3 issues to watch in public health in 2026

We warned you late last year that 2025 was likely to be pretty rock ’n roll. Confession time: We had no idea it would be as cuckoo bananas as it turned out to be. 

That the administration would summarily terminate most global health aid by shuttering the U.S. Agency for International Development? Completely disrupt grant-funded scientific research around the country? Take a sledgehammer to the Centers for Disease Control and Prevention? Those weren’t on the bingo card. (Well, given how deeply Covid-era resentments run, the dismantling of the CDC may be less of a surprise.)

The appointment of a fervent vaccine opponent — Robert F. Kennedy Jr. — as secretary of the Department of Health and Human Services has already led to extraordinary changes in vaccine policy in the U.S. More are definitely on the horizon, as my colleague Daniel Payne recently explained.

So what else might 2026 hold for the fields of public health, both domestically and abroad? We’re probably only scratching the surface here, but these are some things we expect to be dealing with in the months ahead.

Can the CDC still be trusted?

Long considered the world’s preeminent public health agency, the Atlanta-based CDC is now a shadow of its former self. Its workforce has been subjected to successive rounds of layoffs, leaving it with thousands fewer workers than it had at this time last year. There is no Senate-confirmed CDC director, and perhaps little prospect that one will be in place any time soon. Many senior leaders, scientists who rose through the agency’s ranks, have left. An agency where scientific and public health bona fides were the order of the day now finds itself led by a coterie of political appointees.

When Rochelle Walensky was director from 2021 to 2023, in the Biden administration, she had one political appointee in her office. Now the office of the director is staffed with at least 18 whose qualifications make them a puzzling fit for the leadership of an organization charged with safeguarding the nation’s health. Few have any public health or medical credentials or experience. 

The impact of politicization of the agency is becoming apparent. The CDC’s website no longer uses the term mpox for the poxvirus disease related to smallpox; it has reverted to the term monkeypox, which Tedros Adhanom Ghebreyesus, director general of the World Health Organization, urged the world to drop in 2022 — echoing other health experts — because countries where the virus was endemic found it racists and stigmatizing. Scientists from the CDC’s Center on Emerging and Zoonotic Infectious Diseases were not involved in the decision, STAT has been told.

The section of the CDC’s website devoted to the question of whether vaccines trigger autism — a claim debunked by a multitude of studies — was changed to suggest that the question was still an open one. The alteration was made on orders from Kennedy himself. Staff were appalled.

An advisory group that helps the CDC set vaccination policy has been completely overhauled, with former members fired and replaced with a group of people short on relevant experience but long on anti-vax credentials. 

Increasingly, experts are warning that the credibility of the CDC as a source of science-based information is in peril. Professional organizations like the American Academy of Pediatrics have urged their members to ignore new vaccine advice from the agency. 

The remaining CDC staff report being demoralized, but are trying to do their jobs. The question remains, though, how deep the political interference will be allowed to infiltrate the operation. The CDC compiles critical data used by academic researchers and public health departments. Is the integrity of that data at risk? 

So much has changed at the agency in less than a year under Kennedy’s leadership. Will the CDC be recognizable this time next year?

Will U.S. anti-vaccine policy spread abroad?

In early November, Kennedy posted a video on the social media site X that he had recorded for delegates to an international convention on a treaty to reduce human exposure to mercury. The health secretary urged the countries taking part to ban the use of thimerosal in multi-dose vaccine vials, which include the preservative in much of the world to help prevent contamination. 

Kennedy and his allies allege thimerosal in vaccines may be responsible for neurodevelopmental problems in children. Scientific studies do not support the claim. Thimerosal contains ethylmercury, not methylmercury, the target of the treaty.

Vaccine proponents didn’t expect countries at the convention to follow Kennedy’s recommendation. But some experts fear this kind of discussion could nonetheless have consequences. 

Most parents in low- and middle-income countries wouldn’t be familiar with the voluminous research on thimerosal. What they may hear, though, is that the U.S. thinks a component in multi-dose vaccine vials poses a health risk, or that the U.S. president thinks children are getting too many vaccines over too short a timeframe (vaccine experts say this is false), or that combination vaccines like measles, mumps, and rubella should be given as individual shots (vaccine experts say this is unnecessary and would reduce uptake).  All this could influence the way people elsewhere feel about getting their children vaccinated against disease threats. 

Philanthropist Bill Gates shares that concern. “Vaccine skepticism in the U.S. kills more children outside the U.S. — because it transfers that skepticism — than it does inside the United States,” he said in early August at a STAT event.

At the individual level, views about vaccines can be shaped by … vibes. If the U.S. limits vaccine access for American kids, will parents elsewhere question whether something like the combined MMR shot is safe for their children? 

Relatedly, will the administration’s normalization of the spread of measles affect the way other countries think about how hard they should try to limit the spread of the highly contagious virus within their borders? The United States has had more confirmed measles cases this year — 2012 as of just before Christmas — than in any year since the early 1990s, when a decision was made to give measles vaccine in two doses to try to strengthen the immunity the vaccine generates. The country recorded three measles deaths in 2025; there haven’t been so many measles deaths in a single year this century.

Kennedy’s response to the report of the first death this year, which occurred in West Texas, was to downplay the risk measles poses, saying “we have measles outbreaks every year.” 

That was in February. While transmission in West Texas ended a while back, there are other measles hotspots now, notably South Carolina. It’s unclear whether more recent cases are part of the transmission chain that ignited the West Texas outbreak. The New York Times, citing a conference call between CDC officials and state health departments, suggested the virus strain from the outbreak continues to circulate; HHS disputes that, saying “no epidemiological link” has confirmed the more recent cases are part of that earlier chain of transmission. It didn’t rule out the possibility, however.

The Pan American Health Organization, the WHO’s regional office for the Americas, says its measles elimination verification commission will meet at some as-yet-undetermined point after Jan. 20, the one-year anniversary of the first known case in the Texas outbreak, to examine U.S. data. If links between recent cases and the West Texas outbreak can be established, the country could lose its measles elimination status, as Canada did in November. 

If some of the world’s richest countries can’t or won’t contain the spread of measles within their borders, will that give nations with fewer resources license to ease up on their efforts?

That topic you wish we’d never raise again

Here’s the thing: It’s just a fact that the further out we get from the Covid-19 pandemic, the closer we get to the next pandemic. We’re not suggesting there is another one visible on the horizon. But there will be more pandemics. And the Trump administration has been dismantling the systems that had been built to respond to them, whenever they come.

Maybe we’ll be lucky. There was a 41-year stretch between the 1968 H3N2 flu pandemic and the H1N1 pandemic of 2009. But there were only 11-year gaps between the 1957 and 1968 flu pandemics and between H1N1 and the start of Covid-19. (Two 11-year data points shouldn’t be interpreted as a pattern; these things aren’t on a fixed schedule.) We’re now six years out from the start of Covid. We need to be thinking ahead.

Rather than building on what we learned in Covid  — like how to make new vaccines, in mass amounts, even faster — HHS, under Kennedy, canceled grants aimed at helping the vaccine manufacturer Moderna to test and license flu vaccines for strains considered to be pandemic risks, which would have vastly sped the company’s path to market if bird flu pandemic begins. There’s zero market incentive for the company to do this work on its own dime. 

The administration, which has openly distrusted mRNA-based vaccines like Moderna’s, has instead committed half a billion dollars to a project to make a universal flu vaccine using technology many experts consider to be passé, technology which is unlikely — if it works — to offer the production speed of mRNA. 

The U.S. is pulling out of the WHO, and refuses to interact with the agency as the clock on its formal departure winds down. This retreat from international collaborations comes at a cost that is already becoming evident. The CDC’s flu lab, one of the leading influenza laboratories in the world, is getting fewer viral submissions from other countries. 

The upshot of all this? The U.S.’s sightline of what is going on globally is shrinking, at a time when vaccine manufacturers surely feel uncertain about the stability of this market. That’s not a formula for pandemic preparedness.