President-elect Donald Trump is likely to struggle with the outbreak of bird flu, or H5N1, among livestock and wildlife in the United States, which experts are concerned could become a threat to humans should the spread of the virus not be contained. 

The newly circulating bird flu virus has ravaged the wild bird population, but public health experts and government health officials became increasingly alarmed about it starting in April when the first case of the illness was reported in dairy cattle. 

Since then, more than 800 dairy herds across the U.S. have been infected, and 60 human cases have been confirmed, all derived from direct contact with infected cows or poultry. 

So far, there have been no cases of human-to-human transmission of bird flu, but scientists warn it is possible the virus could mutate to become more infectious to humans if it is allowed to continue to spread among livestock. 

Almost five years ago, the first Trump administration strained to contain the initial outbreak of COVID-19, which arrived in January 2020 and took approximately 1.2 American lives in the first two years. 

President Joe Biden and his Cabinet also struggled to control COVID-19, leading some medical experts to fear the same policy mistakes could be repeated should bird flu become a threat to humans.

Richard Ebright, professor of chemical biology at Rutgers University, told the Washington Examiner that there is “no evidence whatsoever” that federal agencies have learned their lesson since 2020.

“Under the current administration, it is absolutely clear that none of the lessons that can be drawn from the response to COVID-19 were drawn or applied to the H5N1 presence in first wildlife, and then in some livestock species, and then in multiple livestock species in the United States,” Ebright said. “So, the same errors that were made in early 2020 are being made by the same agency.”

Ebright, who has been a longtime advocate of improving biosafety in the field of dangerous pathogen research, said he worried that the problems of epidemic management have not been handled well by administrations from either party.

“The only basis for a positive outlook on H5N1 is the hope, and it is merely a hope, that the virus will face biological pressures, biological obstacles, barriers that prevent it from making the leap to humans because it is not facing social or political or response barriers,” Ebright said.

Scope of the problem

Meghan Davis of Johns Hopkins Bloomberg School of Public Health told the Washington Examiner that the scope of the bird flu epidemic among the animal population is “huge.” 

Since October 2021, more than 117,000 wild birds have reportedly died from H5N1 across 315 species and 79 countries, according to the World Organization for Animal Health. Tens of thousands of marine mammals, mostly in South America, have also died from the virus.

Statistics on wildlife infections are rough estimates, with the real figures likely significantly higher than what scientists have recorded. But data for livestock and human infections in the U.S. are much more concrete. 

“We have at least 60 people in the U.S. infected with H5N1. You’ve got 14 million birds. We’ve got over 800 dairy farms. This is big,” Davis said.

Davis specializes in the interplay between animal and human infectious diseases, but her experience as a dairy veterinarian gives her a unique insight into the bird flu epidemic among dairy cattle. 

Davis said the H5N1 outbreak is a “slightly different equation” than the COVID-19 pandemic in part because of the reliance on the U.S. Department of Agriculture, as opposed to solely the Department of Health and Human Services, to prevent the disease from spilling over into the human population. 

The dairy industry in particular, Davis said, is also more heterogeneous than the poultry or swine industries, which are typically vertically integrated into major food production corporations. This means that an outbreak of avian or swine flu in their respective industries is generally met with a quicker, more centralized response than is possible within the highly stratified dairy industry. 

“With dairy, you’ve got, what, 25,000 farms? I’m going to tell you, you have at least 25,000 decision-makers,” Davis said. “Some farms are going to have more than one because they’re family-owned, and everybody’s got to weigh in.”

Trump administration problems

Trump’s Cabinet picks for USDA, former domestic policy adviser Brooke Rollins, and HHS, Robert F. Kennedy Jr., would be tasked with responding to the bird flu epidemic, as both departments have been working in tandem under the Biden administration to prevent the development of human-to-human transmission.

Davis said she thinks the professional relationships among agency leaders and between federal agencies and state governments will continue to be critical, considering that the states have significant authority over both livestock and healthcare policies within their borders.

“The states still have a lot of autonomy to do some of this work. They gain from really good interactions with the federal authorities,” Davis said. “That benefit at the national level is primarily in really coordinating the response efforts, understanding where one state can influence another.”

Federal policies for human health only tangentially related to the bird flu epidemic among livestock could also have unintended ripple effects on the spread of the virus.

For example, raw milk, for which Kennedy is a staunch advocate, has been found to contain high amounts of H5N1 virus particles and has been linked to several deaths of cats who consumed unpasteurized milk products. Removing the federal ban on the sale of raw milk for human consumption across state lines, Davis warned, could have the unintended consequence of spreading the virus throughout the country and increasing human exposure. 

Ebright said he is troubled that Kennedy, who is highly skeptical of vaccines in general, will not take advantage of H5N1 vaccines stockpiled by the Biden administration, which the current administration has no immediate plans to deploy. 

“Efforts to make stockpiled, existing, federally owned vaccines available to contain an outbreak when an outbreak is a very limited scope, and containable, is an essential step, but it didn’t happen under the current administration, and it’s now at a scale where it is less containable,” Ebright said. “But even if we’re at the same stage, I would be concerned that it would not happen under the incoming administration.”

Before suspending his independent presidential campaign and joining the Trump team this summer, Kennedy raised the suspicion in June that bird flu might have been engineered in a laboratory, citing the financial windfall of the pharmaceutical industry from vaccine production.

Improved testing

Human and veterinary medical experts, along with disease research specialists, have been calling for improved testing protocols for livestock and agricultural workers for months. 

Ebright characterized the limited testing and the slow release of testing results as “the same kind of errors that we saw in the first months of 2020” with respect to human testing for COVID-19. 

Davis said that more mandatory testing earlier in the outbreak “would have enabled us to get a really much better handle on it,” saying the decentralized structure of the dairy industry makes enforcing testing protocols more of a challenge.

Increasing testing of both animals and humans for the virus is likely to result in a spike in the number of confirmed cases. Davis says that this likely just means that “you’re doing a good job hunting for it,” not that the disease poses any greater threat. 

Without national-level testing protocols, Davis says H5N1, or any other virus, can essentially lurk in plain sight. 

“If there are some states that are not doing extensive surveillance, and other states that are doing extensive surveillance,” Davis said, “the virus can hang out and hide without us knowing about it in states that aren’t doing any testing.”

Earlier this month, the USDA implemented a mandatory national milk testing strategy to require dairy farmers to test their unpasteurized milk samples for the virus.

Communication is key

Public health experts reflecting on the experience from COVID-19 have also cited the top-down disruption of the doctor-patient relationship as a driving force behind the loss of trust in government health agencies and science in general. 

This was a central theme of the final report from the House Select Subcommittee on the Coronavirus Pandemic published this month after two years of investigation into how the crisis was managed during both the Trump and Biden administrations.

In the context of the bird flu epidemic, Davis recommended a similar approach for communicating information with dairy workers about the dangers of H5N1 with trusted, local sources instead of hierarchically.

“Part of where we’ve seen some success is when you do have people who are local authorities, for example, your veterinarian who’s coming in, that these are people who often, but not always, have really good relationships, professional relationships, with the industry,” Davis said. 

Davis also emphasized the need for what she called bi-directional communication in which public health experts dialogue directly with industry leaders as equals.

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An important goal, Davis says, must also be to prevent the disease from affecting the swine industry, as pigs are so-called “mixing vessels” in which influenza viruses can mutate effectively to infect humans more easily or become more lethal. But this, too, requires solid dialogue, not top-down dictates.

“Some of these decisions that we make are not scientific. They’re economic,” Davis said. “They are related to, really, not just protecting the dairy industry, but also protecting the swine industry and the poultry industry, and trying to bring all of these very important partners together.”