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How Gas Stoves Are Silently Polluting Our Homes

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Friday, May 3, 2024

A study has revealed that households using gas or propane stoves face significant exposure to nitrogen dioxide (NO2), which can lead to health issues like asthma and even premature death. The study conducted by researchers from various institutions, including Stanford, showed that NO2 levels in homes can remain elevated for hours after stove use, affecting even those not directly in the kitchen.People with gas and propane stoves breathe more unhealthy nitrogen dioxide.Households with gas or propane stoves regularly breathe unhealthy levels of nitrogen dioxide, a study of air pollution in U.S. homes found.“I didn’t expect to see pollutant concentrations breach health benchmarks in bedrooms within an hour of gas stove use, and stay there for hours after the stove is turned off,” said Stanford Doerr School of Sustainability Professor Rob Jackson, senior author of the May 3 study in Science Advances. Pollution from gas and propane stoves isn’t just an issue for cooks or people in the kitchen, he said. “It’s the whole family’s problem.”Among other negative health effects, breathing high levels of nitrogen dioxide, or NO2, over time can intensify asthma attacks and has been linked to decreased lung development in children and early deaths. Although most exposure to NO2 is caused by cars and trucks burning fossil fuels, the researchers estimate that the mix of pollutants coming from gas and propane stoves overall may be responsible for as many as 200,000 current childhood asthma cases. One quarter of these can be attributed to nitrogen dioxide alone, according to the paper’s authors, who include scientists from Central California Asthma Collaborative, PSE Healthy Energy, and the Harvard T.H. Chan School of Public Health.“We found that just how much gas you burn in your stove is by far the biggest factor affecting how much you’re exposed. And then, after that, do you have an effective range hood – and do you use it?” said lead study author Yannai Kashtan, a PhD student in Earth system science.Stanford PhD student Metta Nicholson observes a gas burner in a home where scientists measured air pollution as part of their data collection in California, Texas, Colorado, New York, and Washington, D.C.. Credit: Rob Jackson, Stanford Doerr School of SustainabilityLittle Room for Additional ExposureBeyond asthma cases, the long-term exposure to NO2 in American households with gas stoves is high enough to cause thousands of deaths each year – possibly as many as 19,000 or 40% of the number of deaths linked annually to secondhand smoke. This estimate is based on the researchers’ new measurements and calculations of how much nitrogen dioxide people breathe at home because of gas stoves and the best available data on deaths from long-term exposure to outdoor NO2, which is regulated by the U.S. Environmental Protection Agency.The death toll estimate is approximate in part because it does not factor in the harmful effects of repeated exposure to extremely high levels of nitrogen dioxide in short bursts, as occurs in homes with gas stoves. It also relies on past studies of health impacts from nitrogen dioxide encountered outdoors, where additional pollutants from vehicles and power plants are present.Colin Finnegan of the Stanford Doerr School of Sustainability checks a simmering pot on a gas stove that does not have a range hood. Using a range hood that vents air to the outdoors can dramatically influence how much nitrogen dioxide fills the air in a home. Credit: Rob Jackson, Stanford Doerr School of SustainabilityThe researchers used sensors to measure concentrations of NO2 throughout more than 100 homes of various sizes, layouts, and ventilation methods, before, during, and after stove use. They incorporated these measurements and other data into a model powered by National Institutes for Standards and Technology (NIST) software known as CONTAM for simulating airflow, contaminant transport, and room-by-room occupant exposure in buildings. This allowed them to estimate nationwide averages and short-term exposures under a range of realistic conditions and behaviors, and cross-check model outputs against their home measurements.The results show that nationwide, typical use of a gas or propane stove increases exposure to nitrogen dioxide by an estimated 4 parts per billion, averaged over a year. That’s three quarters of the way to the nitrogen dioxide exposure level that the World Health Organization recognizes as unsafe in outdoor air. “That’s excluding all outdoor sources combined, so it makes it much more likely you’re going to exceed the limit,” said Kashtan.Understanding How Gas Stoves Affect HealthThe study is the latest in a series from Jackson’s group at Stanford looking at indoor air pollution from gas stoves. Earlier studies documented the rate at which gas stoves emit other pollutants, including the greenhouse gas methane and the carcinogen benzene. But to understand the implications of stove emissions for human health, the researchers needed to find out how much pollutants spread through a home, build up, and eventually dissipate. “We’re moving from measuring how much pollution comes from stoves to how much pollution people actually breathe,” said Jackson, who is the Michelle and Kevin Douglas Provostial Professor in Earth System Science.With any fuel source, particle pollution can rise from food cooking in a hot pan. The new research confirms that food emits little or no nitrogen dioxide as it cooks, however, and electric stoves produce no NO2. “It’s the fuel, not the food,” said Jackson. “Electric stoves emit no nitrogen dioxide or benzene. If you own a gas or propane stove, you need to reduce pollutant exposures using ventilation.”Home Size MattersEven in larger homes, concentrations of nitrogen dioxide routinely spiked to unhealthy levels during and after cooking even if a range hood was on and venting air outdoors. But people who live in homes smaller than 800 square feet – about the size of a small two-bedroom apartment – are exposed to twice as much nitrogen dioxide over the course of a year compared to the national average, and four times more compared to those living in the largest homes, upwards of 3,000 square feet.Because home size makes such a difference, there are also differences in exposure across racial, ethnic, and income groups. Compared to the national average, the researchers found long-term NO2 exposure is 60% higher among American Indian and Alaska Native households, and 20% higher among Black and Hispanic or Latino households. This exposure to indoor air pollution from gas stoves compounds the fact that exposure to outdoor sources of nitrogen dioxide pollution, such as vehicle exhaust, is also typically higher among people in poorer, often minority, communities.“People in poorer communities can’t always afford to change their appliances, or perhaps they rent and can’t replace appliances because they don’t own them,” Jackson said. “People in smaller homes are also breathing more pollution for the same stove use.”Reference: “Nitrogen dioxide exposure, health outcomes, and associated demographic disparities 3 due to gas and propane combustion by U.S. stoves” 3 May 2024, Science Advances.Jackson is also a senior fellow at the Stanford Woods Institute for the Environment and Precourt Institute for Energy. Additional Stanford co-authors include Metta Nicholson, a PhD student in the Emmett Interdisciplinary Program in Environment and Resources (E-IPER); Colin Finnegan, a laboratory manager in the Department of Earth System Science; and Earth system science postdoctoral scholars Zutao Ouyang and Anchal Garg.This research was supported by HT, LLC.

People with gas and propane stoves breathe more unhealthy nitrogen dioxide. Households with gas or propane stoves regularly breathe unhealthy levels of nitrogen dioxide, a...

Kitchen Stove

A study has revealed that households using gas or propane stoves face significant exposure to nitrogen dioxide (NO2), which can lead to health issues like asthma and even premature death. The study conducted by researchers from various institutions, including Stanford, showed that NO2 levels in homes can remain elevated for hours after stove use, affecting even those not directly in the kitchen.

People with gas and propane stoves breathe more unhealthy nitrogen dioxide.

Households with gas or propane stoves regularly breathe unhealthy levels of nitrogen dioxide, a study of air pollution in U.S. homes found.

“I didn’t expect to see pollutant concentrations breach health benchmarks in bedrooms within an hour of gas stove use, and stay there for hours after the stove is turned off,” said Stanford Doerr School of Sustainability Professor Rob Jackson, senior author of the May 3 study in Science Advances. Pollution from gas and propane stoves isn’t just an issue for cooks or people in the kitchen, he said. “It’s the whole family’s problem.”

Among other negative health effects, breathing high levels of nitrogen dioxide, or NO2, over time can intensify asthma attacks and has been linked to decreased lung development in children and early deaths.

Although most exposure to NO2 is caused by cars and trucks burning fossil fuels, the researchers estimate that the mix of pollutants coming from gas and propane stoves overall may be responsible for as many as 200,000 current childhood asthma cases. One quarter of these can be attributed to nitrogen dioxide alone, according to the paper’s authors, who include scientists from Central California Asthma Collaborative, PSE Healthy Energy, and the Harvard T.H. Chan School of Public Health.

“We found that just how much gas you burn in your stove is by far the biggest factor affecting how much you’re exposed. And then, after that, do you have an effective range hood – and do you use it?” said lead study author Yannai Kashtan, a PhD student in Earth system science.

Metta Nicholson Observes Gas Burner

Stanford PhD student Metta Nicholson observes a gas burner in a home where scientists measured air pollution as part of their data collection in California, Texas, Colorado, New York, and Washington, D.C.. Credit: Rob Jackson, Stanford Doerr School of Sustainability

Little Room for Additional Exposure

Beyond asthma cases, the long-term exposure to NO2 in American households with gas stoves is high enough to cause thousands of deaths each year – possibly as many as 19,000 or 40% of the number of deaths linked annually to secondhand smoke. This estimate is based on the researchers’ new measurements and calculations of how much nitrogen dioxide people breathe at home because of gas stoves and the best available data on deaths from long-term exposure to outdoor NO2, which is regulated by the U.S. Environmental Protection Agency.

The death toll estimate is approximate in part because it does not factor in the harmful effects of repeated exposure to extremely high levels of nitrogen dioxide in short bursts, as occurs in homes with gas stoves. It also relies on past studies of health impacts from nitrogen dioxide encountered outdoors, where additional pollutants from vehicles and power plants are present.

Stove Without Range Hood

Colin Finnegan of the Stanford Doerr School of Sustainability checks a simmering pot on a gas stove that does not have a range hood. Using a range hood that vents air to the outdoors can dramatically influence how much nitrogen dioxide fills the air in a home. Credit: Rob Jackson, Stanford Doerr School of Sustainability

The researchers used sensors to measure concentrations of NO2 throughout more than 100 homes of various sizes, layouts, and ventilation methods, before, during, and after stove use. They incorporated these measurements and other data into a model powered by National Institutes for Standards and Technology (NIST) software known as CONTAM for simulating airflow, contaminant transport, and room-by-room occupant exposure in buildings. This allowed them to estimate nationwide averages and short-term exposures under a range of realistic conditions and behaviors, and cross-check model outputs against their home measurements.

The results show that nationwide, typical use of a gas or propane stove increases exposure to nitrogen dioxide by an estimated 4 parts per billion, averaged over a year. That’s three quarters of the way to the nitrogen dioxide exposure level that the World Health Organization recognizes as unsafe in outdoor air. “That’s excluding all outdoor sources combined, so it makes it much more likely you’re going to exceed the limit,” said Kashtan.

Understanding How Gas Stoves Affect Health

The study is the latest in a series from Jackson’s group at Stanford looking at indoor air pollution from gas stoves. Earlier studies documented the rate at which gas stoves emit other pollutants, including the greenhouse gas methane and the carcinogen benzene. But to understand the implications of stove emissions for human health, the researchers needed to find out how much pollutants spread through a home, build up, and eventually dissipate. “We’re moving from measuring how much pollution comes from stoves to how much pollution people actually breathe,” said Jackson, who is the Michelle and Kevin Douglas Provostial Professor in Earth System Science.

With any fuel source, particle pollution can rise from food cooking in a hot pan. The new research confirms that food emits little or no nitrogen dioxide as it cooks, however, and electric stoves produce no NO2. “It’s the fuel, not the food,” said Jackson. “Electric stoves emit no nitrogen dioxide or benzene. If you own a gas or propane stove, you need to reduce pollutant exposures using ventilation.”

Home Size Matters

Even in larger homes, concentrations of nitrogen dioxide routinely spiked to unhealthy levels during and after cooking even if a range hood was on and venting air outdoors. But people who live in homes smaller than 800 square feet – about the size of a small two-bedroom apartment – are exposed to twice as much nitrogen dioxide over the course of a year compared to the national average, and four times more compared to those living in the largest homes, upwards of 3,000 square feet.

Because home size makes such a difference, there are also differences in exposure across racial, ethnic, and income groups. Compared to the national average, the researchers found long-term NO2 exposure is 60% higher among American Indian and Alaska Native households, and 20% higher among Black and Hispanic or Latino households. This exposure to indoor air pollution from gas stoves compounds the fact that exposure to outdoor sources of nitrogen dioxide pollution, such as vehicle exhaust, is also typically higher among people in poorer, often minority, communities.

“People in poorer communities can’t always afford to change their appliances, or perhaps they rent and can’t replace appliances because they don’t own them,” Jackson said. “People in smaller homes are also breathing more pollution for the same stove use.”

Reference: “Nitrogen dioxide exposure, health outcomes, and associated demographic disparities 3 due to gas and propane combustion by U.S. stoves” 3 May 2024, Science Advances.

Jackson is also a senior fellow at the Stanford Woods Institute for the Environment and Precourt Institute for Energy. Additional Stanford co-authors include Metta Nicholson, a PhD student in the Emmett Interdisciplinary Program in Environment and Resources (E-IPER); Colin Finnegan, a laboratory manager in the Department of Earth System Science; and Earth system science postdoctoral scholars Zutao Ouyang and Anchal Garg.

This research was supported by HT, LLC.

Read the full story here.
Photos courtesy of

New Flu Variant Could Bring Another Severe U.S. Season

By I. Edwards HealthDay ReporterTHURSDAY, Nov. 20, 2025 (HealthDay News) — A new flu variant spreading overseas may set the stage for another tough...

THURSDAY, Nov. 20, 2025 (HealthDay News) — A new flu variant spreading overseas may set the stage for another tough winter in the United States, experts warn.The strain, called subclade K, has caused a rise in flu cases in the United Kingdom, Canada and Japan. And now signs suggest it is beginning to take hold across the United States as flu activity rises.According to the latest U.S. Centers for Disease Control and Prevention (CDC) FluView report, reported flu activity in the United States remains low but is climbing quickly.Last year’s flu season was the worst the United States had seen in nearly 15 years and led to at least 280 child deaths, according to the CDC.Most cases this year are from the H3N2 virus and about half of those belong to the subclade K variant, the same strain that fueled a difficult flu season in the Southern Hemisphere.Because it wasn’t circulating widely when strains were selected for the vaccine update, this year’s flu shot targets close strains of the virus."It’s not like we’re expecting to get complete loss of protection for the vaccine, but perhaps we might expect a little bit of a drop-off if this is the virus that sort of dominates the season, and early indications are that’s probably going to be the case," Richard Webby, a researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, told CNN.Early findings from the UK Health Security Agency suggest the variant carries seven genetic changes on a major part of the virus, making it a bit harder for the body's immune system to recognize.Even so, they found that the flu shot has reduced the risk of hospitalization or emergency care by about 75% in children and 30% to 40% in adults so far this season.What worries experts even more is that fewer Americans appear to be getting the flu shot.Data from IQVIA shows that pharmacies gave 26.5 million flu vaccinations from August through October, down from 28.7 million during the same period last year."I’m not surprised," Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University in Providence, Rhode Island, said.She said recent debates about vaccine safety have "left people confused but possibly at the worst have left people worried about getting vaccinated."Australia’s flu shot rates also fell this year and the country went on to record more than 443,000 cases."What they saw in Australia is that they had a bad season. And so it’s concerning for you and us, what’s coming," Dr. Earl Rubin, division director of infectious disease at Montreal Children’s Hospital, told CNN.Several early indicators already show flu levels rising in the U.S.The WastewaterSCAN network found type A flu in 40% of samples in November, up from 18% in October, according to Marlene Wolfe, an assistant professor in the department of environmental health at Emory University in Atlanta.Only four U.S. monitoring sites in Maine, Vermont, Iowa and Hawaii have officially crossed the threshold for declaring flu activity high, but experts say the trend is clear.While it’s not yet clear whether subclade K could cause more severe illness, a rise in infections alone could cause hospitalizations to skyrocket, Rubin noted."It’s not too late. Go and get your flu shot," Dr. Adam Lauring, chief of the division of infectious diseases at the University of Michigan Medical School, in Ann Arbor, said.These results are preliminary and have not yet been peer-reviewed.The Texas Department of State Health Services (DSHS) has more on the flu vaccine.SOURCE: CNN, Nov. 18, 2025Copyright © 2025 HealthDay. All rights reserved.

Thousands of US Hazardous Sites Are at Risk of Flooding Because of Sea Level Rise, Study Finds

A new study finds that thousands of hazardous sites across the U.S. are at risk of flooding due to sea level rise that could pose public health threats to neighboring communities

If heat-trapping pollution from burning coal, oil and gas continues unchecked, thousands of hazardous sites across the United States risk being flooded from sea level rise by the turn of the century, posing serious health risks to nearby communities, according to a new study.Researchers identified 5,500 sites that store, emit or handle sewage, trash, oil, gas and other hazards that could face coastal flooding by 2100, with much of the risk already locked in due to past emissions. But more than half the sites are projected to face flood risk much sooner — as soon as 2050. Low-income, communities of color and other marginalized groups are the most at risk.With even moderate reductions to planet-warming emissions, researchers also determined that roughly 300 fewer sites would be at risk by the end of the century. “Our goal with this analysis was to try to get ahead of the problem by looking far out into the future," said Lara J. Cushing, associate professor in the Department of Environmental Health Sciences at the University of California, Los Angeles who co-authored the paper published in the science journal Nature Communications.“We do have time to respond and try to mitigate the risks and also increase resilience," she added, speaking at a media briefing Wednesday ahead of the study's release. The study was funded by the Environmental Protection Agency and builds on previous research from California. Climate change is driving and accelerating sea level rise. Glaciers and ice sheets are melting, and the sea's waters are expanding as they warm. In many places along the coastal U.S., sea level rise is accelerating faster than the global average because of things like erosion and land sinking from groundwater pumping, according to the National Oceanic and Atmospheric Administration. Thomas Chandler, managing director at the National Center for Disaster Preparedness at Columbia University who was not involved in the research, said it’s “a really important study” that the public, policy makers and government agencies “need to make note of.” Derek Van Berkel, an associate professor in the school for environment and sustainability at University of Michigan who was also not involved in the study, wasn't surprised to learn about the disproportionate risks. What was “alarming” was considering the magnitude of “feedback effects” from flooding, he said. How researchers approached the data The study's researchers started by identifying and classifying tens of thousands of hazardous sites near the coasts of Puerto Rico and the 23 states with coastline. Next, they wanted to know each site's projected future flood risk. They did this by calculating how likely each year coastal flooding could inundate a site using historical sea level measurements and projected sea level rise in 2050 and 2100 under low and high emissions scenarios. Lastly, they identified and classified communities as being at-risk if homes are located within 1 kilometer (0.62 miles) of a hazardous site with a high threat of future flooding, and compared those communities' characteristics with other coastal neighborhoods with no at-risk sites nearby. But researchers did not include all types of hazardous facilities, such as oil and gas pipelines, nor did they account for groundwater upwelling or more intense and frequent storms in the future, which could lead to underestimates. On the other end, the flood-risk model they used could have overestimated the number of threatened sites. “It is important to note that previous disasters, such as hurricanes Katrina, Rita and Harvey, did result in a lot of toxic contamination from oil and gas pipelines,” Chandler said. The 5,500 at-risk sites includes 44% that are fossil fuel ports and terminals, 30% power plants, 24% refineries and 22% coastal sewage treatment facilities. Most of the sites — nearly 80% — are in Louisiana, Florida, New Jersey, Texas, California, New York and Massachusetts. Potential health impacts from exposure to hazards People exposed to flood waters near industrial animal farms or sewage treatment plants could be exposed to bacteria like E. coli, said Sacoby Wilson, professor of global, environmental and occupational health at the University of Maryland during the briefing. Symptoms can include bloody or watery diarrhea, severe stomach cramps or vomiting and fever. Those living near industrial sites like refineries could be exposed to heavy metals and chemicals that can cause rashes, burning of the eyes, nose and throat, headaches or fatigue, added Wilson, who was not involved in the study. “For folks who are vulnerable, maybe have an underlying health condition, those health conditions could be exacerbated during those flood events.” Longer term, some of these exposures could contribute to cancer, liver, kidney or other organ damage, or have reproductive effects, he said. For Chandler, the Columbia University director, the study highlights the need to heavily invest in hazard mitigation. “It's really important for federal, state and local governments in the United States to address these factors through multi-stakeholder resilience planning and encouraging local governments to integrate climate risk assessments into their mitigation strategies.”The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment.Copyright 2025 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.Photos You Should See – Nov. 2025

RFK Jr.’s Miasma Theory of Health Is Spreading

The agency is picking up Robert F. Kennedy Jr.’s argument that a healthy immune system can keep even pandemic germs at bay.

Last week, the two top officials at the National Institutes of Health—the world’s largest public funder of biomedical research—debuted a new plan to help Americans weather the next pandemic: getting everyone to eat better and exercise.The standard pandemic-preparedness playbook “has failed catastrophically,” NIH Director Jay Bhattacharya and NIH Principal Deputy Director Matthew J. Memoli wrote in City Journal, a magazine and website published by the Manhattan Institute for Policy Research, a conservative think tank. The pair argue that finding and studying pathogens that could cause outbreaks, then stockpiling vaccines against them, is a waste of money. Instead, they say, the United States should encourage people to improve their baseline health—“whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more.”On its own, Bhattacharya and Memoli’s apparently serious suggestion that just being in better shape will carry the U.S. through an infectious crisis is reckless, experts told me—especially if it’s executed at the expense of other public-health responses. In an email, Andrew Nixon, the director of communications at the Department of Health and Human Services—which oversees the NIH—wrote that the agency “supports a comprehensive approach to pandemic preparedness that recognizes the importance of both biomedical tools and the factors individuals can control.” But more broadly, Bhattacharya and Memoli’s proposal reflects the spread of a dangerous philosophy that Robert F. Kennedy Jr., the secretary of HHS, has been pushing for years: a dismissal of germ theory, or the notion that infectious microbes are responsible for many of the diseases that plague humankind.In his 2021 book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, Kennedy, a longtime anti-vaccine activist, argues that modern scientists have blamed too much of infectious disease on pathogens, which he suggests are rarely problematic, unless the immune system has been compromised by poor nutrition, toxins, and other environmental stressors. He credits sanitation and nutrition for driving declines in infectious-disease deaths during the 20th century; vaccination, he has baselessly claimed, was largely ineffective and unnecessary. In his view, germs don’t pose a substantial threat to people who have done the work of “fortifying the immune system”—essentially, those who have taken their health into their own hands.In terms of general health, most Americans would benefit from improvements in diet and exercise. A strong emphasis on both has been core to the Make America Healthy Again movement, and in one important aspect, Kennedy and his allies are correct: The immune system, like other bodily systems, is sensitive to nutritional status, and when people are dealing with chronic health issues, they often fare less well against infectious threats, Melinda Beck, a nutrition and infectious-disease researcher who recently retired from the University of North Carolina, told me. Conditions such as obesity and diabetes, for instance, raise the risk of severe COVID and flu; malnutrition exacerbates the course of diseases such as tuberculosis and measles.But applied to widespread infectious outbreaks, the MAHA prescription is still deeply flawed. Being generally healthy doesn’t guarantee survival, or even better outcomes against infectious diseases—especially when an entire population encounters a pathogen against which it has no immunity. Although some evidence suggests that the 1918 flu pandemic strongly affected certain groups of people who were less healthy at baseline—including undernourished World War I soldiers—“relatively healthy people, as far as we could understand, were the main victims,” Naomi Rogers, a historian of medicine at Yale, told me. Smallpox, too, infected and killed indiscriminately. HIV has devastated many communities of young, healthy people.In his book, Kennedy relies heavily on the term miasma theory as a shorthand for preventing disease “through nutrition and by reducing exposures to environmental toxins and stresses.” He’s employing that phrase incorrectly: Historically, at least, miasma theory referred to the notion that epidemics are caused by bad air—such as toxic emanations from corpses and trash—and was the predominant way of describing disease transmission until scientists found definitive proof of infectious microbes in the late 19th century. But his choice of words is also revealing. In pitting his ideas against germ theory, he plays on a centuries-old tension between lifestyle and microbes as roots of illness.In its early days, germ theory struggled to gain traction even among physicians, many of whom dismissed the idea as simplistic, Nancy Tomes, a historian at Stony Brook University, told me. After the idea became foundational to medicine, scientists still had to work to convince some members of the public that microbes could fell healthy people, too. In the early days of polio vaccination, when the virus still ran rampant in the U.S., some vaccine-skeptical Americans insisted that children were falling seriously ill primarily because their parents weren’t managing their kids’ nutrition well and “had disrupted the child’s internal health,” Rogers told me.Over time, as pharmaceutical companies made global businesses out of selling antibiotics, vaccines, and antivirals, the products became a symbol, for some people, of how germ theory had taken over medicine. Accepting vaccines came to represent trust in scientific expertise, Rogers said; misgivings about the industry, in contrast, might translate into rejecting those offerings. In that skeptical slice of the American public and amid the rise of alternative-wellness practitioners, Kennedy has found purchase for his ideas about nutrition as a cure-all.Since taking over as health secretary, he has on occasion made that distrust in germ theory national policy. In his book, he wrote that “when a starving African child succumbs to measles, the miasmist attributes the death to malnutrition; germ theory proponents (a.k.a. virologists) blame the virus.” Earlier this year, when measles raged through undervaccinated regions of West Texas, the secretary acted out his own miasmist theory of the outbreak, urging Americans to rely on vitamin-A supplementation as a first-line defense, even though deficiency of that vitamin is rare here.But germ theory is key to understanding why outbreaks become pandemics—not because people’s general health is wanting, but because a pathogen is so unfamiliar to so many people’s immune systems at once that it is able to spread unchecked. Pandemics then end because enough people acquire sufficient immunity to that pathogen. Vaccination, when available, remains the safest way to gain that immunity—and, unlike lifestyle choices, it can represent a near-universal strategy to shore up defenses against disease. Not all of the risk factors that worsen disease severity are tunable by simply eating better or working out more. For COVID and many other respiratory diseases, for instance, old age and pregnancy remain some of the biggest risk factors. Genetic predispositions to certain medical conditions, or structural barriers to changing health habits—not just lack of willpower—can make people vulnerable to disease, too.In their article, Bhattacharya and Memoli purport to be arguing against specific strategies of pandemic preparedness, most prominently the controversial type of gain-of-function research that can involve altering the disease-causing traits of pathogens, and has been restricted by the Trump administration. But the pair also mischaracterize the country’s current approach to pandemics, which, in addition to calling for virus research and vaccine development, prioritizes measures such as surveillance, international partnerships, and improved health-care capacity, Nahid Bhadelia, the director of the Center on Emerging Infectious Diseases at Boston University, told me. And Bhattacharya and Memoli’s alternative approach cuts against the most basic logic of public health—that the clearest way to help keep a whole population healthy is to offer protections that work on a societal level and that will reach as many people as possible. Fixating on personal nutrition and exercise regimens as pandemic preparedness would leave many people entirely unprotected. At the same time, “we’re basically setting up society to blame someone” in the event that they fall ill, Jennifer Nuzzo, the director of the pandemic center at the Brown University School of Public Health, told me.Kennedy’s book bemoans that the “warring philosophies” of miasma and germ theory have become a zero-sum game. And yet, at HHS, he and his officials are presenting outbreak preparedness—and the rest of public health—as exactly that: The country should worry about environment or pathogens; it should be either pushing people to eat better or stockpiling vaccines. Over email, Nixon told me that “encouraging healthier habits is one way to strengthen resilience alongside vaccines, treatments, and diagnostics developed through NIH-funded research.” But this year, under pressure from the Trump administration, the NIH has cut funding to hundreds of vaccine- and infectious-disease focused research projects; elsewhere at HHS, officials canceled nearly half a billion dollars’ worth of contracts geared toward developing mRNA vaccines.The reality is that both environment and pathogens often influence the outcome of disease, and both should be addressed. Today’s public-health establishment might not subscribe to the 19th-century version of miasma theory, but the idea that environmental and social factors shape people’s health is still core to the field. “They’re saying you can only do one thing at a time,” Bhadelia told me. “I don’t think we have to.”

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