Healthbeat

Michigan cyclospora outbreak reveals strains on U.S. public health system

2026-08-25T15:00:55+00:00

As the number of people stricken with cyclospora infections across the U.S. finally seems to be winding down, I recently spoke with Dr. Natasha Bagdasarian, the chief medical executive for the state of Michigan, about the challenges her state has faced investigating the outbreak.

Michigan — where the state health department has confirmed more than 14,000 cases of infected people across the state, including hundreds of hospitalizations and two rare deaths — seems to be the outbreak’s epicenter based on case counts.

At its height, Bagdasarian said:

About 400 cases a day were being reported.
Health systems couldn’t keep testing supplies stocked.
Labs were backlogged.
Some healthcare systems restricted testing to hospitalized and immunocompromised patients.

Yet those were only some of the challenges.

The cyclospora outbreak also revealed disconnects in how the U.S. public health system — operating with reduced funding, fewer people and strained federal-state coordination — currently responds when confronted with a massive outbreak, according to what Bagdasarian told Healthbeat.

Click here to continue reading.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

New Medicaid work rules put NYC enrollees and hospitals at risk. Here’s who will be hit the hardest

2026-08-19T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Of the estimated 67 million people in the United States who will likely be affected by Medicaid cuts, about 3.6 million recipients live in New York City, and more than 1.3 million are concentrated in three congressional districts.

Those districts cover parts of the Bronx, northern Manhattan, and Queens, according to a Healthbeat analysis of district data and KFF, a nonprofit organization focusing on health care issues.

New Yorkers rely on Medicaid programs for everything from HIV treatment to home healthcare. The new changes to Medicaid — the public health insurance program for millions of low-income Americans that’s paid for by the federal government and individual states — are the result of H.R.1, the budget package that passed last summer and will slash $1 trillion from the Medicaid program over the next decade. As of Jan. 1, enrollees between ages 19 to 64 must prove that they are working, going to school, volunteering, or participating in a job-training program for at least 80 hours per month to keep their coverage. The rules are intended to push more people into the workforce and reduce what Republicans have described as waste and fraud in government programs.

The New York State Department of Health estimates that at least 475,000 New Yorkers could lose their Medicaid coverage because of the new work requirements. The health department also estimates that New York’s uninsured population could jump by 45%, from approximately 1 million people to as many as 1.45 million people after implementation. A new rule for cancer patients stipulates that a diagnosis is not sufficient for a work exemption; they must officially prove they are unable to work.

The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15. People walk inside the NYC Human Resources Administration, part of the Department of Social Services, in the Bronx. The social service agency provides assistance to New Yorkers, including Medicaid enrollees.

Health advocates say the Medicaid changes won’t be limited to enrollees and will have a cascading effect in communities and their hospitals. New Yorkers who lose coverage will likely forgo check-ins with their primary care physician, if they have one, causing preventable ailments to worsen and require emergency room visits. Hospitals are required by law to treat uninsured patients and will have to absorb the costs, which will likely accumulate. They’ll receive an influx of newly uninsured patients that will exacerbate overcrowding, forcing facilities to scale back on services that are expensive or aren’t lucrative, like pediatrics or primacy care, said Johanna Lister, policy director for the HealthySteps program at ZERO TO THREE, a nonprofit group focusing on early childhood.

“They need to cut based on how they need to protect their remaining incoming revenue,” Lister said.

Some hospitals will be forced to close.

“The financial impact of hospitals is going to be huge, particularly for safety net hospitals, like in the Bronx,” Lister said about the healthcare facilities that provide treatment regardless of the patient’s ability to pay or insurance status. “There’s absolutely no doubt that hospitals will close.”

A coalition of more than two dozen attorney generals and governors, including New York, filed a lawsuit in June against the Trump administration challenging the new

work requirements.

‘Canaries in the coal mines’

In a recent interview with Healthbeat, New York City Health Commissioner Dr. Alister Martin said he was particularly concerned about three areas: the south Bronx, East Harlem, and the Brownsville neighborhood in east Brooklyn.

“These are some of the areas that I think are really critical for us to watch and to see, almost as canary in the coal mines,” said Martin, whose department has brought on specialists to help Medicaid enrollees navigate the new requirements and has hosted public meetings to answer inquiries. His press office couldn’t say how many Medicaid enrollees the counselors have supported.

A Healthbeat analysis of Medicaid data from congressional districts in New York City reveals the following:

The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15. That’s 71% of the district’s population. According to the Urban Health Plan, a community health center in New York State, the Bronx is “ground zero for what H.R.1 means in practice.” Between 20,000 to 30,000 residents in the borough could lose coverage on Medicaid and a separate plan for working-class New Yorkers, and up to $211 million could be pulled out of the Bronx food economy, says the Urban Health Plan.
Congressional District 13, which includes northern Manhattan and parts of the Bronx, is also in the top 10 districts in the United States whose residents rely on Medicaid. That is 426,200 residents, or 59% of the population. The district also has the highest number of seniors in the city enrolled on Medicaid, with 69,900.
Congressional District 14 has 57% of its population enrolled on Medicaid, or 423,800 residents. The U.S. representative for the district that includes the eastern Bronx and north-central Queens, Alexandria Ocasio-Cortez, said in a social media post earlier this month she was meeting with Deputy Mayor Helen Arteaga Landaverde to work on a strategy for combatting the cuts and expanding healthcare. Her office, and other offices for the New York City congressional delegation, did not respond to a list of questions about Medicaid.
New York City’s 11th Congressional District, which includes Staten Island and part of Brooklyn, is in the top 10 of districts with Republican congressmembers, with 304,100 Medicaid enrollees, or 40 percent of its population. It’s the only New York City congressional seat represented by a Republican, Nicole Malliotakis.

Unaware and unprepared: New requirements endanger coverage for millions

Health advocates fear that Medicaid enrollees may overlook important notices or be unaware of the new requirements or not understand them, either because of a language barrier or because the instructions are hard to understand, and then miss important deadlines and fall off.

Bronx resident Frances Bueno might be among them. The 62-year-old Puerto Rican woman said she was unaware of the changes to Medicaid.

“Yeah, I read something like that,” Bueno said after stepping out of a community health center in the Mott Haven neighborhood in the south Bronx. A Medicaid recipient since last year, she had just paid a visit to her neurologist, who canceled the appointment, she said, and she was on her way to buy meat with food stamps.

“It’s going to be rough on a lot of people out here,” she said.

A sign outside the NYC Human Resources Administration in the Bronx directs visitors to a Medicaid office. The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15.

The Bronx, Queens, and Brooklyn are especially vulnerable. According to the United Hospital Fund, an independent nonprofit analyzing health policy in New York, 843,415 people in the Bronx, or 60% of the borough’s population are enrolled on Medicaid; 1.1 million in Brooklyn, or 45% of the population; 973,091 people in Queens, or 42% of the population, 421,264 people in Manhattan or a quarter of the population; and 171,290 people in Staten Island, or 35% of the population, are enrolled on Medicaid.

With this in mind, New York State Senator Gustavo Rivera, whose district includes the Bronx, has introduced the New York Health Act, a piece of legislation that aims to establish a single-payer healthcare system at the state level.

“I’m convinced that this is the way that we need to go,” Rivera, chair of the Senate Health Committee, told Healthbeat. “Taking insurance companies out of the equation means giving better care, having it cost less, and providing it to more people.”

New Yorkers with questions about their coverage can call the New York State Medicaid Helpline at 800-541-2831.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

NYC public health system braces for federal grant cuts under proposed OMB revision

2026-07-30T22:30:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

New York City’s public health system is bracing for possible funding cuts from a federal budget rule change the Trump administration is considering.

A proposed revision from the Office of Management and Budget would give the Trump administration broad discretion over how federal grants are awarded, managed, and terminated. Currently, such grants can’t be canceled without cause, but the new OMB rule would permit termination with minimal explanation or opportunities for appeal.

Though a range of federal agencies could be potential targets of the revisions, known as “Uniform Guidance,” the city’s Department of Health and Mental Hygiene and community-based health centers are particularly vulnerable.

Health officials say about $500 million, or 20% percent of the city’s budget for the Health Department, comes from the federal government. This money is earmarked for emergency preparedness and disease surveillance.

The Health Department has already been a mark. Last year, the Trump administration tried to withhold funding across the United States, including some $100 million earmarked for the city’s Health Department, but a coalition of attorneys general sued. A federal judge halted the effort for now.

“It would not necessarily completely disrupt what they’re doing, but it would maybe destabilize the core functions of the Health Department,” Dr. Oni Blackstock, a primary care physician based in New York City who specializes in HIV treatment, said of the proposed rule.

Blackstock is also the founder and executive director of Health Justice, a consulting firm that aims to promote equity initiatives in healthcare and public health. She previously was an assistant commissioner at the New York City Health Department, leading the city’s response to the HIV epidemic.

The OMB changes could be far-reaching, from the states to counties nationwide. According to the National Association of Counties, a nonprofit group advocating for county government across the United States, the proposed rule is the “most significant overhaul of federal grants regulations in more than a decade.” County programs such as transportation, public safety, housing, and disaster recovery could be affected.

According to the department, “OMB is proposing revisions that would improve transparency, accountability, and oversight for Federal awards across the Federal Government.”

A spokesperson could not be reached for further comment.

Russell Vought, the OMB director, is one of the main architects of Project 2025, the 900-page blueprint that articulated a broad conservative vision for the second Trump administration.

The final version of the rule could take effect on Oct. 1. Until then, the OMB is required to consider every public comment it has received since the rule was announced in late May and address or respond to substantive critiques. The agency received nearly 500,000 comments until the comment period ended on July 13.

The topic of the Trump administration possibly withholding funding from the city’s Health Department has come up before. At a March budget hearing, City Council Health Committee Chair Lynn Schulman asked about contingency plans.

“We are currently in active discussions with (the city’s) OMB, with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities,” Health Commissioner Dr. Alister Martin said at the March hearing. “We will assess and make decisions around what will protect New Yorkers’ health and safety the best.”

A Health Department spokesperson didn’t respond to questions about plans for potential cuts.

Blackstock says the proposed OMB rule could target Health Department funding for outbreak responses, HIV prevention, substance use services, emergency preparedness, and chronic disease prevention.

“All of these programs receive federal dollars through discretionary cooperative agreements,” she said.

In the past, the Centers for Disease Control and Prevention or the U.S. Health Resources and Services Administration would evaluate grant applications, but now political appointees will be making key decisions, she said.

“They’re going to be using their own independent judgment and lack of knowledge and expertise to decide whether these discretionary federal awards are granted,” Blackstock said.

Dr. Oni Blackstock

Community-based groups that receive federal funds could also be affected. That means the pot of money will grow smaller, and nonprofits have cut back on hiring, reduced services, postponed raises, and resorted to layoffs. Nonprofits are also looking at ways to forge alliances and share resources.

A preview of the abrupt withdrawal of federal funding played out earlier this year. Community nonprofits working on substance abuse issues experienced the sudden loss of funding — and ensuing chaos — in January when an agency in the Department of Human and Health Services suddenly revoked roughly $2 billion in funding, only to restore the money the following day because of bipartisan lobbying.

Given that the Trump administration has issued executive orders that target health care services for groups serving LGBTQ+ communities, some nonprofits may decide to pass on federal support.

“If it’s a trans-led organization, they may be discouraged from actually applying for any federal funding because they don’t want to be a target of this administration and have their funds withdrawn,” Blackstock said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Exclusive data: More than 74,000 older adults seek measles immunity tests amid U.S. outbreaks

2026-07-29T20:40:13+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Measles was surging in West Texas as Nancy Churnin eagerly awaited the birth of two grandchildren. She was sure she had been vaccinated decades ago, but she wanted to confirm she was still protected.

She didn’t want to risk spreading the highly contagious disease to vulnerable newborns, so she got a simple blood test last year.

“I wanted to double-check my immunity,” said Churnin, a children’s book author who lives in Plano, Texas, near Dallas.

Churnin is among more than 74,000 U.S. adults over age 50 who have received blood tests checking their measles antibody status from January 2025 through March of this year, according to an exclusive analysis of medical records data conducted in response to questions from Healthbeat.

The rates of older adults seeking measles immunity tests spiked across the country during last year’s West Texas measles outbreak and again earlier this year as South Carolina’s measles outbreak became the nation’s largest in decades, according to the analysis by a research team at Truveta, a healthcare data and analytics company that receives patient care data from major health systems that serve about one in three U.S. residents.

Truveta’s research team said its analysis suggests that public awareness of high-profile local measles outbreaks might be influencing more people across the country to seek the immunity tests, which are called titer tests.

Nina Masters, the principal applied research scientist at Truveta who led the analysis, said she was struck by the spikes in titer testing during outbreaks because historically, the standard recommendation has been to just vaccinate people who don’t have proof of immunity.

“To me, that suggests outbreaks are influencing healthcare-seeking behavior and reflects growing concern among Americans who want to understand their immunity status and protect themselves and their loved ones amid rising measles activity,” said Masters, a former Centers for Disease Control and Prevention epidemiologist who has deployed to multiple measles outbreaks.

As the U.S. this month broke last year’s record number of measles cases, people who are infected are increasingly exposing others to the virus in a wide range of public settings from schools and churches to restaurants, stores, and airports. The virus spreads through the air and can linger in a room for two hours after the infectious person has left, putting anybody who goes through the area at risk if they lack immunity.

The result is large numbers of people need to quarantine at home for up to 21 days if they are not vaccinated against measles or cannot provide proof of their immunity through previous vaccination or illness.

“We think it’s important for people to know their immunity status,” said Dr. Emma Doran of the North Carolina Department of Health and Human Services, which recommends titer tests as one of the ways people can check their immunity before they are exposed.

Titer tests can be particularly helpful for older adults who were vaccinated against measles long before electronic medical records and state immunization registries and no longer have their paper vaccination records. The measles vaccine provides lifelong immunity for most people. Two doses of the combination measles-mumps-ruebella shot is 97% effective against measles, and one dose is 93% effective.

“There is a good chunk of the population there that, unfortunately, if somebody didn’t hold on to that paper, they don’t have it,” said Doran, who is the medical director of the department’s Vaccine Preventable and Respiratory Diseases Medical Consultation Unit.

Immunity tests spiked in U.S. during Texas, South Carolina outbreaks

The new data on titer testing provides a window into one of the many ways the return of measles in the United States is impacting people’s lives. The disease was declared eliminated from the country in 2000. In November, an international public health body will review whether the disease has once again become endemic to the United States.

During 2025 — as a major measles outbreak was underway in West Texas — more than 62,000 older adults across the country went to doctors’ offices to get measles titer tests, the Truveta analysis found.

The surge in testing was dramatic, and not just in Texas.

Nationwide, adults 50 and older received measles immunity testing last year at nearly seven times the rate they had in recent years. From 2021 through 2024, a typical month saw about 50 people get tested for measles immunity for every 100,000 adults who had an outpatient doctors’ visit. But in 2025, that figure reached nearly 341 tests per 100,000 adults.

The rate of titer testing within the state of Texas was particularly high, peaking at 627 tests per 100,000. But even when data from Texas was excluded, the data for the rest of the United States still showed a spike in testing at nearly 309 tests per 100,000.

A similar pattern played out during the first three months of this year, when more than 12,000 U.S. adults over 50 received titer tests as the South Carolina measles outbreak became the nation’s largest in 35 years. The analysis showed an even larger spike in testing rates in 2019, when measles outbreaks also fueled an earlier record number of cases.

The analysis involved an examination of electronic health record data from nearly 30 million patients over 50 who had outpatient visits from January 2018 through March. The data is provided to Truveta by the company’s health system members. The researchers looked at data for older adults to try to focus on those seeking the tests long after childhood vaccination or illness, as well as to reduce the inclusion of routine prenatal testing.

Truveta conducted the analysis after Healthbeat asked the company whether its data could provide any information about whether more people were seeking titer tests amid the recent measles outbreaks.

While the data does not say why the individuals received measles titer tests, Masters and her research team said the spikes in titer testing during outbreaks likely reflect a combination of patient concern, vigilance by healthcare providers, exposure-related evaluations, and adult uncertainty about immunization status. Media coverage might also play a role.

There could be many reasons why an adult might want to check their immunity amid increased spread of measles, the researchers said. They include grandparents seeking to confirm they are protected before visiting infant grandchildren, as well as adults who are worried about the risk of living in or traveling to an outbreak area.

Before her grandson, Ezra, was born last year, Nancy Churnin of Plano, Texas, had her blood tested to make sure she was immune to measles. She didn't want to put him at any risk. Churnin was surprised to discover she wasn't immune, prompting her to get an additional dose of MMR vaccine.

Protecting her newborn grandbabies was Nancy Churnin’s motivation in getting a measles titer test last year before they were born. The babies’ parents were also seeking to safeguard their infants against infectious diseases.

“Anybody who wanted to see the baby was on notice: Get all your shots or we can’t let you around the baby unless you’re fully, fully vaccinated,” recalled Churnin.

When Churnin’s titer test result came back, she was surprised to learn she was not immune to measles. She was certain she had been vaccinated as a child, but she was born in 1957 and she has no access to her records, and her parents aren’t around to ask. After the test, she got vaccinated.

“I was very, very glad I got the test. I’m very, very glad I got immunized,” Churnin said. “I don’t want to do anything to endanger those babies, anybody’s babies.”

Should you get a titer test? Cost, doctors’ views shape decisions.

Most older adults are likely to be protected against measles either because they were vaccinated as children or had the disease before vaccines became available.

Adults born before 1957 are officially presumed to be immune to measles because they were likely infected when they were children, according to the Centers for Disease Control and Prevention. Vaccines against measles have been available in the United States since the early 1960s, with an improved version of the vaccine distributed since 1968.

Should those who can’t find their vaccination records ask their doctors for titer tests?

The CDC recommends that adults born during or after 1957 who can’t find their immunization records get the MMR vaccine. But the CDC guidance also says they can get a measles titer test to determine if they need the vaccine. “There is no harm in getting another dose of MMR vaccine if an individual may already be immune,” the CDC says.

There are several factors to consider in whether to do a titer test or just get another MMR shot, experts said.

Dr. Margot Savoy, chief medical officer of the American Academy of Family Physicians, told Healthbeat that it’s not common for patients to ask for a titer test unless they work in a healthcare field where the test is required.

“The question that they normally ask is: How do I know if I’m protected?” she said.

“For most family physicians, and most physicians in general, their answer would be, I don’t know that I would draw titers on most people. If we’re at all worried that you might not be protected, we would just give you another MMR” vaccine, she said.

Savoy said the time and cost of getting a titer test is not worth it for the average patient, because the test may show the person needs to get vaccinated anyway.

Unlike the MMR vaccine, which is routinely covered by insurance plans without patient cost-sharing, there are no requirements for insurance coverage of titer tests, although insurers can choose to cover them. In addition to getting the tests through a doctor’s office, many direct-to-consumer labs and walk-in clinics also will do the tests without a prescription, but the costs can range from $40 to $150 or more.

Individual patients may weigh the costs and benefits differently when deciding between just getting an MMR shot or getting tested, said Doran.

“I think there’s no one-size-fits-all approach for whether to do an MMR vaccine if you don’t have the records or whether to get a titer first,” she said.

Editor’s note: This story has been updated to reflect that, as of late July, there have been more measles cases in 2026 than in all of 2025.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

‘A long recovery’: A survivor shares her arduous recovery amid Upper East Side Legionnaires’ outbreak

2026-07-27T21:17:18+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Melinda Baron has a story for New Yorkers worried about the Upper East Side Legionnaires’ outbreak: She survived after contracting the disease seven years ago and is grateful for the outcome, but spent many months on the mend.

New York City health officials say 89 people have tested positive for the Legionella bacterium. Seventy-one have been hospitalized, and five others have died since an initial pair of cases was confirmed on July 2.

Most healthy people who are exposed to the Legiononella bacteria don’t get sick, health officials say. But those who do can become seriously ill, like Baron, and end up intubated and in intensive care. Baron’s plight with Legionnaires’ highlights the physical and emotional toil that the severe form of pneumonia takes on people, subjecting them to a recovery that can be arduous and painful.

“Hard, long — it was very difficult,” said Baron, 41, an insurance fraud investigator who works from her home in Maryland.

In the Upper East Side outbreak, 85% of the people who contracted the illness required hospitalization, health officials said. Officials declined to say how many of the hospital patients have required treatment in intensive care, citing privacy.

Legionnaires’ is a severe form of pneumonia caused by the Legionella bacterium. It spreads through airborne water droplets, not by drinking water or through person-to-person spread. Many of the outbreaks in New York City are caused by mist generated by the thousands of cooling towers on top of buildings, and health officials said they believe they have eliminated the source of the current outbreak — possibly a single cooling tower — though dozens of the rooftop machines have tested positive for the bacterium.

An estimated 25,000 people develop Legionnaires’ disease in the United States each year, according to the New York State Department of Health. An additional unknown number are infected with the Legionella bacterium and have mild symptoms or no illness at all. Cases occur sporadically, but outbreaks occur most often in the summer, when building owners operate their cooling towers to keep their tenants cool.

Between 200 and 800 cases are reported each year in New York state, including New York City, according to the New York State Department of Health.

Legionnaires’ has been a perennial concern in New York City, and city officials passed legislation last fall in an effort seeking stricter testing requirements in cooling towers to prevent future outbreaks. An outbreak last summer in Central Harlem resulted in 118 confirmed cases and seven deaths; 92 patients were hospitalized, with 24 admitted to intensive care, according to one study.

There is no vaccine.

Speaker slams city Health Department’s response

The latest outbreak in the Upper East Side has drawn sharp criticism from City Council Speaker Julie Menin, whose district has been the center of infection. She and other officials say the New York City Department of Health and Mental Hygiene was slow to respond.

Chief among the council’s concerns: The Health Department didn’t “proactively” disinfect cooling towers and didn’t do enough to communicate with residents about the outbreak. The City Council plans to hold an oversight hearing in September to “examine the administration’s insufficient response to this outbreak.” Menin said last week.

She raised questions about whether the city has issued fines to cooling tower operators who didn’t comply with the new law requiring monthly testing. The legislation took effect May 8.

The Health Department said it collected approximately $680,000 in cooling tower-related fines for fiscal year 2025 to ensure operators are maintaining the devices to prevent the growth of Legionella. Officials declined to say how many fines have been collected since the new law took effect, adding that an inspection process includes issuing a summons, holding a hearing, and imposing a decision before a fine is collected.

City health officials disputed Menin’s accusation, saying the Health Department responded quickly to the outbreak.

“Remediation and enforcement strategies likely stopped the bacteria from spreading early and were critical to keeping more people from getting sick,” department spokeswoman Chantal Gomez wrote in a statement, adding that health officials have held town hall meetings and press briefings and been updating the public daily.

Health officials say they have not diagnosed a Legionnaires’ case since July 15.

Baron revisits her experience with Legionnaires’

Melinda Baron

Baron fell ill around Memorial Day weekend in 2019, when she and her husband spent time with family at a hotel in central Florida. Around four days after relaxing in a hot tub there, she landed in a hospital in Georgia. Hot tubs are also a source of Legionella.

Two groups are at high risk of getting Legionnaire’s: people older than 50 and smokers. Baron was 34 and didn’t smoke. Her heart rate was unusually high. She had to be hospitalized and put in a medically induced coma and on a ventilator. Seven days later, she was extubated and woke to a strange reality.

“I didn’t know for a minute where I was or what happened,” Baron recalled. “I knew I was in a hospital, because I could see the hospital bed in front of me, and there was a nurse to my left, and my mom was in the corner.”

Her mother told her that the doctors believe she had most likely contracted Legionnaires’ from the hotel hot tub, citing the incubation period. The incubation period for Legionnaires’ ranges from two to 10 days but is usually five to six.

Baron was discharged more than two weeks later. Her recovery was slow and a period of profound isolation. She was often short of breath and disoriented, and her body ached in unusual places.

“It’s been hard, but I’m here, and I’m thankful every single day that I’m here, because it could have gone so much worse,” said Baron. “It’s a long recovery. But you can recover, because I’m living proof of that, and I was at the brink of death.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Wildfire smoke forces Summer Rising indoors as officials limit outdoor activities

2026-07-17T02:41:49+00:00

This story was originally published in Chalkbeat on July 16. Sign up for Chalkbeat New York’s free daily newsletter to get essential news about NYC’s public schools delivered to your inbox.

New York City officials urged summer school programs to limit outdoor activity on Thursday as wildfire smoke wafted into the five boroughs.

The Education Department’s guidance to principals also asked schools to reschedule outdoor trips.

The city’s summer school program, known as Summer Rising, has slots for about 110,000 elementary and middle school students this year, offering a mix of academics, enrichment activities, and trips.

Mayor Zohran Mamdani warned in a social media post that the “combination of dangerous heat and unhealthy air is a serious threat to New Yorkers’ health.”

Thursday’s pivot indoors marked the latest heat- or smoke-related disruption to the city’s public schools. During a heat wave earlier this month, summer programs were instructed to cancel outdoor field trips on July 1 and July 2, according to an internal email obtained by Chalkbeat. In June 2023, the school system switched to remote instruction for a day due to wildfire smoke (though most students already had the day off).

Education Department officials said they follow Health Department guidelines on air quality to make decisions about whether outdoor activities are safe for children. They did not indicate whether they plan to issue a similar warning for Friday when the smoke is expected to ease.

One Brooklyn principal supervising a summer school site, who spoke on condition of anonymity to speak candidly, said the heat and smoke has led them to limit outdoor activities on about half of the days of this year’s summer program, which began July 1 and ends Aug. 7 for middle school and Aug. 14 for elementary schools.

As a result, students are getting less time for recess, basketball, and soccer, because a larger number of students must rotate through the campus’s air conditioned gym. They’re playing games like “7 Up” instead.

“It’s really not ideal — there’s not as much space for free play inside,” the principal said, noting staying indoors is important because many of his students have asthma.

The principal did not receive the guidance that Education Department officials sent to school leaders in advance of the smoke on Thursday and was “literally going off the [New York City Emergency Management] text alerts I personally signed up for” to make decisions about when to limit indoor activities.

Grace Bodenmann, chief education officer at New York Junior Tennis & Learning, said her organization moved programming indoors at the 26 Summer Rising sites they work with as well as the two full-day camps they run at charter schools. They made the move based on instructions from the city’s Department of Youth and Community Development, which sent out two emails Thursday morning, she said.

“It’s not that fun to be in a school from 8 a.m. to 6 p.m.,” Bodenmann said, noting that while Summer Rising sites are required to have air conditioning, not all spaces in a building necessarily have AC, particularly some of the larger spaces such as auditoriums, cafeterias, and gyms. “It’s hit or miss,” she said. “And you can’t open the window.”

Under a recent state law, children are not allowed to be in school spaces that reach 88 degrees or higher.

Students at the New York Junior Tennis and Learning's ACES afterschool program at P.S. 9 in Brooklyn.

Another challenge: Some of the Summer Rising sites have multiple community organizations in one building jostling for space.

But it’s clear that families rely on the program: Attendance was barely down over the past two days, she said. Bodenmann was eager to find out what would happen on Friday, which is when many organizations organize field trips. Rescheduling those trips can be difficult.

Meanwhile, many of the air purifiers the city distributed to every school during the pandemic are gathering dust. Many educators have stopped using them because of concerns that the devices the city bought are noisy and are not as effective as other models. Although the city’s guidance to custodians directs them to keep windows and doors closed when possible and and check HVAC systems, it does not mention using the purifiers.

Some experts previously told Chalkbeat that school systems should think more intentionally about indoor air quality, especially in regions like the East Coast that have less experience responding to smoky conditions.

“On the West Coast, wildfire smoke has just been part of life for a while,” said Patricia Fabian, an associate professor of environmental health at Boston University. On the East Coast, “people have really only started talking about it in the last couple of years.”

Clean indoor air is important for student and staff health, she said. And while she wasn’t familiar with the purifiers New York City purchased for schools, she said that air purifiers can help filter particles and reduce the risk of wildfire smoke.

Alex Zimmerman is a senior reporter for Chalkbeat New York, covering NYC public schools. Contact Alex at azimmerman@chalkbeat.org.

Amy Zimmer is the bureau chief for Chalkbeat New York. Contact Amy at azimmer@chalkbeat.org.

Upper East Side’s Legionnaires’ outbreak: An infectious disease expert weighs in

2026-07-15T23:10:49+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Health officials have yet to identify the source of the Legionnaires’ outbreak on Manhattan’s Upper East Side as the number of infected individuals has climbed over the past two weeks.

Sixty-three people have developed the severe form of pneumonia from the Legionella bacterium as of Tuesday night, health officials said. Seventy-six buildings with cooling towers have tested positive for the bacteria. Fifty-seven of them have drained, cleaned, and disinfected their building towers; and the remaining 19 will be cleaned by Thursday, Health Commissioner Dr. Alister Martin said this week.

Healthbeat spoke to Dr. Aaron Glatt, chief of infectious diseases and hospital epidemiologist at Mount Sinai South Nassau in Oceanside, New York, to get a better understanding of how someone on the Upper East Side might be at risk of falling ill with Legionnaires’.

Legionnaires’ is a severe form of pneumonia caused by the Legionella bacterium and can float through airborne water droplets before someone inhales the germs. The bacteria are not transmitted by drinking water or through person-to-person spread.

Previous Legionnaires’ outbreaks have typically affected the Bronx and Harlem, because of the high density of tall buildings with cooling towers and the high concentration of residents with chronic health conditions. One of the largest and deadliest Legionnaires’ outbreaks happened during the summer of 2015, when 138 cases and 16 deaths were linked to a single cooling tower in the South Bronx.

The current outbreak in the Upper East Side should not come as a surprise. The relatively affluent neighborhood is home to a large number of cooling towers.

The Upper East Side, which is where the mayor’s official home sits, is a core part of City Council Speaker Julie Menin’s district. At a virtual town hall meeting Monday evening, Menin reiterated her concerns on behalf of her constituents, many of whom live in the affected neighborhoods of Yorkville and Carnegie Hill and are particularly vulnerable to Legionnaires’ because they are older than 50.

“I’m hearing from a lot of constituents who are seniors,” she said. “One question they have is: Should they limit their time outside? … I’m getting that question again and again, and I’m really urging the health department to offer some kind of proactive preventative guidance.”

Menin has also criticized the Health Department for not enforcing a new law that took effect in May requiring building owners to ramp up testing for the bacteria.

Of the 63 reported cases, the majority have been hospitalized; 40 have been discharged; and 12 remain in the hospital. Eleven have not required hospitalization.

Glatt spoke by phone about how the bacterium makes the move from a benign germ to a public health hazard and whether you should make that trip to Museum Mile.

This interview has been edited for clarity and length.

How does Legionella spread in the environment?

It’s usually not present in the general environment, but where it is, if it gets aerosolized and then you breathe it in, you can unfortunately get infected. Not everybody gets a serious illness. Some people get no illness. Some people get a minor illness, and unfortunately, some people do get very sick from it, and it can even be a fatal illness, especially in people that have underlying significant illnesses besides Legionella.

What does it take to catch the Legionella bacterium and fall ill?

I can’t tell you if it’s 10 breaths, 50 breaths, 100 breaths. It depends on so many variables. But if it’s in the air, in a cooling tower that is aerosolizing Legionella and a person breathes that … any inoculum theoretically could be significant. Obviously, the larger the inoculum, the longer or prolonged the inhalation, that would increase the risk of a person getting the infection. Their underlying conditions will often determine how seriously ill they get.

New York City health officials have said there’s no evidence that masks are needed to help prevent acquisition. What would you advise to someone nervous about getting sick?

If somebody was in an extremely high-risk situation and they had to walk around in those areas, where all of these buildings are potentially spewing forth aerosols that might have Legionella in them, I can’t tell a person like that that it’s incorrect to wear a mask. But you’re asking: Is there anything somebody can do? (Wearing a mask) might be something that they can do.

Health officials have said the bacterium is ubiquitous in the built environment, particularly in the city’s cooling towers. When does it change from ambient bacterium to a public health hazard?

The cooling towers need to be appropriately cleaned, and they’re supposed to be maintained. Sometimes there’s a very small concentration of Legionella that is present. If you don’t appropriately clean the cooling tower system, it can unfortunately grow and spread. It grows in the hot water, and the potential then for aerosolizing occurs.

I imagine a lot of people are wondering if they’re walking down the street in the Upper East Side, how much are they at risk and what they should be doing to prevent illness?

People can continue to walk. It’s not something that they have to be overly concerned about. But if they have an underlying significant lung disease or other medical problems, then maybe they should consider wearing a mask. Although I don’t have evidence that that would be fully protective, this is part of life. You can’t lock yourself inside. The critical thing is, if you do get any symptoms, to be evaluated right away, because it’s a treatable disease, especially if you treat it early on.

Health officials have said 76 buildings with cooling towers in the Upper East Side have tested positive for the Legionella bacterium. The Guggenheim Museum and the Metropolitan Museum of Art are among them. What would you advise someone who wants to visit one of those museums?

That’s a choice they have to decide they wish to take. If they’re in an extremely immunocompromised state, maybe that’s not the best time to take such a visit to that area.

The Met did not immediately respond to a request for comment. A spokesperson from the Guggenheim said the museum “took immediate steps for remediation,” adding, “The city has confirmed that there is no additional action needed at this time, and this poses no risk to anyone inside the building.”

Anything you’d like to add?

People should know if they’re at high risk, and seek out your doctor if you have initial symptoms, because that would be the best time to diagnose and treat.

People at increased risk include those who are older than 50, smoke or Vape, have chronic heart, lung, kidney or liver disease or diabetes, or a weakened immune system, according to the Health Department. Symptoms include fever, chills, muscle aches, and cough. People may also have headaches, fatigue, loss of appetite, confusion or diarrhea.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

NYC Legionnaires’ outbreak on Upper East Side sparks questions over cooling tower law compliance

2026-07-08T23:15:06+00:00

Data analysis by Sophie Hayssen

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

As the New York City Department of Health and Mental Hygiene tries to identify the source of the Legionnaires’ outbreak on the Upper East Side, elected officials and residents are raising questions about the enforcement of a new law seeking to curb the spread of the disease.

Almost two dozen people on the Upper East Side have been infected since health officials confirmed the first two cases July 2.

Legionnaires’ disease is a severe form of pneumonia caused by the Legionella bacterium. It spreads through airborne water droplets, not by drinking water or through person-to-person spread. Many of the outbreaks in New York City are caused by water vapor spewing from rooftop cooling towers.

For years the city has tried to stem Legionnaires’ outbreaks during the summer months when building owners turn on their cooling towers, which can generate mist containing the Legionella bacterium. The disease has been a perennial concern in the Bronx and Harlem, because of the high density of tall buildings with cooling towers and the high concentration of chronic disease, a risk factor for Legionnaires’. Following a summer outbreak in Harlem the New York City Council passed legislation last October that requires property owners to test cooling towers for the Legionella microbes.

The new citywide law took effect May 8 with limited compliance, the City Council speaker said. New York has almost 6,000 registered cooling towers.

“We know for a fact that many buildings did not comply with that City Council law, which is inexcusable,” City Council Speaker Julie Menin told a crowd of constituents at a town hall meeting Tuesday night at the Church of St. Ignatius Loyola on Park Avenue. “One of the many questions we have about the Health Department is, how many buildings did not comply? Let’s start with looking at those buildings.”

The source of the Legionnaires’ outbreak has not been identified, something Menin called of “great concern to the community,” citing the large number of seniors who live in the affected neighborhoods of Carnegie Hill and Yorkville and are particularly vulnerable to the severe form of pneumonia. She also called for the city to disinfect all cooling towers in the area under investigation, a request she reiterated in a letter sent on Wednesday to the health commissioner.

Officials are urging New Yorkers who live or work in ZIP codes 10028, 10128, and 10075 to contact a healthcare provider if they develop any flu-like symptoms.

Health officials at the town hall meeting had counted 23 cases and 17 hospitalizations as of Monday. Though no deaths have been reported, some patients are in critical condition in the intensive care unit, officials said.

Health officials expect the case count to increase

Health Department Commissioner Dr. Alister Martin expects the case count to climb as testing expands, he told town hall participants.

The city has begun testing cooling towers in the affected neighborhoods and launched community outreach by passing out flyers and holding town hall meetings. Health Department officials said it has rallied more than 100 staff members to investigate the source of the outbreak.

As of Monday, the Health Department had collected samples from 139 cooling towers. The remaining operating towers will be sampled by Wednesday.

Health officials also plan on releasing the addresses of all buildings whose cooling towers test positive for Legionella during an initial screening process. Buildings that test positive will be ordered to immediately drain, clean, and disinfect their cooling towers.

Health officials testified last September that they needed more inspectors to strengthen oversight. When fully staffed, the department will have about 56 scientists and water ecologists to oversee inspections.

In New York City, building owners are required to register cooling towers. Building owners are also required to test the water in the cooling tower for Legionnella and submit the samples, which are logged in a Health Department database.

The new law requires building owners to submit samples every 31 days — down from 90 days — when they are using the cooling towers, which is usually during the summer.

The new law also increased fines, which are now between $2,000 and $4,000.

Healthbeat analysis reveals few building owners have submitted water samples

A Healthbeat analysis of New York City data uploaded to a registration portal offers a compliance snapshot of cooling towers in the city. In some cases, a building owner has included water test dates for Legionella.

Since May 8, the day the legislation took effect, 13.65% of building owners have submitted samples. Also, 110 towers in Upper East Side ZIP codes have submitted samples on or after May 8 — 17.92% of all towers that submitted samples during that time period.

Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health & Health Policy, said it was incumbent upon officials to ensure the city’s cooling systems are up to snuff, because there isn’t a vaccine for Legionnaires’.

“If (the laws) are not enforced, then the only time you actually find out that there’s a problem is when you start having people getting sick and potentially dying from it,” Lee said. “The individual can’t do too much to prevent this type of infection.”

The Health Department recognizes there isn’t a vaccine or medicine available to prevent Legionnaire’s. So it says the best way to avoid the disease is through the proper maintenance of water systems where Legionella may grow.

Martin told reporters after the Tuesday town hall meeting that “it’s too early to tell if this new law is taking effect.”

Fining building owners is not “really what we see as being our biggest tool or lever,” he added.

When asked how many building owners have been fined for noncompliance, Martin didn’t answer.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

To help fight opioid overdoses, vending machines with free public health supplies arrive on Staten Island

2026-06-30T18:58:38+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

In the scrum of the Knicks ticker-tape parade in Lower Manhattan two weeks ago, an off-duty EMT volunteer spotted a stranger showing signs of a drug overdose.

Acting fast, Simone Kelly found someone in the crowd who happened to be carrying naloxone, an over-the-counter drug used to quickly reverse the effects of opioid overdoses, and administered the nasal spray. The man did not die.

New York City Health Commissioner Dr. Alister Martin relayed this anecdote Monday in Staten Island as he and community health leaders announced the arrival of two vending machines that stock “public health” supplies like naloxone kits, also known by the brand name Narcan. Everything in the machine is free.

“Were it not for that individual, and were it not for that Narcan, this person may not be here with us today,” Martin said outside the A Chance in Life health nonprofit, in front of one of the new machines. “The public health vending machines make it more likely that those kinds of life-saving scenarios will happen again in the future.”

The machines have been installed in Staten Island’s North Shore neighborhoods after Adrienne Abbate, executive director of Partnerships for Community Wellness, submitted a proposal to obtain funding from the city’s opioid settlement fund. The pool of money is providing $12 million to expand drug prevention and treatment and recovery services and harm reduction services in Staten Island.

The New York City Department of Health and Mental Hygiene and the Partnerships for Community Wellness unveiled a pair of "public health" vending machines in the North Shore area in Staten Island on June 29, 2026.

Brooklyn and Queens had already had two machines each, since 2023, and Abbate had seen a stark need for the machines in the North Shore area, where fatal overdoses had outnumbered other parts of the borough.

Mirroring nationwide trends, New York City began to see a spike in fatal drug overdoses around 2014 and then peaked in 2022. That year, the city recorded 3,070 fatal drug overdoses, a figure that has since dropped significantly, according to a city Health Department report in October 2025.

The decline was noticeable in Staten Island. After recording the city’s second-highest overdose death rate, the borough dropped to the second-lowest overdose death rate in 2024, according to the city’s Health Department.

Experts attributed the drop in death rates to a combination of factors, including wider availability of naloxone, expanded access to medication, and investment in harm reduction services.

The highest rates of fatal overdoses in the city persist in parts of the Bronx, Upper Manhattan, and Central Brooklyn, according to recent data from the city Health Department.

Today, first-responders carry naloxone and so do local pharmacies — at around $25 — and almost all public institutions in New York state are required to carry naloxone on their premises, according to the Health Department. Every school in New York City stocks naloxone, and school nurses are trained to administer treatment.

But the cost and location can be barriers, especially during an emergency, and the new machines aim to make naloxone more readily available.

“No matter the time or day of the week, community members will have a chance to come grab free supplies and start carrying the tools to protect our neighbors — on the bus, walking on the street, or driving in the car,” Abbate said. “No insurance or appointment needed.”

In addition to naloxone, the machines provide emergency contraception pills, condoms, and socks. Users of machines are asked to enter a ZIP code, which is logged.

Abbate said the decisions about what to stock in the machines come from research that included conversations with people in recovery and others still using drugs.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Dr. Alister Martin: From voter registration startup founder to NYC health commissioner

2026-06-25T19:53:14+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Before becoming New York City’s top health official in February, Dr. Alister Martin juggled being a busy emergency room doctor in a Boston hospital and an entrepreneur focused on remedying inequities in public health.

One widely adopted initiative of his, Vot-ER, introduced the novel idea of registering patients as voters in a healthcare setting.

Martin recently told a group of health policy leaders in Manhattan that his philosophy is simple: “In this country, if you’re not at the table politically, you’re on the menu.”

In some ways, Martin was an unusual choice for the commissioner of the city’s Department of Health and Mental Hygiene. The nonprofit he founded to oversee the voter registration startup employs a staff of fewer than 60. In his new role, he oversees more than 7,000 employees across the city’s five boroughs.

Much like Mayor Zohran Mamdani, his 34-year-old boss, Martin at age 37 is a relative political outsider with an interest in tackling the challenges faced by underserved communities and leveraging his position to increase civic participation. In Martin’s case, he used his skills and access as a physician to do that by building startups with a social justice agenda, such as Vot-ER, and collaborating on journal articles arguing for doctors to encourage their patients to vote.

“I think that might have been one of the reasons Dr. Martin might have appealed to the mayor, despite the fact that he didn’t really have a direct New York City health experience or New York City government experience before he was appointed as the commissioner,” said Jean Bae, a professor at New York University’s School of Global Public Health who has worked as a policy analyst at the city’s health department.

Martin launched Vot-ER as a nonprofit in 2019, built around the idea that civic engagement can improve the overall health and well-being of patients. The group enlists volunteer doctors, nurses, and other healthcare professionals to ask patients about their voter registration status. If the patients aren’t registered, they are encouraged to scan a QR code worn by the doctor or nurse and enter their personal information, after which they receive notices of their nearest voting center or reminders prompting them to register. They can also request an absentee ballot.

The effort has received support from those in the medical establishment who champion the need for civic participation in unconventional corners. According to Vot-ER, more than 2,000 healthcare institutions have registered to use its tools, like the voter registration app. Vot-ER also says it has helped more than 650,000 people by showing their closest voting center and sending reminders to register.

Some observers of the program, however, have questioned the ethics of mixing civic activism with medical care.

“There shouldn’t be anything going on there except efforts to maintain or improve the patient’s health,” said Arthur Caplan, a professor of bioethics at New York University’s Grossman School of Medicine.

Conservative groups have accused Vot-ER of bringing politics into healthcare settings. The Republican National Committee sent letters in 2024 to the secretaries of six swing states urging them to monitor Vot-ER, citing what it saw as the group “weaponizing the healthcare system… across the nation for partisan political purposes.”

Vot-ER officials defend their work as “rigorously nonpartisan.”

New York City Mayor Zohran Mamdani, right, announces Dr. Alister Martin, left, as Commissioner of the New York City Department of Health and Mental Hygiene at the Bronx Museum of the Arts on Jan. 31, 2026.

Registering voters has become a crowded field. Taylor Swift has encouraged her millions of social media followers to register to vote with the click of an Instagram post. Republicans held registration drives at gas stations in the 2022 midterm elections to stress the rising cost of living.

Though Martin stepped away from Vot-ER in February when he became health commissioner, the program may offer clues on how he might lead one of the biggest health agencies in the world.

“I learned so much through the Vot-ER era of my life,” Martin said in a recent interview at the health department’s headquarters in Long Island City, Queens.

“What I want is for someone to have their life be meaningfully different because of the action that we took. That’s going to look a little different than maybe how other health commissioners have intervened, but that’s what I think public health needs to move toward — meaningfully — to impacting people’s lives.”

Martin’s ventures burnished his reputation as civic innovator

Born in New York City, Martin grew up in New Jersey and graduated from Rutgers, where he played on the tennis team. He later earned his medical degree from Harvard Medical School, while also getting a master’s from the Harvard Kennedy School.

“Alister in grad school was someone who was absolutely hungry to learn and understand how the world works and how power works, how to navigate organizations and systems,” said Tim McDonald, a close friend who met Martin at the Kennedy School and became roommates with him.

After graduation, Martin put those skills into practice, launching several health-related startups while working in a hospital. In 2016, Martin developed the first of several startups: an AI tool that helped healthcare providers take notes. Later, he came up with an idea to deliver COVID-19 vaccines during the thick of the pandemic to elderly and disabled residents in some of the low-income neighborhoods of Boston.

In 2017, when Martin was chief resident at Massachusetts General Hospital, he noticed that many of his ER patients were struggling with homelessness, opioid addiction, and poverty — all issues that shape health outcomes. Voting, he realized, could help change such circumstances to possibly prevent future emergency room visits.

After starting Vot-ER in 2019, he continued working on voting rights issues as an adviser in 2021 and 2022 to then-Vice President Kamala Harris; later he joined the U.S. Department of Health and Human Services advisory panel on outreach and education.

The idea of registering voters in a medical setting took on even greater importance after thinking about the Department of Motor Vehicles, which began offering voter registration in 1993 with the National Voter Registration Act, known as the Motor Voter law.

“What the hell does voting have to do with driving? Aren’t voting and health more related than voting and driving?” Martin recounted in a 2023 story in ACEP Now, a publication of the American College of Emergency Physicians. “We want to create that same kind of connection between health and voting.”

Vot-ER started as an iPad on a kiosk in the waiting room of the emergency department at Massachusetts General. Martin got permission from hospital administrators and agreed to keep the effort nonpartisan and not compromise care. He expanded by installing software on iPads affixed to lecterns he had bought online, according to a 2020 story in The New York Times.

In 2020, during the COVID outbreak, the group shifted its focus from emergency rooms and more broadly toward academic medical centers and community health clinics.

Sandra Pimentel, a clinical psychologist and professor at the Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, set up Vot-ER tables in hospital lobbies to greet visitors.

“It was saying, ‘Hey, are you registered to vote? Are you sure? Here’s how to do it. It’s very simple,’” Pimentel recounted from her early days volunteering with Vot-ER.

In some hospitals, Vot-ER offers guidance on how best to approach patients. A Vot-ER training video offers suggestions.

“One way to introduce these tools to patients is during the social history portion of their visit. While asking other questions, such as, ‘do you smoke, do you drink, are you safe at home?’” Vot-ER Senior Field Director Bianca Navarro said in a training video. “You could add, also, ‘are you registered to vote?’”

If the answer is no, the patient is urged to use their smartphone to scan a QR code on a badge provided by the health professional. Clicking on the code, the patient’s smartphone opens to a page and is invited to enter their name, date of birth, and residential address. The app determines the voter’s eligibility by checking with a national database of registered voters.

How voting enters healthcare relationship

Vot-ER staff have described its interaction with patients as “streamlined.”

Bianca Navarro of Vot-ER wrote in an email that asking a patient if they are registered to vote takes less than two minutes. “Healthcare professionals who participate in our work also report reduced burnout and increased hopefulness. This work strengthens the provider-patient relationship rather than detracting from it.”

Sally Satel, a Yale-affiliated psychiatrist and resident scholar at the center-right American Enterprise Institute, argued that the trust patients place in doctors is precisely what Vot-ER threatens to exploit, and that physicians are “guardians of physical, not civic, health.” She said if a doctor raises the subject of voting patients may suspect an ulterior motive and worry that their care could be affected by how they respond.

“It is completely inappropriate for a physician to bring partisan politics directly into patient care,” Satel said in an email. “Even broaching the issue of voting itself in a patient visit is a bizarre distraction from the true issue — the health of the patient.”

Dr. Jennifer Caputo-Seidler is an internist and professor at the University of South Florida in Tampa, Florida, who learned about Vot-ER on social media because she was interested in advocacy and medicine and became a Vot-ER fellow.

“The number one question I always get is like, ‘Do patients give you pushback?’ said Caputo-Seidler. “I’ve never had an upset or angry response from a patient.”

The aim is for Vot-ER volunteers to add questions about voter registration status along with the other standard questions they ask patients during an annual check up.

“Their drug use, their sexual habits, what their bowel movements look like,” Caputo-Seidler said. “Asking somebody if they’re registered to vote is by far not the most invasive question I’m asking them.”

If she were to receive a testy response, she said she would move on.

Vot-ER is gearing up for the 2026 midterms, while Martin has officially left the startup and is turning his attention to his new job.

Martin told Healthbeat he didn’t think the voter initiative played a major role in his winning over Mamdani. It was his interest in focusing on the broader question of affordability and trying to help a patient, for example, who has diabetes but no refrigerator for the insulin, he believes.

“I don’t know if the mayor knew about Vot-ER — maybe he did, maybe he didn’t — that’s certainly not what our conversations were about,” Martin said.

Martin said that his work has aimed to address financial instability in the lives of his patients. “Ultimately what the data shows us is that it’s poverty that makes people sick.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

A preventable tragedy: What my sister’s death taught me about public health

2026-06-24T12:03:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

This year marks the 15th anniversary of my sister’s death from rabies.

In 2010, my sister Ivy bought a home in Sumter, South Carolina, and eagerly began rehabilitating it. Soon, she noticed bats finding their way into her enclosed back porch and main living areas.

Aware that bats can carry rabies, she called the local Animal Control office in 2011 to express her concerns. Instead of health advice, she received a warning: She was told bats are protected, and killing them could land her in jail. No one advised her to seek a medical assessment or contact the health department to protect herself and her son.

Months later, Ivy developed flu-like symptoms. What followed was a harrowing journey of confusion and misdiagnoses before a neurologist finally ordered a rabies test. By the time we had an answer, it was too late. Rabies is 100% preventable before symptoms appear, but there is little that can be done once a patient becomes symptomatic.

Ivy Durant, sister of Tonji Durant.

I recently retired as an epidemiologist for the Centers for Disease Control and Prevention, having spent my career in domestic and global health. Yet, sitting in that intensive care unit, my professional background could not save my sister. Her death illuminated critical systemic gaps in how we communicate public health risks at the local level.

Seven out of every 10 deaths from rabies in people are linked to bats, and rabid bats can be found in every state except Hawaii. A public health survey conducted in Sumter County after Ivy’s death found 3.5% of respondents had bats either living in their home or entering the home. And while respondents generally knew that bats can transmit rabies, they had limited knowledge of the risks or how to protect themselves.

The mistakes surrounding Ivy’s death were born of institutional silos and poor communication:

Disconnected agencies: Animal Control and the local health department were located across the street from one another at the time, yet they did not collaborate on communicating community risks.
Information gaps: The local health department lacked the resources it needed to provide citizens with practical information regarding the fatal risks of bats in sleeping quarters or how to address bats if they’re there. Today there are more resources available online, but they remain challenging to navigate and apply locally. Recent cuts to the CDC also likely limit capacity for expertise, testing, and engagement, which are especially important for complex conditions like rabies.
Diagnostic delays: Because human rabies cases are incredibly rare, the disease was not on the hospital’s radar, delaying crucial decisions regarding her comfort and care.

My mother feels our family was robbed, and she is right. Ivy did not have to die. To prevent this from happening to another family, we must fundamentally shift our public health approach.

Break down government silos: Agencies must communicate. If Animal Control is aware of bat activity or other exposure risks, it must work closely with public health officials so citizens are immediately informed of health risks, not just legal liabilities.
Engage trusted community leaders: We need to return to grassroots strategies. We must engage community-based organizations and trusted local voices to communicate risks and empower residents.
Apply global lessons domestically: Having worked in global health, I know the immense value of the community-building strategies we use overseas. We must rebuild local partnerships, applying the lessons we’ve learned globally to our domestic programs. Whether for maternal health, HIV, malaria, vaccine-preventable diseases, or One Health initiatives that recognize the connections between human and animal health, community-based strategies are at the heart of successful prevention programs.
Prioritize proactive engagement: Ivy’s laboratory and medication bills (excluding her clinical care) for just her final two weeks of life were roughly a quarter of a million dollars in 2011. Today, that’s approximately a half-million dollars. We must invest in a system based on coordinated prevention and not wait until a crisis hits.

One life lost to a fully preventable disease is one life too many. In the last year and a half, we’ve seen significant cuts to public health funding and infrastructure. Without protecting public health investments, declining engagement and resources are inevitable, and we run the risk of repeating past public health mistakes.

Tonji Durant is a retired CDC scientist. She now advocates for stronger health systems and coordinated public health communication to prevent tragedies like her sister Ivy’s death. Tonji is a member of the Southern Alliance for Public Health Leadership, whose work focuses on empowering public health professionals across the South.

How New York’s ‘Essential Plan’ insurance coverage cuts are forcing impossible choices

2026-06-18T16:20:29+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Olivia Killingsworth, an actor and bookkeeper living in Brooklyn has a rare life-threatening genetic condition for which she sees specialists, limits exercise, takes prescribed medication to lower her blood pressure, and monitors her heart rate with a watch.

The 44-year-old is one of some 450,000 New Yorkers who could lose health insurance at the end of the month.

That’s because of a change to the state’s “Essential Plan,” a low-cost health insurance option that covers people who earn too much money to qualify for Medicaid and too little to afford private plans sold on the state health insurance marketplace.

On July 1, New York plans to revert to an earlier plan that will narrow insurance eligibility for low-income residents, potentially leaving thousands suddenly uninsured and looking for coverage options.

Killingsworth and others like her may find themselves in an unusual predicament as they weigh their health insurance options: Do they try to earn more money so they might qualify for a plan that proves to be more expensive or do they work less so they earn less money to be eligible for a separate plan?

“People are really going to be in the situation of making incredibly difficult choices,” said Michael Kinnucan, health policy director at the Fiscal Policy Institute, a nonpartisan think tank that aims to promote sound and equitable fiscal policy to strengthen New York’s economy.

When New York launched the Essential Plan in 2016 with funding from the Affordable Care Act, it was hailed a success. The plan offered no monthly premiums or deductibles, and annual checkups were free. In a state whose monthly premiums for marketplace plans are among the most expensive nationwide, it became wildly popular, now offering high-quality and affordable insurance to 1.7 million New Yorkers.

Of those, about 450,000 are in households making up to 250% of the federal poverty line. That is $39,900 a year for a single adult with no children, like Killingsworth who last year earned around $35,000, or $80,375 for a family of four. The state received federal permission in 2024 to expand eligibility to those New Yorkers.

But the passage of H.R. 1, the Trump administration’s One Big Beautiful Bill Act, changed that. The legislation prompted the state to shrink eligibility and undo its expansion, and the income limit for eligibility dropped from 250% to 200%. There are no changes for the 1.3 million enrollees with income below 200% of the federal income poverty level, or an income below $31,920.

New York City’s Department of Health and Mental Hygiene estimates that 233,000 New York City residents will lose their Essential Plan coverage. The New York State Department of Health, which worked with the Urban Institute, a think tank in Washington, D.C., on its projections, anticipates between 150,000 and 200,000 will become uninsured.

Actor and bookkeeper Olivia Killingsworth gives a health update to her physical therapist Melanie Carminati as part of her PT appointment.

New Yorkers who lose their insurance can go to a federally qualified health center — typically a community health clinic — for preventative care, dental care, and other services and pay on a sliding scale. Or they may visit a medical school that has a student-run clinic offering free or low-cost care.

With so many suddenly losing their insurance, there will be plenty of blame to go around.

“The responsibility for those losing coverage rests squarely with House Republicans, and now New Yorkers are beginning to feel the impact,” New York Health Department spokesperson Danielle De Souza said in a statement.

Killingsworth and health advocates like Kinnucan disagree. They argue that Gov. Kathy Hochul didn’t do enough to preserve coverage in the budget for Essential Plan enrollees. Lawmakers said she could have dipped into funds that she had set aside for her January budget proposal. But the argument failed to gain traction in negotiations.

“We had an opportunity in the state budget to prevent it,” said Kinnucan. “There’s this weird thing that happens with policymakers, where healthcare in theory is some sort of entitlement program that you can cut, but the people who use healthcare are sick and they really need help.”

Olivia Killingsworth poses for a portrait after leaving her physical therapy appointment in Brooklyn.

Killingsworth diagnosed with rare connective tissue condition

In 2019, Killingsworth was diagnosed with Ehlers-Danlos Syndrome, or EDS, a rare group of connective tissue disorders. She has what’s referred to as the vascular kind, which means her connective tissue is very fragile, particularly in the blood vessels and organs. That type of EDS runs in the family and can cause life-threatening complications, such as an aneurysm, and affects roughly 1 in 100,000 to 200,000 people, according to the Ehlers-Danlos Society, an advocacy organization that aims to promote awareness about EDS.

“I’m a 44-year-old woman with the joints and connective tissue of a 74-year-old,” said Killingsworth, who has dyed parts of her graying hair purple.

Killingsworth hasn’t performed as an actor since 2021 but is hoping to return to the stage or TV soon. Treatment keeps her busy.

Care requires visits to a niche cardiologist and a vascular specialist, both at Mount Sinai on the Upper East Side; she consults them on taking long bike rides and is under orders not to over exert herself.

Olivia Killingsworth does exercises with her physical therapist Melanie Carminati at her studio in Brooklyn.

She also sees a physical therapist almost weekly who specializes in EDS, one of the few in the city, if not the country. Each visit runs $250. The physical therapist, the owner of a Brooklyn studio, doesn’t accept insurance like many other physical therapists, because she believes it would limit the quality of care. It’s a stretch for Killingsworth to pay out of pocket, but she can make it work because her other healthcare has been covered.

Killingsworth’s father was diagnosed with EDS, and she believes her aunt likely had it, dying at the age of 70 in 2018 because of an aortic rupture, Killingsworth said. Her aunt’s inheritance allowed her in 2022 to pay cash for her one-bedroom apartment in Brooklyn’s Kensington neighborhood where she lives with her two cats. She paid $521,000, public records show.

Killingsworth realizes that she is lucky enough to live in one of the world’s most expensive cities without having to pay a mortgage or rent. That recognition compelled her to participate in an organized protest in April outside Hochul’s office in Midtown Manhattan. A member of the Democratic Socialists of America who canvassed for Mayor Zohran Mamdani when he ran for office last year, Killingsworth was part of a group arrested in the April demonstration on trespassing charges, which were later dropped.

“I have a college degree, I have a lot of skills, I can do a lot of stuff,” Killingsworth said. “I know that there are lots of other people that aren’t from that position and are facing much worse conditions. They don’t have the same options that I do. So that’s one of the reasons that I wanted to go out there and take that arrest.”

Killingsworth joined the Essential Plan in 2024 and it was a godsend. Because of her yearly salary of around $35,000, she qualified for a plan for New Yorkers whose annual income was more than 200% of the federal poverty line and less than 250% of the federal poverty line. The annual income is between $31,920 and $39,900.

If she were to purchase a plan through the marketplace, she would pay more.

According to a calculation on the marketplace offered by New York state, Killingsworth is eligible for more than 60 plans. The NYS Health Department says that consumers with income between the 200% and 250% poverty line will be eligible for a plan with an estimated average premium of $220 after tax credits and a deductible of $2,150.

If Killingsworth were to pursue one of these plans, she says she would stay with her current insurance whose services she has liked. One estimate she obtained shows she could pay a monthly premium of $432 after tax credits with an annual deductible of $2,050 — reaching a minimum of $7,234 total, or 20% of last year’s income. This doesn’t include costs for imaging, specialists’ visits, or her physical therapy sessions.

She is inclined to see if she can join another tier on the Essential Plan.

There is no monthly premium or deductible, and the maximum out of pocket is $350. A visit to see her cardiologist would cost $25.

To be eligible, Killingsworth would need to work fewer hours so she could earn less money. Her annual salary can’t exceed $31,920.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

RFK Jr. orders hantavirus cruise passenger to remain in secure facility, overrules federal medical review

2026-06-16T23:36:02+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The order from Health and Human Services Secretary Robert F. Kennedy Jr. was slipped under Angela Perryman’s door Monday afternoon inside the secure National Quarantine Unit in Nebraska. This is where she and other former cruise ship passengers have been held since last month because of possible exposure to a dangerous type of hantavirus.

The order signed by Kennedy requires Perryman to stay inside the locked Nebraska facility through June 21, the end of the 42-day quarantine period — even though an HHS-appointed medical review determined last week that Perryman could safely finish her quarantine at home in Florida.

“It has nothing to do with public health at all,” Perryman told Healthbeat Monday evening. “They’re using administrative orders to detain American citizens with no judicial oversight.”

HHS officials did not answer Healthbeat’s questions about the reasons behind Kennedy’s order and why it appears to contradict the findings of the federal government’s own medical review of her detention.

A copy of the order, provided to Healthbeat by Perryman, only says generally that he finds that requirements for federal quarantine continue to be met.

The day after this article was published, HHS said in an emailed statement: “In the absence of proper home monitoring by state authorities, the Administration’s quarantine order is necessary to ensure both Ms. Perryman’s and her community’s wellbeing.”

HHS did not address the detailed findings in the medical review that said the monitoring would be appropriate and protective.

What began as a medical evacuation of Americans from a deadly outbreak aboard an international nature adventure cruise has raised increasing concerns from some public health and legal experts about whether the U.S. government has failed to properly balance protecting public health with ensuring people are quarantined in the least restrictive setting that is safe.

Neither Perryman nor any of the 17 other U.S. passengers who were sent to the Nebraska quarantine facility after leaving the M/V Hondius cruise ship have shown any signs of infection with Andes virus. This type of hantavirus typically spreads through contact with South American rodents, but also is the only hantavirus known to have the potential to spread from person to person.

Of the nearly 150 passengers and crew who were aboard the M/V Hondius, there have been 13 cases of Andes virus, including three deaths, according to the World Health Organization.

Person-to-person spread of Andes virus is “relatively rare and generally associated with prolonged close contact” with a person who is sick, the Centers for Disease Control and Prevention has said in its interim emergency guidance for the public health management of people who have been exposed.

Angela Perryman, pictured during the nature cruise that landed her in federal quarantine.

Recently, HHS has allowed some passengers to leave the facility and finish their quarantines at home – but often under requirements that state and local health departments ensure 24/7 monitoring.

But while Perryman’s home state of Florida is willing to supervise her quarantine at home, it won’t agree to 24/7 monitoring.

“At this time the assessment of the Florida Department of Health is that it is not necessary to implement the federal conditions of 24/7 continuous surveillance and twice daily in-person monitoring of the individual at their residence,” according to a May 28 letter Florida Surgeon General Joseph Ladopo sent to Dr. David Fitter, the hantavirus response incident manager at the Centers for Disease Control and Prevention.

Perryman provided a copy of the letter to Healthbeat.

As part of her quarantine appeals through a federal administrative process, Perryman requested a medical review of the necessity of the terms of her federal quarantine order.

According to the June 11 medical review report, an HHS-appointed official from the CDC recommended that Perryman be allowed to finish her quarantine at home in Florida.

“The disagreement between CDC and Florida over the appropriate monitoring conditions forms a central dispute in this medical review,” wrote Dr. Michael Bell, the appointed quarantine medical reviewer, who is the director of the CDC Division of Healthcare Quality and Promotion.

Bell noted in the report he was not previously involved with the quarantine orders in Perryman’s case.

After reviewing the evidence in the case, Bell said that it was his professional judgment that “less restrictive alternatives would adequately serve to protect public health.”

Bell noted that Florida health officials had proposed once-daily telehealth monitoring with remote temperature checks and symptom assessments. He said these conditions – along with a pre-arranged plan for an appropriate hospital to care for Perryman if she experienced symptoms – would be sufficient to protect public health.

“This is a reasonable and efficient approach that is consistent with the level of transmission risk associated with Andes virus infection,” wrote Bell.

Perryman, who has been appealing her continued detention in Nebraska for several weeks, had her hopes buoyed by Bell’s medical review. But then she received no information indicating anyone was arranging her transfer to Florida.

She said Kennedy’s order on Monday – essentially rejecting the medical review’s recommendations and upholding the current quarantine order – means she’s stuck at the Nebraska quarantine facility until the 42-day quarantine period ends on June 21.

Perryman said she thinks she’s being retaliated against for publicly criticizing how HHS has handled the quarantines.

“A non-physician just overrode the physician medical reviewer,” she said, emphasizing that Kennedy is not a doctor.

Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University, called Kennedy’s order “a shocking disregard for both science and personal freedom.”

“It’s a flagrant violation of due process and should be immediately challenged in the courts,” Gostin said on the social media platform X.

Appealing federal quarantine orders isn’t an easy process, Perryman said she and her attorneys have found. Numerous bureaucratic hurdles first have to be cleared within the federal government’s administrative process before you can seek a court’s review.

“They’ve managed to run the clock down and deny me my Fifth Amendment rights,” she said. “We followed the procedure set forth in the regulation, we complied with the law, and they did not.”

Editor’s note: This article has been updated to include a comment that the U.S. Department of Health and Human Services provided the day after publication.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Second baby formula recall linked to botulism raises questions about safety, oversight

2026-06-15T20:57:35+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

When ByHeart infant formula was linked to a nationwide outbreak of infant botulism last fall, the company encouraged its customers to switch to another premium whole milk formula made by Nara Organics.

Now Nara Organics, which has promoted the “thousands of tests” it runs on every formula batch, is recalling all of its whole milk organic powdered infant formula after the Centers for Disease Control and Prevention linked it to three babies being hospitalized with infant botulism.

The CDC and the U.S. Food and Drug Administration are urging parents and caregivers to immediately stop using Nara Organics Whole Milk Organic Infant formula, which is sold at Target and online. Parents should seek immediate care for their infant if they have symptoms such as poor feeding, loss of head control, difficult swallowing, or decreased facial expression.

Nara Organics organic infant formula. Lot code is found on the bottom of each can. Lot code is outlined in white in the above image

The Nara Organics recall, which follows ByHeart’s recall in November, marks the second time in seven months that a premium organic whole milk infant formula has been linked to an outbreak of infant botulism. The recalls have fueled concerns among parents about the safety of infant formula and the effectiveness of federal oversight.

“Two outbreaks in less than a year show that ByHeart was not a unique accident,” said Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, a consumer advocacy group.

“Something is very wrong in the production of these formulas, and FDA is not moving fast enough to find the cause,” Sorscher said. “The agency is currently conducting testing of milk ingredients, but that process is creeping along at a snail’s pace and they still have no advice to offer on how to control these risks.”

Nara Organics says the recall, announced Saturday, is being done “out of an abundance of caution” because of the risk that its formula is contaminated with Clostridium botulinum bacteria spores, which cause infant botulism. It can take several weeks between when a child consumes the spores and when they start showing signs of illness. If not treated, infant botulism can lead to paralysis and death.

The company said its infant formula has not tested positive for C. botulinum. The CDC said testing is underway of opened cans of Nara Organics formula and unopened product samples from the company. Results are expected “in the coming weeks,” the CDC said.

Nara Organics did not answer Healthbeat’s questions about the decision last fall to promote Nara’s formula as the replacement for ByHeart’s recalled formula during its infant botulism outbreak. Nara also didn’t answer questions about whether the companies have any common suppliers or other relationships.

In an email Monday afternoon, a ByHeart spokesperson said: “ByHeart and Nara Organics are completely separate companies. There is no corporate, financial, contractual, manufacturing, operational, or ownership relationship between ByHeart and Nara.”

ByHeart said it shared a Nara discount code as a resource to help its customers find alternative options quickly.

A ByHeart post on Instagram from Nov. 11 that recommended Nara Organics products and offered a 20% off discount code was deleted Monday after Healthbeat shared the link with both companies. An archived image of the post is available here.

ByHeart told Healthbeat it removed the post “for safety considerations following the Nara news - while the offer is no longer valid, we did not want to take any chances.”

The source of the contamination of ByHeart’s formula is still under investigation. The FDA has focused on ingredients supplied to the company, including a powdered milk ingredient.

The agency said June 3 that while its inspections led to the identification of C. botulinum in a powdered milk ingredient, the agency “did not identify any additional factors within ByHeart’s facilities that could explain the cause of this outbreak. FDA’s root cause investigation is ongoing and will continue with a focus on ingredients.”

The FDA told Healthbeat it is working with experts around the world to understand the risks of C. botulinum in infant formula to inform future monitoring and control measures.

“Last year’s outbreak involving ByHeart powdered infant formula was the first botulism outbreak definitively tied to infant formula anywhere in the world since infant botulism was first described as a distinct clinical entity almost 50 years ago,” the FDA said in an email.

Health and Human Services Secretary Robert F. Kennedy Jr. last year launched an infant formula initiative called Operation Stork Speed, which initially focused on formula nutrients and testing for pesticides, heavy metals, and per- and polyfluoroalkyl substances, or PFAS. In February, in response to the ByHeart recall and infant botulism outbreak, the FDA said it was beginning a sampling project focused on dairy-based ingredients that includes looking for C. botulinum.

Nara Organics formula has been on the market less than a year

Nara Organics launched its infant formula last July, touting celebrity investors such as Serena Williams, Gina Rodriguez, and Nicky Hilton, and saying the company was “setting a new standard that exceeds both U.S. and European safety requirements.”

After initially being sold online, in January, the company announced its first retail launch, which put the product on the shelves of more than 1,800 Target stores nationwide, as well as on the retailer’s website.

The formula is manufactured in Germany from organic ingredients sourced from the United States and the European Union, according to the company.

“At Nara, we run testing three times. On raw ingredients, on our formula powder as it’s being made, and on our finished canned formula,” the company’s website says. “From our first batch, we’ve run voluntary screening for clostridia – a sign of bacteria that can cause botulism – and B. cereus, the organism that produces cereulide.” Cereulide is a toxin that can cause nausea, vomiting, and dehydration in infants.

Officials at Nara Organics did not answer questions from Healthbeat, including about its microbial safety testing and whether its testing methods and protocols are sufficient to ensure botulism bacteria spores are not present in formula sold to consumers. A Nara spokesperson told Healthbeat the company had no comment beyond what was in its recall announcement.

Over the years, some international food safety experts have expressed concerns about the difficulty of testing for and detecting botulism spores in infant formula.

Infants hospitalized in California, Pennsylvania, Washington

The FDA told Healthbeat that it first contacted Nara Organics on Wednesday, June 10, asking the company whether it had received any consumer complaints about infant botulism diagnoses.

Then on Friday, June 12, the FDA said it contacted Nara Organics and recommended the company conduct a recall “due to the severity of illness and the epidemiological signal.” The company, which said it was contacted “late Friday,” announced its recall on Saturday, June 13.

According to the FDA, the three infants – who all had been fed Nara Organics-brand powdered infant formula – fell ill between April and May. All required hospitalization. The last date of illness onset was May 31. The infants, who ranged in age from 2-months-old to 5-months-old, were in California, Pennsylvania, and Washington state.

Leftover formula has been collected for testing in two of the states, the FDA said.

The FDA told Healthbeat that before it was aware of the infant botulism cases, the agency inspected the two firms that manufacture Nara Organics Whole Milk Organic Infant Formula in Europe. “At the conclusion of both inspections, observations citing deficiencies were issued to both facilities. Both firms have submitted corrective action responses to FDA, which are currently under review,” the FDA said. No further details were provided.

The FDA is warning consumers to not use any Nara Organics Whole Milk Organic Powdered Infant Formula. But the agency is suggesting parents and caregivers consider holding onto any opened formula containers for a month – labeling them as “DO NOT USE” – so that they can be tested should their child become ill.

Because Nara Organics’ formula makes up less than 1% of the infant formula sold nationwide, there is not a risk of the recall and outbreak causing concerns about shortages.

Editor’s note: This story has been updated with responses from the FDA and ByHeart, which were sent after initial publication.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine: 5 passengers sent to home quarantine, 13 remain in Nebraska facility

2026-06-01T23:21:17+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Five passengers from the hantavirus cruise ship have been allowed to leave a secure quarantine facility in Nebraska and continue being monitored at home, but 13 others remain at the secure facility, the U.S. Department of Health and Human Services told Healthbeat on Monday.

At least two of those released to home quarantine on Monday will be under around-the-clock monitoring and have been put under an official quarantine order, New York officials said.

Multiple media outlets have reported that federal officials had wanted to require that state health departments ensure a police officer or public health worker was stationed 24/7 outside each of the individuals’ homes. That is an unusual step that may stigmatize people who have shown no signs of infection.

Officials at HHS and the Centers for Disease Control and Prevention did not answer questions about why some passengers are being allowed to leave the facility after 21 days of a 42-day quarantine or why others are remaining inside a secure, institutionalized setting. Nor have they provided any public health or scientific basis for how potential risks from former passengers of the M/V Hondius are being managed.

The lack of transparency and inconsistency in the federal government’s approach to managing potential public health risks in the wake of a deadly outbreak of Andes hantavirus is drawing concern from legal experts and public health officials.

Testing so far has not found any of the U.S. passengers being held in quarantine to be infected with the virus.

“The administration is being quite secretive and arbitrary in its use of quarantine powers,” said Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University.

“Quarantining a person is a massive infringement of civil liberties and must be done using a clear and science-based process,” Gostin said Monday. “I do not think the administration is acting in a transparent or rational fashion.”

The 18 U.S. passengers from the cruise ship were evacuated last month to the National Quarantine Unit at the University of Nebraska Medical Center in Omaha after three people who had been aboard an international nature cruise died from severe respiratory illness caused by an unusual type of hantavirus that has the potential for “limited” spread between people.

So far, health officials in multiple countries have identified 10 additional cases of Andes hantavirus among people who were among the nearly 150 passengers and crew aboard the ship, according to the World Health Organization’s latest update on May 28.

It’s unclear what the terms and conditions are for the five U.S. passengers who on Monday were allowed to leave the Nebraska facility, and whether federal health officials have issued any new or renewed federal quarantine orders to force any of the other passengers to remain in the facility.

Neither HHS nor the CDC would say. Officials at the University of Nebraska Medical Center also did not answer questions from Healthbeat.

“All five remain symptom-free and have met public health criteria to safely continue monitoring outside the NQU,” HHS said in an email to Healthbeat. The department did not respond to questions about what those criteria were.

Health workers in hazmat suits board the Dutch polar expedition cruise ship MV Hondius at a dock in Rotterdam. So far there have been 10 cases of the Andes hantavirus worldwide among about 150 passengers and crew. (Photo by Nicolas Economou/NurPhoto via Getty Images)

The five people being released to home quarantine will not travel on any commercial flights, HHS said. The department said “appropriate biocontainment measures are in place during transport,” but no details were released.

Once these five people are home, HHS said that state health departments will continue “daily symptom monitoring, maintain 24/7 oversight, and provide guidance throughout the remainder of the 42-day monitoring period.”

HHS officials did not answer questions about how the monitoring and oversight would be carried out.

“CDC encourages the public to support the people and families affected by this situation,” HHS said. “Public health monitoring is a precautionary measure that helps safeguard the health of potentially exposed individuals and protect communities.”

Two of the passengers beginning home quarantine have returned to their private residences in undisclosed locations outside of New York City, Dr. James McDonald, New York state health commissioner, said in a statement Monday afternoon. He said they will remain under “around-the-clock surveillance” and under a quarantine order.

A third New York passenger has chosen to complete the remaining 21 days of their quarantine in Nebraska, McDonald said.

Another Hondius passenger who has chosen to stay at the Nebraska facility is Jake Rosmarin, an Instagram content creator who switched from documenting sightseeing aboard the ship to documenting his time in quarantine.

“This whole experience has totally traumatized me,” Rosmarin said in a video posted Sunday to his Instagram account explaining why he’s choosing to stay at the National Quarantine Unit. “I’m afraid to leave this room until I know that I will not get sick. I do not want to leave here until I know that there is a 0% chance of me getting sick, a 0% chance of me risking my family and friends getting sick, or the general public getting sick.”

He said he also wants to be at a facility that can quickly treat him should he develop any symptoms of Andes virus before the quarantine period ends.

Rosmarin said the process that federal officials have set up to allow some Hondius passengers to leave the facility is complex and involves federal, state, and local authorities.

“The media is making it out to be much simpler than it actually is logistically to get people home to self isolate,” he said. “It is a really complicated process, and there’s a lot of factions that have to agree upon us going home to make that work.”

HHS noted that no cases of Andes virus have been confirmed in the United States. The risk to the public remains low, officials said.

The Andes virus is typically spread by rodents in South America, but has in some cases been able to spread from one infected person to another, according to the CDC. But this person-to-person spread usually requires close contact, such as having direct physical contact with the sick person, spending “prolonged” time in close or enclosed spaces, or being exposed to the infected person’s body fluids.

It can take between four and 42 days from when a person is exposed to the virus to when they start showing symptoms, such as fatigue, fever, achy muscles. People who are infected can become seriously ill with Hantavirus Pulmonary Syndrome. There is no specific treatment or vaccine. For those who are sickened, medical care focuses on managing symptoms.

Last month, the CDC issued federal quarantine orders to two of the 18 people being monitored at the Nebraska facility. Those orders were based on a disease list that does not include hantavirus.

The passengers had initially been “requested” to stay at the facility for testing and monitoring through May 31. When two of them began making arrangements to leave and quarantine at home, the CDC issued two federal quarantine orders against them, requiring that they stay in the facility.

CDC and HHS officials did not answer Healthbeat’s questions about the status of these quarantine orders.

Jennifer Nuzzo, an epidemiology professor and director of the Pandemic Center at Brown University School of Public Health, called the approach to managing the U.S. passengers’ risk unusual and concerning.

“Every American should be concerned about the somewhat quixotic and a bit arbitrary approach that they have taken in dealing with these passengers,” Nuzzo said.

Nuzzo noted that some passengers who disembarked the Hondius cruise ship after the first passengers died but before health officials were aware of an outbreak, have been allowed to quarantine at home since their return to the United States.

“To tell some passengers you can’t leave Nebraska, and to tell other passengers it’s okay to be home, that doesn’t make any sense. There’s no public health rationale for that,” she said.

She also questioned why the federal quarantine orders were issued last month to two of the patients who sought to quarantine at home.

“I have not heard a single assertion that these patients don’t want to quarantine,” Nuzzo said.

“The general public health practice, the ethical practice, the historical practice is we impose measures by the least restrictive means necessary,” Nuzzo said. “Quarantining in facilities is not typical, and only done under extreme cases, usually because someone has refused to comply with other measures.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine orders are based on a disease list that doesn’t include hantavirus

2026-05-22T02:34:45+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The deadly hantavirus that has killed three passengers from a cruise ship does not appear on a key list that gives the Centers for Disease Control and Prevention its expansive detention powers, a public health law expert told Healthbeat. That means the federal quarantine orders the agency is using to detain two exposed passengers could face legal challenges.

At issue: Federal regulations only allow the CDC to quarantine people for specific “quarantinable communicable diseases” that are on a list created through presidential executive orders. The list includes a wide range of dangerous diseases: viral hemorrhagic fevers, infectious tuberculosis, measles, severe acute respiratory syndromes, and flu that can cause a pandemic.

However, no type of hantavirus is on this list.

The list can only be updated by presidential executive order, and President Donald Trump has not issued an order to add the deadly Andes hantavirus that has prompted worldwide concern.

Until this week, federal officials had requested, but not mandated, that 18 U.S. passengers from the M/V Hondius cruise ship undergo medical screening and observation at a Nebraska quarantine facility through May 31, which would be the 21st day of their monitoring period.

On Tuesday the CDC announced that it had issued federal quarantine orders to two of the passengers at the Nebraska facility, requiring that they stay until the monitoring period is over.

One of the passengers being held in Nebraska, Angela Perryman, has spoken publicly about receiving a quarantine order after making plans to leave the facility to continue voluntarily quarantining on her own. Perryman could not be reached.

James Hodge, Jr., director of the Center for Public Health Law & Policy at Arizona State University, told Healthbeat that he’s seen a copy of the CDC’s quarantine order. Federal health officials are using a broader category of disease placed on the list more than a decade ago to justify detaining the two passengers.

“Here’s what they’ve done: They are classifying hantavirus, the Andes strain, as a severe acute respiratory syndrome condition,” Hodge said. “That is a listed condition for which the CDC can actually quarantine.”

The Andes hantavirus, which is usually spread through contact with urine or droppings from rodents, can cause severe pulmonary symptoms. It is the only hantavirus that can also spread from person to person.

Hodge said he’s spoken to some medical experts who think it’s legitimate to classify the Andes hantavirus as a type of severe acute respiratory syndrome, but he noted that’s not typically how the term is applied.

“That’s going to be a real question,” Hodge said, “and it might be one for which we do see that quarantine order being significantly challenged.”

Officials at the CDC and the U.S. Department of Health and Human Services did not respond to questions from Healthbeat on Thursday.

Hodge said the CDC’s quarantine orders are relying on a July 2014 executive order issued by President Barack Obama that updated the list of quarantinable diseases to include a broadly defined category of “severe acute respiratory syndromes.”

The executive order defines these syndromes as “diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.”

The order specifies that this definition does not apply to influenza.

It’s unclear whether the executive order was intended to apply to diseases such as those caused by the Andes strain of hantavirus, which has shown the ability to spread from person to person for many years.

The Obama executive order was issued amid heightened concerns about outbreaks of MERS – Middle East respiratory syndrome – coronavirus.

Obama’s order amended an April 2003 executive order issued by President George W. Bush that added “Severe Acute Respiratory Syndrome (SARS)” to the quarantinable list. The SARS coronavirus emerged in China in 2002 and spread to 28 countries before the outbreak ended in 2003.

Given the broadly written definition of severe acute respiratory syndromes in the Obama order, Hodge said the CDC is seeking to make the case that the Andes hantavirus qualifies as a quarantinable disease.

But he said the passengers subject to this week’s quarantine orders also have the potential to make several arguments if they choose to challenge the orders in court, including that the virus wasn’t specified as a quarantinable disease. “I would be saying, you’ve never previously called hantavirus Andes strain a severe acute respiratory condition,” he said.

Hodge added that any uncertainty could be ended with an executive order adding the Andes virus to the quarantinable list. “President Trump could issue that order in the next five minutes and we’d be done here,” he said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Inside the largest U.S. measles outbreak in decades: Records reveal spread in vaccine-hesitant community

2026-05-19T09:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Case #1 in what would become the largest U.S. measles outbreak in decades was a parent in South Carolina’s Upstate Region near Spartanburg.

The next seven people to fall ill were all children. Three of them were being cared for at home – limiting their ability to spread the highly contagious measles virus to others.

But the children who became Cases 5, 6, 7, and 8 were infectious while they mingled with other children at school and in daycare, according to internal records obtained by Healthbeat from the South Carolina Department of Public Health.

By the second week of the outbreak, the number of known infections had grown to 12. The internal records, obtained under the state’s public records law, reveal all of them lived in just four households.

At the center of the nearly seven-month South Carolina measles outbreak – from beginning to end – was a close-knit, vaccine-hesitant Ukrainian- and Russian-speaking community in and around Spartanburg County, according to South Carolina state health officials.

By the time the outbreak was declared over on April 27, the handful of cases that were first identified among a couple of families in October 2025 had resulted in 997 documented measles infections.

How the South Carolina measles outbreak began

A breakdown of the first eight cases:

South Carolina DPH estimates about 90% of these outbreak cases were among members of the area’s Ukrainian- and Russian-speaking community, which has around 15,000 people in Spartanburg County, the department said in emailed responses to Healthbeat’s questions.

“This community was at the center of the outbreak for its whole course,” said the department, which did not grant an interview.

The South Carolina outbreak is the latest example of a trend the Centers for Disease Control and Prevention has documented for decades: Nearly all large U.S. measles outbreaks since 2000 – when the country attained measles-free status – have involved various types of close-knit groups with low vaccination rates.

As measles makes a major comeback across the country, a Healthbeat examination of the challenges encountered controlling the South Carolina outbreak highlights the need for public health officials to understand the specific and sometimes differing reasons for vaccine hesitancy within individual groups.

It also illustrates the importance of identifying at-risk pockets of unvaccinated people and building trusted relationships before outbreaks happen. All are complex tasks made more difficult amid heightened public distrust in the wake of the Covid-19 pandemic and during a time of cuts to public health staffing and funding.

“Waiting for infectious disease to start spreading is too late. It is significantly more effective to prevent an outbreak than to contain it,” said Dr. Eliza Varadi, a Russian-speaking pediatrician in Charleston, S.C.

“Even in a state where most people are vaccinated, those small pockets, that’s where diseases will spread,” said Varadi, the immunization representative for the South Carolina chapter of the American Academy of Pediatrics, who worked with DPH officials during the outbreak and provided advice on culturally sensitive outreach and education.

Close-knit groups have fueled U.S. measles outbreaks since 2000

South Carolina’s outbreak is a case study in how years of declining immunization rates – especially among children obtaining religious and non-medical exemptions from school vaccination requirements – is making localized communities of various types across the country vulnerable to the spread of infectious diseases, according to Varadi and other health experts.

Dr. Satish Pillai, the CDC’s incident manager for the 2025-26 national measles response, noted the role of close-knit groups in “nearly all” measles outbreaks with more than 50 cases since 2000 during a presentation to local public health officials earlier this month.

Outbreak was concentrated in a close-knit community

From October 2025 through March 2026, the outbreak caused 997 known measles infections in and near Spartanburg County. State health officials estimate about 90% were members of the area’s Ukrainian- and Russian-speaking community.

These outbreaks include those that have occurred in New York during 2018-19 largely in an Orthodox Jewish community; in Washington state in 2019 among a Ukrainian- and Russian-speaking community; in central Ohio in 2022 primarily among children of Somali descent; in Chicago during 2024 within a shelter for migrants who were mostly from Venezuela; in Minnesota in 2024 where a Somali community was disproportionately impacted; and in West Texas in 2025 among a rural Mennonite community.

In recent months, Pillai noted, the types of close-knit groups driving measles outbreaks has been evolving. Large outbreaks this year have occurred on the campus of Ave Maria University in Florida and at a federal detention facility in Texas.

“Having large college outbreaks and large detention facility outbreaks at these levels are unprecedented since 2000,” Pillai said.

Meanwhile, lower vaccination rates throughout communities have begun allowing outbreaks that begin in close-knit communities to start spreading widely across populations, as has happened in the ongoing outbreak in Utah, he said.

Schools, families, churches contributed to virus spread in S.C.

South Carolina DPH officials told Healthbeat they do not know the infection source that led to the initial cases in the state’s measles outbreak. They said this indicates unrecognized spread of the virus was already occurring by the time cases started being reported to public health.

Measles poses a significant outbreak threat for unvaccinated, socially, and geographically connected people because it is so contagious and spreads through the air, where it can linger for up to two hours in enclosed spaces.

Families drive early infections

By Oct. 15, state investigators had identified 12 outbreak cases. All were members of just four households.

To prevent ongoing transmission of measles within communities, 95% of people need to be fully vaccinated against the disease, according to the CDC.

Some of the earliest cases in the South Carolina outbreak last October involved Global Academy of South Carolina. The Spartanburg County public charter school was founded by educators from Ukraine whose “passion to help families of immigrants” have prompted them to open tuition-free schools in California, Florida, and most recently South Carolina, according to the schools’ websites.

When the outbreak started, Global Academy’s student body had one of South Carolina’s lowest levels of vaccination coverage: Only 21% of its students were up-to-date on their school vaccinations during the 2025-26 school year, state data show. Even fewer of the school’s students – just 17% – were fully vaccinated during the previous school year.

Only 21% of the students at Global Academy in Spartanburg County were up-to-date on their school vaccinations during the 2025-26 school year, state data show.

Officials with Global Academy of South Carolina, its board of directors, and founders have either declined to be interviewed, did not respond to interview requests, or could not be reached during and after the outbreak.

As the measles cases continued to spread within households, some of those infected were unvaccinated children and teens who unknowingly brought measles into other schools – exposing scores more students who also weren’t vaccinated.

“We know that some schools with a high percentage of children from Ukrainian- or Russian-speaking families have been impacted and a number of public exposures have been reported in churches attended by these community members,” DPH said in response to Healthbeat’s questions.

In low-vaccination communities, one person can expose dozens

Because the initial symptoms of measles – such as a cough, runny nose, red eyes, and fever – can appear like those of a common cold or the flu, people can spread the disease before they know they have it. They are contagious beginning four days before the tell-tale measles rash appears on their face and body.

Further complicating public health efforts to control the virus’ spread is that there can be a significant lag time from when someone is exposed to the virus and when they start feeling ill. Symptoms often develop seven to 14 days after exposure, but it can sometimes take up to 21 days.

Internal South Carolina state health department records obtained by Healthbeat provide a window into how a single contagious person can expose dozens.

How measles can spread

How Case #44 in South Carolina’s outbreak exposed 66* close contacts to the virus who were unvaccinated or lacked immunity through previous infection.

*One individual was both a household member and Lyman Elementary School student.

Outbreak Case #44, identified by state health officials in mid November, exposed 66 close contacts to measles who were unvaccinated or lacked immunity to the virus through previous infection. They included three household members, four patients at a doctor’s office, 58 individuals at Lyman Elementary School (including one of the household members), and two school bus riders from D.R. Hill Middle School, according to an email update from DPH to the South Carolina governor’s office on Nov. 17.

As state public health officials investigated outbreak Case #45, they identified an initial 61 close contacts who had been exposed and weren’t protected against measles. They included four household members and 57 individuals from Boiling Springs Middle School. The person, while infectious, also attended a church with about 250 people in its congregation, according to DPH emails to the governor’s office on Nov. 19 and 20 that do not name the church, but say notification letters in multiple languages were provided for distribution.

As the outbreak continued, infected people participated in services and other activities at several Slavic churches, where services are held in the Russian or Ukrainian languages, including Slavic evangelical and Pentecostal churches.

At one of these churches, the Way of Truth Church in Inman, S.C., a person who was infectious attended on the evening of Nov. 7 and morning of Nov. 9, exposing others who weren’t vaccinated. Over the weeks that followed, at least 30 infections were linked to the church.

Of the 14 newly identified measles cases announced on Dec. 2 by state health officials, eight were people exposed at Way of Truth Church. Over the next week, 16 more people fell ill with measles from exposures at the church. Five more cases linked to the church were announced on Dec. 16, plus one more on Dec. 19.

During late December and into January, state health investigators tracing the movements of people recently diagnosed with measles identified additional exposures that had occurred at several other Slavic churches, including Tabernacle of Salvation Church, Ark of Salvation Church, and Slavic Pentecostal Church of Spartanburg. Church leaders could not be reached or did not respond to Healthbeat’s interview requests during and after the outbreak.

Slavic churches unwilling to host vaccination events during outbreak

Varadi, the state American Academy of Pediatrics representative who worked with South Carolina DPH during the outbreak, told Healthbeat that vaccine hesitancy within the membership of some Spartanburg-area churches was a key challenge in stopping the outbreak.

“The center of the outbreak was not the entire Russian-speaking or Ukrainian-speaking community. It was a small subset that may have been related to specific churches,” Varadi told Healthbeat.

“It’s not that the church leadership was discouraging vaccinations, they just were not encouraging,” Varadi said. “We wish that there would have been a better partnership to work together to encourage vaccination.”

DPH officials, who told Healthbeat that Varadi provided them with “valuable insights and assistance,” acknowledged that no church from within the area’s Ukrainian- or Russian-speaking community agreed to host a vaccination event during the outbreak.

“As is often the case, church leaders made decisions about whether to interact with DPH based largely on the wishes and feelings of their congregations,” the department said in its written responses to Healthbeat’s questions. “While some were willing to discuss outreach and education opportunities, others were not. Importantly, none were forced to meet with DPH to discuss any of these topics.”

Tabernacle of Salvation Church in Spartanburg, South Carolina, was among several Slavic churches that had measles exposure incidents during the outbreak.

One of the close-knit community’s “prominent churches” did voluntarily agree to meet with DPH leadership during the outbreak, the department said, “and that conversation was informative.” DPH declined to name the church.

From the beginning of the outbreak, DPH officials in press briefings emphasized the importance of vaccination in stopping the outbreak. They separately made information about measles available in the Ukrainian and Russian languages on the DPH website and to churches and other groups.

Two doses of the measles-mumps-rubella (MMR) vaccine are 97% effective in protecting against measles, and even one dose is 93% effective, according to the CDC.

While the Ukrainian- and Russian-speaking community remained a vaccination challenge, by January – as the outbreak spiked – the department started seeing wider increases in measles vaccination across Spartanburg County and the state. This increase, combined with the large number of people who became immune to measles through illness, helped end the outbreak, they said.

Dr. Brannon Traxler, the South Carolina DPH’s deputy director and chief medical officer, in response to Healthbeat’s questions during the department’s last media briefing on the outbreak on April 27, said it is important to understand the community’s history and reasons for being hesitant about vaccines.

“We recognize and appreciate there is history there that didn’t occur in South Carolina, often even before they came to the United States, that has led to very legitimate fears of government and of government health,” said Traxler, who last week was named the department’s acting director. “They have a reason to have the doubts that they do.”

How the South Carolina measles outbreak grew from 5 to 997 cases

Traxler did not elaborate. DPH, in response to Healthbeat’s questions, declined to discuss the reasons public health workers have been given by community members for not vaccinating their families against measles.

“Those reasons are theirs to communicate, not ours,” DPH said by email. “Our role in every communication was to provide the best factual information possible with which families could make informed decisions.”

Vaccination programs and government trust have a complicated history in Ukraine and Russia.

The more distant history includes the former Soviet Union’s mandatory and coercive national immunization programs and ongoing vaccine hesitancy and concerns about vaccine safety.

There also was a history in former Soviet republics of some measles vaccines having lower levels of effectiveness in preventing outbreaks that has been attributed to poor manufacturing quality control and improper vaccine storage and handling practices.

While the Russian Federation is estimated by the World Health Organization and UNICEF to have had high levels of measles vaccination coverage for many years, that has not been the case in Ukraine.

In Ukraine, the country’s vaccination coverage dropped dramatically after the high-profile death in 2008 of a Ukrainian teenager, an event later determined to be unrelated to being vaccinated against measles as part of a large immunization campaign.

According to the WHO, 95% of children in Ukraine in 2008 were fully vaccinated against measles. But by 2016, just 42% were protected with one dose of measles vaccine and 31% with two doses. And during 2017-19, the country experienced a measles epidemic that resulted in more than 115,000 reported cases.

Since then vaccination coverage has increased. As of 2024, about 91% of 1-year-old Ukrainian children and about 83% of 6-year-olds were vaccinated against measles, according to information released by UNICEF Ukraine last year.

In South Carolina, DPH officials said members of the Ukrainian- and Russian-speaking community cooperated with the department’s recommendations for isolating and quarantining at home to prevent spreading measles to others.

Quarantines, which could last up to 21 days, had a significant impact on these families’ daily lives, education, and finances, with children having to stay out of school and adults missing work.

DPH said its community health workers, when asked, helped these families identify social service resources, including for food and utility support

Community members are key to building trust in public health

Public health officials at the Washington State Department of Health found themselves facing similar challenges in 2019, following a measles outbreak among a Ukrainian- and Russian-speaking community.

“We didn’t have a lot of connection with that community or a lot of resources for them in their language,” said Danielle Koenig, the department’s health promotion supervisor.

In the wake of the outbreak, Koenig helped secure a CDC grant that for six years funded a project to better understand the needs of the community, build trust, and provide health resources. The grant ended last summer.

The South Carolina Department of Public Health had disappointing turnouts for its mobile vaccination clinics during the outbreak. Churches serving the Ukrainian- and Russian-speaking community at the center of the outbreak declined to host vaccination events, the department said.

The department found that a cornerstone of building trust is partnering with leaders and organizations from the impacted community, listening and responding to their needs – and also hiring members of the community – like Vadim Gaynaliy – to help lead the outreach.

Gaynaliy, a health educator at the department who speaks Ukrainian and Russian and is from a large Ukrainian community in northeast Portland, said his background and those of others involved in the project provided insights into the community’s values and how it functions.

“We’re not even talking about a single community here. There’s obvious political tensions between Russian and Ukrainian communities, there’s different religions and denominations. So we try to address them as different communities who will have different needs,” Gaynaliy told Healthbeat.

The project resulted in the creation of the Nashi Immigrants Health Board – now an independent nonprofit organization run by and for the Ukrainian- and Russian-speaking community that provides a range of resources and support programs beyond just information about vaccination.

“Trust is the biggest ingredient,” said Tamara Cyhan Cunitz, the board’s co-founder, executive director, and a registered nurse and educator whose relatives came to the United States after escaping the Soviet Union during World War II. “People who are from a cultural community will pay attention and connect better with someone who knows their culture and language.”

S.C. gets 5 months of funding to launch outreach project

The huge measles outbreak in the Spartanburg area is finally over, but the area remains at risk of future outbreaks because it continues to have large pockets of people who are not vaccinated against the disease – including in the Ukrainian- and Russian-speaking community.

To help address this, DPH told Healthbeat it is beginning a new partnership with two nonprofit public health organizations to hire community health workers to do education and outreach in two or three areas within Spartanburg County that face higher risks from measles and other vaccine-preventable diseases.

The CDC Foundation, a nonprofit organization that supports the CDC and public health, has agreed to provide five months of funding for the project, the groups said.

“The idea is to reach the specific Slavic community, that from a health department perspective, they have had struggles with reaching over the years and to really make inroads around vaccines and vaccine education,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, which is one of the project’s partners. “Doing this work outside of a crisis is really, really important.”

Terri Jowers, executive director of the South Carolina Community Health Workers Association, the project’s other nonprofit partner, said the project plans to hire three community health workers, with two of them coming from within the Russian- and Ukrainian-speaking community.

Jowers said the project will develop training for this soon-to-be hired team on how to better engage with communities through conversations about why they are hesitant or concerned about vaccines, what they have heard, and ways to work together to find sources they trust to figure out the facts. The training will also be made available to other community health workers in Spartanburg County and across the state, she said.

“The goal is to really start training people by the end of June so that community health workers feel more comfortable having these conversations,” she said.

Five months is not a lot of time to build trust and Jowers said she is hoping that the project will be able to identify additional funding for a year beyond the initial grant. “You have to build those trusted relationships,” she said.

The CDC Foundation, which told Healthbeat it is providing more than $100,000 for the project, said that trusted messengers are critical. The foundation said the project’s limited timeframe is based on funding availability. “If additional funding becomes available, we would consider extending the timing,” it said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Why the hantavirus cruise is getting so much attention – and how much to worry

2026-05-14T11:00:00+00:00

Hello from Nairobi.

This week’s report is heavy on the ongoing hantavirus outbreak. I’m fascinated by this story. Not because the virus itself looks like it will become a global emergency (I strongly believe it won’t), but because the story around it has taken on a force of its own. We’ll also cover Indonesia’s push to eliminate a type of cancer, fake rumors of shrinking genitals in central Africa, and the spiraling health crisis in Cuba.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The hantavirus outbreak … breaks out of health news

Last week, I wrote about the hantavirus outbreak as a marginal item. An interesting story, but not quite a major event.

Since then, I’ve been gobsmacked by how far this story has traveled. Not only are most major media outlets covering the outbreak from dozens of angles and follow-ups, but it’s moved well beyond the usual lane of global health stories into full zeitgeist-meme territory.

The outbreak is clearly catching the broader public’s attention, eliciting no small amount of fear and anxiety… so what gives? Was I wrong to dismiss it?

Disease breakdown: Hantavirus is a family of rare viruses usually carried by rodents. People typically get infected by breathing in particles from infected rodent urine, droppings, or saliva. The strain at play here is Andes virus, one of the few hantaviruses known to spread from person to person, as seen in South American outbreaks going back decades. It can cause severe respiratory illness, with symptoms appearing up to 42 days after exposure. There is no specific treatment or vaccine, so care is mostly supportive.

First off, I won’t argue that the story isn’t captivating. It has all the ingredients of a thriller movie: a rare and deadly disease. A cruise ship unable to reach port. Wealthy, international passengers who had already disembarked and scattered across the globe. The ongoing scramble to contain and quarantine.

And yet, even with all of this, the World Health Organization and national public health agencies globally have been in full-on reassurance mode.

Despite the attention, you can’t find serious global health professionals in panic over this outbreak. Not only has the WHO said that it “assesses the risk to the global population posed by this event as low,” but even for the people stuck on the actual cruise(!), “the risk for passengers and crew on the ship is considered moderate.”

It’s worth taking a big step back here, to break down what actually makes an infectious disease objectively frightening in an outbreak. And why this ain’t it.

(Fair warning: What follows is my own aggressive oversimplification, but a sound and useful one.)

Let’s imagine a mad scientist had created a disease-making box with four dials that control how “scary” an outbreak gets. And the way you tweak those settings will determine whether your virus, bacteria, or parasite is a local headache or a global nightmare. Those dials are:

Deadliness: What are the straight odds this disease kills you?
Existing medical defenses: Do we already have vaccines, treatments, or diagnostics that can fight the illness, or blunt the damage?
Infection window: When and how long will someone spread this disease? Are apparently healthy people passing it around for days, is it just a brief affair that requires someone to be visibly ill?
Finally, contagiousness: How easily does the infection spread? Are we looking at something that hangs in the air for hours like measles, or does it require close contact with infected fluids or tissues, like Ebola?

Now, if the Andes virus came out of our imaginary disease-making box, here’s where our objective fear dials would be set.

On deadliness, the dial is set to… “nightmare”! We’re looking at a fatality rate around 40%. No, not the deadliest disease we know of, but let’s not split hairs. Nobody sane would ever willingly risk those odds.

On medical defenses, the dial is also set to “maximum fear.” There is no specific treatment and no vaccine currently available for this virus, so care is mainly supportive.

Ok, so we’re off to a terrible start.

But the infection window setting is mixed. The bad news is that symptoms can appear as late as 42 days after exposure. That long incubation period means infected people can travel far before anyone knows they are infected, potentially seeding new clusters. But (!) there’s a crucial caveat: People are not contagious that whole time. In fact, the evidence we have suggests that people with the Andes virus are infectious only once they are visibly sick. So we’re setting this dial down to “mild alarm.”

This all brings us to the most important dial: contagiousness. And this one is set way down to “low-grade unease.” Ultimately, this is the big reason health officials are cautious, but not sounding alarms. Yes, the Andes virus is unusual among hantaviruses because it can spread from person-to-person. But the word “can” is doing a lot of work.

As Ion Genomics has reported, the virus does not appear to be some strange new mutant. So, as in older outbreaks, person-to-person spread is largely limited to close contact with a sick person, including direct physical contact, for prolonged periods of time in an enclosed space, or exposure to body fluids. (You can see why a cruise ship is the perfect incubator.) Simply put, it just does not appear to move easily through casual contact.

That’s reassuring, because this type of spread is laggardly enough that competent public health responses can typically move faster than the virus. If officials can identify contacts, monitor them, isolate anyone who gets sick and quarantine people at highest risk, there is a very high likelihood of containing this outbreak. Yes, that containment still requires vigilance, real work, and potentially more deaths. After all, this virus spreads and creeps in ways that do not quash instantly. But “quashing” is nevertheless where we’re headed.

Admittedly, Andes virus sounds terrifying. And for the unlucky people who get sick, it absolutely is. But scary as a disease is not the same thing as scary as an outbreak.

And so, my big takeaway here: The objective risk and threat of this outbreak is incommensurate with the news coverage it has received.

Now, I’m not wagging my finger at the coverage. People are interested, and I get why. But don’t mistake the amount of coverage, or the, uh, “cinematic focus” of it, for a measure of how concerned you should be.

As a threat, this hantavirus is not obviously more alarming than, say, Nipah virus: a comparably deadly infection with similar dynamics, which causes recurring outbreaks every few years in South Asia… all without a fraction of the spotlight.

What the hantavirus panic gets right

To gut-check that read, I reached out to Dr. Ronald Nahass, a clinical professor of medicine and president of the Infectious Diseases Society of America.

He agreed with the assessment that the epidemiology here does not justify outsized worry, but argued the outbreak still revealed something real. “A public health fire drill,” as he put it, and one that showed how important clear communication still is.

First off, we spoke about why this, of all outbreaks, has captured so much attention given the reality of the disease dynamics. My imperfect theory has been that the outbreak mirrors a lot of the media dynamics of a celebrity death. Deaths of course happen every day, but certain deaths break through because the person or circumstances make them feel unusually vivid and close. And this story has vividness in spades. After all, “cruise from hell” is narratively almost too good.

Also, at a certain point, public interest starts feeding on itself. The more coverage a story gets, the more it signals that this is something worth paying attention to, and so the more people want to hear about it.

Nahass broadly agreed that the narrative setting was doing a lot of work (granted, neither of us are media theorists) but he added another factor I had underweighted: the memory of Covid.

Nahass likened the event to a kind of public “PTSD” from the early days of the last pandemic. With a ship at sea, passengers trapped in uncertainty, people dying from a transmissible disease, “that is extraordinarily similar to some of the stories we heard during the Covid outbreak, and so obviously that brings back those images,” he said. “And so we all feel that.”

Still, his greater point was this: Put aside the science for a moment, public health is about people, and the public’s reaction and interest should matter as much as the underlying epidemiology. If people are worried this could be Covid 2.0, meet them where they are.

Sure, he said, “the biology doesn’t necessarily rise to the level of a SARS virus or a novel influenza virus.” But the anxiety is real, and that “emotional toll, or anxiety toll,” he said, and the practical questions people have about what this means for them, well, that’s more than enough to make the focus worthwhile.

And there’s a clear upside. This response is an opportunity for public health organizations to build trust, he said, and to show what a competent outbreak response actually looks like before the next real crisis arrives.

Now … as for how this moment has initially been met, Nahass was blunt enough to assign grades. He gave the WHO decent marks, especially given that no single country, and not even the WHO, had clear authority over a ship at sea. “I’d give them a B, or maybe a B-minus,” he said.

His assessment of the U.S. Centers for Disease Control and Prevention was harsher: “The CDC certainly gets a failing grade. They were absent,” he said, noting that it took the organization almost a week to put out a public response, and to Nahass, that silence fit a larger problem. Behind the scenes, the United States was missing from the kind of global outbreak response it once helped lead.

In the end, Nahass framed the ongoing hantavirus outbreak as “a public health fire drill,” one that showed how much that we still have not learned from the last pandemic. “God forbid this had been something more transmissible,” he said, noting that “we had potential vectors across the United States before we knew what it was.”

Nahass thinks the United States’ takeaway should be a wake-up call about the cost of pulling back from global health, such as departing the WHO. “We’re all interconnected,” he said, “we have to be able to respond to these kinds of events globally.”

As for the rest of the world, I think this “fire drill” is also a useful warning at a moment when the WHO’s global pandemic treaty is still sitting unfinished, as we’ve covered extensively.

Because next time might not be another drill.

Fake rumors of shrinking genitals… no laughing matter!

We’ve gone long on hantavirus coverage, so I’ll be brief with the other stories of the week.

Reuters covered a story about a fake disease conspiracy theory in the Democratic Republic of Congo that has become a real public health crisis.

Last year, rumors of a mysterious illness causing men’s genitals to shrink spread through social media, local outlets, and churches in a province in the center of the country. The rumors elicited “angry mobs [which] attacked and killed four health workers conducting vaccination research,” among other damage and deaths. “In all, at least 17 killings related to the atrophy rumor have been reported,” although Reuters could not independently verify all of them.

The story is grotesque (enough so that I’m not even attempting the obvious jokes), with a broader, painfully familiar warning. Misinformation is not background noise in public health. And it can create new dangers of its own, turning ignorance or confusion into fear and violence, directed at the very people trying to deliver much needed health care.

Cuba: an ‘epidemic of flies, rats, [and] waste’

The Guardian has a depressing follow-up on Cuba’s deepening health crisis, which we’ve reported on before.

As a U.S. oil blockade chokes off fuel supplies, the capital city of Havana has been forced to cut back on trash collection, leaving waste piling up across the city and residents burning trash in the streets. One resident described it as “an epidemic of flies, rats, waste, and foul odors.”

The piece tracks the obvious health risks of all that uncollected and burning waste: toxic smoke, vermin, flies, and gastrointestinal diseases. One Havana doctor told The Guardian, “at the hospital, we’ve seen an increase in hygiene-related illnesses and gastrointestinal issues.”

Less obvious, but just as worrying, trash heaps can collect rainwater in discarded plastic and other debris, causing fears of rising “mosquito-borne illnesses, with the Aedes aegypti [mosquito] species proliferating." That mosquito is one of the primary vectors for many infectious diseases, like dengue, Zika, chikungunya, and yellow fever.

It’s a rough story, and Cuba’s crisis has many causes. But right now, the U.S. fuel blockade is plainly a driving force, enough so that two members of Congress wrote in The New York Times this week after visiting the island, calling for the blockade to end for medical and humanitarian reasons, even while acknowledging the failures of the Cuban government.

Indonesia’s shot at curing [a type of] cancer

We’ll finish today with an inspiring piece in Think Global Health on Indonesia’s push to eliminate cervical cancer, a disease that still kills more than 20,000 women there each year.

This cancer is unique because it’s a form of the disease where most cases are caused directly by a virus. In this case, the human papillomavirus, or HPV.

In countries like Indonesia, HPV is responsible for an estimated “94% of cervical cancer deaths.” So screening and vaccination efforts against this virus are dramatically effective at cutting cancer deaths.

The hard part, as always, is reaching the people you most need. Indonesia’s “285 million people are spread across 17,500 islands,” with a third of the government’s districts classified as remote. So the story here is ultimately about whether an ambitious national health program can reach people on the outskirts of the country.

– William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

It’s a dangerous time for mothers and babies in the U.S.

2026-05-13T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

It was Mother’s Day in the United States on Sunday. In addition to being an important day of celebration, it can also be a solemn occasion, because of the fatal health risks associated with pregnancy and the newborn period. This week I’m highlighting recent stories about emerging risks to mothers and babies in the United States, including restricted access to essential medications, misinformation, and violence.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a global nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

Supreme Court will consider restricting access to medication-assisted abortion

Abortion is an essential medical procedure. Roughly 1 in 4 American women will have one in their lifetime, and, over the past two decades, it has become safer, more effective, and more accessible, largely because of the two-drug regimen of mifepristone and misoprostol.

Today, medication abortion accounts for nearly two-thirds of all abortions in the United States, and about a quarter are provided through telemedicine. A systematic review of 99 studies concluded that the two-drug regimen is safe and effective. At least three studies in the United States have additionally demonstrated it is safe and effective to screen patients by telehealth and provide medications by mail, supporting the findings of a systematic review that included studies from around the world.

Access to abortion medications is now at risk in a case before the Supreme Court. On May 1, the Fifth Circuit Court of Appeals sided with Louisiana in Louisiana vs. FDA, temporarily reinstating a Food and Drug Administration requirement that mifepristone be dispensed in person, a rule the FDA lifted in 2023 after reviewing more than two decades of safety data. Justice Samuel Alito issued a one-week administrative stay on May 4, and the full court will decide soon whether to keep mailed mifepristone available while the case proceeds.

NYC looks to bolster home nursing service to fight health disparities in pregnancy

Louisiana’s argument is, frankly, absurd. Louisiana claims standing because it spent $92,000 in Medicaid funds treating two patients who experienced complications from mifepristone obtained out of state. As the drug manufacturers Danco and GenBioPro argued in their emergency appeal, this theory of injury, if accepted, would let any state challenge any federal policy that ends in a doctor visit the state pays for.

Two years ago, the Supreme Court unanimously rejected a similar challenge from anti-abortion physicians on standing grounds. But I and many others are worried that the conservative super-majority will use this case to further restrict abortion access.

If the court rolls back the 2023 rule, telehealth providers could shift to providing a one-drug regimen with misoprostol, which is less likely to be restricted because it has medical indications beyond abortion. While a single-drug protocol works, it is less effective and causes more pain, bleeding, and gastrointestinal side effects. Quite simply, overturning the FDA’s rule would harm women.

Homicide and suicide are now leading causes of death for pregnant women

One of the most harmful fallacies in the push to restrict abortion access is that abortion is dangerous and that pregnancy is safe. In fact, pregnancy places a woman at high risk of serious illness and death. A new study in the New England Journal of Medicine reveals that there are two less well-recognized reasons why American mothers are dying during pregnancy: overdoses and violence.

Columbia University researchers analyzed every death among pregnant and postpartum women in the United States between 2018 and 2023. Of 7,901 deaths, the single leading cause was unintentional drug overdose (1,152 deaths). Violence, including homicide and suicide combined, was second, at 866 deaths.

Homicide rates were highest among non-Hispanic Black women aged 15 to 24, at 14.3 deaths per 100,000 live births, which was more than four times the rate for white and Hispanic women in the same age group. Firearms were used in 77% of homicides and 39% of suicides.

Taken together, overdose and violence accounted for more than a quarter of all maternal deaths and nearly equaled the combined toll for the four causes of death that we generally believe to be the most important in pregnant and post-partum women: cardiovascular disease, infection, hypertension, and hemorrhage.

Babies are dying because parents are refusing vitamin K

We are now seeing that American babies are also at risk of dying soon after birth, and the primary reason is misinformation.

Newborns are born with very low levels of vitamin K, which the body needs to produce clotting factors. Without enough vitamin K, infants can bleed into their gut, lungs, or, most catastrophically, their brain. Before universal newborn vitamin K injections began in 1961, up to 1 in 60 babies developed bleeding from vitamin K deficiency in the first week of life. A single intramuscular injection at birth, given within hours of delivery, has nearly eliminated the condition.

‘We Can Do Better’: Q&A with childbirth safety expert on ways to stop preventable maternal deaths

Increasingly, parents are rejecting this life-saving injection. The proportion of U.S. newborns not receiving vitamin K rose from 2.92% in 2017 to 5.18% in 2024 — a 77% increase. Babies who do not receive the shot are 81 times more likely to develop late vitamin K deficiency bleeding, and the Centers for Disease Control and Prevention estimates that 1 in every 5 babies who develop the condition will die.

I encourage you to read a detailed article that tells the stories behind these deaths. Reporters reviewed autopsies from babies across the country whose deaths were attributed, in whole or in part, to vitamin K deficiency bleeding. Hospitals are reporting refusal rates that have doubled or tripled since the pandemic. At Idaho’s St. Luke’s system, the refusal rate climbed from 3.8% in 2020 to 9.8% in 2025; one hospital reached 20%.

What is driving parents to refuse vitamin K? Quite simply, it’s misinformation. Parents are telling pediatricians they fear toxins, distrust pharmaceuticals, think the injection will lead to leukemia (it does not), and prefer “natural” approaches. While these same parents refuse vaccinations for children and themselves, I have not been able to understand why they refuse a vitamin.

Many adults who oppose vaccinations consume vitamins and supplements regularly themselves, believing it will enhance their health, but, oddly, they are the same people denying a life-saving vitamin for their newborns.

Celebrating Mother’s Day

Mother’s Day should be a celebration. For me, the best way to celebrate mothers in America is to ensure they and their future babies have access to the medications, care, and accurate information they need to live healthy lives.

- Jay

Dr. Jay K. Varma, who is recognized globally for his leadership in the prevention and control of infectious disease, writes about public health for Healthbeat. He has guided epidemic responses, developed policies, and implemented programs that have saved lives across Asia, Africa, and the United States. He is based in New York. Contact Jay at jvarma@healthbeat.org.

Why it’s so hard to get better drugs for neglected diseases

2026-05-07T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The weekend brought in a bit of natural chaos: rains torrential enough to bring down trees near my home, and marauding Sykes’ monkeys in numbers sufficient to convince me I may never eat the soursops growing in my back yard. (I have long since given up on the mangoes.)

This week we’ve got a proper hodgepodge. A story on why it’s still so hard to get better drugs to people with neglected diseases, even after real medical advances. A damning investigation into an AI-driven health insurance system. Updates on both the widening health toll of conflicts in the Middle East, and the stall in a global pandemic treaty, and, finally, a rare virus trapped on a quarantined cruise ship.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The neglected disease trap for better drugs

We’ll start with a story out in Nature that cleanly captures the maddening challenge to treat and cure some of the world’s most neglected diseases.

Enter our hero: moxidectin.

It’s a drug that’s both safe and proven since 2018 as a dramatic improvement for preventing and treating two widespread parasitic diseases (river blindness and elephantiasis).

The problem for moxidectin? The uptake has been an uphill battle.

Disease breakdown: River blindness, also known as onchocerciasis, is a parasitic disease that’s spread by biting blackflies, which breed in rapidly flowing rivers. The nightmarish parasites grow in the skin and eyes, which cause intense itching, scarring, and lesions that can lead to permanent blindness. There are an estimated 20 million cases of this disease, almost entirely on the African continent, and 250 million people require preventive treatment.
Disease breakdown: Elephantiasis is another terrifying parasitic disease, this one spread by mosquitoes. It can cause extreme swelling in limbs or other tissues (commonly in the breasts and genitals) and skin thickening. Hence the name, which is Greek-derived for “elephant-like disease.” There are an estimated 51 million cases of this disease across the equatorial world, and over 650 million people require preventive treatment.

To be clear, moxidectin’s efficacy is not in question.

For river blindness, clinical trials have shown that it lasts longer in the body and appears to clear parasites “86%” more effectively than the current treatment, an anti-parasite drug called ivermectin. The same is true for elephantiasis. In one small trial referenced in the article, the drug cleared parasites in about 95% of patients, compared with 32% for existing treatments.

The drug itself also has a unique backstory. It was invented in the ‘80s for livestock use, but it wasn’t until last decade that it jumped the expensive hoops for human clinical trials.

Those decades of lag is largely because there’s not a lot of commercial incentive for pharmaceutical companies to invest in something like moxidectin. (Even if the World Health Organization says nearly 900 million total people can use it!) After all, its target market is mostly the very poorest people in the world. And for both diseases, other treatments already exist, even if moxidectin appears to work better.

Instead, it took the altruistic efforts of an organization called Medicines Development for Global Health, a non-profit pharmaceutical company that focuses on neglected diseases, to run the trial gauntlet. And they made history doing so.

As the article outlines, this “development, regulatory approval, and [rollout] without involvement of a commercial pharmaceutical partner…” was “a first-of-its-kind achievement for a non-profit company.”

Where are we now?

While moxidectin was finally approved for river blindness in 2018, its first real-world rollout is only now underway in Ghana, “where around 120,000 people received the new treatment last year.”

Part of the delay is pure regulatory bureaucracy. Countries and the WHO still have to review the data and issue guidance. Part of it is also logistical. After all, someone has to manufacture, buy, and distribute the stuff.

But the cruelest delay is, again, financial: Ivermectin, the older and weaker drug, is donated for free by the pharma company Merck. Moxidectin’s nonprofit maker can offer it at a reduced cost, but not for free. So, as you might imagine, competing with a free pill… makes for a hard sell, especially in an era of tightening budgets.

What’s my takeaway? I said this at the top, but this is a maddening story. The layers of systems built around neglected diseases, even in the face of medical advancements, still seem almost designed to make success as hard as possible.

Still, if there is a silver lining, it’s that there are organizations like Medicines Development for Global Health nevertheless trying to exploit the various cracks in that broken system to get better drugs, slowly, into people’s hands.

Stalled pandemic negotiations, part 2

A month ago, we covered the stalled global pandemic treaty, and noted the sticking point to progress: “one final, unresolved section known as Pathogen Access and Benefit Sharing. Basically an agreement on how countries will share bacteria/virus samples of the next pandemic, and how medicines and tests developed from those samples will be distributed.”

The issue basically being that: Poorer countries are being asked to quickly share samples, but they want guarantees that they won’t be last in line for the vaccines, tests, and treatments made from them… like, uh, they were last time.

Well, Reuters is reporting that WHO member states have now even further extended talks on this same unresolved section, “casting doubt on when a pandemic treaty adopted last year can ‌come into effect.”

To be clear, until these final negotiations finish, there is no active treaty (even though the unfinished treaty was technically signed in 2025).

It’s a terrible limbo of inaction. If another pandemic were to emerge tomorrow, we’d still be at the same place we were in early 2020: no settled rulebook on how we work together as a global community, and (assuredly) plenty of consternation to go around.

What’s to be done? I came across a useful essay by three global health law experts, published almost exactly one year ago. And their argument, today, is all the more salient: This final, unresolved section is buckling because it’s trying to solve two extremely hard problems at once.

“Pathogen and data sharing [and] pharmaceutical supply and distribution… both are vital activities that would be more effectively addressed separately,” they write. But, (and here’s my favorite quote from the essay) “exactly why member states think they can resolve the most contentious issues of the preceding three years simply because it is in a separate annex… is rather baffling.”

Ultimately, their sharper point is that these negotiations are being asked to do too much political work. Because the fight isn’t really about technical details anymore, it’s about trust.

The world needs countries to share dangerous pathogens quickly. And poorer countries need some assurance that they won’t once again help create lifesaving tools they can’t access. But both of these issues may be easier to solve if they are not forced into the same all-or-nothing negotiation.

The takeaway? Break up the negotiations!

Counting global conflict’s health toll

There are two data-heavy stories worth your time this week on the widening fallout from conflicts in the Middle East.

First up, Reuters reports that attacks on health care workers and health facilities are rising globally, with the recent Middle East conflicts driving a clear jump.

By the numbers: Before the outbreak of fighting in Iran and Lebanon, the WHO said “attacks globally on such facilities and staff averaged about 3.7 per day.” But that has now risen to an average of 4.3 attacks per day.

“This is clearly showing that health care is the target,” Altaf Musani, the WHO’s director of emergency health, told Reuters

And that’s not even the bleakest figure in the story!

Here are several more: Since March, Lebanon alone has seen 149 attacks on health care, according to the WHO. Gaza is down to just one fully functioning hospital. In Sudan, only half of hospitals are fully operational. As Musani put it, where “health care is needed most, it is being attacked.”

Meanwhile, The Guardian has a figure-filled story on how the blockade in the Strait of Hormuz has disrupted the global supply chain for humanitarian aid.

To be clear, only part of the issue is food and medicine that’s directly stuck in the strait. For example, how the International Rescue Committee told The Guardian that $130,000 worth of supplies for 20,000 people in Sudan is still stranded in Dubai.

Rather, the big killer is fuel shortages and rising prices, which are in full swing. Like in Nigeria and Ethiopia, where “government oil rations meant the emergency relief body [the International Rescue Committee] was having to limit generator use in its health clinics.”

Save the Children also estimates that every $5 increase in the price of a barrel of oil is costing the charity an additional “$340,000 a month” in shipping, fuel, food, and medical supplies. And if oil stays around $100 a barrel through 2026, that could mean an extra $27 million in costs this year.

In response, humanitarian leaders are calling for a humanitarian corridor through the Strait of Hormuz to freely move food and medical supplies, alongside fuel to address these humanitarian crises. (Which is, let’s be real, an extremely unlikely resolution.)

This is clearly an ongoing story, and one we’ll keep watching.

HealthInsuranceGPT

Sorry, but it’s dealer’s choice for this next one. (When a global health story lands in Nairobi, I’m going to cover it!) The Guardian just published a damning investigation on Kenya’s new national health insurance program.

In short: That program is based on an “AI system used to predict how much Kenyans can afford to pay for access to health care,” but which has “systemically driven up costs for the poor.”

(If you’re tempted to skip this because you’re not especially invested in one country’s health insurance system, fair enough. But you can read this as a broader, cautionary tale about handing off messy human decisions to opaque artificial intelligence systems.)

According to the report, the 2-year-old AI system has been, from the start, “systematically overcharging the poorest Kenyans … while undercharging the wealthiest by underestimating their incomes.”

The core issue is that the “system is structured on a decades-old World Bank bugbear: proxy means testing,” which is “a way of estimating the incomes of the poor based on their possessions and other life circumstances, such as how many children they have or whether they live alone.”

In practice, “this has meant deploying government volunteers … across the country to register their roofing materials, livestock, and children – and feeding those details into an opaque algorithm to decide how much they earn and how much they must pay.”

The end result, according to the reporting, is a widespread mess of misclassification: with “critically ill people who cannot get treatment,” and families “facing a sum of between 10% and 20% of meager incomes.”

“People are dying, people are suffering,” said one of the officials registering families under the system in Nairobi.

Ultimately, The Guardian reports that there is “not a single reason” for these inaccuracies. “Poverty is a fluid category – and using factors such as an iron roof or a pit toilet to estimate a family’s wealth is an intrinsically imprecise undertaking.”

There is one last point worth noting: As development economist Stephen Kidd told The Guardian, failures like this don’t just get numbers wrong and cost lives, they also reduce public faith in government services. “It feels like a lottery,” he said. “The lottery is not a great way of building trust.”

The Hantavirus cruise

I’ll leave you with a story I initially dismissed as too small, but which I’ve come across enough times in enough outlets that I just have to flag.

The BBC reports that a Dutch-operated cruise ship (the MV Hondius) was moored off Cape Verde after a suspected hantavirus outbreak killed three people and left another passenger seriously ill. The ship was sailing from Argentina to the Canary Islands.

In port, two more cases were confirmed. On Wednesday, the ship departed Cape Verde was heading to Spain’s Canary Islands with nearly 150 people on board, the Associated Press reported.

Disease breakdown: Hantavirus is a family of rare viruses usually carried by rodents. People typically get infected by breathing in particles from infected rodent urine, droppings, or saliva. It can cause severe respiratory illness, with symptoms appearing one to eight weeks after exposure. (A lag that can allow cases to silently accumulate.) Human-to-human spread is rare, but has been documented with the Andes virus in South America. There is no specific treatment or vaccine, so care is mostly supportive.

One source at the WHO told the BBC that in this case, some person-to-person spread may have happened among close contacts sharing cabins, but the first infection could also have come from rodents before the ship left Argentina, or during one of its stops.

Still, there’s more questions than answers as of yet.

(Only modestly related here, but this news reminds me of a story I wrote about 12 years ago for Popular Mechanics. I was helping at my father’s automotive shop and we found rats living in a Porsche’s cabin air filter. A Centers for Disease Control and Prevention ecologist told me that was “an ideal way to spread an airborne virus,” since the car’s vents were blowing particles from rodent droppings or urine straight into an unlucky customer’s face.)

Anyhow… a rare virus, a stranded cruise ship, several deaths, and no clear answer yet on where the outbreak began?

Fine. It gets the closing slot!

I’ll see you next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Trump’s drug strategy aims to bolster addiction services — despite gutting of government support

2026-05-06T14:01:02+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The White House’s newly released strategy for tackling the nation’s drug and addiction crisis calls for a number of ambitious public health approaches that some experts say are laudable but will be hampered by the administration’s own actions.

The sweeping 195-page National Drug Control Strategy, published Monday, advocates for making access to treatment easier than getting drugs, preventing young people from developing addictions in the first place, increasing support for people in recovery, and reducing overdose deaths.

Those broad goals are widely supported by public health researchers, addiction treatment clinicians, and recovery advocates.

But accomplishing such goals will be difficult in the face of the administration’s mass layoffs of federal employees, cancellation of research and community grants, attacks on organizations and practices that serve people who use drugs, and cuts to Medicaid, the state-federal health insurance program for low-income people that is the largest payer for addiction and mental health care nationwide.

Many components of the National Drug Control Strategy are “things that we would agree with and that we fully support,” said Libby Jones, who leads overdose prevention efforts at the Global Health Advocacy Incubator, a public health advocacy group.

But there are “disconnects in what the strategy says is important and then what they’re actually going to fund,” she said of the Trump administration. “Those inconsistencies feel particularly loud in this strategy.”

The White House’s National Drug Control Strategy, released every two years, is a touchstone document meant to lay out the federal government’s coordinated approach to what in recent decades has been one of the country’s defining problems.

Since 2000, more than 1.1 million people have died of drug overdoses. Although deaths have decreased recently, the numbers remain elevated compared with earlier decades, and research suggests overdose death rates among Black Americans and Native Americans are disproportionately high.

Psychedelics offer exciting promise for mental health – if rolled out right

The strategy document published this week is the first of President Donald Trump’s current term. In keeping with the administration’s approach to addiction issues, it places heavy emphasis on law enforcement efforts to reduce the supply of illicit drugs. The document repeatedly refers to the ongoing “war” against “foreign terrorist organizations” — the Trump administration’s term for drug cartels — and touts increased enforcement at U.S. borders.

It also outlines plans to implement artificial intelligence technologies to screen for illicit drugs brought into the country and wastewater testing to detect illegal drug use nationwide.

The second half of the strategy focuses on reducing the demand for drugs through public health prevention efforts, addiction treatment, and support for people in recovery. It promotes the role of religion in recovery and calls for the widespread use of overdose reversal medications, such as naloxone.

In a news release, the White House’s Office of National Drug Control Policy called the document a “roadmap” that will “continue dismantling the drug supply and defeating the scourge of illicit drugs in our country.”

The Trump administration did not respond to requests for comment about how the strategy aligns with its other actions.

In December, Trump signed a reauthorization of the SUPPORT Act, which continues several grants related to treatment and recovery and the requirement for Medicaid to cover all Food and Drug Administration-approved medications for opioid use disorder. In January, he announced the Great American Recovery Initiative, including a $100 million investment to address homelessness, opioid addiction, and public safety.

However, few details have been provided about the initiative, and in January, about a month after the SUPPORT Act passed, billions of dollars in addiction-related grants were abruptly terminated and reinstated within a frantic 24-hour period.

That “whiplash” left “a sense of instability and uncertainty in the field,” said Yngvild Olsen, a national adviser with the Manatt Health consultancy. She led substance use treatment policy at the Substance Abuse and Mental Health Services Administration, or SAMHSA, under the Biden administration and left about six months into Trump’s second term.

That insecurity was exacerbated by the president’s 2027 budget request, which proposes cuts to several addiction and mental health programs and the consolidation of key federal agencies working on those matters. Jones’ group and nearly 100 others in the field have signed a letter asking Congress to reject the proposals, as it did with similar requests last year.

The national drug strategy adds new, potentially contradictory information to this confusing landscape.

Increasing access to treatment at odds with Medicaid cuts

One of the most significant public health goals in the strategy, mentioned at least half a dozen times, is to make it easier to get treatment than it is to buy illegal drugs.

National data underscore the necessity: More than 80% of Americans who need substance use treatment don’t receive it.

The administration’s actions on health insurance may make it difficult to improve that statistic.

Medicaid is the main source of health care coverage for adults with opioid use disorder. When implemented, the Medicaid work requirements in Trump’s One Big Beautiful Bill Act are projected to strip that coverage from about 1.6 million people with substance use disorders.

The last time Medicaid rolls were purged — after Covid-era protections expired — many people who had been receiving medication treatment for opioid addiction stopped it and fewer people started treatment, according to a study published last year.

Olsen, who is also an addiction medicine doctor, said she loves the strategy’s emphasis on making treatment readily available to anyone who wants it. But she said that’s “hard to really imagine when now people may have to pay for it themselves because they may be losing their Medicaid insurance coverage.”

One analysis estimated the upcoming Medicaid changes could lead 156,000 people to lose access to medications for opioid use disorder and result in more than 1,000 additional fatal overdoses per year.

An addiction counselor’s ‘aha’ moment: When even saving a life isn’t enough

People with private insurance may be affected, too.

The Trump administration has refused to enforce Biden-era regulations aimed at bolstering mental health parity, the idea that insurers must cover mental illness and addiction treatment comparably to physical treatments. And recently, the administration said it would redo those regulations altogether, raising fears that addiction treatment could become increasingly unaffordable.

The administration did not respond to specific questions about how it reconciles its actions on Medicaid and parity with the goal of increasing treatment.

Prevention efforts may be hampered by funding, staff cuts

The strategy highlights preventing addictions before they begin as one of the keys to reducing demand for drugs. It calls for “promoting a drug-free America as the social norm” and implementing school and community-based programs that are backed by science.

“Investing in primary prevention, before drug use starts, saves lives and resources,” it says, citing several studies about the cost-effectiveness of such programs.

Yet, the president’s budget proposes cuts to these types of programs, and federal layoffs have decimated the agencies that would implement such work.

The White House’s most recent budget request proposes cutting roughly $220 million from SAMHSA’s Center for Substance Abuse Prevention and nearly $40 million from the Drug-Free Communities program.

Since the new administration started, SAMHSA has lost about half of its staff, and the Centers for Disease Control and Prevention is down about a quarter.

“It’s not clear to me that they’re really going to be able to have the funds or the people to be able to carry that out,” Olsen said of the strategy’s prevention goals.

Another wrinkle appears in the strategy’s discussion of marijuana. The document points to marijuana use as one of the drivers of increasing drug use disorders and reports that “convergent evidence from multiple sources” suggests cannabis use increases the risk of psychosis. It calls for developing new tools to treat marijuana withdrawal and addiction.

However, just two weeks ago, the White House moved to reclassify medical marijuana to a lower tier of scheduled substances and is moving to hold a hearing to do the same for marijuana broadly.

“The administration, on the one hand, is moving in a direction of liberalizing access to cannabis,” Jones said, “but at the same time, in the strategy, it talks about the dangers of doing so.”

“There’s a disconnect there that just makes you question: Which one do you believe?” she added.

The administration did not respond to specific questions about its marijuana policies.

‘Rhetoric over reality’ on test strips to detect fentanyl

One of the more surprising elements of the National Drug Control Strategy comes in the last paragraph of the final chapter. It focuses on public drug-checking programs, which often involve using test strips to help people who use drugs determine whether there are more-dangerous substances, such as fentanyl or xylazine, in the batch they bought. That helps them determine whether or how to safely use those drugs.

“Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal,” the strategy document says.

However, SAMHSA announced in a recent letter that it would no longer pay for test strips, as part of the Trump administration’s “clear shift away from harm reduction and practices that facilitate illicit drug use.”

The administration has similarly attacked harm reduction programs in an executive order and its budget requests. It did not respond to specific questions about how this position interacts with the drug control strategy.

Regina LaBelle, a Georgetown University professor who served as acting director of the Office of National Drug Control Policy during the Biden administration, wrote about the contradiction in a blog post: “It is the height of rhetoric over reality to champion a tool while simultaneously cutting off the funding used to acquire it.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Tick bites are rising. What to know about Lyme disease and alpha-gal syndrome.

2026-05-06T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

This week, I’m highlighting the news that tick season has begun, with cases rising three-fold in the past month. We have good news about one of the most feared infections transmitted by ticks, Lyme disease, and not so good news about a non-infectious disease caused by ticks, alpha-gal syndrome.

Tick season has arrived early and aggressively

The Centers for Disease Control and Prevention reported last week that emergency department visits for tick bites have risen roughly three-fold since March, from 34 per 100,000 visits to 96 per 100,000. That is the highest rate for this point in the year since 2017. The Northeast and Midwest have the highest rates of tick bites, with the Northeast already at nearly 50 tick-bite ER visits per 100,000.

What we call “tick season” in the United States is the stretch from roughly April through September, when warming weather draws ticks out of leaf litter and into the grassy, brushy edges of yards, parks, hiking trails, and gardens.

Ticks are often present at the tips of grass blades and low shrubs, then grab onto deer, dogs, or humans as they brush past. Tick bites and diseases transmitted by them are rising because of climate change. Warmer temperatures are allowing tick populations to survive further north and to extend their activity for longer periods of the year.

The two ticks of greatest public health concern in the United States right now are the blacklegged tick (also known as the deer tick) and the lone star tick. The blacklegged tick transmits Borrelia burgdorferi, the bacteria that cause Lyme disease, as well as less common infections such as babesiosis and anaplasmosis.

Another type, the lone star tick, is driving the rapid rise of alpha-gal syndrome, a delayed allergy to red meat. The lone star tick is identifiable by the white spot on the back of adult females and is notable for actively crawling toward people, rather than simply lying in wait to bite.

Lyme disease is, by far, the most common tick-borne illness in the country, with about 476,000 people diagnosed and treated each year. Alpha-gal is rarer, but causes substantial difficulty for patients and may be increasing. Both conditions are the focus of important news in the past month, so let’s take them in turn.

Will we soon have a vaccine for Lyme disease?

A vaccine for Lyme disease is important, because many initial infections are missed. Untreated Lyme can cause arthritis, heart problems, and neurologic complications, and, even when infection is caught early and treated, some patients report long-lasting fatigue and pain. A vaccine could potentially prevent or reduce these conditions.

What’s less well known is that we had a Lyme vaccine in the 1990s. In 1998, the Food and Drug Administration approved LYMErix, a vaccine that was about 76% effective in preventing infection. Although the scientific data for the vaccine was strong, demand for it plummeted after people began reporting arthritis-like symptoms after receiving the vaccine.

Researchers warn of threats – to humans and native plants – from little-known ant

It turns out that the rate of arthritis-like symptoms was similar in the general population and that symptoms did not correlate with the second or third dose, as a true immune-driven side effect should. Nevertheless, a class-action lawsuit was filed, and GlaxoSmithKline pulled the vaccine from the market in 2002.

Now, more than two decades later, Pfizer and Valneva have announced phase 3 results for a new Lyme vaccine candidate, PF-07307405. The vaccine works through an unusual and elegant mechanism: It generates antibodies in your bloodstream that the tick ingests when it bites you. Those antibodies disable the bacteria inside the tick before they can be transmitted into your body.

In the VALOR trial, Vaccine Against Lyme for Outdoor Recreationists, the vaccine was 73% effective at preventing confirmed Lyme disease 28 days after a fourth dose and about 75% effective one day after the fourth dose.

Although these numbers are promising and Pfizer says it will submit for regulatory approval, there are some important concerns.

First, fewer Lyme cases occurred during the trial than expected, so the primary statistical endpoint was not technically met, even though the secondary analysis was.
Second, this is a four-dose vaccine (three shots in the first year, then a booster before the next tick season). In my experience as both a physician and leader for large-scale vaccine programs, it is extremely difficult to get adults to complete a four-dose vaccine series.
Finally, in the current anti-vaccine environment, I worry whether the FDA will consider this vaccine, whether the CDC would promote it even if FDA approves it, and whether the public will actually accept it. It would be deeply unfortunate if we relived the LYMErix story a second time.

Alpha-gal is rising, but is it more widespread than we realize?

If you have not heard of alpha-gal syndrome yet, it’s likely you will in the near future. It is a delayed allergic reaction to red meat (e.g., beef, pork, lamb, sometimes dairy and gelatin) caused by a sugar molecule called galactose-alpha-1,3-galactose, abbreviated as “alpha-gal.”

The lone star tick carries this molecule in its saliva. When the tick bites you, it can trigger your immune system to make antibodies against alpha-gal. After that, eating a hamburger may cause hives, vomiting, stomach cramps, or, in some cases, life-threatening anaphylaxis several hours later. It has been called “the midnight allergy,” because patients often eat dinner, fall asleep, and wake in the night to a full-body reaction.

The foundation of any public health response to a disease is to count it. You cannot prevent what you cannot see. Yet alpha-gal surveillance in this country is patchwork, as described in a recent article.

Arkansas became the first state to make alpha-gal a reportable condition in 2023, and more than 15 states track cases to some degree. New York, which is home to one of the country’s most concentrated hot spots in Suffolk County, does not track cases statewide. New York City does — and has documented 280 suspected cases since 2024 — even though the lone star tick is not common in the five boroughs.

The CDC has documented more than 110,000 suspected cases since 2009 and estimates the true number could be three to four times higher.

Without comprehensive surveillance, public health agencies cannot warn their communities about how common it is and who is likely to get it. Clinicians are less likely to consider it, and patients spend time bouncing between specialists before they are diagnosed.

Where to look for advice on tick bite prevention

Although changes to its website have been problematic, the CDC does remain an excellent resource for information on how to prevent tick bites. The single best protection is a combination of applying Environmental Protection Agency-registered repellents on your skin, treating shoes and clothes in permethrin, walking the center of trails, and conducting full-body tick checks within two hours of coming inside.

If you are bitten, consider using the CDC’s Tick Bite Bot that walks you through what to do.

Until next week,

Jay

Researchers warn of threats – to humans and native plants – from little-known ant

2026-05-01T18:32:46+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Researchers in the South want people to know about an invasive ant species whose painful sting can cause fatal anaphylaxis in some people – and disrupt local ecologies as well.

Asian needle ants are not widely known and often meander outdoors individually, so it’s easy to miss them and get stung. As temperatures grow warmer in the spring, the ants become more active and people spend more time outside.

Dan Suiter, an entomologist with the University of Georgia’s extension service, received calls from three people in 2024 reporting being stung by Asian needle ants and requiring hospitalization for anaphylaxis, an allergic reaction that can be fatal.

Suiter said he wants to make sure people know about the Asian needle ant so they can avoid stings. Since he began putting out press alerts over the past few years, he’s received many more reports from people who were stung and needed serious medical treatment.

@healthbeatnews
Researchers in the South want people to know about an invasive ant species whose painful sting can cause fatal anaphylaxis in some people – and disrupt local ecologies as well. #AsianNeedleAnts are not widely known and often meander outdoors individually, so it’s easy to miss them and get stung. As temperatures grow warmer in the spring, the ants become more active and people spend more time outside. Learn more about the Asian needle ant and how to minimize risk at healthbeat.org. #ants #insects #georgia #south
♬ original sound - Healthbeat

The species, discovered in Decatur, Georgia about a century ago, likely arrived in the United States through international trade.

The ant has been reported in more than 20 states east of the Mississippi River, from Florida to Wisconsin, according to data from the Global Ant Biodiversity Informatics project at the University of Hong Kong.

One study published last year found the ants thriving in a community mulch pile in Watkinsville, Georgia. Gardeners taking mulch from the pile could be contributing to the ant’s local spread, the authors wrote.

The species has a 100-year head start on researchers, and they lack good historical data as to how the ant has spread in the United States, said Christopher Hayes, an entomologist at North Carolina State University.

How invasive ants can affect the environment

As with other invasive species – like kudzu – it’s too embedded in the environment to successfully remove it, Hayes said.

In the Southeast, fire ants and Joro spiders are well-known invasive species.

Scientists are seeking to better understand the Asian needle ant: where it is, its habitat, and its environmental impact. That’s important, Hayes said, because the ant can harm ecological systems.

“On a daily basis, you have these multiple species that they’re always competing with one another,” Suiter said. Asian needle ants “out-compete” other ant species for food, driving those species to “local extinction.”

That’s a problem because those species are often responsible for seed dispersal that allows native plant species to reproduce, he said.

Hayes said he would like to figure out how to preserve native species and mitigate the Asian needle ant’s environmental impact.

Painful sting can prompt anaphylaxis, phantom pain

Allergic reactions to stings by honeybees, wasps, and ants account for up to 43% of anaphylaxis cases and about 20% anaphylaxis-related fatalities. That makes them an important, if sometimes underrecognized, public health issue, according to a 2022 study.

Suiter said people who are allergic to bees and wasps and those who carry EpiPens should know what the Asian needle ant looks like so they can avoid a potentially serious allergic reaction.

Asian needle ants crawl along decaying wood and leaves.

As temperatures warm and summers grow longer, Hayes said, the Asian needle ant will have longer active seasons. While the ants typically “hunker down” over the winter, they become more active in warmer weather, meaning people will have more chances of being exposed to them.

The ants don’t come indoors, instead preferring moist environments, like downed logs, Suiter said.

The ants, whose scientific name is Brachyponera chinensis, are brownish, measure 3/16-inch long, and often live in logs and leaf litter and under rocks and stones.

“One of the ways to minimize the numbers of needle ants in your yard would be simply to clean up all that,” Suiter said.

Asian needle ants are less aggressive than fire ants, Hayes said. They are “stealthier” and more likely to be hidden in piles of wood than the fire ant mounds that Southerners are used to seeing.

And while fire ants are more likely to come pouring out of a mound and bite people multiple times, Asian needle ants will “meander around on your arms” or other body parts until they get squeezed, such as in a gardener’s glove, prompting them to bite, Hayes said.

In contrast to most other ant species that form long trails, Asian needle ants tend to go it alone.

“When you see them in your yard or on the concrete, they’re just kind of meandering around as a single ant, and they don’t really garner your attention” the way ants in long trails might, Suiter said.

“With the Asian needle ant, their rate of triggering anaphylaxis from a single sting is much higher than the rate of a fire ant individual sting triggering anaphylaxis,” Hayes said. “The sting of an Asian needle ant is more dangerous on the individual ant level.”

(Colloquially most people say they were “bitten” by an ant, Hayes said. In reality, most ants first bite people and then either sting with venom or spray an acid.)

The sting looks different than a fire ant sting, which looks like a small zit with a white pustule, Suiter said. Asian needle ant stings have small red dot surrounded by swelling, similar to a yellow jacket sting.

People who are allergic to other insects like bees and wasps are most at risk of anaphylaxis, Hayes said, because the venom is similar.

But there are reports of people with no history of allergies or anaphylaxis also having severe reactions to the Asian needle ant, Hayes and Suiter said.

If you do think you’ve been stung, keep an eye on the site and mark any swelling or redness with a marker on your skin so you can tell if it spreads. If it does spread, or you have difficulty breathing, seek medical advice right away, Hayes said.

He has been stung before – “for science” – and said the sting felt like fiberglass underneath his skin, different from how a fire ant’s sting feels. He keeps an EpiPen and Benadryl on hand to help manage allergic reactions.

The Asian needle ant has an unusual feature: It can cause pain hours after the initial sting, even up to 24 or 48 hours later.

Hayes said his young son was stung last summer and woke up hours later screaming in pain.

Suiter also reported the pain returning hours later after a sting. “It’s got kind of a bizarre response,” he said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Measles concern at Newark airport. NYC fire safety. What to know about medspa peptides.

2026-05-01T16:13:38+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Despite my allergy-induced congestion and mildly itchy eyes (yes, pollen is still quite high), I’ve been LOVING the weather this week. I hope you’ve all had a chance to get outside and enjoy it (and remember to do your tick checks 😉).

For public health news this week, I’m covering a measles exposure at Newark Airport and a local pediatric emergency room, the importance of closing doors for fire safety, and peptides being sold at New York City medspas. With the seasonal change, I’m taking a break from reporting on respiratory viruses, but I’ll be back if anything important comes up. Okay, let’s get to it.

Measles exposure at Newark Airport

New Jersey has reported a possible measles exposure at Newark Airport last week. Anyone who visited these locations during these dates and times may have been exposed:

Newark Liberty International Airport, Terminal B. April 14, 5:30 a.m.-9 a.m. Monitor for symptoms until May 11.
Pediatric Emergency Department, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, New Jersey. 11:15 p.m. April 17 through 3:15 a.m. April 18. Monitor for symptoms until May 11.

Potentially exposed people should contact their health care practitioner if they develop measles symptoms, which usually start like a cold and progress to a rash.

So far, no cases have been identified following these two exposure events. If you do develop symptoms, it’s important to call your doctor or clinic before you visit in person so special precautions can be taken to prevent further spread.

What this means for you:

The best thing to do is to make sure you and your children are vaccinated.
- Kids under 6 months old. Not yet eligible for the measles, mumps, rubella vaccine. If mom was vaccinated, then babies under 6 months should have some protection from immunity passed from mother to baby. This immunity wanes within the first 6 months.
- Kids 6 months to 1 year. Early vaccination can be considered, especially if there’s upcoming travel planned. However, since this is an isolated case in New Jersey and not an outbreak (which is defined as three or more cases), health officials aren’t specifically recommending early vaccination.
- Kids 1 year and older. Follow the standard MMR vaccine schedule, typically administered at 1 year and again between ages 4 and 6.
- Adults. If you have not been vaccinated or are unsure of your vaccination status, it’s a good idea to discuss getting a shot with your doctor.

I’ve seen a lot of people asking about titer tests to confirm immunity. While titers measure antibodies in the blood, they do not account for T cell and B cell immunity, which also offer protection. The main reason to get titers would be as a matter of insurance coverage for a booster, as some plans won’t cover the cost unless titers to one of the MMR viruses come back negative. We can’t give medical advice, but if you’re concerned about whether you are still immune, ask your doctor about getting your titers checked or getting a booster.

To dive deeper, YLE National has a great measles FAQ post.

Building fire codes and violations can mean life or death — here’s how to check yours

Tragically, two people died in a five-alarm fire in the Bronx last week. This week, FDNY investigators said that the outcome could have been different if doors weren’t left open during the fire, allowing it to spread and the stairwell to fill up with smoke, where the two victims were found.

This is not the first time New York City has seen this scenario play out. The January 2022 Twin Parks fire in the Bronx — the deadliest New York City fire in decades, which killed 17 people — was also linked to doors that failed to close, allowing smoke to fill the stairwell of a 19-story building.

I probably learned these lessons when I was in elementary school during fire drills, but nothing sticks like seeing the tragic outcomes play out in real time. The lesson is stark, yet simple: A closed door is a fire barrier. It buys time and saves lives.

What to do:

Heaven forbid there’s a fire in your building, close every door behind you when evacuating — don’t prop building entrances or stairwell doors. And remember: If your apartment door feels hot, do not open it — seal gaps with towels, go to a window fire escape, and signal for help if you need it.
This week, walk your building’s fire escape route so you know it before you need it.
If self-closing doors in your building are broken, report it to your super or call 311. (You can also look up previous building violations and complaints here.) Self-closing doors on stairwells are a legal requirement. Doing this prompted me to talk to our super about a stairwell door that wasn’t fully closing.
Now is also a great time to check your smoke detectors and make sure the batteries still have juice.
This is the kind of risk where preparation genuinely changes outcomes.

NYC medspas are offering clients experimental peptides that have not been FDA-approved

Peptides are getting a ton of attention.

I’ve seen them all over my social media, often promoted by wellness influencers for faster recovery, better skin, and reduced inflammation. But it’s no longer just online. They’re showing up in New York City medspas now, too.

A recent Gothamist report found that Apollo House, a medspa near Union Square, offers a “peptide stack membership” that includes injections of BPC-157, TB-500, and GHK-Cu. These are marketed for healing, recovery, and anti-aging. But they have never been Food and Drug Administration-approved for these uses, and the human evidence for their injection is limited. Several other medspas offer similar packages.

I’m not going to do a full peptide deep dive here, as YLE National just covered that last week. If you want to understand what peptides are and where they stand with FDA, I recommend starting there.

For New Yorkers, there are a couple of issues at play.

New York has already raised concerns about medspas. A recent investigation found unlicensed medical procedures, sanitation violations, expired or unlabeled products, and other safety issues in medspas across the city. (I covered that here.)

When you add on this peptide layer, it gets even murkier. Gothamist reported that the New York state department that oversees compounding pharmacies (special pharmacies that custom-make drugs for patients and often market peptides) has not issued guidance on peptides or where the FDA stands on them.

This is concerning when these peptides are being used in medspas in ways that aren’t FDA-approved. This means that New Yorkers are being left to sort through the noise on their own, trying to sort fact from fiction about the safety of peptides.

We’re also hearing of people self-sourcing and injecting peptides from overseas wholesalers or online vendors, marketing them for “research purposes, not for human consumption.” This can be even more concerning because it may happen without clinical oversight or a reliable way to determine what is actually in the purchased vial.

I want to be clear that I don’t mean to fearmonger. Not all peptides are dangerous. Insulin and GLP-1 medications like semaglutide (Ozempic) are peptides with clinical trial data and FDA approvals for specific use cases. The concern is the growing gray market for unapproved injectable peptides, which leaves purity, dosing, clinical oversight, and potential long-term effects to chance.

What this means for you:

Do not self-inject peptides sourced online or from overseas vendors. There is no way to verify the purity, dosing, or potential for harmful effects.
If you are curious about peptides, discuss them with your primary care clinician. It’s better to talk to a clinician who knows your history than someone at a wellness spa who doesn’t have that context. And if you’re already using peptides, it’s a good idea to tell your doctor.
Watch for updates. I’ll be keeping an eye on the FDA advisory committee meeting in July and sharing anything I learn.

Bottom line

You’re caught up on New York’s public health news. If there are other topics you’d like to see covered here, please drop me a comment here. See you next week!

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health advocate. She specializes in infectious diseases, outbreak response, and emerging health threats. She has led multiple outbreak investigations at the California Department of Public Health and served as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Donnelly is also an epidemiologist at Biobot Analytics, where she works at the forefront of wastewater-based disease surveillance.

Dog poo in NYC Council crosshairs after a filthy winter

2026-05-01T14:24:11+00:00

This story was originally published by THE CITY. Sign up to get the latest New York City news delivered to you each morning. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

They want to curb your dog.

The New York City Council on Thursday introduced a package of bills aimed at helping the scourge of dog poop that intensified during weeks of feces-strewn snow piles this winter.

The four bills, which will have hearings in the coming weeks, focused on both outreach and other ways to make it easier for dog owners to pick up after their four-legged friends.

Speaker Julie Menin reintroduced a bill she first proposed in 2024 that would require the sanitation department to regularly fill dog waste bag dispensers on or next to every public litter basket on city streets.

“We know that dog waste is an enormous issue,” the speaker said before the bills were introduced.

A spokesperson for the sanitation department, Vincent Gragnani, said the agency has previously made it clear it doesn’t have the resources to stock the bag dispensers.

“We need a community partner to maintain these. We don’t have the resources to keep these stocked daily, and our intention was that a local community group, or the local Council member would take on the responsibility of keeping the dispensers full,” he said in an email to THE CITY.

New York City Council passes plan to step up education on vaccines

Another bill introduced by Councilmember Harvey Epstein, a Manhattan Democrat, would create a pilot program to compost dog waste left at dog runs.

“I’m a big composter in this city, I really focused on making sure we understand that we have the opportunity to reduce waste and do waste diversion,” he told THE CITY.

He takes his mutt, Homer, to local dog runs and isn’t able to compost the poo — which he said is a waste.

“There’s a real opportunity to do something about ensuring that we divert that from trash and make it into compost,” he said.

A handful of New York City dog runs have composting for dog feces, but it’s not universal. And it can’t be disposed of in regular brown compost bins and must instead go into the trash, a sanitation department spokesperson said.

“It’s very important to understand that, as a dog guardian, if I leave the poop, I’m adding to the dangers and risks of a public health issue.”
New York City Council Member Shahana Hanif

Councilmember Mercedes Narcisse, a Brooklyn Democrat, introduced a bill that would require signs posted at parks reminding people it’s illegal to not pick up after your dog.

And another bill, from Brooklyn Democratic Council Member Shahana Hanif, would create an educational initiative making sure New Yorkers know “it’s their duty” to pick up waste, she said.

“It’s very important to understand that, as a dog guardian, if I leave the poop, I’m adding to the dangers and risks of a public health issue,” Hanif said.

She and other Council members spoke out on social media during winter storms when human owners didn’t pick up after their pets.

It’s illegal to not clean up after your dog. The city’s “Pooper Scooper” law was enacted in 1978, thanks in part to the advocacy of Fran Lee, a New Yorker who had become obsessed with the public health issue of dog waste.

If caught, the fines are up to $250.

But it’s nearly impossible to ever catch anyone in the act, the city’s former acting sanitation commissioner admitted during budget testimony this year.

“The chances of someone not picking up after their dog while an enforcement officer is watching is very, very slim,” Javier Lojan said, adding that they even set up stings to catch people in areas with a lot of complaints — and came up short.

They issued just two summonses for failure to remove canine waste last year, despite many complaints citywide.

Katie Honan is a senior reporter for THE CITY and co-host of FAQ NYC podcast.

New York City Council passes plan to step up education on vaccines

2026-04-30T21:36:51+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The New York City Council on Thursday passed a package of bills seeking to do more to educate parents about the safety and effectiveness of vaccines as immunization rates show signs of starting to dip.

The five bills aim to make it easier for schools to disseminate accurate information about vaccines to parents, as well as to require the Department of Health and Mental Hygiene to develop a plan by year’s end that will educate New Yorkers about the importance of childhood and adolescent vaccinations.

The package will be sent to Mayor Zohran Mamdani, who has 30 days to sign, veto, or let the bills lapse into law.

The action comes as the federal government led by Health and Human Services Secretary Robert F. Kennedy Jr. and followers of his Make America Healthy Again movement are working to sow doubt and confusion about vaccines, which are scientifically proven to be safe and effective. As a result, state and local governments are taking a greater role in educating the public.

New York state has long had some of the highest vaccination rates in the country, but that record may be faltering.

In New York City, new data suggest parents are delaying routine vaccinations for their children. In March, the city reported that about 1 in 3 2-year-olds had not received all doses of seven vaccines – DTap (diptheria, tetanus, and acellular pertussis); polio; measles, mumps, and rubella; hib; hepatitis B; varicella (chickenpox); and pcv (pneumococcus).

S.C. measles outbreak declared over after 997 cases

This prompted city health officials to launch a $1 million campaign over four weeks encouraging parents to vaccinate their children. Officials say the campaign ran in multiple languages and on TV, radio, print news, kiosks, and transportation hubs in neighborhoods with low vaccination rates.

“The new life that Kennedy is giving to the movement has clearly given new life to the diseases themselves,” City Council Speaker Julie Menin said at the council meeting, before the bills were introduced. “The erosion of public trust in science doesn’t just increase health risks for his own band of followers, it also puts our wider community in jeopardy. As lawmakers and as leaders, we cannot sit back and let that happen.”

The United States has seen more measles cases over the past year than it has in decades. An outbreak in South Carolina reached nearly 1,000 cases. Most of those infected were unvaccinated.

James Alwine, a virologist, professor emeritus at the University of Pennsylvania, and visiting professor at the University of Arizona, is a member of Defend Public Health, a nationwide network of public health leaders and advocates. He applauded the legislation and offered this advice for the health department on vaccine messaging: Keep it simple and straightforward while highlighting the harm that these preventable diseases can inflict on children.

“Stay out of the real science and data — that just doesn’t work,” Alwine told Healthbeat. “You can’t fight against what they’re saying by trying to tell people, ‘Well, here’s the science, here’s the data, here’s the study.’ It just falls on deaf ears, mainly because it’s hard to explain in lay terms.”

Here is a rundown of the bills:

Educating parents: Sponsored by Council Member Shekar Krishnan, Introduction 260-A requires the health department, in collaboration with the Department of Education, to develop informational material about vaccines. DOE is also required to distribute the materials to parents of all New York City public school students, including those enrolled in early childhood programs such as 3-K and Pre-K. The material must include general information on how vaccines work, their public health benefits, their safety, and where to access vaccines required for school attendance.
Educating the public: Sponsored by Council Member Eric Dinowitz, Introduction 693-A requires the health department, in collaboration with relevant agencies, to develop and implement a plan by no later than Jan. 1, 2027, to educate the public about the benefits and importance of childhood and adolescent vaccinations. In developing the plan, the health department is required to consider recommendations adopted by major medical organizations, including the American Academy of Pediatrics.
Authorizing dentists to immunize: Sponsored by Council Member and Health Committee Chair Lynn Schulman, Resolution 273 calls on the New York State Legislature to pass, and the governor to sign legislation authorizing dentists to administer flu shots, Covid vaccines, human papillomavirus vaccines, or a vaccine related to a public health emergency.
Recommending vaccines: Also sponsored by Schulman, Resolution 425 calls on the legislature to pass, and for the governor to sign state legislation requiring vaccines to be regulated, recommended, administered, and insured based on the recommendations of various nationally and internationally recognized health care organizations.
Reimbursing costs for providers: Also sponsored by Schulman, a preconsidered resolution calls on the legislature to pass, and the governor to sign a bill requiring insurance to reimburse the total direct and indirect expenses for providers administering vaccines.

In a written statement attributed to city Health Commissioner Dr. Alister Martin, the health department said it looks “forward to continuing our partnership with Chair Schulman and City Council on this issue.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

NYC food aid groups take stock after rough winter for hungry seniors

2026-04-30T14:52:32+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

As New York City emerges from one of the coldest winters in years, those who serve the growing population of seniors facing food insecurity are reflecting on what more can be done – before summer, when extreme heat could bring another barrier to aid distribution.

“They have to think: Do we want to be hungry or do we want to freeze?” said Tyler Efferon, executive director of EV Loves NYC, a food pantry in the East Village. He noticed seniors were missing from food distribution sites this winter.

“We usually do 384 meals, and this past week we only did 240 meals,” he said in February.

In 2023, 1 in 10 New Yorkers ages 65 and older experienced food insecurity – a 3% increase from 2021, according to Feeding America, a nationwide network of food banks, food pantries, and soup kitchens.

Since the pandemic, the city’s total population has declined – but the senior population has continued to grow, according to a 2025 report by the state comptroller’s office. The city’s 65-and-older population grew 53% from 2000 to 2023 – 17 times faster than the total population.

Many seniors in need don’t have the mobility to get to food distribution sites, especially when sidewalks are slippery with snow and ice, said Alexina Cather, former deputy director of the NYC Food Policy Center at Hunter College.

“When it’s 5 degrees outside, you cannot come,” Julie, 63, told Healthbeat as she braved a frigid evening in February to pick up free groceries from a City Harvest truck on Manhattan’s Upper East Side. She declined to give her last name. “One Monday I came, but it was too cold, so I went home.”

It can be hard during summer heatwaves, too.

City Council Member Elsie Encarnacion, whose district includes part of the Bronx and the Upper East Side, introduced a bill on April 10 at the Committee on Aging to require the city Department for the Aging to develop a protocol for conducting in-person and phone wellness checks during extreme hot or cold weather.

People line up to receive food distributions from City Harvest in New York City in February.

For older people, exposure to the cold poses a higher risk of hypothermia, as the human body’s ability to regulate temperature deteriorates with age.

Chris Jay, a 61-year-old unemployed man who lives in an apartment in Sunset Park, said he defied the cold every Monday this winter to get food at the Gotham Food Pantry, where he received a hot meal at 6 p.m.: chicken, rice, vegetables, and lemon cake.

Afterward, he spent an hour and a half in 23-degree weather on the steps of All Souls NYC Church, waiting for a truck from City Harvest, which redistributes surplus food that would otherwise go to waste.

“A lot of people just come for the meal, and then they leave,” Jay said. “They don’t want to wait around for the truck because we never know when the truck’s going to be here.”

Delivering food directly to seniors’ homes would require more resources, trucks, drivers, and other workers. Gotham Food Pantry operates with only four employees and 100 volunteers, making personalized home delivery out of reach, Executive Director Douglas Silver said.

“I would need to have all the addresses of all those people,” he said. “I don’t have this.”

Advocates say more funding for local food pantries, not just big food banks, could make a difference.

“Right now, a few core companies get all the funding for food access,” Efferon said.

Cather said the city mainly funds the Food Bank for NYC but should be investing in neighborhood food pantries. With more money, she said, local food pantries could schedule delivery to some senior centers, giving food to 100 people at the same location.

“The food pantries are at the front line,” Cather said. “They understand the nuance of their clientele and can meet people where they’re at.”

Meals on Wheels delivers a wellness check

The city Department for the Aging provides one meal every weekday through its Meals On Wheels program. It is dedicated to seniors who cannot cook, travel to food pantries, or stand waiting for hours. The program serves 24,000 of the city’s 1.43 million seniors, according to the comptroller’s report.

Meals on Wheels was created by the Older Americans Act of 1965, when the senior population was only 9% of the whole U.S. population. In 2025, the Census Bureau estimated this same population to be at 61.2 million, or 17% of the total population.

The meals are delivered door to door, providing human contact for older adults, said Susan Zhuang, chair of City Council’s Committee on Aging. ”Meals on Wheels is not only just a meal delivered to their home. It is also a check-in with them.”

Meals are not delivered on weekends. Zhuang said many nonprofits have told her that seniors often fall and cannot reach the phone. Deliverers from Meals on Wheels knock on the door and find them on the floor.

“If it happened Friday night and then the whole weekend passed and no one checked on them, the people are going to die,” Zhuang said. “It’s not only just a meal issue. It’s a meal issue plus isolation issue plus health health issue plus caregiver issue.”

New York City food pantries work to give immigrants a taste of home. Trump’s aid cuts are making it harder.

City Council Member Linda Lee, whose district in eastern Queens includes the Douglaston and Bayside neighborhoods, has introduced a bill to extend Meals On Wheels to seven days a week.

Meanwhile, Citymeals on Wheels, created in 1981, distributes weekend meals to 16,000 to 20,000 people every year. About 2,000 senior New Yorkers get a monthly breakfast box containing the equivalent of 30 breakfasts with perishable and non-perishable items, and the program delivers groceries to 700 seniors a year.

Fear of ICE keeps people from food distribution sites

Fear of being detained by Immigration and Customs Enforcement agents are also hindering seniors from going out for food, advocates say.

Council Member Alexa Aviles, whose district covers Red Hook and parts of Park Slope, Sunset Park, Borough Park, Dyker Heights, Bensonhurst, and Bath Beach where 46% of the residents were born in another country, said she has noticed this fear among her constituents.

“Now that ICE is in the community,” she said, “people are afraid and don’t want to stand in long lines where they feel vulnerable.”

Aviles, whose office participated in food distribution, said that fear of ICE “concerns everyone who does food distributions and any activity where now you have a mass of people.”

“The first question we are now asking is not ‘Do we have enough?’ Now it’s ‘What are we going to do if ICE shows up? How are we going to keep community members safe? Will people come out if we do this?’ ”

NYC Department for the Aging’s budget, which the Committee on Aging oversees, is less than 1% of the city’s budget. Zhuang is negotiating for more.

Rachel Sherrow, COO of Citymeals on Wheels, said society is too focused on youth and doesn’t take enough care of seniors.

“We are talking about universal pre-K, universal child care, universal all of that,” she said. “What about universal older adults, universal meals? An older adult should be getting at least three meals a day.”

Apolline Lamy is a freelance journalist in New York.

Scientists find clue to cause of noma, an illness that disfigures children across Africa

2026-04-30T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we’re following some remarkable medical advances: a potential breakthrough in a long-neglected disease, and new treatments and tests for the world’s deadliest parasite. We also have an update to last week’s story on American HIV aid, and, at the end, a sci-fi-meets-Ken-Kesey story that combines psychedelic toad-licking, ayahuasca, tobacco, and genetically engineered bacteria.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

‘Astonishing discovery’ for a little-studied, disfiguring disease

Scientists believe they may have finally found the root cause of noma, a disfiguring illness in the sad bucket of “neglected tropical diseases,” The Guardian reports.

Disease breakdown: Noma is a rare but rapidly progressing disease of the mouth and face. It’s largely a children’s disease of poverty, with no single, proven cause, but an estimated 30,000 to 140,000 cases a year. Most cases are in children under 6 years old, across a belt of African countries from Mauritania to Nigeria to Ethiopia. Untreated, it kills 90% of those affected, and even with treatment the heartbreaking disease often leaves lifelong facial deformities and scars.

The new discovery was a bit serendipitous. Researchers at the Liverpool School of Tropical Medicine set out to map the bacteria living in the mouths of 19 children with noma across Nigeria. In the process, they uncovered a previously unknown species of bacteria, now called Treponema A.

The obvious question followed: Could this be the cause of the illness? To make sure it wasn’t a fluke, the researchers went back to “reanalyze older samples from other noma patients” and found the same bacteria there, too.

As The Guardian reports, this “astonishing discovery” doesn’t necessarily prove that the new bacteria cause the disease, but it certainly gives scientists something concrete to chase. As one researcher put it, “we don’t know if [Treponema A] can colonize a noma wound, because of the architecture and the environment, or if it causes the noma wound.”

Still, it’s an incredible starting point.

I reached out to Stuart Ainsworth, an infection biology and microbiome expert at the University of Liverpool, and part of the team behind the discovery. We discussed what this finding means and what it shows about the value of researching neglected diseases.

I started by asking Ainsworth how a disease this severe could still have such basic unanswered questions, and how a lead like this could have gone unnoticed for so long. Ainsworth was frank: “There has hardly been any research on noma at all,” he said.

He pointed to a 2021 review of the history of noma research, which found that there have only been 147 studies done on the disease since the year 1850. “In comparison, there were around 650 papers on rabies in 2021 alone,” he told me.

The core issue is that noma, Ainsworth says, “is the quintessential neglected disease. It only affects the very poorest in society and typically occurs in remote rural regions.” And because those who aren’t killed by the disease are often “left debilitated and scarred and generally hidden from society,” he said, “there is little impetus globally to invest in research.”

It’s a brutal dynamic, and one that cuts to the core purpose of medical research. “The goal with all diseases is to eradicate them, or at least control them to the point where they are no longer an issue.” And yet, “all of these things are impossible if you do not have at least a very basic understanding of what is the cause of the disease,” he said.

But that bleak starting point is also what gives this kind of scientific work such an incredible upside. “We know so very little” about noma that even “simple targeted research could potentially have a huge impact,” he said.

Looking forward, Ainsworth says further research could help move beyond the current treatment for noma, which is a shotgun approach of broad antibiotics, and that “we hope that these types of studies will eventually enable us to develop the targeted prevention, diagnostic, and treatment options to eradicate or prevent noma.”

A stalling fight against HIV, part 2

Last week we covered new data that showed U.S.-funded HIV treatment holding steady on paper, but testing, prevention, and case detection dropped sharply, raising fears about a surge in new infections.

Well, there are a few follow-on stories that are worth your time.

(First, we’re owed a correction. I flagged the State Department’s claim that “20.6 million people” are on HIV treatment, but it appears that the official figures don’t actually match the underlying data, which puts the number closer to 20.3 million.)

Second, the person in charge of the science behind that data just left. Mike Reid, the HIV program’s chief science officer, stepped down. He blames a system where American HIV aid is being “entangled with access to critical minerals or geopolitical positioning,” to the detriment of the work, Reuters reports.

Reid posted a full essay on Substack upon his departure, and there are a few sections worth pulling out to understand why he walked.

Reid starts with the core shift:

“When life-saving health assistance, often beyond the immediate capacity of partner countries, is conditioned on unrelated commercial or strategic objectives, something essential is lost … That is not a marginal adjustment. It is a different model. And I do not believe that model is consistent with the purpose of global health. I do not believe it serves patients, or countries, or ultimately even the long-term interests of the United States.”

He follows with a strikingly blunt assessment, which directly contradicts the State Department’s framing, and echoes what many HIV experts have been warning about.

“We have asked partner governments to take on substantial new responsibilities despite constrained fiscal space, high levels of sovereign debt, and growing demographic pressures, all while programs themselves have been weakened by recent U.S. funding cuts. In places like Zambia, which I care about deeply, the consequences of stepping away too abruptly could be devastating, and avoidable. I have to take that possibility seriously.”

Ultimately, Reid casts his resignation as a break with the core idea of the field itself. “I’ve believed that global health — at its best — is a form of solidarity. Not charity. Not strategy.” And now, that very belief “is why I am resigning my post as chief science officer at PEPFAR in the U.S. State Department.”

A malaria drug for newborns

For the first time, there’s a malaria drug for newborns, Deutsche Welle reports.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

The treatment was just approved by the World Health Organization for “babies weighing less than 5 kilograms (11 pounds).” Its development closes what was previously a “medical care gap for 30 million babies born each year in malaria-endemic areas" across Africa, which is by far the hardest-hit continent.

Technically, it’s a new formulation of two existing treatments: artemether and lumefantrine, which were developed thanks to a secret Chinese military project in the ’60s and ’70s to aid the North during the Vietnam war. (Really!)

Together, the drugs hijack the malaria parasite’s eating process, so that the blood molecules (hemoglobin) that should feed it actually end up destroying it.

You may be asking: If this is the first ever treatment, how have sick infants been treated until now? Well, routinely “infants have been treated with drugs developed for older children,” an imperfect workaround, as these drugs can “expose newborns to risks of dosing errors and toxicity.”

My takeaway: It’s encouraging that medical science keeps providing tools to fight and treat this disease. Earlier this month, the WHO also approved three new rapid tests for “malaria parasites [that] have evolved to become harder to detect,” as they stopped producing the molecule that older tests relied on.

Very timely! In some countries in the Horn of Africa (like Ethiopia, Djibouti, and Somalia), those tests started missing “up to 80% of cases.”

India’s largest pharma deal

India’s largest drugmaker, Sun Pharmaceutical Industries, has just made the country’s “largest pharma deal,” Reuters reports.

The company has agreed to buy the U.S.-based Organon & Co. It’s an $11.75 billion all-cash deal, the most expensive overseas acquisition ever by an Indian company.

Why does this matter?

Let me pepper in a bit of context: As we’ve written before, India, the “pharmacy of the world,” is where a fifth of all generic drugs and well over half of all vaccines are manufactured. And Sun Pharma is India’s biggest drugmaker by revenue, churning out over a thousand separate medicines and drug ingredients. A true generics giant, those drugs include everything from diabetes treatments and psychiatric drugs to cancer therapies and dermatology medicines.

Meanwhile, Organon (which started as an insulin producer over 100 years ago) makes specialty medicines: contraceptives and drugs for pregnancy and menopause, along with a variety of other hormone-based therapies. Although it’s a minnow in the American market, it produces “70 women’s health and general medicines sold across about 140 countries.”

If you scan through the link you’ll see that the Reuters story is a business one, full of debt figures and deal details. What’s more interesting is what this deal reflects about India’s pharma sector more broadly.

The big takeaway is this: India’s pharmaceutical sector is enormous, and only growing. Many projections have the entire sector doubling in value from 2025 to just 2030. Much of that growth is expected to come from a shift out of cheap generics into specialty medicines, and so this is exactly the kind of deal that will help make that shift real.

Whatever you do, don’t smoke this

Let’s end on a fairly wild story from New Scientist: A research group based at the Weizmann Institute of Science in Israel has "engineered tobacco plants to produce five powerful psychedelic compounds,” all in a single plant.

As the authors argue, this could offer a more sustainable way to produce psychedelic drugs, “which are increasingly in demand for research and medical uses.”

What I find particularly interesting about this story isn’t just the tie dye-inducing tobacco plant. It’s the fascinating technique the scientists used, which lands just shy of permanent gene-editing.

Here’s the explainer from the story:

“[The scientists] modified Nicotiana benthamiana plants using a technique called agroinfiltration, which involves using a bacterium to introduce genes from other organisms into a plant. The modified plant then makes the proteins encoded by those genes, but the DNA isn’t incorporated into the plant’s genome, so the effect is short-lived.”

Ultimately, those bacteria induced the tobacco plants to produce psilocin and psilocybin, two compounds found in “magic mushrooms”; DMT, which is found in the psychoactive drink ayahuasca; and bufotenin and 5-methoxy-DMT, which are secreted by Colorado river toads.

The researchers argue that their method is a much easier way to produce these molecules for medical testing than, say, raising cages full of toads. And it’s doing it across biological kingdoms, creating compounds from fungi, plants, and animals in a single organism.

The takeaway: As the article outlines, “the idea of growing drugs through pharmaceutical farming, or ‘pharming,’ certainly isn’t new.” As far back as 2002, we’ve had corn engineered to produce trypsin, a digestive enzyme. But doing it temporarily, without forever altering the plant’s genome, limits the risk of these traits escaping or persisting in the wild.

And heck, it makes the infamous “Simpsons” “tomacco” plant look as everyday as a steamed ham.

Until next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Psychedelics offer exciting promise for mental health – if rolled out right

2026-04-29T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a global nonprofit that promotes economic mobility and well-being for vulnerable communities. Views expressed here are my own.

This week I am reminded how little we know about the brain and how that lack of understanding impairs our ability to address two of the most serious public health problems in America: severe mental illness and dementia.

A White House event was either a historic turning point for mental health or a dangerous workaround of the Food and Drug Administration’s safety regulations; and a new report found that Alzheimer’s drugs have almost no benefit.

We also saw updates to two important stories involving the Centers for Disease Control and Prevention and a chance to highlight one of the most important, but least well known, programs it runs.

Psychedelics and mental health: promising, but let’s do this right

In the past decade, there have been several positive developments in mental health, including a growing willingness of prominent people — athletes, elected officials, musicians — to talk about their struggles and reduce stigma. Unfortunately, there has not been an equivalent increase in access to services, and most treatment approaches have limited effectiveness or durability.

That is why there has been so much excitement recently around a new approach to serious mental illness: psychedelic-assisted therapy. We saw a remarkable event at the White House last week. President Donald Trump, flanked by Health and Human Services Secretary Robert F. Kennedy Jr. and podcaster Joe Rogan, signed an executive order directing federal agencies to accelerate research into psychedelic medicines and expand access to them for treating serious mental illness.

Psychedelics are a group of compounds either derived from naturally occurring organisms, such as psilocybin from “magic mushrooms” and ibogaine from a shrub found in Gabon, or synthesized in laboratories, such as LSD and MDMA. While chemically distinct, psychedelics have in common the ability to profoundly alter perception, cognition, and consciousness.

In mental health therapy, psychedelics work very differently from conventional pharmacology. Antidepressants and other approved psychiatric medications primarily seek to alleviate symptoms. Patients must take them daily, and symptoms recur when they stop.

In contrast, psychedelic therapy involves one structured session or a few sessions in which the person takes the psychedelic and undergoes talk therapy before, during, and after. Rather than suppressing emotions or thoughts as with traditional psychiatric medications, these compounds create a window of openness in which patients can access deeply buried feelings, e.g., grief, shame, trauma, and help to rewire the way people feel and think about problems.

As a JAMA editorial put it, the approach “addresses the cause of symptoms rather than merely suppressing them.”

Psychedelic therapy is primarily being evaluated for severe depression, post-traumatic stress disorder, obsessive-compulsive disorder, and substance-use disorders — conditions for which existing treatments often produce only modest, short-lived benefit.

The executive order commits $50 million to ibogaine research and directs the FDA to prioritize review of psychedelics holding the agency’s Breakthrough Therapy designation, reserved for drugs showing early evidence of substantial improvement over existing treatments.

I am genuinely excited about this research. And I am also concerned that the way it’s being rolled out could undermine its promise. While the early data are impressive, making therapy available at scale requires the government to ensure safety and efficacy the way we do for other medications.

The executive order expands access through the Right to Try Act, a pathway designed for terminally ill patients to obtain experimental treatments outside clinical trials. This administration has shown a fondness, unfortunately, for treating unproven compounds as standard consumer goods rather than medications.

For example, Kennedy has used a similar approach to peptides, arguing that individual freedom matters more than safety and efficacy. While there is substantial real-world data on the safety of most psychedelics, we need high-quality research to demonstrate the effectiveness of different dosages and treatment protocols. I believe this study on MDMA-assisted psychotherapy for PTSD, although somewhat controversial, shows what can and should be done to advance the field.

What I want is something modeled after the work of HIV/AIDS activists, such as Treatment Action Group. They believed — correctly — that access and evidence do not have to compete with each other. You can modernize trial designs to accelerate data collection and mobilize staffing to accelerate regulatory review, so that you can have safety, efficacy, and access.

Another more recent example was Operation Warp Speed for Covid vaccines. The result was faster access to medical interventions that actually worked. That is what I want for psychedelics.

Alzheimer’s drugs: when statistical significance isn’t enough

For decades, the leading hypothesis for Alzheimer’s disease has been that dementia is caused by the buildup of a protein called amyloid-beta in the brain, forming plaques that disrupt neurons and cause progressive cognitive decline. This “amyloid hypothesis” has driven billions of dollars in drug development.

The Cochrane Collaboration, an international network that systematically reviews the best available evidence, published an analysis this month of seven monoclonal antibody drugs developed to clear amyloid from the brain. The review examined 17 randomized controlled trials involving more than 20,000 patients and concluded that the clinical benefit of these drugs is, at best, trivial.

Cognitive function, dementia severity, and ability to manage daily activities showed little to no meaningful change after 18 months of treatment. The drugs can also increase the risk of brain swelling and bleeding, though in most patients these side effects cause no symptoms.

Some Alzheimer’s experts argue that the Cochrane review improperly lumps failed drugs together with the two most recently approved treatments. One critic compared it to mixing rotten ingredients with fresh food and declaring the meal inedible. While that is a legitimate methodological concern, even the trial results for those two recently approved drugs showed only modest slowing of cognitive decline, i.e., patients got worse, but just not as quickly as they would have without treatment.

Whether patients or their families can perceive that difference is genuinely unclear. As one Cochrane author put it, the benefit was “far below the minimal effect that’s needed to be noticeable at all for patients and caregivers.”

This points to one of the most underappreciated problems in pharmaceutical regulation: the gap between statistical significance and clinical significance. A drug can clear an approval threshold based on an effect large enough to be measurable, but too small to matter to anyone living with the disease.

One of the successes of public health is longevity: People are living longer across the world. But our ability to prevent and manage conditions of aging is not advancing fast enough. This latest study shows that even the best available pharmacological therapies are not worth using.

CDC: one step backward, one step forward, and one cause for celebration

Two weeks ago, I wrote about how the CDC had been blocked from publishing a study showing that Covid vaccines reduced hospitalizations by about 55% during the past winter season. An HHS spokesman confirmed last week it will not be published, citing methodological concerns, even though a flu vaccine study using the exact same methods was published in the Morbidity and Mortality Weekly Report just one week before the Covid study was blocked.

Unfortunately, this confirms what I have been worried about all along. Even with widespread uproar in the media that a methodologically sound study was being blocked, the current administration will continue to hide data that demonstrate the harms of the Covid virus and the benefits of Covid vaccines.

On a more hopeful note, the White House nominated Dr. Erica Schwartz, a former deputy surgeon general and retired Coast Guard officer, to serve as the permanent CDC director. Dr. Jennifer Shuford, Texas state health commissioner, was announced as incoming CDC chief medical officer. I think the public health community needs to see this as a minor victory in the ongoing battle to protect the CDC from further damage.

I have heard from many current and former CDC colleagues that they have concerns about Schwartz’s actions when she was deputy surgeon general, but they are absolutely elated by the choice of Shuford as chief medical officer.

Many people who have worked with Shuford in the past, including during the large Texas measles outbreak in 2024, have praised her knowledge, skills, and temperament and are holding out hope that she can serve as an effective counterbalance to some of the anti-science positions that HHS leadership continues to push.

Finally, I want to highlight the 75th anniversary of one of the most important and least known public health programs in the country: The CDC’s Epidemic Intelligence Service. I entered the program after completing my medical residency, and EIS taught me skills I could not have learned anywhere else.

I learned to design epidemiologic studies by investigating real outbreaks, received hands-on mentorship in policy development and public communication, and worked with government agencies at every level, domestically and globally over two years.

Since 1951, EIS has trained more than 4,300 people — including physicians, veterinarians, nurses, pharmacists, lawyers — who have investigated nearly every major public health crisis of the past seven decades: smallpox, HIV/AIDS, Ebola, influenza pandemics, the 2001 anthrax attacks, and Covid-19.

Today, 1 in 3 state epidemiologists in the United States is an EIS alumnus, and 4 of the 12 CDC directors in history completed the program. At a moment when the CDC’s institutional capacity is under serious strain, it is worth recognizing what 75 years of investment in training has built and what would be lost if that were allowed to erode.

While many lay people hear about the limits of science and turn away to other approaches, I think we should see those limits as a reason to demand more. We need more trials, more rigorous review of data, and more protection of the institutions, like EIS, that have spent 75 years turning science into health promotion and disease prevention.

Until next week,

Jay

Georgia ranks 48th for Hispanic health care, driven by high uninsured rates

2026-04-29T04:01:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Georgia ranks second worst in the nation for Hispanic health care, with high rates of uninsured adults and children, according to a report released Wednesday by The Commonwealth Fund.

The report used data for 24 health indicators from 2023 and 2024 to rank how states’ health systems perform for different racial groups.

Poor access to care and low quality of services drove Georgia’s 48th-place ranking for Hispanic health. Only Arkansas had a worse score. (There was insufficient data to rank Vermont and Tennessee; Washington, D.C., ranked second).

In Georgia, 40% of Hispanic adults are uninsured, compared to 23% nationwide. Likewise, 18% of Hispanic children are uninsured, compared to 10% nationwide.

That can make it hard to get care, said David Radley, senior scientist at The Commonwealth Fund, a private foundation that conducts health research and promotes health equity. Only 56% of Hispanic children had age-appropriate medical and dental care visits, lower than other ethnic groups in Georgia.

About 1.1 million Hispanic people live in Georgia, about 11% of the state’s population. The segment has grown by nearly a third since 2010, according to a report published by the Latino Community Fund and Neighborhood Nexus in 2024.

Still, the state’s Hispanic residents have better health outcomes on some indicators than other groups.

For example, Hispanic and Asian American people have much lower breast cancer death rates (at 10 per 100,000 female population) than Black and white Georgians.

That’s an example of what health researchers call the Hispanic or Latino paradox: “Hispanic people, in general, have a hard time accessing care, but they also have better health outcomes,” Radley told Healthbeat.

One factor may be age: Georgia’s Hispanic population is younger than the state’s overall population, Radley said.

The median age for Georgia’s Hispanic population is 27.7, compared to 37.6 for the state as a whole, according to U.S. Census data.

Gigi Pedraza, executive director of the Latino Community Fund, said, “People from Latin America that migrate to the U.S. (and in general most immigrants) have better health outcomes that decline the longer we stay in the U.S.”

Once here, they may lack access to healthy foods, have less physical activity, and face social and economic stressors, she said.

Many Hispanic people in Georgia are self-employed, may work physically demanding jobs and cannot afford health insurance. They often cannot access safety-net programs due to their immigration status.

Undocumented immigrants are not able to purchase insurance through the Affordable Care Act or qualify for Medicaid or Medicare in Georgia. The One Big Beautiful Bill passed by Congress and signed by President Donald Trump in July further restricts Medicaid eligibility for many lawfully present immigrants, such as refugees, asylum seekers, and survivors of domestic violence and trafficking.

Anti-immigrant rhetoric and fear about deportations also has contributed to people’s reluctance to seek health care, Pedraza said.

“Parents feel it is not for their families, they cannot trust the system or their decision-makers,” she said.

Asian Americans had the best overall score in Georgia, indicating better health care access, quality, and outcomes, followed by white people.

Health disparities persist for Black Georgians

Health system performance for Black Georgians was slightly better than other states’, but disparities remain, Radley said.

“Tragically, this is reflected across the age continuum,” said Dr. Harry Heiman, a professor at the Georgia State University School of Public Health.

For example, 10.7 Black infants per 1,000 live births die in Georgia, similar to the 10.9 rate for Black people nationally. But that’s more than double the rate for white infants in Georgia, Radley said.

Likewise, while Black women have high rates of screening for breast cancer, Black women die of breast cancer at higher rates than other racial groups.

Sixteen percent of Black adults in Georgia are uninsured, compared to 12% nationally.

People skipping health care due to costs

Overall, health care costs appear to be one driver of poor outcomes in Georgia, in line with nationwide trends.

Rates of people who skipped care because of cost hit record lows in 2021 and 2022, according to The Commonwealth Fund report. That was likely due to pandemic-era policies, such as enhanced premium tax credits for ACA insurance plans and continuous enrollment for Medicaid, Radley said.

Now those numbers have started to increase again nationwide.

High uninsured rates and lack of access to care affect many Georgians, regardless of their race, Heiman said, and reflect “system and structural-level failures that affect all Georgians.”

Georgia is one of 10 states that have not expanded Medicaid.

In Georgia, 17% of Black adults, 29% of Hispanic adults, 13% of white adults, and 10% of Asian American adults skipped care because of cost, according to data from 2023 and 2024.

And that was before recent policy changes that have led to an increase in the number of people without health insurance, Radley said.

More than half a million Georgians have lost health insurance due to increased costs for ACA plans after a tax credit expired in December.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

How the South Carolina measles outbreak grew from 5 to 997 cases

2026-04-27T23:55:10+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The South Carolina measles outbreak is one of the largest in the United States in decades.

It started with just five known cases in October, but by January exploded to 847 – becoming larger than last year’s deadly outbreak in Texas. By mid March, the outbreak had further grown to 997 known cases.

Along the way, hundreds of additional people in South Carolina – many of them children at schools with low vaccination rates – have had to stay in home quarantine for up to 21 days because they aren’t immunized and have been exposed to contagious people.

South Carolina’s state epidemiologist, Dr. Linda Bell, has said there also were likely many more people who weren’t in quarantine, but should have been. They were unaware they had been exposed during the normal course of their lives: Going to work, school, and church, shopping for groceries, dining in restaurants, and visiting museums.

Measles spreads through the air and can linger in a room for two hours after an infectious person has left. The people who are spreading the disease often don’t know they have it: They are contagious for four days before they develop the virus’ hallmark rash.

A Healthbeat review of the outbreak’s history provides a detailed timeline of how the South Carolina Department of Public Health worked to trace and contain new infections. For a while, the outbreak smoldered with few new cases. Then the holiday season supercharged the spread in January.

The South Carolina outbreak was declared over on April 27.

Here is how it happened.

October 2, 2025 - South Carolina announces measles outbreak

Total outbreak cases: 5.

The South Carolina Department of Public Health announces it has confirmed a measles outbreak in the Upstate region, the northwest part of the state that includes Spartanburg County. During 2025, the state had only identified three earlier measles cases: two in July and one in early September – and those were linked to exposures during international travel, plus one close contact of a traveler who became infected. “We now have identified five cases in a little more than a week,” Bell said. “This sharp uptick in cases and the unknown source of two of the recent cases indicates unrecognized community spread.”

October 7, 2025 - Two schools have early outbreak cases

Total outbreak cases: 7. New cases: 2.

Two additional cases of measles are identified in Spartanburg County, raising to seven outbreak cases that had been reported since Sept. 25. None have an identified source, state health officials said, “suggesting that measles is circulating in the community.” Two schools – Global Academy of South Carolina, a public charter school where state data show only 21% of students had all their school vaccinations, and Fairforest Elementary, a public school where 82% of students were up-to-date on their school shots – are locations with confirmed measles cases. Health officials identified 153 unvaccinated students at the two schools who were exposed and at risk of measles infection, resulting in their required exclusion from classes until the 21-day period of potential disease transmission was over. The school exclusion periods were over on Oct. 21 for the Global Academy students, and on Oct. 22 for the Fairforest students.

Vaccination coverage of 95% is needed in local communities to stop the spread of measles. Across Spartanburg County, the state health department estimates that just 90% of school-age children are fully vaccinated. Rates at some schools are even lower, state data show.

Global Academy of South Carolina, a public charter school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

October 9, 2025 - A child in Greenville County has measles

Total outbreak cases: 8*. New cases: 1.

State health officials announce another case of measles, a child in Greenville County, which borders the west side of Spartanburg County. While it was not immediately clear whether the child’s illness was related to the Spartanburg County outbreak, health officials eventually included the case in the outbreak count. “What this case tells us is that there is active, unrecognized community transmission of measles occurring in the Upstate, which makes it vital to ensure that the public have received their measles vaccinations,” the state health department said. The department would later identify the Crunch Fitness gym at 1332 S. Pleasantburg Dr. in Greenville as the source of the child’s exposure on Sept. 30.

(*) Total case count includes this Greenville County child, whose measles case was later determined to be an outbreak case on Oct. 21.

October 13, 2025 – Quarantines appear to be working

Outbreak investigators from the state health department are optimistic about their efforts to control the spread of measles at Global Academy of South Carolina and Fairforest Elementary, according to internal health department records obtained by Healthbeat. “The quarantine of students from Global Academy and Fairforest Elementary appears to be working. The recent confirmed cases in those exposure groups did not lead to additional case investigations because they were already in quarantine,” according to an Oct. 13 email obtained by Healthbeat that the state health department sent to staff in the governor’s office.

October 14, 2025 - School exposures result in more cases

Total outbreak cases: 13*. New cases: 5.

Five new measles infections are confirmed among unvaccinated students who were already in quarantine at home because of previously reported school exposures. The department previously identified exposures at Global Academy of South Carolina and Fairforest Elementary. “Because they were quarantining before they became infectious, no additional exposures occurred with these new cases,” state health officials said. The state health department announces the next day that it will be sending its mobile measles vaccination unit to hold five events at four locations in Spartanburg County – including churches, a community center, and a library.

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 17, 2025 - Three cases among contacts in quarantine

Total outbreak cases: 16*. New cases: 3.

Three new cases are identified among close contacts of people with measles who were already in quarantine at home. State health officials said the new cases show how early quarantine after an identified exposure “is highly effective in preventing community spread.”

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 21, 2025 - Four new cases in Spartanburg County

Total outbreak cases: 20. New cases 4.

Two new cases are confirmed among close contacts of people already in home quarantine. And two additional measles cases are identified in association with a business in Spartanburg that had “no public exposures,” health officials said. They also announce that the Greenville County child exposed at a gym whose case was announced on Oct. 9 is now being considered an outbreak case “due to ongoing unrecognized community transmission.”

October 24, 2025 - Two more sickened with measles

Total outbreak cases: 22. New cases 2.

Two new measles cases are confirmed in Spartanburg County; both are linked to close contacts of people with measles who had been in quarantine at home, state health officials announced.

October 28, 2025 - Mobile clinics give 24 shots as more fall ill

Total outbreak cases: 30. New cases: 8.

As state health officials announce eight new measles cases in Spartanburg County among close contacts of people already in home quarantine, they continue to send their mobile vaccination clinic to offer free measles shots at more locations. Multiple vaccination events have been offered in the community since Oct. 16, but only 24 vaccines have been administered: 19 to adults and five to children, state health officials said.

October 31, 2025 - State emphasizes isolation, quarantine

Total outbreak cases: 34. New cases: 4.

Four new measles infections were confirmed in Spartanburg County. All were linked to close contacts of previously known cases. “No public exposures have been identified from these cases,” state health officials said. “We continue to rely on isolation and quarantine measures for those who have been exposed and are unvaccinated to prevent the spread of measles in the community to contain this outbreak.” The state health department added that its “additional response” to the outbreak “is to encourage protection with the measles-mumps-rubella (MMR) vaccine for those who are not immune.” With free mobile vaccination clinics ongoing, just 28 doses of MMR vaccine – 23 to adults and five to children – have been administered since the outreach events began on Oct. 16.

November 4, 2025 – No new cases as holiday season looms

Total outbreak cases: 34. New cases: 0.

No new measles cases were identified by health officials since the previous Friday. Yet they cautioned that 34 people were still in quarantine because they were unvaccinated and had been exposed to someone who was contagious. The latest end date for those in quarantine to no longer be at risk of developing measles is Nov. 24. “We are reminding people that travel for the upcoming holidays increases the risk of exposures greatly for those traveling and for those accepting visitors,” the state health department said. “Consider getting vaccinated now to prevent measles from disrupting your holiday plans.”

November 7, 2025 – Another case confirmed, more expected

Total outbreak cases: 35. New cases: 1.

State health officials announce they have identified one new measles case and are still investigating how many people may have been exposed to the virus by this person. “We also expect more cases to come in the days ahead from exposed family members of known previous cases,” the state health department said, noting that there are 31 people in quarantine.

November 10, 2025 – Restaurant mistakenly flagged for exposure

While investigating the ongoing outbreak, state health officials put out a press release saying a person who was infectious with measles was at the Kanpai of Tokyo restaurant at 2300 Winchester Pl. in Spartanburg on Nov. 2 from 3 to 6 p.m.; they urged anyone who believes they were exposed – particularly those without immunity – to contact their health care providers. But a mistake was made, and the health department said it had been given the wrong date: The person actually dined at the restaurant in late October – at a time when they weren’t infectious.

“Our business went down for a good two months. We lost sales, we lost wages,” general manager Nick Nakincheng told Healthbeat. “People thought we closed, and then people were just scared to even come at all.” Business is finally returning, he said in January. But the state health department, while acknowledging the error to the Post and Courier in December, still had not corrected its press release as of Jan. 26. The department declined to answer Healthbeat’s questions about the error or explain why the press release remained posted on its website without correction – even though it had corrected at least one other outbreak press release. After Healthbeat published this timeline, the department added a correction to its Kanpai of Tokyo press release.

The general manager of Kanpai of Tokyo said the Spartanburg restaurant lost business after the state health department publicly warned in November 2025 that an infectious person had dined there. It later turned out that outbreak investigators were given a wrong date – and the person wasn’t contagious when they were at the restaurant.

November 12, 2025 – Eight new measles cases identified

Total outbreak cases: 43. New cases: 8.

Of the eight new measles cases announced by state officials, six were household members of known cases who were in quarantine. But the source of the infection for the other two cases, who were people from the same household, is unclear. “The unidentified source of the two new cases reinforces our concern about potential ongoing community transmission,” the state health department said.

November 14, 2025 – One new measles case

Total outbreak cases: 44. New cases 1.

Just one new measles case has been identified since the state’s last update and the extent of others exposed to the person is still under investigation, state health officials said; 18 people are currently in quarantine because of outbreak exposures.

November 18, 2025 – More cases, more public exposures

Total outbreak cases: 49. New cases: 5.

While two of the five new cases are household members of known measles cases in quarantine, the source of the infection of the other three people is unknown, state health officials said. “The initial investigation of contacts of the new cases has determined potential exposures in public settings. Additional information will be provided once more details are obtained,” the department said, noting that 84 people are in quarantine and that direct contacts and facilities that have been impacted are being notified about the potential exposures.

November 21, 2025 – School, church, airport exposures

Total outbreak cases: 52. New cases: 3.

State health officials announce the confirmation of three new measles cases – and that as a result of contact tracing by health workers, there are now 137 people in quarantine because they are unvaccinated and have been exposed, plus one person in isolation because of infection. Many of these people are from schools in Spartanburg County: 57 are from Lyman Elementary School (where 89% of students were up-to-date on school vaccines); 55 are from Boiling Springs Middle School; and one attends D.R. Hill Middle School (where 88% of students were up-to-date on vaccines). Health officials also warned that an employee at the Greenville-Spartanburg International Airport who was infected with measles may have exposed airport visitors between 9 a.m. and 7 p.m. on Nov. 10 and 11. They also said an infectious person attended the Way of Truth Church in Inman, S.C., which is in Spartanburg County, from 7 to 11 p.m. on Nov. 7 and from 10 a.m. to 2 p.m. on Nov. 9.

State health officials linked multiple outbreak cases to exposures that occurred at the Way of Truth Church in Inman, S.C., which is in Spartanburg County.

November 25, 2025 – Public exposure at county treasurer’s office

Total outbreak cases 55. New cases: 3.

On the Tuesday before Thanksgiving, the state health department announces they have identified three additional measles cases. Two of the people are household members of known cases. The source of the third person’s infection is still being investigated. Meanwhile, the department warns of another public exposure location: An infectious person was at the Spartanburg County Treasurer’s Office on Nov. 17 and 18 during the hours the office was open.

November 28, 2025 – Public exposure event at Costco

Total outbreak cases: 62. New cases: 7.

Of the seven new measles cases announced, six were household members of known cases who were in quarantine, and one was a person exposed in a school setting who also was in quarantine. Total people currently in quarantine: 144; six in isolation. State health officials also warn there was a potential measles exposure event at a Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18 between 9:30 a.m. and 1 p.m.

As the outbreak grew, state health officials warned of infectious people potentially exposing others while shopping at a range of retail stores. One incident occurred at the Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18, 2025.

December 2, 2025 - More school exposures, 14 new cases

Total outbreak cases: 76. New cases: 14.

Eight of the 14 new measles cases announced by state health officials were the result of the previously reported exposure at the Way of Truth Church in Inman. Three of the new cases were exposed in a school setting, and the other three are still under investigation. Based on public health investigations of the new cases, the public was alerted that four Spartanburg County schools were the sites of additional measles exposures, requiring dozens of unvaccinated students to be excluded from school and quarantined. The schools involved: Hendrix Elementary School, where state data show 87% of students are up-to-date on school vaccines (40 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (13 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (5 students in quarantine); and Tyger River Elementary School, where 89% of students are up-to-date on vaccines (17 students in quarantine).

December 5, 2025 – Measles quarantines hit more schools

Total outbreak cases: 84. New cases: 8.

Eight new measles cases are announced by state health officials, but the number of people in quarantine and at risk of developing measles has jumped to 281. Based on public health investigations of the new cases, the public was alerted to new measles exposures at four additional Spartanburg County schools: Fairforest Elementary School, where 82% of students were up-to-date on their school vaccines (44 students in quarantine); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (61 students in quarantine); Fairforest Middle School, where 90% of students are up-to-date on vaccines (fewer than 5 students in quarantine); Dorman Freshman Campus, where 93% of students are up-to-date on vaccines (15 students in quarantine). This is the second round of quarantines at Fairforest Elementary, which was one of the earliest sites of known measles cases in early October.

December 9, 2025 – Earlier church exposure fuels new infections

Total outbreak cases: 111. New cases: 27.

Of the 27 new measles cases announced, 16 resulted from previously reported exposure incidents in November at Way of Truth Church in Inman. Eight of the new infections were among household members of known cases. One infection was from a school exposure, one had an unknown source, and one was from an exposure in a health care setting. State health officials said the new cases have resulted in additional public exposures at Inman Intermediate School, where state data show 83% of students were up-to-date on vaccines (43 students in quarantine). Officials continue to encourage those who may have been exposed to measles to alert their health care provider in advance of going to their office, so that measures can be taken to protect against additional exposures.

December 12, 2025 – More than 300 in quarantine, 15 new cases

Total outbreak cases: 126. New cases: 15.

As state health officials investigate the contacts of 15 new measles cases, they identified two more Spartanburg County schools where public exposures have occurred: Campobello Gramling School, where state data show 80% of students are up-to-date on school vaccines (67 students in quarantine), and Boiling Springs Elementary School, where 80% of students are up-to-date on vaccines (16 students in quarantine). Overall, 303 people are in quarantine, many of them students at 11 schools. The large number in quarantine is a potential warning sign of the magnitude of future measles cases because there is a lag time between when people are exposed and when they start feeling sick – typically seven to 10 days, but sometimes as long as 21 days.

Of the 15 new cases, 13 involved exposures within households with known measles cases; one infection involved a neighborhood contact; and the source of one is unknown and under investigation.

Boiling Springs Elementary, a public school operated by Spartanburg County School District Two, is among several schools in South Carolina’s Upstate region that have had multiple rounds of quarantines.

December 16, 2025 - Nine new cases, another school exposure

Total outbreak cases: 135. New cases: 9.

Of the nine new measles cases announced, five were the result of a previously reported exposure at Way of Truth Church in Inman. Three cases involved known household exposures and one involved a neighborhood contact. Investigations of the new cases identified an additional Spartanburg County school with public exposures: Berry Shoals Elementary School, where 93% of students are up-to-date on school vaccines (44 students in quarantine).

December 19, 2025 – Another school with measles exposures

Total outbreak cases: 144. New cases: 9.

State health officials announce nine new measles cases: Four were infections of household members of known cases; one was from a previously identified school exposure; one was from a previously identified exposure at Way of Truth Church in Inman; and the source of three infections is unknown. Contact investigations for the new cases identified an additional school where measles exposures have occurred: New Prospect Elementary School in Inman, where 82% of students are up-to-date on school vaccines (56 students in quarantine).

December 23, 2025 – Nine new measles cases identified

Total outbreak cases: 153. New cases: 9.

Of the nine new cases announced, five resulted from household exposures to known cases; two involved a previously known school exposure; the source of one is unknown; and another is still being investigated.

December 26, 2025 – Three new measles cases identified

Total outbreak cases: 156. New cases: 3.

Amid the holiday season, three new measles cases were reported between Tuesday and Friday. All were the result of a previously reported school exposure, state officials said. There are 252 people in quarantine and three in isolation. The latest end date for those in quarantine is Jan. 15.

December 29, 2025 – School contact tracing delayed by holidays, resistance

Although it was not made public at the time, internal health department records later obtained by Healthbeat under South Carolina’s public records law show how efforts to quickly quarantine schoolchildren exposed to measles before winter break were hampered by school closures, as well as resistance from one school. With students continuing to fall ill with measles in late December, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff and others who had been exposed before the two-week break. The schools where state records show contact-tracing delays occurred included: Global Academy of South Carolina, Sugar Ridge Elementary, Boiling Springs Elementary, and Jesse S. Bobo Elementary. The result: During this critical period in the outbreak, as cases were rising and more people were socializing and traveling, public health officials were not able to warn potentially infected people they needed to quarantine at home.

“Our inability to get contact information for potentially exposed students and notify those families resulted in some people being out and about in the community without knowing that they were infectious,” Bell would later tell Healthbeat. “The consequences being new cases due to additional exposures from people who would have otherwise been in quarantine had we been able to make contact.” At one school that health officials were able to reach by email on Dec. 29 – Westgate Christian School in Spartanburg – the principal refused to provide required information about students who had been exposed to measles. “We will not provide personal details and immunization status information for the students in our school,” the principal replied the next day. After state health officials sent Westgate a “final notice” letter in early January that threatened enforcement actions and potential fines, the school provided the information.

December 30, 2025 – As cases rise, 3 hospitalized from measles

Total outbreak cases: 176. New cases: 20.

Since Friday, state health officials identified 20 new measles cases and learned of three people – including adults and children – who required hospitalization because of complications from the disease. Citing patient privacy, health officials would not provide additional details about the hospitalized cases. The measles virus can cause serious complications such as pneumonia, brain inflammation, risks of premature births for pregnant mothers and it also can weaken a person’s immune system. Of the new cases, seven involved household exposures, five involved a previously known school exposure, two involved a church exposure, and one resulted from an exposure at either school or church, the state health department said.

January 2, 2026 – Nine more measles cases identified

Total outbreak cases: 185. New cases: 9.

Of the nine new cases detected, four were household exposures of known measles cases; one involved a previously reported school exposure; one case is still being investigated; and the source of three cases is unknown. The number of people in quarantine because they lack immunity and have been exposed: 223; three are in isolation for infections.

January 3, 2026 – Exposures at Best Buy, restaurant, library

The state health department announces that a person who did not know they were infectious with measles visited multiple public locations during the previous week. On Dec. 24, they visited the Nose Dive Restaurant, a gastropub at 116 S. Main St. in Greenville, then went to a Best Buy store at 1125 Woodruff Rd. in Greenville. A few days later, on Dec. 27, they attended an afternoon planetarium show about solar superstorms at the Spartanburg County Public Libraries headquarters library in downtown Spartanburg, which in October opened a new planetarium learning center with a 135-seat domed theater. Todd Stephens, the county’s librarian, said a public health official called him the day before the state’s press release went out and let him know someone with measles had been in the library’s theater a week earlier. “We have a response plan on Covid. We don’t have a document like that for this,” Stephens told Healthbeat. “But I can say we applied some of those principles that we’ve learned.” He said he’s not received any calls or concerns from library patrons about the potential exposure and he is not aware of anyone becoming infected.

A person who didn’t know they were infectious with measles attended an afternoon show in the Spartanburg County Libraries 135-seat domed planetarium theater on Dec. 27, 2025 in downtown Spartanburg, according to state health officials.

January 5, 2026 – S.C. outbreak exposes other states

People infected in South Carolina’s outbreak have exposed others while traveling, including at sites in Kentucky, North Carolina, Texas, Georgia, and New Mexico, according to a Jan. 5 memo the South Carolina Department of Public Health sent to staff at the South Carolina governor’s office. “The three latter sites are all associated with one case,” said the memo, which Healthbeat obtained with a public records request. “We sent an exposure notifications [sic] to all U.S. jurisdictions regarding the potential for exposure at the out-of-state-sites.”

January 6, 2026 – Public exposures at more schools, churches

Total outbreak cases: 211. New cases: 26.

Among the 26 new cases identified by state health officials, 19 involved exposures in households with known cases and at schools with previously announced exposures. Four of the new infections resulted from an exposure at church. One case has an unknown source, and two are still being investigated. Another 144 people without immunity are in quarantine because of exposures. Investigations of recent cases identified multiple locations of public exposures. Nine students are in quarantine at two Spartanburg County schools where these exposures occurred: Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines. It was the second time during the outbreak that students at Boiling Springs Elementary had to be quarantined; the previous quarantines were in December. Churches where public exposures occurred, health officials said, included: Tabernacle of Salvation Church, Slavic Pentecostal Church of Spartanburg, Ark of Salvation Church, and the Unitarian Universalist Church of Spartanburg.

January 7, 2026 - Health alert sent to providers, facilities

The state department of public health sent out a statewide alert to all health care providers and facilities about the importance of having “heightened awareness” for measles and providing advice on the recommended measures for the use of masks and rapid isolation of people suspected of having measles infections to protect others in health care settings from being exposed.

January 9, 2026 – Measles cases spike with 99 new infections

Total outbreak cases: 310. New cases: 99.

Between Tuesday and Friday this week, state health officials identified 99 new cases of measles. They said another 200 people were in quarantine because of exposures. Dr. Linda Bell, the state epidemiologist, warned it was becoming increasingly difficult to identify likely sources of infection because of the increasing number of public exposure sites. “The number of those in quarantine does not reflect the number actually exposed,” Bell said. “An increasing number of public exposure sites are being identified with likely hundreds more people exposed who are not aware they should be in quarantine if they are not immune to measles.” The department flags one new public exposure site: Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Jesse S. Bobo Elementary School, a public school in Spartanburg County School District Six, had a measles exposure incident that state health officials announced on Jan. 9, 2026.

January 12, 2026 – Measles exposures at BMW, Michelin plants

Although not publicly known at the time, internal South Carolina Department of Public Health records obtained by Healthbeat show that large manufacturing plants for BMW and Michelin in Spartanburg were the sites of measles exposure incidents in January. While the health department alerted staff at the South Carolina governor’s office about the plant exposures in a Jan. 12 email, these exposures at large, prominent manufacturing plants weren’t publicly announced. When Healthbeat later revealed the exposures, BMW said it kept its workforce informed about measles cases at the plant and that the company was providing on-site access to vaccinations. Michelin declined to answer questions about what actions it took.

January 13, 2026 - Surge continues with 124 new measles cases

Total outbreak cases: 434. New cases: 124.

Health officials announce another surge in cases, with 124 new infections identified in recent days. They said another 409 people are in isolation because they were exposed and lacked vaccination or immunity from previous infection; 17 were in isolation. Investigators have learned of more than 30 public locations where infectious people have potentially exposed others to measles in recent days, Bell said. Besides schools, these locations have included churches, restaurants, and many health care settings, she said. But the department is only naming locations where details about exposure dates and times are available to allow the public to take informed actions, she said.

Adding to concerns: Health officials learned that a person who didn’t know they were infectious had visited the South Carolina State Museum in Columbia – the state’s capital city, which is about 95 miles southeast of the outbreak area in Spartanburg County. No measles cases have been identified outside the Upstate region, officials said. “Circulation of the measles virus is increasing in numerous community settings in the Upstate, and the risk of infection to those who are not immune to measles by vaccination or previous disease is increasing,” Bell said. “This includes people who may be traveling to the upstate region. So [the Department of Public Health] strongly encourages those who are not protected to consider getting vaccinated now to protect against unexpected exposures, against illness, and possible complications.”

January 15, 2026 – S.C. residents spark Washington, N.C. cases

The Snohomish County Health Department in Washington state announces that an infectious family from South Carolina who was visiting the area two weeks ago is now connected to three new measles cases among local children. The three cases are considered an outbreak and a sign the virus is spreading in the community, the department said. The South Carolina family members, one adult and two children, were infectious while visiting multiple locations in Everett, Marysville, and Mukilteo – including schools – from Dec. 27, 2025 through Jan. 1, 2026. They also flew through Seattle-Tacoma International Airport. “We are hoping to contain it, but unfortunately there have been a number of exposure sites already and there are likely more cases in the community that we do not know about yet,” said Dr. James Lewis, the Snohomish County health officer.

In North Carolina, state health officials announce that the South Carolina outbreak is connected to two cases of measles in unvaccinated siblings Buncombe County, N.C.

January 16, 2026 – Schools hit with repeated quarantines

Total outbreak cases: 558. New cases: 124.

Another 124 new measles cases are announced by state health officials; 531 people are in quarantine; and 85 are in isolation. The outbreak continues to be centered around Spartanburg County, they said.

Based on investigations of the newest cases, health officials said public exposures have occurred at nine schools: Holly Springs-Motlow Elementary, where state data show 80% of students are up-to-date on school vaccines (53 students in quarantine); Campobello Gramling School, where 80% of students are up-to-date on vaccines (46 students in quarantine – and the school’s second round of quarantines); Crestview Elementary, where 90% of students are up-to-date on vaccines (22 students in quarantine); Libertas Academy, where 74% of students are up-to-date on their vaccines (15 students in quarantine); Fairforest Elementary, where 82% of students were up-to-date on their school vaccines (14 students in quarantine – and the third round of quarantines at this school); Berry Shoals Elementary, where 93% of students are up-to-date on school vaccines (14 students in quarantine – and the school’s second round of quarantines); Oakland Elementary, where 83% of students are up-to-date on vaccines (6 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (6 students in quarantine – and the school’s second round of quarantines); and Landrum High School, where 94% of students are up-to-date on vaccines (5 students in quarantine).

Additional public exposures occurred during certain hours at: Walmart at 203 Cedar Springs Rd. in Spartanburg on Jan. 3; Wash Depot at 2177 S. Pine St. in Spartanburg on Jan. 3 and 4; and at Bintime Spartanburg at 445 S. Blackstock Rd. in Spartanburg on Jan. 7.

Fairforest Elementary, a public school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

January 20, 2026 – Exposures at schools, Clemson University

Total outbreak cases: 646. New cases: 88.

“As we continue to watch this daily surge in cases, DPH strongly encourages those who are not protected to take advantage of the opportunity to get protected,” Dr. Linda Bell, the state epidemiologist, says at a press briefing about the outbreak numbers released on Jan. 20.

In recent days, state health officials identified 88 new measles cases. They said 538 people are in quarantine and 33 in isolation. Bell said that since the outbreak began,10 people, including adults and children, have required hospitalization for measles complications.

Through investigations of the latest cases, health officials have identified six additional schools where public exposures have recently occurred: Starr Elementary, where 96% of students are up-to-date on school vaccines (17 students in quarantine); Global Academy of South Carolina, where 21% of students are up-to-date on vaccines (13 students in quarantine – and this school’s second round of quarantines); Boiling Springs High School, where 92% of students are up-to-date on vaccines (11 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (fewer than 5 students in quarantine – this is the school’s second round of quarantines); Boiling Springs Elementary (students in quarantine to be determined – this is the school’s third round of quarantines); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (quarantine numbers still being determined – this is the school’s second round of quarantines).

Public exposures have also been identified at Clemson University (where 34 students were in quarantine) and Anderson University (where 50 students were in quarantine). While both universities are in South Carolina’s Upstate region, they are in counties west and southwest of the Spartanburg County area where the outbreak has been centered.

Additional public measles exposures were announced as occurring during certain hours at two grocery stores: a Publix at 2153 E. Main St. in Duncan on Jan. 16; and a Food Lion at 11153 Asheville Hwy. in Inman on Jan. 11 and 12.

January 23, 2026 – Cases reach 700, plus 485 in quarantine

Total outbreak cases: 700. New cases: 54.

The number of known cases in South Carolina’s measles outbreak is approaching the total cases in the huge Texas outbreak last year. When the Texas outbreak was declared over in August 2025, the state health department had confirmed 762 measles cases since late January 2025. Two school-age children died and 99 people required hospitalization. The South Carolina Department of Public Health announces it has identified 54 new measles cases in the Upstate region – raising the total outbreak cases to 700. There are an additional 485 people in quarantine and 10 people are in isolation, the department said. Since the outbreak began, 12 people have required hospitalization.

Case investigations have identified additional public exposures at multiple schools: Cooley Springs-Fingerville Elementary, where 77% of students are up-to-date on their school vaccines (22 students in quarantine); Cannons Elementary, where 95% of students are up-to-date on vaccines (8 students in quarantine); Abner Creek Middle School, where 89% of students are up-to-date on vaccines (the number of students being quarantined is still being determined); Mayo Elementary, where 89% of students are up-to-date on vaccines (student quarantines still being determined); and Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines (student quarantines still being determined, this is the second round of quarantines at this school).

Additional public exposure locations occurred during certain hours at: Anytime Fitness at 3621 Boiling Springs Rd. in Boiling Springs on Jan. 13; the U.S. Post Office at 504 Pennsylvania Ave. in Greer on Jan. 13; Goodwill at 1333 W. Wade Hampton Blvd. in Greer on Jan. 13; and Aldi at 1560 W. Floyd Baker Blvd. in Gaffney on Jan. 17.

January 27, 2026 – S.C. outbreak exceeds Texas outbreak

Total outbreak cases: 789. New cases: 89.

State health officials announce they have confirmed 89 new measles cases, and that there are 557 people in quarantine and 20 in isolation. Outbreak investigators also have identified more public measles exposures that have occurred at several schools: Dorman High, where 96% of students are up-to-date on school vaccines; Inman Intermediate, where students have previously been quarantined and 83% of students are up-to-date on vaccines; and New Prospect Elementary in Inman, where students have previously been quarantined and where 82% of students are up-to-date. The state health department said the number of students that need to quarantine at each of these schools is still being determined. The newly identified cases raise the South Carolina outbreak’s total to 789 – surpassing the number sickened in the deadly Texas outbreak last year. In Texas, 762 cases of measles were confirmed in an outbreak that began in late January 2025 and was declared over in August 2025.

January 30, 2026 – Surge puts 443 in quarantine

Total outbreak cases: 847. New cases: 58.

Numbers released by the state health department show 58 new measles cases have been identified. There are 443 people in quarantine who have been exposed, who lack immunity, and who are at risk of developing the disease in the coming days and weeks. Twenty people are in isolation because of illness. Public health investigators have identified a school and a fast food restaurant with recent public exposures because of the presence of an infectious person. Health officials are still determining how many students need to be quarantined and excluded from class at the school, Lyman Elementary, where state records show 89% of students are up-to-date on school vaccines. The school was involved in a previous exposure situation announced on Nov. 21. The other public exposure event involves a Burger King restaurant at 6196 US-221 in Roebuck, S.C., that occurred on Jan. 28 between 11:30 a.m. and 2:30 p.m.

February 3, 2026 – Fewer infections – but one in Sumter County

Total outbreak cases: 876. New cases: 29.

The state health department announces 29 new cases of measles in the ongoing outbreak in South Carolina’s Upstate region, in and near Spartanburg County. They also said a measles case has been confirmed in a resident of Sumter County – which is located in South Carolina’s Pee Dee Region, southeast from where the outbreak has been occurring. “At this point in the investigation, it is not yet clear whether this new case is linked to the Upstate outbreak centered around Spartanburg County or if the case may have been exposed where measles is occurring in other locations,” the department said. The department said public exposures to measles have occurred during certain specific hours at three locations in Sumter, S.C.: Mariachis Mexican Restaurant at 1072 Broad St. on Jan. 23; Food Lion at 5700 Broad Street Ext. on Jan. 24; and the Walmart Neighborhood Market at 343 Pinewood Rd. on Jan. 25. The health department said there are currently 354 people in quarantine who have been exposed to measles and lack vaccination or immunity; 22 people are ill and in isolation.

February 6, 2026 – Vaccination is up significantly

Total outbreak cases: 920. New cases: 44

State health officials announce 44 new measles cases, plus another 277 people who are in quarantine because they were exposed and are unvaccinated or lack immunity from prior infection; eight people are in isolation because of illness. They also announce new locations of public exposure incidents during certain specific time periods at a Social Security Administration office at 145 N. Church St. in Spartanburg on Jan. 29; Boost Mobile at 1515 Asheville Hwy. in Spartanburg on Jan. 29; Rick Erwin’s Level 10 Restaurant at 225 W. Main St. in Spartanburg on Jan. 29; and the Target store at 6025 Wade Hampton Blvd. in Taylors on Jan. 30.

During a media call earlier in the week, Bell said state health officials are encouraged by increases in measles vaccination during January. In Spartanburg County, the number of measles vaccines given last month was up 162% over January 2025, an increase of more than 1,000 doses, she said. Statewide, measles vaccination was up 72%, with about 7,000 more doses given across South Carolina last month than were administered in January 2025. “So far, this is the best month for measles vaccination during this outbreak,” Bell said.

While complications from measles aren’t reportable to state health officials, Bell said the department has learned of some serious complications among 19 people – children and adults – who have been hospitalized since the outbreak began in October. “Some of these complications include measles encephalitis, or inflammation of the brain in children, and pneumonia.”

In addition, Bell said, several pregnant women were exposed to measles and required administration of immune globulin to protect against the high risk of complications measles poses to pregnant women and their newborns. Bell declined to provide additional details about the exposures of the pregnant women. Earlier in the week, Healthbeat revealed a measles exposure incident had occurred on a labor and delivery unit at Prisma Health Greer Memorial Hospital.

February 10, 2026 – Fewer new cases, but one in Lancaster County

Total outbreak cases: 933. New cases: 13

Just 13 new measles cases are announced in the state health department’s update; 235 people are in quarantine because of exposures, and six are in isolation because of illness. The department noted that a measles infection has been confirmed in a resident of Lancaster County; the source of the person’s exposure is still under investigation. The outbreak has not previously had any cases in Lancaster County, which is in north-central South Carolina. Two schools in Spartanburg County have been the sites of recent public exposures: Libertas Academy, where 74% of students are up-to-date on their school vaccines (nine individuals in quarantine); and Inman Intermediate, 83% of students are up-to-date on vaccines (fewer than five individuals in quarantine). People also remain in quarantine from an earlier public exposure at Lyman Elementary School, where 89% of students are up-to-date on vaccines (23 individuals remain in quarantine).

February 13, 2026 – Concerns linger about undetected cases

Total outbreak cases: 950. New cases: 17

The number of new measles cases announced today continues to be well below the numbers during the January surge. The state health department said 17 new cases of measles have been identified and there are another 186 people in quarantine because of exposures; nine people are in isolation because of illness. The recent identification of measles cases in Lancaster and Sumter counties – with no identified source of exposure – indicate that unrecognized transmission of measles is occurring in the community, Bell told reporters this week. “That can result in more and more transmission if we don’t stay on top of those cases, find out where that transmission is occurring, and implement our disease control measures,” Bell said. The outbreak continues to be centered in Spartanburg County, she said, and about 95% of those who have been infected are unvaccinated. The department announced three locations where public exposures have occurred recently during defined time periods: Children’s Medical Center, 841 S. Buncombe Rd. in Greer, all day on Feb. 4 and 6; Itto Ramen Bar, 1807 Poinsett Hwy. in Greenville, on Feb. 5 from 12:30 p.m. to 3:30 p.m.; and HomeGoods, 1125 Woodruff Rd. in Greenville, on Feb. 5 from 10 a.m. to 12:45 p.m.

February 17, 2026 – Most new infections involve known cases

Total outbreak cases: 962. New cases: 12.

State health officials announce 12 new cases and said there are an additional 127 people in quarantine because of exposures; eight people are in isolation because of symptoms. “The majority of cases are close contacts of known cases,” the state health department said. “However, the number of public exposure sites indicates that measles is circulating in the community, increasing the risk of exposure and the risk of infection for those who are not immune due to vaccination or natural infection.” The department said it is aware of 20 hospitalizations, involving children and adults, since the start of the outbreak. Libertas Academy has been the site of a recent public exposure event (17 individuals in quarantine). This school, where 74% of students are up-to-date on their school vaccines, has had previous exposure events, state records show. The department also announced a public exposure event occurred at Walmart – Powdersville, 11410 Anderson Rd. in Greenville on Feb. 8 from 4 to 8 p.m.

February 20, 2026 – Church, school, community college exposures

Total outbreak cases: 973. New cases: 11.

Health officials announce the identification of 11 new measles cases, and say there are 105 people in quarantine because of exposure and seven in isolation because of illness. “We are seeing a slowing, but it is too soon for us to say when this will end,” Bell said this week. “The concern is that we can see ongoing, smoldering transmission that can be introduced into other communities. The measles virus can find susceptible people wherever.”

While the number of new cases announced continues to be low, state health officials warn that public exposures have occurred recently at multiple locations in Spartanburg County. The exposure locations include Mabry Middle School in Inman, where 81% of students are up-to-date on vaccines and exposures have occurred previously. Other sites: Tabernacle of Salvation Slavic Church, 150 Outlet Rd. in Spartanburg, on Feb. 15 from 10 a.m. to 1 p.m.; Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 11 from 6:30 to 10 p.m .; Spartanburg Community College - Giles Campus, 107 Community College Dr. in Spartanburg, on Feb. 17 from 9:30 a.m. to 7:30 p.m.; Costco, 211 W. Blackstock Rd., Spartanburg, on Feb. 17 from 12 to 3 p.m.

February 24, 2026 – Just 6 new cases

Total outbreak cases: 979. New cases: 6.

Just six new cases of measles are announced by state health officials, plus 91 others who are in quarantine for exposures; one person is in isolation because of illness. The latest end date for those in quarantine is March 15. The newest cases have resulted in outbreak investigators identifying public exposures at Willow Creek Gathers Homeschool Co-op, where 17 individuals are in quarantine, the state health department said. Although South Carolina requires immediate reporting of cases of measles or suspected measles to the health department, the state doesn’t specifically require reporting about whether these cases were hospitalized or had complications. Over the course of the outbreak, the health department says it has learned about 21 people, children and adults, who have been hospitalized.

Since the outbreak began, the South Carolina Department of Public Health has used its mobile clinic to offer free measles-mumps-rubella vaccines in the Spartanburg County area.

February 27, 2026 – Hopes for earlier end to outbreak

Total outbreak cases: 985. New cases: 6.

Since Tuesday, state health officials say they have identified six new measles cases. There are 61 people in quarantine because of exposures; two people are in isolation for illness. The latest end date for people currently in quarantine and who may develop the disease is March 20. “We’re encouraged with the downward trend, particularly in the last two weeks,” Bell, the state epidemiologist, said this week. It’s possible that the outbreak may even end earlier than projected, she said. But the risk of another surge remains because of low vaccination coverage. The department said that based on the recent cases, investigators have identified public exposures that have recently occurred at Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines. Fewer than five individuals from the school are in quarantine, officials said. This is the third round of quarantines for the school, health department records show. Another public exposure incident occurred at Costco - Spartanburg at 211 W. Blackstock Rd. on Feb. 22 from 2 to 6 p.m. It’s the third known measles exposure incident at the store, with the others occurring on Feb. 17 and Nov. 18, according to health department reports. State health officials said their mobile health unit will hold another measles vaccination clinic next week.

March 3, 2026 - Increased vaccination is helping slow outbreak, state says

Total outbreak cases: 990. New cases: 5.

The number of new cases reported to the state health department remains low: Just five new cases since Friday, health officials announced. There are 52 people in quarantine because of exposures and four in isolation because of illness. The latest end date for those in quarantine is March 27. The state health department also said there was a public measles exposure incident at Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 22 from 10:45 a.m. to 4 p.m. This church also had a measles exposure incident on Feb. 11. “We saw another strong increase in measles vaccination uptake during the month of February, which is encouraging,” Bell said at a media briefing this week. “Compared to February of 2025, there was a 133% increase in measles vaccination in Spartanburg County, with around 900 additional doses given,” she said. Statewide, there was a 70% increase in measles vaccination, with an additional 7,000 doses given. “This increase in vaccination is one of the reasons why this outbreak is slowing,” Bell said. “But given the surge in cases we saw following the Christmas holidays, we remain concerned that another surge could occur following spring break, when many people can be traveling and participating in more social activities.”

March 6, 2026 – Just one new case as outbreak cost reaches $1.6 million

Total outbreak cases: 991. New cases: 1.

Just one new measles case is announced by state health officials in their Friday update. There are 52 people in quarantine because of exposures and three in isolation because of illness. The latest end date for those in quarantine is March 27. Meanwhile, state health officials told Healthbeat this week that the public health response to the outbreak has cost taxpayers $1.6 million so far. Most of that has been personnel costs, including for contact tracing and other activities to combat the outbreak, the department said.

Of the 991 outbreak cases, most have been children and teens: 260 are younger than 5; 637 are ages 5-17; 86 are age 18 or older; and the age is unknown for eight cases. Almost all who have been infected have been unvaccinated or only partially vaccinated: 925 were unvaccinated; 19 had only one one dose of the recommended two-dose MMR vaccine; 26 were fully vaccinated with two doses of MMR; and the vaccination status was unknown for 21 cases.

March 10, 2026 – Slow trickle of cases continues

Total outbreak cases: 993. New cases: 2.

State health officials announce just two new measles cases have been identified since Friday; 42 people are in quarantine because of exposures; 2 are in isolation because of illness. The latest end date for those keeping watch for signs of illness while in quarantine is April 2. “We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said this week. The department doesn’t want to have measles cases surge during the upcoming spring break period. Bell said the department has asked all schools in the Upstate region to identify a point of contact who will be available when schools are closed over spring break to provide student contact information if it’s needed for measles exposure investigations. Healthbeat previously revealed how outbreak investigations were hampered and quarantines were delayed during school winter break because health officials couldn’t quickly get contact information from several schools.

March 13, 2026 – Three new cases

Total outbreak cases: 996. New cases: 3.

State officials announce three new measles cases, and that the number of people in quarantine because of exposures is down to 30. Four people are in isolation because of illness. The latest quarantine end date is April 2. Of the outbreak’s 996 cases, 993 have been in Spartanburg County and 36 have been in neighboring Greenville County. A handful of additional cases have been in three other nearby counties in South Carolina’s Upstate region: eight in Anderson County, six in Pickens County, and fewer than five in Cherokee County. Two additional counties in other parts of the state also have a small number of cases: Lancaster County, in the state’s Midlands region, and Sumter County in the Pee Dee region each have fewer than five cases, according to state data.

March 17, 2026 – ‘We are not letting our guard down’

Total outbreak cases: 997. New cases: 1.

State officials announce one new measles case and say there are only eight people in quarantine for exposures and none in isolation because of illness. The latest end date for those in quarantine is April 2. “We are not letting our guard down. It is too early to say that we will not see any more cases,” Bell said this week. She said it’s important that health care providers remain vigilant and continue to suspect measles when they see illnesses with a fever and rash. “That gives us the opportunity to immediately place people in isolation, to place their contacts in quarantine, if necessary,” she said. “If we let our guard down too early, then we just put ourselves in the position of allowing more disease to spread if we are not paying careful attention.” Before South Carolina can declare the outbreak over, there must be two incubation cycles – or 42 days – with no new cases, Bell said. In the meantime, spring break for many schools in the Spartanburg area is scheduled for early April, and state officials remain concerned that travel and socializing during the school break period could result in more measles cases.

March 20, 2026 – No new measles cases since Tuesday

Total outbreak cases: 997. New cases: 0.

State health officials, in their Friday update, announced no new measles cases had been identified since Tuesday. The last time there were zero new cases in one of their twice-weekly outbreak updates was more than four months ago on Nov. 4. There are two people in quarantine because of exposures. Their last date in quarantine is March 28.

March 24, 2026 – Again, no new measles cases

Total outbreak cases: 997. New cases: 0.

For the second update in a row, state health officials in their Tuesday update said no new measles cases had been identified. Two people remain in quarantine because of exposures, with a latest quarantine end date of March 28. Nobody is in isolation because of illness. It will take 42 consecutive days with no new cases – two incubation cycles of the virus – to determine that the outbreak’s transmission chain has been broken, the health department said. If the no cases trend continues, the last day of the outbreak will be April 26.

March 27, 2026 – No new cases, only one person in quarantine

Total outbreak cases: 997. New cases: 0.

South Carolina health officials announce they continue to detect no new measles cases. Just one person remains in quarantine because they lack immunity and were exposed – and that person is almost out of danger. Their quarantine ends March 28. One question lingers: Are there still some measles cases that aren’t being detected and reported? A report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, said it was likely measles cases in the outbreak were going unreported, Healthbeat reported.

While Bell told Healthbeat she remains concerned about unrecognized cases, if they exist, the department doesn’t think there are a lot of them. “Our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” she said. Before the outbreak can be declared over, a period of 42 days – two incubation cycles for the virus – must pass without any more measles cases. If that happens, the last day of the outbreak would be April 26.

March 31, 2026 – No new cases and nobody in quarantine

Total outbreak cases: 997. New cases: 0.

With no new cases reported again and also nobody in quarantine, the countdown to the end of the outbreak continues. The outbreak can’t be declared over until two incubation cycles of 21 days each have passed without any new cases. If that happens, the last day of the outbreak would be April 26, state health officials have said.

April 3, 2026 – Still no new cases

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak remains underway as state health officials again announce no new cases.

April 7, 2026 – Still no new cases as DPH scales back public updates

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak continues as state health officials again announce no new cases. Unless a new measles case is identified, the South Carolina Department of Public Health said it will reduce the frequency of its Wednesday media briefings to every other week. While Tuesday outbreak data updates will continue, Friday updates will be discontinued, the department said. “If a new case is reported, DPH will immediately notify the media and resume briefings and updates as appropriate,” the department said.

April 27, 2026 – DPH declares the outbreak over, risks remain

Total outbreak cases: 997.

After 42 days passed without any new outbreak cases, the South Carolina Department of Public Health declared the outbreak to be over.

“Though we reached nearly 1,000 cases, we are grateful that, by and large, it remained confined to one county and did not spread statewide, as was always our concern and fear,” Dr. Brannon Traxler, the department’s deputy director and chief medical officer, said at a news conference.

Traxler said there are three main reasons state health officials think the outbreak has ended: the large number of people infected, widespread community cooperation with quarantine and isolation, and increased vaccination against measles in recent months.

While this record-breaking outbreak is over, Traxler said conditions remain for another measles outbreak in the future, brought into the state through travel.

“If we don’t continue to see increases in vaccination, I’m worried that we could see another large – maybe not this large, but hopefully not – but another large outbreak in a community where it gets introduced from someone who had traveled.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

South Carolina’s measles outbreak is over: 7 things to know about largest U.S. outbreak in decades

2026-04-27T23:49:47+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Officials at the South Carolina Department of Public Health declared their record-breaking measles outbreak to be over on Monday after no new cases emerged during the past 42 days.

Here are seven things to know about the largest U.S. measles outbreak in more than 35 years:

Most people who got infected weren’t vaccinated

Of the 997 measles cases documented in the outbreak, 932 patients were unvaccinated, 19 had an unknown vaccination status, and 20 were only partially vaccinated with only one dose of the two-dose MMR (measles-mumps-rubella) vaccine, according to the department’s data.

Just 26 people were fully vaccinated with two doses of MMR vaccine. Two doses of the vaccine is about 97% effective in providing protection against measles infections; one dose is about 93% effective, according to the Centers for Disease Control and Prevention.

Infections, increased vaccination credited in stopping outbreak

The 997 people sickened with measles developed immunity to the disease, Traxler said. “Though that carried with it, of course, the risk of severe illness, a weakened immune system and the potential for devastating complications even years from now,” she said.

Another important factor in stopping the spread of the virus, she said, was that the “vast majority” of people who were infected or exposed followed public health instructions to stay home and avoid infecting others.

Lastly, thousands of people got vaccinated. In Spartanburg County, she said, an additional 3,788 doses of MMR vaccine were administered during the six months of the outbreak compared with the previous year.

“In particular, January and February were record months for MMR vaccination in the state,” she said.

Risks for future measles outbreaks continue in South Carolina

This outbreak may be over, but outbreak risks remain in Spartanburg County and across the state. Traxler noted that pockets of people who are not protected against measles remain in many communities.

“We’re going to continue to see sporadic cases that are going to be travel-associated most likely,” Traxler said, noting the goal is to keep one of these travel cases from sparking a larger outbreak.

State’s $2.1 million cost is only part of the outbreak’s bill

The department estimates that the outbreak response cost the state of South Carolina $2.1 million. But that was just the costs the department could calculate for staff time, vaccination costs, and other direct expenses.

It doesn’t include all of the costs to the health care system, schools, businesses, and beyond, she said. “What were the economic impacts to the state of parents who had to miss work?” she asked. It’s not part of that number.

Outbreak began with 5 cases, centered in Spartanburg County

The outbreak was first identified in early October, with just five cases. For weeks the virus seemed to spread slowly – then the holiday season began.

On the Tuesday before Thanksgiving, the state had logged 55 measles cases. By Dec. 12, there were 126 cases – and more than 300 people in quarantine, Healthbeat’s timeline of the outbreak shows.

By mid January – after the December holidays and multiple public exposures at schools and churches – the outbreak surged, with more than 100 new measles cases being identified every few days. By Jan. 20, the department had documented 646 cases. Cases slowed during February and March.

The last time the state announced a new case in the outbreak was on March 17, the day the case total reached 997.

Before the measles outbreak could be declared over, there needed to be two incubation cycles – or 42 days – without any new cases.

Winter break school closures delayed investigations, quarantines

During the critical December holiday period – before the outbreak surged – South Carolina health officials were hampered in their efforts to control measles exposures because of winter break school closures, Healthbeat reported earlier this year.

Internal department records, obtained by Healthbeat, revealed how outbreak investigators were delayed in their efforts to quickly quarantine schoolchildren exposed to measles right before the two-week winter break period began. Because schools were closed, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff, and others who had been exposed to infected people.

To prevent similar communications gaps during the recent spring break period, the department contacted schools across the state’s 11-county Upstate region to identify a person who would be available to provide attendance and contact information during the spring break closures of schools and administrative offices.

Department’s response, lessons learned to be evaluated

“The outbreak is over, but our work to understand and prevent measles and future outbreaks is not,” Traxler said. “A thorough after-action review and analysis is being started. We believe our outbreak response team did a tremendous job under really unprecedented conditions. But there are always things that we can learn from and improve on in our future with future responses, and we are committed to doing so.”

One of the things the department did well, she said, was urging members of the health care community to be pro-active in immediately reporting any suspected measles case – even before any test results come back. That early heads-up, she said, allowed the department to immediately start educating the patient about the need to isolate and begin earlier contact tracing.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Many babies sickened in ByHeart formula botulism outbreak needed more treatment after hospitalization

2026-04-24T22:15:24+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Most of the babies hospitalized in a recent nationwide outbreak of infant botulism linked to ByHeart baby formula have needed additional physical therapy and other medical support after going home, according to new data shared Friday.

“Although many infants are now progressing in their recovery, evaluating their outcomes is essential to understanding the progression and severity of illness observed during this outbreak,” said Myra Brooks, a member of the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, who presented the data at the service’s annual conference in Atlanta. The conference highlights the work of the agency’s disease detectives.

Brooks, a first-year EIS officer, works with the CDC’s National Botulism Consultation Service and was part of the response to the outbreak linked to ByHeart infant formula last year. It is the first documented outbreak of infant botulism linked to powdered formula, she noted.

The CDC declared the outbreak over on Feb. 26, with 48 confirmed and probable cases of infant botulism in 17 states that were linked to the baby formula. All of the infants required hospitalization; there were no deaths. All of ByHeart’s Whole Nutrition Infant Formula products were recalled.

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can activate in their intestines and produce a dangerous toxin that can cause muscle weakness and paralysis. Initial symptoms can include difficulty sucking and swallowing, constipation, and loss of head control. Without treatment, breathing difficulties can develop.

Health investigators were able to obtain and review the medical records for 46 of the 48 infants, which showed that most of those who were sickened had moderate to severe disease.

Those with moderate disease, 61% of the infants in the outbreak, required assisted feeding or non-invasive respiratory support, Brooks said Friday. Another 11% of the infants had severe disease. “During hospitalization, these infants experienced respiratory difficulty, requiring intubation or received a surgically placed feeding tube,” she said.

The remaining 28% of infants in the outbreak were classified as having mild disease, although they still needed hospitalization.

While the outbreak cases stayed in the hospital for a median of eight days, some of those with severe disease were hospitalized for more than a month, according to her presentation slides.

For many of the infants sickened in the outbreak, their medical treatments needed to continue after leaving the hospital, Brooks said.

“A third of infants were discharged with nasogastric tubes to supplement feeding, and two-thirds of infants had follow-up orders for physical, speech or occupational therapy,” she said.

The infant botulism outbreak was first identified in early November by the California Department of Public Health, which runs the national infant botulism program that distributes the only FDA-approved drug to treat children sickened by the toxin. The department noticed an increase in medication requests among babies who had consumed ByHeart formula and alerted federal officials.

Outbreak cases continued to rise in the weeks that followed amid delays by retailers in removing recalled formula from store shelves that were compounded by delays by the Food and Drug Administration in sharing information with state food safety officials about where the product was being sold.

While health officials initially thought babies had started falling ill in August 2025, they later identified cases going back to December 2023.

Although ByHeart’s products made up only about 1% of the formula products sold in the United States, the premium organic brand had a loyal following and the outbreak shook some consumers’ confidence in formula safety generally.

The federal investigation of how ByHeart’s formula became contaminated has in recent months focused on the product’s ingredients. Earlier this year, the FDA announced that tests had detected contamination with Clostridium botulinum – the bacteria that cause infant botulism – in some samples of powdered whole milk used to make the formula.

The FDA has said its investigation into the root cause of the contamination is ongoing, but the agency has not provided any update since Feb. 26.

ByHeart’s media team, in an email to Healthbeat late Friday, said the company continues to work with the FDA on its investigation. “Our root cause investigation remains ongoing, and we’ll share updates as they become available,” the email said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

NYC moves to streamline health department background checks for child care expansion

2026-04-24T19:15:11+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

As New York City moves to offer 2,000 free child care seats by September, it falls to the health department to clear background checks for new providers. Concerned by a history of backlogs, the City Council this week held an oversight hearing and heard two proposals seeking to improve the process.

“If our city’s goal is universal child care, then we must ensure that the administration of that care, including the background check process, is as streamlined as possible, and that new facilities and employees don’t get held up in red tape,” City Council Health Committee Chair Lynn Schulman said at the Wednesday meeting.

“We must also ensure the relevant city agencies have the necessary bandwidth to complete these background checks and screenings in a timely manner. Unfortunately, it appears that DOHMH has struggled to keep up since the implementation of these comprehensive background checks,” she said of the Department of Health and Mental Hygiene’s work to comply with federal requirements updated in 2019.

Expanding child care is among Mayor Zohran Mamdani’s priorities, and the city is in the process of issuing contracts to private child care providers who will get city funding to offer the initial 2,000 seats for 2-year-olds this fall.

Officials are rolling out the program in five school districts, covering areas in Manhattan, Queens, Brooklyn, and the Bronx. Extensive background checks of the providers applying for licenses are required by law. Once a facility is open, the health department conducts unannounced inspections to promote compliance with health and safety mandates. Inspection results are posted on the health department’s website.

The permitting and inspections of the child care facilities are perhaps among of the lesser-known duties of the health department.

NYC’s new 2-K program will offer free child care 10 hours a day, 260 days a year, Mamdani says

New York City Council Majority Leader Shaun Abreu proposed a bill Wednesday to no longer require the health department to mandate a background check for a prospective child care provider, employee, or volunteer if they have already had one in the past five years and have been employed by a child care provider for more than 180 consecutive days.

A second bill, proposed by Council Member Tiffany Cabán, would require the health department to sooner notify parents and others of child care centers that close because of health hazards. The proposal would also require the health department to post a summary of child care service inspection reports no later than 24 hours after an inspection.

The first bill stems from general concerns that the health department has struggled to process background checks in a timely fashion, with some background checks taking up to a year to be processed.

In 2019, when new federal requirements were implemented statewide, a backlog of background checks stretched into the tens of thousands, according to a committee report submitted with the bill. Some applicants looked for jobs elsewhere as the process lagged, taking an average of 36 days.

The bill highlighted a day care center in Greenpoint, Brooklyn, as an example. The facility could have served up to 170 children but closed its doors in August 2023 because of the lack of approved staff. It was waiting for staff clearance that had been submitted nearly five months earlier. Families with children enrolled in the program were left without child care for two months, while the provider lost over $250,000. Advocates said that such delays were not uncommon.

The health department created an online portal in May 2023 to improve background check processing. The agency testified in October 2023 that it had cleared some 5,000 backlogged applications since the portal was launched and whittled the number of applications to 140.

“Background checks are a critical safety requirement in most jobs, especially when it comes to safeguarding young children,” Council Member Jennifer Gutierrez, chair of the subcommittee on early childhood education, said Wednesday in prepared remarks. “Yet the current process has felt burdensome rather than an important step in safety. State, federal, and city requirements are layered on top of one another in ways that are not always well coordinated.”

Emmy Liss, executive director of the Mayor’s Office of Child Care, said the city was planning to work first with existing child care providers as part of the expansion; they already have a license and staffing.

“We anticipate there will be some new hiring to support 2-K and 3-K as there always is in the lead-up to the first day of school, but we do not expect a huge rush,” Liss said. “We are continuing to monitor what the staffing patterns will look like with our partners at New York City public schools and with the health department to make sure that we are prepared.”

Liss added: “As we prepare for the fall of 2027, when we will be bringing many more 2-K seats online, we’ll be planning ahead with the Department of Health and New York City public schools to ensure that there is sufficient staff capacity for onboarding those providers.”

Corinne Schiff, deputy commissioner for environmental health at the health department, said the agency has hired 60 people in recent years who work solely on background clearances.

Other improvements include an online portal for providers, new access to a Department of Education fingerprint system, and a policy change allowing staff to move between child care centers within a 5-year renewal period without a full new background check, as long as they notify the health department.

The current median processing time is about 30 days, Schiff said, with several hundred applications exceeding the 45-day mark, the deadline as required under federal law.

“Do you have plans in terms of lowering those?” Schulman said. “Five hundred is a lot.”

Schiff said the department was “continuing to make upgrades to the to the portal.” She pushed back on “backlog” characterization, noting that some background checks require working with agencies out of state.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

NY health update: Declining MMR vaccinations, high Black maternal death rates, fish safety, and spring health alerts

2026-04-24T15:55:34+00:00

Before I jump into this week’s newsletter, I have to give a shoutout to my mom, who just ran the Boston Marathon. Watching her train so hard, get up at the crack of dawn, and then run 26.2 miles with 30,000 other runners was incredible. I’m so proud of her.

And congratulations to everyone else who left it all on the course last weekend. The videos of runners helping other runners over the finish line, people giving everything they had, and the volunteers, medics, and coordinators making sure everyone stayed safe and cared for — wow. Man, I love runners.

Okay, back to this week’s New York Dose. I’m covering new data on childhood MMR vaccination, what New York is doing to reduce Black maternal mortality, an environmental win for people fishing the Lower Hudson, and a few spring health updates, including what I’m doing to get ready for warm weather.

NYC childhood MMR coverage is down

New York has long had some of the highest vaccination rates in the country. But even here, cracks in that strong foundation are starting to show. In New York City, new data suggest routine childhood vaccination is being delayed. In March, the city reported that about one in three 2-year-olds had not received all doses of the seven recommended vaccines, prompting officials to launch a new campaign in response.

This is the kind of shift that can seem small on paper, but it’s exactly how vulnerability builds quietly over time.

One of the clearest warning signs is measles, mumps, rubella coverage. In 2024, 93% of New York City children ages 24 to 35 months had received at least one MMR dose by their second birthday. In 2025, that dropped to 89%.

Percent of New York City children ages 24-35 months who received at least one measles, mumps, rubella vaccine by their second birthday.

That matters, especially right now. As of this month, New York state has confirmed eight measles cases this year. Nationally, we’ve seen how quickly measles can spread in communities with lower vaccination rates (YLE national has covered that here). And in 2019, New York City experienced a major outbreak, with 649 cases in a largely unvaccinated community in Williamsburg.

Even small percentage-point drops matter. In a city as large as New York, they translate to thousands more children vulnerable to measles if the virus is introduced.

This is one of those issues that can feel abstract until it isn’t. Delayed vaccination leaves young children vulnerable during the exact years when some vaccine-preventable diseases can hit hardest. Measles is extraordinarily contagious, and community protection depends on keeping coverage high.

Black mothers in New York state die from pregnancy-related causes at 4x the rate of white mothers

Black Maternal Health Week (April 11–17) just wrapped up across the state, and unfortunately the numbers underlying it are striking. The week exists in part to address some of the most persistent and devastating disparities in American medicine: Black women are substantially more likely to die from pregnancy than mothers of other races. State data estimate that Black women died of pregnancy-associated causes about four times more often than white women in New York. In New York City, it’s about five times higher.

That gap is shocking, and frankly, unacceptable. But New York is taking steps to reduce Black maternal mortality by putting several policies in place to help.

Here are some programs in New York aimed at reducing maternal deaths:

Postpartum coverage now lasts a full year. New York Medicaid and Child Health Plus extended postpartum coverage from 60 days to 12 months, helping more families stay connected to care during a period when serious complications can still happen.
Doula care is covered by Medicaid. New York Medicaid covers doula services during pregnancy and up to 12 months postpartum, including prenatal visits, labor and delivery support, and postpartum care. Eligible New Yorkers can find participating doulas in the Medicaid program here.
New York became the first state in the country to offer paid prenatal leave. Since Jan. 1, 2025, New York has required private-sector employers to provide pregnant workers with 20 additional hours of paid prenatal leave for pregnancy-related medical care. This is the first law of its kind in the country, and it is separate from other leave options.

The paid prenatal leave policy is especially important. It gives workers paid time off for things like OB visits, testing, monitoring, and other pregnancy-related appointments. And that matters, because barriers to prenatal care are often not about willingness, but can be about whether someone can afford to miss work. It may mean choosing between a clinic visit and food for dinner, a co-pay and prenatal vitamins, an ultrasound, and keeping the air conditioning on. Policies that reduce the financial cost of getting care are one of the clearest ways to reduce barriers to care.

What you can do to access benefits:

If you’re pregnant or recently postpartum and on Medicaid, confirm that your coverage extends for a full year after pregnancy.
If you want labor or postpartum support, check whether you’re eligible for a state-covered doula through New York’s Medicaid doula directory.
And if you work in the private sector, ask your HR department about your paid prenatal leave rights.

For the first time in 50 years, you can eat striped bass you catch from the lower Hudson River

New York state recently updated its fish consumption advice and says you can now eat some fish from the Lower Hudson River for the first time in 50 years. The updated advisory reflects decades of cleanup on the Hudson to lower polychlorinated biphenyls (PCBs — a toxic synthetic chemical) contamination enough to meet health guidelines.

The biggest update is for striped bass: Pregnant women and children under 15 can now eat one meal per month, and the general population can eat up to four meals per month from the Lower Hudson. But some fish, including carp and small-mouth bass, are still off-limits because of PCBs, so it’s still important to check the specific guidance before eating what’s caught.

For example, there are new advisories on forever chemicals known as PFOS, which apply to Lake Ontario, Lake Erie, Lake George, Lake Champlain’s Cumberland Bay, Seneca Lake, and others. So, if you fish or your family fishes, check the local updated guidance before eating your catch.

New York fish advisory regions.

This change is a good reminder that public health wins can be slow, and often unglamorous (no offense to the fish). But the fact that we have cleaner water, better environmental regulation, and long-term monitoring for these chemicals — and can see our progress firsthand — is worth celebrating.

Pollen and tick updates

Some quick notes on spring health.

Tree pollen is ramping up, with some parts of the state now experiencing high levels. For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen makes it worse.

Reducing pollen exposure comes down to a couple key behaviors:

Avoid pollen outside. Check local pollen counts (like on pollen.com) and limit outdoor activity during early morning and on high-wind, dry days. The best time to go outside is after it rains, which helps clear pollen from the air.
Avoid pollen inside. Remove shoes before entering your home, wipe down pets, change after being outside, shower especially before bed to rinse off pollen, keep windows and doors closed, and run a HEPA filter.

For a deeper dive, check out my recent post on pollen.

We’re also in the thick of tick season. From now until about October, ticks will be active across New York, including in New York City. If you’re heading to parks, wooded areas, or anywhere with brush and tall grass, use repellent, and do tick checks on yourself, kids, and pets.

Emergency department visits for tick bites in the Northeast so far this year (green) compared to last year.

Last quick segment. I know the weather has been all over the place, from gorgeous 88-degree afternoons, back to the icy rain we have this week, but I wanted to get a couple things on your radar as we get closer to more warm days.

First, the program that provides free air conditioners is now accepting applications across New York state. This is important because extreme heat is New York’s most deadly weather.

To see if you qualify to get a free air conditioner through the Essential Plan Cooling Program, check out the qualifying conditions and application here.

Second, now is a good time to check the expiration date of your sunscreen. The active ingredients that block UV rays in sunscreen degrade over time, reducing effectiveness, increasing sunburn risk, and potentially causing skin irritation or rashes. It’s a good idea to make sure what you have on hand isn’t expired, and replace it if needed.

Bottom line

You’re all caught up on New York public health news. Have a great weekend, and I’ll see you next week!

Love,

Your NY Epi

Smoke from South Georgia wildfires drives poor air quality, ER visits in Atlanta

2026-04-24T15:29:08+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Wildfires burning hundreds of miles away created a visible haze and poor air quality this week in Atlanta, with some emergency rooms and clinics reporting calls and visits for respiratory conditions exacerbated by the smoke.

A statewide drought that started in mid-September has created ideal conditions for more than 75 wildfires that have burned more than 35,000 acres in the past week. Gov. Brian Kemp has declared a state of emergency in 91 of Georgia’s 159 counties.

The biggest fires are in Southeast Georgia – Brantley County, where homes have been evacuated, and Clinch County – sending smoke into the northern part of the state at times, as winds shifted.

Up to 90% of wildfire smoke contains PM 2.5: particulate matter that is smaller than 2.5 micrometers. The particles are so small that they don’t fall to the ground, which means people can breathe them in, said Colleen Reid, a professor at the University of Colorado Boulder who studies wildfires.

That particulate matter can lodge in the lungs’ small airways (the bronchioles) and even make their way to the bloodstream, said Emory University pulmonologist Dr. Colin Swenson. That can cause health problems, especially for certain at-risk groups.

Atlanta and many other areas of the state have had moderately concerning or worse air quality since Tuesday, according to Airnow.gov, which reports on local air quality conditions. That has driven an uptick in emergency room and clinic visits within the Emory system in Atlanta, Dr. Colin Swenson told Healthbeat.

Wildfires are uncommon in Georgia, where typically high humidity and rainfall protect forests from sparks and allows groundwater and soil to recharge. That didn’t happen this winter, with Atlanta, for example, only getting 54% of the rainfall it normally gets since the start of the year, according to the National Weather Service.

Georgia public health board goes seventh straight month without meeting

The last time the state faced such drastically dry conditions was in December 2016, said Elliot Wickham, the community lead for drought at the National Water Center, a division of the National Oceanic and Atmospheric Administration.

Drought conditions are forecast at least until the end of July, according to the National Weather Service.

Dry vegetation can be ignited in many ways – by power lines, a dropped cigarette, lightning, or even a spark from a broken-down car on the side of the road, said Reid, who offered some advice for Georgians who are not used to dealing with wildfires:

When the air clears, check your home air filters. They may have picked up more pollution than usual.

Here are some other things to know to protect your health amid poor air quality.

Who is most at risk of illness from air pollution?

People with respiratory conditions like asthma, chronic obstructive pulmonary disease, and bronchiectasis, are especially at risk, Swenson and Reid said.
People with cardiovascular diseases like coronary artery disease and heart failure can also be affected, Swenson said.
Pregnant people are vulnerable as well, Reid said. Wildfire smoke can increase the risk of low birth weight or preterm birth.
Children are more prone to asthmatic flare-ups because their airways are smaller than adults’. Schools and sports groups may cancel outdoor activities or move them inside.
The unhoused, people who work outdoors, and those who lack air conditioning will also face more smoke exposure, Reid said.
People who are in lower-risk groups might experience effects like chest tightening when exercising outdoors.

What can people do to alleviate effects of poor air quality?

Monitor air quality. Swenson and Reid recommend checking airnow.gov for information on the air quality index. The AQI is a good indicator of whether it’s safe to spend time outdoors. If it is yellow (moderate) or above, at-risk people should stay indoors. If it is red or above, then everyone should stay indoors, Reid said.
- Reid recommended checking frequently and getting as local perspective as possible.
- “The smoke plume [can] really change the air quality over short periods of time, depending on how the wind blows and and the intensity of the fire,” Reid said.
Run the air conditioning system and use HEPA air filters, Swenson said. That can help clean indoor air. People who don’t have those should try to find indoor spaces to spend time, Reid said.
Keep windows and doors closed.
Wear a mask. Those who are at risk who must go outside should use an N95 mask, Swenson said. That can help protect against the inhalation of the very fine particulates.
Exercise indoors. If you really want to exercise outdoors, early morning and after dusk are best, Swenson said.
Check your air filters after the fires and change them if needed, Reid said. Make sure building managers at large buildings are doing the same.

How long will health impacts last?

There are short- and long-term impacts, Swenson said. The smoke can set off COPD or asthma exacerbations in near-term. Those can last days to weeks, he said. It can also increase the risk of heart attack or cardiac injury for people with underlying conditions.

Over the long term, the smoke can set off “systemic inflammation that can linger for weeks or even up to a month,” Swenson said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

PEPFAR snapshot after funding cuts: Less HIV testing means more cases

2026-04-23T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we’re heavy on the Africa news. We’ll cover two important HIV stories, one about new U.S. data, and one on South Africa. Together, they offer a clearer read on the global HIV response and, I hate to say it, they undo some of the cautious optimism I’d started to feel. We’ve also got a hopeful malaria story from Eswatini, and a broad snapshot of vaccination across the continent.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

New data: a stalling fight against HIV

The U.S. State Department finally released new data Friday on PEPFAR, the two-decade-old U.S. President’s Emergency Plan for AIDS Relief at the center of the global fight against HIV/AIDS.

As Reuters reports, this was the first public update in 16 months, and the only official snapshot of the program after the widespread disruptions in 2025 and a roughly 30% drop in funding. (Worth noting: The data are also incomplete. The update only covers the final quarter of 2025.)

What’s the topline?

The Trump administration is pointing to a single figure: that 20.6 million people are still on HIV treatment. Taken alone, that’d be fine news, because it’s nearly level with the figures from both 2024 and 2023.

But, as Reuters notes, that treatment figure relies on some funky accounting. It includes about “3 million people whose care was provided by their own governments.” And even setting that aside, advocates are worried for a simpler reason: Treatments may be steady, but the data indicate significantly more new HIV infections are slipping through.

The data paint a clear picture.

From 2024 to 2025, 4.7 million fewer people were tested for HIV (a drop of about 22%). About 78,000 fewer people were diagnosed with HIV (20%). And 2 million fewer people were taking preventive treatment (10%).

It’s a fairly shocking downturn, and portends a future of more HIV, not less.

As Charles Kenny, a senior fellow at the Center for Global Development who has been tracking the data, told Reuters: “If people aren’t tested, they can’t know if they’re positive. If we don’t know they’re positive, they cannot be put on drugs … We’re building up problems for the future."

Or, as Kenny told the New York Times, “the long-term trajectory could be back to as depressing as I thought it was going to be last year.”

Inside South Africa’s HIV slowdown

Ok, so that new PEPFAR data give a global view.

But this week Physicians for Human Rights, a U.S.-based non-profit, also zeroed in on what these changes look like with a report from one country: South Africa, home to the largest HIV epidemic in the world.

South Africa is a fascinating case to focus on, because there are several reasons you could expect it would be better positioned to absorb the shock of the HIV funding cuts than many other countries.

Why? For one, it’s an upper-middle-income country that spends a hefty 16.8% of its budget on health. And in recent years, the United States covered just 17% of its overall HIV response, with the majority managed domestically. (That’s far less than in countries like Uganda, Tanzania, or Lesotho, where international funding has historically paid for the vast majority of those programs.)

But in the report, the interviews with health workers, researchers, and patients across South Africa tell a different story: a system where “a future surge in otherwise preventable new HIV infections [is] all but inevitable,” and where “catastrophic” cuts to HIV research are already having global effects.

I reached out to the co-authors of the report: Karen Naimer, the director of programs at Physicians for Human Rights, and Emily Bass, an author and HIV/AIDS expert, to understand what’s actually breaking here.

First, we talked about the hit to laboratories.

As Naimer explained, for years South Africa has been a global center for HIV research, with both a large number of cases and the advanced, scientific infrastructure to study them. That’s one reason why before 2025, South Africa was the largest foreign recipient of funding from the U.S. National Institutes of Health — America’s federal medical research agency. Roughly $400 million went into studies that shaped how HIV is treated worldwide.

But, as she explained, much of that work has been cut off.

Alongside a pullback in dollars, a new NIH rule has blocked U.S. funding from reaching overseas research partners, leaving “terminated studies, the loss of clinical trial capacity, and the attrition of skilled personnel,” she said. And this isn’t just a South Africa problem, “that dismantling of the clinical research infrastructure in South Africa will have global implications.”

What about on the ground – how is everyday HIV prevention and care in South Africa faring?

The report really paints the picture of why testing is falling and fewer HIV cases are being found.

As Bass explained, while the United States funded a minority of South Africa’s overall HIV response, it covered a majority share of the front-line prevention work, especially the more intensive and expensive programs like community testing and outreach. “And virtually all of that investment ended overnight in South Africa,” she said, adding that much of it still hasn’t been replaced.

Ultimately, HIV prevention depends on reaching people who feel fine and aren’t thinking about HIV. They’re not seeking medical care, so the system has to go to them. (Think mobile testing vans or having social media influencers chat about HIV prevention).

Take that away, and you’re left with clinics. And if that’s the whole strategy, it’s no wonder it’s falling short. As Bass put it, “people are not going to regularly elect to go to a clinic and wait hours to get a test, just to find out if they are HIV negative.”

One final note: These cuts to preventive care are hitting just as lenacapavir (the breakthrough HIV prevention drug we’ve been covering extensively) was about to be rolled out.

So, instead of hitting the ground with speed, Bass tells me, the very systems meant to deliver this new drug have been dismantled. “We destroyed that platform, and it really is destruction,” she said.

Holding the line on malaria

The Guardian has an interesting story out of Eswatini (the small, landlocked country between South Africa and Mozambique) that is seemingly close to eliminating malaria altogether.

How close? Well, in 2024, the country of 1.2 million recorded only “362 confirmed malaria cases.” A feat all the more impressive given that “cases have risen globally for six consecutive years,” even in neighboring countries.

As the story shows, part of what’s made the malaria response so effective is the tight disease surveillance system in Eswatini, where individual infections are treated with immediate house-to-house testing and spraying.

There is some peculiarity here worth mentioning. The last mile is often the hardest and most expensive in disease control (polio is a classic example). But malaria is a little different because the symptoms are so visible, and the disease spreads very locally.

What this means is that once malaria cases get very low, a country can concentrate resources on each infection with remarkable efficiency. (This is the very dynamic that allowed the United States to pull off malaria elimination in 1951.)

Unfortunately, Eswatini’s progress nevertheless sits right up against a very different reality in neighboring Mozambique, where there are more than 11 million cases a year. It’s an ever present challenge that, well, mosquitoes don’t care much for borders.

And there are other looming challenges, too. As Mark Edington, the head of grant management at the Global Fund, told the Guardian:

“If you look at the combination of decreased malaria funding, from us and probably from the U.S.; you look at increased resistance towards both drugs and insecticide; you look at population growth; you look at extreme weather events, which are increasing; and you put that all in a mixing bowl, the result is not good … It is worrying.”

What’s the takeaway?

Certainly Eswatini deserves kudos for this heroic effort. But the real question is whether it can hold the line. With 11 million cases just across the border, a lasting elimination of the disease is just not possible, and keeping numbers this low will require the same constant, expensive vigilance year after year.

Immunization across Africa

The World Health Organization has released a new snapshot on the state of vaccinations across the African continent. As the AP reports, it’s both the “first-ever comprehensive analysis” of its type and a mixed bag of news.

Let’s start with the positive, which is the long view. The data in the report make a strong case that vaccination efforts on the continent have been one of the most consequential humanitarian achievements in modern history.

Think I’m overselling it?

Consider that over the last 50 years, vaccination efforts have “saved more than 50 million lives.” Even just since 2000, routine programs have reached “more than 500 million children,” preventing more than “4 million deaths each year.”

Zooming in a bit, there have been some very specific successes, too. Wild polio has been eliminated from the continent (the last case was in 2016). And tetanus infections during childbirth, once a major killer, have also been largely eliminated as a public health threat.

What’s the worse news?

The report outlines that most vaccine-preventable diseases have been mired in stalled vaccination coverage, and in many cases for more than a decade.

For example, only half of children on the continent are receiving two doses of the measles shot, which is the only sure-fire preventative for the disease. HPV vaccination sits at just 28%. And the hepatitis B shot, which is given at birth, reaches only 17%.

The WHO’s target for all these vaccines is 90%. We’re not even close.

And, unfortunately, we’re on track to see things worsen.

The funding behind these programs is shrinking, with the AP noting that “the U.S. withdrawal from WHO in January resulted in the loss of about 40% of the agency’s overseas development funding,” and the Gavi Vaccine Alliance is also “experiencing a financial crunch.”

What’s the takeaway? I have mixed feelings. It’s worth appreciating the extraordinary amount of human suffering we’ve reduced through vaccination. But it’s not enough, and it’s frustrating to realize we may be stuck at an arbitrary high-water mark well short of what we’re capable of.

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Georgia public health board goes seventh straight month without meeting

2026-04-22T21:29:19+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

For the seventh month in a row, the board of the Georgia Department of Public Health will not hold a meeting this month.

The board last met in September. At that meeting, board chair Dr. Jim Curran criticized changes to federal vaccine policy under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr. And the board discussed how to handle the distribution of Covid shots.

The board was next scheduled to meet in November but cancelled. A notice on its website said it would “announce the date of the next board meeting after the first of the year.” No new meeting date has been posted.

DPH manages a $933 million budget and nearly 6,000 state and county public health employees. State law says the board should “establish the general policy” of the DPH, but lists no other specific responsibilities.

Georgia’s open meetings law requires state agency and board meetings to be “held in accordance with a regular schedule,” though the law doesn’t define “regular,” and meetings can be canceled or postponed.

“I find it appalling that the state health system hasn’t met since September,” said Richard T. Griffiths, former president of the Georgia First Amendment Foundation.

“By not meeting and abdicating their responsibility, they are suggesting that there are no issues, no problems in Georgia,” Griffiths said. “You only have to look at things like maternal health to understand why it’s disappointing to see this board not meeting.”

Only about three-fourths of Georgia women receive adequate prenatal care, and the March of Dimes gave Georgia an “F” for its high pre-term birth rate. Rates of maternal mortality and morbidity in Georgia are higher for Black women than the general population.

The board will meet to review 2026 legislative developments and vote on a bond resolution, said DPH spokesperson Nancy Nydam Shirek, but a date has not been set.

More frequent meetings would help the agency take a proactive approach, “which is preferred for public health,” said Stacie Kershner, deputy director of the Center for Law, Health and Society at the Georgia State University College of Law.

Nydam Shirek said the board does not have “statutory authority” over DPH’s everyday work and serves generally “in an advisory capacity.”

She added that board members have communicated with DPH about “emerging issues in the communities where they live and work,” including Covid, congenital cytomegalovirus (an infection that can cause hearing loss in babies), and maternal mortality.

Sidney Barrett, who served as the general counsel for the agency for nine years, said there could be many reasons for the lack of regular meetings and it’s not necessarily a bad sign. He said he has full confidence in Commissioner Kathleen Toomey and believes board members have “clear channels of communication” with her.

Board meetings may not necessarily be the best or only way to build trust with the public, said Darlene Huang Briggs, an attorney at the Public Health Law Network who has looked at how states structure public health systems.

“The health department should be responsive and accountable to the public that it serves,” Huang Briggs said. “The ways to do that may be better communication, better transparency to data that they use to make decisions, even just better understanding of what the health department even does.”

The board’s lack of meetings stands in contrast to other health agencies’ regular board meetings – as well as its own past record. After falling off during the pandemic, the DPH board met 10 times in 2022 and seven times in 2023.

State law requires each board of the 159 county health departments to meet at least quarterly. The Fulton County Board of Health met Wednesday to discuss how the agency is preparing for the influx of global visitors to Atlanta for the upcoming World Cup, which raises the threat of infectious outbreaks, including measles.

The boards of Georgia’s three other health agencies also meet routinely.

For example, the board of the Department of Community Health has met each month this year. Last year, it met 13 times. DCH meetings typically include votes on regulations and updates on programs, budgets, audits, and state and federal policy.

The board of the Department of Behavioral Health and Developmental Disabilities has met once this year, with five more meetings scheduled for the rest of the year. Last year, it met six times. The meetings often include routine business, updates on programs, presentations from people working in mental health in Georgia, and comments from the public.

The board of the Department of Human Services meets quarterly and has held two meetings this year, with two more scheduled. It met five times last year. The meetings include updates from each program within the agency, typically with data, among other routine business.

As with other health agencies, DPH board members are appointed by the governor for three-year terms. They are not paid for their service, but receive small stipends.

Georgia law says the governor can remove members for “inability or neglect to perform the duties required of members,” among other reasons.

Curran, the current board chair, did not respond to a phone call and emails requesting comment.

“Why do we have boards where people agree to serve the public if they’re not going to do their job in serving the public by providing the overall policy and direction for the state Department of [Public] Health?” Griffiths said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Most Americans believe vaccines are safe and effective

2026-04-22T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

This week, a headline about vaccine skepticism made me gasp – that is, until I read the actual data. Then I turned my attention to another important federal health program that is at risk of being gutted the same way Centers for Disease Control and Prevention vaccine policy was. And a surprise comment from President Donald Trump has upended what had been promising bipartisan momentum on child care, a service that is critical to health.

Do Americans trust that vaccines are safe and effective?

I gasped this past week when I read a headline that said that “more Americans doubt vaccine safety than trust it.” With measles and pertussis resurging, this headline suggested that vaccine skeptics are winning and made me worry that even more fearsome vaccine-preventable infections, such as polio and diphtheria, might soon return as well.

The headline came from a Politico poll of 3,851 U.S. adults, conducted in March by Public First. The poll found that nearly half of respondents said the facts on vaccines are “still up for debate” and that it is “damaging to enforce their uptake.” A plurality also said they support reducing the number of vaccines Americans receive. Politico reported that the findings suggest “RFK Jr.’s views are commonplace across the land.”

As an epidemiologist, I knew I needed to set aside time to review the actual data in more detail. Thankfully, other experts I trust had already done that.

Pediatrician and public health physician David Higgins analyzed the poll’s methodology and identified a fundamental flaw. The core question was what survey researchers call a “double-barreled” question, except, as Higgins pointed out, it actually had four barrels.

Respondents were asked to choose between two statements: one saying the science is clear and it is “damaging to question it,” and another saying the facts are “up for debate” and it is “damaging to enforce” vaccine uptake. Those are four distinct and independent beliefs fused into a single complicated and odd choice.

For example, a pediatrician who thinks the science is clear but believes vigorous debate is essential to good science has no good answer. Neither does a parent who trusts vaccines, has chosen to vaccinate their children, and also opposes government mandates. Because this question was so poorly worded, it was wrong for Politico to report the sweeping conclusion that half the country now shares Health and Human Services Secretary Robert F. Kennedy Jr.’s worldview.

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

Other data from the same poll are reassuring and were downplayed. Only 10% of respondents chose the most skeptical position that vaccine risks are significant and enforcing vaccines is dangerous. And only 34% said they see reducing vaccines as a core principle of the Make America Healthy Again movement, the ideological home of anti-vaccine politics.

The idea that vaccine skepticism is now the default is itself a public health threat. People who see misleading headlines may begin to wonder why they are the outlier in trusting vaccines. Public health advocates need to both loudly oppose the anti-vaccine movement and widely celebrate the fact that most Americans still believe that vaccines are safe and effective.

Eager for some good news about vaccine uptake in the United States, I was also pleased to see a famous athlete endorsing vaccines this week. Basketball star Tyrese Haliburton — who led the Indiana Pacers to the cusp of the NBA championship last year before tearing his Achilles tendon in the final game — was recently diagnosed with shingles.

In an interview about his experience, he had this message to the audience: “I would tell anybody over 50 years old to get the [shingles vaccine]. This has sucked.” I strongly agree with that recommendation, as I have written about previously.

What is the future of the U.S. preventive services task force?

A federal program tasked with guiding doctors and health insurance companies on disease prevention has effectively been shuttered, but testimony from Kennedy last week suggests that he might do to it what he did to CDC’s vaccine program.

The U.S. Preventive Services Task Force is one of the most valuable, though least known, programs in American health policy. Established in 1984, it is an independent, volunteer panel of physicians and health professionals that reviews scientific evidence on preventive services and grades them on a scale from A to D. Think about mammograms, colonoscopies, depression screening, cholesterol tests, and HIV pre-exposure prophylaxis. Under the Affordable Care Act, insurance companies are required to fully cover services rated A or B at no cost to patients.

Since he took over, Kennedy has cancelled all of the task force’s scheduled meetings and refused to name replacements for five of its 16 members whose terms expired in December. As a result, there have been no new recommendations on important issues, and the task force was unable to publish a legally mandated annual report to Congress. Nineteen senators sent Kennedy a letter last month demanding he stop blocking the panel’s work.

Leadership disruptions at the CDC endanger American health

Then, in testimony before Congress last week, Kennedy went further. He called the task force “lackadaisical and negligent for 20 years” and said he would appoint new members with “a clear mission.” What’s Kennedy’s version of a clear mission? I worry that he wants the U.S. government to do what he did to the CDC’s Advisory Committee on Immunization Practices and stock it with people ideologically aligned to him. This could mean that the task force starts recommending interventions that have no basis in evidence but that Kennedy endorses, such as peptide injections and raw milk.

Why does this matter so much?

As public health expert Tom Farley argues, the U.S. health care system needs an independent, conflict-free body to evaluate evidence. Otherwise, the guidance that flows to physicians and patients gets distorted by financial interests. Medical specialty societies often publish their own guidelines, but many of their members have financial ties to the companies that stand to benefit from the tests and treatments being recommended.

The task force’s credibility to me and other practicing physicians has always rested on the fact that its members have no such conflicts and consider the totality of evidence, including the costs of testing or treating too much.

The importance of health and safety in child care

Trump recently upended the national conversation about child care saying that he does not believe the federal government should be in the business of paying for it. Until recently, child care had been a rare issue in which there is genuine bipartisan consensus in Washington. Lawmakers from both parties have been advocating for more federal investment, arguing that child care is important infrastructure for adults to be able to work and to grow the U.S. economy.

At an Easter lunch on April 1, Trump said, “We can’t take care of day care. We’re a big country, we have 50 states. We have all these other people, we’re fighting wars. We can’t take care of day care.”

Millions of American families have no child care options available to them, and, even among those that do, the cost is exorbitant, often exceeding the cost of college tuition. Many states are looking for local resources to fund child care expansion. In my home city of New York, the new mayor ran on a promise of universal child care for children from 2 to 4 years old.

If states do find their own resources to expand the number of child care seats, I am hoping that they also allocate sufficient funding for health and safety. In a report I recently authored, I argue that expanding the number of child care seats without ensuring health could make the system even more fragile with facilities closed because of outbreaks or staff shortages.

States need to budget for protecting children’s health, supporting child care workers’ health, and designing and maintaining facilities safely. These are important issues that parents can also try to assess when deciding where to enroll their children.

Until next week,

Jay

Rutgers dean argues public health circles need to better understand humans’ role in outbreaks

2026-04-21T18:35:29+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Public health has long focused on the biology of pathogens — how viruses spread, how vaccines save lives, and how treatments can prevent disease — but Perry Halkitis believes the field should take a closer look at the role that humans play in public health.

Such is the focus of his new book: Humanizing Public Health: How Disease-Centered Approaches Have Failed Us.

Halkitis has served as the dean of the Rutgers School of Public Health since 2017. Prior to that he worked as a professor at the Center for Health, Identity, Behavior and Prevention Studies at New York University; the center has since moved to Rutgers, which he still leads. Halkitis conducted research on HIV/AIDS, drug abuse, and mental health. He is also an epidemiologist, applied statistician, and public health psychologist.

His academic area of expertise is people who have been infected and affected by HIV — a topic he explored in an earlier book, The AIDS Generation. It may come as no surprise that Halkitis saw parallels between the AIDS epidemic and the Covid pandemic and felt compelled to write his latest book on the need for a public health sector that puts humans front and center.

In a conversation with Healthbeat, Halkitis, 63, a New York City native who lives in Manhattan, discussed how public health might “humanize” itself, how the LGBTQ community can serve as a model for tackling public health challenges, the importance of public health influencers, and the reality that five tequila shots might compromise our better judgment.

This interview has been edited and condensed for clarity and length.

Your new public health book has just come out. Can you tell us about it?

It talks about the need for us to understand public health with humans at the center of all diseases. It means that we have to show humanity to each other as members of communities, and it means that we have to attend to the human elements of disease, i.e. people’s emotions or psychological states, their identities — all the things that make people people — and stop treating people like they’re laboratory rats running around mazes.

The book interweaves a story around HIV and Covid, mpox, Ebola, and the 1918 flu — everything from the history of pandemics and diseases that shows that human beings are a problem, for lack of a better term.

Human beings make irrational decisions that seem rational to some of them. They make decisions based on what feels good.

Spurred by Harlem Legionnaires’ disease outbreak, new rules for NYC cooling tower testing to take effect

I remember sitting in a room with a bunch of really prominent researchers, and I was just a new guy. They were talking about the model they were going to develop — the model was if we gave people confidence in using condoms, they would use condoms.

The little young Perry said, ‘not if they’ve had five tequila shots.’ That, for me, summarizes what this book is about, which is, yes, those models work if people are making decisions based on reason and logic.

Public health depends on those models, but people do not make decisions based on reason and logic, and therefore the models are tenuous at best. You need to create emotion-based models in order to change people’s behavior.

Ultimately, if you’re trying to enhance the people’s empathy and altruism, you have to show that there’s a benefit in there for them too.

Public health leaders are trying to get their messaging out, but they’re up against some powerful forces, the mighty algorithm being the latest. How can public health leaders push back against that?

There’s two answers to that question. If you go back and check on all the major networks that had been presenting information during Covid, it was mostly by medical doctors. It wasn’t public health people. That’s public health’s fault.

Number one: We should have demanded that they should have been talking to us, because we know how to talk to people. Number two: We need to be training our students how to use these tools to be able to be effective leaders.

Which means that we need to be engaging with social media companies, to have them come in and train our students just like we train students to do statistics, epidemiology, policy analysis and outbreak investigation. We need to teach them how to be able to message to the top communities that they work with through social media.

The simple answer is that we need to teach people to be public health influencers, and we’re not doing that. At Rutgers, we are trying to do that, we’re changing our curriculum to address this very issue, because our students are telling us, ‘I need these tools to become a public health influencer.’

Your ‘humanizing’ title also seems to be acknowledging that artificial intelligence is in the room, no?

You can bet you can use AI in effective ways to tailor messages. What’s going to work for a 70- year-old or a 50-year-old is going to be different from an 18-year-old. When I say ‘humanizing,’ I’d say use all the tools at your disposal, including industry, which includes AI. And develop those messages that are humanistic, or tell me how to say [certain things].

There’s a new administration in New York City, and public health is being broadly linked to an affordability agenda. What are your thoughts on that approach?

Affordability is a very, very, very, very important characteristic of health disparities, a very important driver of health disparities that we see in New York City. Case in point: If you look at the HIV map in New York City, you will see a lot of people infected in Chelsea, a lot of people infected in the south Bronx and central Brooklyn.

If you put it next to it a map of where people are dying of AIDS, they’re not going to see people dying in Chelsea. But they are dying in central Brooklyn and south Bronx. What’s that about? That’s about affordability and access. It’s about access to care. It’s about access to services, affordability of medications, affordability of good food, affordability to see the best doctors. I agree 100%.

Are there any public health issues in the city that keep you up at night, or that are overlooked?

Obviously homelessness, because we see it everywhere. People are sick. They’re on the street. During this hard winter we had, which was the first rough one in a long time, people were just out there.

What also keeps me up at night is the next viral outbreak. One of the things I write about in the book is you want a model of something that works really well in a population that comes together. Look at what happened in response to mpox. We got that under control.

I do worry about bird flu and a mutating H1N5. I worry about a new clade of mpox. I worry about measles outbreaks now, because [New Yorkers] are not just staying confined in the city.

Greater New York is going to see its share of visitors — more than a million, it’s expected — when the region hosts the World Cup. In light of the dramatic changes to the Centers for Disease Control and Prevention and the World Health Organization, which have traditionally been responsible for disease surveillance, what are your thoughts on how all these local agencies might be able to handle these duties?

I have every confidence that the city will stay on top of it. When people ask where to go for information right now, [I don’t send them] to the CDC site. It’s all garbage. [I send them to] the [New York State Department of Health], which is doing a really good job. It remains a reliable source and a vigilant organization that is very much on the pulse of what’s going on with health issues and is very good about communicating in effective ways about that.

New Jersey is okay, too. They have a pretty good health care system and a public health care system there.

It’s the rest of the country I’m worried about. We’re going to have to be even more on alert in the next few months than before.

Anything else you want to add?

The gay population can serve as a model of how a community comes together and cares for each other. That, to me, is about altruism and care and concern. Maybe it’s because we’re all traumatized for 45 years of AIDS. The thought of Covid, the thought of something else destroying our lives, [compels us to] rally. There is a lesson that hasn’t been played up enough.

This story was updated to clarify that the Center for Health, Identity, Behavior and Prevention Studies is at Rutgers.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Georgia’s ACA enrollment plunges, raising concerns for rural hospitals and the whole health care market

2026-04-21T16:46:13+00:00

This story was originally published at the Georgia Recorder. Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

More than half a million Georgians have dropped health insurance coverage amid stiff premium price hikes for federally subsidized Affordable Care Act plans, according to data obtained by The Current GA and the Georgia Recorder.

The 37% enrollment drop – from 1.5 million Georgians in January 2025 to 950,000 as of April 17, 2026 — dwarfs any previous decline in the state since the launch of so-called Obamacare health insurance plans in 2014.

Rising prices for health insurance policies bought on Georgia’s health care marketplace occurred after the U.S. Congress and President Donald Trump decided against extending Covid-era “enhanced” health insurance subsidies, which sunset Dec. 31, 2025.

Preliminary data released in January about the number of Georgians enrolled in ACA plans hinted at a sizable decline of 190,000. The more complete numbers have been adjusted after those people who had been reenrolled automatically at the start of 2026 failed to make their first premium payments.

The Georgia Office of the Commissioner of Insurance and Safety Fire released the data to The Current following a public records request. It will be reported by the federal government this summer.

The steep decline sparked immediate concern from the organization that advocates for Georgia’s rural hospitals about the financial viability of these vital institutions should the data signify that Georgia’s uninsured rate has soared after years of edging down.

“I don’t know what we’re going to do, honestly” said Monty Veazey, president of the Georgia Alliance of Community Hospitals, when informed of the data by The Current. “It’s a larger number than I anticipated,” he said about the enrollment drop.

He said he was meeting with Gov. Brian Kemp next week and hoped to ask for his plans.

Drop negates recent achievements

Kemp came to office in 2019 promising to tackle Georgia’s adult uninsured rate, one of the highest in the nation. He has touted changes he oversaw to the state’s insurance market as well as the rollout of a state-based ACA marketplace called Georgia Access as solutions to this problem.

The new enrollment figures, however, raise questions about how durable those gains will be. Kemp and Insurance Commissioner John King did not comment on the enrollment figures.

Georgia’s enrollment drop dwarfs many other states’, according to partial ACA enrollment data first reported last week by the Wall Street Journal.

Fluctuations in enrollment for so-called marketplace plans are routine. But year-over-year comparisons for April also project a stark picture. In April 2025, enrollment in Georgia’s marketplace plans had already dipped to 1.3 million, according to state officials. The April 2026 data still represents a 27% drop from that level.

“It’s a really large shift in the market,” said Emma Wager, a senior policy analyst on the ACA at the health research nonprofit KFF.

There is currently no data showing whether the Georgians who dropped their marketplace insurance are now completely uninsured, or whether they took up a new kind of insurance. Some of those previously enrolled could have gotten new jobs with employer-sponsored health care, but it’s likely large numbers of them had no better options, said health policy researchers.

What Georgia can learn from states that revamped public health

In general, said Matt McGough, a policy analyst at KFF, people relying on Obamacare plans “really have nowhere else to turn.”

Wager, who emphasized that she had not seen the latest Georgia enrollment figures, said if the result in disenrollment ends up with a spike in the uninsured rates, then hospital finances across the state will be affected.

“A larger uninsured population means that hospitals have to provide more uncompensated care. And we also know that people who are uninsured are more likely to delay or forgo medical care … they may have severe needs by the time they actually see a doctor.”

Georgia has traditionally had among the three worst uninsured rates, along with Texas and Oklahoma. But lower premium prices during the pandemic helped lead to a surge of Georgia patients getting insured.

U.S. lawmakers including former Rep. Marjorie Taylor Greene said that Congress’s decision last year to allow extra subsidies to expire would put insurance out of reach for many. Extending the enhanced subsidies another 10 years would have cost $350 billion.

Democrats in Congress shut down the federal government last fall in a fight over the health insurance subsidies, but Congress did not renew the funding.

Since those extra subsidies expired, Georgians who make above a certain amount — about $64,000 for a single person — no longer get any federal assistance and must pay the full market price for health insurance. For some Georgians, the cost of premiums more than tripled.

Health providers expect hit

The loss of enrollment will send shock waves through Georgia’s health care industry. The state’s health sector was expected to lose more than $3.5 billion this year as a result of the expiring subsidies, as uninsured patients forgo care or show up in emergency rooms but can’t pay.

Georgia’s expected loss of health sector revenue from that change would be among the three largest in the nation, behind only Florida and Texas, according to the study by the Robert Wood Johnson Foundation and the left-leaning Urban Institute.

Dr. Ben Spitalnick, a Savannah pediatrician, said the premium hikes presented a budget crisis for some of his patients’ parents.

“I know patients who, this year it’s doubled for them,” Spitalnick said. “It’s insane to consider having to drop your health insurance,” he said. “If you’re, sort of solo employed or a very small business, and don’t have the comfort of either Medicaid or have a very large employer who has a large health plan, the exchange was a great option. Now it’s super expensive.”

McGough, the KFF researcher, said the ACA tends to insure people who are juggling hourly jobs or are self-employed. Self-employed often means doing gig work like driving Uber. More than a quarter of farmers and beauticians were insured through the ACA marketplace as of 2023, according to KFF.

The Affordable Care Act was passed in 2010 and the Marketplace launched in 2014. Under the ACA, the federal government mandates basic levels of care such as for prescriptions, mental health, and maternal care; and it also subsidizes premiums for certain income groups. Georgia also began its own subsidies in 2022. Starting with 2025 coverage, Georgia took over the ACA enrollment system at GeorgiaAccess.gov.

Factors influencing whether the numbers of enrollees rise or fall have included how well the system is operating, how much outreach and enrollment assistance the government enacted, and above all, how expensive coverage was. Trump in his first term pulled back on enrollment assistance, and in his second term has allowed massive pandemic-era subsidies to expire.

Georgia Recorder is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. This story was published in partnership with The Current. The Current is an independent, in-depth and investigative journalism website for Coastal Georgia.

To fight heat, NYC sets 2040 tree canopy deadline, with riskiest areas first

2026-04-21T13:24:07+00:00

This story was originally published by THE CITY. Sign up to get the latest New York City news delivered to you each morning. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

On a breezy Monday morning on a quiet corner of Queens, 11 leafy new neighbors arrived on a truck, fresh from a nursery in Kansas City.

Elm, red maple, and cherry trees — some with pink blossoms — would be planted next to the sidewalks across a few blocks of Cambria Heights, a suburban-style neighborhood of homes with grassy front lawns.

As workers hoisted a tree out of a bag surrounding its roots, a woman with a phone to her ear leaving a nearby house called out to ask what kind of tree the workers were planting: an elm that would grow to be up to 70 feet tall over the next three to four decades.

“Adding to the family!” she exclaimed, grinning, before getting into a car.

Cambria Heights is among the neighborhoods with the highest risks of extreme heat, where temperatures are hotter than the city’s average and where some blocks lack any trees.

Monday’s tree-planting session came as part of a strategy in its second year that prioritizes putting new trees in the neighborhoods most vulnerable to extreme heat, rather than in response to ad hoc 311 requests, as had been done in years past.

And planting those trees took on a particular significance as the Mamdani administration on Tuesday released a plan to expand the tree canopy to cover 30% of the city by 2040.

“To reach this 30% goal, it’s going to take work from every actor in the entire city,” said Jessica Einhorn, chief of forestry programs at the Department of Parks and Recreation. “This program planting trees, especially in the high [heat vulnerable] neighborhoods, is really critical towards that equity angle.”

In those riskier areas, the tree canopy — or the area of the city currently covered by trees and their leaves — stands at 19%, compared to about 26% in others, city Chief Climate Officer Louise Yeung told the City Council in March. (Overall, tree canopy covers just over 23% of the boroughs, according to the last count in 2021. That was after a net increase of 1.2% since 2017.)

Trees across the city serve more than an aesthetic purpose — they add to the health and resiliency of a neighborhood. Areas with a robust tree canopy and vegetation have shown to be slightly to significantly cooler compared to places where green space is scarce and pavement is plentiful. Trees also help to purify air and can reduce water runoff to mitigate flooding.

And their value as heat-regulators will only increase in the near future.

By the 2040s — the due date for the 30% canopy goal — New York City’s temperatures could be between nearly 3 and 6 degrees hotter due to the effects of climate change, according to the New York City Panel on Climate Change. Heat is dangerous: It contributes to the deaths of over 500 New Yorkers on average each year, with Black New Yorkers twice as likely to die compared to white residents.

The city experiences the urban heat island effect, meaning it’s hotter because of the density, pavement, and tall buildings than elsewhere. But some areas are significantly greener and cooler than others, while other neighborhoods are more vulnerable to heat based on a combination of physical factors — like existing trees — and social considerations, like residents’ income and access to air conditioning.

Cherry blossoms bloom in eastern Queens on Monday.

The Parks Department’s tree-planting strategy, announced in 2024, does away with the system where anyone can call 311 to ask for a new tree — except for the loophole New Yorkers can make a $1,800 donation to do so, as previously reported by THE CITY.

The new system instead divides the city into more than 400 zones, planting trees in every viable place within a zone while removing stumps and dying trees.

Each community board district will have a zone serviced every three years, and Parks plans to hit all zones every nine years. (Here’s a tentative schedule of tree-planting locations.) The most heat-vulnerable neighborhoods are on track to be completed by the end of 2027, Yeung said.

Money grows trees

Mayor Zohran Mamdani’s plan is the first time the city has set a target date for the goal of a 30% canopy. But critically, the money to pay for it has not been committed.

“Many of the actions in the plan rely on existing program budgets and aim to ensure that we are spending smarter,” City Hall spokesperson Jessica Woolford said in a statement. “We are creatively leveraging funds from government and private sources to advance our shared goals.”

City Hall did not offer its own estimate for the cost. But according to a 2022 estimate from a local environmental advocacy group, it would cost about $500 million to plant a million trees and achieve its canopy goal.

“The plan is great, but what comes after is the most critical part,” said Shravanthi Kanekal, a resiliency planner at the New York City Environmental Justice Alliance. “It’s going to signal a whole lot to see how much they dedicate funding to the plan.”

Climate-proofing: How a Coney Island hospital rebuilt after Superstorm Sandy

Though as a candidate, Mamdani promised to dedicate 1% of the budget to the Department of Parks and Recreation, his preliminary budget this year proposed spending just half of that — cutting nearly $34 million from the department’s budget in the current fiscal year.

“I’m really glad to see the city set a goal of 2040, and I think what we’ve been looking to is how to further accelerate achieving that goal,” said Tami Lin-Moges, director of the cities program at the Nature Conservancy. “But obviously that really relies on increased investments. … Investing in parks and the urban forest is an investment in livability in New York City.”

Greening the city so almost a third of it has tree canopy will require money, manpower, and shoring up interest from New Yorkers, said Simon Skinner, chief of programs and operations at the New York Restoration Project.

He pointed to the successful initiative to plant a million trees that the Bloomberg administration launched in 2007. It took eight years, short of the decade expected.

“It shows it’s possible,” Skinner said. “Everyone was pulling in the same direction because it was such a big initiative coming from City Hall.”

Skinner said several agencies coordinated to prioritize the goal as private landowners got involved, and the government and its partners educated kids and adults on tree planting and stewardship.

Not everyone is happy with new plantings

In Cambria Heights on Monday, interactions with neighbors showed some of the challenges the city may face as it reaches for the goal; not everyone was happy about the newly rooted neighbors.

Derrick Simmons, a long-time resident of a nearby block, stopped by to talk to the Parks workers about the problems he’s had with trees.

“The trees have fallen on different people’s cars. They broke up the sidewalks,” he said. “I know they said that this is supposed to make the neighborhood more beautiful, and I get that. But of course we got 26 trees. We don’t need any more trees.”

A bit later, another neighbor walked by and said the tree roots were messing with his home’s sewer pipes: “I live on the next block. We got tree-lined streets. It sucks!”

Navé Strauss, Parks’ director of tree planting, said, “Our mandate is to plant every available location.”

Einhorn said Simmons and his neighbor’s complaints indicated there was a lot that could be done to “increase the connection between people and their trees.”

“We do as much as we can to care for the trees, but really it’s those blocks where like a property owner or a neighbor will come out and water the tree or maybe plant flowers around that the data shows that those trees are better off than the others,” she said.

To reach the 30% canopy goal, trees will need to be planted on privately owned property, not just in public parks and on streets, Einhorn said — “and more than anything else is preserving our existing tree canopy.”

That maintenance — pruning, watering, cleaning tree beds and removing invasive vines — is important for trees to thrive and for the canopy to expand. All of those tasks require people to do them, which costs money.

“Obviously, it’s sexy and nice to plant a bunch of new trees, but we have to also look after what we already have,” Skinner said. “They have an outsized effect on things like reducing heat and absorbing pollution.”

Samantha Maldonado is a senior reporter for THE CITY, where she covers climate, resiliency, housing and development.

Half the world still doesn’t have a national public health agency

2026-04-16T18:32:06+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

I had a fascinating last week! I drove up to Ol Pejeta wildlife conservancy in central Kenya, and saw the last two northern white rhinos on Earth. I was a bit surprised to find that the story wasn’t exactly the tragedy I was expecting. While the last male rhino died in 2018, there’s hope. Scientists preserved his sperm, and now there’s a few dozen embryos that are being kept frozen in a lab in Italy.

The researchers are attempting to implant those embryos into females of a sister species (because they’re not willing to risk pregnancy complications in the final two) in a last-minute bid for de-extinction.

The last two white rhinos on Earth are at the Ol Pejeta wildlife conservancy in central Kenya.

Anyhow, this week’s stories are a bit more of an emotional mix; some genuinely hopeful, others tougher to sit with. We cover some surprising resilience in setting up national public health agencies around the world, the spread of measles in one of the world’s most densely populated countries, and the shadow of war on health systems in Gaza and Sudan, among other stories.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Public health agencies … rarer than you’d think

Our first story starts with a stat that genuinely surprised me: Of 195 countries, only 101 have a national public health agency, like the U.S. Centers for Disease Control and Prevention. Naively, I had thought them to be nearly universal.

Sure, all countries have something akin to ministries or agencies responsible for health and well-being. (Nobody’s truly flying blind.) But in about half the world, there is still no single institution that oversees disease surveillance, labs, or outbreak response during emergencies, like a pandemic.

That’s a core point of a Think Global Health essay by two World Health Organization officials who are advocating for more of these agencies. The WHO officials argue that they are often the deciding factor in whether outbreaks are contained early in a given country.

They cite Ethiopia’s rapid response to the Marburg outbreak last year, which was centrally coordinated by The Ethiopian Public Health Institute. As we covered in January, within just weeks, Ethiopian authorities “conducted 3,800 diagnostic tests, airlines screened 4.8 million travelers, and health officials ran a prevention-awareness campaign that reached more than 20 million households.” In sum: It was wildly successful.

In countries without a single public health agency, all those functions may have been scattered across various ministries, regional or state governments, or even research institutes. That fragmentation can slow decision-making at exactly the moment when speed matters most. As the authors write:

“It complicates decision-making when every hour is critical. In a scenario when a virus with pandemic potential suddenly emerges in a country, leaders need to do everything they can to stop the disease from spreading before it becomes uncontainable. Whom would the president or prime minister call?”

I reached out to Chikwe Ihekweazu, one of the authors and the head of the WHO’s health emergencies program, to ask whether the crunch in global health funding has slowed the momentum behind building these agencies, and what it takes to stand one up.

First, they thankfully haven’t slowed down. “Despite the current global health landscape” of funding cuts, Ihekweazu said, his team is helping “20 countries” establish these agencies right now. It’s a geographically diverse list that includes “Kuwait, Namibia, Sri Lanka, and Zimbabwe,” among others.

That’s steady progress, especially given that back in 2000, only 51 countries had one of these agencies.

Today, “the majority countries without a national public health agency are small island states in the Caribbean or the Western Pacific” that have historically banded together to share a regional health body, like the Caribbean Public Health Agency, he told me.

I was surprised to learn that the biggest deciding factor for these agencies isn’t so much about funding, Ihekweazu says, but countries recognizing what they’re missing after a crisis. In many ways, the latest countries on the docket are part of the long tail of Covid.

As for what it takes to stand up one of these agencies, Ihekweazu pointed me to a framework the WHO published just this year, which lays out 12 things countries need to get right, from leadership and funding to the nuts and bolts of detecting and stopping outbreaks. (It’s classic WHO: dry, quite lengthy … but technically excellent.)

Strip down that framework, and it points to something simple: In a crisis, a country has to be able to act as one. As Ihekweazu put it, “the next pathogen is sure to emerge, and either clarity or confusion will define the response. For the sake of the world’s health, let every country have the public health agency it needs.”

A measles outbreak in Bangladesh

Bangladesh is scrambling to contain a fast-moving measles outbreak that has killed more than 100 children in less than a month, the Associated Press reports.

The country, which is one of the most densely populated in the world, has launched an emergency vaccination campaign targeting “children age 6 months to 5 years old” in several high-risk districts. So far, “900 cases of measles have been confirmed … since March 15.”

Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

It’s worth noting that the current emergency surge of vaccinations is essentially the only path forward for the country. (Well, the only path that’s not a downward spiral.)

As Healthbeat has been reporting, measles’ level of contagion means outbreaks can take off quickly wherever vaccination rates slip. In the United States, cases have surged past 1,600 this year, with officials warning that infections are likely being undercounted and continuing to spread across multiple states.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

In Bangladesh, the outbreak is likewise exposing deep gaps in immunization coverage, “particularly among zero-dose and under-vaccinated children, while infections among infants under 9 months, who are not yet eligible for routine vaccination, are especially alarming,” Rana Flowers, UNICEF’s representative in Bangladesh, told the AP.

Troublingly, the outbreak is also colliding with political fallout from an uprising last year, where “the vaccination campaign for measles was disrupted.”

My takeaway? What’s particularly terrifying about this story is the math.

Measles requires about 95% vaccination coverage to stop the spread of the disease. Bangladesh has come a long way, from 2% coverage in 1979 to 81.6% today. But with a virus this contagious, that remaining gap is everything.

Gaza: amputees and hypothermia

This week there are two health stories out of Gaza that are worth reading.

The first, from The Guardian, follows Palestinians who managed to leave for treatment in Egypt after losing limbs in the war. The story has both dramatic photos and some fairly shocking figures.

“More than 6,000 adults and children have undergone amputations since October 2023,” including children who were, at one point, losing legs at a rate of 10 per day. But the story isn’t just about the horrors of those injuries. It’s also about what comes after.

Many amputees are currently stranded in Egypt, without legal status, unable to work, and cut off from long-term care. As one patient put it (which put a pit in my stomach,) “I want to return to Gaza because my daughters are there … When I am allowed to leave, I will go back to my daughters.”

The second story, from Think Global Health, is not much better. A health worker from Project HOPE describes this year’s winter in Gaza, where children died of hypothermia in tents, and where wet blankets and fuel shortages turned cold snaps into repeated medical emergencies. Part of this exposure stems from the fact that “81% of all structures in the Gaza Strip” are estimated to be damaged.

The author writes that hypothermia “acts not in isolation but as a deadly multiplier,” worsening malnutrition and disease in a system where most hospitals no longer function, even after the fighting has ceased.

I thought about both these stories when I listened to a podcast Tuesday morning, on a conversation about the “permanent” state of Palestine between commentator Ezra Klein and political scientists Marc Lynch and Shibley Telhami.

Ultimately, the medical situation in Gaza is no longer some acute crisis. The children freezing in tents, amputees stranded across the border, families packed into ruins, and endless limbo with no real horizon for relief…

That is now the baseline. It is daily life.

Famine in Sudan

I’m always a little hesitant about where to draw the line between humanitarian crises and global public health in the Checkup. But I have to include this next story, because I don’t think we truly appreciate what’s unfolding in Sudan right now.

According to Reuters, “millions of people in Sudan are surviving on just one meal a day” as the country’s war grinds into its third year. All told, nearly 29 million people, about 62% of the population, are unable to consistently access enough food to live a normal, healthy life.

The reporting draws on a new analysis from a group of aid organizations, including Action Against Hunger, CARE International, and the International Rescue Committee.

“In the two areas worst hit by the conflict,” the aid organizations found that millions of families often “miss meals for entire days,” with many people resorting to “eating leaves and animal feed to survive.”

The takeaway (and the trajectory here) is unmistakable. It’s the “f” word.

Famine thresholds have already been crossed in parts of the country, with child malnutrition rates “nearly double the famine threshold” in some areas.

This is shaping up to be a catastrophe on a scale the world has not seen in years, potentially decades, if conditions continue to deteriorate. It’s worth noting, the three NGOs I linked to above are taking donations, and saving lives with them.

‘Molecular surgery’

I’ll leave you with an op-ed published in the New York Times, written by Jeff Coller, a scientist who works on gene-editing technology. It is a hopeful-but-frustrated letter on what Coller says may be “the most important medical story of the decade.”

Coller opens with a striking vignette from last year.

A baby is born with a rare and deadly genetic disorder, stemming from a single DNA error. A liver transplant could fix the issue, but only after many months, and likely after “irreversible neurological damage” had set in.

So, instead, doctors and medical researchers designed a custom, DNA-altering therapy specifically for the rare disease in this one child. The drug was injected into his blood and the DNA error was permanently rewritten.

Coller’s point is that the age of truly personalized genetic medicine is no longer theoretical. It has already begun. And today, we are capable of eliminating entire categories of rare genetic diseases, most of which still have no approved treatments.

Ok ok, that was the hopeful bit. Now for the frustration.

As Coller sees it, even if the constraint today isn’t technological, “I believe that the biggest obstacle, however, is structural,” he says. Globally, our medical approval systems simply aren’t built for these kinds of custom treatments. In the United States, each one is treated like a brand-new drug, requiring its own approval process. As he puts it:

“Our regulatory and commercial infrastructure was built for blockbuster drugs that treat millions of patients with the same pill. It was never designed for diseases for which each patient may need a bespoke correction to a unique mutation. But we already have a model for individualized, high-stakes interventions that correct specific defects in specific patients. We call it surgery. Consider a surgeon who performs a heart valve repair. No one asks that surgeon to run a clinical trial before operating on the next patient with a slightly different anatomy.”

That’s the shift Coller is calling for. To stop treating these therapies like traditional drugs, and start approving them more like a platform, or even like a kind of “molecular surgery.”

After all, “radically new science demands radically new thinking about how we regulate, manufacture, pay for, and deliver treatments,” he says.

Ten years from now, if children are still dying of conditions we know how to correct, it will not be because the science wasn’t ready.”

Until next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How politics and AI are making it harder to ‘follow the science’

2026-04-15T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

During the peak of the Covid pandemic, the phrase “follow the science” became a popular refrain, used first by those advocating stronger infection control policies and later by those opposed to them. Today I am discussing how, in the past few weeks, scientific evidence has been selectively chosen to meet a specific political or economic end, and how artificial intelligence is making it harder than ever to know which scientific studies we can trust.

Politics of Covid vaccines and origins continue to cause trouble

The Washington Post broke a story last week that acting Centers for Disease Control and Prevention Director Jay Bhattacharya has been preventing CDC career scientists from publishing a study about the benefit of Covid vaccines during the recent winter respiratory virus season.

The report, which had cleared the agency’s full scientific review process and was scheduled for publication in the CDC’s flagship journal, the Morbidity and Mortality Weekly Report, on March 19, found that, between September and December 2025, healthy adults who received a Covid vaccine reduced their likelihood of emergency department and urgent care visits by 50% and the likelihood of Covid-associated hospitalizations by 55%.

According to the story, Bhattacharya, a health economist, thinks that the methodology used by CDC scientists is flawed. He is arguing that the CDC should only be publishing randomized control trials, a position completely at odds with the overwhelming consensus of vaccine scientists and epidemiologists who work in academia, government, and industry.

Randomized controlled trials are used to answer the question: “Does this vaccine prevent an infectious disease when used as intended in a selected population?” In contrast, the methods used in the suppressed Covid study are used to answer a different question: “Does this vaccine prevent an infectious disease when used in a real-world population under real-world conditions?”

The Food and Drug Administration and industry consider this "real world evidence," and the CDC has been using the exact same method for decades to estimate the effectiveness of the seasonal flu vaccine after each flu season has ended.

A report about flu vaccine effectiveness this past winter, using the exact same methods, was published in the MMWR just a week before Bhattacharya blocked the Covid study. (I covered the flu study last week). Why did his concerns about scientific methods apply to the Covid vaccine study and not the flu vaccine study?

I fear that the real reason Bhattacharya has squashed this study is that he does not want the CDC publishing any data about the benefit of Covid vaccines. Despite his repeated podcasting and writing about the importance of scientific debate, he rose to prominence as a Covid contrarian and is using his positions as National Institutes of Health and CDC director to promote his views and squash opposing scientific views.

On March 20, in his role as NIH director, Bhattacharya hosted the inaugural lecture of a series he is calling “NIH Scientific Freedom.” That talk featured a science writer from the UK named Matt Ridley about the “search for the origin of Covid-19.” Ridley argues that Covid was engineered in a lab and released accidentally. His talk completely disregarded the extensive evidence that points to an opposing hypothesis: The virus spilled over from animals into humans and amplified into an outbreak at a live animal market in Wuhan, China.

Thankfully, a diverse team of experts recently pushed back. Twenty-three of the 27 original members of the World Health Organization’s Scientific Advisory Group for the Origins of Novel Pathogens recently published a careful, detailed review concluding that most peer-reviewed scientific evidence supports that SARS-CoV-2 spilled over from an animal into humans. They found no conclusive evidence for a lab leak, and noted that government and intelligence reports favoring a lab leak rely on political, rather than scientific, arguments. Virologist Angela Rasmussen has written a considerably more caustic assessment of the Ridley lecture that is also worth reading.

In studies about the origins of a virus, we can rarely say anything is 100% certain. While a lab leak is certainly possible, the evidence strongly and consistently points elsewhere.

Politics of raw milk products causes trouble at FDA

Science remains a point of contention in an ongoing outbreak of E. coli O157 infections that CDC and FDA investigators have linked to cheddar cheese sold by a company known as RAW FARM.

Identifying the source of a food-borne disease outbreak is straightforward when people are exposed to the contaminated food at a single event — what’s known as a “point source” outbreak. When the exposure occurs over a wide geographic area and a long period — such as a food product sold around the country over weeks — the investigation is far more challenging.

Epidemiologists need to interview every patient about any foods they may have eaten before they became sick, relying on human memory and electronic records, neither of which are completely reliable.

Microbiologists need to obtain specimens from patients and link them together using genomic analyses. Ideally, they are also able to obtain specimens from food, but this is often difficult because the contamination may have been intermittent or limited to a batch that has already been sold and discarded.

Because it is so difficult to find a “smoking gun,” public health officials need to use a preponderance of scientific evidence to decide what to do, similar to the debates about how much evidence we need to decide Covid originated in nature or that vaccines work in the real world.

In this outbreak, the epidemiological case against RAW FARM is substantial. As of early April, nine people had been infected with the outbreak strain of E. coli across three states. Eight of these nine people were interviewed, and all reported eating raw dairy products. Of the seven who remembered the brand, all named RAW FARM. Genomic sequencing confirmed all the infections were genetically identical, meaning everyone probably got sick from the same source.

And yet RAW FARM twice refused FDA requests to voluntarily recall its cheese, posting on social media that the outbreak was not connected to its products and resharing testimonials from customers who continued to buy and feed the cheese to their children. When the company finally issued a recall on April 2, it did so “under protest,” continuing to deny the investigation’s findings.

Unfortunately, this not just a problem of one defiant cheese maker. The FDA took weeks longer than it would have previously to compel action, and the company’s defiance was likely emboldened by the current political moment, in which the head of the federal department overseeing food safety has celebrated raw dairy as a health food and framed food safety regulations as an assault on consumer freedom.

When leading government officials signal that food safety standards have changed, some producers are going to test that proposition and sicken us in the process.

AI is causing trouble with the scientific literature

An article published last week in Nature illustrates a different and perhaps more insidious threat: how AI can corrupt scientific communication and literature.

A medical researcher at the University of Gothenburg, Almira Osmanovic Thunström, invented a fake skin condition called “bixonimania,” a name she chose specifically because it sounded absurd, a psychiatric term attached to an eye condition.

She uploaded two obviously fake preprints about the condition to an academic website in early 2024, complete with a fictional author, a made-up university, and acknowledgements thanking “Professor Sideshow Bob” and “the Galactic Triad” for funding support. One of the papers stated explicitly that it was “made up.” Her goal was to test whether AI systems would pick up and repeat fabricated medical information.

The experiment worked faster and more thoroughly than she had anticipated. Within weeks, major AI chatbots were telling users that bixonimania was a real condition, describing its prevalence, and advising them to see an ophthalmologist.

Even more troubling, the fake papers were then cited in actual peer-reviewed medical literature, suggesting that some researchers were using AI-generated references without reading the underlying papers. One such paper, published in a Springer Nature journal, was retracted only after Nature’s reporters contacted the journal to ask about it.

As recently as March, some versions of major AI chatbots were still describing bixonimania as an “emerging condition” or a “proposed new subtype” of a real disorder. Millions of people now use AI chatbots as a first stop for health information. If the scientific literature that feeds those systems can be poisoned by fake papers, bad actors could potentially manufacture medical “evidence” to sell products, cast doubt on real treatments, and distort public understanding of disease.

Who controls what counts as evidence?

Who controls what counts as evidence, and what happens when that control is abused? In the past week, we saw examples of this problem from government agencies and the private sector. Scientific reasoning requires understanding what a particular study can and cannot tell you, what the weight of evidence across multiple studies suggests, and where genuine uncertainty remains. That kind of reasoning is hard to do, easy to distort, and, as this week makes clear, under assault from multiple directions at once.

Until next week,

Jay

How a medical student is helping the CDC alert doctors to heat’s effects on medications

2026-04-14T22:25:40+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Medical student Riya Goel’s life has been shaped by climate change. She spent part of her childhood in Bangalore, India, where she experienced frequent asthma attacks, often requiring hospitalization, due to poor air quality.

Other stints living in California and Colorado exposed her to wildfire smoke. She learned firsthand about Atlanta’s extreme heat when she started medical school at Emory University, where she will graduate in May.

Those experiences sparked an interest in understanding the interaction between climate change and health. Goel has developed a resource for the Centers for Disease Control and Prevention that helps clinicians understand how heat could affect patients on commonly prescribed medications, from aspirin to antidepressants.

Many drugs can reduce patients’ ability to withstand higher temperatures. Some drugs increase sun sensitivity, and high heat can reduce the efficacy of some drugs.

Providers need to be aware of the heat risks of drugs so they can educate patients and help offset those, Goel said.

The resource provides information for clinicians about how heat impacts the body along with tips for educating patients. It then provides a list of more than 20 commonly prescribed drug classes and indicates how high heat can impact them.

For example, some common selective serotonin reuptake inhibitors, often prescribed for anxiety and depression, can increase sweating. Aspirin can make it harder for the body to release heat.

Diuretics, which are commonly prescribed for conditions like heart failure and high blood pressure, can cause dehydration, increasing the risk for falls in extreme heat. But the drugs are designed to remove fluid from the body, so increasing water intake isn’t necessarily a good solution. Ideally, people on diuretics would have access to cool environments, Goel said.

“We can be conferring risk even just by very basic prescriptions that we write for our patients,” Goel said.

She’d like to see more medications added to the CDC list, and she wants more clinicians to be aware of the potential interactions.

“A lot of current efforts, including CDC guidance, are focused on building that awareness,” she said.

The tool recommends that clinicians make a plan with their patients for days when the HeatRisk is orange, red, or magenta. HeatRisk is a National Weather Service tool that measures temperature, humidity, and other factors for locations across the United States to help people plan for high heat.

Goel created the medication list working with Dr. Laura Seeff at the CDC. The CDC provided Goel with an initial list of medications to research, and she started with a literature review before diving deeper into how heat can impact each drug.

“I remember just spending hours every day, researching and adding things to the Excel doc,” Goel said. She identified additional medications for the list through her research.

Despite her long interest in climate change and medicine, Goel said her research for the project revealed some facts she hadn’t known before. For example, inhalers like the one she uses for asthma can lose their potency if stored in high heat. They should be kept at room temperature.

Dr. Randall Tackett, a professor at the University of Georgia’s College of Pharmacy, said that kind of information is important for patients. He pointed out that many people get their prescriptions delivered by mail, and sitting outside on a porch or a driveway in hot weather could degrade some medications.

The CDC tool Goel created can be used anywhere but will be especially relevant in cities like Atlanta that have many high-temperature days.

“During the summers [in Atlanta], it’s extreme heat every single day, and there’s so many people on antihypertensives, anti-epileptics, anti-depressants, and they all kind of alter our physiology in ways that are really important to recognize,” Goel said.

The city experiences about two more weeks of high heat days than it did in 1970, Dr. Kristina Dahl, vice president for science at nonprofit Climate Central, told Healthbeat last year.

The effects can vary widely, depending on where people live in the city and their access to cooling. For example, citywide about 96% of homes have central air conditioning, but in some westside neighborhoods, that drops to 80%, a 2023 analysis by Georgia Tech Professor Brian Stone found.

Along with people who lack air conditioning, there are many other vulnerable groups, Goel said. They include:

Children
Elderly people
Unhoused people
People who work outdoors
People with certain mental illnesses or cognitive deficits
People who are immunocompromised
Pregnant people

Goel is especially passionate about that last group because she will start her OB-GYN residency at the University of California in Los Angeles in June.

Pregnant people have “decreased sweating abilities, because there’s just more fluid that’s needed to make sure the circulation is adequate, and they tend to put more fluid towards their extremities,” Goel said. “The way that they expel heat or absorb it is also different.”

Older people are also especially vulnerable, Tackett said, because age impacts the body’s ability to regulate heat. That can increase the risk of people fainting or falling, he said.

“There is always the chance of someone getting out into hot weather and developing heat prostration or fainting,” Tackett said.

Pharmacists want to counsel their patients about the medications they are dispensing, Tackett said, but often people are in a hurry and decline counseling. Patients who start taking a medication during the winter may not be aware that a medication could increase heat sensitivity, he said.

He encouraged patients to take the time to check in with their pharmacist or clinician to learn more about how their medications are impacted by heat.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Spurred by Harlem Legionnaires’ disease outbreak, new rules for NYC cooling tower testing to take effect

2026-04-10T23:45:03+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

New York City property owners with working cooling towers — the cylinder rooftop structures spiking the city’s skyline — will soon be required to step up their testing for the Legionella bacterium.

It’s the city’s latest effort to prevent outbreaks of Legionnaires’ disease, which killed at least seven people in Harlem last summer.

A spokesman for the New York City Department of Health and Mental Hygiene said Friday the new cooling tower regulations go into effect on May 8 citywide. The rules were published in the City Record, a database of records and notices that includes public hearings and agendas, on Wednesday, and registered tower operators were notified. Property owners will also face higher fines for noncompliance.

The final rules were shared with all elected officials and community boards citywide Thursday.

The new regulations come after the City Council in October approved legislation to ramp up requirements for testing building cooling towers for Legionella microbes. In the past, cooling tower operators were required to conduct Legionella sampling every 90 days.

Building owners will now need to test for the presence of Legionella at least every month when the cooling towers are in use, which is generally during warmer weather months. The bill further requires that all such testing be performed by, or under the supervision of, a “qualified” professional.

Harlem has high risk factors for Legionnaires’ disease

Central Harlem was the center of a Legionnaires’ outbreak last summer in which health officials say at least seven people died and more than 100 were sickened, many of them hospitalized. The outbreak was linked to contaminated cooling towers at several locations, including Harlem Hospital, which also had an outbreak in 2021. In that case, health officials determined the facility had not properly managed one of its cooling towers in accordance with local law.

Last month, Gothamist reported that Harlem Hospital ignored its own cooling tower maintenance plan in the weeks before last year’s outbreak when it failed to conduct rapid, weekly tests for Legionella.

New York City Legionnaires’ disease outbreak: Cooling towers, regulations, and lessons from 2015

In a separate Harlem case, two residents in one of the city’s largest residential complexes were diagnosed with Legionnaires’ disease, prompting local health officials in January to open an investigation.

Residents were advised to take baths or sponge baths instead of showers so that they wouldn’t breath in contaminated mist.

Harlem is particularly vulnerable to Legionnaires’ outbreaks, because of its high density of tall buildings with cooling towers, and the concentration of chronic disease — a risk factor for Legionnaires’ — in Upper Manhattan and the Bronx. The health department has also cited historic disinvestment and structural racism as factors.

Legionnaires’ disease tends to emerge more frequently in neighborhoods with older populations and higher rates of poverty, according to health officials. From 2019 to 2022, the city’s highest annual Legionnaires’ disease rates were concentrated in parts of Harlem and the Bronx. Among residents with Legionnaires’ disease in that period, more than 90% had at least one chronic medical condition, and more than 50% were previous or current smokers.

In what seemed like an odd anomaly to Harlem residents, city health inspectors in February found two tenants with Legionnaires’ disease in an apartment building on the Upper East Side.

“I started to believe that Legionella only knew Black and brown neighborhoods,” Marquis Harrison, chair of Manhattan’s Community Board 10 in Harlem, said March 31 on a panel with city health officials hosted by the CUNY Graduate School of Public Health & Health Policy. “We only saw it in the South Bronx and in Harlem, and only communities of color. We were having these outbreaks. … Maybe it doesn’t just exist in our neighborhoods.”

Preliminary budget includes more inspectors

The city held public hearings after last summer’s outbreak.

Health officials testified last September that they needed more inspectors to strengthen oversight and enforcement and hiring has begun. Speaking about the preliminary budget before the City Council’s Health Committee on March 20, health officials said that when fully staffed, the department will have about 56 scientists and water ecologists to oversee work related to the inspections. The city has some 6,000 cooling towers.

“The additional staffing that we got will enable us to conduct the annual inspection and any follow-up that’s needed of every cooling tower in the city, which, as you know, has been our goal,” said Corinne Schiff, deputy commissioner of the environmental health division in the health department.

The preliminary budget plan notes that the health department is devoting more money toward community outreach, cooling tower inspections, disease surveillance and laboratory testing. In the budget hearing, chief financial officer and deputy commissioner Aaron Anderson said $9 million will go toward surveillance and testing in the fiscal year 2027, along with 50 employees. Another $2.5 million will be devoted to the cooling tower inspections and 28 employees, and community outreach efforts will receive $1.1 million and 15 employees.

The outbreak has prompted lawsuits against the city and the construction firms involved in maintaining the cooling towers, with the backing of civil rights lawyer Ben Crump and the Rev. Al Sharpton. In his lawsuit, Crump alleged that the city failed to learn that water towers were unregistered or went uninspected. He also argued that the official death toll was an undercount.

The seven people who died last summer have not been publicly identified.

Harrison said their names may have been lost in the confusion surrounding the summer outbreak.

“It’s very sad for us, because the community couldn’t send their condolences or even celebrate their lives,” Harrison told Healthbeat on Friday, adding that he would renew his request to learn more about the people who died.

At the March budget hearing, City Council Health Committee Chair Lynn Schulman asked Schiff if the health department required further help.

“Do you need additional resources to prevent future outbreaks?”

“The program is to promote compliance with the rigorous requirements that New York City has, and as we discussed in the fall, that is designed as a prevention measure,” Schiff said. “We can’t commit that nothing bad will ever happen again.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

AI could help save lives by easing delivery of treatments that we know work

2026-04-10T11:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

According to tech leaders, artificial intelligence will be transformative for our health. AI could give us “the next 50-100 years of biological progress in 5-10 years,” declared Dario Amodei, CEO of Anthropic. “Maybe with 10 gigawatts of compute, AI can figure out how to cure cancer,” enthused Sam Altman, CEO of OpenAI.

Back in the clinic, our enthusiasm is more guarded. Part of it is the checkered history of health technology, too often extracting humanism in medicine for the pursuit of profits. Another hesitation is because so often, in the real world, the problem is not discovery but delivery. Cures that don’t reach the patients most in need; prevention that never makes it into practice. But what if AI could actually help us change that?

Take one of my longtime patients, whom I recently saw on his 45th birthday. We commiserated about the travails of middle age (I’m also turning 45 this year), and celebrated some progress he had made with his mental health in the last few months. And — with colon cancer affecting more young patients — I recommended a colonoscopy.

He acquiesced to a stool test, which screened positive, but declined the follow-up colonoscopy that might save his life. When I reached him to understand why, I learned that he had lost his job and his health coverage, and felt he had bigger fish to fry. “I’m feeling fine, doc” he said to me. His reassurance just reinforced my own powerlessness to reassure him.

My patient is far from alone: Roughly half of Americans with a positive stool test don’t complete follow-up within six months, despite the proven benefits of early detection and treatment.

This yawning gap repeats itself across American medicine. Less than half of patients with high blood pressure are on an effective regimen for it. Only about a third of patients who qualify for the medicines that could cure them of hepatitis C receive them. Fewer than 1 in 5 patients who would benefit from therapies like buprenorphine for opioid addiction get treated.

Even as we discover more effective treatments, we fail to deliver them to those most in need.

AI can help patients get through complex process to care

The discovery-delivery gap is not new. Three decades ago, health care pioneer Don Berwick highlighted “the gap between what we know and what we do.” But we now have a realistic opportunity to fix this failure, by thoughtfully harnessing AI to save lives.

Take my patient’s positive screen for colon cancer. Several steps are required after the stool test: notifying the patient, arranging scheduling, ensuring coverage, explaining the bowel prep. Sometimes the prep isn’t adequate, and we send patients back to square one.

The complexity of this process explains why many health systems employ patient navigators, and why people with greater means seek out concierge care to cut through the thicket. Artificial intelligence could help scale this kind of personalized, persistent engagement. Imagine a system that calls my patient in his native language, helps schedule his colonoscopy, and answers questions about the bowel prep. Nurses and social workers can focus their precious time on more complicated cases, like helping my patient enroll in Medicaid.

A test for AI apps is whether they enrich the human relationships at the heart of exceptional care. Too often, health technology has eroded relationships: reducing eye contact, depersonalizing interactions, making medicine transactional. Patients become less inclined to trust recommendations. In this environment, trusted intermediaries like community health workers become more important, not less, and technology must work for them.

Human relationships have always been a key to bridging innovations, like vaccines and cures, with implementation. The United States tamed tuberculosis, for example, through painstaking efforts to find and monitor cases in the community and provide subsequent support for completing treatment regimens.

AI can help cures reach patients who need them

Today we have a chance to eliminate modern scourges like hepatitis C, thanks to new therapies like curative antivirals. Hepatitis C is an insidious disease: Tens of thousands of Americans each year progress toward cirrhosis, their eyes yellowing and toxins clouding their minds as the liver fails. Yet a simple 8- to 12-week course of pills can eliminate the virus from the body. AI could help ensure that such breakthroughs actually reach patients.

Casefinding is especially important when people can transmit infection without knowing they are infected. Yet our tools for identifying these “silent carriers” are often blunt. Today, the national recommendation for hepatitis C is to screen every American between 18 and 79 at least once with a blood test. By contrast, a machine-learning algorithm tested in Israel was 100 times more efficient: yielding one diagnosis for every 10 tests instead of one for every thousand.

A similar opportunity exists for HIV prevention. As powerful new tools like the long-acting injection lenacapavir emerge, AI could help ensure that protection reaches those at highest risk.

Eliminating diseases like HIV and hepatitis C, just as we did for smallpox and polio, is within our reach — though it will take more than just technology.

What AI can’t do is solve our all too human problems, like the fact that high prices preclude broad access to some of our most consequential breakthroughs, from antivirals for hepatitis C, to the $28,000-a-year lenacapavir, to the new GLP-1 medications for diabetes and obesity. For this, we will have to work through our messy human systems to forge a better path.

Mere mortals have done it before. In Louisiana, a so-called “Netflix model” facilitated expanded access to hepatitis C medicines for a flat subscription fee. And the Congressional Budget Office estimated that a national subscription model for hepatitis C would save the federal government approximately $6.6 billion over 10 years, in part due to costs averted from hospitalizations and intensive care that would otherwise be borne by Medicare. We can save lives and money.

My patient ended up completing his colonoscopy after our social worker helped find health coverage he could afford. They found a small polyp that was precancerous, and he and I both breathed sighs of relief. But he’s due for another colonoscopy in five years. I hope we can make a century of medical progress by then. At the least, we can make it easier for patients like him to receive the care we already know saves lives.

Dr. Dave A. Chokshi is a physician at Bellevue Hospital and Sternberg Family Professor at the City College of New York. Previously, he served as health commissioner of New York City.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

2026-04-09T21:27:09+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Measles infections continue to spread across the United States, largely fueled by outbreaks – large and small – in multiple states

Since January, there have been more than 1,670 confirmed cases of measles nationwide, with most states reporting at least one case to the Centers for Disease Control and Prevention.

States with 10 or more confirmed cases of measles since January include: Arizona, California, Colorado, Florida, Minnesota, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, Texas, Utah, Virginia, and Washington state, according to federal, state, and local data.

But health officials in multiple states have told Healthbeat they are concerned measles cases are going unreported because there are people who aren’t seeking diagnosis and treatment. They also are worried that recent spring break travel may contribute to more people falling ill with measles in the next few weeks. It can take two to three weeks for symptoms to appear after a person is infected.

The good news: South Carolina, the site of the largest U.S. measles outbreak in decades with 997 cases, hasn’t had a reported measles infection in more than three weeks and will be declared over if that trend continues through April 26.

The bad news: Utah’s outbreak – now the largest, still-growing outbreak in the country – is approaching 600 known cases.

The CDC defines an outbreak as three or more related cases. Here’s what to know about six places where measles has been spreading:

Utah: The largest outbreak that is still growing

Utah’s large outbreak, like others, began with just a handful of cases that started being identified last June. A few were in Utah County, around Provo. Others were in a rural area in the southwest corner of the state – where the virus continued to gain traction, becoming the focus of the outbreak throughout last year.

By the end of 2025, 197 people had been diagnosed with measles largely in that one corner of the state. Then in recent months the outbreak surged statewide. Since January, another 386 people have been diagnosed, bringing the outbreak’s total to 583 reported cases as of this week. At least 47 people have been hospitalized.

Dr. Leisha Nolen, Utah’s state epidemiologist, said the number of cases known to public health officials is an undercount. “I can say confidently that we are missing cases,” she said.

But it’s difficult to say how many.

In some communities that are particularly distrustful of government and public health, as few as 1 in 10 cases may go unreported, she said. Cases in remote rural communities, with limited access to health care, may also have higher rates of underreporting, while more cases may get counted in cities with easier access to doctors and hospitals.

One thing is clear: Utah’s outbreak is continuing to grow. In the last three weeks, state health officials have learned of 121 new cases.

“In the beginning of our outbreak, we did have mostly communities along the southwest border with Arizona affected, and we were really trying to contain it in that area and prevent spread,” Nolen said. “But as you know, people move around.”

A state high school wrestling championship in mid February contributed to the spread of the disease, health officials said. The state’s TriCounty Health District in northeast Utah, with 59 reported cases, has been particularly hard hit in recent weeks following the event.

Kirk Benge, TriCounty Health director, said the region’s outbreak has been centered around the city of Vernal, which is known as “Dinosaurland” because of the area’s rich deposits of dinosaur fossils and nearby Dinosaur National Monument.

“We started with quite a large number of cases in a school,” Benge said. “Now we’re seeing the household spread that comes from all of those cases started in a school setting.”

There are encouraging signs the outbreak in the Vernal area may be slowing, he said.

“We saw week over week doubling there for a little while, and I think it plateaued here this last week, and it may be declining right now. So hopefully that trend continues,” Benge said.

He said that since the local outbreak began, large numbers of parents are seeking vaccines for their children and the number of vaccines administered is up 500% over the same period last year.

“I think we have a lot more just hesitant people who have been confused by mixed messages on social media,” Benge said. This kind of vaccine hesitancy is different than the staunch opposition to vaccination found in some other communities in the state, he said.

Still, many other parts of the TriCounty area remain vulnerable to measles outbreaks because of low vaccination rates – something the county’s board of health warned in a December 2024 open letter to the community that cited an increase from 4.8% to 11.9% of local parents seeking to exempt their children from school vaccines. “We want all residents to understand that individual decisions regarding vaccination impact us collectively,” the letter said.

To prevent outbreaks of measles, 95% of people in a community need to be vaccinated against the disease.

Arizona: Measles outbreak from 2025 continues to grow

A measles outbreak has been underway in Mohave County, along the Arizona-Utah border, since August 2025.

Last year the county had 214 cases. This year, at least 61 cases have been reported, state data show. Officials with the Mohave County Department of Public Health did not respond to an interview request.

Oregon: ‘Worrisome’ infections without obvious source

There have been just 13 measles cases reported across the state of Oregon as of April 3. While not technically an outbreak, Dr. Dean Sidelinger, the state’s epidemiologist, is concerned about hidden spread of the virus.

While the source of some of Oregon’s known measles cases can be traced to travel to another state with an outbreak, disease investigators haven’t found a source for most of the cases.

“That’s very worrisome to us in public health, because that indicates a level of spread in the community that we’re not detecting,” Sidelinger told Healthbeat.

The state’s wastewater testing has also been intermittently detecting measles in areas that don’t correlate with where cases are being reported, he said.

While Sidelinger said 9 out of 10 parents in Oregon have chosen to fully vaccinate their children, the state has localized communities where there are concentrations of unvaccinated people.

“Many of our communities, not just in Oregon, but across the country, who have lower vaccination rates, often have various reasons for that. But some are in more close knit, often faith-based communities that don’t typically seek health care, or maybe have a little bit more of a mistrust or distrust of government,” he said. “We worry that if it gets into one of these communities that it could spread fairly quickly.”

Florida: Cases continue in county with university outbreak

A measles outbreak linked to Ave Maria University in southwest Florida’s Collier County has grown to 106 confirmed and probable cases through April 4, the most recent data available on the state health department’s website. Statewide, there have been 144 measles cases reported since January, including a handful of cases in Broward, Pinellas and Hillsborough counties, the data show.

In recent weeks, spring break travel has resulted in a surge of travelers prompting concerns about the potential for further spread of the virus. The state health department and Ave Maria University didn’t respond to interview requests.

North Dakota: Two outbreaks since February

Since March 23 there have been six cases of measles reported in Ransom County, North Dakota, a largely agricultural area in the southeastern part of the state with a population of about 5,600 people. One person has been hospitalized, according to state data.

Officials at North Dakota Health and Human Services issued a press release on April 1 about the first Ransom County case, saying that the person “likely acquired the infection within the state” and that the case was not linked to a measles outbreak in Pembina County.

A spokesperson for the department said staff were out of the office and unavailable to answer questions about the current status of the outbreaks and efforts to control the spread of the disease.

The outbreak in Pembina County, which is in North Dakota’s northeast corner, involves 23 cases reported in February and March, according to the state’s online data. Four of these people were hospitalized.

A total of 32 cases have been reported across the state since January.

California: An outbreak sparked by travel to South Carolina

In recent months the Sacramento, California region has been experiencing a measles outbreak that was sparked by an unvaccinated toddler who had recently visited South Carolina’s outbreak area.

The toddler’s illness was reported to Sacramento County health officials in late February, then nearby Placer County identified three more measles cases in siblings from a different household who had been exposed to the toddler, according to the California Department of Public Health.

Additional cases have continued to be identified in both counties.

This week, Sacramento County announced that two additional measles cases have been reported. Both are unvaccinated children, raising the county’s number of confirmed cases to five.

“These five confirmed Sacramento County measles cases in recent weeks show the disease is circulating in Sacramento County,” the county health department said in an announcement about the cases. “The overall risk to the general public remains low but residents, especially those who aren’t vaccinated against measles or whose vaccination status is unknown, should be hyper-aware and take steps to protect themselves and others.”

In Placer County, where there have been eight confirmed measles cases, officials also are concerned that measles is spreading in the community. “Nearly all of the measles cases thus far have some association with homeschool enrichment programs in the region, either directly or through family members,” the county health department said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

States face another challenge with Medicaid work rules: staffing shortages

2026-04-09T14:30:30+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Katie Crouch says calling her state’s Medicaid agency to get information about her benefits can feel like a series of dead ends.

“The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

KFF Health News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long wait times for help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office estimated the rules would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia took more than 45 days to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the Covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and more than 25 million lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride, a Delware Democrat. McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States short-staffed for Medicaid

Some states told KFF Health News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made during a public meeting in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told KFF Health News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

KFF Health News correspondents Katheryn Houghton and Samantha Liss contributed to this report, which was originally published at KFF Health News, Healthbeat’s national reporting partner.

The next U.S. aid disruption: HIV, malaria drugs for Africa and Asia

2026-04-09T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

We had a lovely, long Easter weekend. (Both Good Friday and the Monday after Easter are national holidays here.) And later this week, I’m planning on driving some visiting family upcountry to the foothills of Mount Kenya, where we’ll see the last two northern white rhinos in the world.

This week’s stories cover some (déjà vu triggering) disruptions to U.S. medical aid, the rollout of a promising HIV prevention drug, the growing damage that war is inflicting on Iran’s health system, among a few other stories.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A proposal for more U.S. medical aid disruption

The United States is preparing a major, disruptive overhaul in how it delivers HIV and malaria aid, Reuters reports. The proposed changes represent an “upheaval likely to cause more medicine shortages” and risk “a second dislocation of life-saving services in just over a year,” across Africa and Asia.

Some background: For the last 10 years, the United States has routed a fairly astonishing volume of medical supplies through one large program called the Global Health Supply Chain Program – Procurement and Supply Management, which is run by the for-profit company Chemonix. Just how much? Between 2016 and 2024, that program “delivered a total of more than $5 billion of HIV and malaria products to 90 countries,” making the United States by far the largest funder of these tests and medicines worldwide.

But, according to the Reuters investigation, State Department leadership has asked “staff in 17 African countries and Haiti in an email [on March 31] to cease implementing the supply program by May 30.”

The program will theoretically be replaced by new systems set up under “bilateral agreements with other countries” and private distributors, which would have to be negotiated extremely quickly.

All told, the month-and-a-half timeline is raising concerns about “immediate risks to service continuity if the transition is rushed or incomplete,” with potential shortages of HIV drugs, malaria treatments, and other basic health supplies that millions of people rely on. As the article outlines, ordering and shipping medical supplies to remote clinics can take many months.

The directive “did not lay out a clear transition plan, instead asking each U.S. country office to set out how it would implement the handover, and to inform Washington of any risks or need for more time.”

I reached out to a senior, overseas State Department official with direct knowledge of the program, who agreed to speak on background to provide context.

My source confirmed the broader uncertainty around the transition. To their knowledge, even basic guidance on the proposed upheaval (including the email referenced in the Reuters report) has not yet circulated across all countries served by the program.

They echoed the strong concerns in the Reuters report that such a severe and rapid disruption could leave patients without lifesaving medicines. But what I found most interesting is that they noted that even if the United States ultimately shifts medical procurement to the international organization the Global Fund (an option that we reported on last week) simply purchasing medical supplies is only part of the coming challenge.

What remains dramatically unclear is the rest of the supply chain: warehousing, logistics, and actually getting drugs into clinics.

At the risk of getting too in-the-weeds: These risks may be especially acute in countries where the State Department did not inherit parallel supply systems from the now-defunct U.S. Agency for International Development that could temporarily absorb the shock. (In other words, some countries have backup systems to keep medicines flowing. Others do not.)

My takeaway: It’s still unclear how much of this proposal will actually move forward, or whether the State Department may walk back the plan or timeline. I’ll be following this story closely.

Is there enough of this game-changing HIV prevention drug?

Late last year, a new injectable drug to prevent HIV infection called lenacapavir began rolling out in several African countries. The drug has generated enormous excitement because a single injection protects people for about six months, and it provided close to perfect protection in clinical trials.

But that early rollout is already raising questions. In Eswatini, which received the drug first and has the world’s highest rate of HIV, clinics are already running through their tiny initial shipments, The Guardian reports.

One clinic only “received 130 doses.” Nationally, only a few thousand people have started the drug so far. (Keep in mind, a quarter-million people in Eswatini are HIV+). As one source in the story put it, “The coverage so far has been very, very, very low. But my impression is that interest is extremely high.”

The story raises an obvious question, and also had me wondering if this goes beyond one country: Is lenacapavir’s wider rollout already being hampered by supply limits? To ask, I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition, who we last spoke to about lenacapavir in October.

To start, Warren told me to pump the brakes. It is still early days. While “the initial deliveries are quite small to each country … it is actually too early to tell about the actual supply constraints (if any),” he said.

Warren noted that countries like Kenya, Nigeria, and Zimbabwe only just received their first shipments last month. “So we don’t yet know that demand is truly outstripping supply – yet.”

Still, Warren said the bigger picture for HIV prevention is far from reassuring amid the broader pullback in global health aid.

As he put it: “This continues to be a moment of cruelest irony – our best opportunity in HIV prevention coming at the worst time politically and economically.” While there is enormous potential for this new drug, “the foundational programs [which would deliver it] have been severely curtailed, and in some cases entirely decimated.”

Warren also left me with one note that’s often missing from lenacapavir coverage. HIV prevention, he says, “has always been more than a product — it is a program.” And without outreach, testing, and health systems that bring people back every six months, even a “miracle drug” (as the Guardian piece put it) won’t stop the epidemic.

Iran’s civilian health system under fire

For the third week in a row, we’re returning to the Iran war. Granted, it’s been evolving on a fairly volatile timeline, so much of what we know will likely change in the coming days.

Early Wednesday, a fragile cease-fire was holding after U.S. threats to attack Iranian power plants, bridges, and other civilian infrastructure if Iran did not reopen the Strait of Hormuz. Iran had threatened similar retaliation to neighboring countries. Under international law, these are war crimes, and the potential consequences for civilian health and survival could be enormous.

To some extent, that damage is already underway. Al Jazeera reports that U.S. and Israeli strikes have already hit major parts of Iran’s health system. This includes a psychiatric hospital, a pharmaceutical company, and the Pasteur Institute of Iran, “the oldest and most prestigious research and public health center in Iran,” which has “played a central role in fighting endemic diseases such as smallpox and cholera.”

The World Health Organization says it has verified “over 20 attacks on health care in Iran,” resulting in “at least nine deaths,” including an infectious diseases health worker and a member of the Iranian Red Crescent.

More broadly, WHO Director-General Tedros Adhanom Ghebreyesus warned that “the conflict in Iran, and the region, is impacting the delivery of health services and the safety of health workers, patients, and civilians present at health facilities.”

Argentina: easier monopolies for medicines?

After pulling out of the WHO last month, Argentina has made another significant policy shift. The government has scrapped guidelines that limited which medicines could qualify for pharmaceutical patents, according to an essay in Health Policy Watch by leaders in the affordable-medicines advocacy arm of Doctors Without Borders.

Put simply, the essay argues that Argentina has essentially made it easier for pharmaceutical companies to stretch out monopolies by re-patenting small tweaks to existing drugs. (Imagine a company simply rejiggering a new dose of an existing drug, and then re-patenting it just as the original patent was about to expire.)

Ultimately, these patent extensions push generic competitors out of the market for longer, and keep prices much higher. As an example, the authors reference a hepatitis C treatment that dropped from “$147,000 to $120 per person” once generics were allowed to compete.

You may be asking: Why is this (admittedly niche) policy shift for a single country worth covering?

Well, the authors argue that Argentina’s previous “more disciplined system” of patent rules showed how governments could apply strict standards, while still rewarding real innovation. By rolling those rules back, they warn, Argentina risks weakening a model other countries have looked to when trying to limit pharmaceutical monopolies.

As for my takeaway? This story touches on a tension I run into constantly covering global health. Alongside government-funded R&D, private companies are our greatest engine of drug innovation. The big question is how and where we should draw the line between incentivizing companies to invent lifesaving medicines … and demanding those medicines remain affordable once they exist.

Honestly, I’m reluctant to even, say, cast drug patents as a “necessary evil.” As uncomfortable as they are, monopolies ultimately allow companies to recoup the enormous cost of developing new medicines. And there’s nothing shameful in that. When there’s no profit to be made (as we see constantly with the entire field of “neglected tropical diseases”), the results often fall between grim and hopeless.

Human greed is a powerful force! Companies should see value in investing in the medicines we all rely on. But keeping that greed in check is just as important, and I think Argentina is failing in the latter to serve the former.

A ‘mysterious skin disease’ in Pakistan

We’ll finish on a small but worrying report out of Pakistan that’s worth flagging. At least nine children have died in the country’s southeast Sindh province from what officials have described as a “mysterious skin disease,” though the cause has not yet been identified, Pakistan Today reports.

On Monday, “samples from eight affected children had been sent to Karachi [the capital of the province] for testing,” but results have not yet been released.

It’s too early to know what this actually is, although the big worry is a novel outbreak. Local officials have suggested possibilities including chickenpox or mpox. (Although additional reporting suggests that while mpox has been detected in some of the cases, health officials say it was not the direct cause of the deaths.)

With no diagnosis yet and only local reporting so far, this may ultimately turn out to be a familiar disease rather than something new. Still, unexplained childhood deaths are always worth watching closely, and I’ll keep an eye out for further reporting.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How smoking fell to lowest level ever and other public health wins

2026-04-08T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I often write about what’s not working in public health. This week, I want to focus on a few recent studies that show what is working in public health — from reducing tobacco use to preventing one of the world’s deadliest killers — and put it in the context of how we think about interventions to avert illness and death in large populations.

What interventions work best in public health?

When we are trying to improve the health of a population, we try to choose interventions that benefit the largest number of people for the longest amount of time with the least amount of effort required on a daily basis.

In a framework first promulgated by former Centers for Disease Control and Prevention Director Tom Frieden, the most effective interventions address the socioeconomic factors that have the largest impact on health and longevity, such as poverty, education, and housing. The second most effective are interventions that change the default context for how people make healthy decisions, e.g., clean water, safe food, smoke-free places, and seatbelt mandates. These work because the healthy choice becomes automatic.

Third most effective are long-lasting protective interventions, such as vaccines or colonoscopies, that confer durable protection from a single encounter with the health system. Fourth most effective are ongoing clinical interventions, such as medications to treat blood pressure or HIV. And, fifth, the least effective in a population, is counseling and education about health: telling people to eat better, exercise more, stop smoking. Trying to talk one person into changing their behavior is hard. Trying to talk millions of people into changing their behavior is even harder and often fails.

Even though we have a hierarchy of what works best in public health, each of these types of interventions has value, as shown by multiple recent studies.

Changing the context: Tobacco use at a historic low

Cigarette smoking just fell to its lowest recorded level in U.S. history. A study published this month in NEJM Evidence, using 2023 and 2024 National Health Interview Survey data, found that cigarette smoking among U.S. adults dropped from 10.8% to 9.9%, the first time it has ever reached single digits. Tobacco kills roughly 480,000 Americans each year. If this trajectory holds, the United States could meet the Healthy People 2030 target of 6.1% before the decade ends.

What drove this decline? While many people probably think it was because of better education about smoking’s harms, most of the gains in tobacco control came from years of investment in changing the default context: High tobacco taxes and comprehensive smoke-free laws that made smoking expensive to start and disruptive to continue.

Unfortunately, this progress is not guaranteed to sustain. The current administration has had virtually nothing to say about tobacco and even eliminated the CDC’s Office on Smoking and Health. Congress is trying to restore it, and so I remain hopeful that the United States will continue to drive tobacco use down.

Worth noting is that e-cigarette use has not declined and sits at 7% among adults, with rates among young adults running significantly higher than cigarette smoking. And we still do not know what the long-term consequences of vaping will be.

Long-lasting protective interventions: Flu vaccine still worth getting

Vaccines are among the most cost-effective tools in all of public health. Some, like measles or polio vaccines, are delivered in the first few years of life and protect people for decades. Others, like flu vaccines, work differently: Because the virus mutates rapidly, the vaccine has to be redesigned each year, and protection is partial rather than complete.

The CDC just published data showing both the benefits and challenges of getting a flu shot every year. The dominant circulating strain this year (influenza A[H3N2] subclade K) emerged after this season’s flu vaccine was already selected, a mismatch that predictably lowered effectiveness. Among children and adolescents, vaccine effectiveness against outpatient visits ranged from 38% to 41% and, among adults, 22% to 34%.

While those numbers are much lower than I would like, one of the most important axioms of public health is that a small number multiplied by a very big number is a big number. Even partial protection against a disease that infects tens of millions of people means that tens of thousands of people did not end up in a hospital from the flu. For example, during the 2022-23 flu season, when overall flu vaccine effectiveness was also just 30%, flu vaccines still prevented an estimated 71,000 hospitalizations and 4,300 deaths in the United States.

Clinical interventions: DoxyPEP and tuberculosis

While medical care is often seen as the most important part of health, it is often less effective than other public health interventions, because it requires accessing a clinic, getting the right diagnosis, and maintaining adherence to treatment. Public health’s primary role in medical care is making sure that people who need it most complete these steps.

Syphilis rates in the United States have been rising sharply for a decade. In 2023, King County, Washington began actively promoting doxyPEP: prescribing a single dose of the antibiotic doxycycline that patients can take within 72 hours of unprotected sex to prevent bacterial sexually transmitted infections. The intervention is recommended for men who have sex with men and transgender women who have sex with men, the populations at highest risk.

A study published last week in Clinical Infectious Diseases assessed the two years after doxyPEP was introduced in King County. Syphilis cases fell by 52.3% overall, an absolute reduction of more than 3,000 cases. Cases fell among cisgender women as well, likely through an indirect effect: As transmission declined in high-risk groups, it declined in their broader sexual networks, too.

The CDC also just released its provisional tuberculosis data for 2025. Cases declined slightly from 10,395 to 10,260, a 1% drop. Cases had been increasing for four straight years, a reversal of the CDC’s long-standing progress toward eliminating domestic TB transmission.

TB demands more from the health system than almost any other infectious disease, because it requires specialized testing and prolonged treatment. Diagnosis is often delayed, because the symptoms are burdensome but not debilitating, and most cases occur in immigrants and other groups that have limited access to high-quality medical care. Treatment requires months of strict adherence to multiple antibiotics. For this reason, most TB care is either provided directly by public health agencies or monitored closely by them.

I am worried that the United States will not be able to sustain this decline. Much of the progress against TB elimination in the United States has come from sustained investment in domestic public health services and in global TB control, both of which have been cut dramatically in the past year.

What these findings have in common

Tobacco control, flu vaccination, doxyPEP, and TB treatment sit at different levels of the public health hierarchy of interventions, but they share a common feature: None of them happened spontaneously. They required sustained government investment, functioning public health agencies, and the political will to keep at it year after year even when the gains seem small and the benefits invisible to the naked eye.

Until next week,

Jay

Losing NY health coverage due to Trump cuts? Your guide to Essential Plan changes

2026-04-07T19:16:49+00:00

This story was originally published by THE CITY. Sign up to get the latest New York City news delivered to you each morning. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Nearly half a million people in New York State are poised to lose health insurance coverage as funding cuts from the Trump administration’s “One Big Beautiful Bill” begin to take effect.

On April 1, the state’s Department of Health began sending out notices to New Yorkers who receive coverage on the low-cost Essential Plan about how changes in eligibility requirements will take away their health care coverage.

The shift will affect hundreds of thousands of working, low-income New Yorkers who don’t qualify for Medicaid. Are you among them?

Here’s what we know about how the funding cuts will affect coverage, what people can do to stay insured, how to access care without insurance and the battle playing out in Albany to cover the costs.

Why is this happening and who is affected?

President Donald Trump signed a massive tax and spending bill in July 2025, including cuts to federal funding for New York’s Essential Plan. About 450,000 people will no longer be eligible for the program beginning July 1, even after New York state got approval from the federal government to keep about 1.3 million people enrolled.

The cuts primarily affect people with incomes from 200% to 250% of the federal poverty line, which this year equals yearly earnings of about $32,000 and $40,000 for an individual, or $54,000 to $68,000 for a family of three, according to Elisabeth Benjamin, vice president of health initiatives for the Community Service Society.

Q&A: How federal funding cuts will cost 500,000 New Yorkers their health insurance

“These are not wealthy people,” Benjamin said. “It will be much more expensive. They’re going to lose their free, no-deductible coverage, and instead have to pay hundreds of dollars [per month], potentially, for a product with a deductible.”

With the state budget not yet finalized, advocates and officials are pushing Gov. Kathy Hochul to find the money to prevent so many people from losing health coverage.

The cuts will also impact legal immigrants in New York on the Essential Plan by eliminating their premium tax credit eligibility entirely, Michael Kinnucan, health policy director at the Fiscal Policy Institute, said in an interview with Healthbeat.

What should I do if I’m losing health care?

If you are set to lose health care through the Essential Plan on July 1, use the next three months to seek care, Rebecca Wallach, director of New York Legal Assistance Group’s legal resources program, told THE CITY.

“Make an appointment to see a primary care doctor, get prescriptions in order, get whatever you need,” she said.

Pay attention to notices from the New York State of Health Marketplace, whether online or by mail, informing people of when they will lose health care and how they can purchase a new plan on the private market.

On May 16, you can begin shopping for Qualified Health Plans on the Marketplace, which can connect you with health care navigators trained to assist in the enrollment process. You have until Aug. 30 to pick a new insurance plan, said Danielle Holahan, executive director of the New York State of Health. Remember, however, that you will lose insurance coverage on July 1 no matter what, so if you’re still choosing a plan after July 1 and before Aug. 30, you’ll be uninsured during that time.

Call the Marketplace’s Customer Service Center at (855) 355-5777 with any questions. It is open weekdays 8 a.m. to 8 p.m., and Saturdays 9 a.m. to 1 p.m. For help in languages other than English and Spanish, call and request an interpreter.

People walk in and out of Woodhull Hospital in Brooklyn in January.

“We will do what we can to smooth this transition,” said Holahan. “We will work with them to let them know what timeline this is all happening on, when they can come in and pick a plan that would take effect on July 1.”

The experts THE CITY spoke to all said it is critical to meet with health care navigators — trained individuals whose job it is to help people through the byzantine process of getting insured. Mid-May and June are the time to start reaching out, according to Wallach.

This is especially important if your life or home circumstances have changed since the last time you signed up for insurance, like if you are pregnant, have welcomed a new baby into your household, or your income has gone down. These navigators will assist you according to your individual needs.

“It’s really important to have to redo your financial eligibility,” Benjamin said. “If your income this year isn’t as high as last year, you might still be able to get the free coverage.”

The Community Service Society partners with New York state to connect people with trained navigators. It has 17 community-based organizations that will assist you for free as part of its Navigator Network, which can be found here.

Rehan Mehmood is the director for health services and a health care navigator at the South Asian Council for Social Services, one of the organizations in the Navigator Network with an office in Flushing, Queens. He said appointments are not necessary — just walk in, and they will help you.

“Our people will make sure you have access to health care,” Mehmood said. “We speak over 20 different languages. We can assist individuals going through plans, seeing what services are covered and helping them get the care they need.”

Holahan recommends that people not put off choosing a new plan.

“They can always make a change later, but I would encourage people to take action so there’s no gap in coverage,” she said.

If you speak to a navigator and are not eligible for insurance through the New York State of Health, the state’s health marketplace, but have a medical condition that affects your daily activities, Wallach advises reaching out to the Facilitated Enrollment for the Aged, Blind and Disabled — an application assistance program for public health insurance.

Those who could consider FE-ABD include New Yorkers with active cancer treatment, who receive dialysis or have multiple sclerosis, Wallach said.

“For an individual who is not able to get insurance through those systems in New York State of Health, FE-ABD can evaluate and screen a person for the possibility of Medicaid,” she said.

The Community Service Society’s network list of community-based organizations in the FE-ABD Program can be found here. The Department of Health also has a list of facilitated enrollers for FE-ABD, which can be found here.

What if I become uninsured, or cannot afford the insurance I am eligible for?

If you have exhausted your options to access an insurance plan you can afford, the city has a safety net program administered through NYC Health + Hospitals for getting the care you need: NYC Care.

“It is one of the major avenues where we can make sure clients are connected to comprehensive health care,” Mehmood said.

Anyone within the five boroughs who is uninsured or cannot afford the insurance for which they are eligible can access NYC Care.

NYC health department submits budget plan while bracing for potential federal funding cuts

NYC Health + Hospitals administers the program and provides free or low-cost services at the facilities listed here. The enrollment process is outlined here, or you can call (646) 692-2273 for information on how to become a NYC Care member.

These services are available regardless of immigration status, and health care professionals will not record your immigration status, according to the NYC Health + Hospitals website.

There are also free health clinics funded through grants from the U.S. Department of Health and Human Services, where people can seek ongoing care. Enter your location here to find one.

And if you have a medical emergency, do not put off care. “Go to the emergency room,” Wallach said. “That is still true.”

What about accessing the medicine I need while uninsured, or struggling to afford medication?

You can access medication as a NYC Care member, but Wallach said there are other ways to afford many of the medications you need on an ongoing basis.

Seek prescription drug discount programs, like GoodRx that compare prescription drug prices and tell you what pharmacies take specific insurance. NPR also has a good guide on how to get the best price for your prescription when navigating drug discount options.

Can the state make up the Essential Plan funding that the federal government cut?

Gov. Kathy Hochul maintains that the state cannot take on the costs of the cuts to provide coverage for people who will lose their health insurance.

“From the beginning, I sounded the alarm about the devastating impact H.R. 1 would have on our hospitals and health care system, and made clear that no state can fully backfill cuts this severe,” she said in an April 1 statement.

But Benjamin from the Community Service Society said with the state budget yet to be finalized this spring, “it’s not over yet.”

“It can be done for just under a billion dollars. The money’s there,” she said; the entire state budget is about $260 billion. “Get ahold of your state elected officials and the governor to say we don’t have to lose our coverage.”

State Sen. Gustavo Rivera and Assemblymember Amy Paulin introduced legislation last week that would protect half a million people from losing coverage through state funding. The bill has 10 co-sponsors in the Senate.

“We can absolutely cover folks,” Rivera told THE CITY. “You would have 450,000 New Yorkers who without any action would lose their coverage come July.”

“That’s going to happen regardless,” he said. “Since it’s happening during this budget year that we’re negotiating right now, we have to do something.”

Holahan from the Department of Health echoed the governor’s sentiment. “The governor has been pretty clear, states cannot backfill cuts of this magnitude,” she said. “It’s not something that we wanted to do, but the federal government had different ideas.”

Wallach noted that “We do not know where the budget is going to fall, so the advice could change.”

But Mehmood said that currently, Essential Plan enrollees who make up to 250% of the federal poverty line will lose coverage.

“Legislators are still pushing,” he said. “But as of now, what we know is that July 1 is the last day.”

Michigan measles outbreak shows high cost of stopping even a small number of infections from spreading

2026-04-03T22:40:20+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The small measles outbreak that health officials are combating in Michigan began last month with an unvaccinated young woman returning home from visiting Florida, a state where there have been more than 140 cases this year.

Her first symptoms around March 7 seemed like a cold. By the time the telltale measles rash appeared a few days later, she had exposed her family and scores of other people in public settings, according to health officials in Washtenaw County, near Detroit.

The Michigan outbreak is one of 17 new outbreaks nationwide reported to the Centers for Disease Control and Prevention since January. There have been 1,671 confirmed cases of measles reported this year across 32 states, according to CDC data.

Most of this year’s cases – 94% – have involved outbreaks. Some – like those in Texas and Florida – involve more than 100 infections. In a few, cases have surged into the hundreds, as is the case in the outbreak in Utah, which is still growing, and the outbreak in South Carolina, which appears to be ending.

Many of the outbreaks are small – just a few cases. But as public health officials in Washtenaw County, Michigan, are learning, the resources required to keep them that way can be enormous.

Staffing costs for managing a handful of measles cases: $45,000

“We’re still at seven cases,” Beth Ann Hamilton, communications coordinator for the Washtenaw County Health Department, told Healthbeat this week. “We’re definitely not out of the woods yet.”

Meanwhile, another measles case announced Thursday in neighboring Monroe County has state health officials concerned that measles may be silently spreading in the community. No definitive link has been established to the cases in Washtenaw County, but the timing and location of the new case are concerning, officials at the state health department said.

Because of this risk, the Michigan Department of Health and Human Services is recommending young children receive their first measles shot early – at 6 months to 11 months of age.

Yet even with just a handful of known measles cases, the containment workload is already taking its toll.

Spring break travel risks spread of measles across U.S.

At the Washtenaw County Health Department, measles control is taking priority over many other health department services as staff have been needed to help track down and counsel hundreds of exposed people, test them for immunity to measles when they don’t have vaccination records, and monitor those in quarantine.

“Seven cases may not seem like a lot, but it is, and it’s hundreds and hundreds of contacts that our staff have to follow up on and monitor,” Jimena Loveluck, the department’s health officer, told the Washtenaw County Board of Health on March 27.

“We’re not able to get other work done,” she said. “We just don’t have the capacity to respond and then continue all our regular level of services. The expense also is tremendous.”

Exposures have occurred at a popular mall in Ann Arbor, a community college, hospital, urgent care clinics, several stores, and a restaurant.

Investigating and managing the exposures of just the initial three or four cases cost $45,000 in staff time, Ruth Kraut, the department’s deputy health officer, told the board. Other health department staff noted that $100,000 in funding from the state to help with the outbreak had been largely spent.

@healthbeatnews
Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
♬ original sound - Healthbeat

“It’s been a huge effort,” Dr. Juan Luis Marquez, the department’s medical director, told the board. “We get lists of students or patients or whatnot. We don’t have much information to go by other than their name and date of birth. So that basically means our team of nurses and other folks calling everybody to verify their immunization status.”

Because two doses of measles-mumps-rubella vaccine is 97% effective at preventing the disease, public health officials are mostly trying to identify those who aren’t protected so they can be advised to quarantine at home and not spread the disease to others.

But people often don’t remember whether they’ve been vaccinated or don’t have access to their immunization records, Marquez said. So then they need to come to the health department clinic to have a blood test to check to see if they have measles immunity from past vaccination or infection.

The result is that the health department’s clinic is largely focused on measles and vaccine response, he said, and communicable disease efforts are being limited to measles and other high-risk cases.

Like forest fires, measles outbreaks are ‘sending out sparks’

A significant challenge for public health officials is that it’s difficult to know which small measles outbreaks can be quickly and easily contained, and which ones will spread to hundreds of people.

Dr. William Moss, a professor at the Johns Hopkins Bloomberg School of Public Health and director of the school’s International Vaccine Access Center, compared the measles landscape across the United States to a map of forest fires.

“You’ve got these bigger outbreaks, they’re kind of sending out sparks,” Moss said. “If that spark lands in a county or a community with high vaccine coverage, you don’t get much spread. And so you see one of these small outbreaks. But if it does land in a community with a large number of individuals who are under vaccinated or unvaccinated, then you get these larger outbreaks.”

It would be helpful to overlay measles cases onto maps with detailed vaccination coverage data, he said. But sources of vaccination data are limited and fragmented, and while school vaccination data can be helpful, it doesn’t include information about adults in the community.

“We and many other groups have been trying to develop ways to predict or forecast, as best we can, where the hotspots are. It’s just very difficult with measles,” Moss said.

Moss said that to know how easily measles will spread requires having detailed information about the coverage levels of vaccination and immunity within very localized communities where people socialize. But such data isn’t readily available, he said.

The places Moss and his team are watching closely are those where cases have been increasing the most in the past few weeks. That includes Hudspeth County, Texas, where the Johns Hopkins U.S. Measles Tracker has tallied 31 cases in recent weeks, and several counties in Utah, which is in the midst of a surge in its outbreak. Many of the cases in Hudspeth County, Texas involve a federal detention facility.

Since it began last year, Utah’s measles outbreak has sickened 559 people, 362 since January. South Carolina’s measles outbreak, the largest in the United States in decades, has had 997 known cases since October – more than 660 of them since January.

The good news: South Carolina health officials haven’t had a measles case reported to them in more than two weeks. If that trend continues for 42 consecutive days – which is two incubation cycles for the measles virus – that outbreak will be declared over after April 26.

As of early March, the South Carolina Department of Public Health told Healthbeat it had spent $1.6 million on its response to the outbreak.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Georgia lawmakers pass health workforce bills, but leave gaps on community health workers

2026-04-03T20:20:27+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

The Georgia Legislature ended its session late Thursday, passing several bills aimed at shoring up the state’s health workforce and approving a public health budget that calls for little new spending.

HIV prevention drugs and birth control will be easier to get, with pharmacists allowed to prescribe them, and the state’s school day cellphone ban will be extended to high schools, among the bills sent to Gov. Brian Kemp for his signature.

Some health advocates were disappointed that lawmakers did not create a certification for community health workers.

“The need for community health workers across Georgia remains urgent — they are essential to expanding access to care and supporting our communities,” said Natasha Taylor, deputy director of nonprofit Georgia Watch, who has advocated for the bill for several years. “It is deeply disappointing that the Senate chose not to advance the bill for the third year in a row.”

Here’s a summary of other public health action:

Budget includes expansion of maternal home visits

The legislature approved a $933 million budget for the Department of Public Health for fiscal 2027, which starts in July. It’s a slight decrease from last year. It includes $429 million in state funds, with $483 million coming from federal sources.

The budget includes $3.7 million more for the state’s maternal and infant home visiting program, which seeks to help at-risk pregnant women and infants with medical and social services. The program will expand to an additional 33 counties, serving most of the state.

Four states, four strategies: Lessons for Georgia’s public health review

Lawmakers hope this will help improve Georgia’s maternal and infant health outcomes. One-fifth of Georgia mothers do not receive adequate prenatal care, and the state’s rates of severe maternal morbidity and mortality are higher than the national rates, according to the March of Dimes.

The budget also includes an increase of $750,000 to help pay for the core staff who operate the Trauma Recovery Center and an additional $500,000 for the Office of Cardiac Care to make grants to hospitals.

Improved leave benefits for public health employees

This bill, sponsored by Rep. Darlene Taylor, a Thomasville Republican, would allow county public health employees who move to the state health department to retain their accrued leave time. It grew out of a recommendation from a House study committee that looked at improving public health in Georgia. The measure passed unanimously in the House and Senate and now heads to Kemp.

Allowing pharmacists to prescribe HIV prevention drugs and birth control

This measure allows pharmacists to prescribe a group of HIV prevention drugs called PrEP and PEP. The goal is to increase access to the drugs and reduce the state’s high rate of new infections, as well as the cost of HIV care, Sen. Chuck Hufstetler, a Rome Republican, told Healthbeat. While there are some details still to be worked out about how pharmacists will be compensated for their work, advocates hailed the bill as an important step toward increasing access to the drugs.

A separate bill will allow pharmacists to dispense birth control pills and injectable contraceptives without prescriptions. Initially, patients can receive up to a three-month supply, followed by a 12-month supply on subsequent visits. It will take effect on Jan. 1 if Kemp signs it.

Creating a pathway for foreign-trained doctors to practice

After this measure failed to get the needed votes last year, Republican Sen. Ben Watson, a Savannah doctor, sponsored the bill this year and successfully shepherded it through. The bill creates a pathway for doctors trained abroad who meet a lengthy list of requirements to practice in Georgia, first on a provisional license and eventually on a full license.

They must agree to practice in underserved areas during the process. If signed by Kemp, Georgia will join a growing list of states, including neighboring Tennessee, Florida, and North Carolina, with similar provisions. Advocates say it could help address the state’s physician shortage and increase the number of doctors who can provide culturally sensitive care to the state’s increasingly diverse population.

Easing recovery for nurses, counselors struggling with substance use

This bill creates an “alternative to discipline” program for nurses who struggle with substance use. The bill comes in response to nurses’ feedback that the current disciplinary system prevents them from seeking early help for addiction because it is public and punitive and can stop them from working.

The bill establishes a system in which nurses can seek help while they continue to work and are monitored by the nursing board. It sets up a parallel system for counselors and social workers. Such systems already exist for pharmacists, dentists, and doctors, Rep. Ron Stephens, a Republican pharmacist from Savannah who sponsored the bill, told Healthbeat. Advocates hope it will keep more nurses and counselors in the workforce as the state faces a shortage. The measure heads to Kemp for his approval.

Extending cellphone ban to high school

Last year, the legislature enacted a “bell to bell” cellphone ban for students in grades K-8, set to take effect this summer. Some schools and districts have already implemented the ban and provided positive feedback about its impact on student mental health and learning. In response, Rep. Scott Hilton, a Peachtree Corners Republican, introduced a bill to extend that ban to high school. The bill passed and goes to Kemp for approval. It would take effect starting with the 2027-28 school year.

Bill to certify community health workers fails

The House public health study committee report published last year noted Emory University and Morehouse School of Medicine have trained more than 1,500 community health workers in the past two years, but they remain “an under-utilized workforce” because they struggle to find employment. Advocates have urged legislators to create a community health worker certification to regularize and increase respect for the profession. However, the bill this year failed to pass for the third time. The measure had gained the support of a Senate committee but failed to get a needed floor vote. Advocates had hoped a certification process would help with the goal of getting insurers to reimburse providers for CHW services.

Public health cleanup bill becomes mired in controversy, fails to pass

Marietta Republican Sen. Kay Kirkpatrick sponsored a bill to clean up obsolete language relating to the administration of public health. Brought at the request of DPH, it failed to pass after it became attached to two controversial proposals.

On the Senate side, Democrats in February attempted to attach an amendment to the bill that would have called on the state to expand Medicaid, a move Republicans have long resisted. That amendment was voted down and the bill passed unanimously.

It then required House approval, where lawmakers attached language that would have allowed the anti-parasitic drug ivermectin to be sold over-the-counter after a separate bill with the same proposal failed to gain traction. A House committee approved the version of the bill with the ivermectin language added.

The bill also picked up a measure to review whether insurers were following Georgia’s mental health parity laws. The lengthy bill was sent to the House floor, where it was approved on the last day of the session on a mostly party line vote. However, that left no time for the Senate to vote on the new version of the bill, meaning it ultimately failed to pass.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Pollen and ticks on the rise, changes to the Essential Plan, and NY bills to protect vaccines

2026-04-03T17:26:55+00:00

There’s a ton going on in the world of New York health, so let’s jump right into it.

Pollen is here. Ugh.

Is anyone else starting to notice the little tree buds and green sprouts starting to pop up? And despite the confusing false spring/second winter chaos weather we’ve been experiencing in New York, daily temperatures have been warming. That means we can expect local pollen counts and allergies to increase over the next several weeks, along with those cute little sprouts.

Most U.S. communities see three pollen waves — trees, grass, weeds. New York is currently in the tree pollen season. This is relevant because individual allergy sensitivity can vary by pollen type.

If you feel like allergies have been starting earlier or lasting longer, you aren’t imagining it. Over the past few decades, allergy seasons in New York have gotten worse, partly due to climate change and warming temperatures. Earlier this month, the 80-degree day we had in New York City was record breaking — the earliest 80-degree day we’ve had on record.

The length of the average allergy season has now grown by over three weeks since 1970, with higher pollen counts.

Longer and more intense pollen seasons can exacerbate allergies and respiratory conditions for New Yorkers. While simply annoying for many of us, seasonal allergies can actually be dangerous for many with asthma — every spring, emergency department visits for asthma spike.

For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen season really takes off. There are also many actions we can take to reduce pollen exposure and prevent it from entering your home:

Check local pollen counts.
Leave shoes at the door and change clothes after outdoor activities.
Wipe off furry animals after they’ve been outside.
Shower before bed.
Keep windows closed during peak pollen times (midday).
Run air conditioning or HEPA filters.
Dust and vacuum regularly.

Dr. Zach Rubin, an allergy doctor, joined YLE on the America Dissected podcast last year and gave great tips on managing allergies:

To relieve sinus symptoms, it can help to rinse your nose with saline water (like with a neti pot), but only using distilled or sterilized water. I’ve found neti pots to really help.
For medications, second-generation antihistamines like cetirizine (Zyrtec) tend to have fewer side effects than diphenhydramine (Benadryl). As always, talk with your doctor or pharmacist for more information on medications.

Alpha-gal, aka meat allergy, from ticks is increasing in NY

Alpha-gal syndrome, the red meat allergy caused by lone star tick bites, is rising in New York, and Long Island is a hot spot. The Centers for Disease Control and Prevention estimates that 96,000 to 450,000 people in the United States may have been affected since 2010, and cases have been increasing. Suffolk County stands out: CDC data suggest it accounts for about 4% of suspected cases nationwide.

Symptoms can include:

Hives
Stomach pain
Vomiting or diarrhea
In more severe cases, anaphylaxis, which is life-threatening

Reactions can begin 2–6 hours after eating red meat or other mammal-derived products, which can make it harder to link consuming meat with the reaction.

It used to be that alpha-gal syndrome was mostly found in people who spent a lot of time outdoors or in the woods (like hikers, hunters, farmers, and outdoor workers). But now, many communities are reporting it to be more common, even in people who don’t spend much time in rural outdoor spaces.

So how does a tick bite turn into a meat allergy? After feeding on mammal blood, the lone star tick carries a sugar molecule called alpha-gal in its gut. When it bites a person, trace amounts of that sugar slip into the body through its saliva. Because humans don’t naturally carry alpha-gal, our immune system may treat it as foreign and start making antibodies against it (i.e., have an immune response to the sugar molecule). Later, when that same person eats red meat or other mammal products, the immune system recognizes alpha-gal again — and can trigger an allergic reaction, often several hours after a meal.

What else to know:

How long does it last? It’s considered a chronic disease, persisting indefinitely. For some, sensitivity fades after 1–5 years without new tick bites.
Is there a blood test? Yes. A specific blood test can measure IgE antibodies to alpha-gal. It’s the most reliable diagnostic tool available today.
Why is it hard to track? Cases are not nationally notifiable, so public health officials don’t get complete real-time data.

The best protection against alpha-gal syndrome is the same as with Lyme disease: Prevent tick bites in the first place.

Health policy updates

Changes to the Essential Plan and what it means for insurance coverage

But first, where are my “Pitt” fans at?

Remember how earlier this season there was a construction worker (Orlando) who came in with diabetic ketoacidosis after rationing his insulin because he couldn’t afford it? While the acid built up in his blood was life-threatening, he was terrified of what the hospital bill would be. He worked multiple part-time jobs, none of which provided insurance, and he made just above Medicaid’s income cutoff. He was fully employed, but still couldn’t afford health insurance.

This story hit close to home for New York.

New York’s Essential Plan was built for people in this exact situation: those who don’t get insurance through work but earn just over the limit to qualify for Medicaid. It now covers 1.7 million New Yorkers, up from 380,000 when it launched in 2016.

But the program is now shrinking. After budget cuts from the “Big Beautiful Bill Act” (HR 1), New York asked the Center for Medicare and Medicaid Services for permission to switch the current Essential Plan to an older structure. (I wrote about it last month.) CMS just approved that request last week (which to be honest, was a pleasant surprise). This means that income-based eligibility for the Essential Plan will now drop from 250% of the federal poverty level, to 200% on July 1, 2026. This change preserves Essential Plan coverage for about 1.3 million New Yorkers statewide, but about 500,000 are expected to lose it.

For single adults, this means that the income cutoff falls from ~$40,000/year to ~$32,000/year. For a family of four, that threshold drops from ~$83,000 to ~$66,000. People making just above the new thresholds will now likely be pushed to the marketplace to pay for insurance, where coverage can cost far more ($10,000-$12,000 per year out of pocket) with higher deductibles that many families simply can’t afford.

While this is bad news, it could have been a whole lot worse. If CMS didn’t approve New York’s workaround, the entire Essential Plan could have shut down. This move doesn’t save everyone’s coverage, but it did prevent a total collapse.

Here’s what to do:

Check your pay stubs: If your income is between $32,000 and $40,000 as a single adult or ~$66,000 to 83,000 for a family of four, watch your mail closely.
New York has started notifying affected New Yorkers, and coverage changes will begin July 1.
Visit NY State of Health to explore your options, or call the helpline at 1-855-355-5777.

Something to watch: New vaccine bills in NY

Gov. Kathy Hochul and New York lawmakers are moving forward with two bills that would further protect vaccines in New York, as federal vaccine policy has become unstable.

The first bill focuses on insurance coverage for vaccines. It would require state-regulated insurers to fully cover the costs of vaccines recommended by the Advisory Committee on Immunization Practices or recommended by the state’s health commissioner. The goal is to make sure that insurance coverage continues even if federal ACIP recommendations change.

This bill would require private insurers and state-sponsored insurance to cover the cost of these vaccines. So far, it does not make any changes to vaccines covered by Medicaid or the Vaccines for Children program, both of which are still linked only to ACIP recommendations.

The second bill is about broader immunization guidance. It would remove references to ACIP in multiple state laws, like school immunization requirements, the recommended schedule for newborns, and pharmacist vaccine administration rules. Like the first bill, it shifts guidance toward the New York state health commissioner. This could be good, but it could also be risky in the future — politics change, and there’s no guarantee that future commissioners will be as evidence-forward as ours is right now.

The proposed bills build on the executive order Hochul put forward in the fall to preserve vaccine access, and would put those actions into state law. It’s a good step. These bills are also an example of how vaccine access is increasingly becoming a hyperlocal issue. But the bills still need to pass through the state legislature, so they aren’t set in stone yet.

Bottom line

You’re all caught up on New York public health news! Enjoy this weather, and consider stocking up on tissues and bug repellent. :)

Love,

Your NY Epi

U.S. scientists sequence 1,000 genomes from measles, a disease long eliminated with vaccines

2026-04-02T19:08:46+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

This week, the Centers for Disease Control and Prevention posted online its first large tranche of advanced genetic data from measles viruses spreading last year. Scientists with knowledge of the operation expect the agency to post heaps more in weeks to come, revealing whether the United States has lost its hard-won measles elimination status.

The CDC withheld the data for months as a team hit hard by mass layoffs and resignations sorted through the information. But now that scientists at the agency have posted their first batch of whole measles genomes — the genetic blueprint of the viruses — the rest should “start flowing more smoothly at a more rapid cadence,” said Kristian Andersen, an evolutionary virologist at the Scripps Research Institute who isn’t involved with the CDC’s effort but is following it.

The CDC did not answer queries from KFF Health News on its timeline for publishing measles data or analyses. However, once all the data is public, researchers can run quick initial analyses that will signal whether outbreaks across the United States last year resulted from the continuous spread of the disease between states, rather than separate introductions from abroad.

If there was continuous transmission for a year, that means the United States has lost its status as a country that has eliminated measles. That status, which the United States has held since 2000, reflects a country’s vaccination rates: Two doses of the measles-mumps-rubella vaccine prevent most infections and so stop outbreaks from growing.

More careful analyses take weeks.

“We should see a report in April,” Andersen said, “assuming no political interference.”

This is the first time that the United States has applied sophisticated genomic techniques to measles, which largely disappeared from the country a quarter-century ago because of broad vaccine uptake.

Declining vaccination rates, misinformation, and the Trump administration’s budget cuts and lagging response to outbreaks have fueled a resurgence of the disease. With at least 2,285 cases in 44 states, 2025 was the worst year for measles in more than three decades. This year is on track to surpass that, with 1,575 cases as of late March.

While welcoming the science, researchers say the government’s top priority should be to stop the virus from spreading.

“I think it’s incredibly important to do whole genome sequencing for outbreaks,” Andersen said, “but we shouldn’t need to do this for measles in the first place, because we have an extremely effective and safe vaccine.”

How the South Carolina measles outbreak grew from 5 to 997 cases

“That we’re even talking about this is nuts,” he added.

Health and Human Services Secretary Robert F. Kennedy Jr. and other government officials should sound an alarm about measles’ comeback and launch nationwide vaccine campaigns, said Rekha Lakshmanan, executive director of The Immunization Partnership, a nonprofit in Houston that advocates for vaccine access.

“I applaud the science,” she said, “but the more urgent need is to get measles under control as quickly as possible.”

Top officials have instead downplayed the seriousness of the disease, and false notions about vaccines have been granted new life in Kennedy’s CDC. This includes abrupt changes to vaccine information on CDC websites that medical associations say aren’t based on evidence and endanger lives.

Kennedy continues to promote unproven remedies that could mislead parents into believing that they can avoid vaccines without consequence. On the Joe Rogan Experience podcast in late February, Kennedy spoke at length about measures to improve America’s health but didn’t mention vaccines. He said preventive measures could entail “holistic medicine, or take vitamins, or take vitamin D, which is, as you know, it’s kind of miraculous.”

“The risk of measles remains low for most of the United States,” HHS spokesperson Emily Hilliard wrote. “CDC has made $8.5 million available to address measles response activities in seven jurisdictions experiencing outbreaks,” she wrote. “The CDC, HHS principles, and the secretary have been vocal that the MMR vaccine is the best way to protect yourself against measles.”

Genomic data hold clues to outbreak spread

In December, the CDC enlisted the help of one of the country’s leading centers for virus sequencing, the Broad Institute in Cambridge, Massachusetts. Major outbreaks in Texas, Utah, and South Carolina had been fueled by the same type of measles virus, labeled D8-9171. But since that type also circulates in Canada and Mexico, researchers need more data to discern whether it spread among states or entered the United States multiple times.

Whole genome sequencing provides that information because viruses evolve over time. The measles virus acquires a mutation every two to four transmissions between people, said Bronwyn MacInnis, director of pathogen surveillance at the Broad.

“There is enough signal in this data to tease apart questions at hand,” MacInnis said, “the main one being sustained transmission within this country.”

MacInnis’ team worked overtime to sequence the entire genomes of inactivated measles viruses that had been collected from states in 2025 and 2026.

“We’ve done about 1,000 samples and delivered the genome data back to the CDC,” sending it on a rolling basis since December, MacInnis said. “This is the CDC’s data to publish.”

The CDC didn’t post a single one of those genomes until late March, when eight appeared on a public database hosted by the National Center for Biotechnology Information. By Wednesday, an additional 154 had gone online.

“It should be on NCBI within a couple of weeks of being produced,” Andersen said, “and certainly not take longer than a month when you have an active outbreak.”

Dora Nabatanzi, a molecular biologist at the Broad Institute in Cambridge, Massachusetts, prepares chemicals needed to sequence the genomes of measles viruses.

Genomic data hold clues about how outbreaks start and spread. It allows researchers to develop tests, treatments, and vaccines — and detect variants that might evade them.

Such data was critical in the Covid pandemic. Chinese and Australian scientists posted the first SARS-CoV-2 genome online on Jan. 10, 2020, within a week of sequencing it. “It definitely shouldn’t take the CDC months,” said Eddie Holmes, the Australian virologist who helped publish the first coronavirus sequence.

One reason for the delay is that the CDC’s measles lab has been sorely understaffed amid mass layoffs and other turmoil at the agency over the past year, a CDC scientist told KFF Health News. Another reason, the researcher added, is a learning curve: The CDC and health departments haven’t needed to sequence hundreds of whole measles genomes before now. (KFF Health News agreed not to identify the scientist, who feared retaliation.)

In contrast with the CDC, the Utah Public Health Lab has shared measles genomes rapidly. Most of some 970 measles genomes posted online since Jan. 1, 2025, were sequenced by the state, hailing from Utah, Arizona, South Carolina, and other states willing to share them.

“We’ve only got a handful of samples from Texas that were collected kind of in the middle of their outbreak,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services. The genomes of the Texas and Utah measles viruses are similar but distinct, Oakeson said, meaning that intermediate versions of the virus are missing.

If the genetic code of viruses collected late in the Texas outbreak are a closer match to those from Utah’s, that will suggest that spread was continuous and the country has lost its measles-free status. The hundreds of genome sequences still sitting at the CDC probably hold the answer.

Evaluation of U.S. measles status delayed till November

The CDC expected to finish its analysis before April, said Daniel Salas, executive manager of the immunization program at the Pan American Health Organization, which works with the World Health Organization. That’s when PAHO was slated to evaluate the United States’ measles status.

He said PAHO delayed its evaluation until the organization’s annual meeting in November, partly because the CDC needed more time to do the genomic analysis and partly because the measles status of Mexico, Bolivia, and other countries is also under review, and holding staggered meetings for each country is inefficient.

The United States is the only country using whole genome sequencing to answer the elimination question, Salas said. Typically, countries classify measles viruses according to a tiny snippet of genes, then assume that large outbreaks caused by the same type are linked. Whole genomes provide a more accurate view.

CDC outbreak models warn about underreporting in S.C. measles outbreak

“If the U.S. can fill in the blanks with genomic data, that’s a sort of breakthrough,” Salas said. “That doesn’t mean other countries are going to be able to pull off this kind of analysis,” he added. “It takes a lot of specialized knowledge and resources.”

Equipment to sequence and analyze genomes costs upward of $100,000, and the cost to process each sample, including paying the researchers involved, typically ranges from $100 to $500 per sequence.

“I’m pro-science, but we shouldn’t have to do this,” said Theresa McCarthy Flynn, president of the North Carolina Pediatrics Society. “We don’t have to have a measles epidemic.”

Flynn said she regularly fields questions from parents concerned by misinformation spread by Kennedy and anti-vaccine groups, including the one he founded before joining the Trump administration. Parents have also pointed to changes in the CDC’s recommendations and to its websites that are at odds with the scientific consensus.

Before Kennedy took the helm, a CDC website said “Vaccines do not cause autism” in prominent type, and listed several large studies in premier scientific journals that refuted a link between vaccines and developmental disorders.

Last year, the website shifted to saying, “Studies supporting a link have been ignored by health authorities.” The high-quality studies were replaced with a report from a single investigator who has ties to anti-vaccine groups.

In an email to KFF Health News, Hilliard echoed the altered website’s claims about vaccines, disregarding extensive studies on the topic.

Flynn, of the pediatrics association, said, “The CDC itself is spreading misinformation about vaccines. I cannot overstate the seriousness of this.”

Although the acting director of the CDC, Jay Bhattacharya, says vaccines are the best way to prevent measles, he too has undermined vaccine policy. He said the controversial January decision to reduce the number of vaccines recommended to children was based on “gold standard science.” Hilliard wrote that the updated schedule was “aligning U.S. guidance with international norms.”

In fact, the new schedule makes the United States an outlier among peer nations.

A federal court temporarily invalidated the change last month in a lawsuit brought by the American Academy of Pediatrics and other groups.

Bhattacharya hasn’t held briefings with the public or the press on the surge of measles this year or activated the CDC’s emergency capabilities.

“Normally, we’d have a big push to get vaccination rates up in areas where it’s low. We’d do a big social media push, put out ads on getting vaccinated,” said another CDC scientist whom KFF Health News agreed not to identify, because of fears of retaliation. “People at the CDC want to do this, but political leadership at the agency has not allowed the CDC to do it.”

Further, the Trump administration’s cuts and delays to public health funds have made it hard for local health officials to protect communities. Philip Huang, director at Dallas County Health and Human Services in Texas, said the department lost over $4 million when the administration clawed back about $11 billion from health departments early last year as a measles outbreak surged in the state.

“We lost 27 staff and had to cancel over 20 of our community vaccination efforts, including to schools identified as having low vaccination rates,” he said. “There are simultaneous attacks on immunizations that are making our jobs harder.”

This story has been updated to include comments from Department of Health and Human Services spokesperson Emily Hilliard.

Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.

Iran war threatens systems that keep drinking water flowing in Gulf

2026-04-02T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Watamu.

I’m spending a few days on Kenya’s sunny Swahili coast with family and a few friends (it’s an easy one-hour flight from Nairobi). A highlight so far has been a sunset trip on an old wooden dhow, the sailing boats that merchants have plied the Indian Ocean with for over a thousand years.

This week’s newsletter, like last week’s, circles back to some of the biggest geopolitical crises shaping global health right now. We’ll look at more effects from conflict in Iran, the medical consequences of a fuel blockade on Cuba, along with a few other stories on broader global health funding and treaties.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

What happens if the water stops flowing

The ongoing Iran war is leaving a lot of industry at risk. Like oil and fertilizer production, global shipping, and even (as we discussed last week) medicine. But an interview in Think Global Health last week highlights what is arguably the most vulnerable piece of infrastructure: the plants that turn seawater into drinking water.

It’s a fact that Arabian Gulf nations depend more on desalination than anywhere else on Earth. In total, they produce between “45% to 50%” of the world’s desalinated water. It’s a necessity in a broader Middle East that has “6% of the world’s population but less than 2% of renewable fresh water.”

That water, as the article notes, “underpins households, hospitals, schools, hygiene, and sanitation services.” And several early attacks and threats on desalination plants are raising alarms.

The article breaks down how Iran has accused “the United States of attacking a freshwater desalination plant on Qeshm Island,” Bahrain has said that “Iranian drone strikes damaged one of the country’s 103 desalination plants,” and “after President Donald Trump threatened to obliterate Iran’s power plants, [Iranian leadership] vowed to retaliate against Gulf water and energy facilities.”

And on Monday, Trump escalated further, threatening to blow up “possibly all desalinization [sic] plants” in Iran if no peace deal is reached.

Now to be clear, the vast majority of the desalination plants in the Arabian Gulf are currently unharmed. But the story, and taking seriously the threats that the war could spiral toward these systems, has me wondering: How bad could it get if this war starts knocking desalination offline?

To discuss, I reached out to Peter Gleick of the Pacific Institute, one of the world’s leading water resource experts, and Kaveh Madani, director of the United Nations University Institute for Water, Environment and Health, and a former senior Iranian policymaker. The conversations were grim.

“If major desalination plants are attacked and damaged,” Gleick said, “there will very quickly be serious ramifications for public health,” with the worst effects in “countries with the greatest dependence on desalination for public supply, especially Qatar, Bahrain, and Kuwait.”

The issue isn’t just the fragility of these systems, Gleick says. It’s that for many nations, there is no real Plan B if they are destroyed. “Very few nations that rely on desalination have sufficient storage or backup alternatives if those plants were to be attacked,” he says. The logical alternative is groundwater, which has “long been seriously overpumped and overdrafted,” and is now “limited, typically of lower quality, and often not easily accessed in the volumes and locations that would be needed.”

Madani was largely in agreement, and said that generally speaking, “the smaller the state, the more vulnerable it is in this situation.” In countries like Bahrain, where 103 desalination plants provide more than 90% of drinking water for the population of 1.6 million, “in some cases the smaller states have only a few days or few weeks of water reserves” available if those plants are forced offline.

And Madani said some of the most important risks are still being overlooked. For example, “to put a desalination plant out of service, you don’t have to directly attack it,” he said. A power blackout can cripple these systems just as effectively as a bomb.

“And another risk we don’t hear much about is water quality disruption,” Madani said. Few environmental disasters rival a major oil spill. If the conflict leads to more “oil tankers being sunk or attacked,” the resulting spills will contaminate coastal waters and could force desalination plants offline.

Together, the experts I spoke with had a few clear takeaways: First, this conflict must change future water supply planning. Many Gulf nations’ reliance on a small number of massive desalination plants creates an enormous vulnerability. As Gleick put it, the best way to reduce that risk in the future will be to sacrifice some of the efficiency of those large systems and build “smaller, decentralized, and redundant systems,” instead.

And of course, the rising threats to these facilities are also a reminder that drinking water systems are protected under international law. Under the Geneva Conventions, deliberately attacking civilian water systems (which is being actively threatened by both American and Iranian leaders) can constitute a war crime.

Stranded cholera aid

Last week we discussed how the Iran war is scrambling the movement of some global medicines.

This week a Reuters report shows those consequences already bubbling up. Cholera aid for countries across Africa is now snarled in the disruption.

According to the article, “emergency cholera medical supplies for several African countries have become stuck in a logistical quagmire," with vital “stocks stranded in Dubai warehouses.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. It largely spreads through water contaminated with feces, and thrives where basic sanitation has broken down. (Think conflict or flooding.) Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The timing here matters quite a lot. Cholera is a waterborne disease that often surges during rainy seasons. In some high-risk countries like Sudan and Chad, those rains begin around May.

What’s stuck? The supplies in Dubai warehouses are essentially “mini field hospitals … with rehydration treatments, as well as chlorine to treat sewage and drinking water to prevent further spread.”

The good news is that the cholera situation on the continent is no longer as dire as last year, so this delay is less catastrophic than it might have been even just a few months ago. Last year I reported on how Africa was facing “the worst cholera outbreak in a quarter-century, with cases surging in countries as disparate as Sudan, Burundi, and Angola.” But Reuters reports that “so far in 2026, the number of cases is down by about 50% versus 2025.”

Still, progress on cholera can reverse quickly without a sustained medical response. As one World Health Organization official told Reuters, "We’re talking [about] an explosive disease … If you don’t have the time or the resources to control it in a matter of days or even hours, you would have an extreme contamination."

The Global Fund: doing more with less

(Fair warning. We’re about to dive back into some well-trodden Checkup territory: the wonderfully boring budgeting mechanics of global health finance.)

According to an early report of several background sources in Devex, the Global Fund (the international organization that bankrolls over $11 billion in programs fighting AIDS, tuberculosis, and malaria in more than 100 countries) is being tapped to play an increasingly important role in stabilizing global health programs after last year’s funding shortfall.

As one advocate told the outlet, “Everyone now looks to the Global Fund to ensure the continuity of critical health services.”

At least rhetorically, even U.S. officials are boosting the Global Fund. Jeremy Lewin, the senior State Department official tasked with foreign assistance, has called the Global Fund a “critical partner” in advancing the “America First Global Health Strategy.” (For reference, Lewin has been notably critical of international aid organizations; casting the United States as “suckers of the global system for so long.”)

The report describes a few early examples of this dynamic. In several U.S.–Africa bilateral health negotiations, the Global Fund has been asked to join the negotiations to provide technical guidance on programs it supports. Some of those bilateral agreements also purportedly reference its procurement platform, wambo.org, suggesting the United States may increasingly look to the fund to purchase medicines and keep programs running.

What’s my takeaway?

It’s a bit of a surreal moment. As we covered in December, the Global Fund’s latest fundraising round came up nearly $7 billion short of its target (!) and “a quarter less money than the fund received in the previous cycle.” The largest missing chunk of that shortfall was American dollars. If the Devex report is accurate, donor countries like the United States could be increasingly leaning on the fund … even as they cut the money that powers it.

Cuba: no electricity, no health care

Cuba’s fuel crisis is grinding the country’s health system to a halt, according to reporting in The New York Times.

Some background: A tightening U.S. oil blockade (and the sudden loss of Venezuelan oil shipment) has nearly eliminated fuel shipments to the island, triggering rolling, multi-day “nationwide outages.”

The story opens with a vignette that’s really stuck with me over the last few days. Jorge Pérez Álvarez, a 21-year-old Cuban man with a genetic lung disease, survives only because a ventilator keeps him breathing. But power outages keep putting that machine onto a backup battery that’s repeatedly pushed to the brink. And when it dies … he does too.

“His life depends on electricity,” his mother says.

And what does Jorge’s story look like … expanded across an entire health system? (Excuse the length of the following quote, but it really shows how widely the blockade is unraveling basic medical care.)

“Hospitals are canceling surgeries and sending patients home because doctors and nurses can’t commute to work. Clinics are struggling to administer treatments like chemotherapy and dialysis because of power outages. Many ambulances are parked because drivers can’t find gas. Pharmacies are largely empty because the virtually bankrupt state is struggling to buy medicine. Production of medicine has been mostly halted because factories run on diesel. Vaccine makers are searching for ingredients because flights that once carried them are canceled because of a lack of jet fuel. And refrigerated vaccine stocks could soon spoil if the blackouts continue.”

It’s a brutal reality for the people living in Cuba.

What’s the takeaway? Over the weekend, my mind kept wandering back to Jorge (and how his family could possibly cope.) So, for me, the story is a reminder that cold geopolitical decisions always land on real people. Surprisingly, late Monday the New York Times also reported that the United States just allowed a Russian oil tanker to break the blockade, which hopefully keeps Jorge alive.

Stalled pandemic negotiations

We’ll end this week at the WHO headquarters in Geneva, where Health Policy Watch reports the negotiations over the final piece of a global pandemic treaty have stalled.

“A snail would have a faster passage,” the article quips.

The sticking point is one final, unresolved section known as Pathogen Access and Benefit Sharing. Basically an agreement on how countries will share bacteria/virus samples of the next pandemic, and how medicines and tests developed from those samples will be distributed.

At the risk of oversimplifying it, the concern from many poorer countries is a repeat of Covid-19, where these countries found themselves last in line for newly developed tests, vaccines, and treatments. As the article notes, they “want the assurance that if they share [information on the next pandemic], they will be able to benefit from any vaccines, therapeutics, or diagnostics that are developed as a result.”

Meanwhile, several wealthier countries, including “those with powerful pharmaceutical industries … argue that compulsory benefit-sharing will stifle research and development.” And, to put a bit more bluntly, they are also reluctant to lock themselves into binding rules that might limit supply of lifesaving medicines in the future.

So what now?

It’s not clear. Some civil society observers are floating an uncomfortable option: forcing a vote to break the impasse. (Rather than wrapping up the treaty with unanimous consensus among member states.) That could push the agreement forward ahead of the World Health Assembly deadline in May… but it would also risk splitting the fragile consensus behind the pandemic treaty.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

‘Mama Stories’ turns maternal health research into live performance in Atlanta

2026-04-01T18:49:52+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

A new way to communicate about maternal mortality – through actors and poetry – is coming to Atlanta.

“Mama Stories” will be performed April 12 at Spelman College. The collaboration between maternal health researcher Natalie Hernandez-Green and Nashville artist Cynthia Harris aims to find new ways to talk about public health, especially among those who are most affected.

The performance presents the stories of women of color who nearly died in childbirth. The academic-theater collaboration began when Hernandez-Green and her team at Morehouse School of Medicine’s Center for Maternal Health Equity interviewed 87 women, mostly Black and many from Georgia, to better understand their experiences. The goal was to put women’s voices at the center of what Hernandez-Green sees as often “sensationalized” public discussion of maternal mortality.

Georgia, like many other Southern states, has high rates of maternal mortality and morbidity, and it’s even higher for Black mothers than the general population. The mortality rate for women in Georgia is 30 per 100,000 live births but that increases to 55 for Black women, according to America’s Health Rankings.

Black and Hispanic women also have higher rates of severe maternal morbidity (like cardiac conditions and eclampsia) than white women and are less likely to get adequate prenatal care than white women in Georgia.

The study found that women didn’t feel heard by their health care providers and were often unaware of or confused by what was happening to them in the midst of a medical crisis, Hernandez-Green and researcher Kaitlyn Hernandez-Spalding said.

Actors depict the stories of women who nearly died in childbirth in the choreopoem "Mama Stories" by Cynthia Harris.

Relatively high levels of education or income didn’t prevent women of color from having those experiences. Their trauma resulted in short- and long-term effects, with some reporting panic attacks or not wanting to have more children.

Hernandez-Green wanted to make sure that these women’s stories would reach beyond the often inaccessible pages of academic journals – so she reached out to Harris, a playwright and public health researcher at Meharry Medical College in Nashville. Harris wrote a “choreopoem” about these women’s experiences, using their firsthand accounts. The goal was to educate and heal through an emotional and personal medium, rather than dry public health data.

“Our stories are medicine that we can see and understand,” Harris said.

Harris watched each interview, which ranged from an hour to two in length, to better understand the women’s perspectives. Her “verbatim theater process” preserved the women’s stories, including their gestures, expressive language, and facial expressions.

The “purpose is to be plain speaking, to tell the truth, to be as simple as possible, and to reflect not just words but to capture experience, tone, and meaning,” Harris said.

Each performance is followed by a salon where audience members, no matter their background, can reflect and share in a safe space, Harris said.

“Mama Stories” has been performed in Nashville. Harris and Hernandez-Green said women of color who have experienced the stress and trauma of birth – or those close to them – are one audience they want to attend at Spelman.

Each woman who provided an interview for Hernandez-Green’s initial study has been invited to attend the Atlanta performance. The team wants people from the community to attend as well.

“We want them to be more knowledgeable so they can better support mothers of color during pregnancy, delivery, and the postpartum period,” Harris said. “A more educated community is always going to be beneficial for a mom.”

Actors portray the stories of Black women who nearly died in pregnancy in "Mama Stories," which will be performed in Atlanta on April 12.

There are many other audiences, as well. That includes those training in medicine and as nurse-midwives, Hernandez-Green said. The team is starting a pilot project to use that training with medical students at Morehouse School of Medicine. That training is also being used by Blue Cross Blue Shield of Illinois

Asked whether the play might be depressing or traumatic for those who have experienced similar birth challenges, Harris said she makes sure to “double down on hope,” weaving bright spots into the story and finding ways for people to connect, such as in the post-performance conversation.

Hernandez-Green agreed, saying that some of the women interviewed in the original research reported feeling relief from being able to share their difficult stories and she sees the play and associated research as healing and dignifying.

“These women survived, and they were alive to tell their stories, and through their stories, they’re helping us create interventions that will make sure that another woman doesn’t have to go through what they have to go through,” she said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Leadership disruptions at the CDC endanger American health

2026-04-01T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a national nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

This week, I’m focused on what happens when we have no one leading public health in the United States. The Centers for Disease Control and Prevention has been effectively leaderless since President Donald Trump took office again, with vaccine policy mired in legal confusion and states fighting to keep funds they were promised.

Leaderless at CDC, and no easy fix in sight

The CDC still has no permanent director, and news outlets are reporting that the administration is struggling to find a suitable candidate.

The Trump administration’s only Senate-confirmed CDC director, Susan Monarez, lasted less than a month before she was fired by Health and Human Services Secretary Robert F. Kennedy Jr. for refusing to support vaccine policy changes in August 2025. She was subsequently replaced with political operatives until, on February 18, 2026, the administration announced that health economist Jay Bhattacharya, who is already the Senate-confirmed director of the National Institutes of Health, would serve as acting CDC director. This unusual and, frankly, absurd situation is time-limited by law, but there are bureaucratic tricks that could allow the White House to extend this situation almost indefinitely.

According to multiple reports, the White House has been considering at least three candidates — former Kentucky Gov. Ernie Fletcher, Mississippi state health officer Daniel Edney, and Johns Hopkins cardiologist Joseph Marine — but is struggling to settle on a nominee. Why? Politicians use a tactic known as triangulation when they need to make policy between competing and opposing factions. But are there any individuals in America with sufficient health qualifications who can triangulate between the groups most closely invested in the CDC director appointment?

First there is Kennedy’s Make America Healthy Again base, which views the CDC as “corrupt” and wants the agency to withdraw most, if not all, routine childhood vaccine recommendations. Second, there is the Senate committee that has to approve the nominee and has disparate views on how much reform is actually needed at the CDC. And, finally, there is the health community — professional societies, leading academic voices, and patient advocates — which desperately wants a return to the cautious administrative and scientific processes that made the CDC the most well-respected public health agency in the world.

The absence of steady, qualified leadership has torn the agency apart. The New York Times recently published an oral history of the CDC under the Trump administration drawn from interviews with 43 current and former employees. The remarkably poignant, sad story echoes everything I’ve heard from my former friends and colleagues: political appointees issuing orders without attributing the decision to any one leader or title, scientists told to communicate only verbally on sensitive topics to avoid any digital trail of deliberations, career staff taking phone calls outside out of fear that spyware on their computers is recording them.

The CDC and its parent agency HHS have long been considered a great place for federal employees to work, having ranked in the top five best federal agencies for workforce since 2016, according to the Federal Viewpoint Survey. This year, the administration refused to conduct that study, and an outside group (the Partnership for Public Service) stepped in to replicate it. They found that HHS now scores 20.4 out of 100, among the lowest of any large federal agency. Fewer than 3% of HHS employees report that Kennedy’s political team generates high levels of motivation.

On Wednesday, Bhattacharya held an all-hands meeting with CDC staff. Friends and colleagues of mine appreciated that he made statements that others in HHS have not, such as acknowledging the value of CDC employees, recognizing the challenges (a shooting!) they have had to endure, and pledging to address some workforce uncertainty, such as remote working agreements. They were not won over, however, by his inability to articulate what trust in public health and the CDC means and how he and this administration are working to strengthen it.

What does a new CDC director actually need to do?

If the administration nominates a candidate, I think there are three critical issues the nominee should be judged by.

First, what is their vision for the nation’s public health agency, and how will they restore purpose and direction to an agency that has been defamed and degraded? A complex science and policy organization like the CDC cannot function without clear and steady leadership. Career scientists need to understand how to prioritize their time, who has authority over what decisions, and how much they can communicate with the public.

Second, how will they bring order and scientific rigor back to vaccine policy? CDC vaccine policy has become an issue for the courts. In a lawsuit filed by the American Academy of Pediatrics, a federal judge in Boston temporarily blocked Kennedy’s January overhaul of the childhood vaccine schedule and stayed the appointments of 13 members of the Advisory Committee on Immunization Practices, ruling that Kennedy likely violated the Administrative Procedure Act. The judge noted that only six of the ACIP’s 15 panelists appeared to have any meaningful experience in vaccines, despite a legal mandate that they do.

In response to the ruling, the CDC canceled the ACIP meetings that had been scheduled for March. The former ACIP vice chair, Robert Malone, announced he is done with the committee entirely, citing, without any hint of self-reflection, "drama.” The United States now has no functioning vaccine advisory committee, and states, clinicians, and parents have no clarity about what the nationally recommended vaccine schedule is. The AAP lawsuit that produced the March 16 ruling could reach the Supreme Court before the year is out. A new CDC director needs to take a principled stand on returning to the evidence-based decision-making processes that have historically governed the CDC’s vaccine recommendations.

Third, will the new CDC director commit to restoring funding to state and local health departments? This is where the damage from the past year is most direct and most immediate. State and local governments are directly responsible, under the Constitution, for protecting the health of the American people. The Trump administration has sought to terminate CDC grants to states run by Democratic governors, including California, Colorado, Illinois, and Minnesota. In Illinois alone, the cuts would eliminate more than $100 million supporting local health departments, HIV programs, and chronic disease surveillance.

While a federal judge temporarily blocked the terminations, it is unclear what their long-term fate is and whether states are able to hire staff, purchase equipment, or do activities with these funds until the decision is resolved. A new CDC director must commit to restoring federal funding to all states, regardless of their partisan voting patterns.

Anyone nominated to be CDC director must be asked, clearly and publicly, what they intend to do about each of those problems. The Senate confirmation process exists for exactly this purpose. As of March 27, the measles case count is at 1,654, over two-thirds of last year’s total in less than three months, and outbreaks around the country continue unabated. The resurgence of once eliminated diseases are the unfortunate but predictable consequence of a year without functioning CDC leadership.

Until next week,

Jay

What to know about screening for breast cancer

2026-03-27T13:30:00+00:00

Next month, I turn 35. With guidance in the United States saying most women at average risk shouldn’t start routine breast cancer screening until age 40, it honestly hasn’t been top of mind for me. I’ve thought of breast cancer as something to think about for “later me.”

But recently, that has changed.

Last year, a friend of mine was diagnosed with breast cancer. At 34 years old. It was shocking to say the least. Thankfully, chemo worked incredibly well, and her latest test didn’t detect any cancer cells. Hallelujah.

Then, this past week, Amanda Peet, born and raised in New York City, wrote a moving essay in the New Yorker about being diagnosed with breast cancer while also caring for her dying parents. Susie Wiles, White House chief of staff, recently announced her diagnosis. Two years ago, my aunt survived breast cancer. So did a good friend’s wife.

With each of these stories, I started realizing that while “start at 40” sounds simple, it’s really guidance for people with average risk. And not everyone is at average risk.

So, I started reading. Here’s what I’ve learned, and why some women may want to talk to their doctor or a clinic about getting screened earlier than 40.

Breast cancer is common in New York, and early detection matters

Breast cancer is the most common cancer among women in New York state. Every year, about 16,700 women in New York are diagnosed with breast cancer, and about 2,500 women die from it.

Female cancer rates by type of cancer in New York state.

It is estimated that 1 in 8 women will develop breast cancer during her life.

Men also get breast cancer, but it is very rare. About 160 men are diagnosed with breast cancer each year in New York state.

While breast cancer is serious, outcomes and survival are much better than they used to be, thanks to earlier detection and better treatment.

At the same time, breast cancer is not just one disease — outcomes depend on the cancer subtype, its biology, and the stage at diagnosis. That’s why screening matters so much: Earlier detection can mean less aggressive treatment and better odds.

There are important differences in who gets diagnosed, what type of breast cancers are prevalent, and access to treatment. White women are more likely to get breast cancer than Black women, but once they have the disease, Black women are more likely to die from it. Black women are also more likely to be diagnosed with aggressive breast cancers — Black women under 50 have double the rate of triple-negative breast cancer compared to White women. (YLE covered new research into mRNA vaccines for TNBC earlier this year.) Disparities in access to treatment likely also play a role.

This is all to say that breast cancer is common, outcomes are not equal, and early detection matters a lot.

The real question: What makes someone higher risk?

When to start screening hinges on risk level. For women who are at average risk, the U.S. Preventive Services Task Force recommends mammograms every other year from ages 40 to 74. (The age to start screening at 40 instead of 50 was changed in 2024, and YLE covered it here).

But some women really should be screened earlier. Some may need extra screening, like an MRI in addition to mammograms. And for some women, the conversation should start as early as 30 years old.

The following factors can raise risk, and should be used to prompt a conversation about early screening with health care practitioners:

Family history of breast, ovarian, pancreatic, or prostate cancer in a parent, sibling, aunt, or uncle. (All these cancers have been associated with a higher risk of breast cancer.)
Known BRCA1, BRCA2, or other inherited gene mutation. (More on these genes below.)
History of chest radiation at a young age, like radiation therapy for Hodgkin lymphoma.
Possible dense breasts (more on this below), but this is not always an automatic trigger for early screening. (Should be paired with family history and other of the above risk factors).

Although older age is a major risk factor, we are seeing breast cancer rates increase in younger women.

Hypotheses for why breast cancer is increasing in younger women includes delaying having children (affects hormone levels and breast cells), increasing obesity, less movement and activity, increased alcohol use, and environmental exposures causing endocrine disruption.

Put simply, age alone does not determine risk. It’s also important to know that risk factors don’t explain everything — cancer can occur in a person with no family history, genetic predisposition, or other known risk factors. That means it’s super important for everyone, including those at “average risk,” to stay up to date with screening.

This five-minute risk assessment tool or this more comprehensive tool can help contextualize your personal risk. These aren’t perfect — they can’t tell who will and won’t get cancer. Rather, they should be used as a starting point for a conversation with a health care practitioner.

What about the BRCA genes?

BRCA1 and BRCA2 are genes that produce proteins that suppress tumors. When the genes have a mutation, the mutation prevents proper repair of DNA, significantly increasing the lifetime risk of developing breast, ovarian, and other cancers. Everyone has these genes, but mutations cause them to malfunction. Mutations in these genes can be inherited.

Variation in BRCA1/BRCA2 genes account for 5-10% of all female breast cancers. These variations are rare (about 1/400 women) but higher in some groups, like those with Ashkenazi Jewish heritage.

This is to say that while many cases of breast cancer are a result of BRCA gene mutations, the vast majority are not. Understanding overall risk, beyond these genes, is important.

What is dense breast tissue?

This is one of those things that I’ve heard about, but am only recently understanding.

Dense breast tissue is actually quite common — nearly half of women over 40 who get mammograms have it. Having dense breasts means that there is more glandular and fibrous tissue, and less fatty tissue in the breasts.

The reason it matters for breast cancer is two-fold:

It slightly increases the risk for breast cancer, and
It makes it harder to identify tumors on mammography results because dense tissue and tumors both appear white, meaning tumors can be easier to miss.

You can’t tell on your own whether you have dense breasts.

When you start getting mammograms, the facility conducting the exam will tell you if you have dense breasts (they are legally required to). If results are positive for dense breasts, the next step is to discuss with your health care practitioner if follow-up ultrasound or MRI are needed for extra breast cancer screening.

Another common question about screening: mammogram radiation

Yes, mammograms use radiation, because they are a type of low-dose X-ray. But the amount is small. A typical mammogram exposes someone to about 0.4 millisieverts (mSv) of radiation, which is about the same amount of natural background radiation a person would get over roughly seven weeks of everyday life.

This is the kind of question a lot of people have but feel almost silly asking. It’s not silly. If we’re asking people to do screening, they deserve honest answers about any trade-offs. For most women who are due for breast cancer screening, the benefit of catching cancer earlier outweighs the small risk from the radiation exposure.

What happens if the mammogram is positive?

If something is seen on a mammogram, that doesn’t automatically mean you have cancer.

In fact, only about 1 in 10 women called back for more testing are diagnosed with breast cancer. Most abnormalities in a mammogram are not cancer, and often result from harmless factors like dense breast tissue or cysts.

Anything that looks suspicious on a mammogram will get further follow-up tests to determine if it’s cancerous. This could be a diagnostic mammogram (in greater depth than a screening mammogram), an ultrasound, an MRI, and in some cases a biopsy.

The American Cancer Society has a good walkthrough on getting called back after a mammogram.

Accessing free screening in New York

If access is a barrier for you, free screening is available through the New York State Health Department. Call 1-866-442-CANCER (2262) to be connected to a Cancer Services Program near you. You can also visit the U.S. Food and Drug Administration’s website to find a mammogram location.

Bottom line

Don’t panic, but don’t assume guidance is one-size-fits-all. Screening and early detection enable the best outcomes.🎗💗

Love,

Your NY Epi

Q&A: How federal funding cuts will cost 500,000 New Yorkers their health insurance

2026-03-27T10:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The massive federal budget cuts imposed by the Trump administration’s One Big Beautiful Bill Act are beginning to play out. In New York, almost a half-million people are expected to lose their health insurance coverage through the state’s Essential Plan on July 1.

The U.S. Centers for Medicare and Medicaid Services granted the state’s request to revert to an earlier plan in a move that will maintain coverage for 1.3 million low-income New Yorkers. But almost 500,000 will be left without, because they will no longer meet the Essential Plan’s income limit - which is being reverted to $31,920 a year for an individual and $66,000 for a family of four.

The state’s health department has said it will send notices to those affected on Wednesday, laying out their options and next steps.

Michael Kinnucan is the health policy director at the Fiscal Policy Institute, an independent nonpartisan think tank that aims to promote sound and equitable fiscal policy to strengthen New York’s economy.

Kinnucan met with Healthbeat to discuss the Essential Plan — how it works, how it’s been successful, how the cuts will likely play out, and what that means for the broader health care system.

Many of those who lose coverage can turn to the individual market, but the premiums will be much higher and many people won’t be able to afford it. And increasing the number of uninsured people affects the whole community, he said.

“We all go to the same hospitals and doctors, and if half a million people suddenly lose coverage and aren’t able to go to the hospital or the doctor, that feeds through into hospital closures, into long wait lines at the emergency room,” Kinnucan said.

This interview has been edited for clarity and length.

Can you begin by telling us how the Essential Plan works?

The Essential Plan is a unique feature of the health care landscape in New York. It’s something we do differently from almost every other state in the country. In New York, the Essential Plan covers people who earn less than 250% of the federal poverty line, and who are not eligible for Medicaid, either because they earn too much or because they have a legal citizenship status that prevents them from getting Medicaid.

It’s a big program. It covers 1.7 million New Yorkers, and it provides high-quality, very cheap, or mostly free, health insurance to a low-income population — people making up to $40,000 a year for an individual. It’s federally funded, but it’s state-administered. If you go to the New York state health exchange website to sign up for insurance, and it turns out that you’re in an income category and other aspects of your life make you qualified for the Essential Plan, you get this very low-deductible, low-pay, high-quality insurance.

In other states, the equivalent population would buy health insurance on the individual marketplace, and they would get federal premium tax credits to subsidize them. But in New York, the state takes the federal funding and runs the central plan.

The Essential Plan enrollment has grown since it was launched in 2015, right?

[Enrollment has grown from 380,000 in 2016 to 1.7 million in 2025, according to the Community Service Society, a New York-based nonprofit that studies affordable housing and health access. Its popularity stems from lack of monthly premiums and deductibles, comprehensive health benefits, and limited cost sharing.]

That’s right. It’s been a real policy success story. Because it’s low cost, many people enroll in it, and in particular, many healthy people enroll in it, which keeps costs really low. And the result of that is actually the federal funding we currently get to run it has historically been more than enough to support the whole program because costs are very low, lower than they were initially expected.

It’s grown a lot. In 2024, the state was like, boy, this is working so well that they actually did a significant expansion of eligibility for the Essential Plan. Before 2024, you had to earn less than 200% of the federal poverty line to qualify. After 2024, it went up to 250% of the federal poverty line.

But because it’s low cost, because it’s a very efficient program, and a lot of healthy people enroll and keep costs down for everyone, it hasn’t cost the state any money to run the program. It’s been more than fully covered by those federal subsidies that in other states, they would help people buy insurance on the individual market. In New York, we use them to buy people Essential Plan coverage instead.

More recently, H.R. 1, the One Big Beautiful Bill Act, imposed cuts that will affect the Essential Plan. What do those cuts mean for Essential Plan enrollees?

The cuts applied specifically to legal immigrants. Undocumented immigrants are almost entirely not eligible for federal health care subsidies of any kind, be it Medicaid, the Essential Plan, or premium tax credits, but H.R. 1 cut a whole bunch of legal immigrants off from federal health care benefits.

What it did, specifically with those populations, is it made them ineligible for premium tax credits all across the country. If you’re, let’s say, a green card holder, and you drive a cab, you need to buy insurance on the individual market, you’re no longer eligible for premium tax credit, so that plan is going to cost you $10,000 to $12,000 a year.

In New York, because we operate differently with the Essential Plan, the equivalent cut was they cut off federal funding to support legal immigrants who are enrolled in the Essential Plan. That’s a minority, but a very large part of the central plan enrollment.

Roughly speaking, of the 1.7 million people on the Essential Plan, about a million are U.S. citizens, and about 700,000 are lawfully present immigrants. All the funding for them got cut by H.R. 1. What that meant was that group didn’t get kicked off the Essential Plan — they’re still on the Essential Plan. What it meant was that the Essential Plan as a whole is really underfunded. It lost almost half of its federal funding, and that’s forcing the state to make tough decisions.

What do these decisions mean for EP enrollees?

The funding cut from H.R. 1 has been so severe and threatening to the Essential Plan that many of us thought that it might need to be shut down entirely, which would have been a real catastrophe. It would have meant 1.7 million people losing health insurance. The state of New York came up with an alternative to shutting it down, which is to to shrink eligibility — to undo that expansion that happened in 2024 and reduce eligibility back to 200% of the federal poverty line.

It will be a smaller plan that will be cheaper to support. The state can continue to run the plan for everyone else below 200% of the poverty line indefinitely. Their coverage will be protected under this plan, but the people who are between 200% and 250% of the poverty line will be kicked off the Essential Plan. These are quite low-income people. They’re earning between $35,000 and $40,000 a year for a single individual. That eligibility group is about 470,000 people.

Those are the people who are going to lose coverage under the state’s new plan for the Essential Plan. They’re going to lose coverage really quickly, starting this July. It’s very concerning.

What happens next for enrollees?

Most but not all of this population are U.S. citizens. Most of them will be eligible to go in the individual market and purchase health insurance. They’ll be able to get premium tax credits to support that. But the truth is there will be a big struggle to afford health insurance.

Again, these folks are making $35,000 to $40,000 a year. Even with the individual market, even with premium tax credits, they’ll be paying $250 a month out of pocket. They’ll face really high co-pays. The truth is that it’s likely that many, many, many people in this population — probably more than half — are not going to be able to afford that coverage, and they’ll become uninsured.

There’s a separate, smaller group within this population who are lawfully present immigrants, and H.R. 1 actually made them disqualified for premium tax credits. That group, which is maybe 50,000 to 100,000 people — no one exactly is sure — will have no source of alternative coverage. In theory, they could still buy health insurance on the individual market, but they’d be paying over $1,000 a month. Given their incomes, there’s no way they’d be able to afford it.

To summarize, the majority of this population who are U.S. citizens, they may be able to get health insurance in the individual market, but it’ll be a very tight squeeze, and many of them will likely not be able to afford it and become uninsured. And there’s a smaller group of immigrants in this population who will have no source of alternative coverage and will almost certainly become uninsured.

What can the state do to help?

The good news is that the Essential Plan is incredibly cheap and efficient to offer as health insurance, and that’s because it’s low cost. It has a relatively healthy, low-cost enrollment population. The state does a great job of regulating the rates that Essential Plan pays providers. That makes it much cheaper to offer than commercial insurance.

The state was preparing and reserving money for the eventuality where the Essential Plan had to be eliminated, and that would have increased the state’s costs to cover different populations. Now that we know the Essential Plan will be around and it will cover most of its current population, we actually have $2.5 billion allocated in the state budget, which would be more than enough to cover the population at risk of losing coverage now and then.

The state said in a press release this week that it cannot make up for these cuts, but is working with insurers to ensure that anyone moving from the Essential Plan to a Qualified Health Plan mid year will see their deductible cut in half.

I don’t know how to say this politely: It’s not true that the state can’t make up for the cuts. The state has a $260 billion a year budget. It could fully replace this coverage for this group of half a million New Yorkers for far less than 1% of that budget. It is well within the state’s fiscal capacity to protect New Yorkers’ coverage.

As the state legislators negotiate in the budget, it’s their responsibility to make sure that does happen. Cutting people’s deductible in half is good, as far as it goes. It’s better than nothing, I suppose, but it is not remotely a replacement for Essential Plan coverage, which was free, as opposed to $250 a month, and which had very, very low deductibles, as opposed to the 2020 $500 deductibles that are common in exchange plans.

Is there anything you’d like to add?

The Essential Plan cliff happening in July, where half a million people are threatened with loss of insurance, is going to affect those people quite a bit. It’s also going to affect their entire communities and the health care providers in their neighborhoods.

We all depend on the same health care system. We all go to the same hospitals and doctors, and if half a million people suddenly lose coverage and aren’t able to go to the hospital or the doctor, that feeds through into hospital closures, into long wait lines at the emergency room, etc., etc. It’s really a shared interest for all of us to make sure that everyone is covered.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

No new measles cases in South Carolina for a week, but CDC outbreak models warn about underreporting

2026-03-27T09:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

For the first time since South Carolina’s record-breaking measles outbreak began last fall, the state has gone a full week without health officials learning of any new cases.

It’s an encouraging sign that the outbreak – which has 997 documented cases – may be nearing its end. However a report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, raises questions about how many measles infections have been going unreported.

“There are likely some undocumented cases of measles in the affected region, raising the risk of spread to other populations in the region or nearby regions,” according to the March 3 risk assessment from the CDC’s Center for Forecasting and Outbreak Analytics.

@healthbeatnews
Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
♬ original sound - Healthbeat

The assessment says the extent of this underreporting is among several key uncertainties in predicting the future of the largest U.S. measles outbreak in decades.

Before the outbreak can be declared over, there must be a period of 42 days with no new cases – an important sign that chains of transmission of the virus have been broken. The last day of the outbreak would be April 26 if no more cases are reported, Dr. Linda Bell, South Carolina’s state epidemiologist, said Wednesday.

“We remain concerned about the possibility of unrecognized measles transmission, and we remain vigilant in monitoring any potential cases and spread,” Bell said.

State health officials worry spring break travel will spread measles as infections rise across the U.S.

Bell noted that the CDC’s modeling report was completed three weeks ago.

“Since that time, our measles case reports have continued to decline, our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” Bell told Healthbeat.

Tests of wastewater in the outbreak area are not detecting measles, nor is there any sign from people going to emergency departments for measles-like symptoms, she said.

CDC officials did not grant interviews, and the agency’s written statements did not answer Healthbeat’s questions about information in the agency’s measles outbreak forecast report for South Carolina.

Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, said he thinks the state health department is using the best data it has available in its announcements last Friday and again Tuesday that no new measles cases had been reported.

“I think it’s very unlikely we’re at zero,” Thorpe said. “One of the really challenging, frustrating things about measles is that there absolutely can be cases we don’t catch, mild cases in particular.”

The last time South Carolina’s health department reported zero measles cases was on Tuesday, Nov. 4, when the outbreak had just 34 cases. But by Friday, Nov. 7, a case was reported, department records show. State health officials provide case number updates only on Tuesdays and Fridays.

Thorpe said he continues to be concerned about the upcoming spring break travel period increasing measles cases in the area. Many schools in Spartanburg County, where the outbreak is centered, are scheduled to be off for spring break during April 6-10.

It’s a concern Bell has previously expressed as well. South Carolina’s outbreak surged after the winter holiday break period.

‘Inconsistent’ or ‘sub-optimal’ compliance with isolation, quarantine

Outbreak modeling teams at the CDC have produced three “outbreak scenario” assessments for the South Carolina measles outbreak, the first on Jan. 2, plus two updates on Jan. 20 and March 3.

“Throughout the outbreak, our assessment consistently indicated that a larger outbreak, lasting at least six months, with some spread beyond the affected community, is the most likely outcome,” the agency’s outbreak modelers said in a March 6 web post that detailed their assessments.

The South Carolina outbreak was first identified in early October with five known cases.

As of early March, the CDC modelers said positive signs for the outbreak were that the rate of new cases was declining and that there were zero or minimal cases “outside of the affected community in the affected region” and that exposure settings affecting the “general population” had become limited or infrequent. Another positive sign: The number of households, schools, churches, and health care facilities with ongoing measles transmission was limited – a significant improvement from mid- to late January when the outbreak surged.

But in addition to concerns about the likelihood of some underreporting of measles cases, the CDC modelers also wrote that compliance with stay-at-home recommendations by infected and exposed people was “sub-optimal or inconsistent,” and that there had only been low to moderate immunization with the measles-mumps-rubella (MMR) vaccine among unvaccinated people in the area.

“Currently, there is no evidence that unvaccinated residents of the affected region are receiving MMR vaccine in high enough numbers to substantially reduce transmission,” the CDC report said.

How the South Carolina measles outbreak grew from 5 to 997 cases

However, Bell, who is leading South Carolina’s outbreak response, credits increased measles vaccination in recent months as a key reason the number of new measles cases being identified has slowed to a trickle throughout March and to zero reported in the past week. She said that in addition to people who got vaccinated, it is important to also consider that the nearly 1,000 people sickened with measles in the outbreak also acquired protective immunity to the virus through their infections. “That is a very risky way to get immunity,” she said.

“I should also add that our disease containment strategies, our investigation of cases while they’re infectious, and making sure that people remain in isolation, and making sure that people have guidance about being in quarantine, also contributes to preventing ongoing transmission in communities,” Bell said.

CDC forecasts note ‘close-knit’ low-vaccination community

The CDC modelers noted that Spartanburg County, where the outbreak has been concentrated, “is home to a large, close-knit community of about 15,000 people with low vaccination coverage,” and that in schools countywide, just 88.9% of students are vaccinated against measles, compared to a statewide average of 93.7%.

To stop measles from spreading within communities, 95% of the population needs to be vaccinated.

Neither the CDC nor South Carolina’s state health department would identify the “close-knit” community referenced in the CDC outbreak modeling assessments. However state health officials have previously acknowledged outbreak cases and multiple exposure incidents at Slavic-language churches whose members speak Ukrainian and Russian, as well as schools serving students from those communities.

Vaccine hesitancy among Ukrainian and Russian-speaking communities in the United States has been fueled in part by historic distrust of the former Soviet government and its health system, health officials in other states have found.

The CDC’s outbreak assessment updated on March 3 says that the “size of close-knit communities with low vaccination coverage” in the outbreak area, as well as their level of connection to other similar communities across South Carolina is a key uncertainty in predicting the outbreak’s future path.

The assessment notes that much is unknown about the extent of measles vaccination coverage in the region, “particularly among close-knit, under-vaccinated communities.” Use of school vaccination data can be used to help estimate community-wide immunization rates, the report said, but rates vary widely in the region.

Some of South Carolina’s earliest known outbreak cases and exposures involved Global Academy of South Carolina, a public charter school in Spartanburg whose founders are Ukrainian immigrants. Only 21% of Global Academy’s students were up-to-date on their school vaccinations, according to state data.

The Way of Truth Church in Inman, S.C., was identified as the location of a measles exposure incident in early November.

One church, Way of Truth Church in Inman, S.C., was identified as the location of an outbreak exposure incident in early November that resulted in at least 30 measles infections during the weeks that followed, according to state outbreak updates. Over the Christmas holiday period, multiple Slavic churches were associated with measles cases and exposure incidents, according to state outbreak updates. School and church officials have declined or not responded to past interview requests.

‘Intrusion into your life’ when families seek care for measles

Another key uncertainty impacting the future of the outbreak, according to the CDC outbreak modelers, is how quickly people who are experiencing measles symptoms or who have been exposed get tested and seek health care.

The report says “avoidance of testing or health care could give the impression that transmission is slowing when that is not the case.”

The CDC outbreak modelers are not alone in their concern about underreporting of measles cases in the South Carolina outbreak.

Dr. Robin LaCroix, a pediatric infectious disease specialist with Prisma Health, one of the major health systems treating measles cases in South Carolina’s Upstate outbreak area, said earlier this month that underreporting is a “big concern.” LaCroix noted the potential “intrusion” of public health investigations after health care providers notify health officials, as required, about measles cases.

“I think that we have captured only a fraction of the people who have become infected with measles because if you were not ill enough to seek medical care, you are never captured in the numbers that are reported, “ LaCroix told the Why Should I Trust You podcast.

“When you began to see what happened when you sought medical care – you had a call from the DPH, who wanted to know everywhere you had been for the four days before you became ill, or your child became ill, and there was a lot of intrusion into your life and activities related to that,” said LaCroix.

In addition, she said, an infected child’s school also would get reported to public health and other unvaccinated children who were exposed would be sent home for 21 days of quarantine.

“There were big community consequences around coming forward that my child has measles, and so then you open yourself up for again some ostracization within the community, that you caused us to have to send all of our children home. So I do think that there is an underreporting,” LaCroix said.

Prisma Health spokesperson Tammie Epps said LaCroix was unavailable for an interview with Healthbeat.

While Bell said she remains concerned that there may be some unrecognized measles cases, if they are out there and aren’t seeking medical care, she doesn’t think there are currently many because there are no signs of them in wastewater testing and other surveillance systems.

“We don’t see indications there are large numbers of unrecognized measles cases because people are self-isolating,” she said.

“No surveillance system captures 100% of cases,” Bell said, “but with a highly infectious disease like measles, if ongoing transmission were occurring from many unreported cases, it is more likely to be detected by at least one of these means in addition to provider reporting.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

State audit: NYC health department needs to improve language access services

2026-03-26T22:42:24+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

In a city in which hundreds of languages are spoken, the New York City Department of Health and Mental Hygiene isn’t doing enough to reach residents who may have limited proficiency in English, according to a new audit from the Office of the New York State Comptroller.

The March report by State Comptroller Thomas DiNapoli sought to better understand whether the health department, one of the biggest in the world with more than 7,000 employees, was complying with state regulations and local laws to provide “sufficient oversight” of language access services for the millions of New Yorkers with limited English proficiency.

Citing a 2023 American Community Survey conducted by the U.S. Census Bureau, the study points out that an estimated 1.7 million New Yorkers speak hundreds of languages and have limited English proficiency.

The audit, released Wednesday, spans a period from January 2019 to December 2024.

The health department is one of four city agencies required by law to provide free language access services to clients who have limited English proficiency, the audit reported. As such, these agencies are required to provide services such as telephone interpretation, multilingual signage, and document translations, and create a language access implementation plan.

Telephone interpretation must be available in at least 100 languages and handy translations of key documents must be available in 10 designated citywide languages: Spanish, Chinese, Russian, Bengali, Haitian Creole, Korean, Arabic, Urdu, French, and Polish.

A language services unit in the health department’s office of external affairs is responsible for receiving, tracking, and resolving related complaints.

In his report, the comptroller identified “numerous deficiencies in DOHMH’s administration and operation of its LAS that led to potential non-compliance with relevant standards and local laws.”

Key findings include:

The health department does not have a systemwide repository for recording and tracking language access services as required. Language access requests may be underreported and offer an incomplete picture of potential needs.
Health department officials are unaware of the number of instances in which an interpreter could not be located.
The health department has a required fluency assessment, but there are uncertified bilingual staff providing clinical services. The health department inconsistently reports the number of bilingual staff who have completed the fluency tests.
A survey of 50 restaurants and food establishments and review of food inspection data found that many owners and workers were unaware of language access resources or of a bill of rights that states the right to language access services during inspections.

In its audit, the comptroller’s office made seven recommendations, which include:

Develop a system-wide database for collecting and tracking clients’ language preferences across all facilities, and collaborate with vendors to gather relevant data on LAS delivery and unfulfilled requests.
Ensure all communication is geared toward people with limited English proficiency, including telephone systems and appropriate signage.
Ensure staff who provide interpretation complete the health department’s fluency assessment.
Test language access services equipment for each program and facility periodically to ensure access to language access services.

In a response that was included in the audit, the health department said it “generally agrees” with all of the recommendations. The health department noted that a database used for restaurant inspections was set up in 2010, and making changes to “this outdated technology is difficult and costly.”

“Currently this information is captured manually, and we are not able to generate reports,” the department said.

In a separate statement, a health department spokesperson said the agency’s language access services “in 2026 represents the gold standard” and the agency is making improvements.

The statement noted that the audit’s time span overlaps with the pandemic, “when many city services faced disruption and setbacks.”

“Since this audit was launched two years ago, and particularly since receiving the preliminary report in December, we have improved our language access services. Of the seven recommendations, nearly half are complete and the remainder are underway.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Four states, four strategies: Lessons for Georgia’s public health review

2026-03-26T17:11:35+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

State representatives have this year taken a look at how Georgia’s public health system works and what changes might be needed. A resulting report found that there is a “wide variance” in the public health services offered across the state, with many rural health departments offering fewer services than urban ones, and public health departments facing workforce shortages.

Legislators are trying to address the workforce shortage by allowing county workers to retain their accrued leave time if they go to work for the state.

That’s just a first step, said Rep. Darlene Taylor, a Republican from Thomasville who chaired the legislative study committee and also chairs the health appropriations subcommittee in the House of Representatives.

She said Georgians can expect more reforms in future years. The study committee recommended updating the formula that determines how much counties chip in for local public health budgets, creating more consistency across the state’s public health system, and moving from a system of county boards of health to district boards of health.

Public health advocates say more funding will be needed to ensure that Georgians have access to the services they need. Taylor said she hoped that would happen in future legislative sessions, but this year’s uncertainty about federal funding and other legislative priorities meant the public health budget was kept mostly flat.

Here’s how four other states approached similar processes.

Indiana: More public health funding in a fiscally conservative environment

Indiana made a historic 1500% investment in public health funding in 2023: a $225 million increase over two years.

That influx came with strings attached – and a strong degree of local control. The 95 local health departments could decide to forgo or opt in to the new funding. If they opted in, they agreed to provide a set of core public health services and report twice a year on their progress on “key performance indicators” they chose as priorities for their communities.

For example, Posey County in southwest Indiana focused its key indicators on infant mortality and reducing obesity among adults, while Allen County in northeast Indiana is focused on tracking childhood lead screening and immunization rates.

The website for each county highlights local success stories, local data and budget information, and key partnerships, all published on the Health First Indiana website. By the second year of the program, all Indiana counties had decided to opt in.

Success factors:

Make the business case: “We hitched our message to something that we knew resonated with the leadership at the time, which was economic security,” said Shane Hatchett, who was deputy health commissioner during the process. Advocates told legislators that Indiana’s decreasing life expectancy “represents empty church pews, empty families, and empty people in the community to be able to fill in the jobs that the state has been working so hard to recruit and bring in.”
Listen: Then-Gov. Eric Holcomb established a commission to study possible public health reforms and help draft needed legislation. The commission held a listening tour in different parts of the state and met twice each with different organizations to find out what their concerns were, share progress, and build consensus.

That was especially important in the wake of the Covid pandemic, Hatchett said. “We heard a lot about how we got it wrong,” when it came to Covid. “It was them having a chance to tell us face to face what they thought.” The sessions also provided an opportunity to educate people about the basics of public health.

Focus on the local. Even though the funding was coming from the state, the reforms allowed local departments a great deal of leeway to decide on their priorities as long as they agreed to provide a common set of core services. In addition, counties had to agree to provide 20% of the funding to unlock the remaining 80% from the state. That helped lawmakers feel that local health departments had “skin in the game,” Hatchett said.

Two steps forward, one step back

Indiana’s budget runs on a two-year cycle, and last year the legislature decided to cut funding for public health, from a planned $100 million to $40 million after the state faced a large budget shortfall. That’s meant many recently launched local programs are now facing funding hurdles.

“The program is still funded, not at the same level. They at least recognized it was important to put something there, which I consider a win,” Hatchett said.

Mississippi: A public health report card

Mississippi launched a public health report card in 2023 to provide an easy way to look at more in-depth data included in the Department of Health’s annual report, spokesperson Lauren Hegwood told Healthbeat. The two-page document features easy-to-digest graphics that highlight areas of concern, like the state’s high rate of firearm deaths, and successes, like its high rate of vaccinations in school-age children.

State law requires the department to publish an annual report, but the report card was a voluntary effort on the part of the health agency.

“The goal is to give Mississippians and policymakers a clear, straightforward look at our state’s health status,” she said. It’s also created an opportunity to hold an annual press conference at the Capitol to highlight the findings.

Ohio: Pursuing public health accreditation

In 2013, the Ohio legislature granted the state director of health the authority to require local health departments to secure accreditation from the Public Health Accreditation Board.

One goal was to ensure consistency of services offered across the state, whether in urban centers or rural areas, said Tonni Oberly, a professor of public health at The Ohio State University. Of the state’s 113 local health departments, 107 are accredited, according to the PHAB.

In Georgia, just three of the state’s 18 public health districts and the state health department are accredited.

Oberly said the accreditation process helps health departments adopt a quality improvement mindset and improve resource management. Accreditation can also help departments be better prepared to win competitive grants, Oberly said.

Accreditation can tax already busy staff, especially in smaller departments, she said. That led to resistance from some rural departments, who felt the process was a “heavy lift.” The state health department provided technical assistance and some funding to help with that.

“It does take time, it takes effort, and you have to ensure that you’re building that infrastructure for your health departments to be successful,” Oberly said.

Oregon: Three metrics drive a unified effort

Oregon started a public health modernization process in 2013 and made major revisions to its system after the Covid pandemic. That has resulted in $112 million in funding for the modernization project for the 2025-27 biennium.

A Public Health Advisory Board with representatives of local health departments and community organizations helped establish and monitor the metrics.

The metrics focus on three areas: reducing syphilis rates, increasing vaccination rates for children and older adults, and improving climate resilience for extreme heat and wildfire smoke. Within those, the metrics include outcomes and indicators of progress on public health processes. The team also looked for measures that could be broken down by location and different kinds of populations.

While the process started in the 2010s, a post-pandemic 2023 report sets out new baseline rates and goals for the period until 2030. Local health departments get additional funding – up to a 1% boost – if they meet certain process goals, said Sara Beaudrault, strategic initiatives manager in the Oregon Health Authority’s public health division.

The metrics focus on outcomes and factors like how well local health departments develop community partnership, Beaudrault said.

“We didn’t want to measure everything,” Beaudrault said. “The metrics that we have are really just a small piece of what we do, but it gives us a way to talk about the work.”

The state developed the metrics in consultation with local health departments, which increased buy-in, she said.

“I can truly say that OHA [Oregon Health Authority] is not imposing these metrics on local public health,” Beaudrault said. The goal was to find metrics that would help create a baseline level of services across the state even while allowing for local flexibility.

The metrics have prompted tangible change, Beaudrault said, pointing to the example of public health departments working on making sure long-term care residents are getting the vaccines they need.

The outcomes data has helped build the case for public health with policymakers, she said, resulting in sustained funding, even if it’s not always as much as some advocates would like. For example, in 2017, the legislature provided $5 million for the two-year budget cycle – which has now increased to $112 million for the 2025-27 biennium.

Still, there are factors that affect health outcomes that lie outside the purview of public health departments and that can’t be addressed without increased coordination and funding, like housing, Beaudrault said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

5 From the Field Q&A: Trust for America’s Health CEO Nadine Gracia on making the case for public health

2026-03-26T13:31:13+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

As the child of Haitian immigrants, Dr. J. Nadine Gracia says her professional journey into public health began with her parents’ courage and her own desire to have a career of service.

She initially gravitated toward medicine as a way of caring for others, then served in government, eventually becoming deputy assistant secretary for minority health and director of the Office of Minority Health at the U.S. Department of Health and Human Services during the Obama administration.

Since 2021, Gracia has served as president and CEO of the Trust for America’s Health, a national nonprofit, nonpartisan public health research and policy organization that for 25 years has worked across administrations recommending evidence-based policies to improve public health. She previously served as the organization’s vice president and chief operating officer.

In this 5 From the Field interview, Gracia shares insights on five questions about her work in public health and what she sees as key issues that must be addressed. This interview has been edited for clarity and length.

Federal agencies have been undergoing a lot of changes. What did you learn from your time inside government?

What I saw was really the responsibility and the privilege that we had of being public servants to address the needs of the population.

I had the opportunity to learn from and work with so many career government staff. I just learned so much because of the institutional knowledge, the relationships and partnerships that they brought to the agencies, the subject matter expertise, whether it was scientific expertise or other particular areas of expertise.

What I understood there was the power and importance of partnerships, of engaging with community, of listening to identify priorities, of assuring that if policies did not reach or were not helping to support certain groups and populations, that we needed to be able to address those kinds of structural and systemic barriers to health and well-being, and that government has a key responsibility and lever to be able to create that type of change.

What are the most pressing public health issues that you and the Trust for America’s Health are working on?

Public health is at an inflection point.

How do we continue to protect the public’s health and in that, protect and support the nation’s public health system at all levels? And then on the other side of that: How do we take this moment to reimagine and consider the future of public health?

We know that the public health system wasn’t perfect before. This is an opportunity as well to think about how we strengthen and bolster the public health system. It’s important not only to protecting health. It’s also important for strengthening our economy. It’s important for our national security, and we know that public health has been chronically underfunded.

How do we modernize public health? So many of our systems have been antiquated in terms of data and other areas. It’s also thinking about how we stretch and further enhance partnerships.

So really ensuring that we’re providing Congress, the administration, other federal officials, with the evidence and the information to make informed decisions about funding is critically important.

Where do you see opportunities for partnerships?

Strengthening our partnerships with health care. One would think that these two systems [public health and health care] work seamlessly on a day-to-day basis. But often it’s in times of emergency that we see these systems working more closely together.

We can do even more in non-emergency times to really create this broader health ecosystem.

It’s working, for example, with the business community, because we know that good health is good business. Ensuring that employers understand how to protect the health of their workers.

It’s also looking at the design of communities. It can extend to things like transportation and housing, because we know that our health is influenced more by what happens in the places in which we live, where we grow, where we age, and when we work, than just in the four walls of a doctor’s office or the hospital.

What is something the public doesn’t understand about public health?

One is just an understanding of what public health is and the value of public health.

It often is said that many don’t know what public health is until there is an emergency, until there is an outbreak or a pandemic, until there is some kind of weather-related emergency, like a hurricane or tornado.

Yet public health is working each and every day in every community. It’s making sure that the air that we breathe, the water that we drink, the food that we eat, is safe. It’s ensuring that kids can have a healthy start in life, and mothers are able to thrive through pregnancy and early motherhood.

Public health really needs to be a core part of the infrastructure of every community, that it should have significant investment so that we have a strong system that is able to protect and promote the health of its residents.

What’s at risk – and what is the opportunity – for public health right now?

We risk, for example, the gains that we have made over more than a century in life expectancy. The vast majority of the gains in life expectancy in the country are due to public health interventions.

We are seeing the further rise of rates and chronic disease and other health conditions in terms of rising health care spending. The U.S. spends the most among peer nations in terms of health spending, and yet we have the worst health outcomes across many areas, like infant mortality and maternal mortality, and highest rates of chronic diseases.

When we don’t invest in public health, we have to understand that that’s also not investing in our health security. That is the system that is doing disease detection, that is doing the monitoring for outbreaks and other types of emergencies.

My hope is that the path we chart forward is a path where we understand the value of public health and the return on investment that public health brings to communities and to the nation.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

How the Iran war is disrupting the world’s medicine supplies

2026-03-26T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we start with a reminder that the world’s conflicts rarely stay confined to the map. The Iran war is scrambling medical supply chains globally, because the Persian Gulf is not just an energy chokepoint but a critical transit hub for pharmaceuticals.

That said … we’re feeling the energy squeeze, too! Rumors of fuel rationing started circulating in Nairobi early this week, which was enough to send me out late at night to fill up my tank just in case.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The Iran war is a drug shipping fiasco

The starkest warning yet of how the Iran war could scramble global health comes from this must-read analysis in Think Global Health. The short version: The war is choking the movement of medicines around the world.

To be clear, it’s not that the Persian Gulf countries (like Saudi Arabia, Qatar, and the United Arab Emirates) are major drug producers. They’re not. It’s that these countries form “a critical pharmaceutical transit hub,” where drugs and their basic ingredients from India, Europe, and China routinely pass before heading to Africa, Asia, and the United States.

For reference, this is a region whose “pharmaceutical industry is worth $23.7 billion,” but where roughly 80% of that trade depends on medicines or pharmaceutical ingredients passing through.

And right now both ways these medicines largely transit, the sea shipping lane in the Strait of Hormuz and the Persian Gulf’s giant cargo airports, are badly disrupted. Shipping has dropped “90% below pre-war levels,” while air cargo capacity has fallen by “79% in the Gulf region.”

Where will the shocks be felt first?

I reached out to one of the authors, Prashant Yadav at the Council on Foreign Relations, who is a leading expert on global health care supply chains to ask.

Right now the biggest risk is cold-chain medicines, which he writes are “vaccines, insulin, biologics, and cancer therapies” with “short shelf lives” that have to move quickly and stay within a tight temperature range; largely “between 2°C and 8°C,” 35-46°F.

Most cold-chain medicines move by air cargo, Yadav told me, and airlines cannot simply add new capacity overnight if those routes stay disrupted. Even over the medium term, “I don’t think European airlines, or the two major African ones that have stepped in, will enhance their cargo carrying capacity by buying new planes just because this may continue for a few more months,” he said.

When shipments of these drugs are held up, those medicines can spoil. And even when they don’t, delays multiply. As the article notes, cargo carriers “need a week and a half to catch up for every week that air shipments are suspended.”

Also at risk is helium supplies, a gas that is “an essential input for cooling the magnetic resonance imaging (MRI) machines used worldwide for [over 95 million] medical scans,” each year. Qatar alone produces a third of the world’s helium. And the threat is not just constraints from the transit fiasco, but physical damage to the industry, including Iran’s March 18 attack on a major helium production site in Qatar.

Yadav believes we will ultimately see some “supply impact for MRI helium,” but exactly how severe it may become is too hard to untangle right now. Much will depend on how long Qatar’s production remains offline and how exactly limited supplies are allocated between industries, like semiconductor manufacturing (which is an enormous use for the gas).

Perhaps unexpectedly, the war has also put medical research under threat. Yadav’s article describes how the Gulf region was in the middle of a clinical trial boom, driven by “the area’s high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials,” and that supply chain chaos could interrupt ongoing trials.

The good news is that, for now, "short-term risks of drug shortages are low in most countries,” Yadav writes. But that’s because of “inventory buffers” that governments and pharmaceutical companies keep around the world. But those cushions are temporary. If shipping and air freight disruptions drag on, shortages will eventually work their way through the system.

I also asked Yadav whether the war could trigger a price squeeze for medicines made with petroleum products, which is more than you might think. “Most of our medicines have some kind of a chemical precursor, and a very significant portion of those chemical precursors are petrochemical derivatives,” he said. (For example, acetaminophen and ibuprofen are made using an oil-based chemical called propylene.)

But Yadav says, for now, that’s not a major concern. The petrochemical ingredients in something like a pill of ibuprofen only make up only around 5% of the cost, with the rest tied up in processing and manufacturing.

But other cost implications are coming fast. A combination of rerouted flights, rising air-cargo rates, and surging insurance premiums for ships mean that moving medicines are more expensive everywhere. And at least one supply chain logistics firm says that, “consumers could see drug costs affected within four to six weeks.”

Yadav’s article ends with a clear policy warning. Governments may need to temporarily loosen certain import regulations so medicines can move through alternate routes. Longer term, he says the world needs something bigger: a standing G20 coordination system that tracks where medicines are stuck and helps countries respond before shortages hit.

A rare campus outbreak

The UK is facing an outbreak of meningococcal disease among university students in Kent, which is in England’s southeast. It has already killed two people, the BBC reports. The outbreak has drawn serious attention in British media, because while the disease is rare, it strikes with a fairly shocking speed and quickly becomes deadly.

Disease breakdown: Meningococcal disease is an illness caused by a bacteria called Neisseria meningitidis. It spreads through respiratory droplets, similar to Covid, and often starts with flu-like symptoms, followed by patients developing a distinct red and purple rash. It is largely preventable through vaccination, and can be treated with antibiotics, although it can leave survivors with permanent disabilities. Confusingly, outbreaks are sometimes referred to more broadly as “meningitis” in mass media, which is a condition that refers to the often-deadly inflammation of the tissues surrounding the brain and spinal cord.

A Scientific American report on the situation framed the outbreak as a reminder of why vaccination programs matter. William Schaffner, an infectious disease physician at Vanderbilt University Medical Center, told Scientific American that “this outbreak is a very unusual event,” and underscored “how routine, comprehensive vaccination has had a profound effect on really dramatically reducing the occurrence of what was once an extreme, ordinarily feared infection.”

Reading that, my immediate question was if the UK outbreak might portend something broader: like a smaller equivalent of the measles resurgence, where slipping vaccination coverage is allowing outbreaks to return?

Ultimately, that seems unlikely. The Kent outbreak was caused by a rarer strain of meningococcal disease known as strain B. While many children are routinely vaccinated against it, vaccine boosters for strain B are often offered only selectively in places like the UK and United States because cases are so uncommon. That means the gap that appears on college campuses is usually not missed shots but fading protection as immunity wanes over time.

I also reached out to Schaffner directly, who told me that “the outbreak in Kent does not portend similar outbreaks elsewhere.” He emphasized that the disease holds “very little risk to the general public for two reasons,” he said. First, because it needs close, repeated contact to spread. The illness spreads “most readily amongst semi-confined populations such as university students” who share classrooms, dorms, and nightlife, he said. (The epicenter of this spread is believed to have been a bar).

Second, containment is relatively straightforward. In Kent, “the public health response has been brisk and comprehensive,” he said, with health officials quickly giving antibiotics to people who may have been exposed.

Vaccine side effects (... good ones!)

A senior infectious disease reporter I follow, Helen Branswell, just published an interesting article in STAT News that sits somewhere between op-ed and straight news. She walks readers through vaccine by vaccine to explain a simple but often overlooked point: Immunization programs rarely benefit just one person against one pathogen.

Pure speculation on my part, but I’m imagining this story originated as a sort of professional self-care for a veteran health reporter. After watching the maddening vaccine debate circle the bowl of conspiracy-land too many times, maybe you just need to reset the conversation. Anyhow, I’m here for it!

I won’t walk through the whole list here, but three examples really jumped out to me:

Rubella vaccination in kids has essentially eliminated a once-devastating birth defect in mothers that left many babies “deaf, blind, or with developmental delays.”

The meningitis vaccine has helped decimate gonorrhea infections, with surprising studies suggesting the shot offers about a “30% to 40%” spillover protection against the sexually transmitted infection.

And Human Papillomavirus vaccination has turned into what one expert called “one of the most elegant herd immunity stories that we have” in public health, reducing several cancer rates broadly… even in men who were never the original targets of the vaccine program.

Argentina, out of the WHO

Argentina has finally made good on its year-old promise to withdraw from the World Health Organization, Al Jazeera reports. It is the second country to ever do so, after the United States. It may sound symbolic, but the move cuts off Argentina from the United Nations agency which (as we’ve covered extensively) “monitors health trends, tracks disease, promotes health care access, and trains medical providers.”

So why’d they do it?

Argentina’s President Javier Milei has framed the move as a matter of national “sovereignty,” criticizing the WHO’s “health advice during the Covid-19 pandemic,” and saying Argentina will pursue “international cooperation in health through bilateral agreements” instead.

Do those arguments sound familiar? They should, as both the criticisms and the shift toward bilateral deals echo the exact complaints and policies we’ve heard from the Trump administration. So, it’s clearly Argentina’s model.

Not to quibble, but it’s worth noting one key point: The WHO does not control countries’ health policies, and its Covid-19 recommendations were never strong-armed on Argentina. It is an advisory body. (Just ask Sweden, or Argentina’s neighbor Uruguay).

My takeaway? Ultimately, unless this move somehow triggers further exits, I’m not seeing it as a dramatic new fracture in global health cooperation. It’s another aftershock of far-right domestic politics that have been spilling into health policy since 2025.

Secret jungle medical school

Let’s finish this week with a remarkable story from The Guardian, which followed a group of nursing students in Myanmar who just graduated from a “secret jungle school” of medicine built during the country’s civil war.

The background: After the military coup in 2021 destroyed large parts of the public health system, an underground network of clinics emerged. This “parallel secret health system” surfaced to treat injured pro-democracy fighters and “those who cannot risk government-controlled hospitals or who live in the vast areas of the country which are outside the regime’s control.”

Eventually, the effort expanded beyond treating patients to training the next generation of nurses. One nursing teacher “contacted colleagues in the U.K., and together nurses in Myanmar and Britain arranged video masterclasses,” for a full curriculum.

All told, “dozens of international academics recorded lectures for the 58 modules needed to cover Myanmar’s curriculum, and “the Phoenix Bachelor of Nursing Science” degree was born.

The article describes how lectures were “smuggled on memory sticks across the country,” and how the students completed their training under extraordinary conditions: like studying in remote classrooms while dodging drone surveillance and airstrikes. As one organizer put it, “safety is never guaranteed.” Another described bombs landing “right next to the classroom.”

It’s a powerful read, and the new graduates say the program represents something larger than medical training. “The name Phoenix itself is powerful for us. It symbolizes rising from the ashes of the destruction the coup has caused … We are the living proof that education and hope cannot be extinguished by violence.”

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

The vexing challenge with antibiotics: We’re taking too many. And we need to make more.

2026-03-25T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

Antibiotics are one of the most important inventions of the 20th century. They made it safer for humans to do virtually every normal activity: breath air, drink water, eat food, and have sex. In fact, we now depend on antibiotics so much that we now face a vexing situation: We need to start taking fewer antibiotics, and we need to start making more of them.

In this week’s report, I review a new research finding that even a single course of antibiotics may disturb our body, the over-prescribing of antibiotics by dentists, and new Food and Drug Administration action to address a shortage of one of our oldest antibiotics: penicillin.

Do antibiotics harm your body?

A large new study published in Nature Medicine this month offers some of the most compelling evidence that antibiotics could cause lasting harm to our gut microbiome. The gut microbiome is the dense, diverse community of bacteria that live in our intestines and help with digestion, nutrition, and immunity.

Researchers in Sweden linked prescription records from 14,979 adults to data about each adult’s microbiome (specifically fecal metagenomics data) to study the question: Does antibiotic use in the past eight years show up in the gut microbiome today? The answer was “yes.”

First, associations between antibiotic use and lower gut microbiome diversity were detectable for antibiotics whether they were taken within the past year, one to four years earlier, or four to eight years earlier. Second, the effects varied sharply by drug class: Clindamycin was the most damaging, with each course taken in the past year associated with an average of 47 fewer gut species detected. Each course of fluoroquinolones was associated with 20 to 21 fewer species. Standard penicillins, by contrast, showed minimal or no association. (More on penicillin below). The gut, it seems, has a long memory for antibiotics.

I routinely have to convince patients (as well as friends and relatives) why they do not need antibiotics for their runny nose, benign skin rash, or upset stomach. Often they become frustrated, believing that I am somehow gate-keeping a precious and harmless resource that will relieve their symptoms. One way that I try to assuage them is to explain all the ways that antibiotics could actually hurt, not help, them.

Antibiotics can wipe out protective bacteria in the gut, increasing the risk of Clostridioides difficile (C. diff), which kills nearly 30,000 people in the United States annually, as well as Salmonella and other foodborne bacteria. Repeated antibiotic use has also been linked to an increased risk of obesity, type 2 diabetes, cardiovascular disease, and colorectal cancer — all potentially through microbiome disruption. The effects are also not limited to the gut microbiome. Another study just published in Nature highlighted potential risks to the respiratory tract microbiome when doctors inappropriately prescribe a “Z-pack” to patients with Covid.

Whenever we prescribe a drug, we are balancing harms and benefits. The benefit of antibiotics outweighs the harms for many infections – both to cure infections that you currently have and for infections you might get after a high-risk exposure. Whenever a doctor tells a patient that a conventional therapy could harm them, we run a risk that we will frighten them away from taking a medication that could save their lives. (Look at this bizarre and inappropriate statement recently from FDA Commissioner Marty Makary that he would only give his young child antibiotics if he was “on his deathbed or suffering.”) The value of studies like the one in Nature Medicine is to help all of us — patients and providers alike — ensure we use antibiotics only when they are truly needed.

Is your dentist prescribing too many antibiotics?

I recently experienced a version of this problem myself. In February, I had to get urgent dental work done, and the dentist prescribed me a week of amoxicillin after the procedure. I went straight to the medical literature to review the evidence for whether antibiotics are proven to prevent infection and promote healing after the specific procedure I had done. The answer was: There is no evidence of benefit, but it is standard practice by many dentists

Journalist Liz Szabo has just written an illuminating three-part series about dentists over-prescribing antibiotics. She describes how dentists wrote 27.3 million antibiotic prescriptions in 2025 and that 80% of preventive dental antibiotics are inappropriate, meaning they are prescribed to patients before or after procedures where there is no evidence of benefit.

The second most commonly prescribed antibiotic by dentists is clindamycin, the antibiotic found in the Nature Medicine study to have the most severe impact on the microbiome and a drug that carries a black-box warning — the FDA’s strongest caution — for its risk of causing life-threatening C. diff infections.

In addition to the risks to individual patients, every unnecessary antibiotic prescription accelerates the evolution of bacteria that can evade our drugs. Drug-resistant infections already cause an estimated 5 million deaths worldwide each year, a number that is growing as pathogens evolve new ways to survive in the presence of antibiotics.

Changing the behavior of health care providers — whether they are dentists, physicians, or others — is hard. What we learn in our training, even if it’s incorrect, often becomes our default practice for life. With opioids, it took a national crisis, widespread legislation, and mandatory continuing education before dental opioid prescribing meaningfully declined.

The rise of the anti-vaccine movement may also further increase antibiotic use. One of the best ways we have to prevent antibiotic use is to prevent infections in the first place by taking recommended vaccines.

And, in case you’re wondering, I did not take the antibiotics my dentist prescribed, and, so far, my teeth are OK.

We have a dangerous shortage of penicillin

Of course, infectious diseases are still a major public health problem, and antibiotics are often life-saving. What we try to teach clinicians is to prescribe the right drug for the right bug at the right dosage for the right time. That is, make sure you know what bacterial infection the patient has, then prescribe an antibiotic that is specifically targeted to kill that bacteria using the correct dosage for the least amount of time necessary.

What happens, however, when the right drug is not available? And that drug happens to be one of the oldest and most useful antibiotics we have?

One of the most common sexually transmitted infections in the United States is syphilis, and, unlike many other bacteria, it remains uniquely susceptible to plain old penicillin, specifically a long-acting injectable form called Bicillin L-A (benzathine penicillin G).

Syphilis rates in the United States have been rising sharply, particularly in pregnant women in whom untreated syphilis can lead to stillbirth, organ damage, and death of the fetus. No other antibiotic can reliably substitute for Bicillin L-A.

Unfortunately, only a handful of manufacturers worldwide are willing to produce an old drug that is not very profitable. As syphilis cases increase, the United States has been experiencing recurrent supply shortages of Bicillin L-A.

The shortage has gotten so acute that the FDA has authorized the temporary importation of a version of benzathine penicillin called Lentocilin, made by a Portuguese company not normally licensed to sell in the United States. (Interestingly, the only U.S. company willing to import Portuguese penicillin was the Mark Cuban Cost Plus Drug Co., a venture by the billionaire entrepreneur aimed at lowering consumer drug prices).

On March 10, the Centers for Disease Control and Prevention issued guidance to health departments across the country explaining how to use Lentocilin and urging them to conserve the remaining domestic supply of Bicillin L-A.

It’s a difficult paradox that I have to warn both about the danger of excess antibiotic use and the loss of access to antibiotics. Antibiotics are fundamentally a public good, and, as with other public goods, their supply is limited. When we act as if supply is unlimited — prescribing them too much and for the wrong reasons — we degrade a resource we all need.

Until next week,

Jay

From operating room to the Gold Dome: How Georgia’s medical lawmakers shape policy

2026-03-23T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

The typical path to becoming a politician includes law school, public policy, or government work – not necessarily medical training.

But doctors, nurses, pharmacists, and even a dentist or two make up the ranks of legislators in the Georgia General Assembly. They are a vocal and highly educated minority of more than a dozen medicos in a sea of lawyers and business people.

Their frontline experience guides how they vote and their championing of bills to improve Georgia health.

While they are divided on some core issues – like Medicaid expansion and abortion rights – their shared professional backgrounds provide common ground on many other health issues.

Healthbeat recently caught up with three of the state’s elected medical professionals about why they decided to run for office and what they bring to the legislative, rather than the operating, table.

Sen. Kay Kirkpatrick: From hand surgery to policy wonk

The Marietta Republican has served since 2017 in the state Senate, where she chairs the Children and Families committee. Her journey to medicine started when a local doctor told the Kentucky teenager to consider medicine instead of nursing. That inspiration led to her becoming a hand surgeon, which requires years of specialized training.

Georgia state Sen. Kay Kirkpatrick, a Marietta Republican, is a retired hand surgeon who decided to run for the state legislature to bring a medical perspective to the General Assembly.

Why she decided to run: When a seat in her district became open around the time she retired from active practice, Kirkpatrick said fellow doctors asked her to run to represent health care interests at the Capitol. “‘How hard could it be?’” she recalled thinking, but quickly learned, “It’s a lot harder than being a hand surgeon.”

What she brings to the table: “We bring knowledge of what actually works and doesn’t work, and that allows me and my colleagues in the health care business and the legislature to really bring some expertise that otherwise is lacking,” Kirkpatrick said, adding that physicians bring a strong work ethic, good communication skills, and attention to detail to their work as legislators.

Life outside politics: Kirkpatrick is a volunteer in the Georgia State Defense Force’s medical unit, which supports the state’s National Guard. It requires a weekend of training and drills every month, and Kirkpatrick has kept her medical license active for this purpose.

Biggest health accomplishment in the legislature: Kirkpatrick cites her work on prior authorization reforms in Georgia as a major accomplishment, pointing to a bill passed in 2021 that implemented prior authorization transparency requirements for health insurers as one example.

This year, a bill that limits how insurers can use artificial intelligence to decide on prior authorizations is close to final passage, having sailed through the Senate and the House with unanimous approval.

“People know that I’m going to tell the truth and that I know what I’m talking about. And so my bills usually tend to pass, and not all of them immediately, but most of them do,” Kirkpatrick said.

Rep. Michelle Au: Anesthesiologist turned advocate

Au, who represents Johns Creek, is an anesthesiologist who was first elected as a state senator in 2020. Redistricting spurred the Democrat to run in 2022 for the state House, where she has served since.

Why she decided to run: Au said her decision to run as an anesthesiologist and a mother of three wasn’t “natural or obvious” but was driven by her dissatisfaction with state and national policy decisions, including Georgia’s 2019 law banning most abortions.

“One thing led to another in terms of my health advocacy, and I recognized that maybe instead of trying to find someone else to run for that seat, that I should run for the open Senate seat in my district,” she said. “We did not have enough doctors at the state level to inform some of the legislation that they were passing out, sometimes in an ill-advised way.”

Rep. Michelle Au, a Democrat from Johns Creek, is an anesthesiologist.

What she brings to the table: Au said Americans generally distrust politicians but she thinks there is still trust in medical professionals.

“I get a little bit more leeway, and people are more inclined to look at some of the things I do, maybe first through the lens of ‘she’s a physician, she may have expertise in this,’” instead of solely as a Democrat, she said.

Au tries to approach talking about politics the same way she approaches talking to patients.

“I try not to push my own opinions or agendas as much,” instead focusing on achieving the best outcome for the majority of her voters. She also finds value in bringing underrepresented perspectives to the legislature, as a doctor and a Chinese-American.

Bipartisanship is important to her: “I did not come up through the traditional party apparatus,” Au told Healthbeat, and she recognizes that getting bills passed as a member of the minority party is tough.

But passing bills isn’t the only way she measures success. Instead, she focuses on how she helps shape bills as they move through the process and serves as a respected resource for colleagues. She also tries to move the needle on key issues, focusing on pragmatic steps forward.

Legislative pragmatism: Au cited gun safety and tobacco tax legislation as two long-term priorities. And while her bills haven’t yet gotten full legislative approval, she’s seen incremental progress.

She said even some Democrats as well as most Republicans were unwilling to sign on to a bill requiring universal background checks to purchase a gun when she started six years ago.

Now, a measure she originally proposed that would provide a tax credit for safe gun storage measures and later taken up by Republican lawmakers is close to final passage – albeit with the addition of language for a four-day sales tax holiday for purchasing guns and other paraphernalia.

Au would be happy to see her initial idea for the tax credit passed into law despite the changes – an example of her legislative pragmatism.

“It shows how the culture has changed,” Au said. “That was a bill the Republican leadership supported … I don’t think that that could have happened when I first joined the legislature,” she said. That bill could still pass this session.

What she worries about: Au said she’s worried about the erosion of trust in science, especially when it comes to vaccines.

“Public health can sometimes be a victim of its own success,” Au said. “People having not had to encounter what it’s like to have a non-functioning or poorly functioning public health system might feel that a lot of the measures that we take … are unnecessary.” That weakening of public health systems could take a long time to repair and cause needless suffering.

“Obviously you can’t take back mortality, you can’t take back injury, but even more so than that, like when you damage trust, that is extremely hard to undo,” she said.

Sen. Chuck Hufstetler: Foodie, anesthetist

Hufstetler, a Rome Republican, has served in the state Senate since 2012. He has held many other roles, including running a restaurant, working for corporations like Anheuser-Busch and Welch Foods, becoming a master baker, and then an anesthetist after training at Emory University.

Operating room to Gold Dome: Hufstetler said anesthetists are similar to physician assistants but work primarily in operating rooms under the supervision of anesthesiologists. His entrance to Emory’s School of Medicine coincided with the end of his time on the Floyd County commission. “I thought I was done with politics,” he said. But in 2012, when one of the candidates he was supporting for state Senate decided to drop out, Hufstetler stepped in to run – and won.

Sen. Chuck Hufstetler, a Republican from Rome, is also an anesthetist.

Hufstetler says his varied life experiences have contributed to his success as a lawmaker.

“There’s some people that don’t know health care, and there’s some people in health care that don’t know anything else,” he said. “I can maybe look at the big scheme a little bit better than if I didn’t have all those different experiences.”

How his personal experience drives his legislative agenda: Hufstetler said his lengthy experience trying to get credentialed to work at a hospital with a staffing shortage spurred him to sponsor Senate Bill 162. That bill would speed up the credentialing process for medical professionals by creating a uniform system, Hufstetler said.

“If you’re credentialed in one location, you will be credentialed everywhere,” he said. “This will help to bring more people into Georgia” by making it quicker for medical professionals to start working. That bill passed unanimously in both chambers and is awaiting Gov. Brian Kemp’s signature.

His greatest legislative accomplishment: Hufstetler said he’s especially proud of his work on surprise medical billing because it protects ordinary people from high medical costs.

“Medical bills are the number one reason for bankruptcy in Georgia. … Somebody’s in an accident or something happens. They’re not in their hometown, maybe, and through no fault of their own, and suddenly they’ve got massive medical bills that are out of network,” Hufstetler said. His bill aimed to stop that.

Preventive care a priority: Hufstetler said the state should prioritize policies that reduce long-term costs: “I worry that we’re not doing the stuff upstream to take care of people downstream.”

To that end, he’s eager to see his bill allowing pharmacists to prescribe HIV prevention medications get final approval. Preventing HIV would save the state millions of dollars, he said. That bill sailed through the House and Senate and awaits final approval from the Senate.

Like Au, he’d like to see the state increase the cigarette tax to try to decrease smoking, which drives up health care costs.

Mixed feelings on Medicaid expansion: Hufstetler said if he had been a federal politician when the Affordable Care Act passed in 2014, he would have voted against it. He thinks Medicaid is generally inefficient and people fare better on private insurance.

“But as a state, I felt like there were billions of dollars that could have helped our state by providing preventative medical care to individuals, and since they’re not getting that preventative care, I think we’re paying for it in a different way,” Hufstetler said.

Other medical professionals in the Georgia legislature include:

Rep. Sharon Cooper, R-Marietta: Nurse
Rep. Viola Davis, D-Stone Mountain: Nurse
Rep. Lee Hawkins, R-Gainesville: Dentist
Sen. Jaha Howard, D-Smyrna: Dentist
Rep. Anissa Jones, D-Macon: Chiropractor
Rep. Karen Mathiak, R-Griffin: Chiropractor
Rep. Lauren McDonald, R-Cumming: Emergency medical technician
Rep. Mark Newton, R-Augusta: Doctor
Rep. Angie O’Steen, R-Ambrose: Nurse
Rep. Butch Parrish, R-Swainsboro: Pharmacist
Rep. Devan Seabaugh, R-Marietta: Paramedic
Sen. Ben Watson, R-Savannah: Doctor

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

NYC health department submits budget plan while bracing for potential federal funding cuts

2026-03-20T19:24:50+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The New York City Department of Health and Mental Hygiene is bracing for a potentially significant loss in federal funding as the agency submits its preliminary 2027 budget.

Almost a quarter of the health department’s $2.51 billion budget comes from the federal government, making it vulnerable to cuts from the Trump administration. The department’s federal funding mostly supports disease control and emergency preparedness.

With a projected shortfall of $5.4 billion over the next two years, the full municipal budget proposal is to take effect July 1 after negotiations and revisions with the City Council.

In testimony before the City Council’s Health Committee, Health Commissioner Dr. Alister Martin said Thursday the department was preparing for potential cuts, noting that the Trump administration had tried to slash more than $11 billion nationwide in public health funding last year, with some $100 million earmarked for the city’s health department. After a coalition of attorneys general led by New York AG Letitia James sued, a federal judge issued a temporary halt on the efforts to block the funding.

“We must brace for possible future cuts,” Martin told the committee. “We are enduring coordinated and large-scale attacks on public health, and we do not foresee them letting up soon.”

When City Council Health Committee Chair Lynn Schulman asked Martin about the health department’s “contingency plan,” Martin said conversations were underway.

“We are closely monitoring the situation,” Martin said. “We are currently in active discussions with [the Office of Management and Budget], with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities. We will assess and make decisions around what will protect New Yorkers’ health and safety.”

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

It was the first budget hearing for Martin since he began the job Feb. 23, with him and chief financial officer and deputy commissioner Aaron Anderson facing questions about the preliminary financial plan for fiscal years 2026-2030. About $1 billion of that proposed fiscal 2027 budget of $2.51 billion comes from a city tax levy. The remaining support comes from a mix of federal, state, and other funding.

The health department’s projected fiscal 2027 budget represents 1.9% of the city’s proposed $128.9 billion fiscal 2027 budget. The department’s budget consists of public health, mental health, and the office of the chief medical examiner.

The proposal includes funding for child care site inspections that will be required as part of Mayor Zohran Mamdani’s campaign pledge to provide universal child care across the city. Funding is also earmarked for outreach and education for early intervention services for children with learning disabilities and a new public health laboratory.

Budget highlights include support for children

Here are four key areas presented in the preliminary budget documents.

Early intervention. The program helps children under age 3 who have learning disabilities and may require extra support. The preliminary plan includes an additional $78.5 million of city funding in fiscal 2026 for the program, growing to $93 million in fiscal 2027, $108.7 million in fiscal 2028, $125.6 million in fiscal 2029, and $143.9 million in fiscal 2030 for existing early Intervention services.

2-K inspections and early intervention connection. The preliminary plan includes an additional $1.6 million of city funding in fiscal 2027, $2.3 million in fiscal 2028, and $2.9 million in fiscal 2029 and 2030 to enhance the 2-K centers’ ability to screen for disabilities in children. The plan also includes 10 positions to support mandated inspections and 6 for early intervention services.

Child care regulation and monitoring. The preliminary plan includes an additional $5.4 million of city funding starting in fiscal 2026 to expand 3-K child care facility regulation and monitoring with 59 inspectors and 3 staff for after-school services.

New public health laboratory. The preliminary plan includes an additional $7.7 million of city and state funding in fiscal 2026, $16.8 million in fiscal 2027, $15.8 million in fiscal 2028, $16.3 million in fiscal 2029, and $16.8 million in fiscal 2030 for operating costs for a new, state-of-the-art public health laboratory in Harlem that will focus on environmental health issues, as well as funding five positions, including the facility director and IT technicians and managers. The lab is due to be completed this year.

The city is expected to see the restoration of $60 million in core public health services as part of a state funding package from an original $90 million that was cut in 2019 under former Gov. Andrew Cuomo. Schulman, a vocal advocate for the restoration of what’s referred to as Article 6 of the Public Health Law, asked what programs and services might be restored with the new funding.

Schulman suggested that the city do “something publicly” to show Gov. Kathy Hochul how the Article 6 funding was used.

Citing the upheaval at the Centers for Disease Control and Prevention, Schulman asked about the status of federally funded positions at the health department. Anderson said there are 14 such positions and that none of them had been eliminated or furloughed.

The proposed fiscal 2027 budget for disease prevention and treatment is $36.7 million less than the amount allocated in fiscal year 2026, according to documents submitted to the City Council. This includes $26.2 million less for fighting communicable diseases, $1.7 million less for sexually transmitted infection programs, and $1.1 million less for a tuberculosis control program.

The funding difference, the documents noted, are concerning given the recent rise in communicable disease cases like tuberculosis and HIV. The reduced funding could limit the department’s ability to conduct disease surveillance, testing and case management.

Mamdani appoints deputy mayor for community safety

The Thursday hearing coincided with Mamdani announcing at City Hall that he had appointed longtime advocate Renita Francois to serve as the city’s first deputy mayor for community safety. Mamdani said he had signed an executive order to set up an office overseeing that portfolio.

Most recently, Francois served as chief strategy officer and chief program officer at Beyond Impact, a nonprofit that supports social justice issues. She also had a leadership role in a neighborhood safety program under former Mayor Bill de Blasio.

The new community safety office was a central part of Mamdani’s campaign last year. Modeled after similar programs around the United States, the office of community safety aims to accommodate people who are experiencing mental health episodes by sending medical professionals in addition to law enforcement.

With cheers from the rotunda audible from the chambers, Council Member Tiffany Cabán asked if the health department was “involved in the planning for the office.”

Cabán also asked:

“As of now, have you identified any mental hygiene programs that are going to be transferred into that office?”

“We’re still in conversations with City Hall and OMB about what the future will look like, and I’m eager to talk to and build a relationship with the new deputy mayor,” Martin said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Over-the-counter ivermectin availability added to Georgia public health bill

2026-03-20T15:26:09+00:00

This story was originally published at Georgia Recorder. Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Georgians who want to buy a controversial anti-parasitic drug may soon be able to pick it up from their local pharmacist without a prescription.

A state House committee Thursday amended a bill to allow pharmacists to distribute ivermectin over the counter to Georgians 18 and older.

The ivermectin language was added to a bill aimed at updating provisions around the Department of Public Health that had already passed the Senate during the final madcap days of Georgia’s legislative session, set to end April 2. Because the bill was amended, it will need to pass the Senate again, as well as the House, if it is to become law.

The bill passed the House Public and Community Health Committee mostly along party lines despite warnings from medical experts like Johns Creek Democratic Rep. Michelle Au, who is also a physician, that it could endanger Georgians’ health.

“It is galling at this point in session, when time is running out, to have to hear this bill now for the fourth time in the public health committee – a bill that was fine and passed out twice and was yanked back in order to insert this language about ivermectin availability, to waste that amount of time when there are hundreds of real public health bills that would have immediate effect on patients in Georgia,” she said.

Georgia lawmakers advance bills aimed at easing nurse and doctor shortages

Doctors prescribe ivermectin for parasitic infections ranging from the extremely serious, like river blindness, to the more mundane, like head lice. It’s also commonly used in large doses to protect livestock from parasites.

False rumors started on the internet claim that the drug can be used to treat ailments including Covid-19 and cancer, leading some to purchase the drug from agriculture and livestock supply stores for personal rather than animal use. Studies have not found the drug to be effective for those uses.

State Rep. Karen Mathiak, a Griffin Republican who sponsored the original proposal, said her goal is to make sure people who choose to take the drug do so as safely as possible.

“Right now, what people are doing in the state of Georgia is using equine ivermectin out of places like Tractor Supply or your feed store,” she said. “It’s been told to me that farmers have been taking it for years when they’re around cattle and horses, because they tend to have parasites. So that’s the bill, and the thing that I do like about it being behind the counter is then the pharmacist has the availability to speak with their customer about dosage and contraindications.”

Au said drugs available without a prescription typically treat ailments that are easy to self-diagnose, like a headache or stuffy nose, and have a low risk of serious side effects, neither of which are the case for ivermectin.

“You do need specific types of clinical tests to determine, do you have intestinal worms, for example. Some of those diagnostics are not available to a patient at home, and it is also not available to a pharmacist. For example, a pharmacist, as we discussed last time, will not be doing a fecal smear and looking at that under the microscope to look for [parasites].”

According to the Georgia Poison Center, a mild ivermectin overdose can lead to symptoms including rash, headache, dizziness, sleepiness, nausea, vomiting, abdominal pain, diarrhea and mild increased heart rate, while more severe toxicity can cause seizures, coma, acidic blood, respiratory failure, and low blood pressure.

Overdoses may be more likely when using products designed for large farm animals.

Other health care professionals on the committee objected to the bill, including Tucker Democratic state Rep. Imani Barnes, who holds a doctorate in public health.

In addition to potential health risks, opponents said the bill could make pharmacists liable to legal challenges or cause them to choose not to carry ivermectin at all, which could be bad news for people with parasitic infections and prescriptions from a doctor.

Committee Chair Sharon Cooper, a Marietta Republican and registered nurse, expressed reservations of her own.

“I have concerns as a registered nurse, but unfortunately, I think we’re becoming a nation of people who want to be their own doctors,” she said. “I think this may be one step in at least trying to get this into an arena where at least somebody with medical training, i.e., the pharmacist, would be able to talk to them.”

“It may not be the best thing, but better than just going and buying it at the feed and seed,” Cooper added.

At least five other states — Tennessee, Arkansas, Idaho, Louisiana and Texas — have made ivermectin available over the counter.

Georgia lawmakers advance bills aimed at easing nurse and doctor shortages

2026-03-19T20:03:20+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

A bill that would create a new system for nurses and counselors facing addiction problems to get help – and possibly keep more of them working – gained final approval from the state legislature this week.

A separate measure that would create a pathway for internationally trained doctors to become licensed in Georgia is also close to the finish line after the House approved it this week. Georgia faces a growing shortage of doctors and nurses over the coming years.

If current trends continue, Georgia will fall short of its projected registered nurse need by 23,000, meaning 1 in 5 positions will be unfilled by 2036. The picture is even worse for doctors: The state will only have about two-thirds of the doctors it needs in a decade, according to the National Center for Health Workforce Analysis.

The bill on nurses would create an “alternative to discipline” program for those struggling with substance use. It gained final approval from the state Senate last week and now heads to Gov. Brian Kemp’s desk for his signature.

Under the current system, nurses who seek help for addiction must undergo a lengthy and public disciplinary process with the state licensing board. Some nurses say that hurdle deterred them from seeking help.

This bill creates an alternative pathway, where nurses can get help privately and without having their licenses suspended. It will be similar to the system used in Georgia for doctors, physician assistants, and pharmacists. It also allows the licensing board for professional counselors, social workers, and licensed marriage and family therapists to establish a parallel system for them.

The new system still includes an element of supervision and accountability to ensure professionals are getting help and working safely but is less public than the current disciplinary process. The goal is to keep more health care workers in the workforce and allow them to seek help earlier.

Nurses, counselors, and social workers will have to pay for the costs of treatment and monitoring. The respective licensing boards will have to set up the programs, likely by contracting with an outside company to provide the monitoring services.

The bill, sponsored by Republicans Rep. Ron Stephens, a Savannah pharmacist, and Sen. Chuck Hufstetler, a Rome anesthetist, sailed through the House and the Senate this year, with only one “no” vote in the Senate, from Republican Sen. Jason Anavitarte of Dallas.

Once the system is established, Georgia will join 44 other states that have similar programs, according to the National Council of State Nursing Boards.

Bill on internationally trained doctors nears finish line

Separately, a bill that would allow doctors who were trained abroad to practice in Georgia under limited licenses gained approval from the Senate this week. Its supporters hope the measure will increase the number of doctors practicing, especially in underserved areas.

“This is not an effort to make it easier,” said Rep. Mark Newton, an Augusta Republican who is an emergency room doctor. “It’s rather an attempt to recognize that there are similar areas of training and expertise around the world, and many of those are eligible to work in the United States, and we want to make sure there’s a way we can do that.”

The bill sailed through the Senate and the House with only a few “no” votes in each chamber.

Its backers have been pushing for the bill for several years. Last year it was sponsored by Sen. Kim Jackson, a Stone Mountain Democrat, but failed to cross the finish line by the time session ended. This year, powerful Republican Sen. Ben Watson, a Savannah doctor, took up sponsorship of the bill, and Newton sponsored it in the House. The bill now heads back to the Senate for a final vote following minor changes to the measure in the House.

Georgia nurses say fear of discipline keeps them from seeking addiction treatment

To qualify for the program, the doctors must have practiced for at least five years – and in some cases 10 – after training at a medical school listed in the World Directory of Medical Schools. They must also be legally residing in the United States with authorization to work and pass a major medical exam, typically all three parts of the U. S. Medical Licensing Examination or an equivalent, and an English proficiency exam.

If a doctor has met all those requirements and has an offer of employment under a supervising physician in a rural county, or at a hospital or medical school, he or she could obtain a limited provisional license.

The doctor must then practice for four years under a supervising physician in a rural practice, a federally qualified health center for un- and under-insured people, or a medical school or hospital before he or she can apply for a full license. After obtaining the full license, the doctor must continue to practice for two more years in an underserved area.

“Over in the Augusta area, where we’re training the future doctors in Georgia at the state’s medical college, a large part of our medical community … is immigrants from all over the world, and they have been a priceless addition to providing specialty medical care and across all the specialties,” Newton said.

Advocates say the program could help increase the supply of doctors in general and especially those who can connect with the state’s increasingly diverse population.

Other health bills on the move

A bill to extend a cellphone ban in Georgia schools to the high school grades gained the approval of a Senate committee this week. If enacted, it would take effect in 2027-28. It has been approved in the House and now needs a Senate floor vote.
A bill that would allow county health workers to retain the same level of accrued leave if they begin working for the state gained Senate approval on Wednesday. It now heads to the Senate floor for a vote.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

2026-03-19T14:45:00+00:00

There’s a lot going on this week in New York health news, including a city campaign trying to encourage conversations about vaccines, a win for vaccine access at the federal level, and a new program for PFAS testing in private wells. Let’s jump in.

NYC launched a new vaccine campaign. Here’s what it gets right, and where it misses.

The NYC Health Department has launched a new $1 million, four-week vaccine campaign: “Ask Questions, Get Answers, Vaccinate.”

When a friend first shared it with me, I was genuinely stoked. A campaign trying to create a feedback loop between institutions and local communities?! Yes, please! That’s exactly what we need right now —more health departments meeting people where they are, addressing real confusion, and empowering New Yorkers to make evidence-based decisions. Something that closes the distance between officials and the communities they serve.

But after looking into it further, and seeing the price tag, I was honestly pretty bummed.

The campaign will run across TV, radio, print, LinkNYC kiosks, and on transportation hubs, with a focus on neighborhoods with lower vaccination rates. Medical practitioners participating in the Vaccines for Children program will also receive posters and handouts to share with families. The city also launched a webpage that answers common vaccine questions and links to additional resources (which are pretty good FAQs).

The intent was there. And, it’s really important to acknowledge that people have questions about vaccines. That is a good thing.

How to win the war of narratives in global public health

But if you dig deeper, the campaign falls short in a couple of important areas:

The cost. A four-week ad campaign is not the same as long-term trust-building, and it’s expensive ($1M!), especially for its length, at a time when public health departments are scraping for pennies.
Telling people to “talk to your doctor” assumes they have a doctor they trust and can access. One in three Americans don’t have a primary care physician. It also assumes that clinicians themselves feel equipped and empowered to respond to these questions in a short 12-minute visit. What we’re hearing at YLE is that many clinicians need more support in this area.
This also doesn’t move us toward the affordability that the new health commissioner is prioritizing. Telling someone to see a doctor is, for many people, telling them to take time off work, find child care, and potentially take on debt.
There doesn’t appear to be much of a feedback loop. Good communication is not just sharing information; it also means listening and asking for feedback.
It misses some of the places where many families are actually getting health information now, especially social media.

If I had $1 million to spend, it wouldn’t be on a short-term advertising campaign. What is needed is something far more structural: direct public access to the health department and supporting trusted community messengers with the tools, staff, knowledge, and partnerships to reach families where they’re at, sustainably. I would also like to see greater investment in open communication channels for families to share their questions, concerns, and experiences back to the health department, instead of information flowing only top-down.

This could look like:

Hosting listening session in neighborhoods with lower vaccination rates.
Partnerships with community-based organizations, schools, and faith leaders.
Regular surveys and summaries of questions and concerns from New Yorkers.
Clinician training and tools for talking about hot-button topics.
Online and social media monitoring to know what is circulating in real time.

Being trustworthy happens over time, through a set of actions taken over and over and over again. Some of those actions include repeated conversations in communities, schools, clinics, and neighborhood spaces, through relationships.

What this means for you: If you have questions about vaccines, drop them in the comments here, and we will get back to you! And maybe we can send them to the health department as well.

New York is offering free PFAS testing and money to fix contaminated wells

If you own or rent a home with a private well in Westchester, Suffolk, Dutchess, Putnam, Orange, or Ulster County, this is for you.

New York state launched a new program on March 9 that offers free private well testing for PFAS, often called “forever chemicals.” If contamination is found above the state threshold, the state will also help pay to address it.

PFAS (per- and polyfluoroalkyl substances) are a group of manmade chemicals that persist in the environment and in the body. They’ve been used for decades in products like nonstick cookware, firefighting foam, and food packaging. They’re also linked to some health issues, including kidney and testicular cancer, thyroid disease, immune suppression, and pregnancy complications.

This matters especially for people with private wells because private well water does not get the same routine oversight as public drinking water systems. Private household wells are not regulated under the federal Safe Drinking Water Act, and government agencies usually do not monitor or treat private well water—that’s the responsibility of the owner. Sources of PFAS in well water can come from runoff from manufacturing, landfills, wastewater, contaminated soils, or fertilizers.

Here are the details for the new program:

Testing is free for eligible households in six counties.
If PFOA or PFOS (specific types of PFAS) levels are at or above 10 parts per trillion, New York’s drinking water standard, residents may qualify for financial help.
Eligible households can receive up to $5,000 for a PFAS treatment system, or up to $10,000 to connect to public water.
Renters are eligible too, not just homeowners.
Funding is first-come, first-served, with $1.5 million available per county.

Dutchess and Putnam County applications are open now. Orange, Suffolk, Ulster, and Westchester are expected to open in the coming months.

What this means for you: If you live in one of these counties and use a private well, this is a concrete opportunity to check for contamination and get financial help if a problem is found. Apply or learn more here.

A judge blocked RFK Jr.’s ACIP overhaul —what it means for New York

A judge blocked Health and Human Services Secretary Robert F. Kennedy Jr.’s overhaul of the Advisory Committee for Immunization Practices and the related changes to the childhood vaccine schedule. While this is a win for Americans, it likely doesn’t change much day to day for New Yorkers. That’s because New York had already moved to preserve prior vaccine recommendations, protect access, and require insurance coverage, creating a buffer against much of the federal disruption. (I’ve covered this previously.)

In practical terms, the ruling mostly restores nationally what New York had already protected locally.

The bigger issue here is continued confusion: Back-and-forth changes to vaccine guidance are hard for families, clinicians, and schools to follow, even when access is protected. For a deeper dive into the ruling and what it means nationally, read Katelyn Jetelina’s YLE National piece from Tuesday.

Bottom line

The bottom line this week is that the city’s new campaign to improve communications around vaccines has a lot of room for improvement, the state PFAS well-testing program is a clear example of environmental health in action, and the court decision on ACIP was a win for federal vaccine policy but doesn’t practically affect New Yorkers. You’re all caught up — see you next week!

Love,

Your NY Epi

How to win the war of narratives in global public health

2026-03-19T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week we start with an incisive essay on how global public health might win back the narrative war around vaccines, trust, and misinformation. After that, well… let me just say that I really do try to take the “global” in global health seriously. I know that the United States is not the center of the world.

But several of the most important stories I’m tracking follow the health consequences of Trump administration policies playing out across Africa, the Caribbean, and Iran. So, buckle up for a red, white, and blue edition.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Global public health can win the narrative war

Measles is having a comeback. Vaccine skepticism is rising. And during the global pandemic, millions quickly turned against even basic public health protections. It’s pretty clear that somewhere along the way, public health started losing the narrative war.

The question is, how does the field fight back?

That’s the focus of a fascinating essay by Steve Hamill in Health Policy Watch, one which I haven’t been able to stop thinking about since I read it. Hamill is a senior marketing and comms executive at Vital Strategies, which is a nonprofit focused on global disease prevention.

Part of the problem, Hamill argues, is that for decades public health officials worldwide assumed that rational arguments, data, and scientific evidence would be enough to persuade the public. (And hey, for a time, it was!) But the era of institutional trust “dominated by elite opinion makers driving consensus” is over, he writes. And now, as we face a media landscape “driven by algorithms, influencers, and coordinated narrative warfare,” public health must take a new approach. And that includes borrowing several, highly effective tactics from public health’s worst detractors.

I reached out to Hamill about his essay, and we discussed what the field needs to do differently to win back trust and attention.

In our conversation, Hamill pointed to two realities about the modern media environment that ring especially true to me. One is that “we’re in an era of AI slop, where authenticity and trust in who the messenger is now matters even more than the message.” The other is that many persuadable people increasingly form their views about public health by “following culture, not evidence.”

Accepting those realities means recognizing that the battleground for public health is much less likely to be found in press conferences or government PSAs … and more likely to be found on TikTok, YouTube, or the broader “content creator sector.” And that, Hamill argues, is exactly where public health agencies need to start showing up.

Thankfully, Hamill says that engaging in this ecosystem is actually easier than ever. As advertisers have poured money into influencer marketing this decade, “the content creator sector has become much more formalized,” he says. Today, there are several platforms (like CreatorIQ, for example) that can connect public health agencies directly with a stable of appropriate influencers, at scale.

Now, you might ask: Will YouTubers deliver perfectly calibrated public health messages, the way officials might hope? Of course not. But Hamill argues that perfection isn’t the point. More important is that “we have to trust imperfect messengers who have social capital in the communities that we’re seeking to reach,” he says.

That gets to another of Hamill’s points: Public health organizations worldwide must begin staffing the experts and allocating the budgets needed to compete in this new media environment.

Specifically, that means staffing public health institutions worldwide with staff excelling in “public relations, community engagement, advertising and paid media, digital media production,” among other technical expertise, he says. For a field where “communications is rarely seen as a strategic competency,” that would be an enormous shift.

Hamill’s last point is that, offline, public health must stop broadcasting messages from the top down and start working through trusted voices inside communities. A major effort should be focused on “finding people in the communities that believe in the information that we are trying to propagate and working with them to give them the resources to bring that to scale within their community,” he says.

In many ways, this mirrors a key tactic of the MAHA movement: identifying communities that already share a concern and amplifying those voices until they dominate the conversation. The difference is that Hamill argues public health should use that same approach in service of accurate information and public good.

And crucially, he argues, these voices are in the majority. “There are more moms who are scared that their kids are going to go to school with unvaccinated people than there are moms who are scared that the vaccine is going to give their kid autism,” he says.

A battle over Cuban doctors

The Trump administration has been ratcheting up a pressure campaign on one of Cuba’s most valuable exports: doctors.

Guyana and Jamaica just announced that they will pull the Cuban doctors from their countries this year, the Miami Herald reports.

What’s the context here?

For decades, the Cuban government has sent hundreds of thousands of medical workers abroad through state-run medical missions. These programs have operated across the world but are particularly critical in parts of the neighboring Caribbean, where you can find Cuban clinicians staffing everything from hospitals to rural health clinics. Today, the program has more than 24,000 doctors working in 56 countries worldwide.

Why is the United States concerned about these doctors? Money.

Governments hosting Cuban medical missions typically pay Havana directly, with the Cuban state then passing along only a portion of the salary to the doctors. While the Trump administration is framing the issue partly about “labor exploitation” of the doctors, most observers see the campaign as an attempt to squeeze one of the (financially beleaguered) Cuban government’s most reliable sources of foreign currency.

Last year, the Trump administration began leaning hard on the foreign governments hosting Cuban doctors, threatening to cancel visas for anyone working with or supporting the Cuban programs, alongside other consequences. And the threats are working beyond just Jamaica and Guyana. Honduras also cancelled its program this year, and Guatemala has begun winding down its mission.

But the health care reality is brutal. As Al Jazeera reported last year:

“For many Caribbean nations, the short-term consequences could be devastating. Training local doctors takes years, and trained professionals often migrate to other countries, leaving behind a persistent shortage.”

That reality prompted unusually blunt pushback from Caribbean leaders. The prime minister of Barbados has called the U.S. pressure “unfair and unjustified,” and the prime minister of Saint Vincent and the Grenadines noted, “I will prefer to lose my visa than to have 60 poor and working people die.”

My takeaway?

The reporting suggests that this is a cold, geopolitical pressure campaign applied with little regard for the health care void it will create. (For example, the threats are not being paired with resources to replace those doctors.)

Two things can be true at once: Cuba’s medical missions may enrich a terrible government in Havana, while the Cuban doctors themselves provide lifesaving care to communities that will be worse off without them.

Black rain in Iran

New Scientist is reporting that recent strikes that set oil facilities ablaze near Iran’s capital, Tehran, have produced an unsettling phenomenon: black rain.

These “catastrophic scenes have raised concerns about threats to civilian health in Iran,” with “local people complain[ing] of their throats aching and their eyes burning.”

What exactly is black rain? It’s a byproduct of rain falling through heavily polluted air. Or, as Stanford University atmospheric scientist Mark Jacobson told me, it’s rain drops “filled with health-damaging, toxic air pollutants.” He says the drops themselves appear black because the concentration of “soot particles is so high in Tehran’s rain that no light penetrates” them, which is a sign of just how polluted the air above the city has become. (Keep in mind, this is a city with a population roughly equal to New York City’s.)

Ultimately, the toxic rain itself isn’t actually the biggest health worry for the city’s residents. As the article notes, “the biggest threat may be the smoke rather than the black rain.”

One researcher quoted in the article put it plainly: “If you get raindrops on your skin, yes, there will be some potentially carcinogenic compounds on your skin, but you can wash that off … but very fine smoke particles in the air can penetrate deep into the lungs and potentially get into the bloodstream.”

A flawed flu forecast

Two weeks ago, we talked about the strange annual ritual behind the flu shot. Which is how each year the World Health Organization tries to predict which flu strains will dominate in the upcoming winter, so that vaccine makers can aim for that educated guess.

Well, the Associated Press is reporting new data that shows that last year’s guess was … a bit of a flop.

U.S. health officials say the 2025 to 2026 flu vaccine was only about “25% to 30% effective” in preventing adults from getting sick enough that they needed to go see a doctor. All told, it was “one of its worst effectiveness rates in more than a decade.” For reference, “officials generally are pleased if a flu vaccine is 40% to 60% effective.”

What went wrong?

Oddly, this is actually a bit of good news. The culprit is exactly what we discussed two weeks ago: a fast-spreading branch of “the H3N2 flu strain,” which experts have already updated in next season’s vaccine. So, the problem has already been patched.

One final takeaway: It’s worth noting that even a mediocre flu shot still matters. In the United States, at least 101 children have died so far this flu season. Of the deaths where vaccination status was reported, about 85% weren’t vaccinated. That’s not a coincidence. As Vanderbilt University vaccine expert William Schaffner told the AP, that flu shot may not stop every infection, “but it can prevent people from becoming severely ill and dying.”

Health aid as a cudgel

Sorry folks, not ending on a happy note this week.

Two weeks ago, we covered the state of the Trump administration’ s new “America First” global health deals in Africa. I had spoken with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health, who, as I wrote back then, “warned about turning health aid into what is openly described by Washington as a transactional exchange.”

Well, this week the New York Times published a staggering example of what that approach could look like in practice, in Zambia.

According to a draft State Department memo obtained by the paper, U.S. officials are considering withholding HIV assistance to Zambia unless the country expands access for American companies to its mineral sector. (For reference: Zambia is one of the countries most affected by HIV in Africa, with about 1.3 million people relying on daily treatment supported by the United States’ PEPFAR program.)

Here are two quotes from the memo (prepared for Secretary of State Marco Rubio) that really illuminate just how the officials view lifesaving HIV medicines as a raw, political cudgel.

“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale” … “sharp public cuts to American foreign assistance would significantly demonstrate to aid-receiving countries the seriousness of our interest in collaboration and our insistence on tangible benefits under our America First foreign policy.”

My takeaway? When we spoke with Spiegel, we talked about why transactional aid deals make for fragile and ineffective public health policy. That’s still true. But beyond the practical consequences for individual programs, he also made a broader point about what we lose when we treat lifesaving programs as bargaining chips: the trust and goodwill that once made global health “one of America’s most powerful forms of soft power,” he said.

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Spring break 2026: Travel season risks spread of measles across U.S., state officials tell Healthbeat

2026-03-19T09:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The spring break travel season is underway, with tens of thousands of people every day clogging U.S. airports in their quest for sun, surf, theme parks, big city excitement, and other getaways.

It’s a scene that worries public health officials amid another bad year for measles across the country – and the potential for increased spread of the highly contagious disease during this busy travel period.

“It feels like whack-a-mole right now,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership. “Just as the numbers are dying down in South Carolina, you see this big jump in cases in Utah. Then you see cases starting to pop up in other places across the South.”

State health department officials in multiple states – including California, Utah, Colorado, Georgia, and South Carolina – told Healthbeat they are concerned about spring break travel and the potential for measles to spread within and between states.

Driving those concerns: Spring break is happening with the United States on a trajectory to exceed last year’s record-breaking number of measles infections – the worst since 1992.

This year the Centers for Disease Control and Prevention has already logged 1,362 confirmed cases of measles across the country through mid-March, mostly among unvaccinated children and teens. In less than three months, that’s more than half of the 2,284 measles cases confirmed during all of last year.

Since January, there have been at least 14 new measles outbreaks identified across the country, including in Florida, California, Washington state, Texas, and Colorado. These are in addition to ongoing outbreaks that began last year in South Carolina, Utah, and Arizona. Across the country, 30 states have reported at least one measles case this year, CDC data show.

Measles, which is one of the most contagious viruses for humans, is transmitted through the air when an infected person breathes or coughs. The virus can linger in a room for up to two hours.

The disease is preventable with vaccination. Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Most of those being infected with measles aren’t immunized. Nationwide, about 92% were unvaccinated or had an unknown vaccination status, according to CDC data.

“As vaccination rates have just broadly declined across all these communities, it’s just incredibly hard to stop. And that’s just going to get worse,” Thorpe said. “Short of something crazy happening, we’re absolutely going to blow through what our numbers were for last year.”

The contribution of spring break exposures to these national measles case counts won’t be known for several weeks.

After a susceptible person is exposed to the virus, it can take one to three weeks for them to start falling ill with initial symptoms that may seem like a cold or the flu. By the time the hallmark measles rash appears, they will have been infectious for four days – potentially spreading the virus to even more people.

“Everybody’s on high alert,” said Pat Endsley, president-elect of the National Association of School Nurses.

Top spring break destination Florida is No. 3 for measles

Dr. Rana Alissa, president of the Florida chapter of the American Academy of Pediatrics, told Healthbeat she’s very concerned about the potential for spring break travel to spread measles infections – especially in her home state, which already has measles cases in several communities, plus a large outbreak linked to a university.

Florida – with 116 confirmed measles cases since January – ranks No. 3 in the nation for 2026, behind South Carolina and Utah, which continue to battle outbreaks that began last year, according to the latest CDC data.

“Everyone wants to come to Florida,” Alissa said. “It’s always crowded. Orlando is going to be crazy, Daytona Beach, Clearwater, Miami.”

With these crowds comes an increased risk that some of the people are carrying measles. “It is very scary,” said Alissa, who is advising unvaccinated infants and children, as well as people with weakened immune systems, to avoid crowded areas because of the risk of measles.

Besides a fever and rash, measles can cause serious and sometimes life-threatening complications, including pneumonia and dangerous swelling of the brain, as well as “immune amnesia,” which increases a person’s susceptibility to other diseases in the future. Pregnant women and their babies are also at increased risk of complications from measles.

In addition to being a top state for measles this year, Florida is a perennial spring break hot spot. Cities throughout the state continue to be among the nation’s top spring break destinations, according to 2026 booking data from AAA and Booking.com.

At Tampa International Airport, the spring break travel surge is underway, with about 75,000 to 80,000 passengers a day expected through April 13. The biggest travel day, the airport predicts, will be this coming Sunday, when 90,000 travelers are expected to pass through the airport.

In Orlando, airport officials expect this week to bring some of their highest passenger volumes of the spring break period, with nearly 212,000 passengers arriving and departing last Sunday, plus another 205,000 passengers on Monday.

Florida health department won’t discuss large measles outbreak

Officials with the Florida Department of Health did not answer questions from Healthbeat since March 6 about the risks posed by spring break travel to and from the state, and what kinds of measles prevention and control activities the department is performing.

The department’s top official, Florida Surgeon General Joseph Ladapo, last fall announced plans to end all school-age vaccine requirements in the state, a move that has faced resistance in the legislature. In 2024, during a measles outbreak at a South Florida elementary school, Ladapo sent a letter to parents allowing them to keep sending their unvaccinated children to class, despite their risk of infection.

Most of Florida’s measles cases this year are part of a large outbreak linked to Ave Maria University in southwest Florida’s Collier County, about 35 miles northeast of Naples. At least 98 confirmed and suspected measles cases have been diagnosed in the county through March 7, according to state health department data. Five of those cases were reported during the first week of March, the data indicate.

Despite repeated requests, officials at the Catholic university did not respond to Healthbeat’s questions, including about the current status of the outbreak and any actions being taken to address the potential health impact of the school’s Easter break, scheduled for April 2-6.

Florida’s health department also wouldn’t discuss the university’s outbreak or answer Healthbeat’s questions about other locations in the state where ongoing spread of measles may be occurring, and how many people statewide are in quarantine because of measles exposures. While such information – which doesn’t involve identifying specific patients – is routinely made public in other states, the Florida health department’s media relations team said it was unable to discuss ongoing epidemiological investigations because of state confidentiality statutes.

The department’s data show at least 12 other Florida counties have reported confirmed or probable measles cases since January. They include the Tampa-St. Petersburg area, where six cases have been diagnosed in Pinellas County, and two more in Hillsborough County. In the Jacksonville area, Duval County has reported six cases; in the Pensacola area, Escambia County has identified five cases; and in South Florida, two cases have been diagnosed in Broward County and one in Miami-Dade County .

Concerns about measles extend beyond spring break hot spots

In response to interview requests and questions about rising U.S. measles cases and spring break travel sent earlier this month to the CDC, a spokesperson for the U.S. Department of Health and Human Services emphasized the risk of measles being imported from other countries.

“The risk of measles remains low for most of the United States due to high population-level immunity from MMR vaccination,” press secretary Emily Hilliard said in an email Tuesday night to Healthbeat. “That said, anyone who is not protected against measles is at risk if exposed. Since measles is common in many countries, unvaccinated travelers can bring measles to the United States at any time, and it can spread to other people who are not protected against measles.”

Hilliard said the CDC is supplying technical support and funding to states dealing with outbreaks and that vaccination is the best protection, “especially if you plan to travel internationally or to a place with a measles outbreak.”

While international travel can play a role in U.S. measles cases, according to CDC data, only nine of the 1,362 confirmed U.S. measles cases since January involved international visitors; last year just 25 of the 2,284 confirmed cases were international visitors. In both years, most of the measles cases across the country have involved outbreaks where the virus has spread from person to person within U.S. communities with low vaccination rates, such as those that have occurred in South Carolina, Texas, Arizona, New Mexico and other states.

As a growing number of states are already dealing with measles cases this year, officials at several state health departments expressed concerns about the risks posed by spring break travel.

This year California has had three outbreaks of measles – the first outbreaks in the state since 2020. Some of these California cases are linked to an unvaccinated toddler who had recently traveled to a measles outbreak area in South Carolina.

As of Monday, California has had 29 confirmed cases of measles; two have been hospitalized, according to the California Department of Public Health.

“International or domestic travel during spring break carries a risk of transmitting measles to Californians,” the department said in an email. “CDPH continues to closely monitor measles and to work with medical and public health partners to limit its spread during and after the spring break travel season.”

Georgia Department of Public Health spokesperson Nancy Nydam Shirek said that while people who are not immunized against measles are at high risk any time they are exposed to the virus, “that risk increases if they visit crowded tourist destinations, travel through airports, or go to areas with ongoing measles outbreaks.”

Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Two cases of measles have been reported this year in Georgia. One involved a baby too young to be routinely vaccinated who became infected during international travel. State health officials said they don’t know how the other case, a resident of Bryan County near Savannah, became infected and they cannot rule out unrecognized spread of the virus within the state, Healthbeat reported earlier this month.

In Utah, the spring break travel surge comes at a precarious time in the state’s measles outbreak, which began last year and has resulted in 443 reported infections as of Tuesday.

“What is concerning to me is we are seeing spread of this disease through our entire state,” Dr. Leisha Nolen, Utah’s state epidemiologist, said at a media briefing earlier this month. “For a while it was really limited to the southern part of the state, but it is now expanding, and we are having people diagnosed in every part of our state. And these are not just mild infections.”

Measles infections in Utah have resulted in more than 120 people going to emergency rooms, 31 needing to be admitted overnight, and three needing treatment in an intensive care unit, she said.

While the disease has spread in a variety of settings, Utah officials said cases involving school activities are noteworthy.

“We have definitely seen people get infected with measles from wrestling events, from dance-drill teams and from basketball. So we really encourage people to protect their children,” she said. “The measles vaccine is the best thing to protect your child. It is how we can stop this infection.”

In Colorado, where as of Monday 11 cases of measles have been identified along with multiple locations where infectious people potentially exposed others, state health officials said they are working to raise public awareness through media campaigns and provider webinars. The department also is doing direct outreach to families whose children are overdue for their MMR vaccines. In 2025 and 2026, this outreach resulted in 48% of the contacted families getting their children immunized, the department said.

South Carolina shows how holiday breaks can fuel outbreaks

“Measles is spread very easily to anyone who is susceptible,” said Dr. Linda Bell, state epidemiologist in South Carolina, where officials worry spring break travel could reignite an outbreak that has sickened nearly 1,000 people since last fall.

The outbreak has slowed to a trickle in recent weeks. After months of tracking cases, quarantining exposed people, and urging vaccination, the state health department announced Tuesday just one new measles case, bringing the total to four cases identified in the past week.

“The risk of spread is increased by the number of people exposed,” Bell said, “so things like air travel and people visiting tourist attractions during holiday breaks are a concern.”

It’s a risk South Carolina officials watched play out in mid-January, when measles cases surged to hundreds of cases a week after the winter holiday break period where gatherings with families and friends fueled the spread of the disease – not only within South Carolina, but to other states. The department’s measles control efforts were further hampered because outbreak investigators couldn’t get contact information from schools during winter break closures, delaying the quarantine of exposed students, an issue the department is trying to fix for spring break.

As infected South Carolina residents traveled the country during the winter break period, internal health department records show they exposed others to measles at travel convenience stores in Georgia and Florida, at a hotel and a youth conference in Kentucky, and at a hospital and a hotel in Florida, Healthbeat revealed last month.

Many schools in Spartanburg County, the epicenter of South Carolina’s outbreak, are scheduled to close for spring break the week of April 6-10.

State officials remain concerned there could be another surge in cases.

“It is far too early for us to let our guard down,” Bell said Wednesday. “We will see what happens with spring break.”

The problem is there are still many more unvaccinated people in South Carolina and across the country for the virus to infect.

To stop measles from spreading within local communities, 95% of the population needs to be vaccinated. But in most states, statewide vaccination rates among kindergartners have fallen below that “herd immunity” level, according to CDC data. And even where vaccination rates may seem high on a statewide or countywide level, pockets of unvaccinated children and adults within localized communities can still fuel outbreaks, experts said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

How ICE and hospitals are failing at infection control

2026-03-18T12:26:06+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

In the past week, I have been alarmed by the number of infectious disease outbreaks occurring at Immigration and Customs Enforcement detention facilities while the Trump administration is planning to expand their size even more.

It is not just ICE that is failing in infection control: A new survey reveals hospitals are under-investing as well. And we have interesting new data on a topic I covered a few weeks ago — longevity, or the science of living larger — and a further reminder that medications and tests are less important than who and what we surround ourselves with.

Infectious diseases spreading at ICE detention facilities

Elected officials in Maryland recently sent a letter to the U.S. General Services Administration raising alarm about Legionella bacteria detected in the water systems of the George H. Fallon Federal Building in downtown Baltimore.

Legionella is a waterborne bacteria that causes a severe pneumonia (known as Legionnaires’ disease) when contaminated water vapor is inhaled. It thrives in poorly maintained plumbing and ventilation systems and can be fatal, particularly for older adults and immunocompromised individuals, as happened in a large 2025 New York City Legionnaires disease outbreak.

The Fallon building houses an ICE regional office and detention holding rooms. According to the letter from two U.S. senators and seven House members, testing in November found Legionella bacteria in the building’s water system and contamination persists despite hyperchlorination treatment.

The lawmakers report that detainees are being held in overcrowded conditions for far longer than temporary holding rooms are designed to accommodate and that insufficient action is being taken to prevent an outbreak.

Unfortunately, Legionella is only the latest dangerous respiratory pathogen found at ICE facilities nationwide.

In early March, ICE confirmed that there have been, at least, 14 cases of measles at its largest detention facility: Camp East Montana, a tent city located on the Fort Bliss Army base in El Paso, Texas. An additional 112 people have been either quarantined or isolated. Four additional cases have also been diagnosed in the surrounding El Paso community.

Tuberculosis cases have been reported at ICE facilities in Alaska, California, Arizona, Colorado, Washington, and New York over the past year. Just like measles, TB spreads through the air, and outbreaks occur in precisely the conditions ICE facilities create: crowding, poor ventilation, and incomplete screening and testing.

Federal standards require that people be screened for TB within 12 hours of intake, but government investigators have found that is not always happening. Detainees with positive screening are often moved to solitary confinement, but these rooms lack the air filtration and ventilation needed to keep measles virus or TB bacteria from spreading outside a single room.

None of this should be a surprise. A 2021 study in JAMA documented over 2,600 cases of influenza, chickenpox, and mumps between 2017 and 2020 at 22 ICE facilities, including one with a varicella (chickenpox) outbreak that ran for 33 consecutive months. Another study published last October analyzed data about 20 ICE facilities from 2019 to 2023, and found 2,035 influenza cases, 486 hepatitis A cases, and 252 mumps cases across 128 separate outbreaks.

The authors’ recommendations were fairly basic: Reduce crowding, vaccinate detainees and staff against preventable infections, and improve infection control, such as air filtration and ventilation.

As ICE has dramatically expanded detention from roughly 39,000 detainees at the end of the Biden administration to more than 75,000 today, the conditions for outbreaks have worsened proportionally. Crowding intensifies transmission risk, and interfacility transfers seed infections across the system.

The administration is now planning to build even larger facilities. ICE’s “Detention Reengineering Initiative” calls for consolidating hundreds of facilities into approximately 34 regional mega-centers. One is planned for Social Circle, Georgia‚ a small city that would see its population nearly triple. The facility is projected to hold between 7,500 and 10,000 detainees for stays of roughly 60 days.

As the size of these facilities grows, the possibility of further illness and death from infectious diseases grows dramatically. Will ICE learn the lessons from the past few years about preventing measles, TB, and other respiratory infections in their facilities? I’m not, ahem, holding my breath.

Infection control also lagging in hospitals

Any indoor setting that brings a large number of people together in close proximity can lead to an infectious disease outbreak. Hospitals are particularly risky, because they bring two populations close together: people who have a high likelihood of already having an infectious disease and people who are highly susceptible, due to immune suppression or other issues, of becoming severely ill if they are exposed to an infectious disease. This is why federal and state regulations require hospitals to invest in infection control personnel, systems, and equipment.

Unfortunately, a new survey published in February by Infection Control Today reveals how badly hospitals continue to fall short. Infection preventionists are specialized professionals who track and stop pathogen transmission inside health care facilities. The survey found they are overwhelmed with problems to address, while simultaneously lacking the resources and authority to address those problems. According to one respondent, “Without investment, [hospital leaders] will only see the consequences when the patient impacts are already significant, and the costs are high.”

As with ICE facilities, the solutions are not complicated: increased staffing, increased authority and stature of infection prevention staff within leadership, and modernized technology to improve detection and response. Hospital-acquired infections cost the health care system billions annually, many times more than what prevention costs. Infection prevention in facilities, as in the broader community, needs to be framed as an investment, rather than a cost.

Your frenemies may be killing you

A few weeks back, I wrote about challenges with the field of longevity, but I wish I had been able to highlight a study that was just published in the Proceedings of the National Academy of Sciences. We all know toxic relationships - a colleague who undermines you or a family member who keeps score and makes your life worse. But is it possible they are also making you die sooner?

That is the intriguing hypothesis that a research team at New York University set out to test. Using a representative sample of more than 2,300 adults in Indiana, they studied what they called “hasslers”: people in your close social network who “occasionally or often” caused problems or made their life difficult in some way. Nearly 60% of people had at least one.

To measure aging, the researchers used DNA methylation, tiny chemical changes in the genome that accumulate predictably over a lifetime and may be read as a biological clock. Each additional hassler was associated with approximately 1.5% faster biological aging per year, the equivalent of roughly nine months of added biological age. People with more hasslers also had worse self-rated health, more anxiety and depression, and greater rates of cardiovascular disease and diabetes.

One finding I found particularly striking was that the most damaging relationships were not the purely hostile ones, but ambivalent ones, i.e., people who provide both support and stress. It’s easy to identify and exit entirely negative relationships. The ambivalent ones keep you close, keep you invested, and keep the stress going.

While I have some doubts about whether the biochemical changes measured in this study truly measure aging, I am inclined to believe these results, because health — whether it’s preventing infections or living longer — depends far less on medications and tests than on factors outside our body: air, water, food, and the people in our lives.

Until next week,

Jay

Lawmakers seek meeting with RFK Jr. over staff shortages, delays at World Trade Center Health Program

2026-03-13T21:43:52+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

A federal agency seeking to treat emergency responders who fell ill after 9/11 is contending with staffing shortages and delays that could have “devastating medical consequences” as the United States approaches the 25th anniversary of the World Trade Center attacks.

That’s according to a group of New York and New Jersey members of Congress who sent a March 6 letter requesting a congressional hearing with Health and Human Services Secretary Robert F. Kennedy Jr.

The letter from U.S. Rep. Nicole Malliotakis, whose district includes Staten Island and parts of southern Brooklyn, and eight other Republican members of Congress from Greater New York says they want to meet with HHS and Centers for Disease Control and Prevention officials overseeing the World Trade Center Health Program. They are seeking to learn more about the “current operational challenges, the steps being taken to address them, and how Congress can continue to support these important efforts.”

They also say 9/11 responders and survivors have been denied admission to the health program and have been waiting for more than a year for their appeals to be heard.

Of particular concern are reports that the agency has fewer staff members than were initially authorized – at a time when it is seeing enrollment grow. Advocates and others blame the shortage on cuts to HHS brought on by Kennedy and the Department of Government Efficiency. The letter refers to a January report that found only 84 people, out of 120 positions authorized by the Office of Management and Budget, are employed at the program.

“These staffing shortfalls have coincided with widespread delays in treatment authorizations, backlogs in claims processing, disruptions in continuity of care, and reduced oversight of contractors,” the members of Congress wrote.

They also note that program staff members working as Public Health Service Officers have been reassigned temporarily to different departments to work on immigration enforcement and at the Indian Health Service, an HHS agency that provides support to members of federally recognized Native American tribes.

“These reassignments further exacerbate the program staff shortage and harmful wait times for patients,” the letter said. “Responders and survivors suffering from cancers and other life-threatening 9/11-related conditions have reported waiting months for appointments or approvals. These delays can have devastating medical consequences.”

Fifteen years ago, Congress passed the James Zadroga 9/11 Health and Compensation Act of 2010, which created the World Trade Center Health Program in 2011 to provide health care to what has become more than 140,000 responders and survivors nationwide who have fallen ill because of their exposure to the toxic 9/11 attack sites in Lower Manhattan, the Pentagon, and Shanksville, Pennsylvania.

Data collected by the World Trade Center Health Program logs almost 53,000 responders and survivors who were diagnosed with some form of cancer, the most common ailment. Others were found to have a persistent nasal inflammation, heartburn, depression, and post-traumatic stress disorder.

“If you have to wait six months to get an appointment and get your cancer certified, that can make the difference between life and death,” said Michael Barasch, an attorney who has been a vocal advocate for responders and others harmed in the wake of the 9/11 attacks, including Zadroga, a New York Police Department detective who died from a respiratory illness that was attributed to exposure to toxins in Lower Manhattan. “People are going to die because this health program is understaffing.”

Spokespeople for HHS and the World Trade Center Health Program haven’t responded to requests for comment.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Georgia flu deaths highest in five years as RSV, other respiratory viruses rise

2026-03-13T21:28:43+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Deaths from flu in Georgia – 243 since the season started in October – are the highest they’ve been in five years, according to data released Friday from the Georgia Department of Public Health.

The deaths include five children. At this point in the season last year, 95 people had died, with 50 deaths at this point during the 2023-24 season.

Meanwhile, respiratory syncytial virus and human metapneumovirus, a lesser-known respiratory illness, have also been on the rise, said Dr. Andrew Thornton, a doctor with Wellstar in Cobb County. Those two conditions, while typically mild, can be more serious in children and the elderly. Covid rates remain low.

Here’s a look at what’s happening.

Flu rates, death toll still climbing

The death toll for flu since last fall hit 243 this week. Flu can be severe in any year, Thornton said, but the higher death toll could be related to the circulation of a new strain of flu this year.

“It’s possible that this became more severe in some patients and, sadly, led to unexpected death. Influenza can be a bit unpredictable, and it does depend on medical conditions and the immune system of the particular patient, and often the age of the patient,” Thornton said, adding that young children and older adults are often at higher risk.

“I don’t know that we know for sure why certain patients might die from the flu, but that is one of the reasons why we want to vaccinate for it, because it can be unpredictable, it can be severe,” Thornton said.

Nationally, 85% of the 101 reported influenza-associated pediatric deaths from this season were in unvaccinated patients, according to the Centers for Disease Control and Prevention.

Flu will continue to circulate through the spring, Thornton said, so it’s not too late to get a vaccine.

“We are still seeing plenty of flu cases, and we don’t know for sure that we’re not going to get any more spikes during the spring, so I would definitely still recommend it if a patient has not been vaccinated,” Thornton said.

Still, positivity rates are lower than earlier in winter. The positivity rate for tests conducted at select Georgia labs was 16.8% for the week ending March 7. While at the start of the season, most cases were Flu Type A, there has been a slight increase in the rate of Flu B cases, starting in late January, according to DPH data.

Covid rates have remained relatively low this winter, Thornton said. CDC data show low wastewater levels, and hospitalization and emergency room visit rates are lower this year than the same time last year in Georgia.

“We’ve seen less Covid this winter compared to last winter, as well as less hospitalizations, emergency room visits, and death compared to last year, which are obviously great trends for this disease,” he said.

RSV and HMPV rates higher than last year

Respiratory syncytial virus usually causes mild, cold-like symptoms but can be more serious in young children and older adults, according to the CDC.

“We are seeing a later rise in RSV this year compared to most recent years,” Thornton said. “RSV seems to be increasing right now, as opposed to last year, it was decreasing at this point in the year.”

At the same time last year, 1.6% of PCR tests for RSV were positive, while this year that rate is 8.3%, according to DPH data. Georgia wastewater data from the CDC also shows moderate levels of RSV. Hospitalization rates for RSV are also higher than at the same time last year, according to the CDC.

While RSV is typically mild, it can be serious in young people and older adults, especially those with risk factors like lung and heart diseases, a compromised immune system, or residence in a nursing home.

“We really, really pay attention to those younger kids with RSV, and that’s where we are still seeing elevated emergency room visits and hospitalizations in those younger patients.”

There aren’t anti-viral drugs to treat RSV for less severe cases, though there is a treatment that is used in hospitalized patients, Thornton said. Outpatient treatment focuses on managing symptoms. But there are steps parents and older adults can take to protect themselves.

Pregnant women can get an RSV vaccine that passes antibodies on to their infants. There’s also a vaccine for infants whose mothers did not get the shot during pregnancy.

The CDC also recommends that all adults over age 75 get a RSV vaccine and those with risk factors for serious illness who are over 50 get an RSV vaccine.

Another lesser-known virus is also on the rise, Thornton said: human metapneumovirus. The disease is also usually mild and causes cold-like symptoms like cough, fever, nasal congestion, and shortness of breath, according to the CDC.

HMPV tests from selected clinical laboratories in Georgia had a positive rate of 6.4% for the week ending March 7, while at the same time last year the positivity rate was 3%, according to DPH data.

Wastewater levels are also high, having climbed over the past three months, according to Georgia data from WastewaterSCAN.

Thornton said the virus belongs to the same family as RSV and is not related to pneumonia, but both viruses can cause pneumonia in more serious cases. There is no vaccine for it.

HMPV peaked in April nationally last year, Thornton said, and he expects this year’s pattern to be similar to last year.

“In general, a human metapneumovirus will often be more severe than the more mild viruses like rhinovirus,” Thornton said and will be more likely to cause a fever or a severe cough. “It also has a lot to do with the patient and their current medical conditions and immune status.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Doctors warn of a deadly complication from measles outbreaks

2026-03-13T15:57:15+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The first sign came when Deepanwita Dasgupta was 5 and started stumbling more while playing at her home in Bangalore in southern India. The girl was always up to something, so her parents figured extra bumps and bruises were just symptoms of an active childhood. Maybe, they thought, it was ill-fitting shoes.

Relatives described the unicorn-loving child as smart, affectionate, and occasionally rascally. Before she learned the alphabet, she had figured out how to find her favorite show, “Blippi,” on a phone. She was known to sneak butter from the fridge to enjoy a few finger licks.

But then her limbs started jerking. A spinal tap revealed measles in her cerebrospinal fluid. The virus she probably had as an infant had secretly made its way to her brain. Now 8 years old, Deepanwita is paralyzed, unable to talk.

Measles causes complications — ranging from diarrhea to death — in 3 in 10 infected people, according to the Infectious Diseases Society of America. Some are immediate, while others take weeks or months to appear. The one Deepanwita is experiencing, subacute sclerosing panencephalitis, or SSPE, typically takes years to rear its head.

“People think, ‘Oh, you know, if we get measles, then we’ll be fine, because I know my neighbor had it and they’re fine,’” said Yasmin Khakoo, who leads the national Child Neurology Society but spoke to KFF Health News in her capacity as a New York City doctor with expertise in neurologic conditions.

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

Measles, though, can be dangerous: A 7-year-old in South Carolina will have to relearn how to walk after enduring one of the more immediate complications, brain swelling. And every so often, the virus plants a ticking time bomb in the nervous system. A person can recover from measles and continue life as usual, no longer contagious and without any identifiable symptoms — sometimes for a decade or more — before problems appear. While some patients end up severely disabled for a while, Khakoo said, the condition is almost always fatal.

Before the advent of widespread and effective vaccines, the complication occurred enough in the United States that in the 1960s a doctor created a national registry of SSPE patients. Researchers now estimate about 1 in 10,000 people who get measles will develop SSPE, but the risk is significantly higher for those who contract measles before age 5. Populous nations where the virus is endemic, including India, see cases routinely.

Now, doctors and researchers fear that as vaccination rates drop and measles spreads in the United States, cases of this debilitating complication will also rise here. Since the start of 2025, the Centers for Disease Control and Prevention has recorded over 3,500 measles cases — more than in the entire preceding decade — mostly people who were unvaccinated. Many were children. Last year, Connecticut doctors diagnosed a 6-year-old with SSPE, and in California, a school-age child who’d had measles as an infant died of it.

“We are likely to see SSPE cases going forward, especially if we don’t get this under control,” said Adam Ratner, a member of the American Academy of Pediatrics’ Committee on Infectious Diseases and author of the book "Booster Shots."

Concern about SSPE was great enough that in January, the Child Neurology Society published a video to educate U.S. clinicians about the condition, and doctors who have seen such cases are warning their peers.

“We don’t have a way of knowing who’s going to get it, and we don’t have a way of very effectively treating it,” said Aaron Nelson, a professor of neurology with the New York University Grossman School of Medicine. “The one best thing that we can do, ideally, is to prevent children from having to go through it in the first place.”

The recommended two-dose measles vaccine slashes an exposed person’s risk of getting the contagious virus from 90% to 3% — and thus reduces the chance of SSPE. The vaccines carry small risks of febrile seizure and a bleeding condition, but measles itself has a higher risk of causing both.

Researchers find some missed SSPE cases

A 2017 study of California children who developed SSPE after a measles outbreak there years ago determined that 1 case is diagnosed for about every 1,400 known cases of measles in children under age 5, and 1 for every 600 infected babies.

The researchers also found that, over the years, doctors had missed some cases among patients who had died with undiagnosed neurologic illness.

The possibility that future cases could go undiagnosed spurred Nava Yeganeh and her colleagues to publish a news release in September when a Los Angeles County child died of SSPE.

Deepanwita Dasgupta and her mother, Anindita Dasgupta, celebrate the child’s fifth birthday in 2022.

“We’ve had very few cases of measles in the last 25 years in this country,” said Yeganeh, who is the medical director with the Vaccine Preventable Disease Control Program at the Los Angeles County public health department and has had two patients with SSPE. “Unfortunately, that’s changing, and so we wanted to make sure that everyone was aware of this long-term complication.”

The California child who died had gotten measles as an infant, Yeganeh said, before the child could receive the vaccine. Measles is highly contagious, so at least 95% of the population must be immune to it to protect vulnerable people — including babies too young to vaccinate and people who are immunocompromised — from infection.

“This is an example of someone who did everything right, wanted to protect their child against this infection, and unfortunately ended up losing their child because we didn’t have herd immunity for them,” Yeganeh said.

Shortly after Yeganeh’s group published the news release in California, Nelson was working to get the word out, too.

He had recently seen a 5-year-old whose family had traveled to the United States for medical care after the child started stumbling, jerking, hallucinating about bugs and animals, and having seizures. The child had contracted measles as an infant and had been too young to be vaccinated. Nelson diagnosed the child with SSPE.

“Imagine that: Having a child who is healthy and happy, moving to talking less and less, eventually not able to walk,” Nelson said. “It’s a very sad thing.”

He thought he would encounter the condition only in medical school textbooks, as a relic of the past. Instead, in October he found himself presenting the case at the Child Neurology Society’s national conference and participating in the society’s video about the condition. “I’ve now seen something I shouldn’t have ideally seen ever in my career,” he said.

Warning signs come from India

Globally, the number of measles outbreaks has increased in recent years, and physicians in places including the U.K. and Italy have recently seen clusters of SSPE.

The high human cost of measles’ spread is especially evident in India. While total cases aren’t tracked, about 200 families caring for people with SSPE, including Deepanwita’s, are in a single chat group in the Bangalore area.

In New Delhi, Sheffali Gulati studies SSPE and sees about 10 new patients a year with the condition, what she calls the “delayed echo” of measles outbreaks. The youngest she has seen was 3 years old.

“The ages are coming down, and a death or a vegetative state can develop as soon as in six months to five years of onset,” said Gulati, who leads the pediatric neurology program at the All India Institute of Medical Sciences and until recently led India’s Association of Child Neurology.

Gulati hasn’t found any treatments that reverse SSPE’s course, only some that slow its progress. She’s found herself counseling parents: It’s catastrophic, it’s not their fault, and they can do nothing but accept it.

Deepanwita’s relatives try to find joy where they can. They think they noticed the girl smiling when her favorite cousin called recently. Anindita Dasgupta, her mother, said Deepanwita moves her hands and feet on her own and sometimes turns her head, especially when her father enters the room. The girl communicates with her parents through her eyes and a few sounds.

But it’s far from where she was in 2022: At a cousin’s birthday, a few months before noticeable symptoms started, Deepanwita started the birthday song and sang the loudest.

At her own 8th-birthday gathering last year, Deepanwita, wearing a pink eyelet dress and a nasal tube, could only blink and move her eyes as she sat propped up before two cakes that she would not be able to eat. She can no longer swallow, so her mom dabbed a bit of icing on her tongue.

‘The problem could be solved with vaccination’

Roberto Cattaneo, a molecular biologist at the Mayo Clinic in Rochester, Minnesota, has been studying SSPE for years. He recently used postmortem brain tissue to map how the measles virus can spread from the frontal cortex to colonize the entire brain. Still, he said it’s a “black box” what exactly measles is doing in those dormant years between the initial infection and when the symptoms of neurologic damage crop up.

It’s possible the virus replicates in the brain that whole time, undetected, killing off neurons. But with so many neurons in the human brain — 10 times as many as people living on the planet — the brain may find a way to adjust, Cattaneo said, until finally it can’t anymore.

He’s applying for funding to continue research on the disease and possible treatments, though ultimately, he wishes he didn’t have to. The tools to obliterate the condition already exist.

“The problem could be solved with vaccination,” Cattaneo said. The United States should have no cases of SSPE, he said. “It’s just painful.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Brooklyn nurses lose health care for weeks despite $15M from state

2026-03-13T14:36:02+00:00

More than 400 nurses at the Brooklyn Hospital Center, where officials warned of a dire financial hole, have been cut off from health insurance coverage for six weeks, according to their union.

Gov. Kathy Hochul provided $15 million in emergency state aid recently to the financially strapped 181-year-old community hospital that borders Fort Greene Park, multiple sources told THE CITY. Hospital officials requested $160 million last fall, and the $15 million is not enough to restore health benefits for the nurses, according to the New York State Nurses Association.

Officials with the nurses union told THE CITY that workers feel targeted by hospital administrators’ decision not to pay into their health care fund. Nurses are the only hospital employees without coverage; doctors, administrative staff and other workers have been unaffected.

“You chose the nurses, the one group of people that actually show up — rain, sun, sleet, snow,” said Rehana Lowtan, a nurse educator who began her career at the hospital 20 years ago. “We have nurses here that have serious medical conditions. They have families that are on their plans that don’t have access to any kind of care right now.”

The nurses who spoke to THE CITY said they do not know when, or if, coverage will be reinstated.

The Brooklyn Hospital Center sits at the intersection of Fort Greene and Downtown Brooklyn.

“There’s no communication,” said Yvette Byer-Henry, a certified nurse midwife who has worked at the hospital for 25 years. “It just reeks.”

A spokesperson for the hospital, Zachary Fink, said the facility is “working closely with NYSNA and the Hochul administration on a solution.”

“The Brooklyn Hospital Center values our NYSNA represented nurses and recognizes that medical benefits are an essential part of supporting our colleagues and their families. The immediate issue is securing the funds necessary to continue covering those medical benefits,” he said in a statement.

The hospital has requested additional money from the state on top of the $74 million it received in 2025. The plea for help comes as the facility considers bankruptcy, the hospital’s chief executive Gary G. Terranoni, told Spectrum News in November.

Bill Hammond, a senior fellow for health policy at the Albany-based think tank the Empire Center, called the hospital’s failure to pay nurses’ benefits “a move of desperation” that could show the governor it needs the requested aid.

“That would communicate to the state we are in deep trouble, and it would turn the nurses into your allies for pushing the state for money,” he said. “If that is their strategy that would be using them as a bargaining chip.”

Assemblymember Phara Souffrant Forrest, a Brooklyn Democrat, said the reality of safety net hospitals necessitates state aid, explaining that Medicaid reimburses the hospital below the cost of its care.

“The reimbursement rates are not on par with the care that is being given,” she said.

“Ultimately, the responsibility rests with the state that hospitals like Brooklyn Hospital Center should be made whole,” added Souffrant Forrest, who has worked as a nurse. “Unfortunately, the governor is trickling in funding. She did make the choice not to include increases in safety net funding overall in last year’s budget.”

Hochul’s office did not respond to a request for comment.

Brooklyn Hospital Center’s nurses averted a strike in January by coming to a tentative agreement on a labor contract with management. The terms included the hospital fully providing the nurses’ health care and pension benefits.

The nurses, who said they were unaware that the hospital had not paid the benefits fund since November, accepted the contract. They are now legally prohibited from striking due to the contract agreement.

“If they are in a financial crisis, [hospital officials] should not be making promises they can’t keep,” Hammond said.

Byer-Henry told THE CITY the hospital has failed to make monthly payments to the benefit fund in the past, but this is the first time nurses have lost health care.

“When you made the decision to not pay one portion of your employees’ benefit, what was your thinking going forward?” Byer-Henry said. “Because you can’t run a hospital without nurses — nurses are the backbone of the hospital.”

Yvette Byer-Henry has worked as a nurse at the Brooklyn Hospital Center for 25 years.

Brooklyn Hospital Center is a safety net hospital and is not affiliated with large providers such as Mount Sinai Health System or Northwell Health.

Instead, its primary source of income is from its patients. About 80% are covered by Medicaid and Medicare, where the hospital receives its reimbursement and funding, according to a recent report from the Healthcare Association of New York State.

President Donald Trump’s recent cuts to Medicaid have hurt safety net institutions like Brooklyn Hospital.

According to Hammond, the request for state aid also points to a broader issue of hospitals relying on the state for emergency bailouts, rather than having long-term plans to solve their fiscal problems.

“That makes it more likely that hospitals will get in financial trouble in the future because they have a reasonable expectation they can squeeze money out of the state,” he said.

The nurses at Brooklyn Hospital Center currently face what Hammond called, “a very painful irony” — confronting the health care system every day while not having coverage for medical care themselves.

Byer-Henry said she continues to show up at the hospital to work, despite the changes in her insurance. She previously thought her husband’s insurance would cover her, but found out on Wednesday it would not.

“I do it because I love my patients,” she said. “A lot of my patients don’t want to see anyone else.”

Lilly Sabella is a spring 2026 editorial intern for THE CITY. She is a graduate of SUNY New Paltz and a Queens native. Her work has appeared in the Nashville Banner, the Legislative Gazette and The Oracle.

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

2026-03-12T21:28:16+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Amid concerns that spring break could reignite South Carolina’s measles outbreak, state health officials are trying to avoid a repeat of the communication gaps that delayed measles exposure investigations when schools were closed for winter break.

Healthbeat revealed last month that the South Carolina Department of Public Health was hamstrung in late December in its efforts to quickly warn and quarantine students and staff who had been exposed to measles. The problem: Schools were closed over winter break and they had nobody available to provide contact information to outbreak investigators.

The result was that people who were unaware they were infectious continued to interact with others in the community during the busy winter holiday season. In the weeks that followed, cases of measles surged dramatically and the South Carolina outbreak became one of the largest in decades.

“We are concerned that we may see another surge in cases,” Dr. Linda Bell, South Carolina’s state epidemiologist said. “So we have actually been in contact with schools to work with them more closely, to make sure that we have points of contact.”

Bell said Thursday that the department has sent letters to schools in South Carolina’s 11-county Upstate region asking them to identify a person who will be available during the spring break vacation period – when schools and administrative offices are closed – who can provide school attendance and contact information if it is needed for measles exposure investigations.

Here's how the S.C. measles outbreak grew after the holidays

“We’ve been receiving steady responses from the schools for those points of contact,” she said.

The health department said late Thursday that the letters, which requested contact information by March 10, were sent to all public school superintendents in the Upstate region. Only 11 of the 23 superintendents had supplied contacts as of Thursday. “DPH has previously established contacts at private and charter schools that have been impacted by the outbreak,” the department said.

Of the 993 measles cases recorded since the outbreak was identified in October, 936 have been in Spartanburg County and most of the others in nearby Upstate counties, according to state data. Almost all of those who have been infected were unvaccinated and most have been school-age children and teens.

In recent weeks, the number of new measles cases being reported to the department has slowed to a trickle. On Monday, the health department said just two new cases had been identified since Friday.

In Spartanburg County, spring break is scheduled for April 6-10 for many schools, but dates vary throughout the state.

“We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said. School holiday break periods pose an increased risk for the spread of measles because they often involve people traveling and socializing more.

The winter holiday break was a time of significant spreading of measles in the Spartanburg area.

Between early October – when the outbreak began – and Dec. 22, when Spartanburg County schools closed for winter break, there had been a total of 144 measles cases during the nearly three-month period. Then, in just the three weeks after schools reopened in January, there were more than 500 new cases of measles, state data show.

When Healthbeat asked South Carolina’s health department last month why it hadn’t reached out to schools to have contacts in place before winter break, the department said: “DPH cannot direct school employees to come to work to assist with outbreak investigations.”

Bell on Thursday said the new outreach to schools is an example of the department incorporating lessons learned into its outbreak response. “DPH has made the ability to communicate with school officials who have access to the information needed for case investigation a priority ahead of the upcoming spring break,” she said.

Measles is highly contagious and spreads through the air when an infected person breathes, coughs, or sneezes. The virus can linger in a room for up to two hours after an infectious person has left. Because a person is infectious for four days before the telltale measles rash appears, and initial symptoms may seem like a cold, many people spread the disease before they know they have it.

While two doses of the measles-mumps-rubella vaccine is 97% effective in preventing measles, those who are unvaccinated are at high risk of infection if they are exposed.

Christian school refused to share student information

Based on internal health department records, Healthbeat reported last month that during winter break there were delays quarantining people who had been exposed to measles – just prior to the holiday recess – at three public schools and one private Christian school.

In most cases, the schools were closed and didn’t have anyone available to provide information.

But when outbreak investigators reached Westgate Christian School in Spartanburg, the principal refused to provide information required to ensure those at risk of spreading the disease knew of the need to stay in quarantine, according to a health department warning letter to the school that Healthbeat recently obtained under South Carolina’s public records law.

According to the Jan. 9 letter, Westgate Christian School Principal Gail Grab responded to requests for information about exposed students by sending an email on Dec. 30 that said in part: “We will not provide personal details and immunization status information for the students in our school.”

Then when Grab sent outbreak investigators a list of exposed students on Dec. 31, the only names on it were the siblings of the person who had measles.

The department’s “final warning” letter on Jan. 9 gave the school until 1 p.m. the next day to provide the required information about all students who were had contact with the person with measles or the department would issue a public health order, under which the school could face fines of $1,000 per day for each exposed student’s name left off the list.

“Your continued failure to comply with this lawful demand has significantly impeded DPH’s ability to conduct mandatory case investigation, contact tracing, and quarantine monitoring,” the letter said. “This lack of cooperation places quarantined students, school staff, and the families of your students at increased and unnecessary risk of measles exposure, a highly contagious and serious disease.”

The school did comply before the deadline, Bell said.

Grab did not respond to requests for an interview on Wednesday. Pastor James Wooten, Westgate Christian’s president, replied Wednesday to emailed questions about the letter by saying he was traveling. He previously told Healthbeat that the school thought it had provided all necessary information on Dec. 31. He did not previously disclose that the school’s principal had sent an email refusing to provide required information.

Plans unclear at schools with past delayed measles investigations

Officials at the other three schools where state investigations of measles exposure incidents were delayed during winter break did not answer Healthbeat’s questions Wednesday and Thursday about any changes they have made for the upcoming spring break period.

Mark Robertson, principal at Global Academy of South Carolina, a public charter school where state records show only 21% of students are up-to-date with school immunizations, said he had no comment.

A vaccination rate of 95% is needed in communities to stop the spread of measles.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

Cynthia Robinson, a spokesperson for Spartanburg County School District 6, did not respond to emails and calls on Wednesday and Thursday. Delays investigating measles cases over winter break occurred at the district’s Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on vaccines.

Other schools that had delayed measles exposure investigations over winter break were in Spartanburg County School District 2: Sugar Ridge Elementary, where state data show 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines, also had delays investigating measles exposures during winter break, Healthbeat previously reported.

Adrian Acosta, a District 2 spokesperson, did not answer Healthbeat’s questions about what the district will do differently during spring break to avoid the winter break problems providing health officials with measles contact tracing information.

Acosta first sent a statement saying a district nurse supervisor is available 24/7. Then when asked if this person will be available during the spring break vacation period, Acosta emailed another statement saying school administrators are “always on the job.” Acosta added: “If an administrator knows they will be out of touch or unreachable, then it is expected that they have a communication plan in place.”

But Acosta did not respond to questions about what the district will do differently during spring break to prevent a recurrence of the delays.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

How new weight-loss drugs may offer hope for curbing addiction

2026-03-12T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

Last week was an interesting one for me, as I had the chance to moderate a panel hosted by the French Chamber of Commerce here in Nairobi. I focused on a question I’ve been circling in my reporting for months: As global health aid retreats, who fills the gap? The panel included development experts and health care businesses, all wrestling with how and where the private sector can realistically step in.

On to the news: This week we take a look at an unexpected (and unexplained) benefit of GLP-1 weight-loss drugs, a reality check on artificial intelligence tools hunting down antibiotics, and a few other stories on social media bans, the Iran war, and … a drug trial for turkeys?

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A shot at fighting addiction

It’s hard to overstate how much GLP-1 drugs like Ozempic have upended weight-loss treatment and sparked an ongoing pharmaceutical gold rush.

Drugmakers are racing to develop ever newer versions of the drugs, and regulators around the world are approving them at an equally rapid clip. (China, for example, just cleared Pfizer’s newest injection Xianweiying last week.) But their explosive popularity aside, what I find most striking about this moment is just how little we actually understand about the ways these drugs affect our bodies and brains.

Take, for example, results from a new study of health records from more than 600,000 patients in the United States. As reported by the Associated Press, patients taking these GLP-1 drugs showed something remarkable and seemingly unrelated to weight loss: lower rates of substance use disorders.

Background: GLP-1 drugs like Mounjaro, Wegovy, and Ozempic mimic a natural hormone that regulates blood sugar and appetite. In general, they influence the body’s hunger and digestion signals, though researchers are still working to understand exactly how these effects unfold in the brain and body. The “GLP-1” name is an abbreviation for the molecule it mimics, which was originally developed as a treatment for diabetes.

The study found that those on the drugs were less likely to develop addictions “to alcohol, nicotine, cocaine, opioids, and other substances” as compared to patients on other diabetes medications. And for patients already struggling with addiction, the drugs were also “linked to lower risks of [addiction-related] hospitalization, overdose, and death.”

What is going on here? Why would a drug designed to control blood sugar and appetite also seem to affect cravings for alcohol, nicotine, or other drugs? To find out, I reached out to two addiction science researchers not involved in the new study to help me parse the connection.

First, the idea that these drugs might affect addiction did not appear overnight, Dr. Joseph Schacht, an addiction scientist at the University of Colorado told me. Animal studies going back to last decade have found that drugs in this class can reduce alcohol consumption. And as millions of people began taking the drugs this decade, similar reports kept surfacing with doctors. “I became interested in this area when a medical colleague told me that some of her patients [taking GLP-1 drugs] for weight loss had reported they found themselves drinking less alcohol and experiencing less craving for it,” he said.

Still, scientists don’t fully understand the basic biology behind “exactly how these drugs affect the brain’s reward pathways,” he said. What we do know is that the brain contains specific docking points for GLP-1 molecules in several regions involved in motivation and craving. “It is possible that GLP-1 [drugs] cross the blood-brain barrier and bind directly,” to those sites, he said. But that’s not actually been proven yet. Another possibility, he said, is that the drugs act elsewhere in the body and send some other signals that ultimately influence how the brain processes cravings. We simply don’t know yet!

I also reached out to Dr. Anna Lembke, an addiction medicine specialist at Stanford University, who said the research raises the possibility of new, preventative therapies.

After all, if these drugs truly quiet the brain signals tied to craving, they might reduce the risk of the disorder developing in the first place. “But lots of questions remain, including whether short- and long-term benefits outweigh the risks, especially when you’re thinking about giving the drug to people who don’t yet have a disorder,” she said.

Still, “addiction is a massive and growing problem across the globe. We need more tools to help combat it. The GLP-1s hold promise for a novel strategy to combat addiction, and we need all the help we can get,” she said.

AI: An antibiotic breakthrough … or dead end?

One issue I keep returning to is a coming crisis in antibiotic resistance: Essentially, existing antibiotics are failing faster than scientists are discovering new ones.

This is both a “today” and “tomorrow” problem. Already, antibiotic resistance is linked to roughly 5 million deaths a year worldwide as routine infections become harder to treat. And if nothing changes, we will eventually reach a failure point where we no longer stop many common infections … with enormous implications for everything from cancer therapies to simple surgeries.

Now, as we’ve covered before, there are reasons to be optimistic. A big one is artificial intelligence, which is speeding up the earliest stages of antibiotic discovery, as covered in a new essay in STAT News. The authors, an antimicrobial researcher and a drug developer, cite a study from last October in which AI tools discovered “hundreds of [new] molecules with promising anti-bacterial activity.”

That said, this essay is not one of optimism.

As the authors write, even as these early leaps in AI dramatically improve new antibiotic discovery, the economic incentives for actually developing them remain heartbreakingly weak. Put simply: “The antibiotic market does not reward innovation — it often punishes it.”

Why? Because the way we use antibiotics makes it extremely difficult for companies to recoup the enormous costs of clinical trials and later-stage development.

Consider that antibiotics are meant to cure infections over a matter of days instead of, say, lucratively managing a chronic disease for years. And because doctors want to slow resistance, the newest drugs are often used sparingly and held in reserve. It’s “a practice known as stewardship”, which “benefits future patients but crushes commercial prospects. Even a truly novel, lifesaving antibiotic will be used sparingly, priced modestly, and ultimately displaced by generics.”

What’s the takeaway? If “no amount of algorithmic brilliance or predictive learning can overcome a business model that guarantees financial failure downstream … only policymakers are empowered to remedy what ails antibiotic R&D,” the authors argue.

They propose a few solutions, including “subscription-style reimbursement models, in which governments pay for access rather than volume,” or lump-sum government payments “that provide predictable returns for truly innovative antibiotics.”

The alternate solution, they say, is watching helplessly as “world-class laboratories … keep generating promising AI-sourced discoveries that end up in the dustbin of academia.”

Two conflicts with hospitals under fire

We have a few updates on two not-so separate crises, in Iran and Gaza.

First, the World Health Organization says at least 13 hospitals and health facilities in Iran have been hit since the U.S. and Israeli bombing campaign began, The Guardian reports. While the WHO has not provided many details (nor attributed blame), Director-General Tedros Ghebreyesus has gone on record to say that “under international humanitarian law, health care must be protected and not attacked.”

Meanwhile, in Israeli-occupied Gaza, Reuters is reporting that “medical supplies [are] running critically low despite Israel’s reopening of a key crossing.” How low? “Supplies of some items such as gauze and needles have already run out,” and “fuel shortages continue to limit hospital operations.” Hospitals without needles and gauze? It’s a fairly condemnable state of affairs, especially considering that there has been a ceasefire for two months now.

What’s the connection? As Reuters is also reporting, “key humanitarian air, sea, and land routes are being constricted ‌by disruption from the [Iran war], delaying life-saving shipments to some of the world’s worst crises,” which includes Gaza. As the report puts, quite pointedly: “Aid to Gaza and Sudan is grinding to a halt and costs are soaring for help to the hundreds of millions suffering hunger crises around the world.” And that we should expect care to get even worse.

The takeaway? Honestly, I’m worried. If the past two years in Gaza have shown anything, it is that the Israeli and American-backed bombing campaign displayed a total disregard for humanitarian protections around hospitals and medical infrastructure.

That record should make the world prepared for the possibility of a similar humanitarian crisis unfolding in Iran’s health care system, if this war escalates.

Share, like, and subscribe to social media bans?

India’s state of Karnataka has become the latest government to move against youth social media use. It just announced a ban on social media platforms for children under 16, Reuters reports. (The tech-hub state is home to 61 million people and the capital city of Bengaluru, widely known as the “Silicon Valley of India.”)

The policy follows similar efforts across the world: Australia recently approved a nationwide social media ban for under-16s, and several European and U.S. jurisdictions are likewise debating or testing age restrictions.

What does the most up-to-date research actually say about the effects of limiting social media? Well, let’s look at two separate ways researchers combine results across lots of studies. (Fair warning: We’re about to go full data-nerd.)

We can start with an “umbrella review” of youth social-media research from 2025, organized by researchers in Canada, Ghana, and Ireland. (An umbrella review is basically a review of reviews, looking across dozens of previous research summaries to see what the field as a whole is finding.) In this case, they looked at 43 reviews that covered over 1,000 papers.

What did they find? Broadly, higher social media use among adolescents is linked with worse mental health outcomes, particularly on depression, anxiety, and other “psychological distress.” But the picture is complex. The harms appear strongest with heavy or “problematic” use (like passive scrolling or addictive behavior), and some studies found clear benefits for teens, including social support and reduced isolation.

It’s also worth looking at a recent “meta-analysis,” which is when researchers pull out data from many separate papers, and then crunch it all together. In a 2025 meta-analysis, Australian researchers combined 10 randomized controlled trials to understand what really happens when people (adolescents and adults) reduce or stop using social media.

The results? They found that people who cut back on social media have a small but statistically significant drop in depressive symptoms. The effect was modest, but research shows that limiting social media use can improve mental health … but reduction in use was about as effective as total abstinence.

(Honestly, together it’s less of a slam dunk case against social media than I would have thought!)

Turkeys on trial

We’ll end this week with a funky story. Scientists in the UK have launched what is essentially one of the world’s first clinical trials on turkeys, the BBC reports.

Researchers will vaccinate thousands of turkeys and monitor them for about six months, in an effort to see whether a new bird-flu vaccine can safely protect the poultry from the virus.

It’s big news for birds, but don’t just take it from me. Here’s an incredible quote from Mark Gorton, the founder of Traditional Norfolk Poultry, which is leading the trial:

“This is probably one of the biggest days in my poultry life and I think this is one step for poultry but one giant step for poultry kind."

So … why turkeys?

Well, chickens are already vaccinated against bird flu in many parts of the world, and France has been vaccinating ducks for several years. But British researchers chose turkeys for this study because they are particularly susceptible to the disease. In other words, if a vaccine can protect a turkey, it’s a pretty good sign it could work for other poultry, too.

And there’s significant money on the line. “Annual bird flu outbreaks cost the UK government and industry up to £174m each year,” or about $230 million. And as Gorton told the BBC, “it could be a huge economic cost to [turkey farmers] if we catch this disease and we have to have all of our birds culled.”

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

When evidence and policy don’t align: Medicaid cuts and a failed cancer test

2026-03-11T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

In this week’s issue, the federal government is finding new ways to cut the programs that keep the sickest and poorest Americans alive, while a celebrated cancer screening test marketed to healthiest and wealthiest just failed its first big trial.

Medicaid under attack

As part of the most recent budget bill passed by Congress (“The One Big Beautiful Bill”), Congress made large cuts to Medicaid, the federal government’s health insurance program for low-income people. Public health experts decried these cuts, because people on Medicaid are also the most likely to have health conditions that require intensive medical care and cause the most overall illness and death without treatment, such as diabetes, coronary artery disease, and HIV.

Unfortunately, the latest news is that federal officials are targeting another way to cut Medicaid: suspending payments to some states over allegations of fraud.

In Minnesota, the Trump administration froze $259 million in Medicaid payments, citing previous instances of fraud in social services programs. To be clear, hundreds of millions of dollars were stolen through state social service programs, and dozens have been convicted. But the recent Medicaid suspension appears intended not to punish those who committed fraud, but to withhold essential medical services to “turn the screws on [Minnesota] a little bit,” according to Vice President JD Vance. The state’s attorney general, Keith Ellison, has sued to restore the funds, calling the freeze “weaponized Medicaid against Minnesota as political punishment,” and Gov. Tim Walz has called it “targeted retribution.”

New York is next up. Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz sent New York Gov. Kathy Hochul a letter demanding information within 30 days or risk deferred payments, citing what he called a “high proportion” of beneficiaries receiving personal care services like bathing, grooming, and meal preparation. New York’s Medicaid program is the most expensive per-enrollee in the country, at $115.6 billion in fiscal year 2025, covering roughly 1 in 3 New Yorkers.

What Oz’s letter omits is that the underlying Medicaid data can be challenging to analyze accurately: It excludes hospital spending, lacks procedure and diagnosis codes, and a single personal care billing code can represent anywhere from 15 minutes to a full day of care.

Government officials must be rigorous stewards of the public’s money. That was one of the first lessons my supervisors taught me when I began working for the Centers for Disease Control and Prevention in 2001. At the same time, I worry that the suspension of Medicaid payments are guided by political animus, rather than fiscal responsibility, and do not consider the immense potential consequences to Americans that depend on Medicaid.

Fraud exists in all sectors, public and private, and public programs must always balance their legitimate interest in minimizing fraud against the real and immediate harms of suspending funding. When it comes to programs that people’s lives literally depend on, such as Medicaid, I believe that the bar for a complete suspension should be extremely high — the evidence incontrovertible, the scope vast — and funding should continue until an investigation clears that bar.

Cutting HIV and other safety net clinical services

The cuts to publicly funded health services, unfortunately, are not just to the larger Medicaid program. A separate federal government program provides HIV care and treatment funding for people who are not covered by other public or private insurance programs. The Ryan White HIV/AIDS Program is the payer of last resort for about 25% of the 1.2 million Americans living with HIV. The Ryan White program covers medications, laboratory monitoring, and related services for people who fall through the gaps of Medicaid and private insurance.

About 18 states have tightened eligibility or cut covered HIV medications under the Ryan White-funded AIDS Drug Assistance Program, with five more considering changes. The starkest example is Florida, home to the largest ADAP in the country. On March 1, Florida cut off more than 16,000 clients, roughly half its caseload, by dropping the income eligibility threshold from 400% of the federal poverty level ($63,840) to 130% ($20,748), and removing Biktarvy, the most prescribed HIV medication in the country, from its formulary.

With HIV, the harms are particularly worrisome. Effective antiretroviral therapy suppresses the virus to undetectable levels, keeping patients healthy and, crucially, making them unable to transmit the virus to others. Interrupting treatment also risks drug resistance that can itself be transmitted. If HIV treatment disruptions push the United States back toward 2018 infection rates, this will mean an estimated 4,500 additional HIV infections and $3.8 billion in lifetime costs.

We are also seeing cuts in other public safety net health care services. Counties and municipalities across the country, such as Los Angeles, are cutting clinical programs from immunizations to sexual health to behavioral health, as federal funding reductions ripple down to local budgets.

When I began leading infectious disease programs for New York City in 2011, we had to drastically cut back our clinic hours and services because of the Great Recession. We hoped that patients would continue to be able to receive some of these services at other facilities — such as federally qualified health centers and the public hospital system — but we also understood there’s a reason it is called a safety net and not a safety blanket: The net has holes that people fall through.

The other long-term consequence of public health agencies cutting their clinics is that they lose a direct connection to the community. It is difficult for people to advocate for public health when most of the work of public health is not visible to them. Clinics are a tangible way for them to see what public health agencies do for them, ensuring that they are more likely to trust public health officials during emergencies, and providing a constituency that will oppose budget cuts in the future.

Update on blood tests for cancer detection

In a previous newsletter, I discussed how companies were marketing blood-based multi-cancer detection tests to consumers who are eager for any way to find cancer early. The results are now in from a large, rigorous clinical trial of the best-known of these tests, called Galleri, developed by a company called Grail. The Galleri test looks for tiny fragments of tumor-associated DNA in the blood and screens for more than 50 types of cancer. The test has been sold in the United States since 2021 for $949, without Food and Drug Administration approval, under a regulatory framework that permits certain laboratory-developed tests to be marketed without prior review.

The company ran a trial in partnership with the UK’s National Health Service on 142,000 healthy adults aged 50 to 77. It was exactly the kind of rigorous, large-scale prospective study that the field needs. The hope was to show a 20% reduction in advanced cancer diagnoses among people who received the test. The study failed to meet that primary endpoint. There was no statistically significant reduction in Stage 3 or Stage 4 cancers in the group that received Galleri testing compared to the control group.

Most experts interpreted this study to mean that the Grail test should not be funded as part of routine cancer screening for adults in either the UK or the United States. That said, I believe there may be benefit to this and similar tests in selected populations, such as those already at higher risk of cancer due to family history or known genetic abnormalities.

The broader lesson here is how we, as a society, decide what to invest in. The evidence is clear that screening for cancer in adults using a blood-based test does not work. The evidence is also clear that cutting Medicaid and HIV services will lead to more sickness and death. How we get policy and practice to align with evidence is the most difficult challenge in public health.

Until next week,

Jay

Georgia public health bills on foreign-trained doctors, HIV drugs, and school cellphone bans advance

2026-03-10T23:50:41+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Several public health bills have made significant progress toward passage in the Georgia General Assembly, including help for nurses facing addiction, a pathway for foreign-trained doctors to practice, and a measure allowing pharmacists to prescribe HIV drugs.

They are among the bills that survived Friday’s “crossover day” deadline, when they move from the House of Representatives or Senate where they originated to the other chamber for debate. Once they pass the opposite chamber, the bills go to Gov. Brian Kemp for his signature.

A bill that would have barred elected officials from doing business with the state government failed to pass before the deadline.

The bill – while not focused solely on health care – had the potential to shape the future of Georgia gubernatorial hopeful Rick Jackson’s millions of dollars in health care contracts with the state government if he is elected in November.

However, it failed to gain a needed vote in the House. While the standalone bill is dead for now, it could be appended to another piece of legislation and gain passage before the session ends on April 2.

Here are where some other public health bills stand.

These public health bills are moving ahead

Helping nurses facing addiction: A bill that would create an “alternative to discipline” system for Georgia nurses facing substance use struggles awaits a Senate floor vote after getting House approval last year and a Senate committee’s support last month. The measure would allow nurses to privately get help for addiction without impacting their nursing licenses as long as they stay on track with treatment. It emulates programs in many other states. (HB 219)
Improving benefits for public health workers: Many Georgia public health workers are employees of county governments, and if they move on to work at the state public health department, they lose the seniority they’ve accrued in terms of paid time off. This bill would fix that so experienced public health workers have an incentive to work for the state. The bill grew out of a House study committee that looked at how to improve Georgia’s public health system last year. (HB 1096)
Certification for community health workers: Advocates want the state to create a formal certification for CHWs who help patients navigate the medical system and access services. A bill to do that gained House approval last year and now needs approval from the Senate Health and Human Services committee and the full Senate. Advocates say certifying CHWs would add respect and regularity to the profession and could be a first step toward getting Medicaid reimbursement for the services they provide. (HB 291)
Easing foreign doctors’ paths to practicing in Georgia: This bill would streamline the process for doctors trained abroad who lawfully reside in Georgia to practice here, a move advocates say could help address the state’s doctor shortage. It creates a phased system so that doctors could practice under local supervision before advancing to a full medical license, with requirements to practice in underserved areas. Past versions of the bill were sponsored by Democrat Sen. Kim Jackson but this year it picked up the backing of powerful Republican Sen. Ben Watson, a Savannah doctor, and breezed through his chamber. The House Health committee voted in favor of the bill this week, and it now needs House approval before being sent to the governor’s desk. (SB 427)
HIV drugs at pharmacies: Pharmacists could prescribe HIV prevention drugs, which advocates say would increase access and could decrease Georgia’s high rate of new infections. The House and Senate have voted in favor of the bill; now the Senate needs to grant approval to the amended version. (SB 195)
Birth control at pharmacies: Pharmacists could dispense birth control pills and hormonal birth control shots like Depo-Provera. The bill would also require insurers to provide up to a year’s supply of the drugs at a time, which would help increase access, sponsor Rep. Beth Camp, R-Concord, said. Most other states have similar provisions. The legislation would require pharmacists to provide patients with materials about the drugs as well as a statement that abstinence is the only method that is fully effective in preventing pregnancy and sexually transmitted diseases. The bill next needs the approval of the Senate Health and Human Services committee. (HB 1138)
High school cellphone ban: This bill would extend a K-8 cellphone ban set to take effect in the next school year to the high school level, a move Georgia parents supported in a recent Emory University poll. The House voted in favor of the measure and it now must gain the approval of the Senate Children and Families committee before advancing to the Senate for a floor vote. (HB 1009)
Stiffer penalties for insurers that don’t cover services: Georgia passed a landmark bill in 2022 that required insurers to provide mental health services at the same level they provide medical services. That bill included penalties for insurers who do not do so. This year, a bill that would increase some of those penalties, especially for insurers who do not provide required data on mental health parity or follow the state’s “surprise billing” laws, breezed through the House. It now needs Senate approval, first from the Insurance and Labor committee and then the full Senate. (HB 1262)
Closer look at sickle cell disease services: This bill would require the state Department of Community Health, which administers the Medicaid insurance program for low-income residents, to annually review whether the services and medication it offers are sufficient to meet the needs of people living with sickle cell disease. Georgia has the fourth highest-burden of sickle cell disease among U.S. states, according to one estimate. The bill now needs the support of the Senate Health and Human Services committee and then the full Senate before it can be sent to the governor’s desk. (HB 334)
Cleaning-up obsolete public health laws: This bill would “clean up” and modernize older sections of the law to better match current conditions. For example, it eliminates certain reports and committees that are no longer active. And it eliminates a 1973 requirement that couples who register for a marriage license must receive a Department of Public Health “marriage manual” with information on family planning. The measure now awaits a floor vote in the House before being sent to the governor’s office. (SB 440)

These public health bills are unlikely to move ahead

Some bills failed to get approvals by the crossover deadline. That means they’re unlikely to move ahead, although there are procedural tactics that could revive them.

Ivermectin will not be available over the counter. This bill, sponsored by Rep. Karen Mathiak, a Griffin Republican, would have allowed pharmacists to provide the anti-parasitic drug that has been falsely touted on social media for human cancer and Covid treatment despite a lack of scientific evidence for those uses. The measure got the approval of a House committee but failed to get a needed floor vote. (HB 1089)
Plans to increase tobacco taxes fail. Georgia has the second-lowest tobacco tax rate in the country. Public health advocates say increasing taxes could reduce the number of people who smoke and reduce the state’s health care costs. Rep. Michelle Au, a Democratic doctor from Johns Creek, last year proposed bills to increase taxes on cigarettes and vape products. Neither received a committee hearing, meaning they are effectively dead until next year. (HB 83; HB 84)

Other Au bills that would have banned the sale of flavored vape products and required vape manufacturers to disclose ingredients also failed to get committee hearings. (HB 958; HB 959)

Maternal mental health improvement. This bill would have required health care providers to screen pregnant women for mental health concerns at least five times, starting with the first prenatal visit. Insurers would have been required to cover those screenings and treatment, and the Department of Community Health would have had to track maternal mental health quality metrics. The bill gained unanimous support in the House Health committee but failed to get the floor vote needed to advance. (HB 1346)

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Controversial federal vaccine advisory committee: Deadline is Thursday to comment on March ACIP meeting

2026-03-09T15:51:20+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

A controversial federal vaccine advisory committee, which is scheduled to meet next week to discuss Covid-19 vaccine injuries and Long Covid has set a Thursday deadline for the public to submit comments.

The Advisory Committee on Immunization Practices has disclosed few details about its agenda for the meetings on March 18-19 at the Centers for Disease Control and Prevention in Atlanta. The committee was supposed to meet last month, but cancelled its sessions amid an ongoing lawsuit and after failing to post agenda information, as required.

The formal notice for the March meeting published in the Federal Register says the committee’s agenda will include updates on the committee work groups and “discussions on COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. Recommendation votes may be scheduled for COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology.”

No additional details were provided about these topics and the notice also says that the group’s agenda items “are subject to change as priorities dictate.” The ACIP meeting webpage also did not provide any additional details as of Monday morning.

The public can submit written comments online through the Federal Register meeting notice. Comments must be received by Thursday, the notice says.

The committee will also provide time for members of the public to make oral comments. The notice says: “Oral public comment will occur before any scheduled votes, including all votes relevant to the ACIP’s Affordable Care Act and Vaccines for Children Program roles.” Priority will be given those who file a request to speak at the meeting by Thursday. Details on how to make a request to speak at the meeting are found on the ACIP meeting webpage.

The committee, which meets three times a year, had all of its members replaced last summer by Health and Human Services Secretary Robert F. Kennedy Jr. and has come under fire from major medical professional associations that have said the reconstituted committee has been making changes to vaccine recommendations that lack scientific merit.

An ongoing lawsuit brought by American Academy of Pediatrics and other medical groups over the Trump administration’s vaccine changes has sought to stop ACIP’s next meeting because of concerns the committee will take a vote that will result in removing funding for certain vaccines for children from low-income families or who lack adequate insurance. Several state attorneys general are also suing HHS over recent changes to the childhood and adolescent vaccine schedule.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Mamdani’s first major health project uses child welfare agency funds to bolster home nurses for expecting parents

2026-03-06T17:50:12+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The first major public health project announced under New York City Mayor Zohran Mamdani is a $20 million effort that includes strengthening a program that sends nurses into the homes of mothers struggling to make ends meet.

The money would be transferred to the Department of Health and Mental Hygiene from the city’s Administration for Children’s Services under the preliminary 2027 budget to fund more home visits in the Nurse-Family Partnership, which pairs registered nurses with expecting parents who receive Medicaid or WIC.

In the home, the nurses take into consideration the surrounding environment while working one-on-one with clients to develop strong parenting skills in the areas of diet and nutrition, with the aim of supporting a healthy pregnancy and a healthy baby.

“This program is putting families first and those that are in need the most,” Deputy Mayor Helen Arteaga Landaverde said Feb. 27 in announcing the funding at a community health center in East Harlem. She oversees ACS and the health department. “We will use this program to help increase higher rates of breastfeeding, childhood immunization, and, more importantly, making sure that our families keep growing nice and healthy.”

The announcement comes at a critical time. Health officials over the years have wrestled with trying to stem the city’s high maternal mortality rates, especially among Black women, which are some of the highest in the United States. New York City sees about two dozen deaths tied to pregnancy or childbirth each year. Three in four Black maternal deaths are ruled preventable by the health department’s Maternal Mortality Review Committee. For white women, it’s about half.

Mamdani mentioned the disparity last week at a private reception honoring Black History Month. Under the gigantic blue whale model suspended at the American Museum of Natural History, the mayor noted that Black mothers suffer mortality rates much higher than white mothers. Mamdani’s predecessor, Eric Adams, had also raised concerns over high maternal mortality rates, launching a citywide doula program.

City officials see bolstering the NFP program as a potential remedy.

Shutdown deal brought a reprieve for WIC. But NY braces for ripple effect of other looming aid cuts.

Officials from ACS, the city’s child welfare agency, the health department, and a local nonprofit focusing on childhood mental health services met in late January at the ACS office in Manhattan to present the Strong Foundations initiative to expand the NFP service. They had been researching the program since early 2024 and developing a proposal through last May, according to literature circulated at the presentation.

At last week’s announcement, the city’s new health commissioner, Dr. Alister Martin, introduced his mother, a registered nurse seated in the front row, as an example of how an NFP nurse builds connections.

“She was a year-round Santa Claus, delivering things to each family she met with,” Martin said. “But it went beyond the gifts. She delivered connection. She delivered health education. She delivered compassion.”

NFP has helped 25,000 expecting parents in NYC

The $20 million initiative will help expand NFP eligibility over a three-year period by allowing clients who already have a child to register instead of limiting it to first-time parents. They will also be able to enroll later in pregnancy, after 28 weeks. The program aims to double the number of families it serves to 3,000, according to documents from the presentation.

The program will also provide training for early childhood mental health professionals by creating a three-year fellowship program that develops a “pipeline of clinicians with perinatal and early childhood experience,” according to a press release.

NFP has supported more than 25,000 expecting parents in New York City since the program was adopted in Jamaica, Queens, in 2003, officials said. The original Nurse-Family Partnership was created by David Olds, a professor of pediatrics at the University of Colorado, in the 1970s and was later expanded as a nationwide program, hailed for curbing high maternal and child mortality rates.

Sascha James-Conterelli is a “full supporter” of the NFP program and has spent considerable time collaborating with NFP nurses since she came across the program in 2007 while working as a perinatal director at a hospital on Long Island. A member of the New York State Maternal Mortality Review Board, she said she was struck by how NYP nurses provide a true public service, because they understand the nuances and health needs of the community.

Preventing maternal deaths: 5 From the Field Q&A with childbirth safety expert Dr. Elliott Main

“They’re not blindly going in and giving some prescriptive type of advice, like, ‘oh, eat healthy or eat better,’” said James-Conterelli, director of the nurse-midwifery program at New York University, where she’s also a clinical associate professor. “They already have nurses that reside in the area and know what foods are available to them, where their markets are, what religious practices are common in the area.”

In 2023, the Montefiore Health System in the Bronx threatened to cut its $800,000 NFP program until the New York State Nurses Association compelled the health system to salvage it during negotiations related to a nurses strike, said Vanessa Weldon, a NYSNA member and Montefiore RN.

The funds transfer, included in the fiscal 2027 preliminary budget, comes as the city faces a potential budget shortfall of $5.4 billion. The preliminary budget will go to the City Council this spring for public hearings, followed by rounds of revisions and negotiations. The finalized budget is due at the end of June, to take effect July 1.

Luisa Linares, deputy commissioner of the Family Services Division at ACS, told Healthbeat the $20 million had been budgeted for an infant program that ended last year, so the funds were available. The agency’s research suggested there was no need for “traditional procurement,” she said.

“When we knew that that program was going to end, we began doing research to think about what do we do with the funding?” she said.

Community trust essential to NFP’s success

Some advocates raised concerns about any ACS connection to NFP, saying parents could be deterred from signing up if they fear a nurse’s visit could lead to their children being taken away.

“What they’re doing is buying a doorway for reports,” said Joyce McMillan, founder and executive director of Just Making A Change for Families, a local nonprofit known as JMACforFamilies that works to improve the foster care system by keeping families together. “If people are coming in [homes] — because this is for mental health help — they’re going to talk about the things [the parents] struggle with, and then those struggles are going to be turned into cases against the family, separating more kids from their home.”

Mimi Bhatt, a midwife and assistant professor at NYU Rory Meyers College of Nursing, said the faith built between the nurse and a client is critical for the success of the NFP program.

“The ethos of NFP is trust. The nurse develops such a trusting relationship with this family over time and is able to really realize the opportunities for a family and realize their health goals,” she said. “If you say to people that ACS is involved in this expansion, to me, that implicitly communicates that ACS now has a greater hand in people’s homes. And that is a problem.”

An ACS spokesperson said in a statement to Healthbeat that ACS “will not play a direct role in NFP.” The spokesperson added that “by expanding eligibility, NYC is providing more support to families upfront BEFORE child protection intervention is needed.”

“The goal of this partnership is to move resources from ACS to DOHMH to specifically expand DOHMH’s ability to provide services to people in need, without ACS being involved with families — thereby addressing the deterrent that some in the community are concerned about.”

A health department spokesperson wrote separately that the NFP program is a preventive measure:

“ACS does not have a role in the administration of Nurse Family Partnership or the Perinatal Early Childhood Mental Health Clinic Network. This is an upstream approach to prevent ACS involvement and support New Yorkers by connecting at-risk families to long-term support from home visiting nurses and mental health resources.”

ACS has drawn criticism over the years, with Black families accusing the child welfare agency of bias against them. Caseworkers have been accused of showing up unannounced, rummaging through personal belongings and looking for signs of bad parenting, confusing symptoms of poverty for signs of neglect and then seeking to separate families. A year ago, a state appellate court ruled that the ACS practice of requiring child welfare investigations of parents who are victims of domestic violence is illegal.

“If the true goal is to help the citizens of New York, especially the Black citizens and Black mothers in order to reduce the rates of maternal mortality and severe maternal morbidity in our city, and we’re intentional about that, then this should thrive,” said James-Conterelli of NYU. “If there’s a hidden alternative agenda that is not being publicized, then our rates are just going to stay the same, or get worse.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Source of Georgia measles case remains a mystery as people who were exposed continue quarantine

2026-03-05T19:25:28+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

How and where an unvaccinated Georgia resident recently became infected with measles remains unknown and multiple unvaccinated people continue to be in quarantine because they are at risk of developing the disease, according to the state’s health department.

It is unknown whether the person – a resident of Bryan County, near Savannah – became infected in Georgia through undetected measles spreading within the state, or if the infection occurred during recent travel to Washington, D.C., the Georgia Department of Public Health said Thursday in response to questions from Healthbeat.

“We cannot definitively determine whether the individual was infected in Georgia or during travel, but there is no record of exposure to a known case of measles,” said department spokesperson Nancy Nydam Shirek.

The District of Columbia has reported no confirmed cases of measles through Feb. 26, according to the Centers for Disease Control and Prevention. While the D.C. health department has issued alerts about infectious visitors potentially exposing others to measles at events in the nation’s capital, the Georgia person didn’t attend any of those kinds of gatherings, Nydam Shirek said.

Here's how the South Carolina measles outbreak grew

Nationwide, the United States is on track to have another record year of measles cases. During 2025, there were 2,281 confirmed measles cases across the country, according to the CDC. In just the first two months of this year, the CDC has confirmed 1,136 measles cases.

While infectious, state health investigators determined that the Bryan County resident exposed “several dozen” other people in Georgia to the highly contagious measles virus. Most were protected against the disease with up-to-date vaccinations. However, “fewer than 20” were not vaccinated against measles and are in quarantine or under active monitoring, Nydam Shirek said.

While it usually takes about seven to 14 days after exposure for an infected person to start showing symptoms of measles, it can take as long as 21 days. The incubation period for those exposed to the Bryan County person ends on March 15, Nydam Shirek said.

“To date, there are no reported cases of secondary measles infection,” she said.

The department has not announced any locations of public places where the infected person exposed others to the virus. According to media reports, officials at Bryan County Schools last month notified parents that the infectious person was at Bryan County Middle High School on Feb. 13. The district’s spokesperson, Melissa Roberts, did not respond to Healthbeat’s questions on Wednesday and Thursday.

Nydam Shirek said the state health department does not issue public notifications about school exposure incidents. “When there is a school exposure, the communication comes from the school, not DPH,” she said. In other states, such as South Carolina, which is experiencing a major outbreak, the health department also alerts the public about school exposures.

There were no other public locations, such as restaurants or stores, where exposures occurred, Nydam Shirek said, and all people who were exposed have been notified.

So far this year, Georgia has identified one other measles case. It involved a baby who was too young to be routinely vaccinated against measles who became infected during international travel, state health officials said in January.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Trump’s cuts to Medicaid threaten services that help disabled people live at home

2026-03-05T16:24:30+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

OTTUMWA, Iowa — Leisa and Kent Walker recently received a disturbing notice: The private company managing their son’s Medicaid coverage intends to cut nearly 40% of what it spends for caregivers who help him live at home instead of in a nursing home.

Sam Walker, 35, has severe autism and other disabilities. He is deaf and cannot speak. Sometimes when he’s frustrated, he hits himself or others.

Medicaid provides about $8,500 a month for health workers who visit his apartment in the basement of his parents’ home. The staffers help him with everyday tasks, including dressing, bathing, and eating. They also take Walker on outings, such as dining at restaurants, volunteering at Goodwill, and exercising at a recreation center or on park trails. They stick to a strict routine, which soothes him.

His parents say that without the in-home services, their son would need to move to a specialized residential facility in another state. Sending him away would break their hearts and cost taxpayers much more money. They strive to keep him home because they know change makes him anxious.

“The last thing I want is to put him into some kind of care facility, where he’ll just get kicked out,” said his mother, Leisa. The Iowa Department of Health and Human Services did not respond to KFF Health News’ questions about the Walkers’ case.

Federal cuts raise pressure on services

Patient advocates say state administrators in Iowa appear to be reining in Medicaid spending by cutting what are known as home and community-based services for people with disabilities, and they’ve heard of multiple families facing battles like the Walkers’.

Disability rights advocates expect the pressure to intensify as states respond to reductions in federal Medicaid funding called for under the Trump administration’s signature tax and spending law, which passed last year.

June Klein-Bacon, CEO of the Brain Injury Association of Iowa, said the cuts and proposed rule changes appear to be part of a quiet attempt to save money in response to the state’s budget deficit and expected reductions in federal Medicaid funding.

Medicaid, jointly financed by the federal and state governments, covers people with low incomes or disabilities. Walker is one of nearly 2 million people served by “Medicaid waiver” programs, which pay for care that allows people with disabilities or who are at least 65 to live at home.

Unlike most parts of Medicaid, waiver programs are optional for states. Idaho’s governor noted that fact in January, when he suggested legislators consider cutting them. Disability rights groups fear other states will do the same. Leaders in Colorado, Missouri, and Nebraska have considered such cuts this year.

Leisa Walker has heard Trump administration officials claim the national Medicaid cuts are intended to reduce waste, fraud, and abuse. That’s not how it will play out, she said. “These are real people, real families, and this causes real suffering when you do this to people,” she said. “It’s a very scary time.”

Iowa Total Care, a private insurance company that manages Sam Walker’s Medicaid benefits, intends to cut his in-home care coverage by about $3,200 per month, his mother said. Company leaders told a judge they are following state officials’ direction, but they did not dispute Leisa Walker’s math.

Walker has been on the waiver program for three decades. It covers assistance from workers known as “direct service providers” — one of whom has been with him for 25 years. His parents receive no pay for the hours they spend caring for him when the aides aren’t working.

On a February morning, Leisa and Kent Walker drove an hour and a half to Des Moines for an appeal hearing. An administrative law judge sat behind a wooden desk in a conference room as the Walkers and their lawyer faced off against three representatives from Iowa Total Care, a subsidiary of the national insurer Centene Corp.

Leisa testified that her son is 6 feet tall and weighs 230 pounds. Although he knows some sign language, he has trouble communicating, she said. When he becomes frustrated or his routine is interrupted, he sometimes wails and hits himself or other people. “It’s devastating to watch,” she testified.

He’s not a bad person, she said. “He doesn’t understand how strong he is.”

She said her family would try to keep his main caregiver employed under the planned Medicaid reduction but would have to drop others who cover nights and weekends. She said no residential facility near their southern Iowa home could address her son’s complicated needs. She said a case manager told her that a Florida facility might be the closest one that could safely handle him.

Leisa Walker testified that the state’s Medicaid program would pay about $22,000 per month to put him in an institution, more than double what the program spends on his home care.

Sam Walker’s longtime psychiatrist, Christopher Okiishi, testified that Walker’s family and their support staff spent years developing a “fragile” but stable existence for him.

Lori Palm, a senior manager for Iowa Total Care, testified that Sam Walker gets about 16 hours of daily assistance financed by Medicaid. Palm said much of that time amounts to “supervision.” She said state officials recently advised her company that the program should pay mainly for “skill-building” time, not supervision.

The Walkers showed the judge a 2018 document in which a previous Iowa Medicaid director stipulated that supervision of people with disabilities is an allowable service for workers paid under the program.

Sam Walker, who is deaf and has severe autism, uses sign language to communicate with his mother, Leisa Walker, at a recreation center in Ottumwa, Iowa.

Judge Rachel Morgan asked the Iowa Total Care representatives if the recent policy change was made in writing by the state Department of Health and Human Services. They said it was not and that they couldn’t specify who at the department had given them the new guidance.

The judge suggested during the hearing that for someone like Sam Walker, learning to regulate emotions could be an important form of skill-building. Three days later, the judge ruled in the Walkers’ favor, writing that the insurer’s attempt to cut care hours was improper. The insurer appealed the decision to the director of the Iowa Department of Health Human Services, who could overrule it. The dispute could eventually wind up in district court.

Iowa Total Care and the state Department of Health and Human Services did not respond to questions about the reports that many other Iowans with disabilities face reductions in care hours covered by Medicaid. Department spokesperson Danielle Sample said in an email that the agency supports home and community-based services, which, she noted, help “states save money by avoiding expensive long-term facility care.”

Spokespeople for the federal Department of Health and Human Services, which oversees Medicaid nationally, did not respond to a request for comment on the issue.

Medicaid waiver programs started in the 1980s, after President Ronald Reagan heard about an Iowa girl with a disability who was forced to live in a hospital for months because Medicaid wouldn’t pay for home care. The Republican president thought it was outrageous that the girl, Katie Beckett, had to live that way, even though home care would have been cheaper.

Members of Congress approved allowing states to use their Medicaid programs to pay for in-home care. But they made the change optional, to offer states flexibility and encourage innovation.

Designating such spending as optional “waiver programs” also made the change more politically palatable, said Kim Musheno, senior director of Medicaid policy for The Arc of the United States, which represents people with intellectual and developmental disabilities.

Prospects were much different for babies born with serious disabilities before the change, Musheno said. “Doctors instructed families to forget they existed, and to put them in an institution.”

Waivers have been cut before

All states have Medicaid waiver programs, but benefits and the number of people covered vary significantly. Applicants often wait months or years to get into the programs because of limited funding. More than 600,000 Americans were on waiting lists or “interest lists” for waiver services in 2025, according to KFF, a health information nonprofit that includes KFF Health News.

Disability rights advocates and care providers have fought for decades to maintain funding for the programs, but a national leader said the threat feels especially severe now.

“When Medicaid is cut, people with disabilities are at the center of the impact,” said Barbara Merrill, CEO of the American Network of Community Outcomes and Resources, which represents agencies that care for people with intellectual disabilities or autism.

That’s what happened after Congress reduced Medicaid funding in 2011, according to a recent paper published by Health Affairs.

States could again rein in waiver programs by limiting enrollment, reducing covered services, or cutting pay for caregivers, who already are in short supply.

However, states that try to cut the in-home care programs could face legal challenges, Musheno said. The U.S. Supreme Court declared in 1999 that people with disabilities have a right to live outside of institutions if possible. The decision, in the case of Olmstead v. L.C., has been cited in lawsuits against states that fail to provide care options apart from nursing homes and similar facilities.

Several Iowans who belong to a Facebook group for Medicaid participants have posted in recent weeks that their families were notified of impending cuts in coverage of home care services for people with disabilities.

Sam Walker’s main caregiver, Andy Koettel, has worked with him since Walker was in fourth grade. Koettel, who works full-time, knows how to keep Walker calm in most situations and soothe him during a blowup. Their relationship took years to build, and it is a key reason Walker can continue to live at home with his parents, Koettel said.

“If I was not there, it would be incredibly difficult for all of them,” he said.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

‘Maximum disruption, minimal clarity’: How ‘America First’ aid deals are playing out in Africa

2026-03-05T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

We’ve begun the long rainy season here (we get two each year), which means three months of brisk mornings and muddy shoes. Unfortunately, an influx of mosquitoes will soon follow. But this city sits at a higher elevation than Denver, Colorado, so the malaria risk is extremely low. (It’s too cool for the parasite to reliably develop inside mosquitoes!)

Today we’ve got a hodgepodge of news: from the fragile state of America’s new health deals in Africa, to a one-pill breakthrough, and the latest chapter in the story of the woman whose cells changed medicine. We’ll close with a story whose comedic headline left me no choice but to include it.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

America’s health pivot, finally coming into focus

First up: The United States and the Democratic Republic of the Congo “signed a $1.2 billion health partnership” on Feb. 26, the Associated Press reports.

While the full text of the agreement is not public, it’s noteworthy because this is the 19th one-on-one health agreement the United States has signed directly with an African government since dismantling the U.S. Agency for International Development last year.

It also follows news from last week, with Zimbabwe and Zambia backing away from similar deals.

Some background: Generally speaking, these country-by-country agreements are meant to move U.S. health funding away from non-profit aid organizations and United Nations agencies, and into an “America First” framework of direct partnerships with national governments. While these deals represent a dramatic cut in funding from previous years (at least 25%, but potentially more, depending on how many countries end up without deals), the United States nevertheless remains the largest global health donor on paper.

I covered the first of these deals with Kenya back in December (which is still mired in a legal dispute about the data-sharing demands imposed by Washington). But I’ve largely held off on covering the rest.

Why? Because it’s so early and the implementation has been so chaotic that even my sources inside the State Department struggle to explain how these agreements will (or are) functioning in practice.

Thankfully, I was able to speak with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health for some much needed context. Few people have a clearer view of how global health systems are actually working in today’s crisis settings, and we discussed what he’s seeing and how to make sense of these deals so far.

I started by asking Spiegel frankly: Are these 19 deals a sign of stabilization from the chaos of 2025? While he acknowledged some upsides (which we’ll get to) his overall assessment of the deals, and the year ahead of us, was grim. “No. I think things are going to get a lot worse before they get better,” he said.

Spiegel described “maximum disruption right now with minimal clarity,” and that reality on the ground for lifesaving aid programs is still chaotic, with supply chains disrupted and local partners unsure whether funding will continue month to month. He blames the rushed transition “from the old architecture to something so new, so quickly,” he said. “In the meantime, so many people are going to die and suffer.”

We also zeroed in on what worries us both most. The new U.S. strategy is publicly built around channeling major funding directly to governments that (at best!) lack robust oversight and, in some cases, rank among the worst globally on corruption. And the admittedly cumbersome bureaucracy that once helped curb fraud, waste, and abuse has been functionally stripped of many of its guardrails. (That said, let me acknowledge that it’s difficult to judge the concrete risks, because so few of the agreements’ terms have been made public.)

Spiegel also warned about turning health aid into what is openly described by Washington as a transactional exchange. Beyond the moral argument that “humanitarian assistance should follow need and evidence,” Spiegel said there is a hard practical reality. These programs take years to build, and when funding becomes contingent on unrelated political demands or can be withdrawn overnight, systems unravel quickly. As we’re seeing now, the human cost is immediate, and rebuilding takes years.

What are the upsides? Spiegel acknowledged a “kernel of truth” behind the new strategy, which requires both parties to pony up funds. For years, he said, donors failed to ensure governments built the capacity to manage their own systems. Requiring countries to put in more of their own money is “hugely necessary.”

This is (no longer) spinal tap

Europe has approved a new and simple oral medicine that may finally help win the fight against sleeping sickness, the AP reports.

Disease breakdown: Human “trypanosomiasis” is a highly fatal parasitic disease that’s spread by blood-sucking tsetse flies. Symptoms start flu-like, but as the parasites multiply and attack the nervous system, victims often find their sleep-wake cycle flipped (hence the illness’ common name). Without medicines, coma and death usually follow. Thankfully, treatments developed in the early 2000s slashed infections from many tens of thousands a year to today, where fewer than 600 cases are reported annually.

The new, single-dose pill is called acoziborole. To understand why it could be a game changer, it helps to understand two things: Why we don’t just have a vaccine, and the limits of the treatments we’ve relied on for two decades.

First, the worm-like sleeping sickness parasite has long evaded vaccine efforts thanks to its tricky and unique ability to alter the makeup of its “skin” (technically, its outer protein layer). This shapeshifting both helps the parasite stay ahead of immune defenses, and creates a frustrating, moving target for a hypothetical vaccine.

Second, current treatments for the illness are burdensome. They “can take 10 days,” and “require difficult trips to hospitals from remote villages,” with many patients needing to “undergo spinal taps to help doctors understand the stage of infections,” and which drugs to treat them with.

Keep in mind, many of the people affected by this illness live in incredibly rural or remote areas in equatorial Africa. So, when your nearest hospital is a 10-hour drive away, and may not even have the diagnostics you need … you can see the issue.

The new pill (technically three medicines compounded together) obviates spinal taps, and is highly effective against the disease at a range of stages. The most recent study found that “95% of treated patients were considered cured 18 months later.”

Granted, one powerful drug is not enough on its own to meet the WHO’s elimination goal for the disease of 2030. Ending sleeping sickness also means continuing to find new cases quickly, reducing the number of infected tsetse flies, and stopping the disease from spreading again through animals.

Still, the pill may be the breakthrough needed to make that deadline.

The immortal settlement(s) of Henrietta Lacks

In 1951, doctors at Johns Hopkins Hospital took cancer cells from Henrietta Lacks, a young Black woman in Baltimore, Maryland. They were taken without her knowledge or consent, and she would die months later.

Those cells, dubbed HeLa (for her name), became the first human cells to be grown indefinitely in a lab. It is a fascinating story, one detailed in Rebecca Skloot’s best-selling book The Immortal Life of Henrietta Lacks. Which, if you have not read it yet, this is your reminder.

Lacks’ cells helped unlock the polio vaccine, advance cancer therapies, and grounded decades of other biomedical research. (There’s an obvious benefit to having a standard set of cells you can use to compare or replicate work in various labs worldwide.) And they are still used today: I actually have a personal friend in the UK whose cancer research right now is entirely underpinned by this woman’s cells.

Why is this relevant today? Some 75 years later, Novartis, the Swiss multinational pharmaceutical company, has settled a lawsuit brought by her estate over the use of those cells, the AP reports.

The terms of the settlement were not disclosed. But the case is part of a broader reckoning over who profits from the scientific discoveries that followed Lacks’ death. While “Johns Hopkins said it never sold or profited from the cell lines … many companies have patented ways of using them,” including Novartis.

The settlement follows another “in 2023, [when] Lacks’ estate reached an undisclosed settlement with the biotechnology company Thermo Fisher Scientific Inc.” And the AP reports that “there are other pending lawsuits by the Lacks estate.”

The flu vaccine’s own annual booster

Every year, the World Health Organization convenes a panel of flu experts to make a high-stakes prediction: which versions of the virus are most likely to dominate next winter. Once the experts make their call, vaccine makers lock in that recipe and get to work.

But … it’s a strange ritual when you think about it. We do not rewrite most vaccines annually.

That’s because unlike most viruses, flu evolves gradually *and* abruptly. Flu doesn’t just slowly accumulate small mutations as it spreads. It can also trade whole chunks of its genetic material when two different strains infect the same person, creating entirely new combinations almost overnight.

That brings us to the news: Last week, the expert panel updated the recipe for the Northern Hemisphere’s 2026 to 2027 flu shots, Health Policy Watch reports. And it’s a fuller reset than usual. (Although like last year, the panel is recommending three different flu variants targeted in each shot.)

The biggest shift is in one of the three targets from last year, the H3N2 strain, where a newer genetic branch has taken over globally. As I’ve covered previously, in these strains, the “H and N numbers refer to the shape of two important proteins on the outside of the virus.” Hemagglutinin, or “H,” helps the virus latch onto cells. Neuraminidase, or “N,” helps it break free and spread.

It’s news worth noting for two reasons. One, “there are around a billion cases of seasonal influenza annually,” so hitting or missing the mark on the vaccine, while a (let’s be honest) boring bureaucratic process, could prevent millions of cases or fail to address tens of thousands of deaths. That is not small stakes.

Second, it’s a reminder of something important. No matter where you live, the flu will touch you, your family, or your workplace this year. And experts are clear: Vaccination remains a safe and effective way to blunt the damage.

I applaud you, headline writers

Ok, ok. Please allow me to end on a story whose incredible headline alone forced its way into this report.

It is: “Chimp urine test study bolsters ‘drunken monkey’ theory,” Reuters reports.

(Right? How could I not include it!?)

What’s the story? Actually, something rather fascinating. Researchers studying wild chimpanzees in Uganda’s Kibale National Park have found evidence supporting the so-called “drunken monkey” hypothesis: the idea that primates, including early human ancestors, may have evolved a taste for alcohol because it helped them find calorie-rich ripe fruit.

In tests of 20 urine samples from chimps, collected from puddles on the forest floor, nearly all contained a metabolic marker of ethanol. This is a compound that both chimps and humans produce after drinking alcohol. Some of the ethanol levels were roughly equivalent to having thrown back a few beers, or a single cocktail.

Narrowly, the findings suggest that at least some chimps, our closest primate relatives, regularly consume naturally fermented fruit and metabolize the alcohol in it. More broadly, the study adds support to the speculation that our attraction to booze may precede the human inventions of beer, wine, cider, or spirits.

What’s my takeaway? Ultimately, this story is not just about tipsy chimps. It is about why we are drawn to alcohol in the first place, and how deep that relationship runs in our evolutionary wiring. I brew and adore craft beer (and have no plans on stopping), but we know that alcohol use and abuse today drives millions of deaths annually, from liver disease to injuries to cancer. Understanding whether our attraction is cultural, biological, or both is not just trivia.

But also… tipsy chimps!

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

2026-03-04T23:49:23+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

South Carolina has spent an estimated $1.6 million so far on public health efforts to combat its huge measles outbreak, according to information the state’s health department provided to Healthbeat on Wednesday.

The outbreak, which began with just five known cases in October, surged in January following the winter holidays, and has slowed in recent weeks. The total number of people infected in the outbreak, which is centered around Spartanburg County, reached 990 this week.

Most of the estimated $1.6 million spent so far on the outbreak response has been for personnel, the South Carolina Department of Public Health said in response to Healthbeat’s questions.

As the outbreak grew, the number of staff assigned to work full-time on the outbreak grew to as many as 90 people, said Dr. Linda Bell, the state epidemiologist.

Most of these staff, Bell said, have been involved in doing investigations of individual measles cases and tracing their contacts to help identify and quarantine those at risk of infection and further spread of the disease.

S.C. measles cases surged after holiday school closures delayed outbreak investigations

Funding for some of the outbreak’s public health costs has come from the Centers for Disease Control and Prevention, through an immunizations cooperative agreement, which helps with outbreak response activities, the South Carolina DPH said. Additional funding has come from a H5N1 Public Health Crisis Response Cooperative Agreement, which funds influenza and other public health emergency preparedness and response, the department said, as well as some other state and federal funds.

Although the number of new measles cases being detected each week has dropped significantly, the outbreak continues. The department said that final costs will be calculated once the outbreak is over.

But the threat the outbreak could surge again remains – especially with the potential for the virus to spread during the upcoming spring break travel period, Bell said.

“We remain concerned and must be mindful of the fact that we can see cases increase again from the low number that we’re seeing now,” she said. In recent weeks, the outbreak has slowed to about 10 new cases a week amid increases in measles vaccination in the Spartanburg County area and across the state.

The increased travel during school spring break raises the potential for the kind of increased spread of measles that South Carolina experienced over schools’ winter break period. “In the two consecutive weeks following the Christmas holidays, we had over 200 cases reported in each of those weeks,” Bell said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Trump surgeon general pick Casey Means: How her medical experience compares to previous doctors in role

2026-03-04T17:28:51+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

President Donald Trump’s pick for U.S. surgeon general defended her credentials to serve as the nation’s next top doctor during a Senate committee hearing last week.

Dr. Casey Means, a wellness entrepreneur and best-selling author, received her bachelor’s degree in human biology and her medical degree from Stanford University. She then began her residency in otolaryngology, which involves head and neck surgery, at the Oregon Health and Science University in Portland.

But Means quit her medical residency training in the final year of the five-year program. Her medical license is listed as inactive.

A Healthbeat review of the medical backgrounds of every surgeon general confirmed during the past 50 years shows all completed a medical residency and many also had significant leadership experience in academia or government service before becoming surgeon general.

Some have been confirmed despite questions about their credentials. They include the nation’s 17th surgeon general, Dr. Richard Carmona, who took eight years to become board certified for general surgery. Dr. C. Everett Koop, the nation’s high-profile 13th surgeon general, was technically too old for the role, until the rules were changed for him.

As surgeon general, Means would lead the U.S. Public Health Service Commissioned Corps, whose 6,500 members provide health and medical services throughout the federal government. It is one of the nation’s eight uniformed services.

Means has said she resigned her residency “to focus on reforming the ‘sick care’ paradigm in American health care.” The chairman of the otolaryngology department, where Means quit her residency, told Vanity Fair last year that Means left because she found surgical work “too stressful.”

According to the American Medical Association, a residency is a “crucial phase in a physician’s training.” The length of a residency program’s supervised, on-the-job clinical training can range from three to seven years, depending on the medical specialty.

4 calls to action from public health leaders who served in Republican and Democratic administrations

Means has noted she would bring other experiences to the job of surgeon general, including her work as an entrepreneur and health communicator.

In 2019, Means co-founded the wellness company Levels, which sells health improvement memberships that include the use of continuous glucose monitors. In 2024, she published the book “Good Energy: The Surprising Connection Between Metabolism and Limitless Health” with her brother, Calley Means, who is an adviser to Health and Human Services Secretary Robert F. Kennedy Jr.

“My professional history is a feature, it’s not a bug,” Means told senators during last week’s hearing. “I have had a unique history that has merged entrepreneurship, public health advocacy, faculty course direction at Stanford University, as well as being an editor of a medical journal and a biomedical researcher. And in these complex times for American health care, that type of multidisciplinary history is going to be extremely valuable for the American people.”

She compared her credentials to past surgeons general.

“I practiced medicine. I owned my own medical practice, and I’ve seen thousands of patients, and I did over four years of surgical training, which is more than many of our past surgeon generals completed who did medical specialties,” she testified.

Here is the medical background for each of the 10 surgeon generals whose nominations have been confirmed during the past 50 years:

Julius B. Richmond – 12th surgeon general

Service: 1977-81

Nominated by: President Jimmy Carter

Education: B.S., University of Illinois at Urbana; M.S. in physiology and MD, Illinois’s College of Medicine in Chicago

Dr. Julius Richmond

Medical background before nomination: After medical school, Richmond had a rotating internship at Cook County Hospital in Chicago, according to his official surgeon general biography. He then began two pediatrics residencies, with the first at Chicago’s Municipal Contagious Disease Hospital and the second – which was interrupted by World War II – at Cook County Hospital. During World War II, he served as a flight surgeon with the Air Force’s Flying Training Command. After the war, he completed his residency and became a professor, holding various academic positions at the State University of New York Upstate Medical Center in Syracuse, where he became the dean. Over the years, he examined how poverty impacted the psychosocial development of children, becoming the first director of Head Start in 1965. At the time Carter nominated Richmond for surgeon general, he was a professor at Harvard Medical School, where he held multiple leadership positions, including serving as chief of psychiatry at Children’s Hospital Medical Center in Boston.

C. Everett Koop – 13th surgeon general

Service: 1982-89

Nominated by: President Ronald Reagan

Education: B.A., Dartmouth College; MD, Cornell Medical School; D.Sc., University of Pennsylvania Graduate School of Medicine

Dr. C. Everett Koop

Medical background before nomination: After a one-year internship at Pennsylvania Hospital in Philadelphia, Koop did further postgraduate training at the University of Pennsylvania School of Medicine, Boston Children’s Hospital, and the University of Pennsylvania Graduate School of Medicine. Koop’s surgical residency training at the University of Pennsylvania Hospital, which began in 1942, was allowed to be completed in half the usual nine years because of the demand for surgeons during World War II and his skill, according to his National Library of Medicine biography. He was surgeon-in-chief at the Children’s Hospital of Philadelphia from 1948 to 1981, where he established the nation’s first neonatal intensive care nursery and helped establish the American Academy of Pediatric Surgeons, according to his official surgeon general biography. In 1981, Reagan initially appointed Koop as deputy assistant secretary of health “with the promise that he would be nominated as surgeon general.”

Of note: Koop’s nomination was delayed because of rules that required the surgeon general to be younger than 64 – and he was 64 at the time. The rules were eventually changed, according to a 1981 article in CQ Almanac. He then faced significant opposition for his anti-abortion views and opposition to certain birth control methods. The American Public Health Association and the National Organization for Women were among groups opposing his nomination, CQ Almanac reported.

Antonia C. Novello – 14th surgeon general

Service: 1990-93

Nominated by: President George H.W. Bush

Education: B.S., University of Puerto Rico at Rio Piedras; MD, University of Puerto Rico School of Medicine at San Juan; MPH, Johns Hopkins University

Dr. Antonia Novello

Medical background before nomination: After medical school, Novello completed an internship and residency in nephrology at the University of Michigan Medical Center in Ann Arbor, where she also did a fellowship in the Department of Internal Medicine, according to her official surgeon general biography. She did an additional fellowship in the Department of Pediatrics at Georgetown University before working in a private pediatrics practice for a few years. In 1978, she joined the U.S. Public Health Service Commissioned Corps and held various positions at the National Institutes of Health. By 1986, she had become deputy director of the National Institute of Child Health and Human Development and began working on pediatric AIDS.

Of note: Novello was the first woman and first Hispanic surgeon general.

M. Joycelyn Elders – 15th surgeon general

Service: 1993-94

Nominated by: President Bill Clinton

Education: B.A. in biology, Philander Smith College; MD, University of Arkansas Medical School; M.S. in biochemistry, University of Arkansas

Dr. Jocelyn Elders

Medical background before nomination: Before going to medical school, Elders worked as a nurse’s aid in a Veterans Administration hospital, then spent three years in the Army, where she received training as a physical therapist. She then got her medical degree, completed an internship at the University of Minnesota Hospital and a pediatrics residency at the University of Arkansas Medical Center, where she went on to serve as a professor with a focus on childhood sexual development. In 1987, Clinton – then governor of Arkansas – appointed Elders to be director of the Arkansas Department of Health. The year before she became surgeon general, she was elected president of the Association of State and Territorial Health Officers.

Of note: Elders, who was the first Black surgeon general, advocated for sex education in schools. She was forced to resign because of comments she made relating to masturbation being a less risky form of sex that “perhaps should be taught.” She made the comments following a World AIDS Day speech.

David Satcher – 16th surgeon general

Service: 1998-2002

Nominated by: President Bill Clinton

Education: BS, Morehouse College; MD, PhD, Case Western Reserve University

Dr. David Satcher

Medical background before nomination: After receiving his medical degree, Satcher received his residency and fellowship training at Strong Memorial Hospital, University of Rochester, UCLA, and King-Drew Medical Center in Los Angeles, according to his official surgeon general biography. Satcher was a professor and chairman of the Department of Community Medicine and Family Practice at the Morehouse School of Medicine in Atlanta, then served as president of Meharry Medical College from 1982 to 1993 before becoming director of the Centers for Disease Control and Prevention in November 1993. Satcher was CDC director when Clinton announced his nomination for surgeon general in September 1997. Before becoming surgeon general, Satcher had received high-profile professional honors, including being elected to the Institute of Medicine of the National Academy of Sciences in 1986.

Of note: Although initially nominated by Clinton, Satcher served out a four-year term that ended during the administration of President George W. Bush.

Richard H. Carmona – 17th surgeon general

Service: 2002-06

Nominated by: President George W. Bush

Education: Associate of arts degree, City University of New York; B.S. and MD University of California, San Francisco; MPH, University of Arizona

Dr. Richard Carmona

Medical background before nomination: After medical school, Carmona completed a surgical residency at the University of California, San Francisco, and also a National Institutes of Health-sponsored fellowship in trauma, burns, and critical care, according to his official surgeon general biography. He had served as chairman of the State of Arizona Southern Regional Emergency Medical System; as a surgeon and deputy sheriff for the Pima County Sheriff’s Department; and as a professor of surgery, public health and family, and community medicine at the University of Arizona.

Of note: After his nomination, the Los Angeles Times reported that it took Carmona eight years to receive his board certification for general surgery after he twice failed the exam. During Carmona’s Senate confirmation hearing in July 2002, U.S. Sen. Edward Kennedy, the committee’s chair, questioned Carmona about this. “There was never any issue with my competence,” Carmona testified. “I passed the required test for the American Board of Surgery in the time allotted by the American Board of Surgery. That is a voluntary process. No one has to undergo these testing. Most of us do it on a voluntary basis. The Board of Surgery has a window of opportunity that you can apply and take the test. I did so, and passed within the time.” And Carmona added: “As far as my competency or the capacity as a medical professional, a single test is probably not a very good indication of anybody’s specific knowledge. I would say that probably my couple of decades of practice would be a far better indicator of my level of competence.” At the conclusion of the hearing, Kennedy told Carmona: “I am confident you will be confirmed.”

Regina M. Benjamin – 18th surgeon general

Service: 2009-13

Nominated by: President Barack Obama

Education: B.S., Xavier University of Louisiana; MD, University of Alabama at Birmingham; MBA, Tulane University

Dr. Regina Benjamin

Medical background before nomination: After receiving her medical degree, Benjamin completed her residency in family medicine at the Medical Center of Central Georgia in Macon. In 1990, she founded the Bayou La Batre Rural Health Clinic in Bayou La Batre, Ala., where her work received national attention and awards for continuing to treat patients in the aftermath of Hurricanes Georges in 1998 and Katrina in 2005. In 2008, the year before her nomination, Benjamin was the recipient of a MacArthur Foundation Fellowship, a prestigious honor sometimes referred to as the “genius grant.” The foundation cited her work as “a rural family physician forging an inspiring model of compassionate and effective medical care in one of the most underserved regions of the United States.” When she became president of Alabama’s state medical association in 2002, she also became the first Black woman to be president of a state medical society, according to her official surgeon general biography. She also had served as associate dean for rural health at the University of South Alabama College of Medicine and was a past-chair of the Federation of State Medical Boards of the United States.

Of note: While the Senate confirmed Benjamin’s nomination on a voice vote, some raised concerns about her paid service on an advisory board for the fast food company Burger King, which said her work involved nutrition advice. Other critics focused on her weight.

Vivek H. Murthy – 19th and 21st surgeon general

Service as 19th Surgeon General: 2014-17

Nominated by: President Barack Obama

Service as 21st Surgeon General: 2021-25

Nominated by: President Joe Biden

Education: B.A., Harvard University; MD, MBA, Yale University

Dr. Vivek Murthy

Medical background before nomination: After finishing his medical degree and master’s in business administration, Murthy completed his internal medicine residency training at Brigham and Women’s Hospital and Harvard Medical School, then joined the school’s faculty as an internal medicine clinician-educator, according to his official surgeon general biography and personal website. He was a co-founder of VISIONS, an HIV/AIDS education program in India and the United States; and he also was a co-founder of the Swasthya project, which trained women in rural India to be health providers and trainers. He was the co-founder and chair of a software technology company, TrialNetworks, that provides tools for clinical trials.

Of note: Murthy’s confirmation was delayed for more than a year after the National Rifle Association and others promoted posts by Murthy on social media in which he said guns were a health issue. Murthy also drew opposition from Republicans, who cast him as a politically connected supporter of Obama and the administration’s Affordable Care Act. Murthy’s experience prior to his first confirmation hearing included being a co-founder of a nonprofit group called Doctors for Obama, which later became Doctors for America. When he was confirmed for his first term as surgeon general in December 2014, Murthy, who was then 37, became the youngest person appointed to the position and the first person of Indian descent to hold the position.

Jerome M. Adams – 20th surgeon general

Service: 2017–21

Nominated by: President Donald Trump (first term)

Education: Bachelor’s degrees in biochemistry and psychology, University of Maryland, Baltimore County; MPH, University of California at Berkeley; MD, Indiana University School of Medicine

Dr. Jerome Adams

Medical background before nomination: After receiving his medical degree, Adams completed an internship at St. Vincent’s Hospital in Indianapolis and a residency in anesthesiology at Indiana University. His past experience included working as a general anesthesiologist at Ball Memorial Hospital in Muncie, Ind., as a physician rapid responder at Indianapolis Orthopaedic Hospital, as an assistant professor of clinical anesthesiology at Indiana University School of Medicine, and as a staff anesthesiologist at Eskenazi Health. In 2014, then Indiana Gov. Mike Pence, who would later become Trump’s first vice president, named Adams to be commissioner of the Indiana State Department of Health.

Of note: Unlike Trump’s current surgeon general nominee’s hearing last week, Adams’ confirmation hearing in 2017 was described in media accounts as being “mostly collegial” and “largely friendly.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Anti-vaccine polices may be slowing, but the damage could be lasting

2026-03-04T12:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a national nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

This week, I have been watching signs that the federal government’s rollback of vaccines may be slowing, although the detrimental impact on public health may be long-lasting.

Is the rollback of U.S. vaccines ending?

In the 12 months after Robert F. Kennedy Jr. was confirmed as secretary of the U.S. Department of Health and Human Services, the federal government took dramatic steps to stop the development and delivery of vaccines that protect children and adults against infectious diseases. Is it possible these efforts are slowing or even stopping?

Media outlets have recently reported that RFK’s anti-vaccine actions represent a big political risk for the GOP heading into the midterm elections and that he has been instructed to delay or stop anti-vaccine activities — at least for now. According to Politico, President Donald Trump’s own pollster, Tony Fabrizio, found that Kennedy’s moves to downsize the childhood vaccine schedule are broadly unpopular. A White House official summarized the administration’s new posture with striking bluntness: “I think we’re largely done with vaccines.”

Indeed, despite the increasing prominence of the anti-vaccine movement on social media and in politics, polls conducted in the past few months show that the American public still thinks highly of vaccines, favors mandatory vaccination for school attendance, fears the return of vaccine-preventable infections, and believes recent vaccine policy changes will harm children’s health.

How experts and institutions have pushed back

Prominent experts and professional organizations in public health and clinical medicine — including pediatrics, general adult medicine, obstetrics and gynecology, and infectious diseases — have taken strong public stances opposing the administration. Notably, the American Academy of Pediatrics, a longstanding partner and adviser to the Centers for Disease Control and Prevention on childhood vaccines, just published its own independent pediatric vaccine schedule for 2026. At the bottom of the webpage is a pointed note that the CDC has a different vaccine schedule that “is not currently endorsed by the AAP.”

While the pharmaceutical and biotechnology industry has been largely muted in its public statements, one notable exception is Pfizer CEO Albert Bourla. Speaking at the World Economic Forum in Davos in January, Bourla called Kennedy’s rhetoric and policies on vaccines “anti-science” and described his opposition to vaccines as being “almost like a religion.”

The strongest institutional pushback is coming from states. Fifteen states just filed suit against HHS to reverse the administration’s decision to reduce the number of diseases children are routinely immunized against from 17 to 11. The lawsuit also challenges the “unlawful replacement” of members of the Advisory Committee on Immunization Practices and asks the courts to nullify Kennedy’s January revision to the childhood vaccine schedule.

As researchers at Georgetown University’s Commonwealth Fund document, states are working to delink their vaccine and preventive care standards from federal entities that they no longer trust. States are joining together in regional scientific bodies to independently review vaccine evidence and publish their own recommendations. An umbrella organization, the Governors Public Health Alliance, has been created to coordinate across the different regional state coalitions.

Are there positive signs in vaccine policy?

I have some hope that the pushback from experts, professional societies, industry, and states is working. Here are a few important signs from the past month.

On Feb. 11, the Food and Drug Administration surprised the pharmaceutical and biotechnology world with an unprecedented “refusal to file” response to Moderna’s application for an mRNA flu vaccine. Then, a few days later, the FDA suddenly reversed that decision. The FDA’s reversal on Moderna’s vaccine has been widely attributed to White House pressure on the FDA, suggesting that even within an administration that is skeptical of vaccines, they are still reluctant to block vaccine companies from even having their products reviewed by FDA.

The CDC’s ACIP meeting originally scheduled for February has been postponed to March 18, and the agenda is, to say the least, unusual. Rather than proposing revisions to the vaccine schedule, reviewing the efficacy of existing vaccines, or reviewing new vaccines, the ACIP meeting will focus instead on the methodology of how ACIP makes recommendations, on Long Covid, and on vaccine injuries. That is a meaningful retreat from where this panel was six months ago.

The administration also suffered a loss in its effort to find data to support its opposition to the hepatitis B vaccine. A few months ago, the administration directed the CDC to fund a randomized controlled trial of birth-dose hepatitis B vaccine in Guinea-Bissau conducted by the University of Southern Denmark. The protocol proposes to withhold the vaccine from half of 14,000 newborns in Guinea-Bissau, where nearly 20% of people already carry chronic hepatitis B infection and where up to 90% of babies exposed to the virus at birth will go on to develop chronic infection.

The World Health Organization called withholding the vaccine from newborns in Guinea-Bissau “serious and potentially irreversible harm” and raised significant concerns about the study’s scientific justification and ethical safeguards. The government of Guinea-Bissau announced last week that it would not permit the trial to go forward. “It’s not going to happen, period,” the country’s foreign minister told Reuters.

And, perhaps most remarkably, the CDC’s recently appointed principal deputy director, Dr. Ralph Abraham, abruptly resigned after less than two months on the job. Abraham is a prominent skeptic of vaccines and his appointment seemed to signal that the agency was going to completely realign itself in opposition to vaccines. After assuming his position, Abraham shocked the public health community by saying that the ongoing measles outbreaks, including child deaths, and the loss of the United States’ measles elimination status was, in his words, the “cost of doing business.”

Abraham’s departure leaves the CDC without a permanent director or deputy director. (The administration has taken the unusual position of appointing NIH Director Jay Bhattacharya also to be the acting director of the CDC, a move that Yale public health professor and activist Greg Gonsalves says means he can now “do two jobs terribly.”)

U.S. immunization programs face death by a thousand cuts

While I am optimistic that the vaccine rollback is slowing, I am fearful of the damage that’s already been done. Even if HHS slows down or halts future anti-vaccine efforts, the administration has already pursued a “death by a thousand cuts” strategy: defunding basic vaccine science and clinical trials, raising the regulatory bar for FDA approval, stocking advisory committees with self-described anti-vaxxers, and cutting resources for public education and outbreak response.

The damage from 2025 will not be undone by a midterm-driven political pivot. While many states are doing heroic work to preserve vaccine access, some states are moving in the opposite direction, adopting their own anti-vaccine statutes that could outlast any particular administration.

In 2026 and beyond, we are likely to be left with fewer vaccines in development, uneven standards from state to state, confused providers and patients, and the slow erosion of the unified national infrastructure that once made the U.S. childhood immunization program the envy of the world.

Wishing you a healthy week,

Jay

SNAP work requirements take effect: What New Yorkers need to know

2026-03-02T16:19:43+00:00

Some New Yorkers receiving food stamps must prove they are working, studying or volunteering for at least 80 hours per month or risk losing the benefit under new federal rules that began Sunday.

The changes immediately apply to approximately 123,000 able-bodied adults without dependents (ABAWD), according to the city’s Human Resources Administration. That number may rise as more people apply or recertify for benefits, the agency said.

New York, like many cities across the state and country, was left scrambling last year to adjust to the new requirements set by the Trump administration and to help those who will be affected by the changes to the Supplemental Nutrition Assistance Program or SNAP, also known as food stamps, keep their benefits.

No one will lose benefits immediately, said HRA administrator Scott French. Rather, March 1 is when the new work requirements are fully phased in, and recipients who fail to comply for any three months over the next three years would lose benefits.

The changes also apply to people previously exempt from work requirements, including homeless people and veterans.

In an interview with THE CITY, French urged people who believe they may be impacted by the changes to get in touch with the agency as soon as possible, either at an HRA office or through the agency’s online portal — and to respond to notices from the agency immediately.

“The most important thing that I think we can stress to folks is to reach out,” French said. “We don’t want people to not take action because they’re not sure what they’re supposed to do.”

The new work requirements apply to adults aged 18 to 64 who are able to work and do not live with a child under the age of 14. They can satisfy the work rules by doing paid work for at least 20 hours a week, with some exceptions; studying or learning job skills approved by HRA for at least 20 hours a week; or by volunteering.

Many ABAWD’s have already had to prove they are working long before the federal government enacted these changes, said Joel Berg, the CEO of Hunger Free America, a national nonprofit that helps people access SNAP benefits and provides other food assistance. He and other advocates fear that the additional paperwork will mean people who are entitled to their benefits may get kicked off based on simple human error.

“I call them work reporting requirements, because even people who are working have to actually report to the city that they’re working,” he said.

As the March 1 deadline neared, Berg described the emotions he’s heard from SNAP recipients and from community-based organizations that work with them as ranging “from focused determination to outright panic.”

“The bottom line is, this is a huge challenge,” he said. “We’re seeing that from the people we represent, from resignation, to reality, to true fear and worry and panic that some of the most vulnerable people are going to lose their main source of food.”

Rita Vega, who leads the housing and public benefits program at Legal Services NYC, said her group has also heard from older New Yorkers who have found themselves forced to return to work to keep their food stamps. The previous ABAWD rules applied to adults aged 18 to 54, but now adults up to age 64 will have to comply.

“Let’s say I’m 62, and I’m retired — do I still have to work in order to keep my SNAP?” said Vega. “I think people are grappling with these rules that are new to them, and facing these tough decisions themselves.”

Mamdani confident city will ‘meet the moment’

The changes stem from the “Big Beautiful Bill” that President Donald Trump signed into law last July, enacting more than $1 trillion in cuts to Medicaid and SNAP.

Though the federal government initially moved to enact those cuts — including the new work requirements — last fall, several states including New York successfully sued to extend waivers through February in order to give them more time to prepare for the changes.

Since last year, HRA and community-based organizations have been working around the clock to ensure SNAP recipients are aware of the changes, and have stepped up their efforts to help people enroll in workforce development programs. The agency and its partners have also encouraged SNAP recipients to check if they may qualify for medical waivers that exempt them from the work rules.

To date, HRA has held 14 training sessions with its community partners and trained more than 400 people on the new SNAP policy changes, according to the agency.

French, the HRA administrator, was unable to say how many of the 123,000 people the agency identified and reached out to had responded and updated their paperwork, or to say how many were placed in workforce development programs thanks to the agency’s efforts.

“We feel prepared right at this moment, but it’s obviously something that we’re going to track as implementation continues, and make sure that we’re tracking trends and looking where we may need to enhance outreach efforts,” he said.

At an unrelated press conference on Friday, Mayor Zohran Mamdani acknowledged the increased burden on HRA but said he is “confident” in the agency’s ability to “meet the moment, and in our city administration’s commitment to helping them do so.”

Vega, from Legal Services NYC, said that while she commended the city’s efforts to inform people about the changes, the coming months will show if those efforts have been sufficient.

“That may be where the turbulence is. If something is lost in the process, that’s where we know our clients may actually be at risk of losing their benefits,” she said.

Berg from Hunger Free America said the state and city can do more to help, from working with the private sector on jobs programs to partnering with more nonprofits on a comprehensive plan to ensure people keep the benefits they need.

The group has called on state lawmakers and Gov. Kathy Hochul to authorize funding to help anyone who is kicked out of SNAP because of the changes.

“We really need an all-hands, multi-agency state and city response,” he said. “And the truth is, we can’t rely on any help whatsoever from the federal government.”

Additional reporting by Samantha Maldonado.

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

A health care executive is running for Ga. governor. His company has had about $1B in state contracts.

2026-02-27T20:01:25+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

The latest candidate to enter the Georgia Republican primary for governor is a health care executive whose company supplied hospital and nursing home workers during the Covid emergency under a state contract.

Billionaire Rick Jackson’s companies have been paid nearly a billion dollars by state agencies since fiscal 2020, according to a Healthbeat analysis of government records.

That includes about $710 million, starting in 2020, from the Department of Community Health, for health care staffing services. Much of that work ended by 2023, but Jackson Healthcare subsidiaries remain state contractors for other services.

The candidate’s campaign materials describe a rags-to-riches story of growing up in foster care and going on to build a health care empire. Jackson Healthcare, founded in 2000, has grown to include 21 subsidiaries, most of them providing health care staffing. Jackson Healthcare also owns USAntibiotics, which says it is the country’s sole manufacturer of two widely used antibiotics. The company operates in all 50 states, according to his campaign website.

Jackson, 71, who entered the governor’s race in early February, has quickly gained steam against previous front-runner Lt. Gov. Burt Jones in the primary, with two recent polls showing Jackson leading among voters who have made a decision. Jackson plans to spend at least $50 million of his fortune to fuel his campaign, according to news reports.

Jackson’s companies have active contracts with the Department of Behavioral Health and Developmental Disabilities but the agency did not respond to multiple queries about the value of those contracts.

A Department of Public Health representative also refused to answer questions about that agency’s contracts with Jackson Healthcare subsidiaries.

If Jackson becomes governor, he may need to take steps to separate his business interests to avoid ethical or legal challenges over conflicts of interest, legal and ethics experts said.

His campaign wouldn’t make Jackson available for an interview with Healthbeat but said the company “has always and will always follow the law” with respect to its state contracts.

Georgia law generally prohibits elected officials from holding contracts with the state government, said Matt Maguire, a longtime Atlanta attorney who specializes in government contracts. But there are several exceptions – including for contracts that existed prior to an official being elected.

And Georgia law isn’t clear on whether Jackson Healthcare or its subsidiaries could bid for new contracts, Maguire said, pointing to a possible exception for professional employment services. There are also exceptions in the case of an emergency, or if there is only one company that could provide the needed services.

Edward Queen, an attorney and professor at the Emory University Center for Ethics, said that if Jackson is elected, he should disengage from decision-making related to his businesses, and assets related to those businesses should be put in a blind trust.

Queen said he would expect Jackson to resign from Jackson Healthcare and its subsidiaries, and the company should refrain from bidding future contracts with the state while he is in office.

“If you want to do the state’s business as an elected official, then focus on the state, not whatever your ongoing organization or corporate interests are,” Queen said.

It’s important to create such firewalls to bolster the public’s trust in the government and ensure that officials act in the public interest, experts said.

“If there are any questions as to whether the government contracts with this governor are changed, enhanced or in some way further benefit the governor, there will always be a cloud of suspicion as to whether he’s violating that fundamental ethics principle,” said Kedric Payne, an attorney who leads the ethics program at the Campaign Legal Center, a nonpartisan national organization focused on democracy.

Queen and Payne said the public should be informed about elected officials’ business interests well ahead of Election Day. Georgia’s party primaries for governor are scheduled for May 19, with the general election set for Nov. 3.

“Information about the government contracts of the candidate should be made public,” Payne said.

Jackson Healthcare supplied doctors and nurses during Covid

Jackson points to his health care experience as evidence of his commitment to the state’s well-being.

“When Covid hit Georgia, Gov. [Brian] Kemp asked Jackson for more doctors and nurses,” a campaign ad states. “And Jackson delivered again, refusing to send help to New York until Georgia got the emergency care it needed.”

Georgia’s largest health agency, DCH, paid a Jackson Healthcare subsidiary $709 million in federal American Rescue Plan Act funds starting in 2020 for the staffing services. The agency also paid the Alpharetta-based company an additional $511,353 in state funds, said spokesperson Lauren Williams.

The funds paid for doctors, nurses, therapists, laboratory technicians, housekeeping, and food service workers during the pandemic.

DCH worked with DPH to “triage” requests from Georgia facilities that faced staffing challenges, Williams said.

Jackson Healthcare subsidiary Healthcare Workforce Logistics then created contracts with the selected facilities. The costs were subsequently paid by DCH after approval of documentation, Williams said. She did not answer a question about whether those contracts are still active.

The DCH agreement was described as a sole-source contract by Georgia Health News in 2021, and the bidding opportunity is not listed in the Georgia Procurement Registry, the online database that details state contracting opportunities.

Healthbeat requested a copy of the contract from the state via an open records request on Feb. 10 but had not received it by Friday.

Jackson will work to increase health care access and lower costs for Georgians, campaign spokesperson Brian Robinson said, adding, “Other politicians talk about it, Rick will get it done.”

Subsidiaries have had contracts for mental health services

Jackson Healthcare subsidiaries held contracts with other state agencies as well.

DBHDD has held contracts with subsidiaries since at least 2015 for mental health care professionals to work at state psychiatric and other facilities, state records show. Those contracts appear to have been awarded through a competitive bidding process, with other companies also winning contracts.

Department spokesperson Camille Taylor did not respond to a question about how much the company had been paid for its services, but state records indicate the agency has paid Jackson Healthcare subsidiaries about $239 million since fiscal 2020.

Jackson Healthcare subsidiaries also worked for the Department of Human Services, which includes the Division of Family and Child Services that oversees the state’s foster care program. DHS used the existing DCH contract with subsidiary Healthcare Workforce Logistics in 2022 and 2023 due to a staffing crisis, agency spokesperson Ellen Brown said.

DHS paid a total of $7.4 million to the company for workers to help with “complex youth in foster care, including youth who require hospitalization at psychiatric residential treatment facilities, youth with intense behavioral and mental health needs, youth with moderate developmental delays, and youth with autism,” Brown said.

That contract is no longer in effect, she said.

Jackson has been a longtime donor to GOP politicians, including to some of his current opponents for governor: Republican Secretary of State Brad Raffensperger; Attorney General Chris Carr; and former Lt. Gov. Geoff Duncan, who was then a Republican but is now running in the Democratic primary.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

4 calls to action from public health leaders who served in Republican and Democratic administrations

2026-02-27T00:24:54+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Public health is inherently political because it often involves policy decisions, but it shouldn’t be partisan.

That was among the key messages during the 2026 State of the Public Health Union webinar Thursday with three former directors of the Centers for Disease Control and Prevention and a former U.S. surgeon general who served under Republican and Democratic administrations. The 90-minute event, which can be watched on YouTube, is organized annually by the American Journal of Public Health.

Here is one takeaway from each of the four speakers.

Dr. Tom Frieden, former CDC director (2009-17)

Frieden served as CDC director under President Barack Obama. He is now president and CEO of Resolve to Save Lives, a global health organization.

“I don’t agree with the statement that we have to get the politics out of public health. I think we need to get the partisanship out of public health. There are decisions about public health that communities should make. At what [blood alcohol] level should we tell people that they shouldn’t drive? … Should we take over land to make safe water for our community? Does a community decide to be smoke-free in their restaurants or bars or parks? These are community decisions. They’re policy decisions. What has infected public health over the past few years is a partisanship. I think this is something that all of us – right, left, Democratic, Republican, progressive, conservative – should try to address. Sen. [Daniel Patrick] Moynihan used to say that you’re entitled to your own opinion, but not to your own facts. And unfortunately, today, it seems like people feel they’re entitled to their own facts.”

Dr. Jerome Adams, former U.S. surgeon general (2017-21)

Adams served as surgeon general during President Donald Trump’s first term. He is now executive director of the Center for Community Health Enhancement and Learning at Purdue University.

“We’ve got to reclaim public health as consistent with conservative principles, not against conservative principles. It’s about personal responsibility, strong families, a ready workforce, military preparedness, and reducing wasteful downstream spending. Those are all conservative principles. Prevention aligns with fiscal responsibility. Clear, accurate information aligns with individual liberty, because you can’t make an informed choice without trustworthy facts. Second, we need trusted messengers. And in many conservative communities, people are going to be far more likely to trust their pastor, their local physician or pharmacist or nurse practitioner, their sheriff, or their governor than they are any federal agency. So that means empowering state and local leaders and respected voices within conservative circles to speak clearly and consistently about evidence-based health information. And then third, we’ve got to be willing to call out misinformation even when it’s politically inconvenient to the point I raised earlier. If we stay silent, when bad information spreads because it benefits our side, we lose credibility.”

Dr. Robert Redfield, former CDC director (2018-21)

Redfield served as CDC director during Trump’s first term. He is now a senior visiting fellow for biosecurity and public health policy at the Heritage Foundation, a conservative think tank.

“We need to learn how to share our differences of opinion on public health issues, but to do it respectfully ... I’ve said many times that vaccination, I think it’s one of the most important gifts of science to modern medicine. And it’s very disconcerting to see people being encouraged to leave it on the shelf rather than to embrace it. But I think if we could just have a little more honest debate among ourselves about different opinions on what policy directions we think we should go, but to do it in a respectful way, knowing that, you know, each of us really cares deeply about the public health of our nation, and we may see things slightly differently … When we see things that are obviously true, we need to speak out and clearly say that they’re true. For example, we’re dealing as you know now with measles in South Carolina, in Florida, in Texas, in Arizona. And we all know that the best way to stop the measles pandemic is to get the American public vaccinated against measles. Period. There doesn’t need to be any qualifiers around that.”

Dr. Mandy Cohen, former CDC director (2023-25)

Cohen served as CDC director under President Joe Biden. She is now a national adviser at Manatt Health, a health care consultancy.

“In order for us to fulfill our mission of protecting health and improving lives, we need the federal government – and state and local governments – all working well and working together. But there are things that you do not want to create, state by state by state. Some of that is certainly a data architecture, right? … [Public health cannot do its job] if you don’t have that visibility of what’s going on, both around you and, frankly, internationally as well. So CDC certainly has to maintain those connectivities and the data systems. But then it’s also expertise. We have wonderful experts at the state level, but they can’t be an expert in every rare pathogen. And so having both the laboratory expertise, the pathogen-specific expertise at the federal level is really important … I am very concerned about us pulling back in our global footprint. And that is something that needs to be done in a coordinated way at the country level, at a federal level, so that we are making sure to protect us here at home. So those are the things the feds need to do.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

‘You aren’t trapped’: Hundreds of U.S. nurses choose Canada over Trump’s America

2026-02-26T13:57:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Last month, Justin and Amy Miller packed their vehicles with three kids, two dogs, a pet bearded dragon, and whatever belongings they could fit, then drove 2,000 miles from Wisconsin to British Columbia to leave President Donald Trump’s America.

The Millers resettled on Vancouver Island, their scenic refuge accessible only by ferry or plane. Justin went to work in the emergency room at Nanaimo Regional General Hospital, where he became one of at least 20 U.S.-trained nurses hired since April.

Fear of Trump, some of the nurses said, was why they left.

“There are so many like-minded people out there,” said Justin, who now works elbow to elbow with Americans in Canada. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

The Millers are part of a new surge of American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April. As the Trump administration enacts increasingly authoritarian policies and decimates funding for public health, insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system.

Additionally, some nurses were incensed last year when the Trump administration said it would reclassify nursing as a nonprofessional degree, which would impose strict federal limits on the loans nursing students could receive.

Canada is poised to capitalize. Two of its most populous provinces, Ontario and British Columbia, have streamlined the licensing process for American nurses since Trump returned to the White House. British Columbia also launched a $5 million advertising campaign last year to recruit nurses from California, Oregon, and Washington state.

“With the chaos and uncertainty happening in the U.S., we are seizing the opportunity to attract the talent we need,” Josie Osborne, the province’s health minister, said in a statement announcing the campaign.

Fears realized: Nurse killed by ICE

Amy Miller, a nurse practitioner, said she and her husband were determined to move their children out of the country because they felt Trump’s second term would inevitably spiral into violence.

First, the Millers got nursing licenses in New Zealand, but when the job search took too long, they pivoted to Canada.

Justin was offered a job within weeks.

Amy found one within three months.

So they moved. And just a few days later, the Millers watched with horror from afar as their fears came true.

As federal immigration forces clashed with protesters in Minneapolis on Jan. 24, federal agents fatally shot an ICU nurse, Alex Pretti, as he filmed a confrontation and appeared to be trying to shield a woman who was knocked down. Video of the killing showed border agents pinning Pretti to the ground before seizing his concealed, licensed handgun and opening fire on him.

Georgia nurses say fear of discipline keeps them from seeking addiction treatment

The Trump administration quickly called Pretti a “domestic terrorist” who intended to kill federal agents. That allegation was disputed by eyewitness videos that circulated on social media and spurred widespread outrage, including from nurses and nursing organizations, some of whom invoked the profession’s duty to care for the vulnerable.

“I don’t want to say it was expected, but that’s why we are here,” Amy Miller said. “Even our oldest kid, she was like: ‘It’s OK, Mom, because we are not there anymore. We are safe here.’ So she recognizes that, and she’s not even in middle school yet.”

The United States and Canada have a severe need for nurses. The United States is projected to be short about 270,000 registered nurses, plus at least 120,000 licensed practical nurses, by 2028, according to recent estimates from the Health Resources and Services Administration. In Canada, nursing job vacancies tripled from 2018 to 2023, when they reached nearly 42,000, according to a recent report from the Montreal Economic Institute, a Canadian think tank.

When asked to comment, the White House noted that industry data shows the number of nurses licensed in the United States increased in 2025. It dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

“The American health care workforce is the finest in the world, and it continues to expand under President Trump,” White House spokesperson Kush Desai said. “Employment opportunities in the American health care system remain robust, with career advancement and pay that far exceed that of other developed nations.”

Nurses cite White House fears in move

It is unknown precisely how many American nurses have moved north since Trump returned to office, because some Canadian provinces do not track or release such statistics.

British Columbia, which has done the most to recruit Americans, approved the licensing applications of 1,028 U.S.-trained nurses from when the province’s streamlined application process took effect in April 2025 through January, according to the British Columbia College of Nurses and Midwives. In all of 2023, only 112 applicants from the United States were approved, the agency said. In 2024, it was 127.

Increased interest from American nurses was also confirmed by nursing associations in Ontario and Alberta, as well as by the nationwide Canadian Nurses Association.

Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia, said American nurses used to move north because they had fallen in love with Canada (or a Canadian). But more recently, she said, she had met nurses who feared the White House would spur violence and vigilantism, particularly against families that included same-sex couples.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” Wignall said. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

Vancouver Island, which has a population of about 860,000, has gained 64 U.S.-trained nurses since April, including those at Nanaimo Regional, said Andrew Leyne, a spokesperson for the island’s health agency.

One of the nurses was Susan Fleishman, a Canadian who moved to the United States as a child, then worked for 23 years in American emergency rooms before leaving the country in November.

Fleishman said hateful rhetoric from Trump has fueled an angry division that has permeated and soured American life.

“It wasn’t an easy move — that’s for sure. But I think it’s definitely worth it,” she said, happily back in Canada. “I find there is a lot more kindness here. And I think that will keep me here.”

What I’ve learned as a nurse about the power of human connection in public health

Brandy Frye, who also worked for decades in American ERs, said she moved to Vancouver Island last year after waiting to see whether Mark Carney would become Canada’s prime minister. Carney’s rise was widely viewed as a rejection of Trumpism.

Meanwhile, Frye said, the California hospital where she worked had been stripping words associated with diversity and equity out of its paperwork to appease the Trump administration. She couldn’t stand it.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Like many of the American nurses who have moved to Vancouver Island, Frye was first wooed to the area by a viral video that was meant to attract tourist dollars but ended up doing much more.

About a year ago, Tod Maffin, a social media content creator and former CBC Radio host, invited Americans to the port city of Nanaimo for a weekend event designed to offset the impact of Trump’s tariffs on the local economy.

Maffin said about 350 people attended the April event.

“A lot of them were health care workers looking for an escape route,” Maffin said. “They were there to help support our economy but also to look into Canada.”

Maffin saw an opportunity. He repurposed the event website into a recruiting tool and launched a Discord chatroom to help Americans relocate.

Maffin said he believes the campaign helped about 35 health care workers move to Vancouver Island. Volunteers in more than 30 other Canadian communities have since duplicated his website in an effort to attract their own American nurses and doctors.

“There are communities across Canada where the emergency room closes at night because one nurse is out. That’s how thin staffing is,” Maffin said.

“One new nurse in a small town, or in a midsized city like Nanaimo,” he said, “makes a difference.”

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

How milder winters are luring mosquitoes – and the diseases they carry – beyond the ‘tropics’

2026-02-26T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week’s news is heavy on drug trials and some groundbreaking scientific research – two subjects I try to cover cautiously, because scientists, research institutions, and others have incentives to hype early findings. Anyhow, in global health terms, it is a good issue to be grappling with. It means there wasn’t some new outbreak I had to research.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Mainland Europe: a mosquito’s tropical getaway?

There’s a whole rogues gallery of tropical, mosquito-borne diseases that have long been relegated to the warmer and poorer parts of the world. For example: malaria, dengue, Zika, and chikungunya virus.

But global warming and roving mosquitos are rapidly blowing up the traditional boundaries of what counts as “tropical.” A new study in the journal Royal Society Interface finds that many of these diseases can now be transmitted by mosquitoes across most of southern and central Europe, The Guardian reports.

To be clear, the study isn’t just a speculative forecast. For some of these diseases, the shift has already happened.

Take chikungunya. “Up until last year, France had recorded 30-odd cases of chikungunya over the last 10 years or so. [In 2025], they had over 800,” said Steven White, one of the scientists at the UK Centre for Ecology and Hydrology that was behind the new study.

Disease breakdown: Chikungunya (a particular focus of the new study) is a virus first identified in Tanzania in the 1950s. Its name means “that which bends up,” a nod to the symptomatic contortions caused by terrible joint pain and fever. Although there’s no cure, death is rare, with fewer than 1 in 1,000 perishing from the illness. The real cost is in long-term pain: chronic arthritis that can last for months or years.

One of the study’s most unsettling findings for chikungunya was that the virus can incubate inside the increasingly invasive Asian tiger mosquito at much lower temperatures than previously believed. Specifically, “the study found the cut-off temperature for transmission is 13 degrees C - 14 degrees C,” or about 55 to 57 degrees F.

That dramatically expands the map of where outbreaks are possible, “meaning infections can occur for more than six months of the year in Spain, Portugal, Italy, and Greece, and for three to five months of the year in Belgium, France, Germany, Switzerland, and a dozen other European countries.”

What’s the takeaway?

First, it’s increasingly hard to see the northern spread of these tropical diseases (across North America, too) as anything but inevitable. As winters grow milder and warm seasons stretch longer, the conditions that allow these viruses to circulate are expanding … and exponentially!

I reached out to Flavia Riccardo, an independent infectious diseases researcher at the Italian National Institute of Health. She shared a recent study she co-authored that adds an important nuance. For now, the main risk is not these viruses becoming permanently established in Europe. It is infected travelers bringing them in during mosquito season, and triggering local outbreaks that can flare out of control.

My second takeaway is this: If there’s a morbid upside, it may be that once these diseases begin affecting wealthier countries, they could finally attract the sustained research funding and political urgency they need.

Guinea-Bissau stomps out a controversial vaccine trial

Last week, I mentioned in passing that World Health Organization Director-General Tedros Ghebreyesus publicly condemned a controversial U.S.-funded vaccine study on infants in the West African nation of Guinea-Bissau. Now, the country has shut it down, Reuters reports.

Guinea-Bissau’s foreign minister ultimately said, “It’s not going to happen, period,” after scientists, health bodies, and U.S. lawmakers raised alarms.

The trial, backed by the U.S. Centers for Disease Control and Prevention, would have tested the timing of the hepatitis B vaccine in newborns. Some “critics had said it was being used to test theories linking vaccines to autism,” and others (including the WHO chief) decried it as unethical because only half of infants would receive the life-saving shot at birth.

The threat here is clear: “90% of babies exposed to hepatitis B at birth or in their first year of life develop a chronic infection, and 15% to 25% of these die early of related liver failure or cancer as a result.”

To be perfectly fair to the researchers, “under the [proposed] trial, half the infants would receive [the vaccine] at birth,” and “the remainder at 6 weeks,” which is when infants normally receive the vaccine in the formal health care system in Guinea-Bissau. So the researchers hadn’t planned on taking anything away from vulnerable infants. The African nation “plans to introduce the dose at birth only in 2028.”

Still, at 6 weeks, “many infants whose mothers have hepatitis B are already infected,” and as I wrote last week: It is just hard to imagine a similar trial within the United States surviving legal/ethical challenges.

Magic mushrooms go mainstream

Magic mushrooms are having a bit of a clinical moment.

Compass Pathways, a British pharmaceutical company, announced that its synthetic psilocybin (which is the psychoactive chemical found in magic mushrooms) treatment hit its “major goals” in a large, late-stage trial for hard-to-treat depression, Reuters reports.

The report says that the company now plans to meet with the U.S. Food and Drug Administration and could seek approval for the treatment as early as 2027. (Keep in mind, this would be the first approved psychedelic therapy cleared in the United States.)

What’s my takeaway? Before we all start penciling psychedelics into the next generation of antidepressants, I’d strongly recommend reading this thoughtful essay published in STAT last week.

Erica Rex, a writer who participated in an early magic mushroom trial, warns that the rush to commercialize psychedelics is stripping away the therapy, community, and careful supervision that made those early studies feel safe and transformative. She argues that the drug alone is not the treatment. And profit incentives may directly clash with the slow, human elements that made psychedelic therapy work for her.

A ‘clock’ for Alzheimer’s symptoms

A new study published in the research journal Nature Medicine suggests we may soon be able to do something Alzheimer’s researchers have long dreamed of: Detect Alzheimer’s disease early and estimate when symptoms will begin, the Washington Post reports.

The study describes how to use blood draws to “build a ‘clock’ for Alzheimer’s disease that could roughly predict when symptoms will develop.” The core of the work revolves around tracking the levels of “one specific protein, called p-tau217,” in the blood.

This protein is important, because it is a hallmark sign that Alzheimer’s has started. More specifically, it shows that “clumps of misfolded proteins called amyloid plaques [have] begun to build up in the brain.”

Now just measuring that protein in blood draws isn’t enough on its own.

The bloodwork data has to be fed into a computer model that contains information about the patient, such as their age, which is then used to “forecast symptom onset within a margin of three to four years.”

So, yeah… it’s a wide error range. And practically speaking, this kind of prediction isn’t precise enough yet to guide individual treatment decisions.

But (and here’s the important part!) it could matter enormously for the potential, future use of novel drugs. That’s because two big Alzheimer’s studies underway are testing if newly developed “anti-amyloid” drugs can slow or prevent the disease if they’re given early enough.

If those drugs truly work best early, then knowing when “early” begins would be incredibly important.

The quest for a universal vaccine

I want to tread very, very carefully here. This next story is genuinely fascinating, but I’ve covered enough “breakthroughs” to know how easy it is to get carried away. The bigger the claim, the more skepticism we should hold.

The journal Science has just published a paper describing a provocative new approach to developing a “universal vaccine,” the BBC reports. That is, a vaccine that doesn’t just target one virus, but puts the entire immune system on high alert against many.

The paper is not theoretical. Stanford University scientists developed a nasal spray vaccine that they tested on mice against infections that attack the lungs. The end result was a “three-month effect” in which the mice’s immune systems were in a “heightened state of readiness” that “led to a 100- to -1,000-fold reduction in viruses getting through the lungs and into the body.”

This included effective immunity against a medley of cold and flu viruses, among other would-be invaders.

That is big news! So what’s the actual science here? To understand it, it helps to step back and look at what traditional vaccines are actually designed to do.

Traditional vaccines all use different strategies to teach the immune system to recognize a specific virus or bacteria. This is done by either by exposing the body to a weakened, dead, or fragmented germ … or by delivering instructions for the body to make a harmless piece of it (this last one is the new mRNA method, developed during the Covid-19 pandemic.)

This even newer approach is totally different. Instead of teaching the immune system to identify attackers, the vaccine artificially mimics the signals “immune cells [use to] communicate with each other” in the midst of an infection. Normally, when an infection begins, immune cells send out chemical signals that trigger a system-wide defensive response. And when on high alert, immune cells become more active and better able to contain invading viruses or bacteria.

This vaccine recreated that early alarm. It did this by introducing a molecule that flips the sensors inside some immune cells, pushing them into that heightened state of readiness.

Yes, it absolutely does sound like an incredible breakthrough. So … let’s move on to my beloved caveats.

First: This has not been tested in humans. It worked on mice, which is not nothing, but many, many fascinating mouse studies have failed to translate into people.

Second: The researchers now have to run the clinical trial gauntlet. That starts with Phase 1 trial to test safety, Phase 2 to figure out dosing and immune response, and Phase 3 to see whether it actually works in large numbers of people. Historically, only about 10% of drugs that start these trials end as an approved drug. Most are found to be unsafe or ineffective. Even at Phase 3, roughly half still fail.

Still, it’s promising.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Huge S.C. measles outbreak slows, fueling cautious optimism it may end earlier than predicted

2026-02-25T21:56:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

South Carolina’s huge measles outbreak has slowed significantly in recent weeks, raising hopes among health officials that the disease’s spread might end sooner than expected, the state’s epidemiologist said Wednesday.

Since Feb. 17, the South Carolina Department of Public Health has documented 17 new measles cases. That’s far fewer than the 100 or more new cases being identified every few days during mid-January, when the outbreak spiked following the winter holidays.

“We’re encouraged with the downward trend, particularly in the last two weeks,” said Dr. Linda Bell, who has been leading the state’s response since the outbreak was identified in October with an initial five cases.

Since then, 979 people – mostly school-age children – have been sickened with measles. All but 52 of the cases have been in Spartanburg County; about 95% have been among people who were not vaccinated.

“No one should underestimate the hard work and long hours that front-line, often entry level epidemiologists have put into this response, and [who] are largely responsible for this downward trend that is actually occurring a bit earlier than previously projected,” Bell said.

Earlier in the outbreak, Bell said that modeling had suggested the outbreak might last for as long as six months.

“The case counts per week now are really down to the level that we were seeing at the beginning of December,” she said. “We are now 22 weeks into this and we hope, with that continued downward trend, in parallel to the hope that vaccination coverage will increase, will help us end this sooner than was originally projected.”

Bell said the department has asked the Centers for Disease Control and Prevention to assist the department in the coming weeks to do studies to help learn from the outbreak, including studies that examine chains of transmission and the costs associated with the public health response to the outbreak, as well as health care costs.

Officials remain concerned, however, that the outbreak has the potential to spike yet again. “This is not over yet. It’s not nearly over yet,” Bell said. “It is these pockets of under-vaccinated people who remain susceptible. That ongoing susceptibility in our population may continue to fuel ongoing spread.”

To stop measles outbreaks from spreading in localized communities, at least 95% of people need to be vaccinated. But in Spartanburg County, state health officials have said measles vaccination rates for school children across the county are just 90% – and they are even lower within some individual schools and communities.

“Many of the schools in Spartanburg County have some of the lowest vaccination coverage rates in the state,” Bell said. “So all of those are contributing to the reason that the outbreak has been focused in Spartanburg County, because of higher risk there, because of lower coverage.”

This is also a likely contributing factor for why measles cases identified recently in a few other South Carolina counties haven’t spread widely in those locations, Bell said. Of the 979 cases in the South Carolina outbreak, 927 involve people in Spartanburg County.

“Even if we are only seeing a dozen or so cases per week, the risk we can surge remains,” Bell said.

Bell noted that schools will be going on spring break in the coming weeks, bringing with it the risk of people who have been exposed to measles becoming infectious and spreading the disease to others at tourist attractions and while traveling. “This is a great concern,” she said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Join Healthbeat for a community conversation on public health in Queens

2026-02-25T13:35:11+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

These are turbulent times in community health.

Federal funding that supports local health programs and food assistance is under threat. Climate change is bringing new health risks to neighborhoods. Vaccine confusion persists. And for many families, finding reliable health information — and affordable care — is only getting harder.

How is all of this affecting you?

Healthbeat is hosting a free community breakfast and conversation in Queens to hear directly from the people living and working through these challenges every day. We want to know:

How are you coping with uncertainty in health policy and funding?
What barriers are you facing when seeking care or trustworthy information for your or the clients you serve?
What solutions are emerging in your community?
What stories aren’t being told?

Join Healthbeat’s New York City reporter Trenton Daniel and me, Editor in Chief Charlene Pacenti, for a discussion about how health policy is playing out on the ground — in real neighborhoods, with real effects.

Whether you’re a concerned resident, health worker, epidemiologist, researcher, social worker, advocate, or someone serving your community another way, we want to hear your perspective. This conversation will help shape our reporting and ensure we’re covering the issues that truly impact Queens.

Admission and breakfast are free, but advance registration is required.

🗓 March 24, 9–10:30 a.m., King Manor Museum, 150-03 Jamaica Ave., Jamaica, Queens.

Come share your experiences. Help us tell the stories that need to be told. Register now to reserve your spot.

Charlene Pacenti is Editor in Chief of Healthbeat. Contact her at cpacenti@healthbeat.org.

AI can be a transformative health tool. It can also cause harm.

2026-02-25T12:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a national nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

This week, I’m focusing on a question that sounds like science fiction but is increasingly being asked in serious policy circles: Will artificial intelligence kill us all?

AI can help health agencies avert illness and death

Let’s start with my bias. I believe that AI is a transformative tool that can help public health agencies avert illness and death in their communities if used responsibly and ethically. It can help epidemiologists process, analyze, and interpret surveillance data. It can assist health officials in tailoring communications, particularly in emergencies, and improving programs for immunizations, sexually transmitted infections, tuberculosis, and maternal child health.

As AI systems grow more capable, many experts are wondering, however, whether the risks could outweigh the benefits. Some of those risks are distant but catastrophic. Others are happening right now at a smaller scale.

An AI safety leader warns the ‘world is in peril’

Earlier this month, a senior safeguards researcher at the AI company Anthropic resigned, warning that the “world is in peril.” In his resignation letter, he cited concerns about AI, bioweapons, and interconnected global crises.

Anthropic has positioned itself as a safety-oriented firm in the race to build increasingly powerful generative AI systems. The New Yorker just published an in-depth investigation into Anthropic and the inherent tensions people in the company feel trying to build advanced AI systems while safeguarding against risks to humanity. Curiously, the U.S. Defense Department just took the view that Anthropic may be a risk to the U.S. government, because it’s too focused on ethics and protecting human health.

(Full disclosure: I’m a big fan of Claude Code, one of Anthropic’s premier products. Read an excellent review of that product by widely respected AI expert Ethan Mollick here.)

The departing Anthropic researcher had led work on reducing risks from AI-assisted bioterrorism and on understanding how AI assistants could distort human judgment. His concerns are shared by others in the field.

As AI models become more proficient in synthesizing scientific literature and solving technical problems, they may lower the barrier to designing or modifying pathogens. Biology is already digitized. Genome sequences are publicly available. Laboratory protocols are published in journals and databases.

Recent research has tested advanced AI models on graduate-level virology problems, demonstrating that they can perform at or near expert level on tasks involving viral genetics and pathogenesis. While such capabilities can help humanity by improving vaccine design or antiviral discovery, they could also be misused to enhance the infectiousness or immune evasion of pathogens.

Having led outbreak responses in Asia, Africa, and the United States, I still believe that we need to worry most about nature — “spillover” of viruses from animals into humans — when trying to prevent the next pandemic. Nevertheless, the pace of AI development is extraordinary, which means my risk assessment is changing daily as well. An intentionally engineered pathogen designed for maximum spread could have far greater consequences than even the Covid pandemic.

Proposals to reduce biosecurity risks

Researchers and policymakers have outlined approaches to mitigate risk.

One proposal is to secure closed-source biological AI models, restricting access and subjecting users to rigorous vetting and monitoring. Companies can conduct exercises in which they deliberately probe their own systems for vulnerabilities before malicious actors do.

A second approach is to protect high-risk biological datasets from being used to fine-tune open-source models. If detailed genomic data on high-consequence pathogens or advanced laboratory protocols are easily accessible for model training, they can amplify the capabilities of otherwise general-purpose systems. Tighter access controls and clearer publication norms could reduce misuse.

A third area is to restrict AI agents that interface with biological tools. As AI systems move beyond generating text to interacting with laboratory equipment or ordering synthetic DNA, systems need to be in pace to ensure there is a human that is screening DNA synthesis orders and auditing AI-designed workflows.

In the AI era, biosecurity will require multiple layers of defense that protect humanity at the level of algorithms, data, and laboratory infrastructure.

The near-term mental health risks

While headlines often focus on existential threats, I am most concerned at the moment about a more immediate hazard: AI’s impact on mental health and suicide.

Millions of people now interact daily with AI “companion” chatbots designed to simulate friendship, empathy, or therapeutic dialogue. Some users, including minors, disclose suicidal thoughts to these systems. In multiple lawsuits, there are allegations that AI chatbot interactions led to people committing suicide.

In response, California enacted Senate Bill 243 in 2025, the first law in the nation regulating AI companion chatbots. The law requires clear disclosure when a user is interacting with AI rather than a human, mandates protocols for responding to suicidal ideation, and imposes additional rules for known minors, including periodic reminders that the chatbot is not human, and restrictions on sexually explicit content. It also creates a private right of action, allowing civil lawsuits for violations.

California’s law is an important milestone. It acknowledges that emotionally realistic AI systems can foster attachment and dependence, particularly among adolescents. It also recognizes that AI systems need regulation to ensure they do not severely harm mental health and promote suicidal thinking.

We do not know if these regulations, however, will even work. Disclosure that a system is “not human” may not counteract emotional realism. Protocol requirements do not guarantee effectiveness. Operators may avoid collecting information about users’ ages, limiting their obligations to minors.

From a public health perspective, these debates remind me of the challenges with social media platforms. Almost 16 years after Instagram was released, we are now seeing possible the company be held legally liable for its impact on mental health.

Last week, Mark Zuckerberg, CEO of Meta, had to testify in court about whether Instagram (which Meta owns) was designed to addict and harm teenagers. Social media technologies optimized for engagement have amplified loneliness, misinformation, and depression, and AI systems could likely do the same at an ever larger scale.

Evaluating the uncertainty

So back to the original question: Will AI kill us all? I believe the probability of an extinction-level event is low today, but low is not zero, and the consequences would be catastrophic. At the same time, the mental health risks of emotionally persuasive AI systems have already appeared and need to be addressed.

Public health agencies must always prepare for rare catastrophic events while addressing everyday harms. Now, with AI, we must do both simultaneously as well.

Until next week,

Jay

Chaotic federal vaccine committee meeting: It’s off, now it’s on again. But still no word on agenda.

2026-02-24T20:53:32+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The federal Advisory Committee on Immunization Practices now plans to meet March 18 and 19, according to updated information posted on the committee’s website at the Centers for Disease Control and Prevention.

No information had been posted Tuesday about what topics or votes will be on the meeting’s agenda, how the public can comment on agenda items, or even what time the meetings will start and end.

The committee, which meets three times a year, had long planned to meet this Wednesday through Friday in Atlanta. But as the meeting date approached, the committee failed to make public – as required – its planned agenda, jeopardizing its ability to meet legally, Healthbeat reported last week.

The cancellation also followed efforts in a lawsuit filed by the American Academy of Pediatrics and other medical groups that have sought to stop the group’s next meeting because of concerns that ACIP will take a vote that will result in removing funding for certain vaccines for children from low-income families or who lack adequate insurance.

Officials at the CDC and the U.S. Department of Health and Human Services did not immediately respond to questions about the rescheduled meeting.

Federal advisory committees are required to give the public advance notices about their meeting agendas and other basic information about how the public can attend or watch the meetings. Historically committees were required to give at least 15 calendar days notice before a meeting, but in December the Trump administration reduced that to seven calendar days.

On Tuesday, the American Academy of Obstetricians & Gynecologists announced that it was withdrawing as a liaison member of the vaccine advisory committee, citing an array of concerns, including what it said was ACIP’s cherry-picking of data and unilateral changes to childhood and adolescent vaccination schedules without expert input.

“The recent reconstitution of the committee; the removal of ACOG experts from ACIP workgroups; and HHS’ unilateral changes to vaccine recommendations, which bypassed established scientific and clinical processes, represent a fundamental departure from the scientific rigor and impartiality that have been the hallmark of this committee for 60 years,” said ACOG President Dr. Steven J. Fleischman.

The committee had all of its scientific advisers replaced last summer by HHS Secretary Robert F. Kennedy Jr.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48