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Republican presidential nominee, former U.S. President Donald Trump welcomes Robert F. Kennedy Jr. to the stage at a Turning Point Action campaign rally at the Gas South Arena on October 23, 2024 in Duluth, Georgia. 

Anna Moneymaker | Getty Images News | Getty Images

Donald Trump has made one clear promise about who could help take up the government’s health reins if he wins the presidency: notorious vaccine skeptic and conspiracy theorist Robert F. Kennedy Jr. 

The former president said last week that Kennedy, who ended his own independent White House campaign earlier this year and endorsed Trump, will have a “big role” in health care in his administration. Last month, Trump said he would let Kennedy “go wild” on health, food and drug regulation.

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It’s unclear what exactly Kennedy’s role would look like, but the possibility is already raising alarm bells in the broader health community. Some health experts said elevating Kennedy, even in an informal Trump administration position, could potentially lead to severe consequences for patients, drugmakers and the nation’s public health overall. 

“I think it would be a world turned upside down,” Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia who has been an open critic of Kennedy, told CNBC. “Things would not be grounded in scientific truth, just grounded in whatever he or his acolytes believe. It would be a free-for-all. It would be uncertainty and instability. It would be chaos.” 

He said “chaos” could potentially look like lower vaccination rates, increases in preventable disease and greater distrust in federal health agencies, such as the Food and Drug Administration and the Centers for Disease Control and Prevention. 

That could exacerbate the nation’s existing public health challenges, such as declining childhood vaccination rates for several preventable diseases, some experts say. The U.S. also has the lowest life expectancy at birth, the highest rate of people with multiple chronic diseases, and the highest maternal and infant death rate among other high-income nations, according to a 2023 report by the Commonwealth Fund, an independent research group. 

Kennedy, who does not have any medical or scientific credentials, believes drug companies and the federal health agencies that regulate them are making Americans less healthy. He has suggested that some vaccines should be taken off the market — a stance that Trump did not rule out Monday. 

The former environmental lawyer may also bring uncertainty to the pharmaceutical industry, which relies on federal health agencies to greenlight new products, keep old ones on the market, and, in some cases, fund research and development. It will likely be difficult for Kennedy to change the drug approval process, but experts said he could gain a new platform to politicize certain treatments he opposes and tout others that aren’t proven to be safe and effective.

Top leadership roles, such as the FDA commissioner, require confirmation by the Senate, which some experts noted could pose a hurdle for Kennedy. But Kennedy has met with Trump transition officials and could take a broad White House “health czar” position that would not need Senate confirmation, The Washington Post reported Saturday. 

Regardless of what the position looks like, Kennedy will likely gain a “new podium to spread his views,” said Drew Altman, president and CEO of health policy organization KFF. 

“It’s giving one of the chief architects for health misinformation a national podium backed by the president,” Altman told CNBC. “Many more people will hear what he has to say, believe it and act on it. That could pose a risk to their health.”

Kennedy’s team did not immediately respond to CNBC’s request for comment.

Vaccine rhetoric and uptake

A second Trump term could allow Kennedy to elevate anti-vaccine rhetoric, regardless of whether he holds a major role at a federal health agency.

Health experts said that could deter more Americans from receiving Covid shots and routine immunizations against various diseases that have for decades saved millions of lives and prevented crippling illnesses.

“By elevating his message, it normalizes people, parents, opting out of the vaccination schedule,” said Genevieve Kanter, associate professor of public policy at the University of Southern California. “I think we could reasonably predict that there would be a decline in vaccination rates among children, and perhaps vaccination overall.” 

Cynthia Blancas, 42, of Lynwood, receives a Covid-19 vaccine by pharmacist Deep Patel, right, at CVS in Huntington Park on August 28, 2024.

Christina House | Los Angeles Times | Getty Images

Real-world data from the CDC indicates that routine vaccination rates for kindergarten children ticked down during the pandemic and have yet to rebound. If Kennedy manages to push those rates even lower, vaccine-preventable diseases like polio and measles could potentially make a comeback, experts noted. 

For the companies that manufacture shots, an increase in anti-vaccine rhetoric could potentially translate to lower revenue. Drugmakers such as Pfizer and Moderna are still recovering from falling Covid vaccination rates in the U.S., which have dented their profits over the last two years. 

Kennedy may also affect the pharmaceutical industry’s ability to respond to another pandemic if given the power to determine how much federal funding should go toward vaccine development, some experts say. He told NBC News last year that he wouldn’t prioritize the research, manufacturing or distribution of shots if faced with another pandemic, falsely adding that “vaccines have probably caused more deaths than they’ve averted.”

Kennedy’s track record as a vaccine skeptic is extensive: He has long made misleading and false statements about the safety of shots, such as claiming that they are linked to autism despite numerous studies going back decades that debunk the association. Kennedy is the founder of the nonprofit Children’s Health Defense, the most well-funded anti-vaccine organization in the country. 

“He misinforms to the point that children suffer or die, and also stands back and doesn’t take any responsibility for it,” Offit said.

He pointed to Kennedy’s misinformation about the safety of the measles, mumps and rubella vaccine, which was linked to a severe measles outbreak in Samoa in 2019 that left dozens of children dead.

Regulatory process at the FDA, CDC 

It would likely be harder for Kennedy to change how vaccines and other treatments are approved, recommended and regulated — even in a leadership role at the FDA, CDC or the Department of Health and Human Services, which oversees both agencies.

That could be good news for both patients and drugmakers. 

Signage is seen outside the U.S. Food and Drug Administration headquarters in White Oak, Maryland, Aug. 29, 2020.

Andrew Kelly | Reuters

“Approval processes are very well specified and run by civil servants,” USC’s Kanter said. ” I don’t see, in terms of the day-to-day product approvals, that he would have a ton of influence because that’s not the way the FDA is organized, and that’s not the role of an FDA commissioner. And so this process, I think we can trust to stay constant.” 

Recommendations for vaccine approval, use and coverage under certain federal health plans are made by advisory panels to the FDA and CDC, which are composed of outside public health and medical experts. The same applies to other treatments and medical devices. 

Kennedy could try to stack those committees with people who hold similar views on vaccination or other treatments to disrupt the “traditional regulatory oversight that protects us,” Georges Benjamin, executive director of the American Public Health Association, told CNBC. 

But members of those panels have to undergo a rigorous nomination process. Many states that rely on advisory committee recommendations for vaccination schedules and mandates could also choose to ignore them if people sympathetic to Kennedy’s views join the panels. 

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Kennedy’s other proposals for overhauling federal health agencies will likely be difficult to execute. He has proposed cutting funding or headcount at the FDA, but those changes could have to come from Congress. 

Last week, Kennedy warned in a post on X that the “FDA’s war on public health is about to end” and hinted at plans to gut the agency of workers who don’t agree with his views. 

He accused the agency of its “aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

Kennedy has previously claimed that hydroxychloroquine and ivermectin work against Covid, even though several studies say they do not. Hydroxychloroquine is an immunosuppressive drug, while ivermectin is used to treat infections caused by parasites.

“He has embraced a lot of therapies that have been unproven for certain uses and some have been discredited,” Kanter said. 

Chronic diseases

Both Kennedy and Trump have been vocal about tackling the root causes of chronic diseases rather than spending resources on treating those conditions with drugs from the pharmaceutical industry. There are few details on what that would look like and mean for drugmakers, but experts said Kennedy has pushed misleading claims about what factors drive chronic illnesses. 

The prevalence of chronic diseases, which last one year or more and require ongoing medical attention, is a real problem in the U.S. 

An increasing share of people in America are dealing with multiple chronic conditions, with roughly 42% having two or more, according to the CDC. More than 40% of school-aged children and adolescents have at least one. Chronic diseases such as heart disease, cancer, diabetes and obesity are also a major driver of health-care costs in the U.S., accounting for about 90% of the $4.1 trillion annual health-care expenditure, the CDC said. 

Kennedy could spearhead “Operation Warp Speed for childhood chronic disease” under a Trump administration, sources close to the former president’s campaign told NBC News last week. That refers to the title of the Covid vaccine development and distribution project during Trump’s first term. 

It’s unclear what the new program or Kennedy’s role would look like, but the focus on chronic illnesses aligns with his so-called Make America Healthy Again platform.

The initiative — a riff on Trump’s Make America Great Again slogan — aims to remove chemicals from food production, combat the “root” causes of chronic diseases and eliminate conflicts of interest in medical research, among other priorities that largely have bipartisan support. Environmental factors such as air pollution and diet contribute to chronic health conditions, but Kennedy has pushed unfounded claims around certain food ingredients and minerals. 

Last week, Kennedy also proposed advising all U.S. water systems to remove fluoride from drinking water, falsely claiming that it is “an industrial waste” linked to several medical conditions, such as thyroid disease and and neurodevelopmental disorders. Trump has since said that idea sounds “OK to me.”

But fluoride is a naturally occurring mineral found in soil, water and plants. Adding low levels of fluoride to drinking water is widely considered one of the greatest public health achievements of the 20th century for its role in preventing tooth decay. 

USC’s Kanter also said “there is a danger of oversimplifying complicated health problems” and attributing them to a few “root causes,” especially when they aren’t backed by science. Chronic diseases are complex conditions that can be caused by multiple factors, such as a patient’s genetics and socioeconomic status, according to Kanter. 

Kennedy’s nonprofit falsely links vaccines to chronic diseases, citing misleading articles and studies that show unvaccinated populations have fewer chronic conditions than their vaccinated peers. 

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The “Wegovy” brand slimming syringe is sold in the Achat pharmacy in Mitte. The “Wegovy” slimming syringe has been available in Germany for a year.

Jens Kalaene | Picture Alliance | Getty Images

A version of this article first appeared in CNBC’s Healthy Returns newsletter, which brings the latest health-care news straight to your inbox. Subscribe here to receive future editions.

Happy Thursday! New research showing additional health benefits of the weight loss drug Wegovy seems to crop up every week. 

This time around, Novo Nordisk‘s blockbuster treatment helped reduce knee pain in patients with a type of arthritis and obesity, according to research published Wednesday in the New England Journal of Medicine.

The study was funded by Novo Nordisk, which is conducting several studies on the other potential treatment uses of semaglutide, the active ingredient in Wegovy.

The results of the 68-week trial could be a big deal for the Danish drugmaker: It could pave the way for regulatory approval of semaglutide for osteoarthritis, a degenerative joint disease that causes the cartilage and bone in your joints to break down over time. 

It would be yet another expansion of the accepted uses for the blockbuster drug. 

It’s the most common type of arthritis and affects around 33 million people in the U.S., according to the Centers for Disease Control and Prevention. The condition is not a regular part of aging, but it is common among adults 45 and above. 

So, how is the condition related to obesity? The risk of developing the condition is four times higher in people with obesity, the trial’s lead study author Dr. Henning Bliddal, director and research professor at The Parker Institute in Denmark, said in a statement. 

Losing weight can help reduce knee osteoarthritis symptoms, but adherence to those lifestyle changes can be challenging, Bliddal said. There also aren’t very many other effective treatments for the condition. 

“There is a significant need for non-surgical and sustainable treatment options for those living with obesity-related osteoarthritis,” Bliddal added.

Let’s dive into more details on the trial.

It included roughly 400 patients with knee osteoarthritis. Participants had an average age of 56, and roughly 80% of the cohort were women, who experience osteoarthritis at higher rates than men do. 

People either took a weekly injection of semaglutide or a placebo for 68 weeks. Everyone also received guidance on how to maintain reduced-calorie diets and incorporate exercise into their daily lives. 

Patients with osteoarthritis who dieted, exercised and took semaglutide lost more weight and reported a greater reduction in knee pain than those who lost weight with diet and exercise alone. By the end of the trial, people who took semaglutide lost an average of nearly 14% of their body weight, or around 33 pounds, compared to just 3% among those who got a placebo. 

Changes in body weight were also accompanied by reductions in pain, which was measured using a specific index that scores it on a scale 0 to 100. On average, patients in the trial started with an average pain score of 70.9. 

Those who took semaglutide reported a significant reduction in pain – an average drop of about 42 points — while those in the placebo group had an average drop of 27.5 points.

But it’s unclear if semaglutide will have that benefit for all patients, such as those who are mildly obese or overweight. Most of the people enrolled in the trial had a high BMI, so researchers will have to replicate the findings in other populations. 

Feel free to send any tips, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.

Medicare Advantage is now a battleground on two fronts

Private Medicare Advantage plans have become a big source of conflict between the major insurers — and it’s now playing out on two fronts.

For one, they’re battling the government over stricter quality ratings that are creating profit headwinds at a time when plans are experiencing higher medical costs from their senior members. 

That’s creating a second headache: A battle royale between the big MA players and hospitals, which is where much of the higher spending is being incurred.

UnitedHealth is fighting on both fronts, suing the government over the star quality ratings downgrade on its plans, while at the same time raising a red flag about hospitals it says are “aggressively” upcoding patients and in turn raising medical costs.

During their respective earnings calls, hospital operators Community Health, HCA and Tenet Health all touched on what they called more “aggressive” denials from some payers.  

The rate negotiations are now getting so bitter that more hospitals are threatening not to accept Medicare Advantage plans from some carriers.

With more than half of seniors on private Medicare Advantage plans now, this combative trend could create increasing disruption to their coverage.

Feel free to send any tips, suggestions, story ideas and data to Bertha at bertha.coombs@nbcuni.com.

Latest in health-care technology: Change Healthcare breach hit at least 100 million Americans

UnitedHealth Group’s Change Healthcare broke a grim record last week: It has officially suffered the largest health-care data breach that’s ever been reported to federal regulators. 

At least 100 million Americans were affected by the Change Healthcare cyberattack, according to an updated figure published to the U.S. Department of Health and Human Services Office for Civil Rights’ breach portal. The previous record was set by Anthem in 2015 when hackers compromised data from 78.8 million patients. 

The figure is roughly in line with the estimate that UnitedHealth CEO Andrew Witty shared with lawmakers in May, when he guessed that around one-third of Americans had been impacted. The company began mailing written notices to affected individuals in late July. 

Change Healthcare offers payment and revenue cycle management tools for medical providers and payers, as well as other solutions such as electronic prescription software. In February, UnitedHealth disclosed that a cyber threat actor breached part of the company’s information technology network. 

UnitedHealth disconnected the affected systems when the threat was detected, and the disruption caused a ripple of fallout across the U.S. health-care sector. Many doctors were temporarily left without a way to fill prescriptions or get paid for their services, and some providers took thousands of dollars out of savings to keep their doors open. 

In the months following the breach, UnitedHealth paid a $22 million ransom to the hackers, worked to bring systems back online and confirmed that files containing personal information were compromised in the attack. 

The exact type of data that was exposed in the breach varies from person to person, according to UnitedHealth’s website. That means a mix of patients’ contact information, health insurance information, medical records, billing and payment information could have been accessed. 

UnitedHealth is offering two years of free identity theft protections credit monitoring for individuals who think they were impacted. Patients can contact a dedicated call center to inquire about these offerings or speak with a clinician who can provide emotional support services, the company said.

Patients should also watch for suspicious activity across their tax returns and explanation of benefits, bank and credit card statements, according to UnitedHealth’s website.  

Feel free to send any tips, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.

In this photo illustration, a McDonald’s Quarter Pounder hamburger meal is seen at a McDonald’s on October 23, 2024 in the Flatbush neighborhood in the Brooklyn borough of New York City. 

Michael M. Santiago | Getty Images

As McDonald’s and health authorities race to contain a deadly E. coli outbreak, the burger chain faces challenges in the months ahead to keep the trust of diners and investors.

Shares of the fast-food giant have fallen 7% since the Centers for Disease Control and Prevention issued an advisory notice Tuesday, warning that the company’s Quarter Pounder burgers have been linked to an E. coli outbreak in 10 states that has led to one death.

Health investigators have zeroed in on the slivered onions used in the Quarter Pounder as the likely contaminant. McDonald’s confirmed that California-based vegetable producer Taylor Farms is the supplier of onions it removed from its supply chain. Taylor Farms issued a recall on four raw onion products, citing potential E. coli contamination, restaurant supplier U.S. Foods said in a notice to customers Thursday. (U.S. Foods is not a supplier for McDonald’s.)

The CDC initially reported 49 people became ill from the outbreak from Sept. 27 to Oct. 11. The tally has now risen to 75 cases across 13 states, including at least 22 hospitalizations, according to a CDC update on Friday. Health experts say the number of cases will likely rise as the investigation progresses.

Just two days after the CDC issued its advisory notice, it’s too soon to tell how the outbreak could affect McDonald’s business, especially if the case count grows. But investors are already worried that it could cause sales to fall at the company, which has been trying to rebound from lagging traffic by offering deals to price-sensitive customers.

Company spokespeople said Wednesday that’s it’s far too early to share if the outbreak was having any effect on its restaurants’ sales. McDonald’s is expected to report its third-quarter results on Oct. 29 before the markets open.

The damage to the business will depend in part on how effectively McDonald’s has already contained the outbreak — and how well it can convince diners it is safe to eat at its restaurants.

Where the investigation could go next

Investigations into multistate foodborne outbreaks can last from a few weeks to up to several months. 

But Dr. Thomas Jaenisch, an epidemiology professor at the Colorado School of Public Health, believes it will likely take two or three weeks for federal agencies and McDonald’s to determine the exact source of contamination and chain of events leading to the E. coli outbreak. He said any testing of ingredients and supply sources “really shouldn’t take that long.”

The CDC has said the number of confirmed cases related to the McDonald’s E. coli outbreak could grow as the investigation continues, as many people recover from an infection without testing for it or receiving medical care. It also typically takes three to four weeks to determine if a sick patient is part of an outbreak, the agency added. 

There’s also the possibility that cases could crop up in new states or regions that haven’t reported any illnesses, according to Xiang Yang, a professor and meat scientist at the University of California, Davis. 

For example, a person traveling to a state impacted by the outbreak, such as Colorado, could have gotten infected with E. coli and brought it back to where they are from, according to Yang. It is also unclear if the onion supplier ships ingredients to restaurants in other regions of the U.S., which could potentially spread the E.coli strain that caused the McDonald’s outbreak. 

That strain, called O157:H7, can cause a serious complication that can lead to kidney failure. One of the patients in the McDonald’s outbreak suffered from that condition, known as hemolytic uremic syndrome. The federal government essentially bans the sale of any ground beef contaminated with the strain, requiring suppliers to test their products for it.

E. coli can spread through contaminated food or water, or by an individual coming into contact with an infected person, environment or animal. 

The CDC and the 10 states impacted have been interviewing each patient case to get detailed information about their exposure to E. coli, such as what they ate and when, according to Craig Hedberg, the co-director of the Minnesota Integrated Food Safety Center of Excellence. Hedberg is also a member of the McDonald’s Food Safety Advisory Council, but said he has not worked with the company on its response to the outbreak. 

The CDC and the states have been sharing the information they gather with the Food and Drug Administration to trace onion distribution and identify a specific source of contamination, he said. The information is also shared with the U.S. Department of Agriculture’s Food Safety and Inspection Service, which does the same with ground beef. 

The CDC is investigating both the Quarter Pounder’s uncooked slivered onions and its beef patty as the potential culprit for the outbreak. 

Hedberg said contamination of raw onions with E. coli is “highly plausible,” noting several salmonella outbreaks have been linked to onions in recent years. 

McDonald’s uses a single onion supplier, which washes and slices the vegetable, in the affected area. 

Meanwhile, McDonald’s uses multiple beef suppliers in the region, and its burgers are supposed to be cooked to an internal temperature that would kill the bacteria. The size of the outbreak “would imply widespread undercooking by many different individual McDonald’s restaurants” if beef was the culprit, according to Hedberg.

But he said that seems unlikely since most fast-food chains have designed their cooking systems to prevent E. coli contamination of ground beef, which is a widely recognized hazard. Still, investigators will likely examine the cooking practices of multiple locations as part of the investigation, Hedberg noted. 

Jaenisch said he hopes the investigation will also examine the preparation process for Quarter Pounders to see if there is any potential for cross contamination between slivered onions and other ingredients.

“When you prepare the burger at McDonald’s, at which point are the slivered onions added? Do they have a bowl of slivered onions, someone puts their hands in it and then touches the tomatoes?” Jaenisch said. “I would look very closely at that point of preparation.”

McDonald’s has already pulled Quarter Pounders from restaurants in the affected areas. Roughly a fifth of McDonald’s U.S. restaurants are not selling Quarter Pounder burgers at this time. The company has also instructed restaurants in the area to remove slivered onions from their supply, and has paused the distribution of that ingredient in the region.

Customers pass in the Drive Thru lane during breakfast hours at a McDonald’s restaurant on October 23, 2024 in Omaha, Nebraska.

Mario Tama | Getty Images

Learning from the past

Based on past foodborne illness outbreaks at other restaurant chains, it’s not a given that McDonald’s sales and brand image will suffer.

For example, rival Wendy’s dealt with its own link to an E. coli outbreak two years ago. More than 100 people got sick across six states. Still, the incident didn’t have a long-term effect on the chain’s sales.

“They got past it, and you never really heard about it,” KeyBanc analyst Eric Gonzalez told CNBC. “I think there were some operators in the area that probably saw a mid-to-high single digit, maybe 10% decline for a couple days of a week or so, and then it reverted as the news cycle moved on.”

On the other side of the spectrum is Jack in the Box, which became the poster child for food safety issues decades ago.

An outbreak in 1992 and 1993 linked to the chain resulted in the deaths of four children and infected more than 700 people. Media coverage, coupled with the severity of the outbreak, led to a steep decline in sales that year, fueled three straight years of losses and tarnished Jack in the Box’s reputation for years.

And then there’s Chipotle, a more recent example of a chain that struggled for years to improve its food safety and turn around its image after a string of foodborne illnesses.

“It was sort of a victim of its own inexperience, in a way, where not only were there multiple illnesses — E. coli, salmonella, norovirus — but you didn’t really have the expertise and experience level to manage through the crisis,” Gonzalez said.

After the initial wave of outbreaks in 2015, it took Chipotle several more years and a new CEO to rebuild trust in its burritos and bowls.

While investors fear the outbreak will hit McDonald’s sales, it’s unlikely that the burger giant turns into another Chipotle or Jack in the Box.

“We don’t know where this is going to land, as far as McDonald’s is concerned, but you have to have a little bit of confidence in their ability to contain the outbreak,” Gonzalez said. “It’s a very sophisticated organization with a sophisticated supply chain, and I don’t doubt their capabilities.”

Reassuring customers

McDonald’s has already been taking steps to reassure customers about the safety of its food. Barring a much more serious crisis, it may be able to contain the damage to its brand, experts said.

Shortly after the CDC issued its notice, the company released a statement outlining the steps it’s taken to contain the outbreak, along with a video featuring McDonald’s USA President Joe Erlinger.

The following morning, Erlinger appeared on NBC’s “TODAY,” telling viewers — and potential customers — that its food and drinks were safe to consume.

“Any kind of product safety recall requires some crisis communication and reassurance on the part of the corporation that it takes safety seriously, that it takes consumer health seriously and that it will react appropriately,” said Jo-Ellen Pozner, associate professor at the Santa Clara University Leavey School of Business.

She added that she thinks McDonald’s needs to apologize “very publicly” and aim its messaging at both consumers and its shareholders. However, that transparency means more media coverage, which reminds consumers about the crisis and risks scaring them away from McDonald’s restaurants.

Yang said McDonald’s appears to be “doing what they can do so far” while waiting for more information on the specific source of contamination. 

But other experts hope the chain does more to mitigate the potential spread of the outbreak during the investigation.

Dr. Darin Detwiler, professor of food policy and corporate social responsibility at Northeastern University, said he believes locations in other unaffected states should be “doubling up on their sanitation procedures and protocols and do more testing of their ingredients.” 

“Don’t wait until the lawyers or inspectors say you have a problem,” Detwiler said. 

“Why don’t you make the assumption that there could be something in your state, and check out your product,” he said. “That is being proactive. That is corporate social responsibility.”

Bill Marler, an attorney who specializes in cases involving foodborne illnesses, said McDonald’s should also follow in the footsteps of Jack in the Box, which offered to pay medical bills and lost wages for the victims of its E. coli outbreak.

“They just need to be seen as a good corporate player, and that’s really how they’re going to be able to bounce back pretty quickly,” Marler said.

One potential plaintiff tied to the crisis has already reached out to Marler, who represented hundreds of people who sued Jack in the Box in a class-action lawsuit, leading to a settlement of more than $50 million.

McDonald’s is already facing at least two lawsuits tied to the outbreak.

Both Clarissa DeBock, of Nebraska, and Eric Stelly, a resident of Greeley, Colorado, are suing the company for damages in excess of $50,000 after allegedly testing positive for E. coli after eating at McDonald’s, according to court filings.

“McDonald’s has nowhere to hide. They’re strictly liable for producing food that was contaminated. They may be able to point the finger at the onion supplier or the meat supplier, but ultimately they made the hamburger,” said Marler.

McDonald’s declined to comment on the lawsuits.

While media coverage of related lawsuits could bring more attention to McDonald’s, the suits themselves are unlikely to threaten the chain’s existence, according to Pozner.

“McDonald’s is as ubiquitous as Coke. It’s one of these very taken-for-granted brands, for its value as a brand to be diminished in a significant way, would require a much more serious outcome of the E. coli outbreak,” she said. “The scope of this tragedy is still very contained.”

Slumping sales

The outbreak comes as McDonald’s tries to win back diners who balked at years of price increases. For months, McDonald’s has been locked in a war with its rivals over competing value meals.

The restaurant industry broadly has seen traffic fall as inflation-weary consumers cook more at home and visit eateries less frequently. Fast-food chains, including McDonald’s, Burger King and Wendy’s, have turned to discounts and value meals to win back customers.

McDonald’s U.S. restaurants have been offering a $5 value meal since late June. And earlier this month, the chain launched its Chicken Big Mac nationwide, betting that customers would be willing to pay its higher price point because of the novelty. Those moves seemed to be paying off for McDonald’s before the outbreak.

“This is somewhat of a momentum killer for them,” Gonzalez said, adding that the burger category has plenty of “capable substitutes” for McDonald’s.

Combined, McDonald’s, Burger King and Wendy’s control roughly 70% of the burger quick-service restaurant segment, according to Barclays. McDonald’s alone holds 48.8% market share.

“It’s not a zero-sum game, but the burger category specifically is one of the more concentrated segments,” Gonzalez said. “If McDonald’s loses a point of sales, that’s 3 to 4 points up for grabs for Wendy’s or Burger King to capture.”

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