Lisa Gray, an editor at the Houston Chronicle, interviewed Dr. Peter Hotez, a vaccine scientist and specialist in infectious diseases, about the major public health challenges facing the incoming Trump administration. Dr. Hotez shares the story of his effort to persuade Robert F. Kennedy Jr. of the importance of vaccines. This post is the first of two.

Gray wrote:

During the COVID pandemic, Americans came to rely on bow-tied vaccine scientist Peter Hotez for calm, scientific assessments of the virus and the vaccines being developed to fight it. With his team at Texas Children’s Hospital Center for Vaccine Development, Hotez develops low-cost vaccines for low-income nations. He’s also the dean of the National School of Tropical Medicine at Baylor College of Medicine — and is arguably Houston’s most beloved doctor.

He still monitors the public-health landscape closely. To find out what public-health threats await the Donald Trump administration, Houston Chronicle videographer Sharon Steinmann and I interviewed him at his office at Baylor.

Our conversation has been edited for length and clarity.

Q: What are the public health challenges that the Trump administration will face on Day 1? Are you monitoring any major health threats?

A: We’ve got some big-ticket concerns regarding infectious disease and pandemic threats. The new administration is not going to have the luxury of time to organize and think about it. They’re going to be confronted with this from the very beginning.

One of the big threats I’m following is H5N1, an avian influenza. The virus is widespread now in migratory birds that fly from the north to the south.

It’s spilling over into domestic birds and poultry. We’re now seeing a big increase in infections of domestic birds and poultry in California and elsewhere in the western part of the United States, as well as across the northern part of the country. 

An H5N1 strain has also crossed over from birds into cattle. It’s gotten into our herds, including in Texas, as well as in the Great Plains and other parts of the United States.

I’m concerned that, eventually, this virus could spill over to people as well. We’re starting to see human cases. In the last few weeks, we’ve had six human cases. I think eventually H5N1 could become a major human public-health threat.

It’s not there yet. We’re not seeing human-to-human transmission yet. But monitoring it and being prepared for it has got to be a big priority for the new incoming administration. 

Q: Oof. Is that all that’s on the horizon?

A: Guess what? That’s just the beginning.

The other thing that’s happening is, we still have COVID with us. Our COVID-19 numbers are low again, but I expect them to rise. You can protect yourself from that, of course, by keeping your immunizations up to date. If you got a dose of the vaccine in September, like I did, you’ll be due again around January.

But here’s the thing: COVID-19 isn’t the only COVID threat. There are other coronaviruses.

Remember that the name for the virus that causes COVID is the SARS-2 coronavirus. There was a SARS-1, the Severe Acute Respiratory Syndrome that came out of southern China in 2002. We had Middle East Respiratory Syndrome, also caused by a coronavirus, in 2012. And of course, we had SARS-2 cause COVID, the largest pandemic of them all, starting in 2019.

We should expect SARS-3 to come in the next few years.

Q: Why are we seeing these new coronaviruses in people?

A: Because these viruses are widespread in bats. Across China and East Asia, they’re jumping regularly to people. In some cases that’s through intermediate animal hosts. In some cases it’s directly from bats to people.

By some estimates, these new SARS coronaviruses are jumping from bats to people on the order of 66,000 times a year. Every now and then, one catches fire and ignites a pandemic.

So that needs to occupy the attention of the Trump administration. What kind of surveillance are we doing for SARS-3, which is brewing as we speak among bats in Asia?

Q: That’s a lot to take care of.

A: That’s not all we have to worry about. A third big-ticket item is the fact that we’ve seen a significant uptick in the number of virus infections transmitted by mosquitoes or other biting arthropods. We all know about the West Nile virus. Last year was a pretty bad year for infections in the United States, including Texas. But that’s just the beginning.

With these mosquito-transmitted viruses, which we call arboviruses, we know what to expect in the U.S. because we usually see it first in Brazil. In the Western Hemisphere, Brazil is the arbovirus epicenter.  And right now, dengue, Oropouche, Zika and even yellow fever are all expanding in Brazil. They’re even extending beyond the Amazon rainforest, where we typically see them, because of climate change and possibly because of deforestation. 

And unfortunately, what starts in Brazil doesn’t stay in Brazil. It will eventually make its way to the Gulf Coast of the United States, including Texas.  So for next summer, I’m worried about dengue. I’m worried about Chikungunya, and even the possibility of yellow fever. I wrote about the possibility of a yellow fever outbreak in the New England Journal of Medicine; it would be catastrophic. The virus affects pregnant women and could be transmitted to the fetus, causing horrible birth defects. And besides yellow fever, Oropouche virus [pronounced “o-ro-push”] is going to be yet another big-ticket item. It’s spreading fast in Brazil. 

Q: So we’ve got four big-ticket concerns.

A: Wait, wait: We’re not done yet. Anti-vaccine activism accelerated during COVID; we’ve spoken about it many times. Now it’s spilling over to childhood immunizations. We’re seeing unprecedented levels of vaccine hesitancy and of parents refusing to have their kids vaccinated. So guess what?

From 2023 to 2024, we had a nearly sixfold increase in pertussis, or whooping cough, cases. We went from four measles outbreaks in 2023 to 16 in 2024. We’ve even seen polio in the wastewater of New York state.

I’m expecting a big rise in illnesses that are preventable with childhood vaccines.

Q: And the Trump administration has to be ready for all five of these major threats?

A: All of that is going to come crashing down on them. It’s going to be important that they take all those threats seriously.

It’s not just public health that could be affected. We’ve learned that pandemics have all sorts of other aspects. There’s an economic impact. There’s the impact on our security. And if we have a serious epidemic here in the U.S., it could block our travel from the U.S. to other countries.

I don’t have the sense that these big-ticket infectious disease threats are being taken with the seriousness that they need to be.

Q: Is that based on the people Donald Trump has named to health positions?

A: I’m concerned that the Trump administration is picking individuals based on their ideologies rather than either their subject-matter expertise or their ability to get things done in government.

Lisa Gray is the op-ed editor and a member of the Houston Chronicle editorial board. During the pandemic, she was the Chronicle’s lead COVID reporter.