Every week seems to arrive with a theme, and the week ending June 21st makes one especially hard to ignore: ideas have consequences. A decision made in an office shows up weeks later, sometimes as a body count. A dropped flu requirement becomes an outbreak with a fatality. An easy exemption process becomes the largest measles outbreak in three decades. Doubt voiced from the top becomes falling vaccination rates across the country. The thread running through all of it is that ideas and ideology have downstream consequences for real people, and this week those consequences were on full display.
Ebola in the DRC: When You Chase the Virus and Ignore Everything Around It
The Ebola outbreak in the Democratic Republic of the Congo remains the dominant global story, and it has been present nearly every day I have been covering the news. It has now grown into the third-largest Ebola outbreak ever recorded, a containment failure driven less by the virus itself than by the broken conditions surrounding it.
Cases climbed across the week from around 800 to close to 900, and that figure is almost certainly an undercount. There are now more than 200 confirmed deaths. Most concerning, contact tracing is failing, and contact tracing is the single most important way an outbreak like this gets extinguished. Trace rates are sitting near 56 percent, with roughly 28,000 contacts untraced. You cannot break a transmission chain with that many people unaccounted for. If you cannot see where the virus is moving, you cannot stop it, and you have no idea where it will surface next.
This is what I would call a complex, synergistic disaster, and it explains why people keep asking why the outbreak cannot simply be fixed. Where this is happening, one in five people lack clean water. It is hard to keep yourself free of blood and body fluids without clean water. Ongoing militia violence is overwhelming hospitals, and the Red Cross has noted that its surgical suites are still running because of the fighting in the provinces where the outbreak is spreading. Many people seek out traditional healers because they do not recognize Ebola as an infectious disease, so they arrive at hospitals later, sicker, more contagious, and less likely to survive. Patients are fleeing Ebola treatment units because there is no food to feed them. Ebola is only one item on a long list of things that can kill people there, and it is not at the top of that list. They know that, and if a hospital has no food, I do not see how it keeps anyone in a treatment unit. Safe burials remain a problem as well, because viral load peaks near death and a body carries a tremendous amount of infectious material.
There are some bright spots worth holding onto. Clinical trials of remdesivir, monoclonal antibodies, and vaccines are spinning up. Dr. Stafford, the American surgeon treated in Germany, is now back in the United States, and there has been advocacy to deliver the monoclonal antibody he received more broadly, provided the logistics can be put in place. Vaccines look likely to reach trials within months, which reflects a real effort to conduct real-time research during an outbreak involving a rare species of Ebola. The WHO has also released supportive care guidance on replacing IV fluids, managing electrolytes, and controlling blood pressure, all of which can meaningfully reduce mortality if patients reach treatment units that are stocked and have food.
The idea I want to push back on is that a containment response can succeed by chasing the virus alone. It cannot. If you cannot fix the food, the water, and the security in a fragile and neglected region, you get exactly what we are seeing: patients fleeing for lack of food, contact tracing collapsing, and an outbreak that has grown to the third largest in history and is now projected to burn for a year or more. Ebola is interacting with all of these other factors at once, and that is what makes it so difficult.
The Idea Installed at the Top: RFK Jr. and the Vaccine Infrastructure
The next story is one I have covered often: RFK Jr. and the dismantling of the United States vaccine infrastructure. In my view, this is an ideology installed at the very top of HHS, an anti-human ideology, and it is producing measurable damage across the entire vaccine system.
ACIP, the Advisory Committee for Immunization Practices at the CDC, has been reformulated and, as I see it, gutted. He planned this and installed people whose main qualification appeared to be agreement with his worldview, with at least one exception. A judge has blocked the move, and RFK Jr. is now trying to expedite a ruling to undo that. Senate Democrats are demanding an accounting, and Senator Schumer is calling to restore the CDC. I think all of this is insufficient. If RFK Jr. remains in charge at HHS, the politics around it do not change the outcome. He told everyone what he intended to do, so the accounting already exists.
His inconsistency is striking. He is not a physician and does not accept the germ theory of disease, yet he issued a hantavirus quarantine order, overruling the CDC's own hantavirus expert who deemed it unnecessary. I do not understand how someone who rejects the idea that microorganisms cause infection can justify a quarantine at all, and I wish someone would ask him that directly.
We are already seeing the results. Hepatitis B vaccine uptake is falling, more in females than in males, correlated with vitamin K refusal, and it traces back to the reformulated childhood immunization schedule. The University of Maryland's vaccine center has reportedly stopped working on mRNA vaccines, apparently because RFK Jr. dislikes them. It is worth noting that when a survey looked at 13 red states, the majority of respondents actually support vaccines. The loud, angry voices in the comment sections, and I would not advise reading the comments on my videos, are not a reflection of reality.
The idea here is that national vaccine policy is being bent to one official's worldview, and that comes at a cost. ACIP is dysfunctional. mRNA research, the most promising infectious disease work we have seen in a long time and a major reason the world weathered COVID, is being halted. Hepatitis B vaccine uptake is falling, even though it is one of the best vaccines we have and prevents liver cancer and cirrhosis. The entire scaffolding of vaccination is being degraded from the top down. None of this was hidden. He announced it, and people like Senator Cassidy voted to confirm him anyway.
Measles: The Consequence Arrives on the Ground
Measles is the disease on the ground, the flashpoint where anti-vaccine ideology becomes visible. Hotspots have appeared across the country: Buckingham County, Virginia; Amish and Mennonite communities in Lancaster County and Lebanon County, Pennsylvania, where some Mennonite schools report under 50 percent kindergarten vaccination; and Walla Walla County, Washington, which has seven cases this year after several years of none. Pennsylvania is now facing its largest measles outbreak since the 1990s.
Lower vaccination rates in some Amish and Mennonite communities are not new, and Americans have long traveled to measles hotspots abroad. What has changed is our resilience. The communities that traditionally surrounded these enclaves used to have higher vaccination rates, which limited spread. That buffer has now been lowered, and lowered voluntarily, so these pockets of unvaccinated individuals have become kindling for outbreaks.
In Pennsylvania, there is a bill to make vaccine exemptions harder to obtain by requiring a conversation with a physician. The state currently has one of the easiest exemption processes in the country. I think tightening it is the right move. Schools should be run competently, and competent means safe, not operating as pest houses. Utah has also become a focal point in the decision over whether the United States retains its measles elimination status, because it has been dealing with cases since June 2025 and has recorded 680 of them. Whether those represent the same strain and the same outbreak is being adjudicated now, but either way, it is clear the state cannot contain measles. One pediatrician, quoted by the Associated Press, said she was not sure they could get it to end.
That is the situation we are facing. Measles is reestablishing endemicity, not because of any failure of technology, but because people turned against the technology. The idea that vaccination is optional and that easy exemptions are harmless has a direct consequence: the largest outbreak in Pennsylvania since the early 1990s and multiple low-coverage enclaves around the country serving as kindling. We may lose elimination status, but even setting that aside, we can no longer reliably control measles in the United States. It has returned, and it is becoming more common.
Influenza: Two Ideas, Two Consequences
Influenza gave us two competing ideas this week, and each one carried its own consequence.
On the positive side, the VRBPAC committee at the FDA voted unanimously to approve Moderna's mRNA flu vaccine, a vaccine the agency declined even to review just months ago. This would be the first mRNA flu vaccine in the United States, and it matters well beyond seasonal influenza. An mRNA platform allows rapid strain changes during a pandemic or late in a season when it is too late to adjust egg-based vaccines. I think it will set a new standard for how we select strains and meaningfully improve our resilience to pandemic influenza.
It is also worth correcting the belief that the flu vaccine does little good. Even if you still get the flu, vaccination matters, because influenza is not just fever, cough, and aches. It drives inflammation throughout the body that can trigger cardiovascular events like heart attacks and strokes. Vaccinated people are considerably less likely to suffer a cardiovascular death, with a hazard ratio around 0.77, a 23 percent reduction. The COVID vaccine does something similar. For perspective on how far we have come, flu now carries a 43 percent hospitalization rate, higher than COVID, which both reflects the progress of COVID science and reminds us that influenza still takes a serious toll. Secondary bloodstream infections with flu triple the risk of death, and secondary bacterial infections were the leading cause of death in 1918. The flu vaccine also appears to lower the risk of Alzheimer's disease, with one finding of 55 percent lower risk among people who received the high-dose vaccine in the two years afterward. The downstream benefits are substantial: fewer infections, milder cases, fewer deaths, fewer cardiovascular events, and possibly less dementia.
Now the negative idea. Secretary Hegseth ended the military's flu vaccine requirement, apparently on the premise that soldiers do not need one. The consequence followed quickly. There has been a major outbreak at Lakeland Air Force Base, with only about 40 percent of recruits now vaccinated and at least one fatal case. Both ideas, the harmful one and the hopeful one, show how directly decisions translate into outcomes. One produced an outbreak on a military base. The other put an mRNA flu vaccine within reach.
Long COVID: The Cost of a Definition We Don't Have
Long COVID remains an area of unsettled science, but new findings appear constantly. It is best understood as a nebulous umbrella term that likely covers more than one distinct condition, yet it is real and it is costly, perhaps around $1,300 per year for an affected person. There may be a mortality signal suggesting men with a long COVID diagnosis are more likely to die than women, which points to some sex-based interaction, though the definitions are so loose that I would be cautious reading much into it. We also see more cardiovascular disease in people with long COVID. Preexisting mental illness such as depression and anxiety has long been a risk signal, and preexisting physical illness raises the risk as well. The underlying mechanism is still unknown.
The idea I want to challenge is the impulse to manage long COVID as a single disease when it is a poorly defined, catch-all condition. As long as we do that, the data will stay muddled and contradictory. We will not have an integrated understanding of long COVID, or of its subtypes, until we get better at defining what we are actually talking about. The science cannot deliver clean answers under those conditions, and in the meantime patients with genuine health problems are left in limbo while the definitional work remains undone.
West Nile: A Quiet Reminder
Finally, a brief word on West Nile virus, because we are now in West Nile season. A good piece from the CBC noted that Canada recorded nine deaths in 2025. People often assume these mosquitoes cannot survive the cold there, but they can. One of the deaths described in that reporting happened to be the neighbor of a friend of mine in Toronto. It is a real risk, and one you are going to hear more about.
Everything Is Downstream
The point I want to leave you with is that none of this is without consequence. Every one of these policy decisions trickles down to actual people getting actual infections: the Air Force recruits at Lakeland, the children in Utah falling ill, the physicians being harassed for opposing RFK Jr. Everything is downstream of these ideas, and the ideas have real-world consequences. It is worth sitting with that.
