“People Will Die:” Fmr. CDC Official Warns Against HIV/AIDS Cuts

BIANNA GOLODRYGA: Well, 2025 has been a pivotal year in the United States, marked by major, fast-moving changes in politics, the economy, and of course, healthcare. Physicians across America are grappling with the controversial CDC advisory panel decision to end recommending universal hepatitis B shots for babies. This after the U.S. government did not commemorate World AIDS Day last week, shaking up its approach to HIV/AIDS treatment and prevention.

 

In August, Dr. Demetre Daskalakis resigned from the CDC, accusing the agency under Robert F. Kennedy Jr. of ignoring science. Here he is with Hari Sreenivasan.

 

HARI SREENIVASAN: Bianna, thanks. Dr. Demetre Daskalakis, thanks so much for joining us. World AIDS Day just went by and there was a State Department email sent out that said, “Refrain from publicly promoting World AIDS Day through any communication channels, including social media, media engagements, speeches, or other public facing messaging.” And you’re an infectious disease physician who’s dedicated his career to fighting HIV and AIDS. What was your reaction to this?

 

1. DEMETRE DASKALAKIS: Sadly, it was one of not being surprised. I think that this was really symptomatic of the bigger problem, which is the current administration dismantling so many of the systems globally and domestically that have been critical in, in getting us to a place in the, the fight against HIV, where we could potentially see the end of the HIV epidemic in sight – not only go in the US but around the world.

 

SREENIVASAN: The State Department’s justification for this was saying, look, awareness is not a strategy. This doesn’t necessarily solve HIV. We’re doing lots of real work with other countries to try to bring the number of infections down. What’s, what’s wrong with their thinking?

 

DASKALAKIS: Yeah. I mean, what’s wrong with the thinking is that it’s, I agree with them that the commemoration day is not a strategy. But they’re dismantling all the strategies. So I think that it’s a little bit of a bait and switch to say that the commemoration day is not a strategy when they are really attacking PEPFAR, which is responsible for saving 26 million lives. It is critical in making sure that people are getting antiretroviral therapy. And then also accounts for about 90% of the global pre-exposure prophylaxis for the world. That is a strategy, and they’re attacking that as well. So I think that that’s, that’s the problem. There’s double speak. And there’s deflection from the reality that yes, not commemorating World AIDS Day does not necessarily mean that there’s no commitment. What means there’s no commitment is the actions that they’ve taken showing that they want to dismantle the strategies that have worked in the past.

 

SREENIVASAN: So let’s talk a little bit about PEPFAR.

 

DASKALAKIS: Yeah. 

 

SREENIVASAN: I think for people who aren’t that familiar with it. I mean, this was something that has been supported by every administration since it’s been formed — starting with the Republican administrations, right? And this is credited with the types of life saving that you’re talking about, literally in the 24 to 26 million human beings range. And, and it delivers all sorts of HIV testing, antiretroviral, antiretroviral therapies, prevention of mother to child transmission. But it kind of has, in the United States, a couple of different parents, if you will, when it comes to funding. It’s got the State Department and then it’s got HHS or CDC. So what specifically are happening to those sources of funding that are threatening the success or continuance of PEPFAR?

 

DASKALAKIS: Yeah, so, I think one of the important things is that uncertainty around funding has resulted in paralysis of the program. So the first is that that USAID was completely dismantled in the first few months of the administration. For a while, they actually even stopped sending resources to the countries that were being supported by PEPFAR. And through various legal injunctions, et cetera, some of that money flows again. But ultimately you know, there has been an interruption in providing lifesaving antiretroviral therapy, which has manifested itself in tens of thousands of people that have already died — per some of the models that I’ve seen. And so you know, there’s the dismantling of USAID and now also likely an attack on CDC with the president’s budget really not supporting global public health at CDC. So that could mean unplugging of what is one of the most important public health interventions globally — which is PEPFAR — that has, as you said, saved, you know, 26 plus million lives.

 

SREENIVASAN: So, you know, just to put it in perspective for people, I think globally, there were 1.3 million new HIV infections, right? This is not something that we have completely beaten. It is still happening. It is still being transmitted to children from mothers, in between individuals. What’s the status of PEPFAR today? I mean, if these sources of funding are threatened?

 

DASKALAKIS: PEPFAR’s future is tenuous at best. You know, I, it seems as if there is some ongoing commitment to PEPFAR, but it seems as if it is potentially very short-lived. And, and doesn’t really take into account the critical role of PEPFAR in doing two things. Other than doing something very good for maintaining the health of people globally, it maintains global health security because it creates an infrastructure if we have to respond to other big infectious diseases. And so you know, the, the writing is on the wall. There is not only a release of the accelerator on the progress to end the HIV epidemic, this administration is pumping the brakes. So it’s not just slowing down. If PEPFAR goes away that means stopping the entire story. And you know, that’s gonna not mean just some strange policy issue. It’s going to mean that people will die.

 

SREENIVASAN: You know, the, the State Department’s rationale or thinking is, is, look, we have to stop being the people that are the only ones that are writing the check. We have to transition this to the host countries. We have to help them get to a point where they can fight HIV on their own. You know, just Thursday, the U.S. and Kenya signed the, I guess, the first “America First” global health agreement, which we’re gonna see the US contribute about 1.7 billion towards HIV/AIDS, malaria, tuberculosis treatment and prevention in Kenya. And then the Kenyans have to come up with 850 million. And they think that there are going to be — or they say that there’re going to be — other countries that will do this. What’s wrong with that strategy?

 

DASKALAKIS: Yeah, I mean, I, I think really the, the — there’s already been a PEPFAR strategy for transition. And it really was one that was metered and designed to make sure that there were no children or adults left behind who will suffer or die from HIV. Instead, what you’re seeing is an emergency bailout, because for the last, like eight or nine months, there has been no planning around what to do with PEPFAR. There’s only been destruction and decomposition of the programs that support the work. And so one country having an agreement means that we’re many, many, many countries away from having what we need to support the health of people globally. 

 

I think the other part that is important is, you know, the U.S. is the global leader in public health. It is our moral responsibility to support these countries. And if we decide to change our funding strategy, we need to do it in a way that in fact does not let people die. And so I think that the argument is a great one in terms of transitioning responsibility and giving, I guess, more, more dominion to these countries. It’s a great argument. But it needs to be done with a strategy, not with a bilateral agreement that in fact makes aid to the country transactional. Because the other part of those agreements is — you have to give us your data, and you have to give us your specimens. And that is really what is underlying all of this. They’re trying to trade aid — support for people living with HIV — for public health intelligence. And that is their strategy to replace the WHO. And that is not a strategy that is either moral nor potentially one that is durable.

 

SREENIVASAN: You know, we’ve talked a little bit about HIV on the global stage. And I want to bring for our American audience a little perspective to this too. I mean, we’ve had almost 40,000 new HIV infections in 2023. I think the numbers are fairly similar in 2024. And, I wonder, you know, when you have something like sort of pre-exposure prophylaxis — PrEP — that’s available today which prevents infections from even occurring, how is HIV still this large of a public health problem in the United States?

 

DASKALAKIS: Yeah, your answer is what happens when the country decides not to celebrate or commemorate World AIDS Day. This is a stigma and access game in the United States. People do not access care, they don’t access testing because it’s scary. It, it — people are made invisible because of the stigma that that is getting even worse in the United States with some of the activity against LGBTQ health, since they are such a important component of what happens domestically for HIV. You have amazing technology that’s gonna sit on the shelf because people aren’t gonna get tested. They’re not going to access pre-exposure prophylaxis, and that’s gonna mean more HIV infections. 

 

And so you — I am thinking about New York. They’re, they do amazing work in HIV and their new epidemiology shows an increase in HIV. That is not good. And so that is a trend that you’re going to, I think, see throughout the world and throughout the country. And I need to be very clear. It’s going to be worse in states that can at least afford it. So I would expect that we’ll also see increasing HIV rates in the South, given some of the issues related to access as well as stigma. I’ve seen patients in Atlanta, and I have never seen so much stigma actually interact with an infection to result in some terrible outcomes in the people that I’ve taken care of. So I think this is a preview of what’s to come.

 

SREENIVASAN: You know, you recently were at the CDC, you were the director of the National Center for Immunization and Respiratory Diseases. And you very publicly resigned this past August. And in your resignation letter, I just wanna quote one phrase, “I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.” What are some of the specific kind of policies that the CDC was going after that made you say, I can’t be part of this anymore?

 

DASKALAKIS: I think the list continues to grow. I think one great example was the creation of an autism and vaccines webpage that tried to link autism and vaccines despite decades of science demonstrating that that’s not the case. In effect, without any new data, CDC — like a wolf in sheep’s clothing — put up a website that said that there’s no scientific evidence that it is not scientifically accurate to say that vaccines do not cause autism. And that is based on nothing. What you’re seeing is that CDC is create — is being created into a rubber stamp that in fact, cloaks conspiracy and pseudoscience in the garb of science and really valid scientific statements. 

 

We’re literally seeing the Advisory Committee on Immunization Practices make decisions with no presented data. They made a decision about how vaccines should be administered to babies and what testing should be done for vaccines that are based on absolutely no medical or scientific data. That’s why I resigned. If I hadn’t resigned months ago, I would’ve resigned today.

 

SREENIVASAN: Now, in this particular case about Hepatitis B, I mean, this is something that — decades long now — we’ve made a recommendation that newborns get vaccinated — for this liver disease, right? The recent recommendation says that parents if — should check with their doctors and should not give shots any earlier than two months. 

 

DASKALAKIS: Yeah. I mean, what we saw with this decision around the birth dose of Hepatitis B, first of all, they didn’t really change very much. So shared clinical decisionmaking means that you talk to your doctor about what vaccines your kids should. 

 

That’s what we do all the time. So that’s, that’s just trying to have some sort of performative demonstration of support of people who think that there needs to be more medical freedom. So that’s, that’s what you’re seeing. It actually hasn’t changed very much. 

 

On the flip side, the uncertainty created by this discussion implies that there’s something wrong with this vaccine, that there is more risk than benefit, and that is just not correct. You know, of the kids that get hepatitis, about 11% of them do not have a mother or a — do not, don’t have a mother with a positive Hepatitis B test. I find it intolerable in the United States to let about 11% of those kids fall through the cracks because they got it from a caregiver. You know, kids go to daycare. Kids have other caregivers, and you know, there is no amount of medical history in an imperfect system that will tell you which kids are at risk beyond the fact that their mother is negative for hepatitis. 

 

So, you know, there’s no science behind the decision. It’s about vibes. There’s a feeling, and these are the feelings that have been elevated to the place of science using that CDC rubber stamp. And that’s going to, you know, result in children getting Hepatitis B. 90% of them will go onto chronic infection, and 25% of them will die early of that infection. So, as someone on the committee said, this committee is now going to have to take responsibility for a change in policy that will do harm. And that is against our Hippocratic oath as doctors.

 

SREENIVASAN: So you have moved on and you have decided to be the Chief Medical Officer of Callen-Lorde. It’s a community organization here in New York City that provides health services for the LGBTQ+ community. What type of work and why?

 

DASKALAKIS: Yeah, so it’s, it’s going back to my roots. I mean, so much of the work that I did in New York before I went to federal government was around HIV prevention, specifically focusing on the LGBTQ community. So I’m sort of going back to the roots of what brought me to public health. The why is that I don’t think that there’s any point in being involved in the federal government right now because it’s actually looking to destroy public health than build it. And so one of the things that’s part of my career is really moving between local and national and doing it seamlessly. And so I think that right now the grassroots is the place that we need to be to protect the health of people because it’s quite clear that the federal government is not.

 

SREENIVASAN: Given what you are talking about inside federal government, is it easy to recruit? I mean, are there other of your peers that you see who are struggling with these decisions, who are on the fence?

 

DASKALAKIS: I think it’s going to be really hard to recruit people into federal service, especially in public health. I think it is fair to say that many of my colleagues are actively searching for other roles because they’re seeing that their effectiveness in the sort of federal environment isn’t great. There are others who are really trying to steady the ship. And I feel like they’re having a lot of turmoil in their own lives. Because, you know, when you see things like the Advisory Committee on Immunization Practices on capricious announcements around vaccines and autism, it’s really hard to stay. But, you know, they are heroes. 

 

But Hari, I’m just going to give you an analogy. It’s like an airplane. And right now the CDC scientists are on their — on that airplane being held hostage by this leadership at HHS. And you know, really we need to send all the love to those scientists because they’re trying their best to do their job. But you know, that plane is not being navigated by anyone who should navigate it.

 

SREENIVASAN: And I think there are also people in the United States who think, Okay, fine, you know what? There’s gonna be a new administration, we can fix this. What’s wrong with that thinking? I mean, you’ve been talking about kind of infrastructure which has taken years and decades to build. How long will it take to rebuild?

 

DASKALAKIS: The current leadership at HHS — Secretary Kennedy and the people that work for him — are able to, in one or two minutes, destroy decades of work. And so I think that that’s what we’re seeing, like creating mistrust, yanking really significant funding for important work. If you don’t have a workforce and you don’t have research, what that means is that not only does the workforce pipeline dry up, but it also means that the innovation pipeline dries up. So I think, you know, what we’re going to see is less science, less scientists, and ultimately that’s gonna have ramifications for decades. And again, what I’m worried about is that this administration will pass and then a new administration will come, but the impacts of what’s happening today are going to be felt for decades because of how hard it will be to rebuild in the environment that’s been created.

 

SREENIVASAN: Dr. Demetre Daskalakis, thanks so much for joining us.

 

DASKALAKIS: Thank you so much, Hari.