stated on June 1, 2025, in an interview on CNN’s “State of the Union.”

Responding to charges that President Donald Trump’s tax and spending bill would cut Medicaid coverage for millions of Americans, that it targets only waste, fraud, and abuse.

During an interview on CNN’s “State of the Union,” Russell Vought, the administration’s director of the Office of Management and Budget, framed Medicaid as sagging under the weight of improper payments.

An “improper” payment refers to payments made erroneously to beneficiaries and their providers or without sufficient documentation.

Pressed by CNN host Dana Bash about concerns that low-income Americans would suffer if the bill becomes law, Vought called such arguments “totally ridiculous.”

“This bill will preserve and protect the programs, the social safety net, but it will make it much more commonsense,” Vought said. “Look, one out of every $5 or $6 in Medicaid [payments] is improper.”

That would mean Medicaid’s improper payment rate is 16% to 20%.

In a 2024 report covering the years 2022, 2023, and 2024, Medicaid’s parent agency — the Centers for Medicare & Medicaid Services — said the rate was about 5.1%.

One conservative group, the Paragon Health Institute, said the agency has been using an incomplete calculation method and that the percentage could be as high as 25%. Other experts told PolitiFact that the actual numbers could be higher than what the federal government reports, although not as high as Paragon’s estimate.

The White House did not respond to an inquiry for this article.

How High Is the Medicaid Improper Payment Rate?

Medicaid and its closely related Children’s Health Insurance program to roughly , accounting for about one-fifth of health care spending overall. It is funded through a mix of federal and state money and is administered by states under federal government rules.

Every year, the Centers for Medicare & Medicaid Services publishes for the share of improper Medicaid payments, and in other federal health insurance programs the agency oversees.

In a 2024 review of in 2022, 2023, and 2024, the agency found that 5.09% of Medicaid payments totaling $31.10 billion were improper.

The 5.09% rate represented a decrease from the 8.58% rate cited in its 2023 report, which was also based on a three-year time span. The 2024 figure annual decline.

Are These Numbers Complete?

In March 2025, Brian Blase, a conservative health policy analyst and president of Paragon Health, a health policy think tank, that said the official CMS improper payment rate figures were unrealistically low for eight of the past 10 years, because in some years the agency failed to undergo widespread auditing of its beneficiaries’ Medicaid eligibility.

From 2017 to 2019, during Trump’s first term, Blase served as Trump’s special assistant for economic policy. Before that, he served as a health policy analyst for the Senate Republican Policy Committee and has worked for the Heritage Foundation, a conservative think tank.

The report said if the agency’s analysis had looked at eligibility checks every year, more ineligible beneficiaries and payments on their behalf would have been discovered. The report said this might have increased the improper payment rate as high as 25%, based on the rates found in 2020 and 2021, when a high number of eligibility checks were included in the agency’s methodology.

However, it’s hard to confirm whether lack of eligibility auditing caused higher improper payment rates in 2020 and 2021, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, a liberal think tank.

Wagner said Medicaid enrollment procedures have fluctuated, which could help explain the higher rates in some years rather than others. Using two years of data to generalize about trends across a decade, she said, is not necessarily valid.

Robert Westbrooks, the federal Pandemic Response Accountability Committee executive director who worked in government oversight roles during Democratic and Republican administrations, told PolitiFact it’s plausible that the officially reported improper payment rates for Medicaid could be too low.

However, Westbrooks said pinpointing how much higher the rate is in reality is a speculative process. “I don’t believe anyone can credibly quantify the [difference],” he said.

What Is an Improper Payment?

Health care experts emphasized that improper payments are not the same thing as waste, fraud, or abuse.

CMS maintains for these terms:

• Fraud: “When someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program.”
• Waste: “Overusing services or other practices that directly or indirectly result in unnecessary costs to any health care benefit program. Examples of waste are conducting excessive office visits, prescribing more medications than necessary, and ordering excessive laboratory tests.”
• Abuse: “When health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program,” which can include overbilling or misusing billing codes.

By contrast, an improper payment “includes any payment to an ineligible recipient, any payment for an ineligible good or service, any duplicate payment, any payment for a good or service not received, and any payment that does not account for credit for applicable discounts,” Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News, .

“Although all fraudulent payments are improper, not all improper payments are fraudulent,” said Jessica Tillipman, associate dean for government procurement law at George Washington University’s law school. “Most providers identify the improper payments and return them knowing how aggressively enforced” the legal provisions are. “When they don’t, they open the door to significant liability.”

CMS said about 79% of improper payments happened when there was .

This typically involved cases in which a state or provider missed an administrative step, and it did not necessarily indicate fraud or abuse, the agency said. Instead, it could be an accidental oversight or mistake.

In other words, it was rare for ordinary beneficiaries to be scamming the government. “The vast majority of fraud in Medicaid is committed by providers or other actors, not enrollees,” Wagner said.

Our Ruling

Vought said that “one out of every $5 or $6 in Medicaid [payments] is improper.”

The official improper payment rate calculated by the Centers for Medicare & Medicaid Services in 2024 was about 5%, smaller than the 16% to 20% rate Vought described.

A health policy analyst and former Trump adviser said methodological shortcomings in the agency’s analysis could mean the rate is as high as 25%. Although it’s possible the rate is higher than the 5% the government reported, how much higher is speculative.

The statement contains an element of truth but ignores critical facts, namely the federal government’s own data. We rate the statement Mostly False.

Our Sources

Russell Vought, ,” June 1, 2025.

Centers for Medicare & Medicaid Services, “,” Nov. 15, 2024.

Centers for Medicare & Medicaid Services, “,” accessed June 4, 2025.

Centers for Medicare & Medicaid Services, “,” accessed June 4, 2025.

Paymentaccuracy.gov, “,” accessed June 3, 2025.

Â鶹ŮÓÅ, “,” March 18, 2025.

Â鶹ŮÓÅ, “,” April 24, 2025.

Paragon Health Institute, “,” March 3, 2025.

Government Accountability Office, “,” March 11, 2025.

Email interviews with Tammie Smith and Craig Palosky, spokespersons for Â鶹ŮÓÅ, June 2, 2025.

Email interview with Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities.

Email interview with Jessica Tillipman, associate dean for government procurement law at George Washington University’s law school, June 3, 2025.

Email interview with Robert Westbrooks, Pandemic Response Accountability Committee executive director who worked in government oversight roles during Democratic and Republican administrations, June 3, 2025.

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President Donald Trump, in a May 11 post on Truth Social

President Donald Trump expressed high hopes for an executive order to reduce drug prices.

On May 11, the day before he held a White House event to sign the executive order, Trump posted on Truth Social, “Prescription Drug and Pharmaceutical prices will be REDUCED, almost immediately, by 30% to 80%.”

However, theÌý,Ìýunveiled May 12, undercut the president’s description of how soon consumers could experience this potential boon.

The idea of the executive order, he said, was to lower high prescription drug costs in the U.S. to levels more typical in other countries.

“We’re going to equalize,” Trump said at the order signing. “We’re all going to pay the same. We’re going to pay what Europe’s going to pay.”

Experts said Trump’s action could lower the cost of prescription drugs, perhaps by the 30% to 80% Trump said, but they cautioned that the order’s required procedural steps would make it far from an immediate fix.

TheÌýexecutive orderÌýsays that within 30 days, administration officials must determine and communicate to drugmakers “most-favored-nation price targets,” to push the companies to “bring prices for American patients in line with comparably developed nations.”

After an unspecified period of time, the administration will gauge whether “significant progress” toward lower pricing has been achieved. If not, the order requires the secretary of Health and Human Services to “propose a rulemaking plan to impose most-favored-nation pricing,” which could take months or years to take effect.

“Executive orders are wish lists,” said Joseph Antos, a senior fellow emeritus in health care policy at the conservative American Enterprise Institute. The order “hopes that manufacturers will unilaterally lower U.S. prices. The legal authority to intervene in the market is unclear if this implausible scenario doesn’t happen.”

When contacted for comment, the White House did not provide evidence that the executive order would provide immediate results.

Why Do Americans Pay More for Prescriptions?

There is Ìýthat drug prices are unusually high in the U.S. The prices Americans pay for pharmaceuticals are nearly three times the average among a group of other industrialized countries in the Organization for Economic Cooperation and Development.

´¡Ìý, a nonpartisan research organization, found that, across all drugs, U.S. prices were 2.78 times as high as the average prices across 33 OECD countries. The gap was even wider for brand-name drugs, with U.S. prices averaging 4.22 times as much.

The U.S. has lower prices than comparable nations for unbranded, generic drugs, which account for about 90% of filled prescriptions in the U.S. But generics account for only a fifth of U.S. prescription drug spending.

Experts cite several reasons for this pricing discrepancy.

One is that the U.S. has more limited price negotiation with drug manufacturers thanÌýÌýdo. Often, if another country fails to find the extra cost of a new drug is justified by improved results, it’ll reject the drug application. Some countries also setÌý.

Another factor is patent exclusivity. Over the years, U.S. pharmaceutical companies have used strong legal protections to amass patents that can keep generic competitors from the marketplace.Drug companies have also argued that high prices help pay for research and development of new and improved pharmaceuticals. When Trump released the executive order, Stephen J. Ubl, president and CEO of the drug industry group Pharmaceutical Research and Manufacturers of America, , “It would mean less treatments and cures and would jeopardize the hundreds of billions our member companies are planning to invest in America.” (In Trump’s May 13 interview with Fox News’ Sean Hannity, Trump offered a different picture of what drug company officials have told him; he said they agreed “it’s time” to lower U.S. prices.)

Recent studies have cast doubt on the idea that high prices pay for research and development. ´¡ÌýÌýfound that from 1999 to 2018, the world’s 15 largest biopharmaceutical companies spent more on selling and general administrative activities, which include marketing, than on research and development. The study also said most new medicines developed during this period offered little to no clinical benefit over existing treatments.

The long-standing reality of high U.S. drug prices has driven Democratic and Republican efforts to bring them down. Then-President Joe Biden signed legislation to require Medicare, the federal health care program that covers Americans over 65, toÌýÌýwith the makers of some popular, high-cost medicines. And Sen. Bernie Sanders (I-Vt.) has made lowering drug prices aÌýÌýduring his political career.

During his first term, Trump sought to lower prices for certain drugs under Medicare, but the courtsÌý on procedural grounds.

Trump’s drug-price push could attract bipartisan support, experts said.

Jonathan Cohn, who has worked for several left-of-center media outlets ÌýÌýon health care policy,Ìý for Trump’s executive order in The Bulwark, a publication generally critical of Trump, calling it “a serious policy initiative, one that credible people think could bring some relief on drug prices.”

Andrew Mulcahy, a Rand Corp. senior health economist, said one part of Trump’s statement — the possibility of a 30% to 80% price reduction — is plausible.

“Of course, the devil’s in the policy design and implementation details,” Mulcahy said. “But at first blush, a savings of roughly two-thirds on what we spend now for drugs seems in line” with what Rand’s research has shown.

What Would Trump’s Executive Order Do?

Referring to high U.S. drug prices, Trump told Hannity that “I ended it” by issuing the executive order. But that’s not how the order is structured.

The executive order makes plain that any actions will not happen quickly.

“That ‘almost’ in ‘almost immediately’ is doing a lot of work,” Mulcahy said, referring to Trump’s statement.

The executive order also could face court challenges, just as Trump’s first-term executive order did.

“It seems unlikely that the federal government can set prices for drugs outside of the Medicare program,” Antos said. If Trump wants reduced prices to benefit all U.S. consumers, experts said, Congress will likely have to pass new legislation. While executive orders direct federal agencies what to do, requiring action from privately owned companies likely would require legislation passed by Congress, experts said.

If Congress gets involved, that will not only tack on extra time, but it also could draw opposition from the Republican majority in one or both chambers. Historically, Antos said, “federal price controls are anathema for many Republicans in Congress.”

Our Ruling

Trump said that, because of his new executive order, prescription drug prices would be reduced “almost immediately.”

Experts said that if the goals of the executive order are achieved, price reductions would not happen “almost immediately.”

The order sets out a 30-day period to develop pricing targets for drugmakers, followed by an unspecified amount of time to see if companies achieve the targets. If they don’t, a formal rulemaking process would begin, requiring months or even years. And if Trump intends to lower prices for all consumers, not only those who have federal coverage such as Medicare, Congress will likely have to pass a law to do it.

Trump gives the impression that Americans will shortly see steep decreases in what they pay for prescription drugs. But even if the executive order acts as intended — which would require a lot to go right — it could take months or years.

The statement contains an element of truth but ignores evidence that would give a different impression. We rate it Mostly False.

Sources

Donald Trump, , May 11, 2025

White House, “,”ÌýMay 12, 2025

Rand Corp., “,” February 2024

Government Accountability Office, “,” March 2021

The BMJ, “,” Feb. 15, 2023

Pharmaceutical Research and Manufacturers of America, “,” May 12, 2025

USA Today, “,” May 12, 2025

The Associated Press, “,” Dec. 23, 2020

The Associated Press, “,” Aug. 15, 2024

PolitiFact, “,” March 4, 2024

Email interview with Joseph Antos, senior fellow emeritus in health care policy at the American Enterprise Institute, May 12, 2025

Email interview with Andrew Mulcahy, senior health economist with Rand Corp., May 12, 2025

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Kennedy held an April 16ÌýÌýpegged to a new Ìýthat found theÌý rising to 1 in 31 among 8-year-olds, the latest in a series of increases in recent decades.

Kennedy said “autism destroys families” and is an “individual tragedy as well.”Ìý

Kennedy said many autistic children were “fully functional” and had “regressed” into autism “when they were 2 years old. And these are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go out on a date. Many of them will never use a toilet unassisted.”

He also said: “Most cases now are severe. Twenty-five percent of the kids who are diagnosed with autism are nonverbal, non-toilet-trained, and have other stereotypical features.”

Medical experts, along with people on the autism spectrum, told PolitiFact that Kennedy’s portrayal was skewed. A 2023 study written by CDC officials and university researchers found that one-quarter of people on the autism spectrum have severe limitations. But this is on the high end of studies, and many people in that one-quarter of the autism population do not have the limitations Kennedy mentioned.Ìý

The vast majority of people on the spectrum do not have those severe challenges.

“I wish he would spend some time with parents of other autistic children, and well-regarded scientists who have studied this condition for decades,” said David Mandell, a University of Pennsylvania psychiatry professor and director of the Penn Center for Mental Health. “He has a fixed, myopic view.”

The Department of Health and Human Services did not provide data on what share of people with autism diagnoses are unable to do the things Kennedy described.Ìý

“Secretary Kennedy remains committed to working toward a society where people with autism have access to meaningful opportunities, appropriate supports, and the full respect and recognition they deserve,” department press secretary Vianca N. Rodriguez Feliciano told PolitiFact. “His statements emphasized the need for increased research into environmental factors contributing to the rise in autism diagnoses, not to stigmatize individuals with autism or their families.”

Ìýthat an HHS spokesperson said Kennedy “was referring to those that are severely affected by this chronic condition” and that “this was in no way a general characterization.”

We took a closer look at the available data and research.

What Is Autism Spectrum Disorder?

At root, “autism is a difference in how your child’s brain works that shapes how they interact with the world around them,” according to theÌý. People with autism diagnoses, the clinic says, “may excel more in certain areas and need more support in other areas compared to their neurotypical peers.”

Over the years, autism’s definition and diagnosis has changed.

In the 1950s and 1960s, “it is very likely that many people with profound autism were misdiagnosed with ‘mental retardation,’ a term in use at the time, or schizophrenia, while other autistic people probably got no diagnosis at all,” said John J. Pitney Jr., a Claremont McKenna College politics professor, author of the book “The Politics of Autism: Navigating the Contested Spectrum,” and a father of an autistic son who’s about to graduate from college.

In more recent decades, the diagnostic criteria for autism have broadened, producing a spectrum ranging from severe impacts to more modest ones. Today’s definition encompasses “individuals with milder symptoms, stronger language skills, and higher IQs,” said Christopher Banks, president and CEO of the Autism Society of America.

How Common are the More Limiting Forms of Autism?

Autism’s expanded definition means a minority of people on the spectrum have the kinds of severe limitations Kennedy cited, though it’s hard to say how many.

The highest total we found comes from a , written by CDC officials and university researchers. It found that 26.7% of 8-year-olds with autism had “profound” autism, a newly framed (and not universally accepted) definition that included children who were nonverbal, were minimally verbal, or had an IQ below 50. (“Average” IQ is considered 90 to 109.)

People with profound autism “will require lifetime, round-the-clock care,” said Judith Ursitti, co-founder and president of the Profound Autism Alliance, a nonprofit. Ursitti said her 21-year-old son “is not headed towards employment or a career in poetry or baseball. Acknowledging this fact is important, as this population is often excluded from media portrayals and research.”

Other estimates are lower.Ìý

A ,Ìýby researchers at the University of Utah and Children’s Hospital of Philadelphia, looked at 1,368 U.S. children with autism. When parents were asked whether they would characterize their child’s autism as “severe,” 10.1% said yes. Among this group of children with “severe” autism, a minority — 38% — were classified as having a “severe” intellectual disability.Ìý

“Even among those with an intellectual disability, there’s huge variability,” Mandell said. “People with Down syndrome have an intellectual disability but often are quite capable and can do all the things RFK points to.”

The CDC publishedÌý showing that 42% of people with autism had an IQ in the average or higher range, and Ìýhas found that this figure could be as high as 60%.Ìý

Zoe Gross, the director of advocacy at the Autistic Self Advocacy Network, said limited available data suggests that Kennedy’s characterization is exaggerated.

Gross, who is on the spectrum herself, said Ìýfound that 61% of people on the spectrum who were studied were employed. As for baseball, the Special Olympics, which was founded by Kennedy’s family and includes competitors who are on the spectrum, . At least two people who played major league baseball,ÌýÌýandÌý, were public about their autism diagnoses.Ìý

Gross said there is no official data on autistic poets, but she was aware of the poetÌý, a nonspeaking but highly literate advocate. Gross was also unable to find data on dating, but she said she’s married, and she pointed to the Netflix reality show “,” which follows autistic people’s dating lives. It is now in its third season.Ìý

As for not using a toilet unassisted, the 2024 study that analyzed 1,368 U.S. children with autism and found that 10.1% were considered “severe” found that 67% of those in the “severe” category had trouble bathing or dressing, which, if generalizable to the entire autistic population, would be less than 7%. Ìýfound urinary incontinence reported by 12.5% of the autistic people studied and fecal incontinence by 7.9%.

Eric M. Garcia, who is on the spectrum and who has written the book “We’re Not Broken: Changing the Autism Conversation,” was covering Kennedy’s remarks as Washington bureau chief of The Independent. Hearing his words “felt so demoralizing,” Garcia told PolitiFact. “A lot of people will respond by saying, ‘He didn’t mean autistic people like you.’ But that doesn’t make it any better.”

PolitiFact staff writer Madison Czopek contributed to this article.

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A Facebook ad from the campaign of Sen. Jon Tester (D-Mont.), launched on Sept. 6, 2024

In a race that could decide control of the U.S. Senate, Sen. Jon Tester (D-Mont.) is attacking his challenger, Republican Tim Sheehy, for his stance on abortion.Ìý

Montana’s Senate race is one of a half-dozen tight contests around the country in which Democrats are defending seats needed to keep their one-seat majority. If Republicans flip Tester’s seat, they could take over the chamber even if they fail to oust Democrats in any other key races.

In aÌýÌýlaunched in early September, Tester’s campaign said Sheehy supports banning abortion with no exceptions.

An ad launched on Sept. 6 said, “Tim Sheehy wants to take away the freedom to choose what happens with your own body, and give that power to politicians. Sheehy would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women. We can’t let Tim Sheehy take our freedom away.”

Sheehy’s Anti-Abortion Stance Allows for Rape, Health Exceptions

Sheehy’s website calls him “proudly pro-life,” and he’s campaigning against abortion. HeÌý on Montana’s November ballot that wouldÌý to provide the right to “make and carry out decisions about one’s own pregnancy, including the right to abortion.”

In July, we ratedÌýFalseÌýSheehy’s statement that Tester and other Democrats have voted for “elective abortions up to and including the moment of birth. Healthy, 9-month-year-old baby killed at the moment of birth.”

But contrary to the new ad’s message, Sheehy has voiced support for exceptions.

In a Montana Public RadioÌý, Sheehy was asked, “Yes or no, do you support a federal ban on abortion?”Ìý

Sheehy said, “I am proudly pro-life and support commonsense protections for when a baby can feel pain, as well as exceptions for rape, incest, and the life of the mother, and I believe any further limits must be left to each state.”

And in a Ìýwith Tester, Sheehy said, “I’ll always protect the three rights for women: rape, incest, life of the mother.”

TheÌýÌýof Sheehy’s campaign website does not say that he has a no-exceptions stance, nor does it say he would “criminalize women” who have abortions.

In a statement, the Sheehy campaign told PolitiFact that the ad mischaracterizes Sheehy’s abortion position. Allowing no exceptions “has never been Tim’s position,” the campaign said.

Our Ruling

The Tester campaign’s ad says Sheehy “would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women.”Ìý

Sheehy has said he supports abortion ban exceptions for rape or to save a pregnant woman’s life. We found no instances of him saying he would be OK with states criminalizing women who receive abortions in violation of state laws.

What gives the ad a kernel of truth is that Sheehy has voiced support for letting states decide abortion parameters within their borders. The Tester campaign argues that this means Sheehy would effectively enable legislators to pass abortion restrictions that don’t include exceptions or that criminalize women.

The Tester campaign’s argument relies on hypotheticals and ignores Sheehy’s stated support for exceptions, giving a misleading impression of Sheehy’s position.

We rate it Mostly False.

Our Sources

Jon Tester,Ìý, Sept. 6, 2024

Tim Sheehy,Ìý, accessed Sept. 12, 2024

Â鶹ŮÓÅ, “,” last updated July 29, 2024

Montana Public Radio, “,” May 15, 2024Ìý

Ìý(excerpt), June 9, 2024

Last Best Place PAC,Ìý, accessed Sept. 12, 2024

Montana Republican Party, 2024Ìý, accessed Sept. 12. 2024

Daily Montanan, “,” Aug. 22, 2024

Sabato’s Crystal Ball, “,” July 9, 2024

Heartland Signal, “,’” Aug. 30, 2024

Montana Independent, “,” June 11, 2024

Statement to PolitiFact from the Sheehy campaign

Statement to PolitiFact from the Tester campaign

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Robert F. Kennedy Jr. in an April 21 post on X

The National Institutes of Health is the federal government’s main agency for supporting medical research. Is it barred from researching mass shootings? That’s what presidential candidate Robert F. Kennedy Jr. said recently.

Kennedy, whose statements about conspiracy theories earned him PolitiFact’s 2023 “,” is running as an independent third-party candidate against President Joe Biden, the presumptive Democratic candidate, and the presumptive Republican nominee, former President Donald Trump.

On April 21 , Kennedy flagged his recent interview with conservative commentator Glenn Beck, which touched on gun policy. Kennedy summarized his gun policy views in the post, writing, “The National Institutes of Health refuses to investigate the mystery; in fact, Congress prohibits the NIH from researching the cause of mass shootings. Under my administration, that rule ends — and our kids’ safety becomes a top priority.”

But this information is outdated.

In 1996, Congress passed the “Dickey Amendment,” an appropriations bill provision that federal officials widely interpreted as barring federally funded research related to gun violence (though some observers say this was a misinterpretation). Congress in 2018 clarified that the provision didn’t bar federally funded gun-related research, and funding for such efforts has been flowing since 2020.

Kennedy’s campaign did not provide evidence to support his statement.

What Was the Dickey Amendment?

After criticizing some federally funded research papers on firearms in the mid-1990s, pro-gun advocates, including the National Rifle Association, federal government funding for gun violence research.

In 1996, Congress approved appropriations bill language saying that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” The language was named for one of its backers, Rep. Jay Dickey (R-Ark).

But the Dickey Amendment, as written, did not ban all gun-related research outright.

“Any honest research that was not rigged to produce results that helped promote gun control could be funded by CDC,” said Gary Kleck, a Florida State University criminologist. But CDC officials, experts said, interpreted the Dickey Amendment as banning all gun-related research funding.

This perception meant the amendment “had a chilling effect on funding for gun research,” said Allen Rostron, a University of Missouri-Kansas City law professor who has . Federal agencies “did not want to take a chance on funding research that might be seen as violating the restriction” and so “essentially were not funding research on gun violence.”

Also, the Dickey Amendment targeted only the CDC, not all other federal agencies. Congress expanded the restriction to cover NIH-funded research in 2011.

Although the Dickey Amendment didn’t bar gun-related research, federal decision-makers acted as though it did by not pursuing such research.

Moving Past the Dickey Amendment

Over time, critics of the gun industry made an issue of the Dickey Amendment and gathered congressional support to clarify the amendment.

In 2018, lawmakers approved language that said the amendment wasn’t a blanket ban on federally funded gun violence research. By 2020, federal research grants on firearms began to be issued again, starting with $25 million to be split between the CDC and NIH.

By now, the CDC and a “” of firearm violence-related research, said Daniel Webster, a professor at the Johns Hopkins Bloomberg School of Public Health.

Also, the Justice Department’s National Institute of Justice the to date, Webster said, and is for studies of mass shootings.

Our Ruling

Kennedy said, “Congress prohibits the NIH from researching the cause of mass shootings.”

Although the Dickey Amendment, a provision of appropriations law supported by the gun industry, didn’t prohibit all federally supported, gun-related research from 1996 to 2018, decision-makers acted as though it did.

However, in 2018, Congress clarified the provision’s language. And since 2020, CDC, NIH, and other federal agencies have funded millions of dollars in gun-related research, including studies on mass shootings.

We rate Kennedy’s statement False.

Our Sources

Robert F. Kennedy Jr. , April 21, 2024

National Institutes of Health, “,” Sept. 20, 2023

National Institute of Justice, “,” Feb. 3, 2022

National Institute of Justice, “,” Feb. 5, 2024

Centers for Disease Control and Prevention, “,” accessed April 22, 2024

American Psychological Association, “,” April 1, 2021

Allen Rostron, “” (American Journal of Public Health), July 2018

Email interview with Gary Kleck, a Florida State University criminologist, April 22, 2024

Email interview with Daniel W. Webster, professor at the Johns Hopkins Bloomberg School of Public Health, April 22, 2024

Email interview with Jaclyn Schildkraut, executive director of the Regional Gun Violence Research Consortium at the Rockefeller Institute of Government, April 22, 2024

Email interview with Mike Lawlor, University of New Haven criminologist, April 22, 2024

Email interview with Allen Rostron, University of Missouri-Kansas City law professor, April 22, 2024

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President Joe Biden caused a stir in a Ìýon Sept. 18 when he declared that the covid-19 pandemic is over.

“We still have a problem with covid — we’re still doing a lot of work on it,” Biden said. “But the pandemic is over.”

Ìýthat the U.S. is still averaging about 400 deaths daily from the virus, that nearly 30,000 Americans remain hospitalized, and that many others areÌýÌýsymptoms stemming from previous infections.

Two days later, Ìýthat despite the negative reactions by some, the pandemic “basically is not where it was.” White House press secretary Karine Jean-PierreÌý “a lot more manageable.” Past experience means “we know what works,” she said.

PolitiFact has been tracking a campaign promise Biden made in 2020 that is closely related, but distinct, from what Biden told “60 Minutes.” During the presidential campaign, Biden said,Ìý“I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you. “

Biden is on safer linguistic ground with his promise to get covid “under control” than saying “the pandemic is over.”Ìý

There remains some debate among public health experts about whether the pandemic is “over” — or whether it realistically can ever be. There isÌýÌýfor making that decision, and the word “over” suggests a finality that is not well suited for describing a pathogen that will exist in some form indefinitely.

However, we found broad agreement among infectious-disease specialists that the pandemic by now is “under control.”

When Biden was inaugurated, physical distancing was widely enforced, schools were often virtual, public events were rare or tightly controlled, and few Americans had yet received a vaccine. Today, life for many Americans is much closer to the pre-pandemic norm, with virtually all schools open, concerts and restaurants well attended, and travel back to its typical level.

“The nation clearly has made tremendous progress on covid-19 since President Biden’s election,” said Jen Kates, senior vice president and director of global health and HIV policy at Â鶹ŮÓÅ. “I would probably say that we are in a pandemic ‘transition’ phase — that is, moving from the pandemic into a post-pandemic period. But this is a continuum, not a cliff, where it’s a pandemic one day and over the next,” Kates added.

Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, added that the promise to get the pandemic under control “is certainly well on course, or perhaps even met, as far as what the federal government can provide to accomplish that.”Ìý

And Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University, agreed that the “emergent phase of the pandemic is coming to a close. We’re now moving into the ongoing struggle — call it a truce with the virus.”

Medical experts said pandemics inevitably become “endemic,” meaning that the pathogen is here to stay but does not present a widespread emergency.Ìý

“We will always have to manage covid in the medical system,” said Dr. Monica Gandhi, a professor of medicine at the University of California-San Francisco. “Unfortunately, although we can bring down deaths to very low, I don’t think we will ever get to zero deaths from covid-19.”

The level of U.S. deaths from covid is lower today than it has been during most of the pandemic, and it has been that way since the spring.

Notably, the number of “excess deaths” is also down. That’s a metric that gauges how many more deaths are occurring beyond the long-term average for that time of year. The number of excess deaths nationally per week has been consistently between zero and 5,000 since the spring, after peaking at 20,000 to 25,000 per week during four previous surges since the pandemic began.

Hospitalization Ìýrecently at some of the lowest rates of the pandemic. And even this level may overstate the virus’s impact; routine testing upon admission often detects cases that are asymptomatic and largely coincidental to the reason a patient is admitted.Ìý

Gandhi pointed to data from Massachusetts hospitalsÌýÌýmost hospitalized patients who test positive for covid have only “incidental infections,” with only 1 in 3 being treated primarily for a covid-related illness.

Experts noted that hospitalizations and deaths, even at these reduced levels, remain too high,Ìýand they cautioned that infections could increase as winter forces people indoors. Still, they credit the availability of vaccines and therapeutics, as well as the knowledge gained from living with the virus for more than two years, for the likelihood that the darkest days of the pandemic are behind us.

“I am not worried at all that we will go back to the scale of hospitalizations and deaths of the worst days of the pandemic,” said Brooke Nichols, an infectious-disease mathematical modeler and health economist at the Boston University School of Public Health. “We will likely enter into a seasonal covid vaccine situation, potentially combined alongside the flu into the same vaccine, and these seasonal vaccines will become critical to avoiding hospitalizations and deaths during the flu and covid seasons.”

There has been no major new variant since omicron emerged in late 2021, and even the most recent omicron subvariant to emerge, BA.5, has had aÌýÌýas the dominant strain in the U.S., prevailing since early July.Ìý

This doesn’t mean that a more dangerous new strain couldn’t emerge. However, public health experts take comfort from recent patterns. The trend during most of 2022 suggests that a rapid succession of ever-more-confounding — and vaccine-evading — variants is not inevitable. If a major new variant does emerge, mRNA vaccines like those made by Moderna and Pfizer-BioNTech can beÌýÌýÌýfor it.

Vaccination uptake, though, remains an urgent question. About one-third of Americans are not fully vaccinated, and an even smaller percentage have received boosters. Plescia said “the main deciding factor right now is not going to be the president or the response of the federal government — it’s going to be the response of the public.”Ìý

“I think there’s disease fatigue and vaccine fatigue and wearing-a-mask fatigue,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “People are just tired of covid and trying to wish it away, and it’s unfortunate because it’s not gone. We’re tired of it, but it’s not tired of us yet.”

Some experts caution that a pandemic “under control” doesn’t mean the costs will be minimal.Ìý

“The degree of protection afforded by the current vaccines available, especially to the most vulnerable, is of limited duration, and nonfatal outcomes from covid can still have knock-on consequences to the population health,” said Babak Javid, an associate professor in the division of experimental medicine at UCSF.

These consequences are called “long covid,” and nearly 1 in 5 Americans who have had covid are suffering from it. TheÌýÌýlong covid as symptoms lasting three or more months after contracting the virus that weren’t experienced before.

“Under control” suggests progress on keeping further spread within modest limits. It does not mean that people haven’t lost loved ones or felt continuing effects from the virus; clearly, they have.

What Does Biden Still Need to Do?

Biden and his administration still have work to do, experts said.

Several public health experts urged Congress to pass Biden’sÌýÌýin covid-related funds. The White House has framed this funding as a way to be ready for a resurgence even though case levels are low now. It proposes that the funding support testing, research on new vaccines and therapeutics, preparations for future variants, and global assistance. Biden’s open declaration that the pandemic is “over” could make congressional approval less likely, however.Ìý

Gandhi said the federal government should do a better job targeting boosters and therapeutics at populations most at risk of severe breakthrough infections, notably older Americans and people who are immunocompromised.

And Schaffner urged more effective and unified messaging, with efforts to remove any hints of politics. “I wish the federal government would get together on who the main messenger is, and provide sustained, clear, simple messages,” he said.

Biden may not have used the most appropriate word when he described the pandemic as “over,” but the long-term statistical trends have been trending in the right direction, and the vaccines and treatments should dampen the severity of future waves. For these reasons, experts say it’s fair to declare that the pandemic is “under control.” If circumstances change, we will reassess our rating, but for now, this receives a Promise Kept.

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Ad from the American Prosperity Alliance, posted July 19

As Senate Democrats raced to pass what could be their final piece of major legislation before the midterm elections, critics went to the airwaves to blast the proposal as hurting older Americans who rely on Medicare.

Here’s the narration , sponsored by a group called the American Prosperity Alliance:

“Higher gas prices, higher grocery bills, everything today is costing too much. Now, Congress is considering a bill that will strip $300 billion from Medicare, money older Americans rely on for their medicine, their treatments, their cures. We are all paying more today, but stripping $300 billion from Medicare? It’s simply too much. So call Congress and tell them to oppose [President Joe] Biden’s reckless spending package.”

The ad misleadingly paints what is more accurately characterized as nearly $300 billion in savings for consumers and taxpayers.

The American Prosperity Alliance maintains almost no online profile. Ìýprovides only a link to the ad, without any identifying information or pages beyond the homepage. When we asked a better-known group with a similar name, Americans for Prosperity, whether the American Prosperity Alliance was an affiliate, a spokesperson, Bill Riggs, said, “This is NOT our ad and we are not affiliated with this group.”Ìý

The adÌýÌýseen in other attacks on the Democratic-backed proposal, including one at TheÌýWashington Post gave three Pinocchios out of four in June, meaning it contains “significant factual error and/or obvious contradictions.” PolitiFact Ìýin July.

The Senate passed , which includes major provisions on climate change and corporate taxation, on Aug. 7. The House is expected to approve the measure this week.Ìý

The problem with the ad’s $300 billion claim is it frames the spending decline as hurting older Americans insured under Medicare. That’s not so.

Rather, the $300 billion — technically, almost $288 billion, according to the latestÌýÌýanalysis — stems from a provision in the Democratic bill that would end the long-standing bar on Medicare from negotiating with drugmakers over the price of certain medicines. Not being able to negotiate prices has meant that Medicare — the pharmaceutical market’s biggest single buyer — could not leverage its weight to secure lower prices for taxpayers.

The bill is projected to reduce federal spending by almost $300 billion, but that would reflect government savings and not benefit cuts; Medicare recipients would receive the same amount of medicines.

“In reality, the bill’s prescription drug savings would save the federal government nearly $300 billion through 2031 without cutting benefits,” wrote the Committee for a Responsible Federal Budget, a group that favors deficit reduction and has been skeptical of many of Biden’s legislative efforts, citing their cost.

“Lowering Medicare costs is not the same as reducing benefits,” the committee wrote. “Quite the opposite — many measures to reduce costs for the government would reduce costs for individuals as well.”

After combining the drug-cost savings with the bill’s other health care provisions, Medicare beneficiaries would see decreases in premiums and out-of-pocket costs, including through a $2,000 annual cap on out-of-pocket costs, the committee projected. “In addition to saving the government nearly $300 billion, the [bill] would save American families nearly $300 billion more,” the committee has projected.

Steve Ellis, president of Taxpayers for Common Sense, another group that seeks to keep deficits low, told PolitiFact he agrees that the ad’s portrayal of the bill is problematic.

“Those are savings resulting mostly from the government negotiating prescription drug prices and limiting drug price increases to inflation,” Ellis said. “So rather than taking money out of Medicare, it is reducing Medicare costs.”

Our RulingThe American Prosperity Alliance said in an ad that the Senate Democrats’ reconciliation bill “will strip $300 billion from Medicare.”

The federal government would see its outlays reduced by about $300 billion as a result of a Medicare drug-price negotiation provision. However, that reduction wouldn’t represent cuts to Medicare beneficiaries. Rather, by leveraging Medicare’s market power, the government would be able to pay less to provide the same medicines.

We rate the statement False.

Sources

American Prosperity Alliance,Ìý, accessed Aug. 4, 2022

American Prosperity Alliance,Ìý, accessed Aug. 5, 2022

Draft ofÌý

Congressional Budget Office, “,” Aug. 3, 2022

Committee for a Responsible Federal Budget, “,” July 8, 2022

Committee for a Responsible Federal Budget, “,” Aug. 2, 2022

The Washington Post, “,” Aug. 4, 2022

The Washington Post Fact Checker, “,” June 17, 2022

HuffPost, “,” Aug. 5, 2022

PolitiFact, “,” July 25, 2022

Email interview with Bill Riggs, spokesperson for Americans for Prosperity, Aug. 5, 2022

Email interview with Steve Ellis, president of Taxpayers for Common Sense, Aug. 5, 2022

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En cambio, ha surgido un flujo aparentemente interminable de “subvariantes” de ómicron en los últimos meses.

¿Qué tan diferentes son estas subvariantes entre sí? ¿Puede la infección por una subvariante proteger a alguien de la infección por otra? Y, ¿qué tan bien funcionan contra estas variantes las vacunas que se desarrollaron antes de la aparición de ómicron?

Expertos médicos clarifican.

P: ¿Cuáles son las subvariantes? ¿Cuánto se diferencian entre sí?

Las subvariantes de ómicron parecen una sopa de letras y números. La variante ómicron original se llamó . Esa variante inicial engendró subvariantes como BA.1; BA.1.1; BA.2; BA.2.12.1; BA.3; y las más recientes, .

“Todas se diferencian entre sí por tener diferentes mutaciones en la ”, que es la parte del virus que penetra en las células huésped y causa la infección, explicó+ la doctora Monica Gandhi, profesora de medicina en la Universidad de California-San Francisco.

Las mutaciones en estas subvariantes pueden hacerlas ligeramente más transmisibles de persona a persona. En general, cuanto más alto sea el número que sigue a “BA” en el nombre de la subvariante, más transmisible será. Por ejemplo, BA.2 es entre un 30 % y un 60 % más transmisible que las subvariantes anteriores, catalogadas con el número 1.

Estas mutaciones han permitido que las subvariantes se propaguen ampliamente, solo por una subvariante ligeramente más transmisible en unas pocas semanas. Luego el proceso se repite.

En Estados Unidos, por ejemplo, BA.1.1 fue dominante a finales de enero, después de haber superado a la variante inicial, B.1.1.529. Pero a mediados de marzo, BA.1.1 comenzó a perder terreno frente a , que se convirtió en dominante a principios de abril.

Para finales de abril, otra subvariante, BA.2.12.1, cobró fuerza y ​​representó casi el 29% de las infecciones, de los Centros para el Control y la Prevención de Enfermedades (CDC).

P: ¿Qué pasa con el nivel de gravedad de las variantes?

Afortunadamente, las enfermedades causadas por ómicron han sido en general menos graves que las causadas por variantes anteriores, un patrón que parece mantenerse para todas las subvariantes estudiadas hasta ahora. Un análisis en Dinamarca mostró que BA.2 que la subvariante BA.1, dijo Gandhi.

Incluso las subvariantes más recientes que se han descubierto,, no muestran “ninguna evidencia que sugiera que son más preocupantes que ómicron original, más allá de un aumento potencialmente leve en la transmisibilidad”, dijo Brooke Nichols, matemática modeladora de enfermedades infecciosas en la Universidad de Boston.

Dennis Cunningham, director médico del sistema de control y prevención de infecciones en Henry Ford Health en Detroit, que los síntomas de las subvariantes de ómicron “han sido bastante consistentes. Hay menos incidencia de personas que pierden el sentido del gusto y el olfato. En muchos sentidos, es un fuerte resfriado, muchos síntomas respiratorios, congestión nasal, tos, dolor corporal y fatiga”.

P: Si te infectas con una subvariante, ¿estarás protegido contra otras?

Hasta ahora, en todas las variantes hasta la fecha, la capacidad del virus para evadir la protección inmunológica existente “, como lo es para la gripe estacional”, dijo Colin Russell, profesor de biología evolutiva aplicada en el centro médico de la Universidad de Amsterdam.

Si bien algunas personas que tenían BA.1 también contrajeron BA.2, la investigación inicial sugiere que la infección por BA. 1 “brinda una fuerte protección contra la reinfección”, la Organización Mundial de la Salud (OMS).

“Esto puede explicar por qué nuestro aumento de BA.2 en EE.UU. no fue tan grande como el gran aumento de BA.1 durante el invierno”, dijo Gandhi.

El nivel de protección puede variar dependiendo de cuán enferma estuvo la persona, en casos leves la inmunidad aumenta quizás durante un mes o dos y la recuperación de una enfermedad grave concede hasta un año.

P: ¿Cómo se posicionan las vacunas contra estas subvariantes?

Aunque las vacunas y los refuerzos actuales no son tan exitosos en la protección contra ómicron como lo son contra variantes anteriores, generalmente protegerán a las personas de enfermedades graves si están infectadas por una de las nuevas subvariantes.

Las vacunas conocidas como “células B de memoria” y que reconocen a medida que surgen, explicó Gandhi. Las vacunas también desencadenan la producción de células T, , dijo.

“Mientras que las células B sirven como bancos de memoria para producir anticuerpos cuando es necesario, las células T amplifican la respuesta del cuerpo a un virus y ayudan a reclutar células para atacar directamente al patógeno”, dijo Gandhi.

El resultado final es que una infección avanzada para un individuo vacunado “debe seguir siendo leve con las subvariantes”, dijo.

La amplia propagación en EE.UU. de una cepa relativamente leve del virus probablemente tuvo un resultado beneficioso porque proporcionó cierta inmunidad a muchos estadounidenses, vacunados o no. La investigación muestra que quienes habían sido vacunados y luego se infectaron, tuvieron una protección aún mayor que las personas que habían sido vacunadas y no contrajeron covid.

De cara al futuro, los fabricantes de vacunas empiezan a diseñar vacunas dirigidas específicamente a ómicron, y algunos combinarían una vacuna contra el coronavirus con otra contra la influenza estacional en una sola inyección. Pero estas vacunas están en sus primeras etapas de producción.

P: ¿Hay variantes completamente nuevas en el horizonte?

“No hay nada que sepamos que esté al acecho todavía, y la vigilancia es bastante agresiva”, dijeron los expertos.

Se estima que ha estado expuesta a ómicron y más del ha recibido al menos una dosis de la vacuna, dijo Gandhi, “así que cruzo los dedos para que el desarrollo de nuevas variantes se ralentice con este grado de inmunidad de la población”.

Gandhi reconoció cierta sorpresa por lo tranquilo que se vislumbra el horizonte en este momento, algo que ve como un desarrollo positivo.

“Ya han pasado cinco meses desde que oímos hablar de una nueva variante, lo que espero refleje el aumento de la inmunidad en la población mundial”, resumió.

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Instead, a seemingly endless stream of “subvariants” of omicron, the most recent Greek-letter variant, has emerged in the past few months.

How different are these subvariants from one another? Can infection by one subvariant protect someone from infection by another subvariant? And how well are the existing coronavirus vaccines — which were developed before omicron’s emergence — doing against the subvariants?

We asked medical and epidemiological experts these and other questions. Here’s a rundown.

Q: What are the subvariants? How much do they differ from one another?

The omicron subvariants seem like an alphabet soup of letters and numbers. The original omicron variant was calledÌý. The initial omicron variant begat such subvariants as BA.1; BA.1.1; BA.2; BA.2.12.1; BA.3; and the most recent,Ìý

“They all differ from each other by having different mutations in theÌý,” which is the part of the virus that penetrates host cells and causes infection, said Dr. Monica Gandhi, a professor of medicine at the University of California-San Francisco.

The minor-to-modest mutations in these subvariants can make them marginally more transmissible from person to person. Generally, the higher the number following “BA” in the subvariant’s name, the more transmissible that subvariant is. For instance, BA.2 isÌýÌýabout 30% to 60% more transmissible than previous subvariants.Ìý

These mutations have enabled subvariants to spread widely, only Ìýby a slightly more transmissible subvariant within a few weeks. Then the process repeats.

In the United States, for instance, BA.1.1 was dominant in late January, having overtaken the initial variant, B.1.1.529. But by mid-March, BA.1.1 began losing ground toÌý,Ìýwhich became dominant by early April. By late April, another subvariant — BA.2.12.1 — was gaining steam, accounting for almost 29% of infections,ÌýÌýfrom the Centers for Disease Control and Prevention. (The delta wave of late 2021 has been a non-factor during this time frame.)

Q: What about the severity of illness?Ìý

Fortunately, the illnesses caused by omicron have typically been less severe than those caused by previous variants — a pattern that seems to hold for all the subvariants studied so far. One analysis from Denmark showed that BA.2ÌýÌýthan the BA.1 subvariant, Gandhi said.

Even the most recent subvariants that have been discovered,Ìý, show “no evidence to suggest that it is more worrisome than the original omicron, other than a potentially slight increase in transmissibility,” said Brooke Nichols, an infectious-disease mathematical modeler at Boston University.

Dennis Cunningham, the system medical director of infection control and prevention at Henry Ford Health in Detroit,ÌýÌýthat the symptoms from the omicron subvariants “have been pretty consistent. There’s less incidence of people losing their sense of taste and smell. In a lot of ways, it’s a bad cold, a lot of respiratory symptoms, stuffy nose, coughing, body aches, and fatigue.”

Q: If you get infected by one subvariant, will you be protected against others?

So far, in all variants to date, the ability of the virus to evade existing immune protection “, much like it is for the seasonal flu,” said Colin Russell, a professor of applied evolutionary biology at the University of Amsterdam’s medical center.

While some people who had BA.1 have also gotten BA.2, the initial research suggests that infection with BA. 1 “provides strong protection against reinfection with BA.2,” the World Health OrganizationÌý.

“This may explain why our BA.2 surge in the U.S. was not that large as the very large BA.1 surge over the winter,” Gandhi said.

The level of protection can vary depending on how sick you were, with mild cases boosting immunity for perhaps a month or two and recovery from a severe illness granting up to a year.

Q: How do existing covid-19 vaccines stack up against these subvariants?

Although the current vaccines and boosters aren’t quite as successful in protecting against omicron as they are against earlier variants, they will generally protect people from severe disease if they are infected by one of the new subvariants.Ìý

“We’re steady as she goes with the vaccines we’re using,” said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University. “I have not seen a single study from the field that shows a substantial distinction between the vaccine responses to omicron subvariants.”

The vaccinesÌýÌýknown as “memory B cells” andÌýÌýto recognizeÌýÌýas they emerge, Gandhi said. The vaccines also trigger the production of T cells,Ìý, she said.Ìý

“While B cells serve as memory banks to produce antibodies when needed, T cells amplify the body’s response to a virus and help recruit cells to attack the pathogen directly,” Gandhi said.Ìý

The end result is that a breakthrough infection for a vaccinated individual “should remain mild with the subvariants,” she said.

The wide spread in the U.S. of a relatively mild strain of the virus likely paid dividends by providing many Americans with some immunity, whether or not they had been vaccinated. Research shows that people who had been vaccinated and then were infected had even greater protection than people who had been vaccinated and not gotten covid.

“This family of omicron could indeed offer a bright side” in the course of the pandemic, Schaffner said.

Looking ahead, vaccine manufacturers are beginning to design vaccines that specifically target omicron, and some would combine a coronavirus vaccine with a seasonal influenza vaccine in one shot. But these vaccines are in their early stages, and Schaffner said he suspects they won’t be ready and approved by this fall’s flu vaccination season.

Whether such new vaccines represent the next step in the fight against covid will be up to the FDA and the CDC.

Q: Are any entirely new variants on the horizon?

Experts agreed that the only newcomers in recent weeks have been incremental subvariants —Ìýcertainly nothing that seems as game changing as delta or omicron were when they first appeared.

“There’s nothing we know of that’s lurking yet, and the surveillance is pretty darn aggressive,” Schaffner said.

There are estimates thatÌýÌýhas been exposed to omicron andÌýover Ìýhas received at least one dose of the vaccine, Gandhi said, “so I am keeping my fingers crossed the development of new variants will slow with this degree of population immunity.”

Gandhi acknowledged some surprise at how quiet the horizon is right now, but she sees it as a positive development.Ìý

“We have now gone five months since hearing about a new variant, which I hope is reflective of increasing immunity in the world’s population,” she said.

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The charts below tell various aspects of the story, from the deadly force of the disease and its disparate impact to the signs of political polarization and the United States’ struggle to marshal an effective response.

Covid rocketed up the list of leading killers in the U.S. like nothing in recent memory. The closest analogue was HIV and AIDS, which causes of death from 1990 to 1996. But even HIV/AIDS never reached higher than eighth on that list.

By contrast, covid shot up to third in 2020, its first year of existence, covering only about nine months of the pandemic. Only heart disease and cancer killed more Americans that year.

“The leading causes of death are relatively stable over long periods of time, so this is a very striking result,” said a professor of preventive medicine and health policy at Vanderbilt University.

Covid generally hit people of color harder, a pattern experts trace back to historical disparities in income, geography, medical access, and educational attainment.

“This tells us something about our society — it’s a kind report card,” Schaffner said. Studies have shown that illness and prevention are even more strongly correlated with educational background than with income.

“There was some effort to correct the disparities,” said , a professor of bioethics at New York University’s Grossman School of Medicine. “But these were band-aids on a system that remains broken.”

Older people tend to be more vulnerable to disease than younger people, because of weaker immune systems and underlying health problems. That’s been especially true with covid.

“Many other infections affect the very young and the very old disproportionately, but covid-19 stands out in being so age-dependent,” said a professor of medicine at the University of California-San Francisco. “Children were remarkably spared from severe disease in the U.S., as they were worldwide.”

Deaths among older Americans, however, were especially widespread in the early days of the pandemic due to the close contact of seniors living in nursing homes.

“Some will argue that [the] old are frail anyway, but I find that morally repugnant,” Caplan said. The deaths of so many older people “makes me extremely sad.”

The good news, experts say, is that older Americans were the most likely to get vaccinated, with a 91% full vaccination rate for those between ages 65 and 74. This almost certainly prevented many deaths among older people as the pandemic ground on, Schaffner said.

Although the pandemic has had its peaks and valleys, due to largely seasonal factors and the emergence of new variants, it has continued to produce deaths at a fairly steady rate since its beginning two years ago.

The pandemic is “impressive in how it just keeps going,” Schaffner said.

The slow grind is “why we’re exhausted,” Caplan said. “It’s like we can’t make a significant dent, no matter what we do.”

There have been five distinct peaks: the initial one in April 2020, a summer spike in August 2020, a winter spike in January 2021, the initial outbreak of the delta variant in September 2021, and the omicron surge in January 2022.

The on-off nature of the pandemic “has led to a lot of the confusion and grumpiness,” Schaffner said. Caplan compared it to the exhaustion of the American public when hearing body counts during the Vietnam War.

Once a natural disaster like a hurricane or a tornado has passed, Schaffner added, it’s gone and people can rebuild. With covid, it’s just been a matter of time before the next wave arrives. The coronavirus also affected the whole world, unlike a localized disaster.

Such factors “stretched the capacity of the public health system and our governance,” Schaffner said.

Not surprisingly, the number of deaths in each state was heavily dependent on the size of the state’s population. California and Texas each lost more than 80,000 people to covid, while Vermont lost 546.

But once you adjust for population, distinct differences emerge in how various states fared during the pandemic.

The seven states with the worst death rates include densely populated New Jersey, an affluent, educated Northeast state, and Arizona, a fairly diverse Southwestern state. The other five are Southern states that the 11 states with the lowest levels of educational attainment and : Mississippi, Alabama, Louisiana, Tennessee, and West Virginia.

Among the states with the lowest death rates, Hawaii and Alaska (and, to an extent, Vermont and Maine) are isolated and may have had an easier time keeping the virus out.

“For all the grumbling you hear about federal mandates and enforcement, you can’t help but look at this list and see that the pandemic has been handled state by state,” Caplan said.

The world’s performance in battling covid is analogous to the United States’: Some places did it well, and others did not.

And in the international context, the United States’ record was not so hot.

When comparing death rates around the world, it’s clear how much worse the U.S. has fared than other wealthy industrialized nations.

The countries that have a higher death rate than the U.S. are largely medium-size and middle-income. The industrialized Western nations that are the United States’ closest peers all managed to do better, including the United Kingdom, France, Germany, Italy, and Canada.

Meanwhile, other affluent countries did far better than the U.S. did, including Japan, South Korea, and Taiwan (which have more experience with airborne diseases and greater public tolerance for masking), and two island nations: Australia and New Zealand.

In general, Schaffner said, countries that performed better than the U.S. tended to have “sustained, single-source, science-based communication. They communicated well with their populations and explained and justified why they were doing what they were doing.”

It’s impossible to look at the United States’ response to covid without factoring in the extent to which it became politicized. Almost from the beginning, basic communications about the severity of the disease and how to combat its spread broke down along partisan lines. The way Americans responded also followed a partisan pattern.

Most states that voted for Joe Biden for president in 2020 had above-average vaccination rates. Most states that voted for Donald Trump in 2020 had below-average rates.

Among the outliers in that pattern were Arizona, Nevada, Michigan, and Georgia, which supported Biden but had below-average vaccination rates. All four had very tight races in 2020; and Trump won three of them in 2016. The outliers on the other side were Florida and Utah, which supported Trump but had higher-than-average vaccination rates.Ìý

Efforts to promote vaccination as advancing the common good “got beaten back by arguments about autonomy and individual freedom,” Caplan said.

The rejection of vaccines by many Americans helped bring down U.S. vaccination rates compared with other countries as well.

The U.S. full-vaccination rate of just under 66% was higher than the world average of about 54%, but not especially impressive considering the United States’ wealth and the fact it was producing many of the key vaccines in the first place. Essentially every other high-income country has vaccinated a higher share of its residents than the U.S. has.

The fact that the United States has both a lower rate of full vaccination and a higher death rate than other high-income countries “makes me wonder how we might have done as a country if our pandemic response had not been so politicized and polarized,” said an infectious-disease mathematical modeler at Boston University.

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