From Dr Jeremy Faust at Inside Medicine 9/25/25:
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"The United States federal government is about to run out of money. If Congress does not pass a spending bill—or a short-term continuing resolution that keeps money flowing temporarily—there will be a federal government shutdown this coming Tuesday.
"Moments like these are rare opportunities for the party that is not in control of Congress. As The New York Times described it, “passing a government spending bill that can win the necessary 60 votes depends on attracting at least a small amount of Democratic support. That will require bipartisan negotiation, an art that has been fading steadily on Capitol Hill and has so far been lost altogether during Mr. Trump’s second term.”
"In other words, Democrats have some leverage here. How should they use it?
"So far, I’ve heard the usual fantasies, which boil down to using the threat of a shutdown to convince the other side to abandon its most cherished projects.
"Try as they might, Congressional Democrats are not going to get their Republican counterparts to get religion on, say, reversing $1 trillion in cuts. But there’s something that Democrats can do. They can make the Republicans an offer they can’t refuse.
"Congressional Democrats should make an uncharacteristic offer to support some deep cuts enumerated in the recent House and Senate markups of the appropriations bill for the coming fiscal year. In exchange, they should require that President Trump fire HHS Secretary Robert F. Kennedy Jr, or accept his prompt resignation.
"Democrats should consider including some extraordinary deep cuts proposed in President Trump’s requested budget, floated earlier this year, cuts that were so extensive that neither chamber of Congress included them in their recent versions of the spending bill. To be clear, these cannot be superficial concessions, but must instead be impressive enough to get Republicans’ attention. These cuts must be carefully chosen, but they would have to be significant enough that, absent the offer, many or most of the included proposals would be likely to die during the negotiation process otherwise. That’s the only way to get their attention. Remember, without a deal like this, many of these cuts are likely to eventually happen anyway.
"This deal would be worth it for both sides. Whether President Trump realizes it or not, this deal would indeed be to his longterm advantage. Secretary Kennedy poses a singular, unique threat to President Trump’s primary legacy from his first term, Operation Warp Speed, the successful effort that led to effective vaccines against Covid-19 in months, instead of years. Trump’s leadership on Covid-19 vaccines in 2020 saved hundreds of thousands, perhaps millions, of American lives.
"However, since his confirmation as health secretary, Kennedy has taken several steps that could destroy Trump’s vaccine legacy. He has spread falsehoods about the vaccines, including that they are the most dangerous vaccines ever created. He has canceled hundreds of millions of dollars in research that could prevent another pandemic or end the emergency phase of one sooner.
"Secretary Kennedy also poses a unique threat to President Trump’s legacy in his second term, too, something the President may not yet recognize. By attacking our nation’s vaccine infrastructure—by dismantling the rigorous and transparent process that ensures that our policies are firmly rooted in the best-available totality of the science, and by paving the way for actions that may scare vaccine manufacturers off the market—Kennedy is risking the lives of millions of American children. If more measles outbreaks occur as a result of decreased vaccine uptake, the attendant increases in severe pediatric illnesses and deaths will squarely be Trump’s responsibility.
"Kennedy’s inability or refusal to understand the way science actually works is also starting to create self-defeating optics for the administration, including the bizarre spectacle of the President of the United States repeatedly yelling “Don’t take Tylenol” from behind a podium at the White House. (The FDA had to walk back some of what was said at that press event.) This unforced error—trying to pin increased rates of autism on Tylenol use during pregnancy when the evidence on this is far from certain—is likely to backfire for the President in many ways. First, millions of Americans will feel incorrectly shamed for having taken a medication that is safe and effective. In fact, the medication may actually contribute to lower rates of autism in pregnant women who take it to treat fevers. The “precautionary principle” invoked by the President’s FDA Commissioner is therefore not applicable here. Second, the complete abandonment of norms in developing public health policy might someday cause the President’s opposition to embrace a similar style when they are in control. While an eye-for-an-eye approach would not be the ideal response (a return to the commitment to rely on rigorous, settled science would be), it’s easy to imagine that that’s where we’re headed. No one is served by this, short-term victories notwithstanding.
"President Trump can end these threats to our nation’s public health by requesting Secretary Kennedy’s immediate resignation. This would also be a gift to Republicans, many of whom sense that Kennedy’s damage will soon be unpopular.
"Yes, Kennedy’s replacement will have to pass Senate confirmation. But this time, the Senate will not be so easily fooled by false assurances, the fate that befell Senator Bill Cassidy (R-LA), a pro-vaccine physician, who was bamboozled into offering the last-minute support Kennedy’s successful nomination needed.
"The 20th century was the first one in which surviving childhood became the norm. Life-saving vaccines were a big part of that achievement. Equally important, though, is our national vaccine infrastructure, which is what assures that people can receive them. Removing threats to access to vaccines—threats introduced by Secretary Kennedy—matters more than almost anything in the 2026 spending bills. Congressional Democrats should be willing to swallow a bitter pill on some cuts if it means a generation of children will be guaranteed the protection offered by vaccines."

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