Here we are, at the halfway point in a decade, in terms of global health and infectious diseases, a lot.
The second decade of the 21st century began with the most severe pandemic since the Spanish Flu of 1918. As the worst of the COVID-19 pandemic began to subside, the world learned about smallpox, a cousin of smallpox that spread from people who came into contact with infected rodents in forested parts of the country. In West and Central Africa, it spreads from person to person. In Europe, the Americas and beyond, mainly through sex. In 2024, bird flu became cow flu, or Mo flu, as some researchers like to refer to it. Between outbreaks in dairy cows, outbreaks in poultry operations, and outbreaks in wild birds, the amount of H5N1 virus in the environment has reached alarming levels.
So, what does 2025 hold for us on the global health front? Unfortunately, 2020 doesn’t seem like it’s ready to cut us any breaks. The list of things we’re watching at STAT is long, but there are three things we’re sure will make headlines in the new year.
What will happen with H5N1 bird flu?
The H5N1 virus, a viral family with origins in an influenza virus that was isolated in China’s Guangdong province in 1996, frequently drew the ire of the scientific world over the next three decades. After a period of relative calm in the second half of the last decade, this phenomenon has reappeared in the past two years, affecting a large number of the population. Amazing collection Of mammals. (It’s amazing because this is, after all, a version of bird flu.) In 2024, the world discovered that the virus was being transmitted between dairy cows in the United States, a stark reminder that you should always expect the unexpected with H5N1.
Influenza viruses that do not spread between humans can cause pandemics if they acquire the ability to easily infect humans. There are two ways they can make this leap. The first is by mutation, that is, the acquisition of random genetic changes that would allow a virus currently suitable for infecting birds to mutate into a virus that can easily infect humans. Spending time infecting mammalian species such as cows could put H5N1 on this path.
The second is a process called rearrangement. When different influenza viruses infect a host — a duck, a pig, or perhaps a cow, or a person — they can swap genes, giving rise to hybrids of the original viruses. As flu season arrives across the country, some farmworkers will get seasonal flu, and some will go to work sick. If someone becomes infected with seasonal influenza and the H5N1 virus at the same time, the former could give the latter some genes that could make the H5N1 virus transmissible between people.
Will that happen? There is no way to estimate probabilities. If H5N1 causes a global pandemic, will it be deadly? This is another question that cannot be answered. But the spread of this virus in dairy cows is like allowing Mother Nature to keep rolling the dice at a craps table. The house usually wins. But this is not always.
Since the H5N1 virus found its way into cows, it has been making regular invasions into humans. As of December 23, the Centers for Disease Control and Prevention had confirmed 65 human infections in 10 states in 2024. And that’s just part of the story. There have been plenty of anecdotal reports of dairy workers with similar symptoms who didn’t go for testing. Studies that look for missed cases by studying the blood of people exposed to the virus have found that more people are infected than are confirmed as cases. With the exception of the case recorded in Louisiana earlier this month, all known cases in the United States have been mild.
From the beginning, the dairy industry treated this outbreak as if it were just a cow problem, a problem to be overcome. The US Department of Agriculture did not object to this in any way, asserting without any clear evidence that the virus would eventually burn out. Only recently did the department decide to actively search for the virus, through a mandatory mass testing program that began in just six states but has since been expanded to seven more states.
Whether the virus will burn out in cows is another unanswerable question about H5N1. States that infected their herds early — Kansas, for example — haven’t reported new infections for months. Is it because there is no one? Or because farmers won’t test their cows? There are answers to these questions, but getting them requires political will that was absent in a presidential election year.
The answer may come from California, the nation’s largest dairy producer, where the virus has swept through more than two-thirds of the state’s herds — 675 — since the first infections were detected at the end of August. California is actively researching and reporting its findings on infections in cattle and infections in humans. It is assumed that if the virus begins to spread among the herds for a second or third time, it will be detected there.
Meanwhile, studies The specific version of the virus currently circulating suggests that there may be fewer obstacles standing in the way of replicating the H5N1 virus, known as branch 2.3.4.4b, gaining the ability to infect people more easily than previous versions of the virus.
Is the stage set for an H5N1 pandemic? We don’t know. But we will continue to monitor this story closely.
Can the spread of mpox disease be stopped?
In the spring of 2022, health authorities in Britain stunned the world when they announced that they had detected local transmission of monkeypox, a disease caused by a member of the poxvirus family. It quickly became clear that the virus was transmitted from one person to another, in multiple countries, through sexual contact. Mpox, as the disease has since been renamed, quickly found its way around the world.
In 2022, outbreaks were largely occurring in gay, bisexual, and other men who have sex with men communities. Behavioral changes and the dissemination of vaccines developed to protect against smallpox (related viruses) slowed the spread of the virus, although cases of this version of smallpox, called clade IIb, still appear in parts of the world where smallpox did not previously exist. Found.
In 2024, the mpox story has taken a new, unwelcome twist. Two other versions of the virus, branches Ia and Ib, have spread from person to person in a number of African countries. It is also spread through sex in some cases; In other cases, household contacts of infected people also become infected with the virus.
Transmission of Tier 1 viruses out of Africa has not yet reached the levels seen in 2022 with Tier 2 viruses. But a number of African countries are struggling to contain its spread. Twenty countries on the continent have reported nearly 14,000 laboratory-confirmed cases and 60 deaths this year; Laboratory confirmed cases only capture a portion of the actual transmission. Globally, nearly 22,500 confirmed cases and 78 deaths have been reported from 82 countries this year.
The world’s ability to manufacture the Mbox vaccine depends on the size of the previous market for the product. The purpose of this market was not to vaccinate at-risk people in multiple countries, but rather to produce a vaccine for emergency stocks held by rich countries in case smallpox was released as a weapon of bioterrorism. As a result, stores of the main product available, the two-dose Genius vaccine in Bavaria Nordic, are limited and expensive. Donated doses are being used in a number of countries, but the need exceeds supply.
Global susceptibility to smallpox stems from decisions made decades ago to halt vaccination against smallpox, a virus that was declared eradicated in 1980. The cessation of these vaccination efforts has created a growing group of children, adolescents, and adults who have no immunity to smallpox viruses. The vast majority of confirmed cases since 2022 have been in people between the ages of 18 and 49, according to Aggregated data By the World Health Organization.
In July 2022, the World Health Organization declared the smallpox outbreak a public health emergency of international concern. The state of emergency was lifted in May 2023, as the international spread of smallpox slowed, but did not stop completely. In August this year, another public health emergency was declared for mpox.
As the world looks forward to 2025, a question arises: Can the spread of these viruses be overcome? Or is human-to-human transmission of smallpox a fact of life in a world characterized by low immunity to smallpox viruses?
Is the sun beginning to set on American influence in global health?
The first Trump administration sent notice in July 2020 — a few months after the COVID-19 pandemic emerged — that it intended to withdraw the United States from the World Health Organization. Before the withdrawal could be completed, Donald Trump lost his bid for re-election. On his first day in office, President Joe Biden He canceled the withdrawal notice.
Fast forward four years: Trump’s second presidency is about to begin. The next administration It actually makes sounds About the announcement of the United States’ withdrawal from the World Health Organization on the first day. The soon-to-be-reinaugurated president has denounced the Geneva-based global health agency’s handling of the Covid pandemic, accused it of being subservient to China, and generally feels that the United States is bearing more than its share of the costs of international institutions.
the Constitution of the World Health Organization It does not include provisions providing for the withdrawal of member states. but Decision taken by Congress in 1948 Allowing the United States to join the WHO sets the rules under which a country can revoke its membership. One year’s notice and payment of any outstanding financial obligations are required before departure. US dues for 2025 These amounts amount to just over $130 million, which is significantly more than the dues owed by any other member state. (China’s estimated contribution, as WHO membership dues are called, comes in second at about $87.6 million.) The benefits constitute only a portion of the funding that rich countries such as the United States provide to the World Health Organization. In terms of voluntary contributions – which are usually earmarked for specific programs that the donor wishes to support – the United States is also the largest single donor. Overall, the United States is the largest contributing member country to the World Health Organization.
The World Health Organization has tried that – Diversifying its funding sourcesBut losing the United States would be a huge blow to the agency. In addition to losing funding, that would raise questions about the role the United States plays in the myriad programs run by the World Health Organization, such as selecting virus strains for the flu vaccine or the country’s contribution — in terms of human expertise — to health emergencies. Responses.
No country — let alone one that plays such a senior role in the agency — has ever withdrawn from the WHO before. “We don’t know what will happen if we withdraw,” a global health expert told STAT.
One possible outcome is that far fewer Americans will work at WHO headquarters in Geneva, where the US contingent has long been large. In fact, a US withdrawal could actually trigger the situation that Trump complained about: increased Chinese influence in Geneva. It is difficult to imagine that China, the European Union, or other major contributors to the WHO will not demand the seats at the tables currently occupied by US scientists.
The United States’ membership status in the WHO is not the only place where American influence in global health could decline. The prospect of major cuts in research efforts (at the CDC) and funding (through the National Institutes of Health) could send scientists looking for new homes.
Some in Europe are already anticipating a scientific migration. Isabella Eckerle, director of the Swiss Geneva Center for Emerging Viral Diseases, predicted that European institutions are about to face a “golden opportunity” to recruit the best American talent.
“I think that at least in infectious disease research, the United States will see an unprecedented brain drain from academics.” Eckerle said On the social network Bluesky, indicating The flow you expect It would “promote European infectious disease research and drive innovation in tools, data science, drug and vaccine development, etc.… [S]Strategically, this would be a major victory for Europe in the coming decades!
All of this is to say that if you have any downtime scheduled over the holidays, take a break. 2025 could be a beautiful year for rock and roll.
