Dr. Ashish K. Jha is dean of Brown University School of Public Health and a contributing Globe Opinion writer.
I recently found myself at our local grocery store, staring at an empty shelf where we usually find eggs. My wife found them at another store but at a shockingly high price. The supply of eggs is down and egg prices are up (a 134 percent increase since last January), giving Americans a firsthand introduction to the bird flu outbreak disrupting the nation’s food supply. Without immediate clear and decisive action, rising prices, and increasing threats to human health, will rapidly expand in the months ahead.
For decades, scientists have worried about a human pandemic from bird flu, or H5N1, for one main reason: The virus is deadly. Historically, about half the people known to be infected globally have died. But the virus was limited to small subspecies of birds, would occasionally infect poultry, and rarely infected mammals of any kind, including humans.
That changed over the past few years. The virus now infects a large proportion of migratory waterfowl (think ducks and geese), has caused devastating outbreaks in poultry (leading to the killing of 150 million birds in the past two years), and has evolved so that it’s now more effective at infecting a range of mammals, from sea lions to cats to, most recently, dairy cows. And with rampant spread on dairy farms, there are increasing infections among farm workers. Thankfully, there has not been any spread between humans yet, and most of the cases among farm workers have been mild. So far.
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That silver lining — no human-to-human transmission among dairy workers and most human cases being relatively mild — should not make us complacent. In fact, the time for action is now. It is possible that the virus is just a small number of mutations away from sustained human-to-human transmission, which would be devastating for human health. Because most dairy workers were probably infected from touching infected surfaces or milk, such exposures tend to cause milder illness. If this virus begins to spread from person to person, it will almost surely do so through the lungs, and there would be significantly more severe illness.
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The Trump administration, through the US Department of Agriculture, recently released actions to address bird flu that are helpful but incomplete. To truly reduce the impacts of bird flu, the administration must immediately act on these five priorities:
First, vaccinating poultry is critical to preventing flock outbreaks and must be a cornerstone of the nation’s avian influenza prevention strategy. In early January, the Agriculture Department announced plans to rebuild a stockpile of vaccines for poultry, an action taken during previous outbreaks in 2014 and 2015. The department licensed a poultry vaccine, but the vaccine is not yet approved for commercial use. Health and Human Services Secretary Robert F. Kennedy Jr. has weighed in, stating that the federal health agencies are all recommending against the use of the vaccine.
Previous outbreaks have shown the utility of poultry vaccination. Over the past few years in China, vaccinating poultry against a similar flu virus slowed the evolution of the virus even though the vaccine wasn’t a perfect match. This vaccination campaign also reduced human infections for poultry farm workers. Without widespread vaccination, a single infected hen necessitates culling entire flocks, leading to economic losses for farmers, disruptions to food chains, and increased costs to consumers.
Second, the administration can reduce the risks to the dairy cattle industry by accelerating bovine vaccination development. In late 2024, the Department of Agriculture announced ongoing trials of two vaccine candidates for cows. With nearly 1,000 herds already infected with H5N1, the risk to our nation’s milk, dairy, and meat supply is significant.
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The United States produced 26.4 billion gallons of milk in 2023. Although dairy cows usually recover from H5N1 infections, their milk production can decline significantly. If the infections among dairy cows continue unabated, it will harm milk production, lead to more human infections for dairy farm workers (and for consumers drinking raw, unpasteurized milk), and may become economically ruinous for dairy farmers. The strategy here should be simple: Develop and deploy a vaccine for cows. It is likely the only way to protect the dairy industry from large losses and ensure the affordability of food products Americans rely on to feed their families. Most importantly, this approach will dramatically reduce the exposure for farm workers.
Third, investing in the rapid development of a human vaccine is essential to staying ahead of avian influenza. The COVID-19 pandemic showed us the value of programs like Operation Warp Speed to build the mRNA platform for vaccines. The Trump administration should be building on these successes, working with vaccine manufacturers to advance research on avian influenza vaccines. They should also continue to make and stockpile existing flu vaccines that target this strain of H5N1. Vaccine development and manufacturing processes take time, and getting started once there is a full-blown outbreak will be too late. If we prepare now we can save lives and avert a global public health crisis.
That is why the Biden administration made a large investment in building an mRNA platform for avian flu vaccines — and it makes no sense to see reports that the Trump administration is considering terminating this work. If avian influenza starts spreading among people, there will not even be enough vaccines to vaccinate all health care workers, let alone farm workers, vulnerable Americans, and others who will want the vaccine. The federal government should be investing in more options, not less.
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Fourth, medical treatments must be improved to prevent serious illness and loss of life if avian influenza spreads significantly among humans. The existing medications to treat H5N1, including oseltamivir, zanamivir, and peramivir, are limited. They must be given early in a patient’s illness and typically have only modest benefit. The COVID-19 pandemic showed us that treatments are essential to lowering morbidity and mortality, especially in vulnerable patients. Now is the time to significantly invest in developing new and better treatments to mitigate severe outcomes. This includes identifying monoclonal antibodies that will work against avian flu and building up a stockpile. Monoclonals were successful during COVID in saving lives and will be a critical tool again.
Finally, there must be continued robust testing of milk samples and wastewater for H5N1. The Centers for Disease Control and Prevention, along with state and local health officials, have made progress, but more must be done, including engaging with farmers and farm workers to ensure they are adequately protected and have access to widespread testing. Taking a proactive approach reduces the risk of disease spread, ensures a safe food system, and protects public health.
There are so many reasons for the Trump administration to take a far more proactive approach to mitigating the risk and consequences of H5N1. Inaction and half measures will drive spread among animals and could lead to a virus that mutates to spread easily among humans and cause a potentially catastrophic pandemic.
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We know enough to act. If we do, we can get these outbreaks under control now, protecting our farms, our pocketbooks, and, most importantly, the health and well-being of the American people.
