Author: zuniga

  • No Smoking Gun: Fauci’s Journals and the Weaponization of Science

    For full disclosure, I have known and respected Dr. Tony Fauci for almost four decades as he led the nation’s HIV and other infectious disease research agenda from his perch as Director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH). He spoke at several conferences I organized, and I was proud to recognize him as an “IAPAC Hero in Medicine” during a 2006 ceremony at the XVI International AIDS Conference in Toronto.

    That long association inevitably informs my perspective, but it does not require me to ignore either the human frailties revealed in the wrongful release of more than 1,100 pages of Dr. Fauci’s private journals or any legitimate questions raised by his public record. The journal entries offer a remarkable window into how a scientific mind works under extraordinary pressure. They document uncertainty, competing hypotheses, rapidly changing evidence, political interference, media demands, and the burden of advising a country confronting a novel and deadly pathogen.

    They also reveal something far more ordinary: the humanity of the person behind the public figure. Dr. Fauci recorded irritation with colleagues, frustration with political leaders, pride in favorable coverage, and fascination with his sudden transformation into a cultural icon. Some entries are unvarnished. Others are self-conscious or self-congratulatory. They reflect the stickiness of the celebrity cult that developed around him and, at moments, the difficulty of remaining entirely untouched by it as I suspect many of us might struggle.

    But the journals must be read (if at all) as contemporaneous notes from a scientist attempting to understand an unfolding crisis. Scientific uncertainty is not evidence of dishonesty. Considering several hypotheses before reaching a provisional judgment is not a conspiracy; it is how science works. The scientific process requires questioning initial assumptions, testing competing explanations, revising conclusions as evidence accumulates, and remaining open to the possibility that even the most informed judgment may prove incomplete or wrong.

    The entries show that Dr. Fauci convened scientists to consider competing explanations for the origin of SARS-CoV-2, including natural spillover and a possible laboratory-associated origin. They show debate, doubt, and an insistence that the question not be dismissed. What they do not provide is a “smoking gun” proving he orchestrated a cover-up or knowingly deceived the American people. Indeed, the origin of COVID-19 remains unresolved, and the journals do not change that fundamental fact.

    None of this means Dr. Fauci’s decisions, statements, or judgments should be immune from scrutiny. And given his prolific testimony before the US Congress over so many years, it is clear he knows that fact. The pandemic response must be examined rigorously, including where guidance changed, communication failed, institutional caution became counterproductive, or public health leaders underestimated the social consequences of risk mitigation policies. Accountability is indispensable and no one is above the law. But accountability is not the same as humiliation.

    Balanced against Dr. Fauci’s imperfections is a storied legacy of public service spanning nearly four decades as NIAID Director and service under seven presidents. His leadership extended from HIV to Ebola, influenza, and COVID-19. During the pandemic, he worked alongside Dr. Deborah Birx, a friend and colleague whom I deeply admire, and other public health leaders whose collective efforts – including the acceleration of vaccines, treatments, testing, and prevention measures – saved millions more lives than COVID-19 claimed.

    That is why it was painful to watch Republican senators direct irresponsible and insulting words towards him during a US Congressional committee hearing today. This was not the searching inquiry that the country deserves; it resembled a performance staged around a verdict already reached. The committee’s chairman, Sen. Rand Paul, has repeatedly called for Dr. Fauci’s imprisonment. At the July 29, 2026, hearing, Dr. Fauci invoked the Fifth Amendment and described Sen. Paul’s campaign as an “unhinged obsession” with sending him to prison.

    The damage extends far beyond Dr. Fauci, though. Every such spectacle further erodes trust in public institutions, scientific expertise, and the possibility of good-faith public health leadership. It tells future scientists that service may end not merely in criticism, but in threats of imprisonment by elected officials seeking political advantage. As I write in my book, “Aftershocks,” the politicization of public health damages individual leaders and institutions just as it also weakens our capacity to confront the next crisis.

    Reclaiming the public health narrative will require enormous work that I also outline across multiple “Aftershocks” chapters. Trust cannot be restored through nostalgia, institutional defensiveness, or demands that people simply “follow the science.” Public health must acknowledge mistakes (when they are truly mistakes), explain uncertainty more honestly and effectively, communicate with humility and cultural competence, and demonstrate that changing guidance can reflect new evidence rather than bad faith.

    At the same time, political leaders must stop weaponizing science. We cannot rebuild trust while powerful officials turn public health hearings into tribunals and scientists into enemies of the state. President Trump has the authority and the responsibility to stop this madness by rejecting threats of political retribution against Dr. Fauci. Regrettably, he is far more likely to encourage this spectacle than to bring it to an end which is a sad statement about our body politic.

    Dr. Fauci’s journals reveal a brilliant, imperfect, sometimes vain, sometimes frustrated human being working through an unprecedented crisis. Now that they are in the public domain, they warrant reflection and scrutiny. But the smoking gun promised by his accusers is simply not there and no amount of political fury can manufacture it for us without further sacrificing truth, due process, and public trust in science and those who devote their lives to advancing it in service to the public.

    Dr. José M. Zuniga

  • Silence Is Not a Sound Public Health Strategy: Cyclosporiasis and the Cost of a Federal Leadership Vacuum

    Public health leadership is measured not only by scientific expertise or institutional capacity, but by the willingness to communicate clearly, consistently, and transparently during moments of uncertainty. Americans expect and deserve timely information about health threats, practical guidance to reduce risk, and reassurance that the nation’s public health institutions are actively monitoring emerging challenges. Increasingly, however, that expectation is going unmet.

    The growing outbreak of cyclosporiasis offers a troubling illustration. With more than 3,000 reported cases as of mid-July 2026 and the number continuing to climb, the United States is experiencing one of the largest documented outbreaks of this foodborne parasitic disease in recent years. Yet the federal response has been marked less by visible leadership than by conspicuous silence. While state and local health departments continue investigating cases and clinicians diagnose and treat patients, there has been little sustained national communication that reflects the seriousness of the situation or helps Americans understand how to protect themselves.

    Cyclosporiasis, caused by the parasite Cyclospora cayetanensis, is not new. The infection typically spreads through contaminated fresh produce and causes prolonged diarrhea, fatigue, abdominal cramping, nausea, and weight loss. Although healthy individuals generally recover with appropriate antibiotic treatment, illness can be severe and prolonged, particularly among older adults, young children, and people with compromised immune systems. Rapid public communication about outbreaks serves two essential purposes: helping consumers reduce their exposure and supporting efforts to identify contaminated food sources before additional people become ill.

    Instead, Americans have largely been left to piece together information from scattered state advisories, inconsistent media reports, and occasional technical updates. This fragmented communication environment undermines public confidence precisely when national coordination is most needed. One of the first rules of public health is to communicate with the public early and often with clear, consistent, and transparent messaging. If the COVID-19 pandemic taught us anything, it is that silence, inconsistency, or mixed messages from federal health leaders carry real consequences. Effective risk communication is every bit as important as surveillance, laboratory testing, and epidemiologic investigation in protecting the public’s health.

    The communication vacuum cannot be separated from the broader dismantling of federal public health infrastructure over the past 18 months. Deep staffing reductions across key health agencies, elimination of experienced scientific and communications personnel, restructuring of long-established programs, and reduced investment in surveillance capacity have collectively weakened the government’s ability to detect, investigate, and respond to health threats. Public health systems function as integrated networks; when epidemiologists, laboratory scientists, communications specialists, and emergency preparedness experts disappear, the consequences extend well beyond internal organizational charts.

    Equally concerning is the apparent reluctance of senior federal leaders to speak directly to the American people. Public health emergencies require trusted voices willing to explain what is known, acknowledge what remains uncertain, and provide practical recommendations grounded in evidence. Silence creates space for confusion, speculation, and misinformation. It also signals an abdication of one of government’s most fundamental public health responsibilities: keeping people informed.

    This leadership gap extends to the highest levels of the Department of Health and Human Services (HHS). Secretary Robert F. Kennedy, Jr., has frequently attracted attention through statements on a range of controversial health issues. Yet during an expanding foodborne disease outbreak affecting thousands of Americans, there has been no comparable, sustained effort to educate the public about cyclosporiasis, reinforce food safety practices, or demonstrate visible federal coordination. Leadership is not measured by media appearances alone; it is measured by whether communication helps protect people’s health.

    The absence of consistent federal messaging also places additional burdens on state and local health departments. These agencies remain the backbone of outbreak detection and response, but they rely on strong national coordination, laboratory support, interstate data sharing, and unified public communications. When federal leadership recedes, local agencies must fill gaps with limited resources while simultaneously responding to increasing public concern. The result is a patchwork response that varies across jurisdictions rather than a coherent national strategy.

    The consequences extend beyond this single outbreak. Every episode in which federal institutions fail to communicate effectively erodes public trust. Trust is not rebuilt through slogans or political rhetoric; it is earned through transparency, scientific integrity, and regular engagement with communities. During outbreaks, uncertainty is inevitable. Silence, however, is a choice. As I write in my new book, “Aftershocks,” pathogens exploit biological vulnerabilities, while misinformation exploits institutional silence. Both flourish when leadership is absent.

    The United States has long been recognized as a global leader in epidemiology, outbreak investigation, laboratory science, and emergency preparedness. That reputation was built over decades through sustained investment in institutions and the professionals who served within them (many of whom remain in their posts today under significant duress). Allowing those capabilities to erode while diminishing public communication represents a dangerous departure from that legacy that we have unfortunately also witnessed over the past 18 months.

    Cyclosporiasis will eventually subside, as foodborne outbreaks often do. The larger question is whether the lessons will be learned before the next public health threat emerges. Infectious diseases do not pause while governments reorganize, budgets shrink, or leadership remains quiet. Pathogens exploit gaps in surveillance, response, and communication alike. Every missed opportunity to strengthen those defenses increases the likelihood that the next outbreak will be detected later, spread farther, and exact a greater human and economic toll.

    Public health leadership requires visible, credible voices that inform rather than alarm, educate rather than confuse, and reassure through transparency rather than silence. Americans deserve federal public health leaders who recognize that communication is not peripheral to public health; it is one of its most essential interventions when it is grounded in science. And they deserve a public health infrastructure robust enough to detect threats early, respond rapidly, and support the clear, coordinated communication that protects lives.

    Dr. José M. Zuniga

  • Two Humanoid Robots Enter the Operating Room: Not a Joke But A Glimpse into the Future of Surgical Care

    A remarkable milestone in surgical innovation was reached this week as researchers at the University of California San Diego reported the successful use of two teleoperated humanoid robots to complete minimally invasive gallbladder removal procedures during preclinical testing. While the surgeries were performed on large animal models rather than human patients, the achievement represents the first documented use of humanoid robots in live surgical procedures and offers an intriguing vision of how technology may reshape healthcare delivery in the years ahead.

    Unlike conventional surgical robotic systems that are purpose-built for specific procedures, these humanoid robots were adapted from commercially available platforms designed to mimic human movement. Controlled remotely by experienced surgeons, the robots successfully performed complex surgical tasks including tissue retraction, dissection, clipping, and gallbladder removal. Importantly, the robots were not autonomous. Every movement remained under the direct control of a human surgeon, underscoring that this breakthrough is about extending – not replacing – human expertise.

    The significance of this advance extends well beyond technological novelty. Healthcare systems worldwide continue to face shortages of surgeons, operating room personnel, and specialized medical services, particularly in rural communities, humanitarian crises, conflict zones, and low-resource settings. Humanoid robotic platforms could eventually allow expert surgeons to deliver sophisticated care remotely while enabling hospitals to use versatile robotic assistants capable of performing multiple clinical functions beyond surgery. Because these robots are built to operate in environments already designed for humans, they may require far less infrastructure investment than many existing surgical robotic systems.

    Nevertheless, substantial challenges remain before humanoid robots enter routine clinical practice. The procedures required repeated recalibration, experienced delays between surgeon input and robot response, and took considerably longer than comparable operations performed using established robotic platforms. Extensive engineering refinements, regulatory review, safety validation, and human clinical trials will all be required before these systems can be considered for widespread patient care.

    Perhaps the most important lesson from this breakthrough is that the future of healthcare should not be framed as a competition between humans and machines. Rather, it is increasingly becoming a story of collaboration. Artificial intelligence, robotics, and digital technologies have enormous potential to augment clinical expertise, reduce provider burnout, improve precision, and expand access to high-quality care. Their greatest value will come when they strengthen the human relationships at the center of medicine.

    As healthcare systems grapple with rising demand, aging populations, workforce shortages, and persistent inequities in access to care, innovations like these deserve careful attention. The operating room of the future may well include humanoid robotic assistants standing alongside surgeons, nurses, and anesthesiologists as integrated members of the clinical team. If developed responsibly and deployed equitably, such technologies could help bring lifesaving surgical care to populations that have long been beyond the reach of traditional healthcare systems.

    The future of surgery is unlikely to be fully autonomous. It is far more likely to be human-led, technology-enabled, and increasingly accessible to patients wherever they live. Implemented with ethical and safety considerations at the forefront, these advancements have the potential to transform surgical care while maintaining trust and accountability in medicine.

    Dr. José M. Zuniga

    Here is a link to the University of California San Diego story about their surgical innovation: https://today.ucsd.edu/story/surgeons-use-teleoperated-humanoid-robots-to-perform-live-surgery-a-world-first?utm_source=chatgpt.com

  • COVID-19 Is Not Over; It Has Simply Evolved: Why Vigilance Still Matters for People with Comorbidities

    There is a growing narrative – subtle but pervasive – that COVID-19 is no longer something to worry about. Case counts are lower than in previous years, emergency declarations have ended, and daily life has largely resumed. But this narrative is not only incomplete; it is dangerous. COVID-19 has not disappeared but instead has evolved and settled into endemic circulation. Although it gets less coverage, it continues to exact a measurable toll, particularly among people with comorbidities and those living in urban environments where both infectious and non-communicable diseases intersect.

    First, the data are unequivocal: SARS-CoV-2 continues to cause substantial morbidity and mortality worldwide. While global reported case counts may appear modest with roughly 38,000 cases reported across 80 countries in a recent 28-day period, these figures mask significant underreporting due to significantly reduced testing and surveillance. Indeed, experts have long cautioned that official COVID-19 death counts underestimate the true burden because of limited testing, inconsistent reporting, and misclassification of deaths.

    More importantly, COVID-19 is no longer a uniform threat; it is a stratified risk, disproportionately affecting those with underlying health conditions. Individuals with cardiovascular disease, diabetes, chronic respiratory illness, cancer, and immunocompromising conditions – including people living with HIV – continue to face elevated risks of severe outcomes, hospitalization, and death. The interplay between SARS-CoV-2 infection and these comorbidities is not incidental; it is synergistic. COVID-19 exacerbates existing conditions while those same conditions impair the body’s ability to respond effectively to infection.

    This is particularly concerning in urban settings. Cities are epicenters not only of economic and social activity but also of disease concentration. HIV prevalence, alongside non-communicable diseases such as hypertension, obesity, and diabetes, is often higher in urban populations due to a combination of structural inequities, environmental exposures, and access disparities. These same populations, already navigating layered health vulnerabilities, are at heightened risk when COVID-19 circulates and thus priority candidates for vaccination.

    And circulate it does. One of the clearest indicators comes from wastewater surveillance. The U.S. Centers for Disease Control and Prevention (CDC) continues to track SARS-CoV-2 levels in wastewater across the country, updating data weekly as part of its National Wastewater Surveillance System. Wastewater analysis provides a community-level signal of viral activity independent of individual testing behaviors. Importantly, studies consistently show a strong correlation between wastewater viral levels and subsequent hospitalizations, often with a lead time of one to two weeks.

    In other words, the virus is still spreading even when we are not testing for it.

    Dr. José M. Zuniga

  • Growing Two Flowers with One Seed: A Mandate for Public Health and Social Justice Efficiency

    In times of deepening ideological divides, advancing public health and social justice often feels like planting seeds in barren soil. Yet, resilience demands innovation. In an era where political ideologies obstruct meaningful action, we must refine our strategies to maximize impact. If the political environment restricts resources, funding, or policy support, then efficiency becomes not just a virtue but a necessity. We must learn to grow two flowers with one seed, extracting double the value from every effort, finding synergy in unexpected places, and ensuring that progress is not contingent upon the whims of political cycles.

    Political ideology has long been a gatekeeper of human progress. Whether it is resistance to universal healthcare, climate action, or harm reduction programs, public health and social justice initiatives are often stalled not by lack of evidence but by the deliberate erection of ideological roadblocks. These barriers create a scarcity of resources, forcing advocates and practitioners to operate within constraints that would not exist in a purely rational policymaking landscape.

    Consider the ongoing battle for comprehensive sexual and reproductive health rights, harm reduction services for people who use drugs, or access to HIV pre-exposure prophylaxis (PrEP). Science and experience tell us that these interventions work. Yet, their rollout remains subject to political whims. Similarly, addressing structural racism in healthcare or the intersection of climate change and health is often derailed by those who view equity-based policies as political overreach rather than moral imperatives.

    So, what do we do when the soil is hostile? We grow two flowers with one seed. The metaphor of growing two flowers with one seed encapsulates a mindset shift that prioritizes efficiency, dual-purpose interventions, and multi-sectoral collaboration. It is about designing initiatives that achieve compounded impact – strategies that, when deployed, yield benefits in multiple areas simultaneously.

    Take, for example, urban health initiatives that address both climate change and disease prevention. Expanding green spaces in cities not only mitigates the urban heat island effect but also improves mental health and cardiovascular outcomes. A single intervention – creating accessible, tree-lined public spaces – advances climate resilience, reduces health inequities, and fosters social cohesion. That is two (or more) flowers from one seed.

    Similarly, integrating HIV prevention with primary healthcare ensures that people at risk of HIV also receive screening for other conditions such as diabetes or hypertension. This not only improves patient outcomes but also strengthens health systems by breaking down silos between disease-specific programs. In politically fraught environments where standalone HIV programs may face backlash, embedding them into primary care can be a tactical safeguard.

    Or consider the efficiency of leveraging community health workers to address multiple health and social needs. Rather than deploying separate outreach programs for mental health, HIV care, maternal health, and chronic disease prevention, a single, well-trained cadre of community health workers can be empowered to provide culturally competent, multi-faceted care. Again, one intervention, multiple benefits.

    Efficiency in times of political resistance also means building unexpected alliances. Public health leaders must cultivate partnerships beyond traditional health actors, tapping into education, labor, environmental, and corporate sectors to achieve shared goals. For example, embedding workplace wellness programs into discussions about economic productivity and labor rights can circumvent ideological pushback against universal healthcare expansion. Similarly, framing housing as healthcare and demonstrating how stable housing reduces healthcare costs can appeal to fiscally conservative policymakers who otherwise resist direct investments in social services.

    Even within the realm of harm reduction, we see this principle in action. In the United States, the expansion of naloxone access through libraries, community centers, and even faith-based organizations has circumvented political opposition that would have blocked direct government intervention. By integrating harm reduction into broader community well-being initiatives, advocates have managed to grow two flowers – public health impact and social acceptance – with one policy seed.

    What does this all mean? Optimizing resources by designing interventions that simultaneously address multiple health and social challenges. Leveraging intersectionality to ensure that progress in one area advances broader justice and equity goals. Building coalitions beyond ideological battle lines to create resilience against political headwinds. And embedding

    public health in all policies, ensuring that health equity is integrated into economic, environmental, and social policy frameworks.

    In an ideal world, every cause would have the resources it needs to flourish. But in a world where political and ideological forces create artificial scarcity, we must be the gardeners who refuse to accept that scarcity as destiny. We must plant with intention, cultivate with care, and ensure that every seed we sow yields more than expected. For those of us working at the intersection of public health and social justice, the goal is not simply to sustain progress but to accelerate it and to ensure that even in times of constraint, we are not just surviving but thriving.

    Dr. José M. Zuniga