Thought Leadership

Mosquitoes and Malaria: Could the U.S. Be at Risk?

Mosquito habitats are rapidly expanding in the United States due to climate and environmental changes, exotic species, and urbanization. This raises new concerns about malaria’s re-emergence.

Published November 24, 2025

Image courtesy of anake via stock.adobe.com.

The United States is experiencing a swift expansion of mosquito habitats. Contributing factors include; invasive species, urbanization, climate change, and man-made changes to the environment. Warmer weather, shifting rainfall patterns, and less severe winters allow the Anopheles mosquito to breed and live in more places, and for longer periods of time. This problem becomes more serious as cities expand.

Because mosquito larvae thrive in standing water, which can be found in plenty in urban areas near construction sites, stormwater systems, and containers, mosquitoes are able to plague even the most densely populated urban areas. Another concerning issue is the discovery of a new invasive urban-adapted malaria vector, Anopheles stephensi, in the U.S. Their ability to survive in artificial water sources raises the risk of malaria transmission in previously low-risk areas.

Recent U.S. Malaria Cases Signal a Changing Landscape

In the summer of 2023, there were reports of ten cases of malaria that were locally acquired in the U.S. These were the first cases like this in 20 years and the largest cluster in 35 years. Seven of them happened in Sarasota County, and Florida, indicating focal transmission by local Anopheles mosquitoes. The last three cases were found in Texas, Maryland, and Arkansas. This shows that transmission can happen in places that are far apart when the right conditions are met.

The U.S. records about 2,000 cases of malaria each year, mostly among international travelers and recent immigrants from areas where the disease is common. The ten states that have been hit the hardest are New York, Maryland, California, Texas, New Jersey, Georgia, Virginia, Florida, Massachusetts, and Pennsylvania. The risk of local spread is higher in the summer because more people travel internationally, which is when mosquitoes are most common.

A Changing Climate Reshapes Disease Risk

Climate change makes the planet warmer and changes ecosystems. These changes affect how mosquitoes reproduce, live, and spread diseases. Since 1951, malaria has been eradicated in the United States. But because of rising temperatures and changing rainfall patterns, competent mosquito vectors now have improved chances to thrive. Recent reports of malaria cases in the United States that were acquired locally remind us that getting rid of the disease doesn’t mean we will be safe from it in the future.

Why Temperature Matters for Malaria Transmission

Mosquitoes need warm places to breed. As temperatures rise, Anopheles mosquitoes, which are the main carriers of malaria, can now live in more parts of the country. In the U.S., the number of days with conditions favorable for mosquito activity has increased over the years by an average of 16 days. These changes let mosquitoes live in places that were once too cold for their entire life cycle, which raises the risk of malaria. The Plasmodium parasite needs heat to grow during the mosquito stage of its life cycle. Even small increases in temperature can speed up the growth of parasites in mosquitoes, increasing the likelihood of transmission.

Could Malaria Re-Establish in the U.S.?

In the U.S., malaria can still be spread by mosquitoes, especially when cases brought in from other countries are met with favorable environmental conditions. For re-establishment to happen, there must be three things: competent mosquito vectors, favorable climate, and people who are infected with malaria. The U.S. has strong protective systems, such as constant monitoring, quick case detection, vector control programs, and easy access to healthcare. These systems make it less likely that the country will become a malaria-endemic country. But even with these protections, it’s still important to be careful. To stop a resurgence, there needs to be sustained surveillance and rapid public health action.

Climate Change Makes Global Health Everyone’s Business

Changes in climate are changing how diseases spread around the world. Health risks that used to be limited to tropical areas are now spreading to new places. This change impacts how countries, communities, and people must get ready. The U.S. can’t ignore the signs that malaria might come back, even though it probably won’t come back as bad as it did a hundred years ago. Warmer weather, mosquitoes spreading to new areas, and occasional local cases show that we still need to be careful. Acting on climate change protects public health, ecosystems, and infrastructure. Taking climate change seriously is important for many reasons, including protecting communities from diseases spread by mosquitoes.

Also read: New Insight into the Evolutionary History of Urban Mosquitoes

Vaccines Gave Us Back Our Tomorrows. We’re Squandering Them.

A medical professional gives a patient a shot/vaccine.

More than half a century of vaccine progress, dubbed the “immunization era,” is swiftly being undone because of politics and propaganda.

Published November 19, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP

Image courtesy of InfiniteFlow via stock.adobe.com.

In public health, most victories arrive quietly. No headlines mark the measles case that never happened, or the child spared from polio paralysis. But a landmark analysis released 50 years after the Expanded Programme on Immunization gives voice to those silent triumphs: since 1974, routine immunization has saved 154 million lives and added 10 billion years of human life, making vaccines the single biggest driver of infant survival in the modern era.

For those of us who have worked through outbreaks the study confirms what we already knew: vaccines are the closest thing we have to a time machine. They don’t just prevent death in the present – they create futures, unlocking on average 66 additional years of health.

Courting Amnesia

As a public health and healthcare leader, I’m moved by the evidence. As a mother of four, I’m grounded by something simpler: peace of mind. My kids are up to date on every recommended shot. That doesn’t make our family special; it makes us fortunate to live in a place and time where protection is possible.

And yet we are courting amnesia.

Just a couple months ago, Florida announced plans to become the first state to ban all vaccine requirements, including for schoolchildren. Earlier this year, the United States formally withdrew from the World Health Organization (WHO). In June, it pulled back funding from Gavi, the Vaccine Alliance that helped vaccinate a generation of children and built outbreak stockpiles for cholera, yellow fever, meningitis and Ebola. These reversals, paired with rhetoric that clouds evidence-based policy at home, are eroding the infrastructure that protects vulnerable families abroad. When the U.S. steps away, the ripple effects are felt immediately: in last-mile clinics, health workers are left to decide whether limited cold boxes hold lifesaving measles doses or nothing at all.

The Impact of Preventative Services

As a board member of Project HOPE, which operates in many of these communities abroad, I’ve seen the consequences firsthand. When routine immunization falters, measles resurges first, then polio eradication gets harder and already strained health systems lose the “tugboat” that pulls in preventive services. Vaccines create the scaffolding on which stronger health systems are built, expanding capacity to tackle everything from cancer care to ensuring safe deliveries. Remove that foundation, and decades of progress can collapse almost overnight.

This is not an abstract budget debate. Gavi’s most recent replenishment fell short of its goal. Without U.S. support, an estimated 75 million children will miss out on routine vaccinations and 1.2 million children in low- and middle-income countries will die over the next five years.

I welcome counterarguments so long as we follow where the data leads. The world’s most comprehensive modeling shows vaccines save lives at scale across continents and generations. Since the introduction of polio vaccines in 1955, worldwide cases have dropped by over 99% – from an estimated 350,000 cases in 1988 to just 6 reported in 2021. This massive reduction has saved millions of lives and spared countless children from lifelong paralysis.

Rigorous economic analyses demonstrate that immunization pays for itself. In low- and middle-income countries, returns on investment range from roughly 16:1 to more than 26:1, depending on how you count the benefits, a yield greater than any other health intervention.

A Call to Action

So here is the call, from a public health leader, a humanitarian, and a mom:

Congress should restore sustained U.S. support for Gavi and codify predictable funding for outbreak stockpiles. This is low-cost insurance against pandemics we’d prefer never to fight.
The Administration should reverse course on WHO. Walking away from the body that coordinates global monitoring, and response doesn’t make Americans safer; it makes us blind.
States should align with evidence-based recommendations and invest in trusted messengers to rebuild vaccination confidence.
The CDC must be insulated from politics and provide public health guidance anchored in science, communicated with clarity, and humility. If Americans lose trust in our own health agencies, compliance will erode, inequities will widen, and we’ll be more vulnerable when the next crisis strikes.

Fifty years into the immunization era, the proof is irrefutable: vaccines are time restored, measured in millions of children reaching birthdays they would have otherwise missed. My kids’ protected tomorrows are no more precious than those in Kinshasa, Karachi, or Kansas City. For decades, U.S. support helped eradicate smallpox, drive polio to the brink of extinction, and build the global vaccine architecture that made those tomorrows possible. We should not be the ones to dismantle it home or abroad.

* The views and opinions expressed in this article are those of the author and do not necessarily reflect the views or opinions of The New York Academy of Sciences.*

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Chikungunya on Long Island: A Warning Sign of Our Changing Climate

The recent confirmed case of Chikungunya virus on Long Island marks a significant public health moment for New York. While a single confirmed case is not cause for alarm, it is cause for attention. Climate change is altering disease dynamics faster than many systems are prepared for.

Published October 27, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP

New York health officials have confirmed the first locally transmitted case of Chikungunya virus in the United States since 2019, after a Nassau County resident on Long Island tested positive for the mosquito-borne illness. The patient, who developed symptoms in August, had recently traveled within the country but not abroad.

While one confirmed case does not constitute an outbreak, it marks a notable shift in public health realities and a reminder that the changing climate is influencing disease patterns in ways that demand attention and preparation.

Understanding Chikungunya

Chikungunya is a mosquito-borne viral illness transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes. First described in Tanzania in the early 1950s, its name derives from the Kimakonde language meaning “that which bends up,” describing the stooped posture caused by severe joint pain.

Typical symptoms include fever, rash, and intense joint pain that may persist for weeks, months, or even years. Although rarely fatal, Chikungunya can cause long-term disability and severely impact quality of life. The United States has reported no locally acquired Chikungunya cases since 2019. Historically, local transmission has been rare, confined to cases in Florida in 2014 and Texas in 2015. Each year, roughly 80 to 100 travel-associated cases are reported nationwide, primarily among individuals returning from the Caribbean, South America, and Asia. Before 2006, the virus was seldom detected in U.S. travelers, but since becoming a nationally notifiable condition in 2015, surveillance has documented a steady trickle of imported infections.

A First for New York

State officials have verified that the Nassau County case represents New York’s first known local transmission of Chikungunya. Prior to this, all infections detected in the state were travel related.

In August 2025, the Department issued a Health Advisory on Chikungunya virus, reminding healthcare providers of testing and reporting protocols and noting that while the virus is not routinely found in the United States, it can be imported into new areas by infected travelers. The advisory also highlighted Level 2 CDC Travel Health Notices for regions including Bolivia, the Indian Ocean area, and China, where outbreaks have recently occurred. The mosquito vector Aedes albopictus is well established in downstate New York, including Long Island. Its northward expansion, facilitated by warmer temperatures and wetter summers, is a direct reflection of our changing climate.

Climate Change and the Expanding Reach of Disease

Rising temperatures, shifting rainfall patterns, and longer warm seasons are allowing disease-carrying mosquitoes to thrive in new territories. Climate change doesn’t only warm the planet, it transforms where and when pathogens can circulate.

Around the world, Chikungunya has re-emerged with surprising reach, with local transmission reported this year in parts of France, Italy, and China, in addition to ongoing outbreaks in tropical regions. The Long Island case should therefore be read not as an isolated incident, but as a signal of growing vulnerability. Public health agencies will need to adapt surveillance and prevention systems to meet a future where diseases once considered “tropical” may no longer stay that way.

What New Yorkers Should Know

The risk to the public remains low, according to state health officials, but prevention remains essential — especially during the warmer months when mosquitoes are active, typically from late spring through early fall. New Yorkers can reduce exposure by using EPA-approved repellents such as DEET or picaridin, wearing long sleeves and pants during peak mosquito hours, and eliminating standing water around homes where mosquitoes breed. These precautions should continue until cooler temperatures and the first frosts bring mosquito activity to a halt, usually by October or November. Clinicians are urged to remain vigilant and to consider Chikungunya in patients presenting with unexplained fever and severe joint pain, even in the absence of international travel, as locally acquired infections are now possible.

Preparing Clinicians for a Changing Health Landscape

As climate change reshapes patterns of vector-borne and infectious diseases, clinicians have a vital role to play, not only in diagnosis and treatment, but in public communication. A group of us developed the Climate Health Champions training program to prepare healthcare professionals to recognize and respond to the health impacts of climate change. This initiative helps providers integrate climate-informed care into clinical practice, while equipping them to discuss with patients how rising temperatures and changing ecosystems are affecting their health and well-being.

Clinicians are trusted messengers. By engaging in meaningful conversations about the connections between climate and health, they can empower communities to understand that climate change is not a distant environmental issue, it is a present and growing public health concern. Learn more about this initiative here.

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Finding Calm in the Chaos: Strategies for Mental Resilience

In a time of constant breaking news, ever changing doomscrolls, and, what seems like a never-ending stream of life stressors, the toll on our mental health is real and measurable.

Published June 23, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP and Jessi Gold, MD, MS

Image courtesy of tirachard via stock.adobe.com.

Research consistently shows that prolonged exposure to crisis-oriented media can elevate stress, worsen anxiety, and erode emotional resilience. For healthcare workers, students, and the broader public alike, it can feel impossible to catch our breath. But evidence also shows that even small shifts in behavior can help buffer our minds from the weight of the world. Here are three science-backed strategies to build calm and preserve mental well-being:

1. Practice Mindful Media Consumption

In a world of endless notifications and breaking news alerts, limiting media exposure is not just wise, it’s essential for mental health. According to psychologists interviewed by the American Psychological Association (APA), we are experiencing a surge in what’s now described as “headline stress disorder,” “doomscrolling,” and “media saturation overload.” These terms reflect a growing body of evidence that constant news exposure especially via social media is linked to higher rates of anxiety, depression, and emotional exhaustion, particularly among younger adults and women.

A study during the COVID-19 pandemic in Psychological Trauma identified a direct link between social media news consumption and increased symptoms of depression and PTSD. The takeaway: limit notifications, schedule news check-ins, and create tech-free time daily. Even if it doesn’t always feel like it, what you are looking at can affect your mood and is not mindless—check in with yourself regularly, and listen to your mind and body when it says to take a break or go to sleep.

2. Anchor Your Day with Mindfulness or Breathwork

Mindfulness-based interventions, including guided breathing exercises, are among the most researched and effective tools for reducing anxiety and regulating the nervous system. A meta-analysis in JAMA Internal Medicine confirms that even 10 minutes of daily mindfulness can significantly reduce symptoms of stress and depression. People often worry they don’t have enough time for their own wellbeing, but all of us can find 10 minutes between tasks or Zooms to prioritize ourselves.

3. Create a Routine that Includes Joy and Rest

The uncertainty of global events can leave us feeling helpless. But creating structure through sleep hygiene, regular movement, and deliberate moments of joy offers stability. A study found that daily routines are strongly correlated with better emotional regulation and resilience during periods of collective stress. When you think of grounding yourself in the concepts used in recovery like the serenity prayer, knowing what can and can’t control, makes a difference. Your routine: Is within your control. Find time for sleep, rest, and social support. Maybe even eat a meal with a friend at work instead of alone in front of the headlines.

We are not powerless in the face of uncertainty. By turning inward with compassion, even for a few minutes a day, we can find the steadiness needed to face the changes in the world with clarity and strength.

About the Co-Author

Dr. Gold is the chief wellness officer for the University of Tennessee System and the author of “How Do You Feel?” which focuses on the difficulties of caring for oneself while also caring for others through patient narratives and her personal experience as a psychiatrist caring for healthcare workers.

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Breastfeeding Medicine Is Essential Postpartum Care

A firsthand account of why more mothers should know about it, what exactly they should do, and how it can help.

Published June 6, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP

Image courtesy of pingpao via stock.adobe.com.

Three weeks postpartum, I developed a painful, swollen lump in my breast–mastitis. Despite having breastfed all three of my children for over a year each, and now currently my fourth, I was still caught off guard by the physical toll. I spiked a fever, experienced intense chills, and felt utterly fatigued. I had to pile on two blankets just to stop shivering and spent two full days in bed, only getting up to breastfeed the baby. It was a stark reminder of how vulnerable the postpartum period can be, no matter how experienced you are.

My mastitis persisted for nearly a week. I required antibiotics and tried multiple strategies: warm and cold compresses, therapeutic massage, and nursing in awkward positions to relieve the blockage. On the third day, I sought out a lactation consultant who eventually referred me to a physician specializing in breastfeeding medicine (also known as lactation medicine), a field I wasn’t even aware of until I needed it.

The experience was eye-opening. The clinic provided comprehensive medical care tailored to the unique and complex needs of lactating mothers. Staffed by board-certified pediatricians and International Board-Certified Lactation Consultants, the practice offered deep expertise, careful evaluation, and timely follow-up. Services addressed not only mastitis but also challenges such as low or excess milk supply, painful latch, and breastfeeding after surgery.

Contributing to Therapeutic and Public Health Strategies

Over the years, I’ve experienced an oversupply of breast milk and have frequently donated to milk banks to support other families. During the first year of the COVID-19 pandemic in 2020, just after giving birth to my third child, I participated in a groundbreaking study at the Icahn School of Medicine at Mount Sinai, led by human milk immunologist Rebecca Powell, PhD. In April 2020, I tested positive for COVID-19. Shortly afterward, I joined a research effort examining whether breast milk from women who had recovered from COVID-19 and later, those who were vaccinated, contained protective antibodies that could be used therapeutically.

The study enrolled 1,600 lactating women, including 600 who, like me, had tested positive for COVID-19. Early findings revealed that 14 out of 15 donors had significant levels of virus-reactive antibodies in their milk. These antibodies, known as secretory immunoglobulins, are uniquely suited for mucosal surfaces like the lungs, where respiratory viruses such as SARS-CoV-2 initiate infection.

The idea that breast milk could not only nourish infants but also contribute to therapeutic and public health strategies was both humbling and profound. In a related piece published on the blog for the Harvard Kennedy School’s Belfer Center for Science and International Affairs, I argue how “profoundly alarming” it was when Health and Human Services Secretary Robert F. Kennedy, Jr. removed COVID-19 vaccines from the CDC’s immunization schedule for healthy pregnant women and children.

And yet, despite how vital lactation support is, it often ends the moment a mother is discharged from the hospital. While pediatric care continues seamlessly for the infant, mothers are frequently left to manage complex breastfeeding challenges on their own, with little clinical guidance or structured follow-up.

Safeguarding Health, Dignity, and Resilience

This gap in care is reflected in national data: while 84% of U.S. mothers initiate breastfeeding, only 59% continue at six months, and just 39% at one year. These numbers don’t reflect a lack of motivation–60% of mothers report that they stop breastfeeding earlier than they intended. Instead, they highlight systemic failures: challenges with latching and milk supply, concerns about medications, inadequate parental leave, unsupportive work environments, cultural pressures, and hospital practices that fall short. All of this unfolds during one of the most physically and emotionally demanding times in a mother’s life.

Mastitis alone affects up to 25% of breastfeeding women. It can lead to early weaning, chronic pain, or even hospitalization. Yet many mothers are unaware that medical treatment exists for these complications. Too often, they are left to trouble shoot on their own while exhausted, overwhelmed, and in pain.

The Fourth Trimester, the 12 weeks following childbirth, is a critical period of recovery and adjustment for both mother and baby. Yet it remains one of the most neglected phases in maternal healthcare. Mothers are typically discharged with minimal support and may not see a provider again for six weeks, even as their infants receive multiple well-child visits during that same period. This disparity in care must be addressed.

Whether navigating breastfeeding for the first time or the fourth, mothers should not have to go it alone. Breastfeeding medicine should be fully integrated into routine postpartum care, just as pediatric care is standard for newborns. Supporting mothers in this way isn’t just about helping them feed their babies, it’s about safeguarding the health, dignity, and resilience of families and communities.

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Whooping Cough Is Surging in the U.S.: What You Need to Know

The United States is facing a sharp and deeply concerning resurgence of pertussis, better known as whooping cough, a vaccine-preventable illness that was once nearly eliminated thanks to robust public health efforts.

Published May 5, 2025

Image courtesy of 9nong via stock.adobe.com.

By Syra Madad, DHSc, MSc, MCP, CHEP, and Boghuma K. Titanji, MD PhD

To date in 2025, the Centers for Disease Control and Prevention (CDC) has reported over 8,000 cases of whooping cough, a more than two-fold increase from the same time last year. At the current rate, the nation could see up to 70,000 cases by year’s end, more than doubling last year’s total. If this trajectory continues, the United States may experience the highest number of infections since the introduction of the pertussis vaccine in 1948.

What Is Whooping Cough?

Whooping cough is a highly contagious respiratory illness caused by Bordetella pertussis. It spreads through respiratory droplets when an infected person coughs, sneezes, or breathes near others. Symptoms begin like a common cold, runny nose, low-grade fever, and mild cough but progress to violent coughing fits that can last for weeks. The characteristic “whoop” occurs as the patient gasps for air between spasms. In severe cases, the force of repeated coughing can lead to rib fractures, which may then result in lung collapse, or pneumothorax, a potentially life-threatening complication.

For infants and young children, pertussis can be life-threatening. Complications include pneumonia, seizures, encephalopathy, and even death. Health officials have reported three recent pediatric deaths linked to whooping cough, two infants in Louisiana and a child under 5 in Washington state who died in late 2024. Infants under one year of age face the highest risk of severe illness and death, as their immune systems are not yet fully developed, and this group consistently accounts for the highest rates of reported pertussis cases.

Why Are Cases Rising?

Several converging factors are driving this resurgence:

Declining Vaccination Rates: In 2024, the CDC reported that less than 93% of kindergarteners were vaccinated against pertussis, falling from 95% in 2019.
Vaccine Hesitancy and Misinformation: The rise in anti-vaccine sentiment has had a measurable impact on immunization rates. This includes increasing vaccine exemptions and a decline in timely childhood vaccinations. Social media disinformation, politicization of vaccines, and public figures promoting skepticism have all contributed to declining coverage, fueling the resurgence of pertussis.
Waning Immunity: The acellular pertussis vaccine introduced in the 1990s was designed to reduce side effects like fever and injection site reactions. However, it is less durable than the older whole-cell vaccine, with immunity diminishing over time.
Genetic Mutation of the Pathogen: Emerging evidence indicates that Bordetella pertussis is evolving in ways that may affect vaccine effectiveness. Studies from CDC surveillance and genetic sequencing are ongoing to understand the implications of these changes.

Treatment and Prevention

There is no treatment that effectively halts the hallmark coughing fits once they begin. The clinical manifestations of the disease are mediated by bacterial toxins which damage the delicate hairlike structures (cilia) on the cells that line our airways. The main function of cilia on respiratory tract cells, is to help with clearing mucus. Once the damage is done, administering antibiotics for treatment does not reverse it, nor does it speed up the recovery and repair of these cells. Antibiotics such as azithromycin are instead used to reduce transmission by eradicating the bacteria from the nasopharynx–prevention through timely vaccination remains the most effective tool.

The Vaccine: Safe, Effective, and Critically Underused

Pertussis vaccines have been in use for decades, are well studied, and significantly reduce the severity of illness and prevent hospitalizations and deaths. CDC-recommended vaccination and booster timing includes:

Vaccine	Target Group	Doses	Booster Needed
DTaP	Infants and children	2, 4, 6 months	Boosters at 15-18 months and 4-6 years
Tdap	Preteens and teens	Age 11 or 12	Every 10 years
Tdap	Pregnant individuals	Each pregnancy (27–36 weeks)	Protects infant via maternal antibodies
Tdap	Adults	If not previously vaccinated	Every 10 years thereafter
Tdap	Adults in close contact with infants under 1 year	One dose	To reduce risk of transmission to vulnerable infants

While no vaccine is perfect, vaccinated individuals are far less likely to experience life-threatening complications.

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Containing Ebola in a Shifting World

A conversation with Uganda’s outbreak commander as the African nation deals with the ramifications of the 2025 Sudan Ebola outbreak.

Published April 10, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP

This transmission electron microscopic (TEM) image revealed some of the ultrastructural morphology displayed by an Ebola virus virion. Image courtesy of Dr. Frederick Murphy via CDC.

In a world confronted with a growing tide of infectious disease threats, the 2025 Sudan virus outbreak in Uganda serves as a stark reminder that epidemic intelligence must evolve from being reactive to anticipatory.

Increased human encroachment into wildlife habitats, and shifting global health funding landscapes, means that diseases like Ebola, once considered rare and geographically isolated, are emerging with greater frequency and unpredictability.

To better understand the shifting dynamics of this outbreak and its implications for the future of global health security, I spoke with Henry Kyobe Bosa, PhD, Uganda’s National Incident Commander for Epidemics. A distinguished public health leader, Colonel in the Uganda People’s Defense Forces, and seasoned epidemiologist, Dr. Kyobe has led responses to some of the most complex health emergencies in the region, including Uganda’s COVID-19 response and the current Sudan Ebola outbreak.

In this timely and sobering conversation, Dr. Kyobe shares firsthand insights into the evolving trajectory of this year’s Ebola outbreak, the innovations and tools Uganda is using to contain it, and the global lessons we must heed. Dr. Kyobe’s remarks have been lightly edited for clarity and length.

As Uganda’s National Ebola Incident Commander, can you walk us through the current state of the Sudan virus outbreak from its initial detection to the most urgent challenges your response teams are facing today?

The 2025 Sudan virus outbreak in Uganda is a unique phenomenon. Unlike all previous outbreaks (n=7), this one was first identified in the capital, Kampala, a metropolitan city of over 6 million inhabitants, with complex transnational and national travel routes. This created initial challenges, as the index case, a 34-year-old male nurse working in a children’s ward at the national referral hospital, was diagnosed with Ebola only after death.

Prior to his passing, he had seeded two clusters: an extended family cluster (involving his mother, brother, son, and housemaid), and a hospital cluster (three healthcare workers from a private facility where he had sought care).

Since then, another cluster, again a family cluster has emerged. Apart from a temporal relationship that suggests either a point source or common source transmission, there is no epidemiological link between the two transmission chains.

These two chains, though involving relatively few cases, quickly spread to three of Uganda’s ten cities, spanning from the eastern district of Mbale to the western district of Ntoroko, with contacts identified in over 15 districts. This early spread posed a significant threat of rapid outbreak expansion.

This all occurred amid an ongoing mpox outbreak, Uganda is currently the second most burdened country for mpox globally and at a time when the U.S. was revising funding support to many health systems in the country, some of which play complementary roles in Ebola response.

As of now, it has been over 10 days since the last confirmed case tested negative for Sudan virus and was discharged. The overall response infrastructure remains in place and will continue until after 42 days (two incubation cycles) before transitioning to another phase of optimum control. We are keenly monitoring and looking forward to this milestone.

Given that this is Uganda’s sixth outbreak of Sudan virus since 2000, what have these recurrent episodes taught us about the nature of Ebola and its persistence in animal reservoirs? Are these outbreaks becoming more frequent or harder to contain and if so, why?

The 2000 Sudan virus outbreak remains the largest in Uganda and the third largest Ebola virus outbreak globally. Since then, successive outbreaks have occurred in different regions of Uganda. Notably, no two successive outbreaks have originated from the same location, not even this one.

As with previous outbreaks, the natural reservoir of Sudan virus, the possible presence of transient hosts, and the mechanisms of spillover remain elusive. What is clear so far is that the virus continues to resurface under unpredictable conditions.

Many people associate Ebola with terrifying headlines from past outbreaks. For someone reading this from New York or Los Angeles, why should they care about an Ebola outbreak happening thousands of miles away in Uganda?

Ebola is a highly infectious disease with high mortality among those infected. We saw this in the 1970s and more recently, 11 years ago in West Africa, where over 11,000 people died in three countries in just two years, with nearly 24,000 total cases. The outbreaks also devastated the economies of those countries.

Any suboptimal response to Ebola anywhere is a threat to global health security. It increases the likelihood of disruptions to international trade and travel.

The negative impacts of Ebola have not changed much since the virus was first identified 50 years ago. What has changed, however, with successive outbreaks, is the growing efficiency of outbreak response. While traditional tools like contact tracing, quarantine, and movement restrictions remain important, new advancements have helped us slow transmission and reduce outbreak size. For instance, in this current outbreak, the rVSV ring vaccination trial was launched just four days after the outbreak was declared.

While there are currently no Ebola cases outside of Uganda, what should healthcare systems in the United States be doing right now to prepare for potential importation of cases? What’s your message to frontline clinicians and emergency managers across the U.S.?

The risk of cross-border transmission beyond Uganda is currently remote. We have identified all known contacts, placed them in institutional quarantine, and added them to no-fly lists in accordance with International Health Regulations guidelines to protect other countries.

That said, individuals presenting with persistent febrile illness, with or without hemorrhagic manifestations and recent travel from Africa should be evaluated for possible viral hemorrhagic fevers, not just Sudan virus.

As someone who led Uganda’s response to both COVID-19 and now this Ebola outbreak, what do you believe are the core lessons we must carry forward to build resilient, community-trusted public health systems both in Africa and globally?

For a long time, we’ve relied on traditional public health tools. They’ve been effective, but also costly for populations and often associated with prolonged outbreaks. We must increasingly rely on newer and more effective tools.

Today, we can use cellphone data to collect temporal geospatial information to understand individuals’ movements and interactions and identify contacts.

In this outbreak, we deployed remdesivir in real-time because we had a balanced stock from the 2022 outbreak, effectively a stockpile. We probably would not have saved all 10 patients who arrived alive at treatment centers without this stock. Stockpiling essential commodities is critical.

Modernizing surveillance systems and ensuring they are appropriately linked to effective laboratory networks is critical. In the current outbreak, an existing mortality surveillance system detected the outbreak just in time, as it had already spread to three cities and several districts. This early detection was timely; had we missed this case, the outbreak could have grown exponentially.

There’s a lot of mistrust in public health around the world right now, especially after COVID. How are you working with communities in Uganda to build trust, fight misinformation, and encourage people to seek care early?

Misinformation takes many forms. The most valuable asset a public health worker can have is the trust of the community they serve.

The best way to maintain that trust is to be reliable.

We must be truthful, reliable, and consistent even when evidence changes in the face of new information. Our public health predecessors succeeded because they remained honest.

To fight misinformation, we must get ahead of the curve and provide correct information in real time. Only then can we progressively rebuild public trust.

What does success look like to you in this outbreak response, not just in stopping the virus, but in what we build afterward?

Success means being able to document best practices from this outbreak and learning from the mistakes of the past.

Want to be part of an impactful network of scientists across the globe? Join the Academy’s International Science Reserve.

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Understanding Hantavirus and How to Stay Safe

Hantavirus pulmonary syndrome, or HPS, has been in the news lately following the death of Betsy Arakawa, wife of actor Gene Hackman. But what is HPS?

Published March 12, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP and Waleed Javaid, MD, MBA, MS, FACP, FIDSA

Hantavirus pulmonary syndrome is spread through contact with rodents. Image courtesy of Art Johnson via stock.adobe.com.

The recent passing of Betsy Arakawa, wife of actor Gene Hackman, due to hantavirus pulmonary syndrome (HPS), has brought this rare but serious disease into public focus. Hantaviruses are a family of viruses primarily transmitted to humans through contact with infected rodent excreta, particularly urine, droppings, or saliva. In the United States, the deer mouse (Peromyscus maniculatus) is a common carrier.

HPS typically begins with nonspecific, flu-like symptoms such as fever, fatigue, and muscle aches. As the disease progresses, patients may experience coughing and shortness of breath due to fluid accumulation in the lungs. The mortality rate for HPS is approximately 35%. There is no specific treatment or vaccine for hantavirus infections; therefore, prevention, early recognition and supportive medical care are crucial.

More than 800 Cases Since 1993

Since the Centers for Disease Control and Prevention (CDC) began tracking hantavirus infections in 1993, a total of 864 cases have been reported in the United States through 2022. The majority of these cases have occurred in the western states, particularly in the Four Corners region, where Arizona, Colorado, New Mexico, and Utah converge. Notably, New Mexico has reported the highest number of cases, with 122, followed by Colorado with 119 cases. This distribution underscores the importance of heightened awareness and preventive measures in these areas to mitigate the risk of hantavirus exposure.

In New York State, hantavirus cases are exceedingly rare. Since surveillance began in 1993, there have been five identified cases. Notably, a case reported in 2017 involved a Long Island woman who contracted the New York orthohantavirus, leading to severe respiratory failure and cerebral complications. Ultimately, the patient required surgical intervention and was asymptomatic after one year of treatment.

Minimizing Risk

To minimize the risk of hantavirus exposure, individuals should:

Control rodents both inside and outside the home, as this is the best way to prevent hantavirus.
Remove and secure trash around the home and workplace to limit rodent access.
Seal holes and gaps in homes to prevent rodent entry.
Call a professional exterminator if the infestation is severe.
Store food in rodent-proof containers to reduce the likelihood of attracting rodents.
Dispose of dead rodents properly by using gloves, placing the animal in a double plastic bag, and discarding it in the trash—avoiding direct handling.
Use gloves, a mask, and disinfectants when cleaning areas contaminated by rodent droppings. Avoid actions that can aerosolize the virus, such as sweeping or vacuuming.
When cleaning rodent droppings, wet them down first with a 10% bleach solution and wear gloves to minimize exposure risk.
Avoid contact with rodents and rodent burrows when spending time outdoors in areas where hantavirus may be present.

While hantavirus infections remain rare, the tragic death of Betsy Arakawa underscores the importance of awareness and preventive measures, especially in areas where human-rodent interactions are more likely.

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About Waleed Javaid, MD, MBA, MS, FACP, FIDSA, FSHEA

Dr. Waleed Javaid is Professor of Medicine and Hospital Epidemiologist at the Icahn School of Medicine at Mount Sinai.

Then Along Came the Second Trump Administration

Academy President and CEO Nicholas B. Dirks highlights some of the ways higher education and science in the United States are under threat during the second Trump Administration.

Published March 12, 2025

Originally published by Times Higher Education

By Nicholas B. Dirks

A 1940 Group photo of E. O. Lawrence, A. H. Compton, V. Bush, J. B. Conant, K. Compton, and A. Loomis. Image courtesy of the U.S. Department of Energy/Lawrence Berkeley Laboratory via Wikimedia Commons.

There was little direct federal support for US scientific research until the National Defense Research Committee was convened in 1940. But on the back of the committee’s key role in developing radar, sonar and the nuclear bomb, its instigator, former MIT vice-president Vannevar Bush, wrote a report, The Endless Frontier, laying out a vision for the creation of a post-war National Science Foundation.

Established in 1950, the NSF provided unprecedented funding for fundamental research, conducted principally in America’s universities by faculty researchers whose projects were evaluated by scientific peers. The National Institutes of Health (NIH), which dates back to the late 19th century, also grew dramatically in the post-war years. And, together, the two agencies turned institutions that had previously struggled to support science into the gold standard for research universities globally.

Science may still be the “endless frontier”, but the federal funding that came as a result of Bush’s influential report may not be.

By 1964, government funding for research and development hit 1.9 per cent of US GDP, amid bipartisan support. But in recent decades it has fallen back to 0.7 per cent. The real growth in support over that period has come from the private sector, but, important though that is, it is too often confined to applied and proprietary research. Real progress, by contrast, is critically dependent on the open, global scientific ecosystem of fundamental research.

The 2023 State of Science in America report by the Science and Technology Action Committee (a non-partisan alliance of non-profit, academic, foundation and business leaders) strongly endorsed the importance of dramatically increasing federal support for science. The justifications voiced in surveys conducted across multiple sectors, including as many self-identified Republicans as Democrats, included a belief that science powers both the economy and national security and a concern that China was spending a much higher percentage of its GDP on research.

But then along came the second Trump administration.

While the effort to dismantle DEI in government offices, corporations and universities was announced in advance, the abrupt halt of NIH and NSF funding took universities by surprise. And even as some funding resumed, programmes presumed to have any connection to DEI “policies” or “preferences” (a far broader interpretation of DEI than had been expected) were peremptorily cancelled, along with other research programmes connected to concerns about climate change.

At the same time, a new – extremely low – cap on overhead rates was set at 15 per cent, abruptly withdrawing support for necessary scientific equipment, infrastructure and other real costs of research. Meanwhile, programme officers and other administrators have been fired, and elaborate protocols for granting and administering funding have been disrupted in ways no one seems yet able to grasp fully.

The consequences of all this are likely to be dire. Scientific research not only helps to drive the economy: it is the core reason why US technological innovation has exceeded that of any other nation. And while it may be commonly overlooked, federally funded research really is the bedrock of that dynamic.

For example, there is a popular myth that Steve Jobs and his team at Apple invented the iPhone. They did package an array of technologies in a single device with nifty design features, to be sure. But, as Mariana Mazzucato has shown in her 2011 book The Entrepreneurial State, those technologies – including the internet, GPS, touchscreen displays and voice-activated Siri – derived from federally supported research.

There are many reasons for the populist scepticism, distrust and downright dislike of science and research universities. Some of these reasons are doubtless our own fault. But it should not only be those directly affected who are upset by the prospect of dismantling the research apparatus of “elite” universities – where the bulk of non-profit scientific research in the US is conducted.

It will also do irreparable harm to the world’s entire scientific, technological and biomedical enterprise, not to mention US prosperity, security and health. University leaders may be correct to be cautious in voicing their alarm, but they would not be wrong to panic. Along with all the rest of us.

What You Need to Know About H5N1 Bird Flu and Everyday Precautions

Guidance on navigating the ongoing avian flu outbreak including how to prepare food, maintain bird feeders, and keep pets safe.

Published February 26, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP

Image courtesy of azerbaijan-stockers via stock.adobe.com.

The highly pathogenic avian influenza (HPAI) H5N1 virus, commonly known as bird flu, is making headlines and leaving its mark on grocery shelves. Just last week, I visited two supermarkets, both completely sold out of eggs. Over at a corner bodega in NYC, a dozen eggs were going for a jaw-dropping $16.99. Before bird flu hit, that same dozen cost only a fraction of that. It’s clear that the ripple effects of this virus go beyond the headlines—right down to our daily menu.

Initially spreading among domestic waterfowl, the virus has now migrated to commercial poultry, mammals, cattle, and a host of other animals across the United States. As of February 26, 2025, there have been 70 confirmed, sporadic human cases in the United States. Exposures have been largely tied to dairy herds (58.6%) and poultry operations (34.3%), with smaller proportions linked to other animal exposures (2.9%) and unknown sources (4.3%). The Centers for Disease Control and Prevention (CDC) currently assesses the public health risk as low, with no documented human-to-human transmission, but vigilance remains essential.

Public health agencies are closely monitoring the situation, individual vigilance, such as following proper food safety protocols and being mindful of interactions with pets and wildlife, remains essential in preventing infection. While there is growing concern about the spread of H5N1 to humans, practicing a few hygiene protocols should help to mitigate risk.

1. Are Eggs, Chicken, and Beef Safe to Eat?

The good news: Poultry, eggs, and beef are safe to eat when properly handled and thoroughly cooked. According to the CDC, there have been no reported cases in the U.S. of people contracting H5N1 from food prepared using standard safety practices. However, in Southeast Asia, a small number of avian influenza A virus infections have been linked to the handling or consumption of raw or undercooked poultry and related products, such as blood.

Essential food safety tips include:

Poultry and Eggs: Cook all poultry products to an internal temperature of 165°F (74°C). This includes ensuring scrambled eggs are fully set and avoiding runny yolks in fried or poached eggs.
Egg Safety: Commercial eggs in the U.S. undergo washing and sanitization, significantly reducing risk. Still, always refrigerate eggs and avoid consuming raw dough or batter containing eggs.
Beef: Ground beef should reach 160°F (71°C), while whole cuts should be cooked to at least 145°F (63°C) with a three-minute rest period.
Prevent Cross-Contamination: Keep raw meat separate from ready-to-eat foods. Wash your hands, utensils, and cutting boards thoroughly with soap and water after handling raw meat.

These steps not only protect against H5N1 but also other foodborne pathogens like Salmonella and E. coli. Always wash your hands with soap and warm water for at least 20 seconds after handling raw or undercooked foods! Not sure how long that is? Try singing the “Happy Birthday” song twice while scrubbing to make sure you’re washing long enough.

2. Should I Take Down Bird Feeders?

Bird feeders are a favorite for many of us (myself included), but they can serve as gathering spots where diseases spread among wild birds. The U.S. Department of Agriculture (USDA) doesn’t universally recommend removing bird feeders unless you keep backyard poultry or live near poultry farms.

If you choose to keep your feeder up:

Wear rubber gloves when refilling your feeders or touching them for any reason.
Clean feeders with a bleach solution routinely (wearing appropriate PPE).
Remove spilled seed to prevent attracting large flocks.
Keep pets and children away from feeders and droppings.

If you spot a sick or dead bird:

Do not touch it with bare hands.
Report it to your state’s wildlife agency or the USDA’s wildlife services.
Wear appropriate PPE and wash hands thoroughly after handling feeders or cleaning up around them.

3. Why Avoid Raw (Unpasteurized) Milk?

The detection of H5N1 in nearly 1,000 U.S. dairy herds is concerning. Raw (unpasteurized) milk can harbor the virus, along with other dangerous pathogens like Listeria and Salmonella. Pasteurization, heating milk to a high temperature for a set period, kills these germs, making it the safest choice.

Why skip raw milk products:

Raw milk from infected cows is “teeming” with the virus, potentially posing a direct infection risk.
Vulnerable populations (children under 5, pregnant women, older adults, and immunocompromised individuals) are especially at risk.

Safety tip: Always check labels to ensure dairy products are pasteurized. Refrigerate perishables at 40°F (4°C) or colder and discard expired items.

4. How Can I Keep My Pets Safe?

Pets, particularly cats and dogs, can be exposed to H5N1 through contaminated environments or foods. Alarmingly, there have been recent recalls of raw pet food products due to H5N1 contamination.

To protect your pets:

Avoid raw pet diets: Cooked, commercially prepared pet foods are safest.
Wash hands after feeding pets or cleaning bowls and after handling any raw pet food.
Don’t let pets roam in areas with sick or dead birds or on farms with infected poultry or cattle.
Stay updated: Monitor pet food recall notices and consult your veterinarian for concerns.

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