that really stepped up to take a legal challenge against some of the orders affecting public health. Can you just for this audience, tell people what that case was and who your partners were and how it went? Just give us a summary of what you achieved there.

Benjamin: Well, we did a couple of things. First of all, right after the president was elected — not elected, sworn in — we went after the DOGE [Department of Government Efficiency], which is this group that was fairly nondescript that the president had put together head[ed] by Elon Musk to actually look at funding. And we felt that it’s not been transparent at all and that it needs to follow the Federal Advisory Committee Act. All of us who’ve ever given, as civilians, given jobs in our jobs, in our private lives, to have given advice to the federal government, we’ve had to fill out ethics forms. We’ve had to sign attestations. We’ve had to operate in a manner which was transparent to the public. Public notice, people could see the meetings, the minutes of the meeting to the extent they… some could be public, some couldn’t, but there was a process to do that. They are operating, in my view, in a lawless manner and not doing it the way consistent with the Federal Advisory Committee Act.

Now, the president did sign an executive order creating DOGE as an entity within government, but I believe it still violates the law, the Federal Advisory Committee Act, because there are lots of things they’re doing and nobody knows what they’re doing. There’s been no public notice. It’s still a mess.

And then the second thing we did was we recognized when they filed, the OMB [Office of Management and Budget] told all aspects of government that they should put a pause, based on the president’s executive actions, on funding. They basically paused all funding by their actions. And so we went to court to get a temporary restraining order, and that order has been upheld as of Monday. And so we’re pleased with what the courts have done so far. We are beginning to see funding flow to some organizations, but it’s still pretty much a haphazard manner and we’ll be tracking over the next several days. But the intent with us and the [National Council of Nonprofits] and a couple other groups who we worked tirelessly on this effort was again, to try to make sure that the government’s upholding the spirit of the law.

And it’s caused enormous disruptions with funding and organizations that can’t pay their bills and are having to let people go. It’s really been a real mess.

Faust: I’m curious about the logistics of this decision to be in the center of this storm. Obviously, public health is a target of this administration clearly, but just, you wake up in the morning and you see this federal grant freeze. And when I saw it, I called my leadership at my hospital and I said, “Wait, are we going to sue because don’t we have standing? This is going to affect us.” And their answer was, “Well, somebody’s going to sue. Really, we don’t know if it’s going to be us or not, and who’s going to do it? Who is going to do it?” And the next morning or whatever I read, it’s you. It’s like you said, the nonprofit associations. What’s the decision process that says, “You know what? It’ll be us.”

Benjamin: Well, you have to think strategically about what you’re doing, and I really can’t talk about legal strategies, but I think at the end of the day, somebody has to stand up and say, “Enough.” And I think we just felt that it was a substantial enough problem for the public health community, at least we needed to be part of the solution of this. Policymaking in this country is not only done by the president. The president absolutely is a major policymaker and has a perspective and has rules and things, ideas that he or she wants to promote. Having said that, the Congress has a role. The courts have a role in policymaking. We in civil society have a role. The president is not the only decision maker. If we had a king that would be the case, but we don’t have a king. We have a president. And that president leads the executive branch. And the executive branch obviously is our government and the processes and directions they want to take it, but he does not have a mandate. He has his perspectives and the perspectives of people he brings around him, but they’re not… again, he’s not a king. He doesn’t get up any morning and say, “I want the sky to be green.” Not going to happen.

And so I think that for organizations like ours, we’re eager to work productively with our elected leaders. There’s no question that we want to do that, but it needs to be principled and it has to be on the right ideas.

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