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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.”

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

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.

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

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.

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.

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

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.

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

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.

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.

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.

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.

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

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

Community schools oversight, emergency response grants moving from Education Department to HHS

2026-02-24T14:32:24+00:00

This story originally published at Chalkbeat. Sign up for Chalkbeat’s free weekly newsletter to keep up with how education is changing across the U.S. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The U.S. Department of Education is moving oversight of several programs to the Department of Health and Human Services, as the agency continues to offload responsibilities to fulfill the president’s vow to dismantle the federal education department.

The move announced Monday includes transferring management of grants schools receive after traumatic events — such as school shootings, natural disasters or major bus accidents — disrupt learning. It also shifts oversight of major grant programs meant to foster more community and wraparound services in schools in vulnerable neighborhoods.

The Education Department still has not made any announcements about whether special education oversight will move to Health and Human Services. Disability advocates are nearly unanimous in opposing that change.

The department already announced in November that it would move administration of major K-12 and higher education programs to the Department of Labor, including management of both the Office of Elementary and Secondary Education and the Office of Postsecondary Education. And before that, the department moved career and technical education to Labor.

Education advocates and others criticized these moves for sidestepping Congress. While the Trump administration wants to eliminate the agency entirely, only Congress can shutter the department.

Education Secretary Linda McMahon repeated the administration’s promise to “return education to the states” in a news release sent Monday announcing the latest interagency agreements. She said the change would represent “a practical step toward greater efficiency, stronger coordination, and meaningful improvement” and should not disrupt any programs.

Programs moved over the federal health department include:

School Emergency Response to Violence: Known as Project SERV grants, these emergency funds go to schools where students have experienced traumatic and tragic events, including school shootings.
Ready to Learn Programming: Promotes creation of educational content, including television and digital media. Public broadcasting companies have received this grant funding. For instance, Twin Cities PBS used the funding to create an animated series focused on skill-building for the workforce.
Full Service Community Schools and Promise Neighborhoods programming: Helps schools and other institutions provide comprehensive resources (such as mental health, nutritional health, and other supports for students) to low-income communities.
Statewide Family Engagement Centers: This funding goes to education institutions for training and development of programs to stoke family engagement in schools.

The Education Department also announced that the State Department will monitor foreign donations to universities through a separate interagency agreement.

The administration has framed the use of interagency agreements to parcel out functions to other departments as a continuation of longstanding practice. Advocates have raised questions about the legality of these agreements.

Democrats pushed unsuccessfully in the most recent spending bills to limit the Education Department’s ability to move programs to other agencies without congressional approval.

U.S. Sen. Patty Murray, a Democrat and vice chair of the Appropriations Committee, called the latest agreements illegal in a press release and lamented that her Republican colleagues won’t constrain the Trump administration’s actions.

“These illegal agreements aren’t just creating pointless new bureaucracy that burdens our already-overworked teachers and schools,” Murray said in a Monday statement. “They are actively jeopardizing resources and support that students and families count on and are entitled to under the law.”

Chalkbeat National Editor Erica Meltzer contributed reporting.

Lily Altavena is a national reporter at Chalkbeat. Contact Lily at laltavena@chalkbeat.org.

Preventing maternal deaths: 5 From the Field Q&A with childbirth safety expert Dr. Elliott Main

2026-02-24T10:00:00+00:00

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

Maternal deaths and serious childbirth complications in the United States are often preventable.

Dr. Elliott Main, a professor of obstetrics and gynecology at Stanford University and a founder of the California Maternal Quality Care Collaborative, has spent decades studying why mothers die or nearly die from pregnancy and childbirth — and what can be done to protect them.

Main helped pioneer the creation of what have become national “patient safety bundles” and toolkits to help hospitals and health care providers standardize their use of evidence-based best practices for identifying complications early and providing effective treatments.

In recent years, about 650 to 1,200 women across the United States have died annually from causes related to pregnancy, according to federal data. Thousands more have been at risk of dying because of severe complications, including from hemorrhaging, cardiac and blood pressure issues, and infections.

The rate of maternal deaths is far higher for Black mothers (43.3 deaths per 100,000 live births) than it is for white (13.8 deaths), Hispanic (11.1), and Asian (12.8) mothers, according to provisional data from the Centers for Disease Control and Prevention for the 12-month period ending in September.

In the context of all of the births that occur each year, maternal deaths and severe complications are relatively rare. But each statistic is a person’s life and case reviews have found that 80% of deaths could have been prevented.

“We do need to do better, and we can do better,” Main told Healthbeat as he recently provided insights on five questions about making pregnancy and childbirth safer.

This 5 From the Field interview has been edited for clarity and length.

Are we where we need to be on maternal safety?

There is lots of room for improvement.

One of the biggest struggles we see is with disparities among different races. It’s not just Black mothers. It’s other mothers, too, that may not speak English well, or who are in some ways different from their care providers.

How do you create trust between the physician and the nurses with the patients if they are from very different backgrounds? That’s a challenge. You’re in labor and things change rapidly and you’re making life and death decisions. The best physicians have developed skills to sit down and ask what the patient’s goals are, what she’s fearful of and work out ways of working together. Trust is a common issue that we’re failing at in some circumstances.

Another significant issue is support, particularly in transitions of care. One of the biggest areas of weakness in the medical system is when you transition from the hospital to home.

Why do some hospitals struggle more than others when it comes to preventing maternal deaths and serious complications?

Obstetrics is way undervalued in the current medical reimbursement system. That means there’s not much incentive to make investments in obstetric care, and that’s particularly an issue in hospitals that are less well-funded, rural hospitals, inner city hospitals. And in certain parts of the country that are poorly funded to begin with, in particular the South, that has terrible outcomes for maternity care.

Looking at public health data from my state, that has over 200 hospitals, and in other states, there is great variation that we see among hospitals. All the measures show extreme variation. And that shouldn’t really be.

How connecting with nature helps Black women have healthier pregnancies

In medicine we have a long tradition, unfortunately, of blaming the patient. And that’s really clear in this setting. When you control for patient conditions, the degree of hypertension or diabetes or advanced maternal age or obesity, there is still huge variation.

What I’ve seen over the years is that hospitals – if they are doing poorly on the national measure, they will first blame the patient, then blame how the data is collected, then blame the measure itself. But they should be spending the time figuring out how they can learn from others and improve their care.

You need to have leadership, both at the physician and nursing levels, for there to be meaningful change. It’s hard to change practice behaviors or the culture of a unit unless you have strong leaders involved.

Why are so many maternal deaths and severe complications preventable?

There are two driving forces. One is that, in general, maternity goes well in at least 95% to 97% of the cases. Everyone gets kind of lulled by the expectation of normality. So we tend to overlook deviations from that. You don’t want to over-call things because most of the time it goes fine.

The second issue is that many of the symptoms of significant complications are actually easily confused with the symptoms of normal pregnancy.

One of the biggest killers in the postpartum period is cardiac disease. The symptoms of heart failure are tiredness, shortness of breath, and having a hard time sleeping. And you know, most postpartum women are tired – but what degree of tiredness is abnormal?

Many postpartum women are much more focused on the care of their infant than themselves. So, things get delayed. Doctors tend to not respond to phone calls about such generalized symptoms. And so it spirals until it’s too late.

Where has standardizing maternity care made the biggest difference?

We have done better in the U.S. for hemorrhage, so it’s no longer the leading cause of death here as it is worldwide. But it is still the biggest cause of major complications for morbidity.

Essentially about 3% to 5% of women will have a significant amount of extra bleeding at birth. And that was the first thing we tackled, and we realized that every doctor had a different way of approaching it. No one had a standardized approach, or even a standardized definition of how much bleeding was too much.

So that was the genesis of a safety bundle, of having all the tools you need in a hemorrhage cart or kit that could be immediately brought into a room. You had a standardized procedure that you could teach and practice, you do drills and then assess afterwards. And then having a

standardized way of collecting the blood, so you could see exactly where you were in the process. It’s so easy to say she’s bleeding a little, but not that much, and lose count.

Those kinds of standardized approaches actually made a really big difference. And they have become now a national safety bundle, supported by bodies like the American College of OB/GYN and even the Joint Commission. CMS is now wanting every hospital in their Medicaid reporting system to document they have included it. And the WHO is supporting the bundle approach worldwide.

What still needs to be done?

We have to keep the momentum up for supporting change in the medical system. One of the things we’ve helped support is the development of perinatal quality collaboratives in every state in the country. Those can be based in or partnered with public health departments.

We now have bundles and toolkits for hemorrhage, hypertension and sepsis, cardiac disease, and mental health. But the trick is always about implementation. That’s always the hard part – how you implement that in every hospital, in every practice in your state.

That’s where you want a collaborative that includes medical leadership, organizations like the American College of OB/GYN and the maternal fetal medicine society, the nursing societies… all the providers, the payers, Medicaid and the insurance companies, and community organizations.

Data is the critical piece. This is where public health organizations can play an important role. Everybody wants to think that they’re doing well, and everyone is surprised when the data doesn’t show that. The data really does drive change.

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.

Health leaders, advocates applaud partial restoration of Article 6 funding for NYC public health services

2026-02-23T14:26:00+00:00

New York City public health officials, community advocates, and Democratic state lawmakers are praising the partial restoration of funding earmarked for vital public health services in New York City after Mayor Zohran Mamdani and Gov. Kathy Hochul reached an agreement on his $127 billion preliminary budget for the next fiscal year.

The arrangement includes what’s referred to as Article 6 of the Public Health Law and is supposed to restore $60 million in core public health services from an original $90 million that was cut under former Gov. Andrew Cuomo in 2019. It’s part of a broader funding package of $1.5 billion in additional state operating support that was agreed upon for New York City over two years.

There’s still a $5.4 billion gap over the next two fiscal years, and City Hall will need to work with Albany to figure out how to plug the hole. (Mamdani said that only two options are available — persuade Hochul to tax the richest New Yorkers or raise the city’s property taxes.)

The budget proposal is to take effect July 1 after negotiations and revisions with the City Council.

It’s too soon to say how the Article 6 money will be spent specifically on New York City public health efforts, but news of its potential restoration brought some relief to public health corners after successive New York City health commissioners and community advocates had spent the past several years trying to unblock it.

“We’re still getting the details here, but what a massive victory,” acting Health Commissioner and Chief Medical Officer Dr. Michelle Morse told Healthbeat last week. “I can’t think of a more strategic time for the match to be restored, because we do have so many threats to public health, and long-term resources from the CDC, frankly, are still a bit in flux.”

The Centers for Disease Control and Prevention has long provided critical support for state and local public health programs across the United States, but millions of dollars have been withheld since Donald Trump returned to office. Last year, New York City’s Health Department saw more than $100 million in federal funding slashed from its budget. The money had funded a public health lab that conducted testing for pathogens like measles, tuberculosis, rabies, and bird flu.

Dr. Michelle Morse to continue health equity work in refocusing on CMO role

In his remarks at a news conference last week about the budget plan, Mamdani briefly noted the changes: “Much of this state assistance reverses longstanding Cuomo-era cost shifts.”

Through Article 6, local health departments pay for public health work ranging from immunizations to infectious disease surveillance, and the state picks up the rest of the tab. The state provides each municipality that delivers core public health services with a base grant of $750,000, or $1.30 per capita for larger municipalities like New York City. Beyond the grant, the state reimburses localities for 36% of the cost of core public health services.

As a result of the 2019 cut, New York City was only reimbursed for 20% of those services. That means that the city had to cover 80% of their cost, not 64%. Advocates say that the cut is especially punitive for a city with a large, diverse population that bears a disproportionate burden of the state’s public health costs.

The Cuomo administration justified the cut with the argument that New York City receives some funding directly from the federal government. Advocates countered that the cuts had unfairly stemmed from a strained relationship between Cuomo and former Mayor Bill de Blasio.

Assembly Member Jessica González-Rojas, a Queens Democrat who sponsored a bill that sought to restore the equal reimbursement rates, welcomed the decision. She and City Council Health Committee Chair Lynn Schulman had pushed for their return.

“We’ve been fighting to restore that funding for a number of years now. And, yeah, I’m just really thrilled that it’s happening,” González-Rojas told Healthbeat. “It took a lot of lobbying from those of us that cared deeply about this issue.”

Advocates say the cuts had cost the city $90 million each year, hampering the Health Department’s ability to deliver and expand certain services such as tuberculosis control, which calls for extensive resources.

Preventative screenings for communicable diseases like TB is just one of the things Carlos Arnao, director of the healthy communities program at the New York Immigration Coalition in Manhattan, said he would like to see the funding go toward.

Arnao called the partial restoration “a really great start, and it signals a willingness to at least talk about a full restoration,” he told Healthbeat.

He said the money could also go toward vaccine education and outreach programs at a time of confusing and false information coming from the federal government. It could also go toward addressing maternal and infant mortality rates in the Caribbean community, and toward homeless outreach, he said, citing the recent multi-week cold spell that resulted in at least 20 deaths.

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

With highest rate of new HIV cases, Georgia moves to allow pharmacists to prescribe prevention drugs

2026-02-20T16:33:09+00:00

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

Lawmakers in Georgia, the state with the highest rate of new HIV infections in the country, are moving to allow pharmacists to prescribe and administer HIV prevention drugs.

The bill aims to make the drugs easier to get and lower the costs of care – two challenges that have hampered attempts to stem the number of new cases.

Pharmacists could provide both the pill and long-acting injectable forms of pre-exposure prophylaxis, known as PrEP, which that prevents HIV, as well as PEP, post-exposure prophylaxis, a course of drugs that can prevent HIV after exposure if taken soon enough.

The measure could be “a game changer for shifting the landscape of the epidemic,” said Natalie Crawford, a professor at Emory University’s Rollins School of Public Health.

At eight, Georgia has one of the lowest PrEP-to-need ratios in the country, indicating that people who need the drugs are not getting them. That overall ratio hides deep inequities in how many people are accessing PrEP. The ratio is 32 for white people but plummets to 4 for Black people, according to the latest data from AIDSVu, an online tracking tool based at Emory University.

At least 20 other states allow pharmacists to prescribe the drugs.

Pharmacists said they welcome the legislation – even though some details, especially around payment, still need to be worked out.

Pharmacies are much more accessible to many rural Georgians than doctors’ offices and clinics, said Jordan Khail, a professor at the University of Georgia College of Pharmacy. Pharmacies often also have longer hours than doctor’s offices.

Pharmacies could bring drugs closer to patients

Rural residents often have to travel long distances to a facility that prescribes the drugs, Crawford said.

Even some in urban areas have the same problem. While there are more new HIV cases on the south side of Atlanta, the clinics that provide the drugs are typically on the north side, Crawford said.

Georgia leads in U.S. HIV cases. Here’s why the lifesaving drug PrEP faces barriers in the state.

“As a PrEP user and Georgia resident, I am in full support of pharmacy-based PrEP, but to be truly effective we must continue to work to protect PrEP coverage for insured individuals and expanding access for uninsured populations through a national PrEP program,” said Michael Chancley, communications and mobilization manager for PrEP4All, a nonprofit that advocates for increasing access to PrEP.

The bill’s sponsors – Sen. Chuck Hufstelter, a Republican anesthetist from Rome, and Rep. Mark Newton, a Republican emergency physician from Augusta – said expanding access to the drugs could lower the number of new infections and save the state money in the long run by reducing the number of patients that need state-funded care.

Lifetime HIV-related costs can range from about $420,000 to over $1 million.

“It’s in the best fiscal interest of the state to prevent HIV transmission,” said Jeff Graham, executive director of Georgia Equality, an LGBTQ advocacy group.

The bill includes several requirements for a pharmacist to administer the drugs:

Pharmacists need a protocol agreement with a physician, advanced practice registered nurse, or physician assistant.
Pharmacists would need to complete a qualified training program about the drugs.
Any drugs for PEP or PrEP that are determined by the state Board of Pharmacy to be approved by the Centers for Disease Control and Prevention for preventing HIV infections will be eligible.
Pharmacists would have to notify the patient’s primary care provider. If the patient does not have one, the pharmacist would have to provide a list of physicians and clinics to contact for follow-up care.
The patient would need to provide proof of a negative HIV test within the past seven days, or take a test that proves negative on the spot.

Pharmacists would be able to issue at least 30-day and up to 90-day supplies of the drugs.

Payment models haven’t been determined

Khail and others said pharmacists excel at finding the lowest-cost options for patients. Most American insurers are required to cover the cost of PrEP and PEP, though uninsured people may need to jump through extra hoops to afford them.

While the injectable forms are typically more expensive, pharmaceutical companies’ patient assistance plans can lower the cost for the uninsured.

But the bill also asks pharmacists and pharmacy technicians to do work like counseling the patients and making sure they don’t have any reactions to the drugs.

“We definitely have to talk compensation for pharmacies, and I would even push it further to say pharmacy technicians,” said Dr. Kenric Ware, a professor of pharmacy at Mercer University.

A similar measure in Louisiana included payment provisions for pharmacists, Khail said.

That part still needs to be worked out for Georgia – perhaps through a companion bill or administrative regulations that don’t need legislative approval.

Ware and Khail pointed to the model used for immunizations, in which pharmacists are compensated for the extra work they do in counseling and supervising patients and providing the shots, as a good model for PrEP.

A lack of a plan to reimburse pharmacists could limit how many pharmacists decide to offer the service when it takes effect.

If it passes, the law would take effect July 1, with a Jan. 1, 2027 deadline for the state pharmacy board to designate training programs for pharmacists.

Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

Pharmacists and the bill’s advocates said a range of options are needed to address the state’s high HIV rates. Georgia typically has at least 2,400 new cases each year, amounting to a rate of 26 per 100,000 people, second only to Washington, D.C.

Telemedicine works well for some, but it has downsides.

People who live with others may not want to receive their drugs via mail at home for privacy reasons. Others may lack the internet service or digital literacy needed to access the service, Ware said.

Black and brown communities, especially women, tend to use telemedicine services for PrEP and PEP at rates far below their white counterparts, Crawford said, in part because marketing efforts have left them out.

The bill gained the unanimous support of the Senate last year. The House Representatives overwhelmingly voted for it, with only seven “no” votes.

The measure must now return to the Senate for final approval before it can be sent to Gov. Brian Kemp for his signature.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

CDC vaccine advisory committee ‘in violation’ of public meeting rule cancels next week’s sessions

2026-02-20T00:21:24+00:00

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

A controversial federal vaccine advisory committee has canceled a planned meeting next week, a spokesperson for the U.S. Department of Health and Human Services said Thursday.

The cancellation of the meeting of the Advisory Committee on Immunization Practices came after the committee failed to make public – as required – the details of its planned agenda for next week’s sessions, which raised questions about whether the meeting could legally occur, Healthbeat reported Wednesday.

It also follows efforts by the American Academy of Pediatrics and other medical groups to have a federal court in Massachusetts stop the ACIP meeting, court records show. The medical groups, which are suing HHS over changes made in January to the childhood vaccination schedule, told the court it feared the group would take a vote at the meeting that would remove funding for certain vaccines for children who are from low-income families or lack adequate insurance.

HHS spokesperson Andrew Nixon would not elaborate on why next week’s meeting was canceled. “We will not hold the ACIP meeting later this month,” Nixon said in a brief statement Thursday. “Further information will be shared as available.”

The American Academy of Pediatrics and other medical groups, in court filings this week, said that they anticipated the ACIP would be voting at its February meeting to downgrade from “routine” to “non-routine” several vaccines that are no longer routinely recommended under the contested January vaccine schedule. Such a vote, the groups said, would cut off access to hepatitis A, hepatitis B, rotavirus, influenza, and meningococcal vaccines to children who rely on the federal Vaccines for Children program to pay for their immunizations.

The medical groups noted to the court that although no agenda had been posted for the ACIP meeting, the committee Vice Chair Robert Malone had publicly written on his Substack about how “the ACIP will need to vote during their next meeting to approve language aligning the Congressionally mandated Vaccines for Children Program [VFC] with the new schedule.”

Lawyers for HHS on Wednesday countered that concerns the vaccines would be removed from the Vaccines for Children program were “purely speculative.” On Thursday they filed a notice with the court saying that the ACIP meeting, which had been scheduled for Feb. 25-27, had been “postponed” and that the committee would not be meeting in February.

The committee – which in its last meeting made significant changes to the childhood vaccine schedule – had not made public its agenda or other key details for the meeting next week at the Centers for Disease Control and Prevention, despite federal requirements.

“Legally, I believe that HHS is in violation of federal law,” Lawrence Gostin, Founding O’Neill Chair in Global Health Law at Georgetown University, told Healthbeat on Wednesday. “But Secretary Kennedy has long been flouting federal law, especially when it comes to good governance, transparency and administrative practice.”

Officials from HHS and the CDC did not answer questions about why no meeting notice and agenda information had been posted in the Federal Register or on the ACIP’s website before Wednesday.

The committee – which last summer had all of its scientific advisers replaced by HHS Secretary Robert F. Kennedy Jr. – has become a front line in the political, cultural, and scientific war over vaccines. During its last meeting, in December, Republican U.S. Sen. Bill Cassidy, a Louisiana physician, called the committee “totally discredited” for seeking a briefing from a lawyer and vaccine critic with ties to Kennedy.

The late cancellation of the upcoming ACIP meeting is just the latest controversy for the group.

Federal advisory committees historically have been required to let the public know about their meeting agendas and other basic information at least 15 calendar days in advance of the meeting. In December, the Trump administration reduced the advance notice to at least seven calendar days before a meeting. Wednesday was seven days before the ACIP meeting date listed on the CDC website.

Federal rules require that the public be told – through a posting in the Federal Register – details such as the time and location of the meeting, how to attend electronically, and whether registration is required for attendance. The rules also called for the committee to post a summary of the agenda, topics to be discussed, and instructions for how to access meeting materials, as well as how the public can comment in writing or in person.

The only way a committee can give less than seven days of notice, the rules say, is “if the President determines this is necessary for reasons of national security, or if the head of an agency determines this is necessary due to exceptional circumstances,” with the reasons being included in the Federal Register meeting notice.

“These meetings are one of the few opportunities for the public to make their voices heard,” said Michaela Jackson, program director for prevention policy at the Hepatitis B Foundation. “When notice comes too late, people lose the chance to share their experiences and help shape policies that directly affect their health, their families, and their communities.”

Jackson said it takes significant research for stakeholders to prepare for ACIP meetings. “Contributors want to present the strongest evidence available to support our positions, but it is extremely difficult to craft meaningful or relevant comments when no agenda or list of topics is provided in advance.”

Gostin said the lack of required public notice for the ACIP meeting ran afoul of both the Federal Advisory Committee Act and the Administrative Procedure Act. He said the public should care because it’s important to have thoughtful public input into government decisions – such as vaccine policy – that will impact people’s lives.

“Advance notice and comment are the hallmarks of transparency, good government, and democracy,” Gostin said. “Without advanced notice and an opportunity to comment, major stakeholders cannot weigh in and feel as though they are left in the dark, which they are.”

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.

S.C. measles cases surged after holiday school closures delayed outbreak investigations

2026-02-17T10:00:00+00:00

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

South Carolina’s state health department faced a significant problem in the critical weeks before the state’s measles outbreak surged in January.

As schoolchildren continued to fall ill with measles in late December, outbreak investigators needed help from schools to get contact information for the classmates, staff, and others who had been exposed. They needed to be warned quickly so they wouldn’t spread the virus to others if they were infected.

But schools were closed for their two-week winter break. Nobody was available at most schools to provide the information health officials needed, according to South Carolina’s state epidemiologist and records obtained by Healthbeat.

This communication gap between the South Carolina Department of Public Health and schools in Spartanburg County – the outbreak’s epicenter – resulted in delays quarantining people who were at risk of unknowingly spreading the highly contagious disease. An infected person is contagious beginning four days before the tell-tale measles rash appears.

At the same time, the state health department was grappling with its own holiday staffing challenges, according to the internal DPH outbreak reports that Healthbeat obtained under South Carolina’s public records law.

While the number of measles cases grew in December, the number of DPH staff assigned to combat the outbreak dropped. The internal DPH reports repeatedly note concerns about holiday staffing, workloads, burnout, the availability of backup staffing, and “limited support due to workforce reduction in April 2025.”

Only after New Year’s Eve did outbreak staffing begin to increase significantly, records show.

Dr. Linda Bell, the state epidemiologist who is leading South Carolina’s outbreak response, said that despite challenges, public health staff “worked diligently throughout the holidays.”

“DPH made many efforts to reach impacted schools over the holidays with limited success because the schools were closed,” Bell said in written responses to Healthbeat’s questions.

By early January, the South Carolina measles outbreak surged to become one of the largest in the United States in decades.

“It’s impossible to know exactly what impact school closures and the resulting delays had on the spike in cases,” Bell told Healthbeat.

However, the delays hampered one of the department’s key strategies for slowing the virus’ spread: Rapid identification and home quarantine of exposed children and adults who were at risk of developing and further spreading the disease because they aren’t vaccinated.

“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 said. “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.”

This occurred during a time of increased socializing over the holidays, she noted.

It usually takes a week to 12 days, and sometimes as long as three weeks, for people infected with measles to start showing symptoms. The virus spreads through the air when a contagious person breathes, sneezes, or coughs.

Before Spartanburg County schools closed for winter break on Dec. 22, the state health department had logged 144 measles cases since the outbreak began in early October, state data show. In the three weeks after schools reopened during the week of Jan. 5, outbreak investigators were chasing after more than 500 new cases of measles.

The outbreak continues to grow, reaching 950 confirmed cases in South Carolina as of last week, a tally that doesn’t include cases sparked in other states.

School officials with Spartanburg County’s District 2 and District 6, whose elementary schools were among those with delayed exposure investigations during winter break, have declined repeated requests from Healthbeat for interviews or information about their procedures for providing time-sensitive public health information during extended school break closures.

Both districts have had multiple measles exposure incidents in their schools since the outbreak began last fall, requiring dozens of students to be excluded from class due to quarantines.

What happened in South Carolina is a cautionary tale for health departments and schools across the United States – especially as measles makes a resurgence amid declining vaccination rates. So far this year, at least 24 states have reported measles cases to the Centers for Disease Control and Prevention.

In the coming weeks, schools across the country will be closing again for spring break.

“I just want to emphasize how normal Spartanburg is,” said Scott Thorpe, executive director of the nonprofit Southern Alliance for Public Health Leadership, noting that the pockets of low vaccination rates that have fueled the South Carolina measles outbreak are also common in other communities. “I hope that everybody is really preparing for this, because I don’t think it’s going anywhere anytime soon.”

With some communities having multiple school districts plus numerous private schools, Thorpe said that strengthening lines of communication between public health and schools takes time. “To try to figure out how to interact successfully in all these circumstances, in a crisis situation, is really hard,” he said.

School nurses, staff often not paid to work over breaks

Pat Endsley, president-elect of the National Association of School Nurses, said school breaks can pose a special challenge for health departments doing infectious disease contact tracing because school nurses and other staff often aren’t being paid to work during those periods – and they may even be traveling out of town.

With every state operating differently, Endsley said she’s not aware of any national best practice for addressing school contact tracing for measles during extended school break periods. A lot of the best practices were written specifically to address the emergence of the Covid-19 pandemic, she said.

“The gold standard would be to have some kind of person who is at the school, who’s not going anywhere, who could have access to information,” said Endsley, who served as a school nurse in Maine for 23 years and now teaches full time.

“Maybe that’s something that would come out of South Carolina, or Texas, or these other places with measles,” she said. “Based on this information, we could develop some exemplars of communication.”

How the South Carolina measles outbreak grew from 5 to over 900 cases

In at least some communities, health departments have found ways to ensure measles exposure investigations aren’t thwarted by school breaks.

Health officials battling another large measles outbreak along the Utah-Arizona border said they had no difficulties reaching impacted schools over the recent winter break.

“Our epidemiologists report that contact tracing and other issues involving students ran uninterrupted over the winter holidays, mainly due to frequent communication with an established point of contact with our largest school district,” said David Heaton, a spokesperson for the Southwest Utah Public Health Department. The school contact was available to help over the holidays, Heaton said.

Dani Lagana, a spokesperson for the Mohave County Department of Public Health in Arizona, said the department’s measles response activities are not dependent on school calendars.

“Effective contact tracing in school-associated cases relies on established communication protocols and coordination between public health and education partners,” Lagana said by email. “Health departments routinely plan for coverage during holidays and breaks to ensure appropriate notification and follow-up when needed.”

It’s unclear why – before winter break closures began – similar arrangements weren’t put in place between the South Carolina DPH and schools in Spartanburg County.

“DPH cannot direct school employees to come to work to assist with outbreak investigations,” the South Carolina department said in an emailed statement to Healthbeat.

The department said it has contact lists for school administrators, but these administrators may not have access to the detailed information outbreak investigators need when schools are closed.

“Comparisons of response activities from one jurisdiction to the next should be made with caution,” the state health department said. “Each jurisdiction has unique circumstances including differences between centralized vs. autonomous county public health agencies.”

Winter break delays in investigations of measles exposures occurred at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In South Carolina, public health activities are centralized and provided by state DPH employees at offices across the state. Arizona and Utah, have multiple local health departments covering a single county or multi-county region, in addition to state health departments.

Healthbeat asked each of Spartanburg County’s seven public school districts whether they had any policies or procedures that would specifically enable rapid sharing of student contact information during holiday breaks with public health officials who are trying to control infectious disease outbreaks. None of the districts provided answers to these questions.

Schools play an important role in helping public health investigators quickly determine which students, teachers, staff, and visitors may have been exposed to the infected individual. Not only does measles spread through the air, the virus can linger in a room for two hours after the contagious person has left.

School staff can provide health investigators detailed information about the movements of an infected student – and who was around them while they were contagious – by going through class schedules and rosters of those participating in extracurricular activities and riding on school buses. They also know which students lack immunity to measles because school records show which ones have exemptions from vaccine requirements for medical or religious reasons.

Rapid notification of at-risk individuals is critical, health officials say, so they know to quarantine at home and watch for early signs of measles that might otherwise be mistaken for a cold or the flu. In the four days before measles’ hallmark rash appears – and the person is already contagious – their earliest symptoms are typically a fever, cough, runny nose, and red, watery eyes.

“I definitely can see the issue that DPH had during winter break with schools closed two to three weeks, and no way to do that school notification, contact trace, get information from nurses,” said Dawn MacAdams, president of the South Carolina Association of School Nurses. “But then you run into: nurses don’t get paid during that time.”

MacAdams said that during Covid, school nurses faced overwhelming workloads and long hours helping with contact tracing without being paid for the extra work. “Nurses were working Christmas Eve, Christmas Day, New Year’s because the numbers were exploding and the guidance was changing,” she said.

MacAdams said she’s not sure what the solution is for ensuring timely contact tracing of school-associated measles exposures when schools are closed.

“That’s a really good question to think about with DPH on what are the things we can do,” she said. “Most spring breaks are somewhere the first or second week of April this year. So we’re going to be in another desert of the availability of school personnel to provide information.”

Records show quarantine delays at five Spartanburg schools

Internal South Carolina DPH reports show there were delays during winter break notifying and quarantining people who had been exposed to measles at three public schools, one public charter school, and one private Christian school.

For the exposure incidents at these schools, the department’s internal daily outbreak summary reports during winter break repeatedly listed that health officials were reaching out to the facilities or that the status of quarantine actions were still “TBD” – or to be determined.

It’s unclear how many exposed students and staff weren’t contacted quickly because these schools were closed. “Parsing out all those we were working to reach, whether students or others, during that time when cases were surging is not possible,” Bell said.

Measles investigation and quarantine delays occurred at Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines.

One of the schools where winter break investigation and quarantine delays occurred is Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines, including the measles, mumps and rubella shot. To prevent measles outbreaks, 95% coverage is needed.

It took Global Academy until Jan. 9 to provide outbreak investigators with a requested “line list” detailing the names and contact information for exposed students and staff, the DPH documents obtained by Healthbeat show. The school’s winter break was Dec. 22-Jan. 2.

“Global Academy finally provided a line list yesterday, and we are going through it,” a DPH official said in a Jan. 10 email updating the South Carolina governor’s office on the outbreak response.

The school’s principal, Mark Robertson, did not answer Healthbeat’s questions and told a reporter to contact DPH.

Global Academy was one of the first two schools to have confirmed measles cases when the outbreak began in early October. The school has had repeated rounds of students being quarantined and excluded from class.

Other schools that had delayed winter break investigations of measles exposure incidents included large public elementary schools in Spartanburg County School Districts 2 and 6, the records show. Throughout the outbreak, the district’s schools have had exposure incidents requiring students to quarantine, state records show.

In District 2, winter break delays occurred in investigations of exposures at Sugar Ridge Elementary, where state data show 78% of students are up-to-date on school vaccines, and at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In District 6, the delays also occurred at Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Officials with both districts have declined repeated requests from Healthbeat since Jan. 9 for interviews or answers to specific questions about the outbreak’s impact on student health, as well as the circumstances surrounding the exposure investigation delays over the winter break.

Health officials’ efforts to get complete exposure contact information from one school were so protracted coming out of the winter break that they were preparing to issue a formal public health order to force compliance. The school says it promptly provided information.

Maternity unit, BMW plant among groups exposed in South Carolina measles outbreak, records reveal

In January, the state health department issued a “final notice letter” to Westgate Christian School in Spartanburg because of the school’s continued “noncompliance,” Healthbeat reported earlier this month. The school was closed for its Christmas break from the afternoon of Dec. 19 through Jan. 2.

Outbreak investigators had been asking for contact information for exposed students and staff since Dec. 29, Bell said. A list that the school provided on New Year’s Eve was deemed “insufficient.”

When Westgate Christian’s break was over and the requested information still hadn’t been provided, Bell said the department issued a “final notice” to the school on Jan. 9. The letter warned that if the information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.”

The issue was resolved the next day when the school provided the requested information, Bell said.

Pastor James Wooten, Westgate Christian’s president, said that until the school’s administrator received the “final notice” email – at 5 p.m. on Friday, Jan. 9 – she thought the health department had been provided everything it needed on Dec. 31.

“Other than a thank you acknowledging receipt, she received no further correspondence or request for information until the final notice warning,” Wooten told Healthbeat last week. School officials wonder why, if outbreak investigators needed more information, “they didn’t simply reply to the email and request it,” Wooten 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

Georgia bill would make ivermectin available over the counter. Critics warn of risks.

2026-02-13T14:46:35+00:00

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

Georgia lawmakers are considering a bill to make a controversial anti-parasitic drug available over the counter. Even though ivermectin has been shown to have no effect on Covid or cancer, false claims spread on social media encourage those uses.

A state House committee held a hearing on the bill this week but did not vote.

State Rep. Karen Mathiak, a Griffin Republican, said she wants people to be able to buy the drug at pharmacies rather than farm supply stores. She said that though the U.S. Food and Drug Administration has not approved the drug for Covid treatment, people are using it that way.

“What happens now is people are buying it out of Tractor Supply and farm supply houses, and dosing by weight, by the patient’s weight,” Mathiak said. “I’m asking for it just to be over the counter.”

Sen. Colton Moore, a Trenton Republican, introduced a similar bill last year. It was assigned to the Agriculture and Consumer Affairs committee but did not get a hearing.

At least four states – Tennessee, Arkansas, Idaho, and Louisiana – had enacted similar legislation as of last summer, and similar bills were proposed in at least 12 other states, NBC News reported.

U.S. cancer institute studying ivermectin’s ‘ability to kill cancer cells’

Ivermectin was discovered in the 1970s and was first used to treat parasites in animals. During the pandemic, it was promoted by fringe medical groups as a treatment for Covid. Some social media influencers have hyped it as a miracle cure for a variety of diseases, including cancer.

“We’ve done clinical studies looking at ivermectin, and there is not enough evidence clinically for the FDA to approve this as an indication for Covid, in terms of having it as an over-the-counter medication,” said Dr. Colleen Kraft, a professor in the Departments of Pathology and Infectious Diseases at Emory University School of Medicine.

Inappropriate use of the drug can cause harm, ranging from mild symptoms like vomiting and diarrhea to more severe effects like confusion, loss of balance, seizures, and even death, said Dr. Tom Moore, a parasitologist who is a clinical professor of medicine at the University of Kansas School of Medicine.

He said that’s especially true for people who take the drug in large doses or via transdermal application or subcutaneous injections.

The number of cancer-related social media posts mentioning ivermectin doubled in the first half of 2025 compared to all of 2024. Such posts touted ivermectin’s purported ability to treat cancer or enhance chemotherapy or immunotherapy’s benefits, KFF, a nonprofit health policy think tank, found last year.

The National Cancer Institute is studying the drug, director Anthony Letai said. He said results are expected in a few months, KFF Health News reported this week. The move has prompted criticism from career scientists at the agency, who said it diverts resources from more promising treatments “based on nonscientific ideas.”

Ivermectin does have limited use for humans in the United States. As a pill, it can be used to treat strongyloidiasis, a type of roundworm infection, and river blindness, a neglected tropical disease found primarily in Africa.

A topical version of ivermectin can also be used for scabies and head lice but is typically not a frontline treatment for simple cases, Kraft said. It can also be prescribed for rosacea.

Kraft and Moore said some of the confusion around ivermectin during the pandemic was prompted by early test tube studies in which scientists experimented with a wide range of drugs to find something that would work for Covid. An early signal of the potential efficacy for ivermectin against Covid took on a life of its own, even as large-scale clinical trials failed to show evidence of the drug’s efficacy.

That focus on ivermectin during the pandemic deterred some people from seeking more effective medical treatments.

“There are some people that wish they had come to the hospital sooner instead of taking ivermectin,” Kraft said about patients she saw. There are now proven treatments like Paxlovid and remdesivir that have FDA approval for Covid, she said.

It’s important that physicians be able to help patients manage their medications and potential interactions, and opening the door to over-the-counter ivermectin could mean patients take the drug without proper medical guidance, she said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

A warning on the price of aid cuts: 9.4M preventable deaths

2026-02-12T12:00:00+00:00

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

Hello from Nairobi.

It’s been an interesting week. On Tuesday I joined a panel hosted by the American Foreign Service Association to talk about why taxpayers across Western countries don’t see the benefits of aid, or really see its reduction or absence either. It was a great chat, and on a topic I can’t help but be annoyingly sincere about!

This week we have a few stories that feature philanthropies, which are a small but increasingly important part of global aid, especially as Western government funding continues to shrink.

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.

9.4 million: the death toll of aid cuts

The science journal The Lancet Global Health just published a rigorous analysis on how last year’s global aid cuts are translating to deaths, reports the (sadly beleaguered) Washington Post.

The topline? Staying the course, we should expect about 9.4 million additional preventable deaths through 2030.

If aid funding drops even further, the researchers say that deaths could easily rise to 22.6 million; roughly equal to the entire death toll from WWI. (To be clear, I’m internalizing this more severe scenario as a warning, rather than an earnest forecast.)

We’ve previously covered models that have pointed in this direction, but this new paper is the most comprehensive yet. It was also partially funded by a philanthropy, the Rockefeller Foundation, which I reached out to. After all, as aid contracts, the funding that hasn’t retreated is more important than ever.

Eric Pelofsky, the foundation’s vice president for global economic recovery, spoke with me about the findings and about how philanthropies like his see their role in this moment.

First off, “the takeaway here is that any sort of assertion that this aid reduction could be done without [a high] cost of human life is just not grounded in the facts,” Pelofsky told me. He also stressed the immediacy of the findings. “If you came away thinking this is a problem that we can deal with in four years, I think the answer is absolutely not. The urgency is too great,” he said. We are, after all, talking about over 9 million human lives.

Where do philanthropies like the Rockefeller Foundation fit in this moment?

First, at the big-picture level, it’s worth remembering that only about 5% of humanitarian and development aid comes from private philanthropy. So, after last year’s cuts, “even if we were all to drop everything and try to fill the holes, we couldn’t do it,” Pelofsky said.

Instead Pelofsky sees their advantage right now elsewhere: in taking risks governments won’t with taxpayer money, backing analysis (like this paper), and working at financial plumbing of global development, rather than just writing checks. This includes “incredibly boring and incredibly important,” work like what his foundation has done to help development banks restructure their balance sheets so they can get more money out the door where it’s needed.

Still, Pelofsky was clear: They’re facing the same hard tradeoffs as everyone else, weighing what needs desperate attention right now against “where our dollar can make the biggest impact.”

Can philanthropy save us?

On this very topic … the world’s biggest philanthropy is likewise signaling that it can not play savior. The Gates Foundation told the AP it will “not change course in the face of massive foreign aid cuts.” (Disclosure: The Gates Foundation funded the launch of Healthbeat).

Instead, the foundation’s CEO Mark Suzman said the foundation will focus at least 70% of its money toward preventing maternal and child deaths and fighting key infectious diseases, while trimming or winding down other lines of work. “Not only will we not be taking on new priorities, we’re actively narrowing our priorities,” he said.

Why? As we discussed with Pelofsky, the scale of aid cuts simply does not allow even the best funded foundation to replace vanished government aid, and this is the Gates Foundation’s acknowledgement of that reality.

Second, Suzman says they are choosing to concentrate where they think the life-and-death returns are clearest. This means winding down less-urgent programs like ones “that aimed to give more people in sub-Saharan Africa and South Asia access to digital financial services.”

My takeaway? The Gates Foundation is betting that we will not see a quick rebound in aid generosity. They are planning for a world where the active threat is … 9.4 million additional preventable deaths by 2030.

A resurgence of cholera … vaccines!

A little background here: About four years ago, cholera vaccine production shrank to just one producer in South Korea. With a vanishing supply, this effectively brought pre-emptive global vaccination to a halt. (Countries could use what little was left to react to outbreaks, rather than trying to prevent them.)

The vaccine shortfall helped fuel a resurgence of cholera in Africa, which as we reported in October, became the worst outbreak on the continent in about 25 years.

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that 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.

But the World Health Organization just announced that the vaccine shortage is ending, France 24 reports. Since 2022, “global supply of oral cholera vaccines [has] doubled”, and now the WHO is doling out 20 million doses to Mozambique, Bangladesh, and the Democratic Republic of the Congo to get vaccination campaigns rolling again.

So what happened? The WHO and organizations like the Gates Foundation basically scrambled to help get the lone South Korean producer, EuBiologics, to ramp up supply. This included backing a simplified new vaccine that can be manufactured more quickly at a massive scale.

My takeaway: This shows exactly why the WHO matters. When pharma companies do not see a profitable market, it’s this global body that steps in to push lifesaving vaccines into production.

Taking ‘addictive’ snacks seriously

I’ve read a lot of scientific papers over the 15 years as an on-again, off-again science journalist. Let’s be real, even on fascinating subjects … they’re usually a bit of a slog. So trust me when I say it’s actually worth your time to read this paper on ultraprocessed foods in full, which was covered by The Guardian. It reads like part nonfiction book, part provocative essay.

The paper compares ultraprocessed foods and tobacco products to a somewhat shocking effect. The authors’ walk through how each is deliberately designed (from the dosing of ingredients and the engineering of sensory cues) to tap into reward pathways in the brain. For the foods, this is to deliver fast, reinforcing hits of refined carbs and fats.

For example, they describe how food engineers intentionally design snacks so the taste does not linger, which nudges you to take another bite. One put it bluntly in a TV interview: This is “so that you want more of it,” the engineer said, and when pressed on whether that is about addiction, he replied, “that’s a good word.”

Effectively, these foods and snacks are “engineered to encourage addiction,” just like cigarettes. And the takeaway is clear: If they’re made like cigarettes, perhaps they should be regulated like cigarettes.

I have long been wary of the impulse to ask governments to micromanage personal food choice. I think personal responsibility still matters, and that you should be able to have chips and a Coke without the state wagging its finger at you.

… but if you are like me (skeptical of soda taxes yet convinced that tobacco regulation has saved countless lives) it’s worth hearing the argument on how many of today’s ultraprocessed foods may have crossed a line in the design for addictive consumption.

As the lead author of the study, Ashley Gearhardt, told me over email: “We regulate thousands of tobacco and alcohol products differently based on risk. Most alcoholic beverages are mostly water, yet it’s clearly labeled because once it’s engineered to alter mood and seed cravings, it’s no longer about hydration. Ultra-processed foods operate similarly. They’re not about nourishment so much as craving and mood effects.”

Just enough WHO funding

Let me end on a bit of good news.

The WHO is now reporting that it “has mobilized about 85% of the resources” needed for this and next year’s core budget, thanks in part to countries agreeing to increase their mandatory contributions. That is not nothing!

“Eighty-five percent sounds good – and it is,” said WHO Director- General Tedros Ghebreyesus, with a “deeper crisis averted.” That said, he warns that the remaining 15% will be “hard to mobilize,” which I’m giving you permission to read as “absolutely not going to happen.”

What’s missing in that 15%? At least in part, it’s the WHO’s work on “emergency preparedness, antimicrobial resistance, and climate resilience.”

Still, this is a partial stabilization in a still fragile moment for global health.

I’ll see you next week!

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

Georgia lawmakers consider first steps to streamline public health system

2026-02-11T19:07:11+00:00

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

Citing historic underfunding of public health in Georgia, a legislative committee studying how the system is structured and financed has issued five recommendations for change.

In forming the committee, the House resolution noted that less than $1 of every $10 spent on Georgia’s three health agencies goes to the Department of Public Health, which is tasked with disaster and outbreak preparedness and response, air and water quality, disease prevention, and many other areas of population health. (The other two are the Departments of Community Health, the lead agency for Medicaid, and the Department Behavioral Health and Developmental Disabilities).

The committee’s proposals, developed after hearings around the state with experts and administrators, are aimed at streamlining Georgia’s hybrid public health system, in which control is shared between 159 county health departments and a state public health department. Only one proposal deals with funding, and four of the five would need legislation to enact; one bill has been filed.

“The ultimate answer is that local health departments will – at some point – need more money or will need to cut programs and services. It’s that simple. So it would be nice to see that reflected in here somewhere,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership.

Rep. Darlene Taylor, a Thomasville Republican who chaired the committee, told Healthbeat the legislature will take up increased funding for public health – but not this year. She cited federal budget uncertainty, as well as a need to change the system “piece by piece.”

Georgia Senate panel advances bill to ease path for foreign-trained doctors

A House committee has approved the first recommendation to become legislation – a bill to make it easier for county health workers to retain their accrued leave if they move into a state health department job. Taylor said she started there because many public health leaders said it was necessary to create a career ladder for public health workers.

Other recommendations from the study committee could come at the expense of local control, some said.

“These recommendations are sort of contrary. Number one, it says we want counties to contribute more. And then it …. basically says, ‘Oh, by the way, we’re going to do away with any coordination with your local county officials, the people supposed to be raising the taxes for this’,” said Jack Bernard, chairman of the Fayette County Board of Health.

Here’s a look at the five recommendations from the report.

Recommendation: Consider updating the county match requirement for county funding contributions to county health departments.

Rationale: The bulk of local public health funding comes from the state and federal funds.

But counties are also required to contribute funding to local public health departments. The formula to determine how much they contribute is based on population and tax digest data from prior to 1972, the last time the formula was updated, DPH chief financial officer William Bell said during an August hearing.

In fiscal 2024, counties provided a total of $48.5 million for local public health activities, Bell said. That figure is “above and beyond” what counties were required to contribute, which was just $12.2 million across all Georgia counties.

In turn, DPH provided a total of $187.8 million (in FY 2025) to the counties for general public health expenses. That amount is determined through a formula updated each year based on population and poverty levels. DPH also provides counties with additional funds for specific activities like HIV prevention or emergency preparedness.

William Bell, chief financial officer for Georgia's Department of Public Health, explains to state legislators how funding for public health works on Aug. 20.

This is the one recommendation that would not require legislation, said DPH spokesperson Eric Jens. The payments are governed by a contract between each county and the DPH.

Reactions: “Modernizing these public health funding formulas is a really important step toward strengthening our public health infrastructure and being able to keep Georgia’s community safe and healthy,” said Leah Chan, director of health justice at the Georgia Budget and Policy Institute. But she added that the state should also increase funds for public health.

While some counties might be willing to increase their contributions, in general they are opposed, said Todd Edwards, director of government affairs for ACCG, the association of Georgia’s counties.

Georgia nurses say fear of discipline keeps them from seeking addiction treatment

That’s because the state House of Representatives is considering a proposal to allow a referendum on whether to significantly reduce homestead property taxes by 2032. If adopted, that would significantly decrease county funding, Edwards said.

“We’re not looking to increase additional expenses on counties when our revenue is about to be decreased,” Edwards said.

The state had a total budget surplus of more than $14.6 billion at the start of this fiscal year, with $5.6 billion in its rainy day fund, officially known as the revenue shortfall reserve, and another $9.1 billion in undesignated reserves.

“The state should have put more money into this and not dump it on the county. Our state is wealthy,” said Bernard, pointing to the surplus.

He said doing so could exacerbate inequalities between rich and poor counties.

“Counties which are wealthy will have no trouble coming up with the matching funds,” Bernard said. But poor counties likely will.

Thorpe said the plan might not work as well as lawmakers expect. Many rural counties have seen their populations shrink since the 1970s, so their contribution would shrink if the formula continues to be based on population.

“The recommendation doesn’t outline a specific funding formula for squaring that circle - but in communities (particularly in South Georgia) that struggle with funding already, there would need to be a clear solution,” Thorpe said.

Recommendation: Allow local board of health staff to retain their accrued leave when they transition to a state appointment.

Rationale: Georgia’s hybrid public health system means that county public health workers are employed by counties, while many district health workers are employed by the state. When local workers move to a state job, they lose their accrued leave rate, akin to taking a step down in seniority.

State and local public health departments together employ nearly 6,000 workers, Jens said.

Reactions: Taylor introduced the bill to enact this proposal, which gained the unanimous approval of the House Public and Community Health committee.

Taylor said the bill aims to create “a sustainable career ladder that will help in improving employee retention in public health.” She said it will ensure experienced county health workers are not disincentivized from shifting to working for the district or state health departments because they would lose their leave rates. That, in turn, could open the door for younger public health workers to join at the county level, she said.

“It’s good for Georgians because it’s allowing them to keep that hard-earned leave as they move to a different position,” Chan said, but more is needed to address the state’s public health workforce shortage.

“We know that recruiting and retaining qualified staff, particularly in rural areas, is a very, very significant challenge. We’ve got below market average salaries. We’ve got a lot of staff that are eligible for retirement in the next five years. So this is really threatening the stability of our public health workforce,” Chan said.

It will be hard for the public health system to compete with private employers and retain staff “without first recognizing and addressing the compensation gap,” said Chris Scoggins, a professor of public health at Middle Georgia State University and a member of the Georgia Rural Health Association board.

Recommendation: Update and streamline the public health system to create clear lines of authority to the state office, consistent service standards, and transparent accountability measures for local health departments across the state.

Rationale: Georgia has a unique public health structure in which each county has its own public health department. Those are then grouped into 18 districts. Each district is headed by a director who reports to the state.

Reactions: Chan said stronger accountability measures for local health departments and districts should be paired with increased funding to ensure they can meet those standards.

Bernard said he’d like to see Georgia require that all public health boards be accredited. Currently only four entities are accredited by the Public Health Accreditation Board: the state DPH; Cobb & Douglas Public Health; Gwinnett, Newton, Rockdale Public Health; and District 4 Public Health, which covers 12 counties southwest of Atlanta. Bernard said the accreditation process helps public health departments plan and then evaluate whether they are meeting their goals.

“The public health certification process takes it away from theory and puts it into practice that you’ve got to set down your goals and objectives, and whether or not you’re achieving the goals and objectives, and what you need to do to modify what you’ve been doing,” Bernard said.

Recommendation: Transition from individual county boards of health to district boards of health, consisting of representation from each county, to consolidate administrative burden on local public health operations.

Rationale: The report states that many rural health departments cannot afford to offer a wide variety of services because of limited resources.

“Rural communities cannot leverage economies of scale as costs increase in rural environments,” the report noted. “The fixed costs of providing public health services within a small county do not scale.”

Reactions: Different states use different models, Thorpe said. Neighboring South Carolina has a highly centralized system directed by the state, he said, while North Carolina public health has a high degree of local control.

The North Carolina model works well because it provides local people and leaders a voice in public health, Thorpe said.

Bernard pointed out another benefit: County boards help mobilize local leaders to work on behalf of public health. Georgia law requires that county boards of health include a member of the county commission, a representative of the school district, a doctor who practices in the county, a consumer representative, and a representative of the largest city in the county.

“The reason you need the local boards is that those are the kind of people on it, and it creates support for public health in those institutions,” Bernard said. He said when his health department was trying to find a new building, members from the county commission and school board helped them find an older county building at a reduced price.

Recommendation: Provide DPH the authority to update health district composition without requiring unanimous local consent.

Rationale: This would allow DPH to shuffle which counties are in each of Georgia’s 18 districts without all of the constituent counties’ agreement. That could make it easier for the state to reconfigure districts to meet current demographics and needs.

Reactions: Bernard said Georgia’s 159 counties make administration unwieldy sometimes. But without further details about how the state would reshuffle the districts it’s hard to know whether to support the proposal.

“To truly modernize our system, greater regionalization will be necessary, without question. Doing so in a way that preserves the voice, values, and lived experience of our rural residents is critical,” Scoggins said. “I am encouraged by the committee’s recommendations, in that, there is a recognition that local input must be preserved yet reimagined.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

‘Bet on the optimists’: It’s a time of change for public health. It’s also an opportunity.

2026-02-11T12:00:00+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 new weekly report that aims to provide context about important topics in public health from around the United States.

My name is Dr. Jay K. Varma, and I am 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. (The views expressed here are my own and do not represent Fedcap.)

The goal of this report is to highlight and explain key stories that are shaping public health in the United States, from policy to research to outbreaks. The topics I choose are inherently subjective, informed by my background as a public health practitioner who has worked domestically and globally in government, academia, and the private sector. As this report evolves, please send ideas to me about topics you think need greater attention or perspectives that differ from my own.

Public health in the United States is undergoing dramatic changes, and, while I lament many of them, I am also an optimist. I believe that this period of change is also an opportunity to advance health protection, opportunity, and social justice at all levels of our society. As former Centers for Disease Control and Prevention Director Bill Foege (more on him later) said, “Bet on the optimists. You need the optimist to say, ‘We’re going to try to do it.’”

CDC not updating data on vaccine-preventable diseases

Last year was marked by the Department of Health and Human Services making major changes in policy, staffing, and funding at the CDC with a particular focus on immunizations and vaccine-preventable disease programs. While the consequence of that is primarily being measured in outbreaks — such as the rising outbreak of measles in South Carolina — it can also now be measured in one of CDC’s most critical functions: disease surveillance.

Academic researchers found that, of 82 regularly updated and publicly available CDC databases, 38 (46%) are no longer being updated regularly. Which databases have been most impacted? “Of the 38 paused databases, 33 (87%) were vaccination-related topics compared with none of the 44 current databases,” the authors write. The epidemiologist in me can’t help but conclude this pattern is not due to random or topic-neutral decision-making. The data show a near-perfect association between vaccines and data collection: Vaccination-related databases were paused, and others largely were not.

We can only speculate about why this might be happening. It could be that there simply are not enough staff to do these updates, because of staffing cuts. It could be that staff are available but otherwise occupied, including possibly making databases compliant with new requirements related to gender and other Diversity, Equity, and Inclusion-related topics. It could be that they have been instructed to focus on other health conditions. Or it could be a combination of all of these.

What we do know is that surveillance — counting who gets sick or dies — is the foundation of all public health, and that, when public health agencies do not measure a disease, the public and policy-makers begin to think that the disease is not a problem.

For example, if a policy maker sees that the CDC is reporting fewer flu-related deaths in children, then they might erroneously conclude that flu is not a problem and seasonal flu vaccination is not so necessary.

The invisibility of public health activities like surveillance to the general public is also what makes these activities so susceptible to distortion and to funding cuts. I applaud these researchers for conducting surveillance of CDC’s surveillance databases, because diseases only count when they are actually counted.

Early detection of cancer through blood tests? Buyer beware

One health condition that always gets high-profile attention is cancer. Rather than one specific disease, cancer is hundreds of different diseases, all of which are characterized by the uncontrolled growth and spread of abnormal cells in the body. While five-year death rates for people diagnosed with cancer are declining in the United States, companies are increasingly advertising to the public ways they can detect and treat cancer earlier, specifically blood tests otherwise known as “liquid biopsies” or “multi-cancer early detection” tests.

Sure enough, during the Super Bowl on Sunday night, the direct-to-consumer medical platform Hims & Hers promoted its latest offering: pay $750 on top of your usual annual subscription price and receive the Galleri test (manufactured by Grail Diagnostics) for cancer detection.

My inherent bias is to be skeptical of companies selling these tests to consumers until there is strong evidence that they work, such as large studies in diverse populations in which people are followed for several years.

The Super Bowl ad for the Galleri tests shows a man breathing a sign of relief when he looks at his phone and sees a result that says, “No cancer signal detected.” In fact, in the largest study done on Galleri, the test had an overall sensitivity of 51.5%, suggesting that a result that reads “no cancer signal detected” could be inaccurate up to 50% of the time.

I was not surprised to hear the news recently about another up-and-coming company in this field, Cancer Check Labs, that is being investigated for fraud.

The Securities and Exchange Commission complaint says investors in Cancer Check Labs were told their money would fund research, clinical trials, and Food and Drug Administration or European approval for a blood-based cancer screening device. What happened instead, according to the SEC, is that more than $10 million was diverted for personal spending and unrelated ventures.

While the complaint focuses on securities fraud, not medical fraud, it describes a familiar pattern in the consumer blood testing space: bold scientific claims, vague regulatory promises, and little evidence that the underlying technology works as advertised.

The most high-profile example of this was Theranos, in which a company moved rapidly from medical device development to direct-to-consumer testing without demonstrating analytical validity (does the test measure what it says it’s measuring?), clinical validity (does the test provide information useful to a person’s health?), or real world benefit (does the test help detect and cure cancer earlier?).

Unfortunately, the existence of a blood test on the market does not mean it has actually been proven accurate, useful, or safe. As more companies promote early cancer detection through blood screening, this case underscores the need for strong regulatory oversight and for all of us to be skeptical of claims unless there is high-quality independent evidence that the tests work. The UK National Health Service is currently running one such trial on the Galleri test: a randomized control trial of more than 140,000 people to evaluate whether this test actually reduces the incidence of late-stage cancer and cancer death, with results expected this year.

The legacy of two men on public health in the 20th century

At the beginning of this report, I mentioned Bill Foege, former CDC director, who died on Jan. 24. A week earlier, another scientist with an important impact on public health died: Peter Duesberg. The legacies of these two men could not be more different.

Foege focused his career on reducing human suffering. He helped lead the eradication of smallpox and mentored generations of public health leaders. He believed that evidence, humility, and collective action could change history. He never stopped reminding students that certainty is dangerous and kindness is essential.

Duesberg followed a different path. Once a respected virologist who did pioneering work showing that viruses can cause cancer, he rejected overwhelming evidence that HIV causes AIDS and used his scientific credentials to amplify falsehoods across the world. His words encouraged people to refuse lifesaving treatment and shaped policies that contributed to hundreds of thousands of preventable deaths.

Foege taught that progress comes from questioning tradition while staying anchored to data, ethics, and social justice. Duesberg modeled what happens when certainty hardens into ideology, healthy skepticism becomes dangerous denial, and arrogance drives activism.

Foege used language to build trust, share credit, and widen the circle of care. Duesberg used language to inflame and to malign people and institutions that save lives.

If you want to be inspired, take 25 minutes to watch Foege’s 2016 graduation speech at Emory University.

Here’s one of my favorite excerpts: “I keep wondering why I was not born in a village in New Guinea. I am no self-made person. I was born in this country, urged on by family, traveled roads paid for by government, went to schools that required thousands of people to put together … I avoided dying of tuberculosis, food poisoning, toxic water because of a government, rarely appreciated. Not because I deserved it but because of a coalition of government, religious institutions, and public and private groups, all conspiring to help me.”

Until next week,

Jay

U.S. cancer institute studying ivermectin’s ‘ability to kill cancer cells’

2026-02-10T17:10:56+00:00

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

The National Cancer Institute, the federal research agency charged with leading the war against the nation’s second-largest killer, is studying ivermectin as a potential cancer treatment, according to its top official.

“There are enough reports of it, enough interest in it, that we actually did — ivermectin, in particular — did engage in sort of a better preclinical study of its properties and its ability to kill cancer cells,” said Anthony Letai, a physician the Trump administration appointed as NCI director in September.

Letai did not cite new evidence that might have prompted the institute to research the effectiveness of the antiparasitic drug against cancer. The drug, largely used to treat people or animals for infections caused by parasites, is a popular dewormer for horses.

“We’ll probably have those results in a few months,” Letai said. “So we are taking it seriously.”

He spoke about ivermectin at a Jan. 30 event, “Reclaiming Science: The People’s NIH,” with National Institutes of Health Director Jay Bhattacharya and other senior agency officials at Washington, D.C.’s Willard Hotel. The MAHA Institute hosted the discussion, framed by the “Make America Healthy Again” agenda of Health and Human Services Secretary Robert F. Kennedy Jr. The National Cancer Institute is the largest of the NIH’s 27 branches.

During the Covid pandemic, ivermectin’s popularity surged as fringe medical groups promoted it as an effective treatment. Clinical trials have found it isn’t effective against Covid.

Ivermectin has become a symbol of resistance against the medical establishment among MAHA adherents and conservatives. Like-minded commentators and wellness and other online influencers have hyped — without evidence — ivermectin as a miracle cure for a host of diseases, including cancer. Trump officials have pointed to research on ivermectin as an example of the administration’s receptiveness to ideas the scientific establishment has rejected.

“If lots of people believe it and it’s moving public health, we as NIH have an obligation, again, to treat it seriously,” Bhattacharya said at the event. According to The Chronicle at Duke University, Bhattacharya recently said he wants the NIH to be “the research arm of MAHA.”

The decision by the world’s premier cancer research institute to study ivermectin as a cancer treatment has alarmed career scientists at the agency.

“I am shocked and appalled,” one NCI scientist said. “We are moving funds away from so much promising research in order to do a preclinical study based on nonscientific ideas. It’s absurd.”

KFF Health News granted the scientist and other NCI workers anonymity because they are not authorized to speak to the press and fear retaliation.

HHS and the National Cancer Institute did not answer KFF Health News’ questions on the amount of money the cancer institute is spending on the study, who is carrying it out, and whether there was new evidence that prompted NCI to look into ivermectin as an anticancer therapy. Emily Hilliard, an HHS spokesperson, said NIH is dedicated to “rigorous, gold-standard research,” something the administration has repeatedly professed.

Ivermectin approved for worms, lice, rosacea

A preclinical study is an early phase of research conducted in a lab to test whether a drug or treatment may be useful and to assess potential harms. These studies take place before human clinical trials.

The scientist questioned whether there is enough initial evidence to warrant NCI’s spending of taxpayer funds to investigate the drug’s potential as a cancer treatment.

The FDA has approved ivermectin for certain uses in humans and animals. Tablets are used to treat conditions caused by parasitic worms, and the FDA has approved ivermectin lotions to treat lice and rosacea. Two scientists involved in its discovery won the Nobel Prize in 2015, tied to the drug’s success in treating certain parasitic diseases.

The FDA has warned that large doses of ivermectin can be dangerous. Overdoses can cause seizures, comas, or death.

Kennedy, supporters of the MAHA movement, and some conservative commentators have promoted the idea that the government and pharmaceutical companies quashed ivermectin and other inexpensive, off-patent drugs because they’re not profitable for the drug industry.

“FDA’s war on public health is about to end,” Kennedy wrote in an October 2024 X post that has since gone viral. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.”

Previous laboratory research has shown that ivermectin could have anticancer effects because it promotes cell death and inhibits the growth of tumor cells. “It actually has been studied both with NIH funds and outside of NIH funds,” Letai said.

However, there is no evidence that ivermectin is safe and effective in treating cancer in humans. Preliminary data from a small clinical trial that gave ivermectin to patients with one type of metastatic breast cancer, in combination with immunotherapy, found no significant benefit from the addition of ivermectin.

Cancer patients regularly asking about ivermectin

Some physicians are concerned that patients will delay or forgo effective cancer treatments, or be harmed in other ways, if they believe unfounded claims that ivermectin can treat their disease.

“Many, many, many things work in a test tube. Quite a few things work in a mouse or a monkey. It still doesn’t mean it’s going to work in people,” said Jeffery Edenfield, executive medical director of oncology for the South Carolina-based Prisma Health Cancer Institute.

Edenfield said cancer patients ask him about ivermectin “regularly,” mostly because of what they see on social media. He said he persuaded a patient to stop using it, and a colleague recently had a patient who decided “to forgo highly effective standard therapy in favor of ivermectin.”

“People come to the discussion having largely already made up their mind,” Edenfield said.

“We’re in this delicate time when there’s sort of a fundamental mistrust of medicine,” he added. “Some people are just not going to believe me. I just have to keep trying.”

A June letter by clinicians at Cincinnati Children’s Hospital Medical Center in Ohio detailed how an adolescent patient with metastatic bone cancer started taking ivermectin “after encountering social media posts touting its benefits.” The patient — who hadn’t been given a prescription by a clinician — experienced ivermectin-related neurotoxicity and had to seek emergency care because of nausea, fatigue, and other symptoms.

“We urge the pediatric oncology community to advocate for sensible health policy that prioritizes the well-being of our patients,” the clinicians wrote.

The lack of evidence about ivermectin and cancer hasn’t stopped celebrities and online influencers from promoting the notion that the drug is a cure-all. On a January 2025 episode of Joe Rogan’s podcast, actor Mel Gibson claimed that a combination of drugs that included ivermectin cured three friends with stage 4 cancer. The episode has been viewed more than 12 million times.

Lawmakers in a handful of states have made the drug available over the counter. And Florida — which, under Republican Gov. Ron DeSantis, has become a hotbed for anti-vaccine policies and the spread of public health misinformation — announced last fall that the state plans to fund research to study the drug as a potential cancer treatment.

The Florida Department of Health did not respond to questions about that effort.

Letai, previously a Dana-Farber Cancer Institute oncologist, started at the National Cancer Institute after months of upheaval caused by Trump administration policies.

“What you’re hearing at the NIH now is an openness to ideas — even ideas that scientists would say, ‘Oh, there’s no way it could work’ — but nevertheless applying rigorous scientific methods to those ideas,” Bhattacharya said at the Jan. 30 event.

A second NCI scientist, who was granted anonymity due to fear of retaliation, said the notion that NIH was not open to investigating the value of off-label drugs in cancer is “ridiculous.”

“This is not a new idea they came up with,” the scientist said.

Letai didn’t elaborate on whether NCI scientists are conducting the research or if it has directed funding to an outside institution. Three-quarters of the cancer institute’s research dollars go to outside scientists.

He also aimed to temper expectations.

“At least on a population level,” Letai said, “it’s not going to be a cure-all for cancer.”

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

Public Health Service workers are quitting over assignments to Guantánamo

2026-02-09T09:00:00+00:00

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

Rebekah Stewart, a nurse at the U.S. Public Health Service, got a call last April that brought her to tears. She had been selected for deployment to the Trump administration’s new immigration detention operation at Guantánamo Bay, Cuba.

This posting combined Donald Trump’s longtime passion to use the offshore base to move “some bad dudes” out of the United States with a promise made shortly after his inauguration last year to hold thousands of noncitizens there. The naval base is known for the torture and inhumane treatment of men suspected of terrorism in the wake of 9/11.

“Deployments are typically not something you can say no to,” Stewart said. She pleaded with the coordinating office, which found another nurse to go in her place.

Other public health officers who worked at Guantánamo in the past year described conditions there for the detainees, some of whom learned they were in Cuba from the nurses and doctors sent to care for them. They treated immigrants detained in a dark prison called Camp 6, where no sunlight filters in, said the officers, whom KFF Health News agreed not to name because they fear retaliation for speaking publicly. It previously held people with suspected ties to al-Qaida. The officers said they were not briefed ahead of time on the details of their potential duties at the base.

Although the Public Health Service is not a branch of the U.S. armed forces, its uniformed officers — roughly 5,000 doctors, nurses, and other health workers — act like stethoscope-wearing soldiers in emergencies. The government deploys them during hurricanes, wildfires, mass shootings, and measles outbreaks. In the interim, they fill gaps at an alphabet soup of government agencies.

The Trump administration’s mass arrests to curb immigration have created a new type of health emergency as the number of people detained reaches record highs. About 71,000 immigrants are currently imprisoned, according to Immigration and Customs Enforcement data, which shows that most have no criminal record.

Homeland Security Secretary Kristi Noem has said: “President Donald Trump has been very clear: Guantanamo Bay will hold the worst of the worst.” However, several news organizations have reported that many of the men shipped to the base had no criminal convictions. As many as 90% of them were described as “low-risk” in a May progress report from ICE.

In fits and starts, the Trump administration has sent about 780 noncitizens to Guantánamo Bay, according to The New York Times. Numbers fluctuate as new detainees arrive and others are returned to the United States or deported.

While some Public Health Service officers have provided medical care to detained immigrants in the past, this is the first time in American history that Guantánamo has been used to house immigrants who had been living in the United States. Officers said ICE postings are getting more common. After dodging Guantánamo, Stewart was instructed to report to an ICE detention center in Texas.

“Public health officers are being asked to facilitate a man-made humanitarian crisis,” she said.

Seeing no option to refuse deployments that she found objectionable, Stewart resigned after a decade of service. She would give up the prospect of a pension offered after 20 years.

“It was one of the hardest decisions I ever had to make,” she said. “It was my dream job.”

One of her PHS colleagues, nurse Dena Bushman, grappled with a similar moral dilemma when she got a notice to report to Guantánamo a few weeks after the shooting at the Centers for Disease Control and Prevention in August. Bushman, who was posted with the CDC, got a medical waiver delaying her deployment on account of stress and grief. She considered resigning, then did.

“This may sound extreme,” Bushman said. “But when I was making this decision, I couldn’t help but think about how the people who fed those imprisoned in concentration camps were still part of the Nazi regime.”

Others have resigned, but many officers remain. While they are alarmed by Trump’s tactics, detained people need care, multiple PHS officers told KFF Health News.

“We do the best we can to provide care to people in this shit show,” said a PHS nurse who worked in detention facilities last year.

“I respect people and treat them like humans,” she said. “I try to be a light in the darkness, the one person that makes someone smile in this horrible mess.”

The PHS officers conceded that their power to protect people was limited in a detention system fraught with overcrowding, disorganization, and the psychological trauma of uncertainty, family separations, and sleep deprivation.

“Ensuring the safety, security, and well-being of individuals in our custody is a top priority at ICE,” Tricia McLaughlin, chief spokesperson for the Department of Homeland Security, said in an emailed statement to KFF Health News.

Adm. Brian Christine, assistant secretary for health at the Department of Health and Human Services, which oversees the Public Health Service, said in an email: “Our duty is clear: Say “Yes Sir!,’ salute smartly, and execute the mission: Show up, provide humane care, and protect health.” Christine is a recent appointee who, until recently, was a urologist specializing in testosterone and male fertility issues.

“In pursuit of subjective morality or public displays of virtue,” he added, “we risk abandoning the very individuals we pledged to serve.”

Into the unknown: PHS officers’ questions unanswered

In the months before Stewart resigned, she reflected on her previous deployments, during Trump’s first term, to immigration processing centers run by Customs and Border Protection. Fifty women were held in a single concrete cell in Texas, she recalled.

“The most impactful thing I could do was to convince the guards to allow the women, who had been in there for a week, to shower,” she said. “I witnessed suffering without having much ability to address it.”

Stewart spoke with Bushman and other PHS officers who were embedded at the CDC last year. They assisted with the agency’s response to ongoing measles outbreaks, with sexually transmitted infection research, and more. Their roles became crucial last year as the Trump administration laid off droves of CDC staffers.

Stewart, Bushman, and a few other PHS officers at the CDC said they met with middle managers to ask for details about the deployments: If they went to Guantánamo and ICE facilities, how much power would they have to provide what they considered medically necessary care? If they saw anything unethical, how could they report it? Would it be investigated? Would they be protected from reprisal?

U.S. service members stand by during an April 2025 simulated medical evacuation of immigrants detained at Guantánamo.

Stewart and Bushman said they were given a PHS office phone number they could call if they had a complaint while on assignment. Otherwise, they said, their questions went unanswered. They resigned and so never went to Guantánamo.

But PHS officers who were deployed to the base told KFF Health News they weren’t given details about their potential duties — or the standard operating procedure for medical care — before they arrived.

Stephen Xenakis, a retired Army general and a psychiatrist who has advised on medical care at Guantánamo for two decades, said that was troubling. Before health workers deploy, he said, they should understand what they’ll be expected to do.

The consequences of insufficient preparation can be severe. In 2014, the Navy threatened to court-martial one of its nurses at Guantánamo who refused to force-feed prisoners on hunger strike, who were protesting inhumane treatment and indefinite detention. The protocol was brutal: A person was shackled to a five-point restraint chair as nurses shoved a tube for liquid food into their stomach through their nostrils.

“He wasn’t given clear guidance in advance on how these procedures would be conducted at Guantánamo,” Xenakis said of the nurse. “Until he saw it, he didn’t understand how painful it was for detainees.”

The American Nurses Association and Physicians for Human Rights sided with the nurse, saying his objection was guided by professional ethics. After a year, the military dropped the charges.

A uniformed doctor or nurse’s power tends to depend on their rank, their supervisor, and chains of command, Xenakis said. He helped put an end to some inhumane practices at Guantánamo more than a decade ago, when he and other retired generals and admirals publicly objected to certain interrogation techniques, such as one called “walling,” in which interrogators slammed the heads of detainees suspected of terrorism against a wall, causing slight concussions. Xenakis argued that science didn’t support “walling” as an effective means of interrogation, and that it was unethical, amounting to torture.

Torture hasn’t been reported from Guantánamo’s immigration operation, but ICE shift reports obtained through a Freedom of Information Act request by the government watchdog group American Oversight note concerns about detainees resorting to hunger strikes and self-harm.

“Welfare checks with potential hunger strike IA’s,” short for illegal aliens, says an April 30 note from a contractor working with ICE. “In case of a hunger strike or other emergencies,” the report adds, the PHS and ICE are “coordinating policies and procedures.”

“De-escalation of potential pod wide hunger strike/potential riot,” says an entry from July 8. “Speak with alien on suicide watch regarding well-being.”

Inmates and investigations have reported delayed medical care at immigration detention facilities and dangerous conditions, including overcrowding and a lack of sanitation. Thirty-two people died in ICE custody in 2025, making it the deadliest year in two decades.

“They are arresting and detaining more people than their facilities can support,” one PHS officer told KFF Health News. The most prevalent problem the officer saw among imprisoned immigrants was psychological. They worried about never seeing their families again or being sent back to a country where they feared they’d be killed. “People are scared out of their minds,” the officer said.

No sunlight in high-security Camp 6

The PHS officers who were at Guantánamo told KFF Health News that the men they saw were detained in either low-security barracks, with a handful of people per room, or in Camp 6, a dark, high-security facility without natural light. The ICE shift reports describe the two stations by their position on the island, Leeward for the barracks and Windward for Camp 6. About 50 Cuban men sent to Guantánamo in December and January have languished at Camp 6.

A Navy hospital on the base mainly serves the military and other residents who aren’t locked up — and in any case, its capabilities are limited, the officers said. To reduce the chance of expensive medical evacuations back to the United States to see specialists quickly, they said, the immigrants were screened before being shipped to Guantánamo. People over age 60 or who needed daily drugs to manage diabetes and high blood pressure, for example, were generally excluded. Still, the officers said, some detainees have had to be evacuated back to Florida.

PHS nurses and doctors said they screened immigrants again when they arrived and provided ongoing care, fielding complaints including about gastrointestinal distress and depression. One ICE monthly progress report says, “The USPHS psychologist started an exercise group” for detainees.

Doctors’ requests for lab work were often turned down because of logistical hurdles, partly due to the number of agencies working together on the base, the officers said. Even a routine test, a complete blood count, took weeks to process, versus hours in the United States.

DHS and the Department of Defense, which have coordinated on the Guantánamo immigration operation, did not respond to requests for comment about their work there.

One PHS officer who helped medically screen new detainees said they were often surprised to learn they were at Guantánamo.

“I’d tell them, ‘I’m sorry you are here,’” the officer said. “No one freaked out. It was like the ten-millionth time they had been transferred.” Some of the men had been detained in various facilities for five or six months and said they wanted to return to their home countries, according to the officer. Health workers had neither an answer nor a fix.

Unlike ICE detention facilities in the United States, Guantánamo hasn’t been overcrowded. “I have never been so not busy at work,” one officer said. A military base on a tropical island, Guantánamo offers activities such as snorkeling, paddleboard yoga, and kickboxing to those who aren’t imprisoned. Even so, the officer said they would rather be home than on this assignment on the taxpayer’s dime.

Transporting staff and supplies to the island and maintaining them on-base is enormously expensive. The government paid an estimated $16,500 per day, per detainee at Guantánamo, to hold those accused of terrorism, according to a 2025 Washington Post analysis of DOD data. (The average cost to detain immigrants in ICE facilities in the United States is $157 a day.)

Even so, the funding has skyrocketed: Congress granted ICE a record $78 billion for fiscal year 2026, a staggering increase from $9.9 billion in 2024 and $6.5 billion nearly a decade ago.

Last year, the Trump administration also diverted more than $2 billion from the national defense budget to immigration operations, according to a report from congressional Democrats. About $60 million of it went to Guantánamo.

“Detaining noncitizens at Guantanamo is far more costly and logistically burdensome than holding them in ICE detention facilities within the United States,” wrote Deborah Fleischaker, a former assistant director at ICE, in a declaration submitted as part of a lawsuit brought by the American Civil Liberties Union early last year. In December, a federal judge rejected the Trump administration’s request to dismiss a separate ACLU case questioning the legality of detaining immigrants outside the United States.

Anne Schuchat, who served with the PHS for 30 years before retiring in 2018, said PHS deployments to detention centers may cost the nation in terms of security, too. “A key concern has always been to have enough of these officers available for public health emergencies,” she said.

Andrew Nixon, an HHS spokesperson, said the immigration deployments don’t affect the public health service’s potential response to other emergencies.

In the past, PHS officers have stood up medical shelters during hurricanes in Louisiana and Texas, rolled out Covid testing in the earliest months of the pandemic, and provided crisis support after the deadly shooting at Sandy Hook Elementary School and the Boston Marathon bombing.

“It’s important for the public to be aware of how many government resources are being used so that the current administration can carry out this one agenda,” said Stewart, one of the nurses who resigned. “This one thing that’s probably turning us into the types of countries we have fought wars against.”

Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.

NYC health department joins global network after U.S. pulls out of WHO

2026-02-05T20:15:29+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 announced Thursday it has joined a World Health Organization network that works on disease outbreaks and other public health emergencies around the world. The city said it was the first U.S. municipality to do so.

The decision to join WHO’s Global Outbreak Alert and Response Network is the latest example of a government agency in the United States seeking to work with the WHO following the Trump administration’s withdrawal from the organization in January, coupled with deep cuts to the U.S. Centers for Disease Control and Prevention. California Gov. Gavin Newsom announced last month that his state was joining the network; on Tuesday, Illinois Gov. JB Pritzker announced his state would join.

The WHO group is an international public health network that brings together more than 300 public health institutions, governments, academic centers, laboratories, and response organizations. Their aim is to rapidly detect and respond to public health threats and emergencies. To this end, the different entities receive direct access to early-warning alerts and outbreak intelligence, along with training and exercises.

New NYC health commissioner is ER doctor with policy degree: ‘Not a traditional pick’

The membership will likely prove essential this summer when the United States, along with Mexico and Canada, hosts the 2026 FIFA World Cup. Matches will take place in major cities throughout North America, culminating with a final in July at MetLife Stadium in East Rutherford, New Jersey. Greater New York alone is expecting more than a million visitors. For its part, the White House has created a World Cup task force, led by Andrew Giuliani, son of former New York City Mayor Rudy Giuliani, that is housed at the U.S. Department of Homeland Security.

Public health experts say the Trump administration’s retreat from the WHO will make the world – and the United States – more vulnerable to disease outbreaks and other public health threats. The United States has long been a key player in containing outbreaks in other parts of the world that might otherwise show up at the U.S. borders. The United States was the WHO’s single largest donor, with contributions fluctuating, donating $1.2 billion during the 2022-23 biennium.

In an interview with Healthbeat last week, New York State Health Commissioner James McDonald said the state was also looking into joining the WHO network.

McDonald said the U.S. withdrawal from the WHO would undermine global immunization efforts, which would bring illness as a result. A healthier world means a healthier New York state and United States.

“One of my big concerns is by pulling out of the World Health Organization and by underfunding CDC, what risk are we inviting in the United States?” McDonald said. “Because people get in planes and travel, and you are literally 12 hours away from the biggest surprise ever. I don’t understand why we’re willing to live in this period of ignorance."

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 Senate panel advances bill to ease path for foreign-trained doctors

2026-02-05T16:55:45+00:00

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

A bill to make it easier for foreign-trained doctors to practice in Georgia passed a Senate committee with a unanimous vote on Wednesday, opening the way for the measure to pass two years after it was first proposed.

A similar bill last year failed to gain approval before the end of the session. This year, the bill gained the sponsorship of a powerful Republican backer, Dr. Ben Watson, a Savannah doctor who chairs the Senate Health and Human Services committee.

The measure would create a pathway for lawfully present doctors who trained in other countries to practice in Georgia if a long list of conditions are met. The idea is to match foreign-trained doctors to medically underserved areas.

If Georgia adopts the measure, it would join a growing list of states – at least 17, according to the American Medical Association — that have done so, including neighboring Tennessee, Florida, and, most recently, North Carolina, whose law took effect in January.

Senators said they support the bill because it could help ease Georgia’s rural physician shortage. The state is short by more than 8,000 physicians, according to the National Center for Health Workforce Analysis. That’s especially pronounced in rural areas, with 10 counties without any physicians at all and 63 counties lacking pediatricians in 2023-24, according to state data.

“If it helps in any way address the shortage in rural areas, then it’ll be a great thing,” Sen. Chuck Hufstetler, a Republican from Rome, said.

Watson said the extensive requirements in the bill would help ensure that the foreign-born doctors are able to provide high-quality care.

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.

State senators vote unanimously in favor of a bill to make it easier for foreign-trained doctors to practice in Georgia on Wednesday.

Doctors must also demonstrate they have passed a major medical exam, typically by passing all three parts of the United States Medical Licensing Examination, or an equivalent foreign exam, or gaining board certification in a medical specialty. They must also pass 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 can obtain a limited provisional license.

The doctor must then practice for four years under the supervising physician 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, which includes rural areas, as well as federally qualified health centers that serve un- and underinsured Georgians in urban and rural areas.

While the bill eventually gained unanimous support, some senators expressed initial concerns about the proposal. For example, Sen. Ed Setzler, an Acworth Republican, said he wanted to make sure that businesses or hospitals cannot recruit foreign doctors to work here for lower rates than domestically trained doctors.

Advocates say the bill would increase the supply of doctors who can connect with Georgia’s diverse population.

“Many immigrant physicians are already here. They’re trained, they’re experienced, and they’re ready to work,” said Stefanie Zaenker, strategic director of the LIBRE Initiative, a free market advocacy group focused on the Latino community.

“These doctors bring critical language skills and cultural understanding to underserved Latino communities and other minority communities, which improves trust, communication, and health outcomes,” Zaenker said.

There’s no straightforward data on how many doctors in Georgia would qualify for the program, said Darlene Lynch, legal and policy director for the Georgia Appleseed Center for Law and Justice. She has been advocating for the measure for years.

Lynch said she knows of internationally trained doctors who have left Georgia because they cannot practice here – or decided to pursue another profession entirely, like social work.

“We know there are a lot of doctors who were working in ICU for decades, or as OB-GYNs or or primary care docs and [are now] literally selling Uber Eats or working at the CVS,” Lynch told Healthbeat after the hearing.

“They worked super hard, and they want to practice medicine, and they want to help people. And if Georgia doesn’t give them a way, they will go somewhere else,” Lynch said.

The Senate rules committee – of which Watson serves as vice chairman – must now decide to send the bill to the Senate floor for a vote before March 6, the deadline by which bills must get the approval of their home chamber to have a chance of passing this session.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

It’s 2026 and you’re uninsured. Now what?

2026-02-02T15:38:49+00:00

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

Health policy changes in Washington will ripple through the country, resulting in millions of Americans losing their Medicaid or Affordable Care Act coverage. But there are still ways to find care.

Over the next decade, the GOP’s One Big Beautiful Bill Act is expected to slash nearly $1 trillion in spending from Medicaid, the state-federal program for people with low incomes and disabilities. The implementation of new work rules will cause some beneficiaries to lose their Medicaid coverage.

Millions of Americans are facing enormous increases in their out-of-pocket costs for ACA coverage. So far, 1.2 million fewer people have signed up for Obamacare plans compared with last year, and health policy analysts estimate more will lose coverage as they fail to pay their premiums.

Health costs are a top concern for Americans. Two-thirds of the public say they are somewhat or very worried about affording health care, more than express the same worries about utilities, food, housing, or gas, according to a January poll from KFF, a health information nonprofit that includes KFF Health News.

“All of this pain just doesn’t have to be there,” said Cheryl Fish-Parcham, director of private coverage at the health consumer group Families USA.

Doctors and health policy researchers say health coverage, of any kind, is the best protection against major medical debt.

Caitlin Donovan, a senior director at the Patient Advocate Foundation, recommends exhausting every available option for health coverage before going uninsured.

Even a high-deductible plan can protect patients from medical bankruptcy “if the absolute worst-case scenario happens,” she said.

Here are five ways that the uninsured can find affordable care.

1. Don’t be afraid to talk with your doctor about money

Patients can be hesitant to tell their doctors they’re uninsured or be wary of expressing concern about being able to afford care.

But some hospitals, physicians, and other providers offer cheaper cash pay options, said Cynthia Cox, a senior vice president and the director of the Program on the ACA at KFF.

Often prices are negotiable. “Always ask,” she said.

How New York’s state health chief is navigating the ‘Great Desensitivation’

Health care providers can make adjustments if they know patients are worried about money, said Ateev Mehrotra, a doctor and researcher at Brown University.

“If my patient tells me, ‘Doc, I’m gonna have to pay for this out-of-pocket,’ I’m gonna make a different risk calculus,” Mehrotra said.

That doesn’t mean a patient won’t get the care they need, he said. A doctor, for instance, might order an ultrasound instead of an MRI, which is more expensive.

2. Search for providers that specifically work with uninsured patients

If your usual provider won’t budge on prices, then search for providers that cater to patients without insurance.

Federally qualified health centers, or FQHCs, and other community clinics offer routine and non-emergency care, such as treatment for flu or infection, for low-income residents and the uninsured. Community health centers charge based on a sliding scale and see 52 million patients annually in some of the country’s most underserved areas, according to the National Association of Community Health Centers.

The Trump administration has made funding cuts that might lead some of the country’s approximately 1,500 FQHCs to close or cut services. But the administration still maintains a site to find a local center.

Planned Parenthood also accepts uninsured patients. Its centers test for sexually transmitted diseases, provide birth control options, and offer postpartum and gender-affirming care and other services.

And the National Association of Free & Charitable Clinics also offers a tool to help people find free or low-cost care.

Most community clinics don’t offer specialty care, but they can usually refer patients who need more intensive services to providers willing to work with uninsured patients.

And academic medical centers tend to have more charity care programs that help uninsured patients lower their bills.

“If you’re uninsured or even underinsured, you might be able to qualify for a significant discount on the cost of your care,” Cox said.

Still, be wary of heading to the emergency room, which is the most expensive place to get care. While ERs are federally required to stabilize all patients regardless of their ability to pay, they can still leave you with a big bill — and often do.

3. Call your local health department

Health services vary widely from county to county, but many offer free vaccinations, family planning services, and testing for sexually transmitted infections, as well as for flu, Covid, and tuberculosis.

Some county health departments also offer more advanced care, such as dental services and mental health or substance abuse programs. And some states have consumer assistance programs that can guide residents in finding care, Fish-Parcham said.

In addition, the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program makes free or low-cost breast and cervical cancer screenings available to low-income women in all states and territories. And some states cover screenings for other types of cancer as well.

4. It’s easier to shop around for drugs than doctors

Don’t just fill your prescription at the closest pharmacy. Instead, research generic drug options and look around for the best price on brand names.

A handful of sites such as GoodRx and WellRx offer comparison shopping tools and information on other ways to get drug discounts.

And some retailers offer low-cost access to common prescription drugs — at prices cheaper than you would find if you had insurance. Walmart, for instance, sells 90-day prescriptions of dozens of generic versions of drugs for $10. As does Target, Costco, and a new site called the Cost Plus Drug Company.

Many drugmakers also offer patient assistance programs, coupons, and rebates on some medications. Check their websites for details on how to apply.

Millions of Americans are expected to drop their Affordable Care Act plans. They’re looking for a Plan B.

States also offer drug assistance programs. The steps to qualify and types of drugs vary, but this tool has a list of programs and how they work.

Joining a clinical trial is another way to access treatment. The National Institutes of Health and its National Cancer Institute have lists, but patients must first meet the criteria. Clinical trials aren’t necessarily free, even with insurance, Donovan said, so be sure to ask about any associated costs.

5. Your diagnosis might lead you to specialized resources

Patients with a specific diagnosis might have additional options for specialty treatment.

For example, someone with breast cancer should check with the American Cancer Society and the nonprofit Susan G. Komen organization, Cox said.

The Patient Advocate Foundation hosts a list of vetted foundations that can help offset the cost of medical bills and provide other resources such as transportation and lodging, Donovan said. Just type in basic information such as age, location, and diagnosis to see what is available.

Disease-specific foundations such as those for lupus or irritable bowel syndrome can also steer patients to free or low-cost resources or cover some costs of care, Donovan said.

“Everything is out there,” she said.

As you research affordable care options, don’t be tricked by plans that look like health insurance but don’t offer guaranteed protection against big bills.

Some short-term plans and health care sharing ministries might seem like good deals, but read the fine print. Some red flags to look for: too-good-to-be-true monthly payments; no coverage for preexisting conditions; morality clauses such as those prohibiting the use of alcohol or drugs; or a lack of coverage for benefits such as mental health counseling that are required in ACA plans.

KFF Health News correspondent Sam Whitehead contributed to this report, which was originally published at KFF Health News, Healthbeat’s national reporting partner.

How New York’s state health chief is navigating the ‘Great Desensitivation’

2026-01-30T19:15:45+00:00

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

Dr. James McDonald is leading the New York State Department of Health at a tumultuous time for public health in America.

Disruptions to federal health funding, vaccine recommendations, and operations at the Centers for Disease Control and Prevention are creating new challenges for state public health systems.

As head of one of the nation’s largest state health departments, McDonald is tasked with leading the response to those challenges – keeping New Yorkers insured at the top of the list.

McDonald, 62, a pediatrician, joined the state health department in July 2022 and became commissioner on June 9, 2023. He has also served at the Rhode Island Department of Health and the Indian Health Service in the Navajo Nation in Chinle, Arizona.

This week, he sat down with Healthbeat for a conversation in his office at the Erastus Corning Tower in Albany, sharing his perspective on issues like looming cuts to Medicaid, a new public health alliance in the Northeast, how global health affects New York, and how the CDC is “forever changed” in this era he calls the “Great Desensitivation.”

Here’s the interview, which has been edited for clarity and brevity.

What are the top three public health health challenges facing New York this year? What keeps you up at night?

The biggest threat is the change in how the current [federal] administration is looking at insuring New Yorkers. I have worried a little bit about Medicaid coverage. Starting in 2027, when you look at the work requirement that’s part of H.R. 1, what they’re trying to do is get people off Medicaid. It’s based on a concept that people don’t need Medicaid. The reality of it is a lot of people on Medicaid already are working. They don’t make much money, and they need Medicaid because that’s their health insurance. That’s one of my biggest concerns for this year and next.

Although the federal health policy is they want to make America healthy again, the actions look more toward just promoting suffering. This should bother more people than it does on a national level.
Dr. James McDonald, New York state health commissioner

One of my other big concerns is what’s happened to the Affordable Care Act. We’re addressing it as best we can. In 2024 we expanded our coverage to people up to 250% of the federal poverty level. Just to make that real, that’s like an individual making up to $39,000 a year. Those are working New Yorkers, and that’s changed. Now we have to change that to accommodate where the federal government is going.

The third concern I have is that as a country we are in a period that I’m going to call the Great Desensitization. We’re tolerating things that we never would have tolerated before. That encompasses things like hearing misinformation about vaccines, and people are confused by this. I was concerned about how the shutdown was handled. The government was comfortable with people losing food benefits, and the state of New York stepped in to protect our New Yorkers. What I see with people becoming uninsured is an overarching theme, and one of my concerns is, although the federal health policy is they want to make America healthy again, the actions look more toward just promoting suffering. This should bother more people than it does on a national level.

Let’s go back to one of the things you’ve just said: H.R.1.

What I’m concerned about is people who need health insurance won’t get health insurance. The challenge for any state is going to be, how do you apply the exceptions for people who can’t work, so you can actually keep them insured. One of the challenges states are going to have is we don’t have the rules and regulations yet that the federal government is going to use to enforce this. Those come into being by June 30. So that gives us till Dec. 31 — six months – to implement a very substantive change. We are doing our best to get ready for that, but without seeing the regulations, there’s only so much we can do.

What I’m concerned about is that you’re going to end up with people who aren’t going to get health care. Most of us would agree, generally, if you find cancer early, you get better outcomes, whether it’s breast cancer or colon cancer. But if you don’t have health insurance, you’re not going to have a mammogram, because you’re going to say, I’m not going to pay for that. That’s not something you go to the emergency department for. But if you don’t have health insurance, you’re not going to have a colonoscopy. If you don’t have a mammogram, we’re not going to find your breast cancer before it turns into cancer or the early stages. As annoying as a colonoscopy is, they’re really important to have. If you don’t have a colonoscopy, we’re not going to find that polyp that was precancerous and remove it.

We all learned growing up, an ounce of prevention is worth a pound of cure. I see the federal health policy being this smorgasbord of chaos and confusion.

Could the new CDC guidelines that seem to emphasize “choice” deter New Yorkers from getting vaccinated, and what is New York state doing to push back on this messaging and reach people who might need to hear these guidelines?

It’s important to know there was no new science presented; there was really no new information presented. This was implementing something that was really politically motivated.

No vaccine in New York or any state is given without informed consent. I’ve been a pediatrician for over 35 years. I’ve given over 100,000 vaccines easily in my career, and every single one of them has had informed consent. No one gets vaccines without consent, and shared clinical decision making is simply a risk-benefit conversation with your health care provider. That already happens.

What happened to the CDC schedule is it went from something that was easily understandable to something exceptionally confusing. I don’t think the impact in New York is going to be significant. New York’s vaccine requirements, which are mandated by New York state law, haven’t changed. I don’t think they’re going to change.

How might you be able to reach people who are skeptical of vaccines?

There’s no one way to solve that issue. We put forward honest, objective information. We go to different communities. We work with local leaders, we work with local health departments, we work with community-based organizations. What a lot of people want to do is they want to hear the truth from people they know.

We are not going to convince everyone of everything about every vaccine and people still have informed consent. Having said that, there’s still the vaccine requirements. If they want to enter school, they’re going to have to adhere to the vaccine requirements. The thing I worry about, as a physician and as a pediatrician, is I’ve seen adverse health consequences and vaccine-preventable diseases.

One of the first children I took care of in medical school, before the Hib [Haemophilus influenzae type b] vaccine came out, was a little 3-year-old who had amputations below her knees because of Haemophilus influenzae type b meningitis. There was no vaccine then. That was terrible. It’s someone who had to live a whole lifetime with health consequences.

The CDC sidelined these childhood vaccines. Here’s what they prevent.

I’ve seen less than a handful of kids with Hib meningitis who weren’t immunized for whatever reason. But this is a disease that should really not be something we’re even worried about because it’s a vaccine that works so well. I worry about parents having to live with a preventable tragedy.

One of the things I’m concerned about the current vaccine direction with the federal government is this nonchalance about the seriousness of vaccine-preventable disease, almost as if being hospitalized for a child for a vaccine-preventable disease is no big deal. I can tell you, when a child is in the hospital, the child is very sick, the child is suffering, and the parents are suffering along with their child.

In light of the changes at the CDC and other federal health agencies, we’ve seen the Northeast Public Health Collaborative come to fruition and work as a regional outfit focused on public health. What role do you see the collaborative playing in the region?

The Northeast Public Health Collaborative is 17 jurisdictions from Maine to Maryland. It’s health departments collaborating with each other in an organized manner — it was something we used to do informally. But what’s different about this is that it’s health departments collaborating in an organized manner about matters of common interest, so we can coordinate efforts and learn together. We should have done it years ago, but it’s part of our forever future. It’s not a political response. One of the things I think about too is that sometimes one state might have experience with a problem, another state might not, but we can share the expertise. One of the things about the collaborative is there are tiny states and big states. New York is 20 million people, Rhode Island is 1 million.

You said that the collaborative is not meant to be a political response, but there could be some who view it that way and might see it as a rival to the CDC. What would you say to that?

The CDC is forever changed. There are still good people doing great work at the CDC, and we talk to them every day. What you’ve seen now is politics dictating change at CDC. When I really think about what health departments are collaborating on, it’s like, how do individual health departments work better together? If you think about public health, we all have similar missions. We might write them differently, but most health departments want to improve the health and well-being of the population.

There’s no political affiliation with the Health Department. We’re objective. We don’t want to deliver public health based on political party [affiliation]. That’s never part of the conversation. There is no politics built into the collaborative. It isn’t about that. Most people in public health aren’t interested in politics. They’re interested in public health. They’re very different things.

Let’s say there’s a disease outbreak here in New York state, or somewhere else in the Northeast. Would New York state or the collaborative reach out to the CDC? Would you all be in touch?

We do that routinely. Let’s take measles. When we have a case of measles, we talk to the CDC, but it’s usually informing them. It’s not getting their advice. Because most health departments know what to do when it comes to containing a disease — this is really fundamental public health. We don’t usually need CDC to help us with an outbreak. Where CDC helps with an outbreak is when you have something unusual going on in your state or in a very large number and then CDC will still send what’s called an Epi Aid Team, and that can still happen. There’s no reason that that will change in the future, and this is where CDC will still be a helper.

I don’t know that they’re going to be the national lead on things as much as they used to be, because what you’re seeing now is the political overlay. What you’ll see is we do work with CDC every day in New York state, and we still will, and they still work with us, but when it comes to health policy for states, states are going to rely less and less on CDC and more on their own state health department, and that is probably a better thing for everybody in the long run anyway, because your state health department and local health departments know your state better than any federal entity will.

One thing about the CDC is the CDC was trying to create recommendations for the entire United States, which is all the way from Maine to the Northern Mariana Islands — very different places. Regionalized and localized recommendations make more sense for everybody.

Last week, California Gov. Gavin Newsom said his state will join the World Health Organization’s Global Outbreak Alert and Response Network. Have there been conversations here in Albany related to that? Is this something that you all have considered doing?

We’re looking at it. One of the things the New York State Department of Health does is we created something called the Global Update. Every week we give a weekly report for anyone who wants looking at what are the global outbreaks going on. If you want to know what’s going on with chikungunya, we’ll tell you.

What the U.S. leaving the WHO means for health in America and the world

It’s important to underscore that the United States leaving the World Health Organization has a much larger impact, because what we’re not doing is we’re not financially supporting global immunization campaigns — overall, helping people be healthy. And one of the reasons why I’m concerned about it in New York state is we’re the gateway to a lot of America. But generally, if people are healthier overseas, that benefits New York state and the United States, because they don’t bring the disease here. The World Health Organization does a lot of things coordinating with CDC and others when there’s a viral hemorrhagic fever.

For example, no one talked about the Marburg outbreak in 2024 in Tanzania, in the United States, because it didn’t come here. The reason why viral hemorrhagic fever didn’t come here is because the World Health Organization worked with CDC to address it in Tanzania. We knew what was happening, and we were ready in case it came here, but it was contained. And one of my big concerns is by pulling out of the World Health Organization and by underfunding CDC, what risk are we inviting in the United States? Because people get in planes and travel, and you are literally 12 hours away from the biggest surprise ever. I don’t understand why we’re willing to live in this period of ignorance.

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.

What the U.S. leaving the WHO means for health in America and the world

2026-01-29T12:00:00+00:00

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

Hello from Nairobi.

Over the weekend, I had the pleasure of seeing Mahmood Mamdani launch his new book, Slow Poison, here in the city. The book traces Ugandan history, particularly the bizarre and violent reign of Idi Amin and the long rule of Yoweri Museveni (who entered his fourth decade in power in sham elections held just this month.) It’s a great read. Mamdani is one of East Africa’s most respected political scholars and, in a curious bit of trivia, he’s also the father of Zohran Mamdani, New York City’s new mayor.

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

U.S. pulls out of the WHO

The United States officially pulled out of the World Health Organization on Thursday, making good on the Trump administration’s yearlong pledge, Al Jazeera reports. (One complicating factor not in the Al Jazeera coverage: The United States still owes WHO roughly $260 million … money it’s unlikely to pony up.)

As a reminder, the WHO is the United Nations body that coordinates global disease surveillance, sets health standards, and helps countries respond to outbreaks.

Is the U.S. pullout mostly symbolic, or will it reshape global health in real ways? I reached out to Gavin Yamey, director of the Center for Policy Impact in Global Health at Duke University, to discuss.

Yamey is exceptionally clear: The pullout will “have major consequences for both the United States and the WHO itself.”

On the American side, “the U.S. has shot itself in the foot,” he says. “It has now made itself much more vulnerable to disaster and devastation when the next epidemic or pandemic hits. Outbreaks don’t respect national borders,” and now “the country will no longer have access to crucial data about emerging health threats.”

For context, before the exit, “if there was an overseas outbreak, the [U.S. Centers for Disease Control and Prevention] would play a critical role in the scientific discussions and deliberations convened by WHO on the status of the outbreak, the risk of spread, and the best way to contain and control the outbreak. Now, having left the WHO, the U.S. will be excluded from these crucial conversations,” blunting its ability to track fast-moving outbreaks and advise at home in real time, Yamey says.

On the WHO side, Yamey says the loss is twofold. The WHO is losing “some of the finest expertise in the world” at the CDC, but the deeper blow is financial. “The U.S. was the single largest donor to the WHO,” he says. Without American dollars, “the organization will be weakened in its ability to carry out its critical activities. And there is no other body on the planet that does, or can do, what the WHO does. There’s no other body that has the same global reach, representation, legitimacy, and ability to convene experts and determine best scientific practice. Its activities are the bedrock of global health,” he says. “By weakening the WHO, the U.S. has made the world less safe — which in turn makes the U.S. less safe.”

(I promised you, after last week’s optimistic report, we were in for a heavy dose of reality.)

But Yamey also wanted to make one other point explicit, especially for American readers: The United States is leaving WHO after weakening its own public health system. He says that Robert F. Kennedy Jr., the U.S. secretary of Health and Human Services, “arguably one of the world’s most extreme and dangerous anti-vaccine activists and conspiracy theorists … has spent the last year dismantling the U.S. federal public health system and its vaccination systems. He has fired hundreds of critically important federal public health workers, massively weakened the CDC, interfered with the CDC’s science-based guidance, and rolled back vaccination, even as vaccine-preventable diseases are returning.”

His takeaway?

“Even without exiting the WHO, the U.S. has over the past year greatly weakened its own domestic capacity to deal with health threats, and leaving the WHO makes a bad situation immeasurably worse,” Yamey said.

A Nipah virus outbreak

India is facing an outbreak of deadly Nipah virus in the eastern state of West Bengal, which borders Bangladesh, the Global Times reports. Authorities have quarantined nearly 100 people and confirmed five cases, including infections among health care workers at a hospital near Kolkata.

Disease breakdown: Nipah virus is an animal-borne disease that typically originates in fruit bats and can either spread directly, through proxy animals such as pigs, or through close contact with an infected person’s bodily fluids. There is no treatment or vaccine. It can cause fever, muscle pain, and respiratory distress, which often moves to a deadly inflammation of the brain. In past outbreaks, 40% to 75% of those who contracted the disease died.

The outbreak has spooked several countries in the neighborhood across South and Southeast Asia. This includes Thailand, which has begun “screening air passengers arriving from India for possible Nipah virus infection;” Nepal, which “heightened nationwide alertness to prevent the possible entry of the Nipah virus;” and China, which is “strengthen[ing] quarantine and control measures for people entering China from India.”

Some context: Nipah is a scary disease, but it’s not new. It was identified in the late ’90s, and the virus has surfaced repeatedly over the past decades. In Bangladesh, for example, small spillover events appear “almost every year,” according to the WHO, and usually involve only a handful of cases.

The takeaway? The travel screening and alerts across South and Southeast Asia are not panic moves. They are the global health system clicking into gear. Nipah is highly deadly and so carefully treated and monitored … but history suggests outbreaks like this are usually stopped before they spread far.

Neither screw nor worm; still horrible

OK, fair warning: This next one is fairly gross.

As Healthbeat reported earlier this month, North America is experiencing a resurgence of a flesh-eating fly larva known as the New World screwworm. (Despite the name … it is not a worm.) The situation is dire enough that the United States Department of Agriculture has announced $100 million for “innovative projects” to fight the parasite.

The parasite is the larval stage of a blowfly that burrows into open wounds and feeds on living tissue. It was once endemic across much of the southern and southwest United States, Mexico, and Central America. It was largely eradicated from the ’60s through the late ’90s. Before that, the screwworm caused massive losses in livestock (the big threat) and, on rare occasions, infected humans.

How was it killed off? The eradication relied largely on a suite of partially U.S.-funded programs that released millions of sterile male flies to crash the wild populations. It worked so well that the insect all but disappeared … until now. The parasite has crept back through Central America and has reached as far north as about 70 miles below the U.S.-Mexico border.

Why is it back?

We lapsed in the sterile fly release program, essentially. According to a report published in September by the American Veterinary Medical Association, the Covid-19 pandemic disrupted sterile fly production in Panama, reducing the releases that normally keep wild screwworm populations in check. (The report also notes that the closure of U.S. and Mexican fly factories in previous decades left current control efforts with basically just the Panamanian facility.)

For the sake of all of our nightmares … let’s get these facilities up and running again.

A million missing midwives

The world is facing a shortage of nearly 1 million midwives across 181 countries, The Guardian reports. This data come from a new study in the science journal Women and Birth.

No surprise here, but the medical care shortage is not evenly spread. Nearly half of the global gap is in Africa, with large midwife shortages also concentrated in the Eastern Mediterranean and parts of the Americas. The report notes that the problem is not just a lack of training, but “a failure in many countries to employ trained midwives where they were needed.”

Why does this matter? Beyond childbirth, midwives handle much of the frontline work in pregnancy and postpartum care across much of the developing world. When they are absent, the researchers warn, preventable complications and deaths rise quickly.

The study does offer a small silver lining. It estimates a modest reduction in the roughly million-person gap by 2030 as more midwives are trained each year. The problem is that population growth in the hardest-hit regions largely keeps pace with those gains. Even under the researchers’ most optimistic scenarios, hundreds of thousands of midwives will still be missing, well into next decade.

What’s the takeaway? It’s hard to pick one. Obviously, this is a complicated amalgam of training and medical staffing issues across very different countries. Still, one conclusion is that this is a solvable problem the world is choosing to tolerate, even though midwives remain one of the most cost-effective ways to keep mothers and babies alive.

AI: Revolutionizing the ‘unsexy’ parts of drug development?

Artificial intelligence has yet to tackle the core of drug development: actually discovering new, breakthrough medicines. (To be fair to AI, it’s been busy with more important work, like producing goofy songs about Chimpanzees and Borsht.)

But AI is quietly speeding up some of the more banal parts of the drug R&D process.

According to a Reuters report from the JP Morgan Healthcare Conference, drugmakers are using AI to recruit patients for clinical trials, pick trial sites, and draft regulatory paperwork. This “unsexy stuff,” as the Israel-based Teva Pharmaceutical Industries CEO Richard Francis put it, is shaving weeks off slow and expensive work, and is where AI “makes a difference,” in the industry today, he says.

One interesting vignette from the article: Novartis said it used AI to cut a four- to six-week site-selection process for a massive heart-drug trial down to a single two-hour meeting. (Which, let’s be real, maybe says more about their corporate meeting culture than the power of AI.)

Of course, it’s still an open question of how much (or if!) these incremental time savings will actually translate into faster drug approvals or lower costs for patients.

I’ll see you next week.

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

Trump policies at odds with emerging understanding of Covid’s long-term harm

2026-01-27T15:54:55+00:00

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

Possible risk of autism in children. Dormant cancer cells awakening. Accelerating aging of the brain.

Federal officials in May 2023 declared an end to the national Covid pandemic. But more than two years later, a growing body of research continues to reveal information about the virus and its ability to cause harm long after initial infections resolve, even in some cases when symptoms were mild.

The discoveries raise fresh concerns about the Trump administration’s Covid policies, researchers say. While some studies show Covid vaccines offer protective benefits against longer-term health effects, the Department of Health and Human Services has drastically limited recommendations about who should get the shot. The administration also halted Biden-era contracts aimed at developing more protective Covid vaccines.

The federal government is curtailing such efforts just as researchers call for more funding and, in some cases, long-term monitoring of people previously infected.

“People forget, but the legacy of Covid is going to be long, and we are going to be learning about the chronic effects of the virus for some time to come,” said Michael Osterholm, an epidemiologist who directs the University of Minnesota’s Center for Infectious Disease Research and Policy.

The Trump administration said that the Covid vaccine remains available and that individuals are encouraged to talk with their health providers about what is best for them. The Covid vaccine and others on the schedule of the Centers for Disease Control and Prevention remain covered by insurance so that individuals don’t need to pay out-of-pocket, officials said.

“Updating CDC guidance and expanding shared clinical decision-making restores informed consent, centers parents and clinicians, and discourages ‘one size fits all’ policies,” said HHS spokesperson Emily Hilliard.

Is Covid during pregnancy linked to autism? What a new study shows, and what it doesn’t

Although Covid has become less deadly, because of population immunization and mutations making the virus less severe, researchers say the politicization around the infection is obscuring what science is increasingly confirming: Covid’s potential to cause unexpected, possibly chronic health issues. That in turn, these scientists say, drives the need for more, rather than less, research, because over the long term, Covid could have significant economic and societal implications, such as higher health care costs and more demands on social programs and caregivers.

The annual average burden of the disease’s long-term health effects is estimated at $1 trillion globally and $9,000 per patient in the United States, according to a report published in November in the journal NPJ Primary Care Respiratory Medicine. In this country, the annual lost earnings are estimated to be about $170 billion.

One study estimates that the flu resulted in $16 billion in direct health costs and $13 billion in productivity losses in the 2023-24 season, according to a Dec. 30 report in medRxiv, an online platform that publishes work not yet certified by peer review.

Studies show Covid’s growing reach

Much has been learned about Covid since the virus emerged in 2019, unleashing a pandemic that the World Health Organization reports has killed more than 7 million people. By the spring of 2020, the term “long Covid” had been coined to describe chronic health problems that can persist post-infection.

More recent studies show that infection by the virus that causes Covid, SARS-CoV-2, can result in heightened health risks months to more than a year later.

For example, researchers following children born to mothers who contracted the virus while pregnant have discovered they may have an increased risk for autism, delayed speech and motor development, or other neurodevelopmental challenges.

Another study found babies exposed to Covid in utero experienced accelerated weight gain in their first year, a possible harbinger of metabolic issues that could later carry an increased risk for cardiovascular disease.

These studies suggest avoiding severe Covid in pregnancy may reduce risk not just during pregnancy but for future generations. That may be another good reason to get vaccinated when pregnant.

“There are other body symptoms apart from the developing fetal brain that also may be impacted,” said Andrea Edlow, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School who was involved in both studies. “We definitely need more research.”

Epidemiologists point to some specific, emerging challenges.

A U.K. study in the New England Journal of Medicine found people who fully recovered from mild Covid infections experienced a cognitive deficit equal to a three-point drop in IQ. Among the more than 100,000 participants, deficits were greater in people who had persistent symptoms and reached the equivalent of a nine-point IQ drop for individuals admitted to intensive care.

Ziyad Al-Aly, a clinical epidemiologist who has studied longer-term health effects from Covid, did the math. He estimated Covid may have increased the number of adults in the United States with an IQ of less than 70 from 4.7 million to 7.5 million — a jump of 2.8 million adults dealing with “a level of cognitive impairment that requires significant societal support,” he wrote.

“People get Covid-19, some people do fine and bounce back, but there are people who start experiencing problems with memory, cognition, and fuzzy brain,” he said. “Even people with mild symptoms. They might not even be aware.”

Diane Yormark, 67, of Boca Raton, Florida, can relate. She got Covid in 2022 and 2023. The second infection left her with brain fog and fatigue.

MRNA vaccines, once a Trump boast, now face attacks from some in GOP

“I felt like if you had a little bit too much wine the night before and you’re out of it,” said Yormark, a retired copywriter, who said the worst of her symptoms lasted for about three months after the infection. “Some of the fog has lifted. But do I feel like myself? Not like I was.”

Data from more than a dozen studies suggest Covid vaccines can help reduce risk of severe infection as well as longer-lasting health effects, although researchers say more study is needed.

But vaccination rates remain low in the United States, with only about 17% of the adult population reporting that they got the updated 2025-26 shot as of Jan. 16, based on CDC data.

Trump administration officials led by HHS Secretary Robert F. Kennedy Jr. have reduced access to Covid vaccines despite the lack of any new, substantiated evidence of harm. Though the shots were a hallmark achievement of the first Trump administration, which led the effort for their development, Kennedy has said without evidence that they are “the deadliest vaccine ever made.”

In May he said on X that the CDC would stop recommending Covid shots for healthy children and pregnant women, citing a lack of clinical data. The Food and Drug Administration has since issued new guidelines limiting the vaccine to people 65 or older and individuals 6 months or older with at least one risk factor, though many states continue to make them more widely available.

The Trump administration also halted almost $500 million in funding for mRNA-based vaccines. Administration officials and a number of Republicans question the safety of the Nobel Prize-winning technology — heralded for the potential to treat many diseases beyond Covid — even though clinical trials with tens of thousands of volunteers were performed before the Covid mRNA vaccines were made available to the public.

And numerous studies, including new research in 2025, show Covid vaccine benefits include a reduction in the severity of disease, although the protective effects wane over time.

How Covid may affect brain health

Researchers say more and broader support is important because much remains unknown about Covid and its impact on the body.

The growing awareness that, even in mild Covid cases, the possibility exists for longer-term, often undetected organ damage also warrants more examination, researchers say. A study published this month in eBioMedicine found people with neurocognitive issues such as changes in smell or headaches after infection had significant levels of a protein linked to Alzheimer’s in their blood plasma. EBioMedicine is a peer-reviewed, open-access journal published by The Lancet.

In the brain, the virus leads to an immune response that triggers inflammation, can damage brain cells, and can even shrink brain volume, according to research on imaging studies that was published in March 2022 in the journal Nature.

An Australian study of advanced brain images found significant alterations even among people who had already recovered from mild infections — a possible explanation for cognitive deficits that may persist for years. Lead study author Kiran Thapaliya said the research suggests the virus “may leave a silent, lasting effect on brain health.”

Al-Alay agreed.

“We don’t know what will happen to people 10 years down the road,” he said. “Inflammation of the brain is not a good thing. It’s absolutely not a good thing.”

That inflammatory response has also been linked to blood clots, arrhythmias, and higher risk of cardiovascular issues, even following a mild infection.

A University of Southern California study published in October 2024 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology found the risk for a major cardiac event remains elevated nearly three years after Covid infection. The findings held even for people who were not hospitalized.

“We were surprised to see the effects that far out” regardless of individual heart disease history, said James R. Hilser, the study’s lead author and a postdoctoral fellow at the UCLA David Geffen School of Medicine.

Covid can also reactivate cancer cells and trigger a relapse, according to research published in July in the journal Nature. Researchers found that the chance of dying from cancer among cancer survivors was higher among people who’d had Covid, especially in the year after being infected. There was nearly a twofold increase in cancer mortality in those who tested positive compared with those who tested negative.

The potential of the Covid virus to affect future generations is yielding new findings as well. Australian researchers looked at male mice and found that those who had been infected with and then recovered from Covid experienced changes to their sperm that altered their offspring’s behavior, causing them to exhibit more anxiety.

Meanwhile, many people are now living — and struggling — with the virus’ after-effects.

Dee Farrand, 57, of Marana, Arizona, could once run five miles and was excelling at her job in sales. She recovered from a Covid infection in May 2021.

Two months later, her heart began to beat irregularly. Farrand underwent a battery of tests at a hospital. Ultimately, the condition became so severe she had to go on supplemental oxygen for two years.

Her cognitive abilities declined so severely she couldn’t read, because she’d forget the first sentence after reading the second. She also had to leave herself reminders that she is allergic to shrimp or that she likes avocados. She said she lost her job and returned to her previous occupation as a social worker.

“I was the person who is like the Energizer bunny and all of a sudden I’d get so tired getting dressed that I had to go back to bed,” Farrand said.

While she is better, Covid has left a mark. She said she’s not yet able to run the five miles she used to do without any problems.

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

Federal funding cuts threaten help for NYC domestic violence survivors

2026-01-27T12:00:00+00:00

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

Federal funding cuts under President Donald Trump’s administration are putting domestic violence survivor services at risk across New York City, particularly for nonprofits that provide culturally specific, trauma-informed care to immigrant and marginalized communities.

Advocates and service providers warn that the cuts could lead to reduced counseling services, longer wait lists, and fewer safe options for survivors — outcomes that public health experts say will have lasting consequences for physical and mental health.

Last February, the North Brooklyn Coalition Against Family Violence, an organization that serves survivors of domestic violence and sexual assault within Latinx, immigrant, and LGBTQ+ communities, applied for federal funding as it has every year since the organization was founded in 1998.

However, the grant language had changed in ways that felt exclusionary and potentially dangerous for clients, said Leana Pardo, the coalition’s executive director.

“I contacted the rest of the team immediately,” Pardo said. “It felt like a direct attack on the people we serve.”

How the Violence Against Women Act is affected

The Trump administration has argued that certain Department of Justice grant programs have funded initiatives tied to diversity, equity, and inclusion, feminist organizing, and what it characterizes as “cultural Marxism.” The administration has characterized these programs as progressive initiatives rather than ones focused on combating crime and protecting U.S. citizens.

Those priorities have translated into cuts and revised guidelines affecting programs funded under the Violence Against Women Act, a critical resource for survivors of domestic violence.

In New York, advocates say the survivors who rely on services offered in their native languages are likely to be among the first affected.

Organizations like North Brooklyn Coalition serve clients who speak languages other than English, requiring bilingual staff, translated materials, and culturally informed care.

Organizations like North Brooklyn Coalition serve clients who speak languages other than English, requiring bilingual staff, translated materials, and culturally informed care. Those needs increase operating costs, making federal support especially critical.

The revised grant guidance included terms such as “human trafficking,” “crimes linked to illegal immigration,” and “cartel operations,” language that raised concerns among providers that survivor services could be conflated with immigration enforcement or criminal investigations.

Pardo said her primary concern is client safety. About 21% of the coalition’s clients are undocumented, recipients of Deferred Action for Childhood Arrivals, or holders of U visas, an immigration protection program available to certain crime victims who assist law enforcement.

The new guidelines emphasize anti-trafficking efforts and include language linking trafficking to illegal immigration. Pardo worries that reporting requirements could pressure organizations to share information that puts survivors at risk.

“We’re concerned that under the current federal administration, this could lead to requests for confidential client information during reporting,” she said.

Under standard Office on Violence Against Women rules, organizations submit semiannual reports detailing how funds are used and what services are provided. With the updated language, Pardo fears increased scrutiny that could expose survivors — particularly recent arrivals, including Venezuelan clients who were trafficked for sexual exploitation before reaching the United States.

With funding shrinking or if reporting conditions become untenable, organizations may be forced to turn survivors away.

‘Domestic violence is a public health issue’

Public health experts emphasize that domestic violence is not only a criminal justice issue but a major health concern.

“These funds are not wasteful,” Pardo said. “Domestic violence is a public health issue.”

Research backs that up. The World Health Organization classifies domestic violence and sexual assault as public health crises due to their severe physical, mental, and reproductive health impacts.

ICE crackdown heightens barriers for immigrant domestic violence survivors

One in 3 Latinas will experience intimate partner violence in her lifetime, and 1 in 12 experienced domestic violence in the past year, according to Esperanza United, an organization focused on ending gender-based violence.

Dr. Denis Nash, an epidemiology professor at CUNY’s Graduate Center, said funding cuts disproportionately harm communities that are already facing barriers to care.

“Vulnerable communities that already struggle to access public health services are the first and worst affected,” he said. “Cuts like these reduce prevention, de-escalation, and safe exits from dangerous situations.”

Fewer resources available to meet higher demand

The Department of Justice supports survivor services primarily through the Office on Violence Against Women and the Crime Victims Fund, which distributes money under the Victims of Crime Act. Funds are allocated to states based on population, and in New York, the Office of Victim Services distributes grants to shelters, hospitals, and community organizations.

While some organizations have avoided direct cuts so far, the broader funding picture is grim.

“We’ve been fortunate not to lose funding outright,” said Kristen McGuire, development director for the Domestic Violence Project at the Urban Justice Center. “But we’re also not receiving new funds, even as demand continues to grow.”

According to the New York State Coalition Against Domestic Violence, many programs have lost staff due to funding shortfalls. That translates into fewer shelter beds, shorter hotline hours, and fewer advocates available to help survivors obtain orders of protection.

The organization said that 90% of the funding New York state uses to support domestic violence services comes from the federal government.

Data from the National Network to End Domestic Violence show that domestic violence programs in New York assist about 67 survivors every hour. Yet at least 1,717 survivors were unable to access services due to lack of funding, staffing, or resources.

New York state trying to fill gaps

The cuts are not just financial but political. New York Attorney General Letitia James has sued the Department of Justice, arguing that the federal government is unlawfully conditioning VOCA funding on cooperation with immigration enforcement.

According to the lawsuit, those conditions could undermine trust in survivor services and deter people from seeking help.

Gov. Kathy Hochul has attempted to offset some of the damage, allocating $100 million in state funding to cover anticipated VOCA losses. In January 2025, the Office of Victim Services opened applications for a three-year, $379 million state grant cycle — the largest in its history.

State Assemblymember Maritza Dávila, who represents North Brooklyn in Albany, said lawmakers are trying to fill federal gaps, but she acknowledged limits.

“We’ll do everything we can in Albany to continue supporting these organizations,” Dávila said. “Our priority is our community.”

Still, advocates warn that state funds alone cannot replace federal support, particularly for smaller, culturally specific organizations that rely heavily on grants to operate.

For decades, federal funding has been a financial backbone of domestic violence survivor services. Without it, providers say they face impossible choices: Reduce services, lay off staff, or close programs.

For survivors, the consequences can be devastating.

“These programs aren’t optional,” Nash said. “They are essential to safety, recovery, and long-term health.”

If you or someone you know is experiencing domestic violence, call New York State’s confidential hotline at 1-800-942-6906 or text 844-997-2121. Counselors are available 24/7 in Spanish and many other languages.

Ilvea Lezama is a freelance reporter in New York.

Georgia nurses say fear of discipline keeps them from seeking addiction treatment

2026-01-22T18:02:24+00:00

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

Georgia nurses who have struggled with – and even overcome – addiction want to see the state adopt a less punitive approach to discipline that would remove some of the obstacles to treatment and employment.

A bill before the state legislature that has broad bipartisan support as well as support from the state nursing board would change how Georgia handles such cases. The bill’s supporters say it’s an important tool to keep nurses in the workforce amid a nursing shortage, and an acknowledgement that addiction is a disease, not “a moral failing.”

Healthbeat spoke to five nurses who have experienced addiction and to representatives of recovery organizations. They described how Georgia’s disciplinary system deterred them from seeking early treatment for fear of losing their licenses and their jobs.

That’s because to get or renew a license, nurses must report treatment for alcohol or substance abuse within the past five years on the application. The acknowledgement triggers a lengthy, public, and costly disciplinary process.

Courtney Robinson, who works at Northeast Georgia Health System, fought an alcohol addiction for years. She wanted to get treatment but worried that doing so would result in losing her license. When she finally got sober, she answered the question honestly during her license renewal, acknowledging a past addiction and stint in rehab.

That started a process of establishing a consent order with the state nursing board. Consent orders are posted in a spreadsheet and in a searchable database on the Board of Nursing’s website, allowing anyone to look up disciplinary actions for a particular nurse.

Robinson’s order requires that she participate in weekly support groups as well as regular and random drug screening for five years. It also requires quarterly reports from employers to the nursing board and restricts Robinson from working in some roles, including assignments through a nursing agency and in-home nursing.

“As far as jobs, it is very difficult, unless you have some connections or know somebody, to find a decent nursing job with a consent order,” Robinson said.

Nurses said the costs of medical evaluations and repeated drug testing can be a heavy burden for those working through a consent order. Ashley Walden, an occupational health nurse in Moultrie, said the annual costs for exams, drug testing, and program fees add up to more than $4,000 a year for her.

Ashley Walden is an an occupational health nurse in Moultrie, Georgia.

The proposed alternative to discipline program would make it easier and less punitive for nurses to get help with addiction.

Forty-four states have such systems in place, according to the National Council of State Boards of Nursing. The programs involve support and supervision, and they are typically confidential, unlike Georgia’s open process.

“The alternative to the discipline program would enable the nurse to be monitored, to continue to practice, to ensure the public safety, because they are under this specific monitoring contract, but it doesn’t show up as a disciplinary action against the nurse’s license,” explained Jim Cleghorn, deputy chief policy officer at the council and a former executive director of Georgia’s nursing board.

“If they violated any provision of that contract, then it can roll over into the more traditional discipline model,” Cleghorn said.

State nursing board, legislators support alternative to discipline

The Georgia Board of Nursing supports adopting an alternative to discipline program, said Natara Taylor, the board’s executive director.

“An ATD Program helps prevent unsafe practice by encouraging early treatment and monitoring, allowing nurses to recover while protecting the public,” Taylor said. She said the board and nursing organizations have been working “for years” to try to get the legislation and funding to establish such a program.

The nursing board took a total of 238 disciplinary actions in 2024, but it isn’t clear how many of those were related to alcohol or substance use. The Georgia Nursing Association, the state’s largest professional nursing association, sees 200 to 250 nurses in its Peer Assistance Program for addiction at any one time, the program’s Executive Director Felicia Chatman told Healthbeat.

A bill to establish an alternative to discipline program got unanimous approval in the state House last year. But it stalled out in the Senate and didn’t get a floor vote before the session ended.

The bill’s sponsor, Rep. Ron Stephens, a Savannah Republican who is also a pharmacist, said the legislature just ran out of time.

Because this is the second of the state’s two-year legislative session, the bill will start in the Senate, where Stephens expects it will be considered in mid-February. If the Senate approves the bill, it would then head to Gov. Brian Kemp’s desk for his signature.

“I don’t want it to fall by the wayside,” Stephens told Healthbeat on Wednesday.

Stephens said doctors and pharmacists have similar programs that have worked well. He’s not sure why nurses don’t, but he’d like to “close the loop” for them. The bill would also establish a similar program for professional counselors, marriage and family therapists, and licensed social workers, all of whom are governed by a separate board.

“It’s an effort to get somebody that has a problem to come forward, rather than continually hide the problem … so that a patient might get hurt,” Stephens said. The goal is “to get these people back into the workforce and being fruitful contributors.”

Georgia is projected to fall short of its registered nurse need by 25,110 RNs by 2038, according to a December analysis from the National Center for Health Workforce Analysis, leaving the state with 1 in 5 projected positions unfilled.

Recovery and nursing advocates speak at the state Capitol about a proposal to reform the state's discipline process for nurses who are fighting addiction.

Stephens said the alternative to discipline program isn’t expected to raise costs for the Board of Nursing because participants will pay for their own drug testing and other services. The board could also outsource the management of the program to another entity under the bill.

Nurses want ‘a safer environment’ for conversations about addiction

States began adopting alternatives to discipline in the early 1980s, starting in Florida, said Timothy Arehart, senior policy adviser at the NCSBN.

“It’s kind of a shift in culture for the U.S. overall, in which you went to more of a compassionate, non-punitive idea,” Arehart said. “It’s due to advances in the perceptions of substance use disorder and alcohol use disorder as a disease, as opposed to more of a moral failing.”

Robert Taylor is a former methamphetamine addict who got sober more than two years before enrolling in nursing school.

Though he passed his nurse licensing exam in January 2025, Taylor hasn’t been able to work as a nurse because of a past arrest for drug possession. The state nursing board required him to attend an intensive outpatient treatment program and complete other requirements before he could start practicing under a three-year consent order.

Taylor said his experience at Georgia Pines, a community service board that provides mental health services and treatment for addiction, inspired him to become a nurse. He’s been employed there as a medical technician while waiting for his license to be sorted out and will finally start work there as an RN in early February.

“I knew there would be some type of barrier, but I had no clue it would be so extensive,” Taylor said.

Like Robinson, he wants to see the system treat nurses in recovery with more leniency.

“Be just a little more lenient on your people like me that have actually shown that they’ve made a change in their lives,” Taylor said.

Cori Fletcher, a licensed practical nurse who works at a recovery center, said she’s grateful for the consequences imposed by the nursing board because they helped her become the nurse she is today. Still, the punitive system has limits, she said.

“The consent order was a no-go, and they didn’t want to hire me because of that,” she said of trying to find work during the disciplinary process. Now she is going back to school to become a registered nurse.

“What I would like to see different is a safer environment for these conversations to be had, a safer environment for nurses to feel like they can discuss these things without losing their job,” Fletcher said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

What’s going well: Marburg virus winding down. A cheap malaria defense. The future of antibiotics.

2026-01-22T12:00:00+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 has an unexpected but welcome throughline: optimism! From effective outbreak control to promising new research, we have a few stories that suggest key parts of the global health system are still functioning well, even under strain. (For the disappointed masochists out there, don’t worry. I’ll likely be back with some bummer news next week.)

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

Marburg virus: Not too early to celebrate

We’ve been covering how Ethiopia is faring during its first-ever outbreak of Marburg virus, an Ebola-like hemorrhagic disease with no vaccine.

How this outbreak unfolds matters beyond this one country and one disease. For me, it’s the second real test after last year’s Ebola flare-up in the Democratic Republic of the Congo of whether the international order still has the muscle to contain deadly outbreaks in an era of austerity.

Oddly, there has been very little sustained reporting on how the outbreak is actually progressing. (And, mea culpa, my cynic’s heart usually assumes no news means bad news!) So as I promised last week, I’ve followed up. I reached out to International Medical Corps, one of the organizations leading the Marburg fight, and spoke with Lawrence Mutharia, its country director for Ethiopia. What’s the state of play?

An unambiguous success.

“We are now at day 36 with no confirmed new cases,” Mutharia told me on Monday. He reports that the focus has shifted from an active response to making sure systems are in place if the virus resurfaces, “while waiting for the outbreak to be officially declared as over.”

This outcome was not guaranteed. The virus hit the outskirts of Jinka, a remote, under-resourced area with no prior experience handling a disease this lethal. I’ve hesitated to describe that reality too vividly in past updates, partly to avoid sliding into lazy stereotypes or misleading ideas about what “rural Africa” looks like. But the truth is that the communities surrounding Jinka follow culturally and socially traditional ways of life, with Indigenous conceptions of medicine that are far removed from modern biomedical practice. Without putting too fine a point on it: I have attended only one meeting in my life where participants arrived in full body paint, scarification, and feathered headdresses. It was in Jinka.

You could imagine this could be a tough setting for an outbreak response built on community cooperation with foreign medical guidance.

Nevertheless, Mutharia says that early, effective outreach to local communities was actually one of the response’s key strengths. That, a rapid influx of funding, early deployment of medical teams, and clear leadership from Ethiopia’s federal Ministry of Health. “Timely and coordinated efforts are crucial” for stopping fast-moving outbreaks like Marburg, he noted, and in this case they were deployed close to a best-case scenario.

Perhaps more importantly, and beating another one of my nagging fears, Mutharia told me that donor support for the response was “quite adequate.” That support included, to their credit, rapid funding from the U.S. State Department. Given the tightening of purse strings globally and America’s pullback last year, this was all the more striking. As Mutharia put it, “we are currently in a situation of trying to do more with less.”

My takeaway?

First, you have to applaud the responders to this crisis. And taken together with last year’s Ebola response in the DRC, this outbreak offers clear proof that the international community has lost neither the will nor the ability to respond to serious global health risks. For viruses like Marburg and Ebola (truly nightmare diseases) each day of delay makes them exponentially harder and more expensive to contain. At least for now, that lesson has not been unlearned.

Who controls Europe’s medicines?

Two stories out this week focus on Europe’s drug supply problem. (No, not the Ibiza kind.)

First, the Financial Times is reporting that U.S. pharmaceutical companies are openly threatening to withhold new medicines from Europe if governments refuse to pay higher prices.

Speaking at the JPMorgan health care conference, Pfizer CEO Albert Bourla framed the choice starkly: “When [we] do the math, shall we reduce the U.S. price to France’s level or stop supplying France? We [will] stop supplying France.” Other executives said they were considering delaying or skipping European launches altogether as they try to offset revenue lost from Trump-era price cuts in the United States.

At the same time, on Tuesday the European Parliament moved to shore up Europe’s pharmaceutical defenses. Lawmakers adopted proposals to rebuild manufacturing capacity inside the European Union and coordinate national stockpiles. Ultimately, the EU is pushing a “Buy European” approach that prioritizes security of supply and production within the bloc.

The takeaway? Europe is caught in a squeeze. Drugmakers are signaling they are willing to use access as leverage to raise prices, just as European lawmakers are trying to reduce their dependence on those same companies.

How the economics and politics will play out next is unclear, so I’ll be following up on this story.

Antibiotic optimism (with caveats)

A lot of modern medicine rests on a very fragile assumption that our antibiotics will keep working … and, uh, we know they won’t.

Drug-resistant infections kill millions of people globally each year, and new antibiotics are not being developed fast enough to keep up with the spread of resistance. (A large part of the issue is that antibiotics rarely recoup their R&D costs. In fact, biotech companies that specialize in them have a bad track record of going bust.)

But in an essay in the Washington Post, biochemist and antibiotic researcher Andre Hudson argues that the future may be a hopeful one. His case for optimism rests on the idea that (putting aside our laggardly development of new drugs) other scientific advancements may catch up to the threat.

He makes four main points: First, faster and more precise diagnostics are increasingly reducing unnecessary antibiotic use. Second, antibiotics are no longer the only tool in town. Hudson outlines how researchers are developing alternatives, including genetically engineered viruses (!) that hunt bacteria and gene-targeting tools to “disable resistance genes” in bacteria.

Third and fourth, Hudson finds hope in a clearer understanding of how resistance moves through entire systems, and in policy solutions meant to fix the economics behind antibiotic development. (Being frank here: This is where I feel the optimism is less earned.)

On the systems side, Hudson argues that drug resistance is finally being understood as more than a hospital problem. Antibiotics move through farms, food, wastewater, and trade, and that matters. But understanding the problem is not the same as controlling it. On policy, he points to ideas meant to fix the broken economics of antibiotics, including draft U.S. legislation that would pay companies for having lifesaving drugs available rather than selling more of them. It is a sensible fix. It has also been stuck in Congress for three years.

Still, a hopeful take!

American dollars … revisited?

Two stories out this week clarify what last year’s U.S. pullback in global health funding really amounted to, and what may come next this year.

The damage? All told, in 2025 the United States (still the world’s largest funder of global health) slashed its spending by roughly 66%, according to new end-of-year estimates reported in Think Global Health. It took months for this picture to come into focus, and “the cuts are bigger than we expected, not less,” said Joseph Dieleman, who leads financing tracking at the Institute for Health Metrics and Evaluation, a research group that analyzes health spending worldwide.

We’ve reported extensively on earlier data of the pullback, but it’s worth reading this article, particularly for the data visualization on where the cuts landed.

Looking forward, things are murkier … which is better than bad.

Devex is reporting that a draft, bipartisan foreign assistance bill for 2026 would allocate $9.4 billion for global health. That is still well below recent highs (down a quarter from the $12.4 billion in 2024) but far more than many expected after last year’s upheaval. The bill preserves core funding for HIV, malaria, tuberculosis, and polio, and includes unexpected support for the vaccine funding organization GAVI, alongside family planning money, and dollars for several U.N. agencies the administration had tried to zero out.

One takeaway is that this is a signal that the U.S. government is not ready to walk away from global health. Another is that the bill exposes a sharp divide between the majority Republican Congress and the Trump administration on global health funding.

Mitchell Warren, executive director of the HIV nonprofit AVAC (and a friend of the Checkup!) raises the most trenchant questions in the article: “Will both houses of Congress approve the bill? Will the president sign it? And, perhaps more importantly, will the president actually spend congressional appropriations and accept at last that it is Congress, and not him, who has the power of the purse?” he said.

What do these two stories mean together? “Bottom line is that while most programs have been gutted, most of the budgets are being preserved. Where and how those funds get spent remains to be seen,” Dieleman told me.

A ‘dirt cheap’ malaria defense

We’re going all in on optimism today, so why not end on a high note?

A clever new study suggests malaria prevention may already be woven into daily life, The Guardian reports. Researchers found that treating baby-carrying cloth wraps with insecticide cut malaria cases in infants by roughly two-thirds in parts of western Uganda.

The idea is brilliant. In many communities, babies spend much of the day tied to their mothers’ backs in cloth wraps. (I can’t stress enough just how ubiquitous this is in East Africa.) Treating those wraps with permethrin, the same insecticide used in bed nets, adds protection during hours when nets are not in use.

Anecdotal, but as one mother told the researchers: “I’ve had five children. This is the first one that I’ve carried in a treated wrap, and it’s the first time I’ve had a child who has not had malaria.”

The best part? “It’s dirt cheap,” reports one of the researchers.

As mosquitoes increasingly bite outdoors and earlier in the evening, treated wraps could help close one of malaria prevention’s most stubborn gaps. They won’t replace bed nets or vaccines, but they add protection exactly where infants already are, in a way that fits seamlessly into daily life.

I’ll see you next week!

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

As U.S. is poised to lose measles-free status, RFK Jr.’s new CDC deputy downplays its significance

2026-01-22T01:38:12+00:00

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

After a year of ongoing measles outbreaks that have sickened more than 2,400 people, the United States is poised to lose its status as a measles-free country. However, the newly appointed principal deputy director at the Centers for Disease Control and Prevention, Ralph Abraham, said he was unbothered by the prospect at a briefing for journalists this week.

“It’s just the cost of doing business with our borders being somewhat porous for global and international travel,” Abraham said. “We have these communities that choose to be unvaccinated. That’s their personal freedom.”

Infections from other countries, however, accounted for only about 10% of measles cases detected since Jan. 20, 2025, the official start of the deadly measles outbreak in West Texas, which spread to other states and Mexico. The rest were acquired domestically. This marks a change since the United States eliminated measles in 2000. Measles occasionally popped up in the United States from people infected abroad, but the cases rarely sparked outbreaks, because of extremely high rates of vaccination. Two doses of the measles, mumps, and rubella vaccine strongly prevent infection and halt the virus’ spread.

To maintain its measles elimination status, the United States must prove that the virus has not circulated continuously in the nation for a year, between Jan. 20, 2025, and Jan. 20, 2026. To answer the question, scientists are examining whether the major outbreaks in South Carolina, Utah, Arizona, and Texas were linked.

Health officials confirmed that the main measles virus strain in each of these outbreaks is D8-9171. But because this strain also occurs in Canada and Mexico, CDC scientists are now analyzing the entire genomes of measles viruses — about 16,000 genetic letters long — to see whether those in the United States are more closely related to one another than to those in different countries.

The CDC expects to complete its studies within a couple of months and make the data public. Then the Pan American Health Organization, which oversees the Americas in partnership with the World Health Organization, will decide whether the United States will lose its measles elimination status. And that would mean that costly, potentially deadly, and preventable measles outbreaks could become common again.

“When you hear somebody like Abraham say ‘the cost of doing business,’ how can you be more callous,” pediatrician and vaccine specialist Paul Offit said in an online discussion hosted by the health blog Inside Medicine on Tuesday. “Three people died of measles last year in this country,” Offit added. “We eliminated this virus in the year 2000 — eliminated it. Eliminated circulation of the most contagious human infection. That was something to be proud of.”

Abraham said vaccination remains the most effective way to prevent measles but that parents must have the freedom to decide whether to vaccinate their children. Several states have loosened school vaccine requirements since 2020, and vaccine rates have dropped. A record rate of kindergartners, representing about 138,000 children, obtained vaccine exemptions for the 2024-25 school year.

Information on vaccines has been muddied by Health and Human Services Secretary Robert F. Kennedy Jr., who previously founded an anti-vaccine organization. He has undermined vaccines throughout his tenure. On national television, he has repeated scientifically debunked rumors that vaccines may cause autism, brain swelling, and death.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, disparaged the Trump administration’s focus on finding genetic technicalities that may spare the country’s measles-free status. “This is the wrong thing to pay attention to. Our attention has to be on stopping the outbreaks,” she said.

While scientists race to study spread of measles in U.S., Kennedy unravels hard-won gains

“If we keep our status, it should be because we have stopped the spread of measles,” she said. “It’s like they’re trying to be graded on a curve.”

The Trump administration impeded the CDC’s ability to assist West Texas during the first critical weeks of its outbreak and slowed the release of federal emergency funds, according to KFF Health News investigations. However, the agency stepped up its activity last year, providing local health departments with measles vaccines, communication materials, and testing. Abraham said HHS would give South Carolina $1.5 million to respond to its outbreak, which began nearly four months ago and had reached 646 cases as of Tuesday.

If the CDC’s genomic analyses show that last year’s outbreaks resulted from separate introductions from abroad, political appointees will probably credit Kennedy for saving the country’s status, said Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August.

And if studies suggest the outbreaks are linked, Daskalakis predicted, the administration will cast doubt on the findings and downplay the reversal of the country’s status: “They’ll say, who cares.”

Indeed, at the briefing, Abraham told a reporter from Stat that a reversal in the nation’s status would not be significant: “Losing elimination status does not mean that the measles would be widespread.”

Data show otherwise. Case counts last year were the highest since 1991, before the government enacted vaccine policies to ensure that all children could be protected with measles immunization.

Lauren Sausser contributed reporting. Amy Maxmen is a national reporter for Healthbeat through a partnership with KFF Health News.

Millions of Americans are expected to drop their Affordable Care Act plans. They’re looking for a Plan B.

2026-01-12T16:30:50+00:00

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

It’s feeding time for the animals on this property outside Nashville, Tennessee. An albino raccoon named Cricket reaches through the wires of its cage to grab an animal cracker, an appetizer treat right before the evening meal.

“Cricket is blind,” said Robert Sory, who is trying to open a nonprofit animal sanctuary along with his wife, Emily. “A lot of our animals come to us with issues.”

The menagerie in Thompson’s Station includes Russian foxes, African porcupines, emus, bobcats, and some well-fed goats.

The Sorys are passionate about their pets and seem to put the animals’ needs before their own.

Both Robert and Emily started 2026 without health insurance.

Robert had been covered through a marketplace plan subsidized through the Affordable Care Act. His share of the monthly premiums was $0. When he looked up the rates for 2026, he saw that a barebones “bronze”-level plan would cost him at least $70 a month. He decided to forgo coverage altogether.

“When you don’t have any income coming in, it doesn’t matter how cheap it is,” he said. “It’s not affordable.”

Couple lost jobs within days of each other

Marketplace plans from the Affordable Care Act no longer feel very affordable to many people, because Congress did not extend a package of enhanced subsidies that expired at the end of 2025. Last week, the House did pass legislation to extend the expired subsidies, and negotiations have moved to the Senate. Without a deal, an estimated 4.8 million will go without coverage this year.

But even without a health plan, people will still need medical care. Many, like the Sorys, have been thinking through their plan B to maintain their health.

Georgia ACA enrollment falls as federal changes push prices higher

The Sorys both lost jobs in November, within days of each other. Robert worked as a farmhand. Emily worked at a staffing firm and lost her insurance along with her position.

“It’s a horrible, horrible market right now. Really tough,” she said.

The first time she had to pay out-of-pocket for her three monthly prescriptions, the cost was $184.

“To equate that to kind of how we think about it, you’re talking about 350 pounds of food for these animals,” Robert said. He pointed to his bobcats, who eat only meat.

Newly uninsured look for workarounds

To keep kibble in the food bowls, the Sorys are prepping for an uninsured future. They see the same psychiatrist and met with him to make a plan. He was willing to work with them by charging $125 per visit. They’ll have to go every three months to keep their prescriptions current.

And if other medical problems emerge? They’re hoping for the best.

“I’m not somebody who gets sick super often, thank God,” Robert said. “And if I do, generally I go to an emergency room where they’re going to bill me later.” Robert said he would arrange a repayment plan for bills like that.

Emily has costly health conditions and has already taken on substantial medical debt. “It’s just sitting there, and I’ve racked up money,” she said. “But I’ve had to go to the doctor.”

Emily Sory feeds foxes at her home in Thompson’s Station, Tennessee.

Help for uninsured includes donated drugs and sliding scales

Hospitals and clinics are bracing for the influx of newly uninsured patients. They’re also concerned that people won’t know about alternative ways to get medical care.

“We don’t have marketing dollars, so you’re not going to see big billboards or radio ads,” said Katina Beard, CEO of Matthew Walker Comprehensive Health Center in Nashville. It’s one of the country’s 1,400 federally qualified health centers, also called FQHCs.

FQHCs are partially funded by the federal government. Although they do not usually offer free care, their fees tend to be lower or on a sliding scale.

Uninsured people who get care receive a bill, Beard said, “but the bill will be based on their ability to pay.”

FQHCs often have on-site pharmacies, and some offer prescription medications free of charge through a partnership with the Dispensary of Hope, a Nashville-based nonprofit.

Many hospital pharmacies also partner with the nonprofit, which has distributed medication donated by pharmaceutical companies to 277 sites in 38 states. Participating pharmacies must make the medicine available free of charge to people without insurance who have annual incomes below 300% of the federal poverty limit.

The organization primarily sources medications for chronic conditions such as high blood pressure, diabetes, and mental health. Demand is expected to outstrip supply in the new year, according to CEO Scott Cornwell.

“We’re projecting and engaging with our manufacturers and asking them, ‘Are you willing to help support, for this future status that we are anticipating?’” he said. “By and large,” he said, pharmaceutical companies have said they’re willing to step up.

“It’s a continuous conversation that we’re having,” Cornwell said.

10 states have a Medicaid ‘gap’

Hospitals will also have to find a way to care for more patients who cannot pay. Industry groups such as the Federation of American Hospitals have been vocal about the threat to hospitals’ financial health and have urged Congress to extend the enhanced subsidies, which take the form of tax credits.

The impact might be most acute in states like Tennessee that have not expanded Medicaid to cover people who work but do not have job-based insurance and cannot afford it on their own.

Ten states have chosen not to expand Medicaid to uninsured, low-income adults — an optional provision of the ACA that is mainly paid for by federal funds.

This Medicaid “gap” is expected to cause uninsured rates to jump, at the high end of the spectrum, by as much as 65% in Mississippi and by 50% in South Carolina, according to the Urban Institute.

As Emily Sory pets a Russian fox, she acknowledges she is keenly aware that she will soon become part of this growing population. After all, her last job involved health care staffing. Her mother is a nurse.

“I understand the system. And I get it’s people like me that don’t pay their bill are why it suffers. And I feel bad,” she said. “But at the same time, I don’t have the money to pay it.”

This article is from a partnership that includes Nashville Public Radio, NPR, and KFF Health News, Healthbeat’s national reporting partner.

Shutdown deal brought a reprieve for WIC. But NY braces for ripple effect of other looming aid cuts.

2026-01-12T10:00:00+00:00

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

The WIC program, which has provided healthy food, health care referrals, and breastfeeding support for women, infants, and young children for more than 50 years – historically receiving strong bipartisan support – came out of the fall federal government shutdown intact for another year. But New York City public health experts fear that President Donald Trump’s looming transformation of public assistance will have ripple effects that will still hamper WIC access.

“We are headed toward a very uncertain future,” said Jack Newton, who directs the Public Benefits Unit in the Bronx office of Legal Services New York, helping people obtain and retain public benefits. “The next two years will be a sea change among low-income New Yorkers, who will find a dramatic change for nutrition assistance and health care.”

The U.S. Department of Agriculture reported that about 6.7 million people received monthly WIC benefits, including about 41% of all infants nationwide. That same year, 233,703 New Yorkers relied on WIC each month – over half of the state’s total beneficiaries, according to the New York State Comptroller.

On a typical day at a WIC agency in New York City, parents and their children come in for a health check, breastfeeding advice, or a nutrition consultation. They come to get referrals to prenatal or pediatric health care. They might also refill their eWIC benefit cards they can use to purchase healthy food and baby formula for a few months. Often they get help enrolling in other public assistance programs, such as the Supplemental Nutrition Assistance Program (formerly known as food stamps), the Head Start early education program, Healthy Start, or Medicaid.

Since the Covid-19 pandemic, WIC services have increasingly moved to remote access, allowing families to avoid taking time off work or organizing child care to keep their required appointments. Yet, throughout the country, and across New York City, local clinic offices, rooted in their communities, remain a key feature of the program.

When the federal government shut down on Oct. 1, unable to pass a budget for fiscal year 2026, WIC recipients and providers worried about how long the local agencies could remain open, and what changes might occur in the short term. Concern ran parallel to fears about SNAP benefits, which were disrupted in early November, delayed and debated in court, and finally distributed to New Yorkers on Nov. 9.

Cuts to food benefits stand in the way of RFK Jr.’s goals for a healthier national diet

Each new day of the shutdown brought new, often conflicting information. Several states, including New York, jumped in to cover a looming funding lapse with their own budgets. The USDA moved money around to cover WIC benefits. The White House injected emergency funds. Most WIC clinic managers in New York proceeded with a precarious “business as usual,” taking one day at a time and keeping a low profile.

As New York state’s largest WIC Vendor Management Program and WIC provider, Public Health Solutions, however, quickly took a vocal stance. On Oct. 8, leaders of the non-profit organization gathered for a press conference at their WIC office in the Bronx with Democratic U.S. Rep. Ritchie Torres. Speakers highlighted the urgency of the situation – and the consequences of a sudden lapse in or loss of WIC benefits for the 35,000 low-income women, infants, and children that PHS annually serves through their WIC program.

A chart presented at a news conference on Oct. 8, 2025, in the Bronx shows the impact of the WIC program.

For the Bronx, Torres said, WIC is essential.

“My congressional district is the largest recipient of WIC of any congressional district in New York state,” Torres said. On that day, he was speaking “not only as a United States congressman, but as the product of a strong single mother, who raised my twin brother and me on the strength of the WIC program.”

PHS was responding to the immediate crisis. But concern about the future of WIC had begun before the shutdown, and remains top of mind for many recipients and advocates, despite the funding deal’s reprieve.

The recurring, principal concern is that social benefits are not designed as isolated forms of support – they work together. Changes to one part of the system, the non-profit National WIC Association explains, will not be contained. Changes in other programs to eligibility criteria, new work requirements, enrollment procedures, cost-shifting onto the states, and, now, a potential expansion of the nation’s “public charge” determination means fewer people might access WIC.

Many recipients of public assistance have been anticipating those ripple effects, Newton said. Participants who visited Legal Services New York in mid-October were seeking clarity. Their shutdown anxiety, he said, was “greatly compounded” by the One Big Beautiful Bill Act and its looming cuts to SNAP and Medicaid, new eligibility and work requirements, and the long-term consequences of shifting the costs of the programs to states.

On the one hand, Newton said, it is the combination of different public benefits – SNAP plus WIC, for example – that helps low-income families access adequate nutrition.

“When you’re pregnant or have young children, your need for nutrition increases - so the already inadequate SNAP benefits plus WIC gets you closer to a place where you can provide adequate nutrition and healthy nutrition,” he said.

How connecting with nature helps Black women have healthier pregnancies

On the other hand, WIC is “extraordinary” among benefits, Newton explained, because it does not have immigration requirements like SNAP and Medicaid.

“For some families, that is the only benefit they have,” Newton said of WIC. But to get even just that, a pregnant or new parent would have to feel inclined, safe, and comfortable enrolling in the program. For public health experts, the “chilling effect” of the federal government’s immigration-related actions, and the sense of chaos and uncertainty many experience, is a considerable source of concern.

To the alarm of many, days after the shutdown came to an end, the government re-introduced possible changes to the public charge rule, which, if passed, could discourage people from enrolling in public assistance.

Here’s what else to know about WIC.

What is WIC?

“WIC is best thought of as a public health program,” Nell Menefee-Libey, senior public policy manager for the National WIC Association, told Healthbeat in a recent interview. “The goal of WIC is to support and improve pregnancy and birth outcomes, child development outcomes, with a very specific nutritionally tailored food package, with nutrition education, and breastfeeding support.”

Launched as a pilot program in 1972 to address a growing concern over malnutrition and poor health outcomes of mothers and children across the nation, WIC offers eligible families through pregnancy and early childhood direct nutritional assistance (vouchers and cash benefits) and other support.

It is managed at the state level, often through contracted local independent agencies – primarily public hospitals, community health centers, or non-profits. Embedding the program within institutions providing health care services typically helps promote WIC’s mission to improve health outcomes.

WIC’s purchasing guidelines are strict. The benefits can only be used for specific foods, in specific quantities, based on the recipient’s specific circumstances (fully breastfeeding, partially breastfeeding, or not). Covered items include dairy, cereal, canned fish, whole wheat bread, dry or canned legumes, baby food, peanut butter, and fruits and vegetables, through the popular Cash Value Benefits.

Eligibility is determined by income, nutritional risk, and/or enrollment in other public benefit programs, also known as “adjunctive eligibility.” The income limit is set at or below 185% of the U.S. Poverty Income Guidelines. In 2025, according to the U.S. Department of Health and Human Services, that represented $59,477.50 a year, for a family of four.

What has been the impact of the WIC program?

Over the past five decades, studies have shown WIC to be effective in improving diet quality (including consumption of important nutrients such as iron, protein, and vitamins); increasing access to early prenatal health care, as well as post-partum and pediatric health care, and reducing adverse maternal and birth outcomes, such as premature births, low and very low birth weight, or fetal and infant mortality.

“The consequences of a child not getting enough nutrition are multifaceted,” Dr. Adam Aponte, pediatrician and CEO of the East Harlem Council for Human Services, said in a recent interview. “It affects brain growth, it affects all sorts of organ systems within the body. If [children] do not have proper nutrition during those early years, that can have consequences for the remainder of their life.”

Aponte highlighted the considerable energy needs for growth of the baby in utero, those of the child in its first two years of life, and the changes to nutritional demands that occur in a pregnant person’s body. WIC, he said, directly helps ensure children and their mothers have access to good quality, nutritious foods and get connected with other forms of support and health care.

For over 40 years, Aponte said, EHCHS ran its own WIC program. Since the organization has a Federally Qualified Health Center component – the Boriken Neighborhood Health Center, which provides pediatric and OB-GYN care – managing a WIC program was “very convenient.” It embodied the embedded, streamlined, and comprehensive continuity of care that makes many WIC programs unique.

But the agency ceased operating its WIC program in 2022, Aponte said, due to a post-Covid provider consolidation effort across the city, and the increase in online and remote services. Other WIC providers serve the area, including the NYC Health + Hospital in Harlem and the Institute for Family Health.

How will cuts to SNAP and Medicaid affect WIC?

The funding deal struck to end the government shutdown includes the full year of appropriations for the USDA, where WIC’s budget resides, Menefee-Libey explained. So its funding is assured through October 2026.

The funding deal gave WIC two other wins, the NWA noted. Reductions to the program’s fruit and vegetable benefits, which had been proposed over the summer in Trump’s and in the House Agriculture Committee’s budgets, were dropped. And the federal government refilled WIC’s emergency contingency fund, which played a key role in holding the program over during the shutdown.

But other cuts to the ecosystem of public benefits are expected this year, and that could affect WIC access.

“Programs like WIC, Medicaid, and SNAP all work together to help to improve public health outcomes,” Menefee-Libey said. “Upheaval or uncertainty in any of these programs doesn’t stay isolated; it will have ripple effects.”

For many of the families Newton’s office helps access, retain, or increase public benefits, losing one, or both, he says, would have “very adverse consequences.”

The consequences are practical: They are about how much food a family will be able to have on the table if they have to manage without SNAP, or what health care will look like for them if they lose Medicaid.

But beside the immediate implications of losing other benefits for a family supported by WIC lies an important bureaucratic “domino effect.”

“If someone is participating in Medicaid and SNAP,” Menefee-Libey explained, “they are presumed to be eligible for WIC – their certification process is streamlined.” That process is called “adjunctive eligibility.” The point of this is to increase the reach of the public benefit programs, and simplify the bureaucratic process.

But the looming changes throw a wrench in the machine. If people lose access to one kind of public benefit, and then become pregnant and want to enroll in WIC, they would, at the very least, need to complete additional administrative steps. But, in the worst case, Menefee-Libey said, they could “lose their eligibility entirely.”

That concern is particularly relevant in the states like New York that expanded Medicaid under the 2014 Affordable Care Act, Menefee-Libey said. The ACA gave states the option to extend Medicaid coverage to address the “coverage gap” that left adults with incomes too high to qualify for traditional Medicaid, but too low to afford for private health insurance – and who often had no access to employment health benefits – with virtually no options.

Now, people who stand to lose access to Medicaid may lose WIC, too.

What would Trump’s proposed ‘public charge’ rule mean for WIC?

On Nov. 19, the federal government reopened the “public charge” rule dossier, as Trump had done in his first term.

The rule refers to a test under federal law that allows immigration officials to deny applications for lawful permanent residence, or a green card, and certain visas if they determine that the applicant could become a “public charge.” The current policy for the test does not consider participation in health care programs like Medicaid, nutrition programs, or housing programs, and focuses instead on cash assistance and long-term institutionalized care. It was established in 2022 and remains in effect.

Ripple effects of ICE raids create health challenges for New York City

But the Trump administration is seeking to considerably broaden the test. Effectively, the new proposed rule does not provide explicit guidance as to which benefits would or would not be considered.

WIC providers have said that such an expanded rule could further discourage immigrant and mixed-status families from seeking enrollment in WIC and other benefits.

“The fear is that many immigrant and mixed-status families will withdraw from public benefit programs entirely, including from WIC,” Menefee-Libey said. “We know that will have tremendous implications for public health impact generally – worse health and pregnancy outcomes, and real uncertainty and fear during a challenging period” of pregnancy and early parenting.

Multiple studies have documented the relationship between punitive immigration policies and decreased health care utilization among immigrants (known as the “chilling effect”).

Answering the public comment period for the rule, which is open through Jan. 26, many public health organizations and individuals have voiced opposition. The Protecting Immigrant Families Coalition issued a response, signed by 725 national, state, and local organizations, including PHS, the NWA, New York’s Legal Aid Society, and the Committee for Hispanic Children and Families.

“Unknown rules lead to chaos and bias,” the coalition wrote Dec. 19. “This proposal would remove essential guardrails that protect millions of immigrant families, in favor of an unknown immigration policy that invites arbitrary decisions and political bias. It will deter millions of U.S. citizens in immigrant families, as well as lawfully present immigrants, from seeking care and aid for which they qualify under law. It will undermine the nation’s health and weaken our country’s economy, while making every social problem we face worse.”

Julie Flandreau is a freelance reporter in New York.

Amid funding threats, nearby measles, and vaccine changes, Georgia’s public health board hasn’t met in months

2026-01-09T21:41:34+00:00

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

As the federal government makes major changes to food and vaccine policy, uncertainty swirls in Washington over public health funding to states, and neighboring South Carolina is battling a surging measles outbreak, the board of the Georgia Department of Public Health has decided it doesn’t need to meet this month.

“As there is no official business pending for the Georgia Board of Public Health, no meeting is scheduled at this time,” state Department of Public Health spokesperson Nancy Nydam Shirek told Healthbeat on Friday.

The nine-member board last met in September. It unexpectedly cancelled a November meeting “due to unforeseen scheduling issues,” according to a note on its website.

The date of the next meeting “is to be determined,” Nydam Shirek said.

“This is an agency with a budget pushing more than $800 million,” said Richard Griffiths, former president of the Georgia First Amendment Foundation and an open government advocate.

“There’s no reason for them to meet at all? That seems farfetched. For the board to not meet is effectively saying that everything is perfect, and we know that’s not the case, because Georgia ranks the eighth worst in the country for infant mortality.”

Georgia lawmakers return as federal health funding uncertainty looms

When the board does meet, it typically hears from public health Commissioner Dr. Kathleen Toomey and State Epidemiologist Dr. Cherie Drenzek about disease trends in the state. Public health employees also give updates on topics ranging from newborn screening to food service inspections.

The meetings, held via Zoom, provide board members a chance to ask questions about how programs are working. For example, at the September meeting, Dr. James Curran, the board’s chair, criticized new vaccine policies introduced by U.S. Health and Human Services Secretary Robert F. Kennedy Jr.

Toomey said at that meeting the agency would consider following other guidelines, such as those from the American Academy of Pediatrics, if the federal government changed its recommendations around routine childhood vaccines.

The federal government did change its recommendations this week.

The board met just four times each in 2024 and 2025. It also met just twice during the first two years of the Covid pandemic, but resumed meeting more regularly in 2023. Georgia’s open meetings law requires state agencies to meet “in accordance with a regular schedule.”

In response to questions from Healthbeat about why it does not meet more frequently, Nydam Shirek said, “The Georgia Department of Public Health regularly issues news releases and posts on social media on topics of interest and public health matters of concern. DPH also maintains a website that provides information about all DPH programs.”

Since the September meeting, flu rates have spiked in Georgia, and health department workers put in hundreds of working hours to contain a measles outbreak at Georgia State University.

Now a measles outbreak in South Carolina has surged to 310 cases since October 2025, and Georgians are worried about spread. In the 2023-24 school year, 88.4% of Georgia students had received two doses of the measles vaccine, which is below the 95% needed for herd immunity, according to data from the Centers for Disease Control and Prevention.

“Wouldn’t the board be wanting to know what the Department of Public Health has prepared in case that outbreak crossed into Georgia?” Griffiths said.

And the federal budget, which contributes more than half of Georgia’s public health budget, is bogged down in Washington. Looming cuts to Medicaid and Affordable Care Act health insurance plans could impact 492,000 Georgians by 2034, according to a Georgia Health Initiative analysis.

“It is unfortunate that the board isn’t meeting regularly, especially at a time when public health faces such profound funding and messaging challenges from HHS,” family medicine doctor and GSU professor of public health Harry Heiman told Healthbeat.

“Ensuring transparency and presenting the critical role of public health agencies is more important than ever,” Heiman said, adding that board meetings serve as an opportunity to talk about the good work DPH does, too, “like our effective response and containment of measles outbreaks,” as well as share its plans to address poor health outcomes and health inequities.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia lawmakers return as federal health funding uncertainty looms

2026-01-09T17:34:31+00:00

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

As uncertainty swirls around key health policy issues in Washington, Georgia lawmakers will return to the Gold Dome on Monday to plan next year’s budget and consider public health proposals that died on the vine last year.

The Georgia General Assembly’s main task will be deciding how to allocate state funds for the remainder of this fiscal year, which ends on June 30, and for fiscal 2027. This summer, Gov. Brian Kemp instructed state agencies to maintain current spending levels as part of “conservative fiscal management.” But that could be complicated by potential cuts to funds for health and other social service programs in Congress.

Here are three public health issues Healthbeat will be watching during this year’s session.

Georgia public health funding uncertain as federal budget in limbo

Each year, the state legislature takes up two budget bills. The “small budget” makes tweaks to the current year’s budget, while the “big budget” lays out the budget for the next fiscal year, which starts in July.

This year, Georgia’s “big budget” that would start on July 1 could be complicated by federal funding cuts to the U.S. Centers for Disease Control and Prevention. The state Department of Public Health receives about half of its nearly $940 million in funding from the federal government, much of it via the CDC.

If there are cuts to Georgia’s federal funds, “we will have to look at our budget and look for funds to put and fill holes,” said Rep. Darlene Taylor, the Thomasville Republican who chairs the state House’s appropriations health subcommittee.

Georgia ACA enrollment falls as federal changes push prices higher

For example, most of the state’s funding for HIV prevention work (nearly $26 million) comes from the CDC, with only $1.1 million coming from state funds for work providing pre-exposure prophylaxis drugs in Georgia, according to DPH spokesperson Nancy Nydam Shirek.

The federal budget is under negotiation in Washington, and it’s not clear when Congress will pass the spending plan and what it will include.

Taylor said she wants to make sure the state Department of Public Health and county health departments have the funds needed to do important educational work on topics ranging from diabetes to the harms of smoking. Still, she said, it will be hard to plan the state’s budget until more is known about the federal budget.

“I’m concerned about it. We are all watching it, and I’m sure the right decisions will be made when it comes to making sure that our people of Georgia have access to health care,” Taylor said.

Licensing for community health workers

A bill to establish licenses for community health workers got close to crossing the finish line last year but ultimately failed to get a needed floor vote in the state Senate.

Taylor, who sponsored the bill, said she plans to push for its approval this year.

Community health workers are similar to health care navigators and, increasingly, employed by health systems in Georgia, among other organizations. CHWs are not medical professionals but typically have close ties to the communities they serve, either because they live in those communities, come from similar cultural or linguistic backgrounds, or have experience with particular diseases like diabetes or cancer.

Georgia has training programs for community health workers. The bill would regulate standards for training and certification, overseen by the state DPH.

Certification could help pave the way for CHWs to be paid by the state Medicaid program and other health insurers. The hope is that CHWs could help Georgians stay on track in managing health conditions like diabetes or asthma and more easily navigate a complex health care system.

Helping people in recovery – especially nurses

Recovery advocates want to see Georgia join 44 other states in creating an “alternative to discipline” program to help nurses who are struggling with addiction.

Currently, nurses must undergo what many consider a “punitive” and public system before the state nursing board if they admit to seeking help with substance abuse. Georgia differs from most other states, which employ a more layered system that allows nurses a way to seek help without jeopardizing their licenses – typically called an “alternative to discipline” system.

The hope is that the recovery-focused alternative would allow nurses to get help sooner without fear of losing their right to practice – and their livelihoods. Nurses in recovery told Healthbeat the current system deterred them from getting help for alcohol or drug addiction even when they wanted it because they knew they would face disciplinary measures that could stop them from working.

‘Terrified’ to seek help: Georgia nurses can lose license if they admit addiction. Advocates want to change that.

A bill to establish the alternative system in Georgia failed to get a Senate floor vote last year after it was passed unanimously by the House. Rep. Ron Stephens, a Savannah Republican who sponsored the bill, said the legislative clock ran out, but he hopes it will get early Senate approval this year. The legislation will be taken up by the Senate when the session opens next week.

Recovery advocates also want to see the legislature implement uniform regulations for recovery residences, often called halfway houses, to ensure quality, said Laurisa Guerrero, executive director of the Georgia Council for Recovery.

A bill to do that failed to pass last year, but a study committee met to look more closely at the issue during the legislative “off season” and recommended creating licenses and quality measures for these residences that would be administered by the state Department of Behavioral Health and Developmental Disabilities.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Higher life expectancy tops 15 health wins in New York

2026-01-09T16:36:21+00:00

If you know someone who works in health, chances are they banged their head against a wall at least once in 2025 — myself included. The past year brought the largest measles outbreak in decades and a tidal wave of false information on vaccines, including from the highest levels of government. Just days into 2026, the Department of Health and Human Services overhauled the recommended childhood vaccine schedule — not because of new science, but because of politics.

To put it simply, we’ve been through a health gauntlet.

But, despite the chaos, there’s a lot to still celebrate.

Across New York, health workers, policymakers, and supporters kept showing up, day in and day out, working toward a healthier New York, regardless of what was said on the news. That is worth celebrating.

I’ve put together a few milestones from the past year. It’s not exhaustive (there’s always important work happening behind the scenes that doesn’t make headlines), but here’s a roundup of some of the key wins that made New York a healthier place in 2025. I’ve also got your regular infectious disease weather report at the end.

1. New York City life expectancy reached a record high.

New York City’s average life expectancy hit 83.2 years, surpassing the city’s HealthyNYC goal years ahead of schedule. This milestone reflects progress across several issues, including things like chronic disease management, overdose prevention, and Covid-19 treatment and vaccination, among others.

New York City life expectancy.

2. New York City had a significant reduction in overdose deaths.

New York City had a 28 % drop in overdose deaths in 2024 — the largest decline in nearly a decade. Staten Island experienced the most dramatic drop, tied to localized interventions and broader access to naloxone and treatment.

3. Youth tobacco use declined in New York state.

Tobacco use among high school students across the state continued to fall to record lows, showing the effectiveness of prevention efforts.

4. New York strengthened vaccine access and regional collaboration.

In 2025, New York City and the state continued to expand vaccine access through:

Joining and helping lead the Governors Public Health Alliance, a 14-state effort to safeguard vaccine infrastructure, and the Northeast Regional Public Health Alliance.
Passing new state laws that guarantee Covid-19 vaccine access for all New Yorkers, despite changes in federal vaccination recommendations.
Continuing to recommend the hepatitis B vaccine birth dose for all newborns.

5. Investment in public health data infrastructure.

New York City launched a new Vaccination Data Explorer to help identify immunization gaps and inform outreach, and updated its respiratory illness dashboard. At the state level, New York also updated its respiratory virus reports and rolled out a new Heat Illness Risk tool to monitor extreme heat threats across the state.

6. Progress in medical debt relief and medication cost reductions.

Financial wins in 2025 included:

New York City relieved $80 million in medical debt for New Yorkers with low incomes.
New state laws eliminated cost sharing for asthma inhalers and eliminated co-pays for insulin under state-regulated plans.

These changes will improve access to live-saving medications and help reduce long-term health disparities tied to chronic illnesses like asthma and diabetes.

7. New York City opened a clubhouse to help New Yorkers with serious mental illness.

The Venture House clubhouse opened in Brooklyn to support people living with serious mental illness. Its goals are to provide community and social connections, supported employment and education, and recovery services through a supportive community of peers.

8. New York hospitals accomplished several medical milestones.

A patient was cured of sickle cell anemia at Cohen Children’s Medical Center using a groundbreaking new therapy.
Northwell Northshore University Hospital doctors performed a rare triple transplant — heart, kidney, and liver — on a Long Island patient that saved his life.
A pediatric heart transplant saved the lives of three kids at New York Presbyterian Morgan Stanley Children’s Hospital. When one child received a full heart transplant, parts of her former heart were able to be transplanted for two other children in need.

9. New state laws and research centers in New York advanced maternal and reproductive health.

Those who are pregnant or trying to become pregnant are now guaranteed 20 hours of paid leave for prenatal care.
New York state laws expanded protection for reproductive health care clinicians and patients, including privacy safeguards on prescriptions for abortion medications.
A new endometriosis research center was opened at the Cold Spring Harbor Lab on Long Island.

10. New York state surpassed the national breast cancer screening goal.

Some 81.9% of New York women were up to date on screenings, higher than the national goal of ~80.3%.

11. Improved air quality and citywide composting in New York City.

A new study showed that air quality in Manhattan improved following the implementation of congestion pricing. In the first 6 months of the program, PM2.5 (particulate matter in the air, associated with major health issues like asthma) dropped by 22% in the Congestion Relief Zone.
Citywide composting across all five New York City boroughs kicked off in 2025. The program helps build environmental resilience, reduce food waste sent to landfills, and reduce rats getting access to food scraps. It also provides compost back to city residents who can use it for gardening. Compost pick-up sites and events are located throughout the city from April to September.

12. NY SWIMS funded water safety and pool access.

Over $200 million was distributed through the NY SWIMS program to expand access to safe public swimming facilities across the state — supporting physical activity and reducing drowning risk.

13. The Wadsworth Center was recognized for national leadership in laboratory health science.

The Wadsworth Center, New York’s public health laboratory, was named a National Influenza Reference Center. Its director, Dr. Kirsten St. George, received a national award for her contributions to public health innovation, including expanding New York public health surveillance to incorporate wastewater monitoring and sequencing data to track new variants and outbreaks.

14. Albany began lead pipe replacement.

The state is funding a $129 million project to replace lead service lines in Albany, addressing a critical environmental health risk.

15. New York worked to increase temporary housing and meal access for those in need.

The construction of a new emergency shelter in Buffalo broke ground.
In Syracuse, a community-led program delivered a record-breaking number of free Thanksgiving meals to families in need. This was their 138th year serving Thanksgiving meals.

These victories are a testament to what’s possible when data, policy, and communities come together to improve health. Here’s to building on this progress in 2026 and beyond.

Quick infectious disease ‘weather report’

Flu: The flu has been intense this year! My partner and I got it this past weekend. But there’s some good news — data from New York show that we may be turning a corner.

In New York City, the latest data through Dec. 27 show that influenza is actually declining, i.e., we may have passed the peak.

Percent of emergency department visits due to the flu.

New York state shows the same — positive tests for influenza are declining. But we still see very high and increasing hospitalizations for flu, meaning we are still in the thick of the season.

RSV: Potentially at the peak. In New York City and New York state, emergency department visits and hospitalizations for RSV are still increasing, but the number of cases in New York state is starting to decline.

Covid: The same is true for Covid — the number of emergency department visits in New York City and New York state are still going up, but the number of cases is going down.

To sum it all up, declining case numbers for respiratory illnesses doesn’t mean we’re out of the clear. Influenza transmission is still really high, and many people are still being hospitalized. Don’t let your guard down yet. It’s still a good idea to keep masking in crowded, indoor spaces, especially if you are at higher risk for severe illness (immunocompromised, pregnant, older, etc.).

Bottom line

Even amid major federal disruptions to health guidance and policy, New Yorkers did what New Yorkers do best — we kept moving forward. And we have a lot to show for it. So here’s to building on that progress and improving health even further in 2026. Happy New Year!

Love,

Your NY Epi

NYC’s new deputy mayor for health went from Covid patient to hospital CEO

2026-01-09T13:47:07+00:00

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

The new deputy mayor overseeing the New York City health department and related agencies is a veteran health professional and hospital executive with strong community ties and very much a product of Queens, where she and her family immigrated from Ecuador.

Helen Arteaga Landaverde, 49, comes to the job at Health and Human Services after five years as the CEO of NYC Health + Hospitals/Elmhurst, a 545-bed public hospital in Queens that was at the “epicenter of the epicenter” in the early days of the Covid-19 pandemic, when a refrigerated truck stored bodies, and overwhelmed doctors and nurses rationed ventilators.

Arteaga Landaverde herself was a Covid-19 patient at Elmhurst, treated only a few weeks into the outbreak. Years before, her father had been treated for leukemia at Elmhurst. His death helped shape her worldview.

“You see, here is where my advocacy was born. It is here where my dad died without having … insurance. It was here that I survived Covid,” Arteaga Landaverde said at the Elmhurst news conference on Dec. 30 when Mayor Zohran Mamdani announced her appointment. Her voice catching with emotion, she looked up from the lectern and into the crowd. “And it’s here that I want to say, ‘Madre, tu sacrificio valió la pena.’”

Mom, your sacrifice was worth it.

Here’s a look at who’s advising Zohran Mamdani on health policy

Arteaga Landaverde steps into the new mayor’s administration with challenging responsibilities at a chaotic time for public health. In addition to the Department of Health and Mental Hygiene, she will lead the departments of Social Services, Aging, Veterans’ Services, Youth and Children’s Services, NYC Health + Hospitals, and Office of the Chief Medical Examiner. She succeeds Suzanne Miles-Gustave, who was named to the post in March 2025 following an exodus at City Hall tied to the U.S. Department of Justice asking a court to drop federal corruption charges against then-Mayor Eric Adams.

Federal funding cuts, primarily from President Donald Trump’s One Big Beautiful Bill Act, will have a profound impact on the health and well-being of New Yorkers from all five boroughs. The changes include cuts of $10 trillion over 10 years to Medicaid, the source of health coverage for almost half the city’s population, and the Affordable Care Act.

On Monday, the Trump administration froze $10 billion in funding for child care subsidies, social services, and cash support for low-income families in Democratic-run states, including New York. The suspension of such funding will surely complicate Mamdani’s efforts of realizing his affordability agenda, which consists of introducing free child care.

How Mamdani and Arteaga Landaverde plan to protect the health of New Yorkers is not yet clear. During the campaign and his transition, and since his Jan. 1 inauguration, Mamdani has said little about his health policies. Arteaga Landaverde, too, has offered few details.

How states and cities can defend public health in 2026

“To every New Yorker that trusts us enough to show up, and to those that are suffering in silence wherever you are because they do not know if government will protect them or treat them with dignity, I promise you today that I will work so hard to ensure that you are seen and that we are thinking big and courageous about solutions that will allow you to thrive in the city that we love,” Arteaga Landaverde said at the Elmhurst press conference. “You see, I see you. ’Cause your struggles are mine. I am who I am, because of them.”

Arteaga Landaverde did not respond to multiple requests to be interviewed.

One of her first tasks will be picking a permanent health department commissioner. Dr. Michelle Morse has been serving in an acting capacity since October 2024, her limbo status a source of constant speculation. She applied for the permanent job with the Mamdani administration via an online portal and has conveyed her interest in staying on through allies. (Morse is on the board of directors for NYC Health + Hospitals.)

In a statement Thursday, Morse said she looked forward to Arteaga Landaverde’s leadership. The two had met in 2021 — Morse as the inaugural chief medical officer and deputy health commissioner, Arteaga Landaverde as the Elmhurst CEO — just after officials had announced Covid-19 vaccination mandates for health care workers.

“Dr. Arteaga personally met with every employee who had initially refused vaccination. She heard their concerns at all hours of the day and night, and it was thanks to her leadership that vaccine uptake increased. That story has long stayed with me as an example of her grace, compassion, and deep understanding of public health.”

A father’s lesson: ‘How can I help my neighbor?’

Born in the United States and raised in Ecuador, Arteaga Landaverde returned to Corona, Queens, as a girl with her parents and sisters. With a full scholarship at New York University, she studied chemistry because she saw so many of her neighbors die of AIDS and wanted to find a cure. To that end, she had enrolled in medical school but withdrew following the death of her father.

She later earned a master’s degree in public health from Columbia University and a PhD in community health and health policy from CUNY. Her dissertation explored flu vaccine hesitancy among Hispanic adults in the United States. The loss of her father offered an epiphany of sorts: The quality of health care in Hispanic neighborhoods wasn’t the same as in other neighborhoods, and she felt compelled to change that.

“He used to tell me, ‘My daughter, you can’t change the world, but you can change this block, this house,’” she recounted in a 2022 Spanish-language interview with Fox 5 New York. “That stayed with me. He said, ‘I can’t fix the whole world, but how can I help my neighbor?’”

In 2009, she co-founded Plaza Del Sol Family Health Center in Corona, Queens, a federally qualified health center that brought to the community rare specialty care like mental health services, gynecology, family planning, mammography screening, breast imaging, optometry, and nutrition guidance. Patients found a family center where staff spoke Spanish. Arteaga Landaverde fought hard to secure a mammogram machine.

“This would have happened only because of Helen and her innovation,” Matthew Kusher, a family doctor who is the center’s clinical director, told Healthbeat. “Her ingenuity, her insight was able to force this health center to continue to grow and to thrive and to be as it is today.”

Queens was especially hard hit in the early days of the Covid-19 outbreak, and center records show that the novel virus was circulating in the borough in late 2019, Kusher said. But by March 2020, the facility and others nearby became inundated with patients, many of them belonging to large families living in close quarters and unable to practice social distancing.

That spring, Arteaga Landaverde caught Covid from her son, Kusher said, and sought treatment in the emergency room at Elmhurst, which had become synonymous with the horror of the outbreak: Doctors and nurses were forced to ration ventilators. A refrigerated truck parked outside held bodies of those who had died. In just one 24-hour period, at least 13 patients died of Covid at the hospital.

It took a few months for Arteaga Landaverde to recover and return full time to work, Kusher said. By February 2021, she received a job offer she couldn’t pass up: CEO of Elmhurst. She became the first Latina to lead the hospital’s executive team. Competition was stiff: According to an NBC interview with her in 2024, she had 21 interviews for the job, and there were 300 applicants.

“I was actually surprised when she told me that she became the CEO of Elmhurst, because she doesn’t have that hard-driving vibe, and I think that’s what makes her special,” said Chris Palmedo, a clinical professor at the CUNY Graduate School of Public Health & Health Policy who served as her dissertation adviser.

Elmhurst experience key to Mamdani appointment

Three years later, in May 2023, Elmhurst became the target of a rare strike. Galvanized by tough working conditions during the pandemic, some 165 trainee doctors belonging to the Committee of Interns and Residents-SEIU went on strike to air their grievances of being paid less than their counterparts on the other side of the East River, in Manhattan. It was the first physician strike at a hospital in New York City in more than 30 years.

While the doctors worked at Elmhurst, part of the public Health + Hospitals system, their residency program was run by Mount Sinai’s Icahn School of Medicine in Manhattan. The strikers delivered a letter to Arteaga Landaverde hoping that the CEO would come to the bargaining table and use her influence to help avoid a walkout.

After three days, the strike ended. A tentative agreement included wage increases of 18% over three years, a $2,000 ratification bonus, and an enforceable agreement to negotiate on hazard pay.

Central to her selection as deputy mayor, Mamdani said, was her experience growing up in Queens and running the borough hospital.

“It was the kind of leadership Elmhurst residents came to expect from a daughter of the community – someone who grew up like them, cared about people like them, and understood New Yorkers with less are often treated with less,” Mamdani said as Arteaga Landaverde looked on. “That leadership, driven by empathy and guided by an unshakable belief that every New Yorker deserves a life of dignity, is no less than what the people of this city will expect from their new deputy mayor.”

This story has been updated to reflect that Arteaga Landaverde was the first Latina to lead Elmhurst’s executive team.

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.

ByHeart baby formula outbreak prompts global safety study as U.S. struggles to find botulism source

2026-01-08T16:06:51+00:00

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

An international food standards committee of the United Nations and World Health Organization has called for a scientific risk assessment of botulism spores in powdered infant formulas as a result of the U.S. outbreak linked to ByHeart products.

The action by the Codex Committee on Food Hygiene, supported by attendees from 50 member countries, noted the “global implications” of contaminated baby formula. It was taken as U.S. health agencies have struggled since early November to determine how ByHeart’s formula became contaminated.

Investigations have been ongoing since early November.

At least 51 U.S. babies have been sickened with infant botulism in the outbreak, with no new cases identified in recent weeks; all required hospitalization. The U.S. Food and Drug Administration has said it was first alerted on Nov. 6 to an initial cluster of illnesses linked to ByHeart formula and that its investigation has been underway since then.

ByHeart has recalled all of its formula products. Federal officials have said they cannot rule out the possibility the company’s formula – which was marketed as a premium, organic formula “closest to breast milk” – has been contaminated with botulism bacteria since it was first put on the market in March 2022.

Food safety advocates said they supported the international risk assessment, but noted it will likely take years to result in any reforms to protect against future outbreaks.

A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe.”
Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest

“It’s a really bad sign for Americans when a slow-moving international scientific agency has now initiated public plans, and yet our own regulators responsible for preventing this outbreak haven’t taken any public action,” said Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest, a consumer advocacy group in Washington, D.C., that focuses on food issues.

“A well-functioning food safety agency would have some answers by now about what caused the outbreak and would be committed to doing widespread product testing to ensure other formula brands are safe,” Sorscher told Healthbeat. “Instead, we have utter silence. It’s a complete failure of leadership.”

Officials with the FDA, Centers for Disease Control and Prevention, and U.S. Department of Health and Human Services said their investigations are ongoing but they did not answer Healthbeat’s questions this week about what challenges may be contributing to delays in finding the cause.

They also didn’t respond to questions about whether it’s surprising that a source of ByHeart’s botulism bacteria contamination hasn’t yet been identified.

Federal regulators haven’t decided whether a U.S. risk assessment is needed

Infant botulism is caused by babies ingesting spores of Clostridium botulinum bacteria, which can take 30 days to start growing in their immature guts and produce a toxin that can cause symptoms ranging from constipation, loss of head control, difficulty swallowing and breathing, and respiratory arrest.

Recent tests by government investigators and ByHeart have detected botulism bacteria in some containers of the company’s formula. The company received a formal warning letter from the FDA in August 2023 about contamination issues with a different type of bacteria and its plants have been cited by FDA inspectors for manufacturing and sanitation issues.

A HHS spokesperson, in an email to Healthbeat, said the FDA advocated for the Codex committee’s request for the international risk assessment. Staff from the FDA and U.S. Department of Agriculture participated in the Codex meeting, the meeting’s report shows.

ByHeart baby formula recall exposes dangerous gaps in food safety

“We welcome any and all scientific evidence that can inform recommendations on this important public health matter,” HHS said.

When asked whether the FDA or CDC would be doing their own U.S. assessment of risks for infant formula contamination with Clostridium botulinum bacteria, which cause infant botulism, HHS said that has not yet been determined. The FDA will decide the need for any additional risk assessment after more information is gathered about the current outbreak, HHS said.

“Additional testing by ByHeart, FDA, CDC, and state partners is currently underway, and more results are expected in the coming weeks,” HHS said. No details were provided about the types of testing being done.

ByHeart said the ongoing investigation “includes a rigorous audit of every step of our supply chain” and that the company is working closely with regulators to identify the source of the contamination.

HHS Secretary Robert F. Kennedy Jr., in launching Operation Stork Speed last spring, said that “safe, reliable, and nutritious” infant formula is a priority of the administration.

During the Codex Committee on Food Hygiene, which held its multi-national meeting Dec. 15-19 in Nashville, Tenn., members discussed the need for scientific input to inform a potential revision in the international code of hygienic practice for powdered infant formula. The code has sections that need updating, including sections on cleaning and environmental monitoring when producing formula, participants said.

Global review seeks to identify safety gaps in powdered formula manufacturing

“While Members acknowledged that historical data had not always categorized Clostridium botulinum as a major risk in these products, the importance of investigating whether current gaps in [the powdered infant formula code] contributed to the risk was underlined,” according to the report of the meeting.

The committee’s request seeks a risk assessment of spore-forming pathogens in powdered infant formula, and specifically cites Clostridium botulinum, which causes infant botulism, and Bacillus cereus, which can produce a toxin that causes nausea, vomiting and diarrhea.

Nestle is undertaking a global recall of certain infant formulas because of possible contamination with the toxin produced by Bacillus cereus. The company said a potentially contaminated ingredient is the culprit. While the recall involves formula sold in dozens of countries, the company’s recall advisory as of Thursday morning did not list the United States.

The Codex committee also has asked for an update to the existing risk assessment and scientific advice on environmental pathogens, such as Cronobacter and Salmonella, and to provide additional scientific advice to inform recommendations for strengthened pathogen control measures in all stages of the formula manufacturing process.

During last month’s meeting, a representative of the Food and Agriculture Organization of the United Nations, also referred to as the FAO, said that the scientific advice requested by the committee would be provided by an international scientific expert group called JEMRA – the Joint FAO/WHO Expert Meetings on Microbial Risk Assessment. The FAO did not respond to questions from Healthbeat about how long the risk assessment process will take or what it will involve.

Elisabeth Sterken, a nutritionist with the International Baby Food Action Network Global Council, said actions to address infant botulism and other microbial risks in powdered infant formula need to be taken sooner than will occur through this process. IBFAN is an international coalition that advocates for public policies that favor breastfeeding and investigates the marketing of infant formula.

“From JEMRA, which will likely take years, its recommendation will then go back to the Codex Committee on Food Hygiene, and any changes in the Code of Hygienic Practice will take at least another two years,” Sterken told Healthbeat.

Moms say ByHeart recall has shaken their trust in baby formula safety

“From there the final recommendations go to national regulatory bodies,” she said. “In the meantime, infants will continue to be at risk from the serious health consequences of potentially contaminated powdered infant formula.”

HHS, the FDA, and CDC have not responded to a Dec. 8 letter from the Safe Food Coalition, a group of major food safety organizations, that has called for actions to address “dangerous deficiencies” in the nation’s food inspection and regulatory systems that they say have been highlighted by the ByHeart recall and infant botulism outbreak.

Sorscher, whose organization – the Center for Science in the Public Interest – is a member of the coalition, called the lack of any response to the five-page letter “unacceptable.”

“These agencies owe answers to the public, and the silence at this point speaks volumes about their current ability to protect our food,” she said.

The letter, among many recommendations, has called for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

Other coalition members that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

The HHS last month told Healthbeat it has received the letter and will be responding to it.

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

The CDC sidelined these childhood vaccines. Here’s what they prevent.

2026-01-06T23:46:20+00:00

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

The federal government has drastically scaled back the number of recommended childhood immunizations, sidelining six routine vaccines that have safeguarded millions from serious diseases, long-term disability, and death.

Just three of the six immunizations the Centers for Disease Control and Prevention says it will no longer routinely recommend — against hepatitis A, hepatitis B, and rotavirus — have prevented nearly 2 million hospitalizations and more than 90,000 deaths in the past 30 years, according to the CDC’s own publications.

Vaccines against the three diseases, as well as those against respiratory syncytial virus, meningococcal disease, flu, and Covid, are now recommended only for children at high risk of serious illness or after “shared clinical decision-making,” or consultation between doctors and parents.

The CDC maintained its recommendations for 11 childhood vaccines: measles, mumps, and rubella; whooping cough, tetanus, and diphtheria; the bacterial disease known as Hib; pneumonia; polio; chickenpox; and human papillomavirus, or HPV.

Federal and private insurance will still cover vaccines for the diseases the CDC no longer recommends universally, according to a Department of Health and Human Services fact sheet; parents who want to vaccinate their children against those diseases will not have to pay out-of-pocket.

Experts on childhood disease were baffled by the change in guidance. HHS said the changes followed “a scientific review of the underlying science” and were in line with vaccination programs in other developed nations.

HHS Secretary Robert F. Kennedy Jr., an anti-vaccine activist, pointed to Denmark as a model. But the schedules of most European countries are closer to the U.S. standard upended by the new guidance.

For example, Denmark, which does not vaccinate against rotavirus, registers around 1,200 infant and toddler rotavirus hospitalizations a year. That rate, in a country of 6 million, is about the same as it was in the United States before vaccination.

“They’re OK with having 1,200 or 1,300 hospitalized kids, which is the tip of the iceberg in terms of childhood suffering,” said Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a co-inventor of a licensed rotavirus vaccine. “We weren’t. They should be trying to emulate us, not the other way around.”

Public health officials say the new guidance puts the onus on parents to research and understand each childhood vaccine and why it is important.

Here’s a rundown of the diseases the sidelined vaccines prevent:

RSV. Respiratory syncytial virus is the most common cause of hospitalization for infants in the United States.

The respiratory virus usually spreads in fall and winter and produces cold-like symptoms, though it can be deadly for young children, causing tens of thousands of hospitalizations and hundreds of deaths a year. According to the National Foundation for Infectious Diseases, roughly 80% of children younger than 2 who are hospitalized with RSV have no identifiable risk factors. Long-awaited vaccines against the disease were introduced in 2023.

Hepatitis A. Hepatitis A vaccination, which was phased in beginning in the late 1990s and recommended for all toddlers starting in 2006, has led to a more than 90% drop in the disease since 1996. The foodborne virus, which causes a wretched illness, continues to plague adults, particularly people who are homeless or who abuse drugs or alcohol, with a total of 1,648 cases and 85 deaths reported in 2023.

Hepatitis B. The disease causes liver cancer, cirrhosis, and other serious illnesses and is particularly dangerous when contracted by babies and young children. The hepatitis B virus is transmitted through blood and other bodily fluids, even in microscopic amounts, and can survive on surfaces for a week. From 1990 to 2019, vaccination resulted in a 99% decline in reported cases of acute hepatitis B among children and teens. Liver cancer among American children has also plummeted as a result of universal childhood vaccination. But the hepatitis B virus is still around, with 2,000-3,000 acute cases reported annually among unvaccinated adults. More than 17,000 chronic hepatitis B diagnoses were reported in 2023. The CDC estimates about half of people infected don’t know they have it.

Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, about 70,000 young children were hospitalized and 50 died every year from the virus. It was known as “winter vomiting syndrome,” said Sean O’Leary, a pediatrician at the University of Colorado. “It was a miserable disease that we hardly see anymore.”

The virus is still common on surfaces that babies touch, however, and “if you lower immunization rates it will once again hospitalize children,” Offit said.

Meningococcal vaccines. These have been required mainly for teenagers and college students, who are notably vulnerable to critical illness caused by the bacteria. About 600 to 1,000 cases of meningococcal disease are reported in the United States each year, but it kills more than 10% of those it sickens, and 1 in 5 survivors have permanent disabilities.

Flu and Covid. The two respiratory viruses have each killed hundreds of children in recent years — though both tend to be much more severe in older adults. Flu is on the upswing in the United States, and last flu season the virus killed 289 children.

What is shared clinical decision-making?

Under the changes, decisions about vaccinating children against influenza, Covid, rotavirus, meningococcal disease, and hepatitis A and B will now rely on what officials call “shared clinical decision-making,” meaning families will have to consult with a health care provider to determine whether a vaccine is appropriate.

“It means a provider should have a conversation with the patient to lay out the risks and the benefits and make a decision for that individual person,” said Lori Handy, a pediatric infectious disease specialist at the Children’s Hospital of Philadelphia.

In the past, the CDC used that term only in reference to narrow circumstances, like whether a person in a monogamous relationship needed the HPV vaccine, which prevents a sexually transmitted infection and certain cancers.

The CDC’s new approach doesn’t line up with the science because of the proven protective benefit the vaccines have for the vast majority of the population, Handy said.

In their report justifying the changes, HHS officials Tracy Beth Høeg and Martin Kulldorff said the U.S. vaccination system requires more safety research and more parental choice. Eroding trust in public health caused in part by an overly large vaccine schedule had led more parents to shun vaccination against major threats like measles, they said.

Georgia parents show strong confidence in childhood vaccines as federal guidance shifts

The vaccines on the schedule that the CDC has altered were backed up by extensive safety research when they were evaluated and approved by the FDA.

“They’re held to a safety standard higher than any other medical intervention that we have,” Handy said. “The value of routine recommendations is that it really helps the public understand that this has been vetted upside down and backwards in every which way.”

Eric Ball, a pediatrician in Orange County, California, said the change in guidance will cause more confusion among parents who think it means a vaccine’s safety is in question.

“It is critical for public health that recommendations for vaccines are very clear and concise,” Ball said. “Anything to muddy the water is just going to lead to more children getting sick.”

Ball said that instead of focusing on a child’s individual health needs, he often has to spend limited clinic time reassuring parents that vaccines are safe. A “shared clinical decision-making” status for a vaccine has no relationship to safety concerns, but parents may think it does.

HHS’s changes do not affect state vaccination laws and therefore should allow prudent medical practitioners to carry on as before, said Richard Hughes IV, an attorney and a George Washington University lecturer who is leading litigation against Kennedy over vaccine changes.

“You could expect that any pediatrician is going to follow sound evidence and recommend that their patients be vaccinated,” he said. The law protects providers who follow professional care guidelines, he said, and “RSV, meningococcal, and hepatitis remain serious health threats for children in this country.”

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

Hochul proposes mental health first-aid training for all New York 10th graders

2026-01-06T13:42:53+00:00

This story was originally published at Chalkbeat. Sign up for Chalkbeat New York’s free daily newsletter to get essential news about NYC’s public schools delivered to your inbox. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

New York Gov. Kathy Hochul wants to make mental health first-aid training available to every 10th grader in the state.

The plan – announced Monday in a preview of the governor’s State of the State proposals – would expand a program that teaches students to recognize and respond to mental health and substance use challenges among friends and peers.

The Teen Mental Health First Aid program is a 4.5-hour course developed by the National Council for Mental Wellbeing, a nonprofit. It teaches teens to identify signs that their peers are struggling, understand the effects of school bullying and violence, and talk with friends and classmates about mental health. The program also gives young people tools to monitor and care for their own well-being.

As Healthbeat reported in September, researchers at Johns Hopkins University found that students who took the first aid training were more likely to intervene appropriately and empathetically with peers facing mental health challenges.

“We hear all the time, ‘Our teens are in crisis, our teens are anxious. But if you empower them with tools to have conversations about mental health, you see the impact right away,” said Katie Oldakowski, senior director of training and programs at Mental Health Association in New York State, which currently administers the first-aid training program in 43 schools.

New York state high schools train teens in mental health first aid

“When we give teens language to talk about mental health, we build resilience,” Oldakowski said.

New York state invested $10 million in the Teen Mental Health First Aid program in July, reaching close to 4,850 students since then, Oldakowski said. Under the governor’s new proposal, the program would grow to include 180,000 students annually. The governor’s announcement did not say how much the expansion would cost, and her office did not immediately respond to requests for information.

The training initiative is part of Hochul’s ongoing agenda to expand access to mental health support in schools. In the past five years, New York has increased the number of state-supported, school-based mental health clinics by nearly 50%, bringing the total to 1,300 clinics, based in 25% of the state’s public schools. Monday’s announcement did not include a commitment to increase funding for school-based clinics.

Any effort to expand school-based mental health support “is a great step in the right direction,” said Alice Bufkin, an associate executive director at the Citizens’ Committee for Children of New York, an advocacy group calling for increased investment in mental health service for kids and teens.

Experts warn mobile sports betting could be gateway to gambling crisis for young men in New York

However, schools and school-based clinics continue to struggle to pay for much of the essential work they do, Bufkin said. For example, clinics typically cannot bill for providing treatment to undocumented students, who are not eligible for Medicaid. Nor can they be reimbursed for work like helping teachers manage students with behavioral challenges, or intervening when students are in emotional crisis.

“Our state has a long way to go to fully support students in schools and communities. We are still facing a behavioral health crisis for children and families throughout New York,” Bufkin said.

In other efforts to tackle the teen mental health crisis, Hochul is trying to keep kids safe from social media-related threats and online gaming platforms by expanding age verification requirements, disabling AI chatbot features, and including “privacy by default” settings, giving parents control over who can connect with young people under the age of 13.

Abigail Kramer is a reporter in New York City. Contact Abigail at akramer@chalkbeat.org.

ByHeart baby formula recall: What to know about 4 new developments

2025-12-19T23:30:03+00:00

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

It’s been six weeks since ByHeart Inc. began recalling its popular organic baby formula amid a nationwide outbreak of infant botulism – and nearly two years since children started becoming infected across the country.

Here are four things to know about the latest developments in the outbreak investigation and formula recall.

Some good news: No new cases of sick infants discovered in the past week

The U.S. Food and Drug Administration announced this week that the identification of new infant botulism cases linked to ByHeart infant formula has slowed, with none identified during the past week.

The number of infants known to have been sickened in the outbreak remains at 51 – and all of them required hospitalization. The infants live in 19 states. There have been no deaths.

The most recent date a child started showing signs of illness was Dec. 1, according to the FDA.

The lack of new cases is an encouraging sign. ByHeart did an initial, limited recall of its formula products on Nov. 8, followed by a recall of all of its products on Nov. 11.

But it can take up to 30 days after an infant ingests botulism spores for the bacteria to start growing in the child’s immature gut and produce a toxin that causes symptoms, such as constipation, poor eating, loss of head control, difficulty swallowing and breathing, and potentially respiratory arrest. And ByHeart formula remained on the shelves of some stores for weeks after the recall. (More on this below.)

Some bad news: The discovery that babies started being sickened two years ago

Until recently, federal health officials had said the earliest outbreak illnesses began in August. But they’ve now identified children who were fed ByHeart formula who were hospitalized with infant botulism as far back as December 2023.

The Centers for Disease Control and Prevention has expanded its outbreak case definition to include any infant with botulism who was exposed to ByHeart baby formula at any time since the product first went on the market in March 2022.

Initially, investigators were focused only on infants sickened since Aug. 1, 2025. When they looked at earlier infant botulism cases, they identified 10 additional children who consumed ByHeart products and fell ill from December 2023 through July 2025. Those cases are included in the 51 total outbreak cases.

While no cases have been identified before December 2023, the investigation is ongoing, and the FDA said it “cannot rule out the possibility that contamination might have affected all ByHeart formula products.”

Federal officials and ByHeart say they are still investigating how botulism bacteria spores got into ByHeart formula.

FDA issues warning letters to retailers that kept selling recalled ByHeart formula

Retailers across the country continued to sell ByHeart infant formula for weeks after the recall began on Nov. 8 and was expanded to include all products on Nov. 11.

State and local food safety officials along with FDA inspectors performed more than 4,000 spot-checks of retail stores across the country to ensure recalled ByHeart’s formula was no longer being sold. Yet they continued to find ByHeart products on store shelves at more than 175 locations in 36 states, the FDA said.

However, those checks of retail stores, Healthbeat reported last month, were slowed by FDA delays in sharing ByHeart product distribution lists with state and local officials.

The FDA says it hasn’t received any reports of recalled ByHeart formula still being on store shelves since Nov. 26.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered ByHeart single-serve “anywhere pack” sticks on a shelf with a promotional “Sale!” sign offering a $2 discount more than a week after all of the company’s products were recalled because of botulism risks.

This week the FDA called on food industry officials across the country to improve their compliance with protecting the public from recalled products.

The FDA also announced it sent formal warning letters on Dec. 12 to corporate officials at Target, Walmart, Kroger, and Albertsons Companies for failing to remove ByHeart products from their store shelves.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered a promotional “Sale!” sign offering a $2 discount off recalled ByHeart single-serve “anywhere pack” sticks from Nov. 16 to Nov. 22, according to the FDA’s warning letter to the company.

Investigators found recalled ByHeart formula on Target store shelves across 20 states from Nov. 12 to Nov. 20, the FDA’s letter said.

Workers at Target stores – as well as those at Walmart stores in 21 states, Kroger stores in 10 states, Albertsons Companies’ stores operated under various names in 11 states – gave state and local inspectors a variety of explanations for the presence of ByHeart formula in stores after the recalls were launched, the letters say.

Explanations included that store associates weren’t aware of the recall and that there was confusion over which specific lots were recalled. Workers also told investigators that there were failures to remove all of the recalled products from shelves and that stocking of shelves occurred when recalled products arrived after the recall notification, the warning letters say.

The four companies have 15 days to respond to the FDA warning letters with steps they are taking to address violations or provide information supporting why they believe they haven’t violated the law.

In a statement to Healthbeat, Walmart said: “We take all reports of inaction seriously and will respond to the letter.” The company said it “moved swiftly” to issue a sales restriction and remove the product from its stores and online platform.

Albertsons Companies said they have procedures to address product recalls and that ByHeart products have been removed from their stores. Target and Kroger did not immediately respond to Healthbeat’s requests for comment on their warning letters.

Food safety groups call for botulism testing, investigation of recall delays

The ByHeart formula recall and outbreak has “exposed dangerous deficiencies” in the nation’s food inspection and regulatory systems, according to a letter sent to the heads of the FDA, CDC and Department of Health and Human Services by the Safe Food Coalition, whose members are national food safety advocacy groups.

The five-page letter calls for a range of reforms to strengthen food safety inspections and regulations and improve the speed of recalls. It also urges fully funding food safety work and illness surveillance systems at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.

Citing Healthbeat’s reporting, the coalition is calling for the FDA to investigate bureaucratic delays in releasing to state food safety regulators the names of retailers that received ByHeart’s recalled products. It’s a lengthy process “that can and must be streamlined not just with respect to recall communication, but for all communication with state regulators,” the Dec. 8 letter said.

The Safe Food Coalition letter, among its many recommendations, also calls for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

“I think it’s critically important that the agency go out there in the field and do a survey of all the infant formula out there to reassure consumers and to understand whether this is a broader problem,” Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, told Healthbeat.

Other groups in the Safe Food Coalition that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

Federal officials have not yet replied to the coalition’s letter. “HHS is in receipt of the letter and will respond directly to the requestors,” HHS said Friday in an email to Healthbeat.

“FDA acted quickly to protect the public, issuing multiple warnings alongside the firm’s initial and expanded recall,” HHS said in its email.

The FDA has previously not responded to Healthbeat’s questions about delays in sharing ByHeart’s product distribution lists with local and state food safety regulators.

HHS said Friday that the FDA began conducting its own recall effectiveness checks “at the corporate level of large retailers” on Nov. 10 – two days after ByHeart announced its initial recall of two batches of formula.

The FDA didn’t receive ByHeart’s product distribution lists from the company until Nov. 12, the day after the company expanded the recall to all products, HHS said. The list was shared the same day with a subset of state food safety regulators who had information-sharing agreements on file with the FDA, the HHS said.

HHS acknowledged that the FDA had to go through a process to obtain exceptions for local and state regulators that lacked information agreements and “where such sharing of commercial confidential information would be otherwise prohibited under the Trade Secrets Act.”

Healthbeat reported last month that according to the Association of Food and Drug Officials – whose members are state and local regulators – the FDA didn’t start fully sharing ByHeart’s product distribution lists with all state and local officials until a teleconference held at 6 p.m. on Nov. 14 – nearly a week after the formula was linked to the outbreak and the company had launched its initial recall on Nov. 8.

HHS did not say how many states had information sharing agreements with FDA that allowed them to receive the distribution lists on Nov. 12. The department only said a “majority” of the 50 states and the District of Columbia have the agreements.

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 FDA’s vaccine uproar: It’s not just about Covid shots

2025-12-19T16:02:40+00:00

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

Six days after a senior Food and Drug Administration official sent a sweeping internal email claiming that Covid vaccines had caused the deaths of “at least 10 children,” 12 former FDA commissioners released an extraordinary warning in the Dec. 3 issue of the New England Journal of Medicine.

They wrote that the claims and policy changes in the memo from Vinay Prasad, the head of the FDA’s Center for Biologics Evaluation and Research, pose “a threat to evidence-based vaccine policy and public health security” and break sharply from longstanding scientific norms.

What is unfolding inside the FDA is not a narrow dispute over Covid vaccines. It is an attempt, according to critics and vaccine scientists, to rewrite the rules governing the entire U.S. vaccine system — how risks are weighed, how benefits are proved, and how quickly lifesaving shots reach the public. Former agency leaders warn that if these changes take hold, the consequences could be lasting: fewer vaccines, slower updates, weakened public trust, and more preventable outbreaks.

Prasad made clear he sees the moment as corrective. “Never again will the U.S. FDA commissioner have to himself find deaths in children for staff to identify it,” he wrote, telling employees the agency’s mission, and its “worldview,” would change.

Prasad’s email reopened old arguments about Covid vaccines, using what is generally considered weak and misleading science in the peer-reviewed research community. He claimed that FDA staff had found “at least 10” deaths in children that happened “after and because of” Covid vaccination, using reports from the Vaccine Adverse Event Reporting System.

The VAERS system is notoriously crowdsourced, meaning anyone can contribute, and scientists say it serves only as a clearinghouse for reports. For example, a person could file a report saying that after getting a flu shot, their hair turned purple. Though that report would remain in the database until it was reviewed, it cannot prove the cause of medical events. But Prasad argued that the true number of deaths was likely higher because many cases go unreported.

On Substack, Inside Medicine reported Dec. 11 that Prasad used incomplete information and that a Dec. 5 internal FDA memo set the pediatric death toll from Covid shots somewhere between zero and seven. Department of Health and Human Services spokesperson Emily Hilliard wrote, “The FDA’s investigation into deaths caused by Covid vaccines is still ongoing and there’s no final count yet of those deaths.”

Prasad also accused the FDA and the Centers for Disease Control and Prevention of downplaying the risk of heart inflammation, called myocarditis, in young men; criticized the agency for approving shots for teenagers; and suggested that school and workplace vaccine mandates may have “harmed more children than we saved,” adding that “we do not know if we saved lives on balance.”

By comparison, more than 2,100 American children died of Covid itself since the pandemic began, the CDC reported.

Based on his erroneous and misleading claims about Covid vaccines, Prasad proposed a major overhaul of how vaccines are approved. He said the FDA should stop relying on immune markers to establish the efficacy of shots, such as antibody levels, and instead require large placebo-controlled randomized trials that track hospitalizations and deaths before approving most new vaccines.

Many immunologists and vaccine experts say it’s unethical to test vaccines known to be effective against disease with a control group that would receive a placebo, exposing them to infection.

“There is a rock-solid principle in bioethics that it is unethical to test any drug or vaccine against a placebo if it is known to be safe and effective. The reason is that such placebo-controlled trials would effectively deny patients access to a vaccine that could prevent a dangerous infectious disease,” said Lawrence Gostin, a professor of global health law at Georgetown University.

Prasad called the current flu vaccine system an “evidence-based catastrophe,” questioned the approval of vaccines for pregnant women based on immune response alone, and raised concerns about giving multiple vaccines at once. He told staff to rewrite FDA guidelines to match his new “worldview” and said anyone who disagreed with his “core principles” should resign.

The former FDA leaders expressed alarm in the NEJM article. They said Prasad is exploiting public frustration over the federal response to Covid to spark doubt about the entire childhood vaccine system, which could undo decades of success in protecting children from deadly diseases.

“This is really different. And it’s really dangerous. And people will be hurt, particularly by the vaccine decisions,” former FDA Commissioner Robert Califf said in an interview. He also warned that Prasad’s proposed policies — which he noted echo positions on vaccines held by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist — could shake the entire vaccine market.

“The goal of RFK seems to be to make it impossible for vaccines to be available in the U.S.,” he said. If the proposals advance, he added, “it won’t be a viable business.”

Hilliard pushed back sharply on those concerns, writing: “The American people deserve evidence-based science. Prasad’s email lays out a philosophical framework that points us toward that higher standard. We will soon release documents laying out that framework and data confirming how the Covid vaccine resulted in children’s deaths that previous leadership failed to properly investigate.”

For generations, the childhood vaccine program has depended on clear rules, strong safety systems, and public trust. Experts say Prasad’s ideas, based on claims they argue are not supported by real evidence, could make it much harder to test, approve, and deliver vaccines to families.

Prasad’s framework could fuel parental doubt

Prasad’s memo indicates he considers VAERS reports as proof that vaccines caused children’s deaths. The system, though, is designed to be only an “early warning system” for potential safety issues with vaccines that can be investigated further.

“VAERS signals should never be taken as proof of true vaccine risks without careful, confirmatory studies,” said Katherine Yih, an epidemiologist and longtime investigator with the Vaccine Safety Datalink, a CDC program.

Doing so, scientists say, directly feeds public fear at a time when many parents are already unsure whom to trust.

“Causation requires converging evidence, not just one report or coincidence,” said Robert Hopkins, medical director of the National Foundation for Infectious Diseases.

Prasad’s framework, however, treats uncertainty as a reason to halt development entirely.

Experts fear this doubt won’t stay limited to Covid vaccines. Once parents start to question the FDA’s honesty, they may begin doubting longstanding vaccines for measles, polio, or whooping cough — shots that have protected children for decades.

“Science must be transparent,” Gostin said. If families believe the FDA is misusing data or silencing experts, confidence in the entire vaccine system can collapse, he said. “There’s a public narrative that people have lost trust in science, but that’s not true. The vast majority want the FDA to make decisions based on the best scientific evidence. Once they believe that the agency is marginalizing scientists and cherry-picking evidence, their trust will plummet.”

Vaccine pipeline is delicate

Prasad’s new framework will likely make it far harder for companies to produce or update vaccines. The 12 former FDA commissioners warned that requiring clinical trials for all new or updated shots would slow vaccine improvements and leave people unprotected. His plan, they wrote, “would impede the ability to update vaccines in a timely fashion, especially for respiratory viruses.”

For fast-changing viruses like flu and Covid, this could be disastrous. There’s simply not enough time to run full clinical trials every time a virus mutates.

There are also major business effects. Vaccine development is costly, and companies may decide the United States is no longer worth the risk. If companies slow down or leave the market, families could face shortages, fewer innovations, and fewer protections for their kids.

Science depends on ‘checks and balances’

Science depends on open and public debate. Prasad’s memo warned his employees against it. In addition to demanding that FDA staff members who disagree with him resign, he said their disputes should stay private and called leaks “unethical” and “illegal.”

Susan Ellenberg, a former director of the FDA’s Office of Biostatistics and Epidemiology, warned that Prasad risks destroying the process that makes science credible. “If disagreement is treated as disloyalty, you lose the only mechanism that keeps science honest,” she said.

Without strong internal debate, safety reviews become weaker. “You lose the checks and balances that make vaccine safety science credible,” said Kathryn Edwards, a pediatric infectious disease specialist at Vanderbilt University Medical Center who served on the Clinical Immunization Safety Assessment Network during the Covid pandemic.

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

Georgia ACA enrollment falls as federal changes push prices higher

2025-12-18T21:13:20+00:00

As federal changes drive up the cost of Affordable Care Act health insurance plans for next year, about 190,000 fewer people in Georgia had enrolled ahead of the Dec. 15 open enrollment deadline than last year, data show.

While about 1.5 million people had enrolled by the deadline in 2024, this year about 1.3 million people had, according to data from the federal Centers for Medicare & Medicaid Services and the Georgia Department of Insurance.

More than two-thirds of current enrollees were automatically enrolled into the same or similar plan for 2026, meaning they took no action to select a plan for next year, spokesperson Bryce Rawson said. Those customers could face sticker shock as higher premiums come due in January.

Some may decide not to pay and eventually be disenrolled, Rawson said, adding it will take a few months to figure out the impact of the higher rates.

Georgians had to enroll by Dec. 15 to ensure coverage started Jan. 1. Those who missed the deadline have until Jan. 15 to enroll for coverage to start Feb. 1.

The higher ACA prices for next year are due to the expiration of enhanced premium subsidies first enacted in 2021. Congress has not renewed the subsidies, though four House Republicans have joined with Democrats to force a vote on the issue next year.

Other federal policy changes to ACA and Medicaid policies are also expected to drive up the number of uninsured Georgians in the coming years. An estimate from the Georgia Health Initiative found that those and other federal changes could result in close to a half-million people losing health insurance between 2025 and 2034.

Those would be added to 1 million Georgians under age 65 who are already uninsured.

Public health advocates say the increase in uninsured Georgians could result in greater pressure on local health departments, charity clinics, and hospitals, as uninsured people seek health care they can’t pay for. Those pressures will be made more acute by cuts in funding for safety-net hospitals and potentially dramatic public health funding reductions.

How insurance coverage changes can impact public health

Local health departments often provide low-cost or free basic health services to uninsured people. They rely on revenue from insurance for services they provide to patients on Medicaid, Medicare, the Affordable Care Act, and employer-sponsored insurance plans.

How much local public health departments bring in from insurance varies widely, however.

For example, only about 5% of DeKalb Public Health’s $46 million budget comes from fees patients pay out-of-pocket or through insurance for services. That’s nearly evenly split between out-of-pocket payments and payments from Medicaid, Medicare, and private insurers.

Of the $3.3 million the county health department received for these services, $2.6 million came from patients paying out of pocket, with the remainder coming from services provided to Medicaid, Medicare, and private insurance.

In rural Miller County, in southwest Georgia, 15%, or nearly $60,000, of the county’s public health budget comes from fees for services provided to patients. The vast majority of that came from patients with insurance, whether private insurance, Medicaid, or Medicare, with only about 9% of that revenue coming from patients who paid out of pocket.

“We’ve relied on Medicaid reimbursement, private insurance reimbursement, to make health departments run well and to fund their work, and some of that money is going to go away, and there’s no funds there to immediately replace it,” said Scott Thorpe, executive director of nonprofit Southern Alliance for Public Health Leadership.

“What we know is that in particular, for rural communities and underserved communities, when people lose access to care, they tend to rely more on safety-net services like those provided at their county health department,” said Leah Chan, director of health justice at the Georgia Budget and Policy Institute.

Thorpe said he doesn’t expect health departments to have to close their doors if funding decreases and demand for services increases. Instead, agencies will spread staffers out to provide services on an increasingly thin basis. That could detract from other important preventive programs like lead testing.

“They’re a customer-facing organization, and they want to do everything they can to continue to offer the services that they offer because they … want to do the best job they can,” Thorpe said.

Charity clinics and hospitals are also anticipating an increase in demand for their services, though with federal funding up in the air, they aren’t sure what the impact will be.

Dr. Theresa Jacobs of the Georgia Primary Care Association, which represents the state’s federally qualified health centers, said those clinics are not yet seeing an impact, but the organization will be watching what happens at the federal level in January.

Jeremy Cole, executive director of the Mosaic Clinic in Clarkston, which serves uninsured people, said there is a lot of uncertainty about how federal changes will affect his team’s work, but they are planning for a “significant increase” in uninsured patients seeking their services.

“What we are currently anticipating and planning for, unless things change, is a domino effect in the years ahead, each one causing more people to lose their health insurance: first, the lapsing of the enhanced subsidies on Jan. 1 (again, unless Congress acts before then); second, the cutting of federal benefits for refugees and asylees who have been here less than 5 years (this is at least how we understand it, although it is all a bit confusing) starting next October; and finally, the Medicaid cuts that we understand go into effect in 2027,” Cole said.

Georgia hospitals are also concerned, said Anna Adams, senior vice president of government relations at the Georgia Hospital Association. Hospitals will continue to provide care to patients but may not be compensated for that care if people are uninsured, forcing them to “stretch already scarce resources.”

Federal funding for public health in jeopardy

Meanwhile, it’s unclear exactly how public health will be funded in fiscal 2026. About half of Georgia’s public health funding comes from the government – much of it funneled through grants administered by the Centers for Disease Control and Prevention. Congress has not yet decided on a budget for fiscal 2026, but President Donald Trump’s proposal would dramatically cut the agency’s funding. If adopted, that would have downstream effects on state and local public health funding.

That’s left a question mark hanging over planning for Georgia’s budget process, which will start when the legislature opens in January.

The state public health department has presented a mostly flat budget request that assumes federal funding will continue and provides state funding at current levels. Commissioner Kathleen Toomey did not address potential federal cuts during a preliminary December budget hearing at the state Capitol.

Once the session starts on Jan. 12, the legislature will first take up the current year’s budget and make any adjustments needed, said Rep. Darlene Taylor, a Republican from Thomasville who is chairwoman of the House appropriations health subcommittee. After that, legislators will work on the budget for next year.

Taylor said she anticipates Congress enacting the fiscal 2026 budget by the time the state legislature gets to that budget, which would resolve many questions about how much money the state will have for public health and other programs.

She is concerned about Georgians’ access to health care and the burden hospitals and health departments could face, but emphasized that there are resources for Georgians seeking care.

One area Taylor wants to ensure continues to get funded is public health education, she said, pointing to the work public health departments do in educating people about “everything from stop smoking to diabetes control.”

She said she’d work to plug holes in funding for such educational efforts if needed.

“Until I see that budget, I really can’t say, let’s plug the hole here,” Taylor said.

She cited resources for Georgians who lack insurance, including public health departments, charity clinics, and hospitals.

But those entities could be crunched by a change enacted in the One Big Beautiful Bill signed by Trump in July to payments Georgia uses to supplement rural hospital funding. Those cuts will be phased in beginning in 2028 and, along with other changes, will reduce funding for safety-net and rural hospitals, according to a Georgia Health Initiative analysis.

“If you go to the hospital, and you don’t have insurance, they’re still going to treat you,” Taylor said. “What concerns me there is the cost and the burden for the hospital to be able to treat patients when they’re not being compensated for it.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Hospitals mum on how they’ll handle new guidance on hepatitis B shots for newborns

2025-12-18T00:11:17+00:00

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

Maternity hospitals across the country will now play a significant role in whether babies will universally be vaccinated against hepatitis B at birth as the federal government drops its long-held recommendation for the shot.

But many of the nation’s largest maternity hospitals wouldn’t answer questions over the past week about their current policies and how they will handle the changing guidance.

The guidance now only recommends a birth dose of the vaccine for a subset of babies whose mothers test positive for the hepatitis B virus or whose status is unknown. They further suggest that mothers who test negative for the virus but still want to vaccinate their babies delay the shots for at least two months after birth – a dramatic change that major medical societies say will cause a resurgence of liver disease.

Late Tuesday, the Centers for Disease Control and Prevention announced that its acting director, Jim O’Neill, had approved the vaccine recommendations made early this month by an advisory panel that had been reconstituted to only include members selected by Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine critic.

Healthbeat asked 10 of the nation’s largest maternity hospitals and systems that deliver the most babies about their existing policies for hepatitis B birth doses and whether they are changing as a result of the new CDC Advisory Committee on Immunization Practices guidance. These 10 hospitals and systems delivered more than 227,000 babies in 2024, according to the American Hospital Association’s annual survey data.

All but two of these large maternity hospitals wouldn’t answer specific questions – in writing or in an interview – about their hepatitis B birth-dose policies, existing standing orders for newborns, or any impact of the new federal guidance.

“Unfortunately we will not be able to provide anyone to speak on this matter at this time,” said a spokesperson for Northside Hospital in Atlanta. The spokesperson didn’t respond to questions about why.

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

At Orlando Health Orlando Regional Medical Center in Florida, a spokesperson responded similarly and without explanation: “We are unable to assist with this request.” Healthbeat received similar responses from several of the other large maternity hospitals.

HCA Healthcare, one of the nation’s largest hospital chains, equivocated without answering questions about individual hospital policies or how they may change. HCA helps operate St. David’s North Austin Medical Center in Texas, which is listed among the American Hospital Association’s largest maternity hospitals.

“As a health system, it is our practice to support our physicians by providing information and best practices, including the latest guidance from CDC as well as professional societies, so they can use their extensive training and experience to exercise their independent medical judgment to assess patients’ needs and determine appropriate care,” HCA said in a statement to Healthbeat.

Other hospitals and systems that didn’t answer Healthbeat’s questions included: NYU Langone Hospitals in New York City, Parkland Health in Dallas, AdventHealth Orlando in Florida, and Northwestern Memorial Hospital in Chicago.

A spokesperson for the American Hospital Association said the group had no comment on why so many of the nation’s largest maternity hospitals seemed reluctant to discuss how they are responding to the change in federal guidance.

Two large maternity hospitals told Healthbeat they plan to continue to offer and recommend universal hepatitis B vaccination for babies born at their facilities regardless of whether their mothers have tested positive, a practice that continues to be endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, and numerous other major medical societies.

At Memorial Hermann Greater Heights Hospital in Houston, the birth dose of hepatitis B vaccine will continue to be offered to all newborns, said Dr. Luis Ostrosky, chief epidemiology officer for the Memorial Hermann Health System.

“Following best evidence and guidance from major medical societies, Memorial Hermann will continue to offer and recommend neonatal hepatitis B vaccination, in line with the American Academy of Pediatrics immunization schedule,” Ostrosky said. “Parents will continue to have the choice – as has always been the case – to accept or decline the recommended guidance, in consultation with their health care provider.”

Babies born on the Inova Fairfax Medical Campus, located in Falls Church, Virginia, near the nation’s capital, also will continue to be universally offered a birth dose of the vaccine, which a spokesperson for the system said remains a part of its standard newborn nursery order to be given within 24 hours of birth with parental consent.

“Inova follows the American Academy of Pediatrics recommendation for universal Hepatitis B vaccination at birth due to the decades of clinical and scientific evidence demonstrating its safety and efficacy in preventing serious illness,” the health system said in an email to Healthbeat. “Decisions regarding vaccination are always made collaboratively between Inova patients and their care providers.”

It appears that New York-Presbyterian Hospitals in New York City also are continuing to provide universal birth doses. This system gave an obscure, one-sentence response to Healthbeat without providing details of its birth dose policies or standing orders. It said: “All our hospitals follow NYSDOH guidance and established best practices,” referring to the New York State Department of Health. The department’s website says it continues to recommend the universal birth dose.

The CDC had recommended universal vaccination of newborns since 1991. Since that time the annual number of reported cases among U.S. infants and children has dropped by 99%, from 16,000 to less than 20, according to the American Academy of Pediatrics.

The birth dose of the vaccine prevents the virus from being transmitted to babies during childbirth and protects them during childhood against infections that can be spread by family members and other caregivers who often are unaware they are infected.

The virus is highly contagious and spreads through contact with blood and body fluids. It can spread through sharing personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and the use of unsterile needles.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

“This is a vaccine that we have several decades of experience with. We know it’s safe, we know it’s effective, and we know that it’s important,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes, who previously served as the associate administrator of the federal Health Resources and Services Administration’s maternal and child health bureau.

Warren said it’s unclear whether the changing federal guidance will create any barriers to families accessing birth doses for their infants when they deliver at hospitals across the country.

“Hospital policy absolutely does matter,” Warren said. “Almost all babies in this country are born in hospital settings, and so the hospital is really this important front door to a life of good health, and that starts with that routine newborn care, including that birth dose of hepatitis B vaccine.”

If hospital policies were to create barriers, it would contribute to a decrease in vaccination rates and an increase in cases of hepatitis B infections, which can cause cirrhosis, liver failure, and liver cancer, he said.

Warren said he can’t speculate why hospitals seemed reluctant to answer Healthbeat’s questions about their policies and response to the federal guidance. He said he’s heard anecdotally that some hospitals are planning to continue offering universal birth doses.

In Michigan, several health systems – Corewell Health, Henry Ford Health, McLaren Health Care, Munson Healthcare and the University of Michigan Health – have said they will continue to provide universal hepatitis B immunization of newborns, according to the Detroit Free Press.

Warren noted that several state health departments have issued recommendations encouraging parents to continue to have their babies universally vaccinated at birth. A few have issued standing orders or executive directives that authorize providers to administer the doses.

“I hope that their hospitals and those states will follow those recommendations,” Warren said.

Parents who want their babies to receive the birth dose or who have questions about the vaccine can talk with their obstetricians and pediatricians, he said.

“We hope that families are always asking questions about routine newborn care and why it’s important to have these recommended pieces of care done,” Warren 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

Here’s a look at who’s advising Zohran Mamdani on health policy

2025-12-17T17:06:40+00:00

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

Among the more than 400 advisers New York City Mayor-elect Zohran Mamdani has assembled to help populate his administration are a team of 25 focused on health policy.

While free child care and free buses are a central part of Mamdani’s affordability agenda, the city will also face a monumental challenge in funding public health and health care. President Donald Trump’s “One Big Beautiful Bill Act” will slash funds for Medicaid, SNAP benefits, and the city’s hospitals and health systems.

More than 2 million people across the state are expected to lose their health insurance, and another 1.3 million will lose Medicaid coverage due to new eligibility and verification rules, according to Gov. Kathy Hochul. About half the city’s residents rely on Medicaid.

Mamdani, who takes office Jan. 1, has yet to publicly say how he will meet this challenge, or who he will appoint to lead the Department of Health and Mental Hygiene, the largest and oldest health department in the United States.

The Mamdani campaign did not respond to requests for comment. Many of the members of the mayor-elect’s health committee reached by email declined to comment or didn’t reply, adhering to a request from the campaign not to speak to the media.

Who are Mamdani’s health policy advisers?

The committee includes a mix of hospital executives, former city and state health commissioners, and scholars from public and private universities, union leaders, and LGBTQ advocates, many who share Mamdani’s progressive politics.

The larger institutions represented include SBH Health System in the Bronx, the Greater New York Hospital Association, the New York State Nurses Association, and Planned Parenthood of Greater New York.

Some large New York health institutions are not represented on the health committee, such as Norwell Health and Mount Sinai, a major employer in the city. Also absent, said Bruce Y. Lee, a professor of health policy and management at the City University of New York: expertise in the field of artificial intelligence and health care.

Lee also noted the absence of a certain kind of rigor: “I do wonder, in general, whether there is a dearth of scientific expertise.”

Former health commissioners on the team include:

Oxiris Barbot, president and CEO of the United Hospital Fund who served as city health commissioner in the early days of the pandemic.
Torian Easterling, a physician and former city deputy commissioner who now serves on the board of directors at the Brooklyn Communities Collaborative, a nonprofit that promotes health equity in Kings County.
Mary Bassett, a former city and state health commissioner who is leaving her post as director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard in January. A Harvard task force on antisemitism and anti-Israeli bias cited the center in a report as focused “heavily on Palestinians” in course offerings and guest lectures.

Among the more well-known names on the health committee is Demetre Daskalakis, an infectious disease doctor who resigned in August as director at the national immunization center at the Centers for Disease Control and Prevention, citing the Trump administration’s political interference in science.

Daskalakis recently accepted a position as chief medical officer at Callen-Lorde, an LGBTQ+ health center in Manhattan. A former employee of the New York City health department, Daskalakis is scheduled to begin his new job in February.

In a video for a Fund for Public Health event Dec. 3 in New York, Daskalakis urged viewers to chart a new course because the CDC is no longer a “credible source of information.” He didn’t name Mamdani, but singled out New York City as an impetus for change.

“After this dark age, there will be a renaissance, and it starts here — not in Atlanta or Washington, D.C.,” Daskalakis said in the video. “We’re not going to fix the Acropolis, but instead work to build the Sistine Chapel — a new public health, by and for the people, founded on science and equity.”

Who will be Mamdani’s health commissioner?

Michelle Morse, a longtime global health advocate and internist who has been serving as the city’s acting health commissioner since October 2024, hasn’t met with Mamdani but has communicated through mentors like Bassett her interest in staying on. She submitted an application through an online job portal that has received more than 70,000 applications.

At the Fund for Public Health event, Morse spoke on a panel about the near future of public health in the city. Her enthusiasm for the incoming administration was evident.

“It is an anything-is-possible kind of moment,” she said. “I actually think that investing our time in the success of the platform that our mayor-elect has put forward would be a massive public health win.”

Morse has focused on health equity in her time as acting commissioner. She also works part time as a hospitalist at Kings County, serves as an assistant professor at Harvard Medical School, and is a co-founder of EqualHealth, a global network of health professionals, educators and activists that aims to achieve “health justice through social medicine.”

Mamdani has decided to keep on New York Police Commissioner Jessica Tisch from Eric Adams’ administration.

Fund for Public Health CEO Sara Gardner wished the same for Morse at the event: “I’m saying a little prayer at night that she continues as commissioner.”

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.

5 From the Field: Q&A with dean Ali Khan on the path forward for public health

2025-12-16T19:30:08+00:00

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

Trust, transparency, and sustained investment in public health will help determine how well the United States responds when the next public health crisis arrives, according to Dr. Ali Khan, dean of the College of Public Health at the University of Nebraska and a former assistant surgeon general.

Healthbeat spoke with Khan to get his insights on five questions about issues facing public health, including the “dismantling” of the Centers for Disease Control and Prevention, where he had a 23-year career that included serving as director of the Office of Public Health Preparedness and Response.

Despite financial and physical threats across the country, Khan says he remains optimistic about the opportunity public health professionals have to reshape and grow their relationships with their communities. This 5 From the Field interview has been edited for clarity and length.

You have a long history with the CDC. What are your biggest concerns about the changes underway there?

We’re not reforming the agency. We’re dismantling the agency. Sometimes it feels like we’re humiliating the agency.

We need to go back to what we are: a science-driven, neutral public health agency that was trusted by the American people.

I hear these complaints that we need to rebuild trust in public health. Unfortunately, the people saying they need to rebuild trust in public health are the ones who destroy the trust.

CDC came out of concerns about malaria in war areas. The U.S. has depended on CDC again and again. Whether it was the Cutter incident around contaminated polio vaccine [in 1955], foodborne outbreaks, Ebola, and our hurricane responses. After Hurricane Katrina, I was left on the tarmac in New Orleans with the advice to do good work, and the plane takes off. What I have is my team and access to a humvee and that was it. We reestablished a rudimentary public health system in that city to keep people safe.

That is the CDC I know. It’s very response oriented.

CDC was in a very uncomfortable position [during the pandemic]. CDC gives advice that for a respiratory pathogen, wearing a mask, staying away from other people, and getting vaccinated saves lives. Somehow we have forgotten that there was a point in time when we were thinking about can you use one ventilator for two people.

Across multiple administrations, CDC has not had the leadership that’s understood the culture of the agency. We need to make sure we have the right leadership at CDC.

CDC has always been a science-based, boots-on-the-ground agency. Just give them the opportunity to do that again without this partisan interference in what they do.

What drew you to public health?

I tell people I’m an accidental public health practitioner. I wanted to be an infectious disease doctor after reading about Louis Pasteur. I’d done my residency in internal medicine and pediatrics.

I was lined up to do an infectious disease fellowship, and had a great mentor who said: Why don’t you go to CDC? And I said: How do you spell that?

So there I am, off to the EIS, the Epidemic Intelligence Service disease detective program.

I fell in love with public health and the ethos of public health, the mission of public health to address the health of people writ large, worldwide, millions at a time, not just one at a time, and really not about sick care, but about helping people be healthy and promoting health within communities.

What was supposed to be a little two-year stint as a disease detective has now become almost a 35-year career working at the interface of medicine and public health. That’s the space I’m in every day, and I love it. I whistle to work every day.

What challenges are your students facing that the faculty didn’t have to contend with at the start of their public health careers?

It’s a completely different landscape for our students. A lot of this has to do with how they now manage a mistrustful public.

We need to develop our own trust with our communities, and we need to be visible in the work we do. Also better skills around information and disinformation. We are awash in data. How do they use that data to drive better policies? We have to train them differently.

They need to be more visible at community events, more visible at the legislature and county meetings. I’ve gone beyond telling my students that they need to have good relationships with policymakers and politicians, to saying they should become policy makers and politicians.

Also more time with their expertise spent on social media. I want to see more public health influencers.

But I’m excited about public health because they get to do something I didn’t get to do, which is they get to define what public health looks like in the 21st century, and they get to reintroduce public health to America and say: This is what I do for you, and I am so much more than infectious disease preparedness work.

What are some of the most pressing public health issues right now?

I think it’s a duality of chronic diseases and health equity in the United States.

If you look at, for example, obesity, 40% of Americans are obese. If I flip to other high-income countries, it’s somewhere between 18% and 25%.

I like to show that discrepancy globally to remind people we get to choose how healthy our community is. That’s a choice. There’s nothing biologically about Americans that make us obese. It’s about a social system and structure around us that allows this to happen.

Social justice, to me, is the heart of public health, and that includes equity issues for our community.

We need to recognize that your ability to be healthy is a function of what’s called social determinants of health. Do you have a job? Do you have transportation? Do you have shelter? Do you have access to fresh fruits and vegetables?

The second thing is the erosion in public health people and systems that we’re seeing across the nation.

There’s been a significant attrition in the systems and the people we need to keep our communities healthy. And the workforce is burnt out, not well paid, and many of them are threatened – not just mentally, but physically. Heck, somebody shot up CDC.

The core science we’re doing right. I think about the genomics, the data science, and the clinical advances. And when I tell somebody their ZIP code is more important than their genetic code, people generally don’t scratch their head anymore. They sort of get it. So that part we’re doing right.

What we’re not doing right is the way our systems are structured. Prevention is not at the heart of our health system in America. It’s actually sick care that is at the heart of the American health care system.

We’ve underinvested in public health systems at the state and local level. We’ve underinvested in our data systems. We’ve definitely underinvested in our ability to formulate and move policy within our communities.

What do you see as the root causes of the decline in public trust and what can be done?

I think we should be honest with ourselves that trust issues have deep roots. It’s not brand new.

If I talk about vaccine hesitancy, even [Edward] Jenner had to deal with vaccine hesitancy [in the 1800s] around his cowpox vaccine.

We need to be honest that actions on behalf of CDC and local and state public health officials over years have also undermined some of this trust, recognizing that the large decline in trust we saw was definitely during the pandemic.

Some of the communication failures, our inability to frame scientific uncertainty the way it should have been framed, so that when we make changes, it’s not like all of a sudden we decided this. It’s because science has changed. When we say follow the science, people think science is fixed. That’s not true about evolving science around an emergency. You get new information.

Social media has made this so much more possible. There has been a weaponization of science. It’s highly partisan right now.

I think we need to take the blame or however we want to frame it, for our missteps as public health practitioners and how we communicate with communities.

We’ve been invisible too long. The first time you hear from your public health practitioner should not be when they stand in front of a microphone and they put on a mask, and you go: Who are you telling me what to do?

They should have known that even before you were born, public health practitioners were worried about putting folate in cereal so that this child didn’t have a birth defect. And after you’re born, making sure that you’re vaccinated so you don’t have hepatitis B from your mom, the people putting you in a car seat, the people who are inspecting your restaurants, the people making sure you can turn on the tap and drink the water.

We’ve been too invisible for too long and that needs to change.

We also need to realize some people will never change.

While our vaccination rates are not 95%, which is what we’d like them to be, 92% of Americans – despite all of the misinformation and disinformation out there – still believe our advice and are going out to get kids vaccinated.

Maybe I should focus on educating the 92%, which is across the political spectrum, across race, ethnicity, every divide.

For that 92%, how do we have them trust us better as public health practitioners?

A lot of that is about radical transparency, talking about what matters to them at the local level, reminding them what public health does every day. We are the kids who help you think about what’s the right car seat size. We’re the kids who make sure when you walk into a restaurant you don’t get food poisoning.

I want to focus on the 92% in a nonpartisan way. I don’t want to lose that 92% because we’re becoming too shrill or becoming too personally partisan to remind people why they have a CDC. And I’d rather that happen before the next pandemic, as we’ve undermined our pandemic preparedness across the United States.

I’m hopeful. I’m going to give you a Warren Buffett quote because I’m in Nebraska. He said, “Never bet against the United States.” I know he meant it in a financial standpoint. But I’m going to say it in terms of public health and taking care of our communities.

I’m never going to bet against us.

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 parents show strong confidence in childhood vaccines as federal guidance shifts

2025-12-12T22:03:50+00:00

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

At a time when federal health officials are questioning or even abandoning long-held childhood vaccine recommendations, nearly 90% of Georgia parents believe the vaccines are safe, and more than 93% trust their pediatricians to guide them, according to a new survey.

Data was released this week from the Emory University Center for Child Policy from an online survey of 1,002 parents conducted by polling firm Ipsos between Oct. 30 and Nov. 24. Results found that 87.9% believe routine childhood vaccinations are safe.

Researchers released the data earlier than planned in the wake of last week’s decision by a federal immunization advisory panel to reverse a recommendation that all newborns be vaccinated against hepatitis B.

Lead author Dr. Stephen Patrick, a neonatalogist, said he was reassured that so many Georgia parents still support the vaccines.

“Despite all of this noise, Georgia parents have the same level of confidence in vaccines that they had a year ago,” Patrick said. “My worries as a clinician and a public health professional are that this is going to weaken people’s views … it doesn’t appear that that’s happened yet.”

Georgia parents appear to be in step with national trends, which show that “the vast majority of parents believe that vaccines are effective for protecting both their children and the community,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, an advocacy group that works in four Southern states, including Georgia.

More than 70% of the parents surveyed said they strongly or somewhat support the hepatitis B vaccine at birth. Close to 13% said they somewhat or strongly oppose the newborn shot. Receiving it within 24 hours of birth is “highly effective in preventing infection in newborns,” according to the American Academy of Pediatrics, and 98% of children who receive the full three-dose series achieve full immunity to hepatitis B.

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

In Georgia, 72.7% of newborns received the vaccine within 24 hours of birth in 2021, with that number rising to 77.1% within three days of birth, according to Centers for Disease Control and Prevention data for children born in 2021, the latest available. That’s down from a decade ago, when 83.8% of newborns got the shot within three days of birth.

Georgia’s numbers are close to but slightly lower than national rates. The state’s rate has also fallen from a decade ago.

The new recommendation, that doctors and parents engage in “shared decision making” about the vaccine, was approved Dec. 5 by the CDC’s Advisory Committee on Immunization Practices. The move has sown confusion among parents, doctors, and hospitals, Patrick said. He and other medical providers already consult with parents about the newborn hepatitis B and other routine vaccinations, so the new recommendation will not change how he practices.

“There’s a conversation first, and there’s consent that is given, period,” Patrick said.

“That recommendation just broadly weakens our approach, and it gets confusing,” Patrick said. “This is just another narrative that inserts doubt into parents to something where we know it’s both safe and effective and prevents a pretty bad illness that is lifelong for children.”

The birth dose of hepatitis B has all but eliminated the disease in American children, with a 99% drop in pediatric infections since the birth dose was introduced in 1991. It helps protect people from complications from the disease, including cirrhosis and liver cancer.

Hepatitis B can spread easily through contact among family members and live on surfaces for up to a week. The birth dose has prevented more than 6 million hepatitis B infections and nearly 1 million hospitalizations, according to a CDC analysis.

As leaders like Health and Human Services Secretary Robert F. Kennedy Jr. question longstanding childhood vaccine schedules, researchers added new questions to the survey to measure parents’ knowledge of how insurers decide whether to pay for vaccines and parents’ willingness to pay out-of-pocket for the shots, Patrick said.

About two-thirds of parents reported not knowing that ACIP recommendations shape whether insurers will cover routine childhood vaccines.

That makes sense, Thorpe said, adding that parents should not be expected to understand the “inner workings” of a committee “created to provide an expert, data-driven approach to vaccine recommendations.”

Most parents said they would be willing to pay cash for a vaccine for their child if insurance did not cover it, or they could not obtain it for free through a public program. Sixty percent said they were very or somewhat likely to; 20% said they were somewhat or very unlikely to; and 19.8% remained neutral.

But the number willing to pay for children’s vaccines dropped to 47.6% for parents making less than $75,000 per year. It was higher (67.7%) for those making more than $75,000 per year.

“That raises this potential rising issue that if we see big changes from ACIP, and insurers follow, then we might start running into trouble, particularly with folks that are not high income,” Patrick said.

The overwhelming majority of parents (93.4%) trust their child’s doctor for vaccine information. They also broadly trust local, state, and federal health agencies to provide accurate safety information about childhood vaccines.

Here’s how many Georgia parents trust these entities either a great deal or somewhat, according to the survey:

Their child’s doctor: 93.4%
Georgia Department of Public Health: 83.8%
Their county’s Department of Public Health: 80.9%
CDC: 73.3%
U.S. Food and Drug Administration: 71.17%

The findings about Georgia parents’ views on cost and trust are in line with national trends, Thorpe said, adding that many Georgia parents may skip vaccines for their children not due to misinformation alone, but because of logistical and cost barriers.

“Thousands of kindergartners in Georgia this year are neither up-to-date on vaccines nor claiming a religious exemption,” Thorpe said, suggesting their parents may have faced challenges in getting them to a medical provider in part due to cost.

“While it is encouraging that parents trust their child’s health care provider, that relationship isn’t helpful if parents lack the resources to afford a visit,” Thorpe said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

What a Supreme Court decision on inclusive curriculum could mean for vaccine laws

2025-12-12T15:04:39+00:00

What does the book “Pride Puppy!” have in common with a measles vaccine?

Some religious parents don’t want their children exposed to either one.

But is that position enough to overturn New York law and force the state to offer a religious exemption to Old Order Amish parents and others who say their faith does not allow them to vaccinate their children? That’s a question the U.S. Supreme Court recently told a lower court to consider.

In its Mahmoud v. Taylor ruling last summer, the Supreme Court’s conservative majority found that Montgomery County Public Schools’ interest in having all children learn from an LGBTQ-inclusive curriculum was not greater than parents’ rights to direct their children’s religious upbringing. Parents must have the ability to opt out, the court said.

On Monday, the Supreme Court vacated a decision by the U.S. Court of Appeals for the 2nd Circuit upholding New York’s vaccine mandate, which does not allow for religious exemptions, and told the lower court to reconsider it in light of the Mahmoud decision.

Legal experts told Chalkbeat that doesn’t mean the Supreme Court is poised to require religious exemptions. It’s not unusual for the Supreme Court to ask lower courts to re-examine rulings in light of new decisions that have even a tangential connection, they said. Often, the outcome remains the same.

But if the Supreme Court were confident Mahmoud had no bearing on vaccine law, the justices could have simply declined to take the case and let New York’s law stand, said Dorit Reiss, a law professor at the University of California San Francisco who has studied religious exemptions. Vaccine supporters should be concerned by the court’s decision not to take that course, she said.

“At the very least, they think there might be something there,” Reiss said. “But how much they believe it is up in the air.”

The case is playing out during a tenuous time for public health and as the Supreme Court steadily expands the bounds of religious freedom. An investigation by NBC News and Stanford University found vaccination rates falling and the use of exemptions rising in many communities. A measles outbreak killed two unvaccinated children in Texas, and the United States is at risk of losing its measles elimination status.

Many public health experts fear that under Health and Human Services Secretary Robert F. Kennedy Jr., the federal government is dismantling a vaccine infrastructure that saved countless lives and is actively undermining public trust in vaccines.

In a Dear Colleague letter earlier this year, Kennedy warned states they risk their federal funding if they don’t allow religious exemptions.

Most states already have religious or personal belief exemptions. Any change in the legal status quo would have limited effect. But it would take away a tool — narrowing or reducing exemptions — that has been shown to increase vaccination rates. Four of the five states without religious exemptions — California, New York, Connecticut, and Maine — tightened their requirements in recent years in response to disease outbreaks.

“It adds worry at a time when we have a lot to worry about with vaccines,” Reiss said.

Religious exemptions raise questions about sincerity

School vaccine mandates go back to the 19th century, and the courts have repeatedly upheld their validity, even without religious exemptions.

A 1970 measles outbreak in Texarkana underscored the role mandates could play in increasing vaccination rates — nearly all the cases occurred on the Texas side of the city, where there was no school mandate. Arkansas, in contrast, had a school mandate and had conducted mass vaccination campaigns. Along with federal incentives, the Texarkana example contributed to more widespread adoption of school vaccine requirements.

Many states adopted religious exemptions, Reiss said, with the assumption that only very small religious minorities would use them. Most major faith traditions allow or even encourage vaccination. But over time, these exemptions became widely abused and hard to police, she said. The government could not make religious exemptions conditional on membership in a particular faith, nor could the government require, say, that a Catholic follow the Pope’s teachings, or that a Jewish person listen to their rabbi.

But more significantly, Reiss said, people lie. Anti-vaccine Facebook groups coach non-religious parents on what to say to obtain a religious exemption, and studies find that parents claiming religious exemptions often cite safety concerns when questioned.

That dynamic contributed to states like California and New York removing religious exemptions. They now allow only medical exemptions.

The Texas-based First Liberty Institute, which is representing the Amish parents, argued in its petition to the Supreme Court that because New York allows medical exemptions, the lack of a religious exemption amounts to discrimination.

“Today in New York, if a vaccine would harm your lungs, you may be exempted; but if it would harm you soul, you may not,” attorneys wrote.

While not all Amish families reject vaccines, no one doubts the religious sincerity of the families suing the state, Reiss said. That makes the case one to watch.

“Yes our Almighty God wants us to fully put our faith + trust in Him,” Joseph Miller, one of the Amish parents suing New York, said in written testimony. “Which is in conflict to put our trust in vaccines. We are also commanded to not be conformed to this world.”

West Virginia’s vaccine mandate, with no religious exemption, has been in place since 1905, and the state enjoys very high vaccination rates. Gov. Patrick Morissey, a Republican, issued an executive order allowing religious exemptions shortly after taking office in January, but the state Supreme Court blocked the order from going into effect. The mandate remains in place for now.

That shift highlights how views of vaccines are increasingly partisan, with support declining among Republicans. In a related development, vaccine legislation became nearly as partisan as abortion even before the pandemic, according to research by Kevin Estep, a sociologist and associate professor of health administration and policy at Creighton University.

“The most dangerous thing right now, in my mind, is putting fuel on the fire of the idea that the government is infringing on parental rights,” Estep said. “That might create new vaccine hesitancy where there wasn’t before.”

It’s unclear how expanding religious freedom affects vaccines

Richard Katskee, an assistant clinical law professor at Duke University, authored an amicus brief in support of the school district in Mahmoud, and he believes the case sets a dangerous precedent. But the justices were careful to stick to curriculum, which could limit how widely it applies.

“I still think there will be real wariness from the court to hurt public health,” Katskee said. “There has been a history of deference.”

Douglas Laycock, a professor emeritus at the University of Texas and the University of Virginia, wrote a brief in support of the parents in Mahmoud. But he agrees that applying Mahmoud to vaccine exemptions could be a stretch.

“One [case] is about asking kids to listen to these stories that are about topics that are pretty religiously sensitive,” Laycock said. “The other is about a medical requirement that protects every kid in the school from diseases that are at best a problem and at worst disabling or fatal.”

Mahmoud isn’t the only Supreme Court decision potentially weighing on vaccine law.

In Tandon v. Newsom, the Supreme Court overturned a California restriction on in-home gatherings during the depths of the pandemic that was challenged by a couple that held Bible study in their home. A federal judge in 2023 cited that case in ruling that Mississippi must allow religious exemptions to its school vaccine mandate.

The reason Mississippi had no religious exemption at the time was because the state Supreme Court had struck it down in 1979. In that ruling, the justices could not believe that the First Amendment requires that “innocent children, too young to decide for themselves … be denied the protection against crippling and death that immunization provides because of a religious belief adhered to by a parent or parents.”

Mississippi regularly boasted the highest vaccination rates in the nation. Now that religious exemptions are allowed, Mississippi still has high overall vaccination rates, but it’s no longer No. 1. Rates for children under 2 years old are now below the national average.

Erica Meltzer is Chalkbeat’s national editor based in Colorado. Contact Erica at emeltzer@chalkbeat.org.

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

2025-12-12T14:36:10+00:00

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

When Su Wang was in medical school, she donated blood. That’s when she learned she was infected with hepatitis B, a virus that attacks the liver and can lead to cancer and death decades later.

“I was 18, healthy, in college,” she said. “And suddenly I had a chronic illness I didn’t even know about.”

Born in Florida in 1975, Wang grew up before the hepatitis B vaccine was routinely given to newborns. For years, she assumed she had been infected by her mother, only to discover later that both her parents were negative. “It turns out my grandparents, who cared for me after birth, probably passed it to me,” she said. “That’s how easy this virus spreads — not from some exotic risk factor, just family.”

Today, Wang is the medical director for viral hepatitis programs at RWJBarnabas Health in New Jersey. Her story now sits at the center of a historic turning point in public health.

On Dec. 5, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to end the universal U.S. recommendation for the newborn dose of the hepatitis B vaccine, instead adopting a policy urging individual-based decision-making.

Under the new approach, only infants born to mothers who test positive for hepatitis B will automatically receive a dose of the vaccine and hepatitis B antibodies shortly after birth. For everyone else, if the parents choose to vaccinate, the birth dose can be delayed until 2 months of age.

All the committee members were appointed by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. In an 8-to-3 vote, the panel decided that since most pregnant women now receive hepatitis B testing, administering the vaccine at birth should be reserved for infants whose mothers test positive. They framed the shift as a way to reduce interventions deemed unnecessary, align vaccination with test results, and give parents more control over timing. Supporters of the decision described it as a move toward parental choice rather than a reflection of changing epidemiology.

Vaccine panel drops recommendation that all newborns get hepatitis B shot

But to many clinicians and epidemiologists, the change represents a dangerous rollback that could reverse three decades of progress toward eliminating a disease that still infects as many as 2.4 million Americans and kills tens of thousands each year. They see echoes of the 1980s, when risk-based vaccination left entire generations unprotected, and worry the country is about to repeat that mistake.

Moreover, the panel’s move on hepatitis B — in the face of overwhelming data that show the birth dose is effective and safe — portends further upheaval for the nation’s childhood vaccine schedule, a cornerstone of public health.

“They’re not just trying to change one vaccine,” said Angela Rasmussen, a virologist and an editor of the scientific journal Vaccine. “They’re trying to dismantle how vaccine policy is made.”

Department of Health and Human Services spokesperson Emily Hilliard responded: “ACIP reviews all evidence presented and issues recommendations based on evidence and sound judgment to best protect America’s children.”

The authors of a new independent review by the Vaccine Integrity Project, which evaluated more than 400 studies and reports, warned in a public comment that delaying the birth dose “would reduce protection for infants and increase the risk of avoidable HBV infections, undermining decades of progress” toward eliminating the hepatitis B virus. The review was led by researchers at the University of Minnesota’s Center for Infectious Disease Research and Policy, which created the Vaccine Integrity Project in response to what it regards as Trump administration actions that “put the federal vaccine landscape at risk,” and it was vetted by outside experts.

“We fought hard for that universal birth dose because targeted approaches missed too many babies,” Wang said. “We know what happens when you wait.”

What’s unfolding now is not just a technical policy update but a fundamental test of the systems meant to protect the most vulnerable. The debate turns on a few critical questions — whether testing is reliable enough to replace universal safeguards, how infectious hepatitis B truly is, why past strategies failed, and what the CDC’s internal shake-ups mean for vaccine policy writ large.

Why universal vaccination was created

Hepatitis B testing sits at the center of the new ACIP recommendation, but even the CDC acknowledges that testing alone can’t guarantee protection. Pregnant women may test negative if the virus was acquired late in pregnancy or during the “window period,” before hepatitis B surface antigens become detectable. False negatives happen. No testing system, no matter how well designed, can catch every infection. That’s why universal vaccination was created in the first place.

If a mother’s status is unknown at delivery, hospitals are supposed to give the newborn a hepatitis B vaccine within 12 hours, adding hepatitis B antibodies for premature infants or if the mother later tests positive. But in real clinical settings, these safeguards routinely break down. Results take time. Nurses miss or misread labs. Pharmacies delay deliveries. Documentation gets lost.

“Every step you add increases the chance that something falls through the cracks,” Wang said. “Delaying the vaccine just adds another.”

ACIP’s vote shows how that logic is being challenged.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

Some committee members suggested dropping the third hepatitis B shot if antibody levels look high after the second.

But Brian McMahon, a liver disease specialist who has spent decades treating hepatitis B, told the panelists that the data doesn’t support that idea. “Only maybe 20% to 30%” of infants have an adequate antibody level after the first dose, he said.

“You need two doses to really reach a high level of protection,” he said, with the third shot giving a stronger, longer-lasting response.

He said the overall message coming from the committee seemed designed to “discourage the birth dose.”

“They’re making it more and more difficult,” McMahon said.

In a second vote, ACIP also encouraged parents and clinicians to order post-vaccine serology tests — blood tests that measure protective antibody levels — after the second or third dose. The tests, ACIP said, should be covered by insurance.

Hepatitis B is more infectious than HIV or hepatitis C

Hepatitis B can survive on toothbrushes, razors, and household surfaces for a week. It spreads not just from mother to child but also through ordinary family contact: shared items, open sores, small blood exposures. In the 1980s, researchers found that about half of infections in American children came not from mothers but from other household members.

That’s why state health departments continue to insist that every newborn be vaccinated within 24 hours of delivery, regardless of maternal status. “Delaying vaccination misses a crucial period of potential exposure,” a New York advisory warned this year. The vaccine, it noted, is 80% to 100% effective when given on time.

The Vaccine Integrity Project report underscores the stakes. Since the universal birth dose was introduced in 1991, pediatric hepatitis B infections in the United States have dropped by more than 99%. A 2024 CDC analysis estimated that the current schedule has prevented more than 6 million hepatitis B infections and nearly 1 million hospitalizations.

The benefits are lifelong. Infants vaccinated at birth are shielded not just from hepatitis B but also from the liver failure and cancer it can cause decades later. Yet because the disease unfolds slowly, the consequences of policy shifts may not surface for 20 or 30 years.

Trieu Pham, a California physician, doesn’t need to imagine those consequences. Born in Vietnam in 1976, he probably contracted the virus at birth. “If the vaccine had existed then, I wouldn’t have gone through what I did,” he said. Diagnosed in his 20s, he developed cirrhosis by 40. At 47, he was coughing blood from ruptured esophageal veins. Eventually, he required a liver transplant to survive.

“You live with this constant fatigue and fear,” he said. “And the saddest part is it was preventable.”

His three children, all vaccinated within hours of birth, are free of hepatitis B. “That’s the difference a day can make,” Pham said.

Data show the universal strategy is most effective

In 1982, ACIP recommended the new hepatitis B vaccine only for adults at high risk: health care workers, injection drug users, and men who have sex with men. But by the late 1980s, it was clear that risk-based vaccination couldn’t contain transmission. Many newly infected adults didn’t fit any defined risk group. Identifying high-risk people proved imperfect, stigmatizing, and ultimately ineffective.

Meanwhile, infants infected during or shortly after birth had a 90% chance of developing chronic infection, compared with less than 5% in adults. Yet public health officials repeated the same targeted strategy, this time with newborns. In 1988, the CDC recommended universal prenatal screening and linked an infant’s vaccination to the mother’s test result, again basing protection on a risk marker instead of vaccinating all infants.

As before, it failed. Many infected mothers weren’t correctly identified. Some were never tested, some were tested too early, and others had results that were misread or never communicated. Too many infants slipped through the cracks, proof that another targeted approach couldn’t reliably protect them.

In 1991, the CDC issued its landmark guidance recommending that all infants, regardless of their mother’s infection status, receive a hepatitis B vaccine at birth, followed by two additional doses in infancy. By 2005, the policy was fully embedded in the routine immunization schedule, then reaffirmed in 2018. This evolution was based on data showing that a universal strategy, rather than a targeted one, was the most effective in preventing infections.

U.S. stands alone in abandoning birth dose

The CDC’s new hepatitis B policy rests on the premise that moving the decision to parents will strengthen trust in the vaccine system. Supporters frame it as an empowerment shift — a way to give families more control.

In 1999, when it was last recommended to postpone the first dose of hepatitis B vaccine for infants born to uninfected mothers, vaccination rates also dropped among infants born to those who were infected.

“Opt-in policies sound patient-centered,” Wang said, “but in practice they’re inequitable. They leave behind the very families who need protection most” — the ones most likely to miss prenatal care and testing, have infections that go undetected or arise after testing, or slip through gaps in hospital care, as well as infants who can be exposed and infected by other caregivers and household members.

Those are often immigrant families, including from Asian and Pacific Islander communities in which hepatitis B remains endemic. “We already underdiagnose and undertreat these populations,” Wang said. “This change would deepen that gap.”

The United States is now the only country to abandon a universal hepatitis B birth dose recommendation. Though it will take decades to gather outcomes data, some researchers predict that delaying the first dose of hepatitis B vaccine to 2 months of age could result in over 1,400 preventable infections and about 300 cases of liver cancer per year.

“We don’t get to choose what we inherit,” Wang said. “But we do get to choose what we pass on.”

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

Many Georgians could see ACA insurance rates double with no tax credit extension

2025-12-11T23:16:29+00:00

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

After two congressional proposals to alleviate the rising costs of Affordable Care Act health insurance plans failed to pass Thursday, many Georgians could see their rates more than double for next year.

At issue are tax credits that lowered the cost of ACA plans that are set to expire Dec. 31. The credits were enacted as part of a Covid relief package in 2021. Unless Congress takes action to extend the credits, premiums for Georgians will, on average, more than double, a recent Georgia Health Initiative analysis found.

The enrollment deadline is Monday for coverage to begin Jan. 1.

The GHI analysis predicts that the higher costs would prompt about 340,000 of the 1.5 million Georgians who are enrolled in the ACA to go without insurance next year. The analysis is based on data showing how many people enrolled after the premium tax credits took effect.

Congress is set to recess for the holidays next week. On Thursday, a Democratic proposal to extend the subsidies and a Republican proposal to provide enrollees with additional funds for health care costs instead both failed on 51-48 votes in the U.S. Senate.

The exact amount of the rate increases will vary based on several factors, but on average, premiums in Georgia will more than double, from an average of $69 per month this year to $148 per month in 2026, according to the GHI report.

Many will likely “buy down” to lower-coverage plans that may have lower premiums, but higher out-of-pocket costs, the analysis said.

How will higher costs impact health care in Georgia?

People who make more than 400% of the poverty level (about $62,600 for a single person, or $128,600 for a family of four) will see the biggest increases if Congress doesn’t act, said Louise Norris, health policy analyst for Healthinsurance.org.

“All of a sudden they’re faced with full-price premiums, which are really high, depending on how old you are, and where you live,” Norris said. People making less than 400% of the federal poverty level will also see increases, she said.

Many people will opt to go without insurance, which will increase health care costs across the board, Norris said.

Employer-sponsored plans and Medicare plans have also set higher premiums for next year.

“When you increase the uninsured rate, you do drive up costs for everyone who still has insurance,” Norris said.

Anna Adams, senior vice president of government relations at the Georgia Hospital Association, said, “Hospitals will continue to provide high-quality care to all patients, regardless of their ability to pay, but the loss of coverage for many of those patients will have a substantial impact on hospitals’ ability to stretch already scarce resources.”

Many patients without insurance will turn to emergency room care, Norris said, for which they won’t be able to pay. That will cause hospitals to raise rates, which will drive up premiums for everyone.

Who is eligible for Affordable Care Act insurance and where to find plans in Ga.

U.S. citizens, nationals, or lawfully present immigrants who are not incarcerated can enroll in the plans. About 1.5 million Georgians, or around 13% of the population, currently use the plans.

Most of those enrolled do not have access to insurance through their employers.

To compare plans and enroll, visit GeorgiaAccess.gov. In the past, Georgians purchased their insurance through a federal website called the Marketplace. The state established its own portal last year.

What happens if Congress doesn’t extend the tax credits by the Monday deadline?

The rates listed on GeorgiaAccess are the rates that will take effect if Congress does not act, Norris said. She advises selecting a plan by Monday’s deadline.

“You can base your decision on those numbers. Pick a plan, but then don’t just tune out completely. Make sure you still keep an ear to whether or not anything is changing,” she said.

Congress could still renew the subsidies or agree to another plan to lower costs even after the deadline, retroactively.

What happens if you miss the Monday deadline to enroll?

Those who have health insurance through Georgia Access will be re-enrolled in the same plan or the most similar plan available for next year.

Aetna will not be offering ACA insurance in 2026, so those customers will be shifted to another company, said Bryce Rawson, a spokesperson for the Georgia Office of Insurance and Safety Fire.

Those who don’t already have health insurance and miss the Monday deadline can enroll until Jan. 15. But coverage wouldn’t start until Feb. 1.

What options are available for those who cannot afford health insurance?

Here are some resources available in Georgia for uninsured people.

Many charity and low-cost clinics across the state operate on a sliding scale for low-income and uninsured people. Here are some directories to help find one near you.
For DeKalb and Fulton residents, Grady Health offers financial assistance, often called a “Grady card,” for inpatient and outpatient care. For residents of other counties, Grady provides financial assistance for emergency services.
Contact your health system or doctor and explain the situation. Hospitals are often able to write off debt, provide lower bills, or set up a payment plan. Just ask.
Make sure you are being charged the lower “self-pay” rate rather than the insurance rate.
Local public health departments offer an array of low-cost services, including vaccinations, many routine screenings like mammograms, and sexually transmitted infection prevention and treatment services.
Eligibility for Medicaid varies. Typically, people who are eligible for the ACA are not eligible for Medicaid. Those who are eligible include:
- Children from low-income families
- Adults 19-64 with incomes up to 100% of the federal poverty level ($15,650) who work, volunteer, study, caregive or complete another qualifying activity for 80 hours per month.
- People with certain medical conditions or who are aged, blind, or disabled.
- Pregnant and post-partum women with low incomes.
- Parents of children under age 19 who earn very low incomes

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

How states and cities can defend public health in 2026

2025-12-11T13:19:07+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In 2025, the federal government pursued a deliberate strategy to reduce its role in protecting public health. As a result of changes to the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and other operating divisions, public health experts agree that the country is now less well protected against infectious diseases, environmental hazards, unsafe food, and chronic conditions.

In 2026, the question facing governors, mayors, and local health officials is glaring: What can be done now to protect public health if the federal government will not? The answer is that state and local governments need to act to support the supplies, staff, systems, and statutes needed to enable and enforce public health.

Supplies: Build stockpiles for public health emergencies and reproductive health

Every public health emergency requires supplies, such as diagnostics, vaccines, therapeutics, and personal protective equipment. For most routine events, states and local governments can rely on their own reserves and commercial supply chains for these so-called “countermeasures.”

For larger or unusual events, they have historically relied on the federal government, such as test kits produced and shipped by the CDC or through supplies released from the Strategic National Stockpile (initially established in 1999). That assumption is no longer safe.

In 2025, staffing to maintain and support this stockpile was cut, along with funding for vaccine research, procurement, and delivery. Similarly, the White House blocked the release of federal emergency funding for response and recovery from environmental disasters in North Carolina and Illinois because they have Democratic governors.

Outside of acute events, there is an additional risk that the federal government could restrict medications for reproductive health given the administration’s strong position opposing abortion.

In 2026, state and local governments could start planning for supply instability by building or expanding countermeasure stockpiles to infectious diseases, reproductive health, and other health emergencies. At a minimum, these stockpiles would need to cover the first weeks of an emergency and ensure continuity of routine services if federal systems falter.

To prepare for the possibility that the federal government’s role could be permanently reduced, states could also consider investing, potentially through a multi-state consortium, in capacity to manufacture or complete the final preparation and distribution of countermeasures. Consider, for example, how California is working to produce and distribute insulin to improve costs and access for its residents. A multi-state network could stabilize supply, support research and development, and reduce dependency on the federal systems.

Staffing: Mitigate the loss of public health workforce

The United States entered the pandemic with a public health workforce that had already been thinned out. In 2025, that situation worsened considerably. Federal grants support a large percentage of staffing at state and large municipal health departments. The administration has cut this funding by canceling grants, rescinding funds already awarded, impounding funds appropriated by Congress, and passing cuts through legislation. Many health agencies have had to eliminate staff and have no funding to replace those functions.

Rebuilding the workforce requires money. In 2026, states will need to find additional funding to restore personnel working on surveillance, community outreach, environmental health, laboratory testing, maternal and child health, and emergency preparedness. It will also fall to them to recruit and retain the next generation of workers with programs that used to be supported by the federal government, such as loan repayment and training programs for public health advisers, field epidemiologists, microbiologists, and related fields.

Even with more funding, no jurisdiction will be able to replace all of the staff lost through federal cuts. This is where artificial intelligence could play an important role. A large percentage of public health practice is cognitive labor: People gather data, clean it, interpret it, and translate it into protocols, policy, and public communications. AI systems purpose-built for public health can automate much of this work, freeing time for humans to conduct field investigations, engage with the community, and work with stakeholders on policy.

Systems: Ensure continuity of disease surveillance systems

Public health relies on systems to monitor health conditions that are largely invisible to the public. These surveillance systems link together data collection in the community, at health care facilities, and from the environment with laboratories and information management systems. These systems require long-term investment to ensure public health agencies can monitor the trends in important health conditions and the impact of interventions.

Some systems have been dismantled, and others are being starved of resources. If this continues, states will lose the ability to detect emerging threats, monitor ongoing ones, and issue credible guidance both within their borders and to understand what is happening in neighboring localities.

In 2026, states will need to begin constructing their own analytic infrastructure and supporting existing academic initiatives, such as Beacon. This can take several forms. It could be in the form of multi-state coalitions that synthesize data across multiple jurisdictions, share resources for laboratory testing, information management, and data analysis.

Statutes: Bolster public health legal authority before it is challenged

According to the U.S. Constitution, public health authority is vested in states and localities. During the pandemic, those laws became targets. In many states, new statutes have been passed to weaken isolation and quarantine powers, vaccine requirements, and emergency authority. The federal government is also asserting greater control over immigration, law enforcement, and regulatory powers in ways that may undermine local action during health emergencies.

In 2026, states and cities will need to publicly clarify and codify their health authorities. This begins with rapid legal reviews of existing statutes governing disease reporting, isolation and quarantine, environmental enforcement, reproductive health, and emergency powers. Those authorities could then be updated and enacted into law.

Even in situations in which existing authorities have not changed, there may be value in conducting these reviews publicly and issuing public statements or passing new laws that signal to courts, the media, and the public that these powers are legitimate, expected, and necessary.

In 2026, states may also need to prepare for conflict with the current administration if there are infectious disease emergencies where they need to restrict people’s movement or mandate vaccines. Multi-state legal defense coalitions may need to be formed now to coordinate litigation, share expertise, and act quickly to defend state authority for public health emergency powers.

The need for states to act now to protect public health

The dismantling of federal public health is likely to proceed further in 2026 as the safety net for health insurance (Medicaid) becomes weaker and the impact of declining vaccination rates grows. While states cannot replace the enormous role that the federal government has played and needs to play, communities will be more reliant than ever on their local health agencies than at any point in recent memory. While each of the actions described above requires a different tactic, they all share the same principle: Do not underestimate the risk. The time to act is now.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

Kenya signs first U.S. aid deal – but can it afford to pay its share?

2025-12-11T12:00:00+00:00

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

Hello from Nairobi.

Last weekend I went to an ugly-sweater holiday party at the start of the dry season and learned something important about hubris. There is hot, there is very hot, and then there is “woolen knitwear in equatorial sun.” I will choose differently next time.

What’s new this week? Some big moves on American foreign aid, plus we’ve hit the point in the year when the consequences of the past 12 months are starting to show up in the data. Some of what follows is tough reading, but I promise we will end on something light.

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

Kenya signs the first ‘America First’ health deal

Allow me start this week’s opening story with a short rewind on what happened this year to America’s aid bureaucracy. (Bear with me, the background really does matter.)

Earlier this year, the Trump administration shut down America’s foreign aid agency, the United States Agency for International Development. While most American aid programs ended with it, about 17% of USAID’s former contracts survived. These included some (though not all) lifesaving global health programs. By July, those programs were all transferred to the State Department, which has been quietly rehiring former USAID staff as temporary contractors to keep them running. Still, for months the ultimate fate of that remaining health aid was anybody’s guess.

Finally, in September, the State Department announced a new plan for American health aid moving forward, which was presented under the banner of “America First.” The heart of the new approach would be country-by-country deals. But the announcement left huge questions about actual funding and long-term commitments unanswered.

Still with me? This brings us to the latest news.

The United States finally signed the first of those global deals here in Kenya last week, Health Policy Watch reports. The agreement promises “$1.6 billion over the next five years,” for priorities like malaria control and disease surveillance, and hinges on Kenya committing to raise its own health spending by $850 million. Moving forward, American officials say as many as 49 more agreements could follow in Africa alone.

There has been some hubbub in Kenya about one clause in the deal, which requires the Kenyan government to share health surveillance data with the United States for 25 years, including providing U.S. businesses with genetic data. (I initially didn’t read this as a nefarious data grab, but instead as Washington trying to patch the disease reporting gap it opened when it pulled out of the World Health Organization.)

Meanwhile, Secretary of State Marco Rubio praised the agreement’s new approach by saying, “We are not going to spend billions of dollars funding the NGO industrial complex while close and important partners like Kenya either have no role to play or have very little influence over how health care money is being spent.” It’s worth noting: That framing is flat-out inaccurate, since USAID historically co-designed Kenya’s health programs with the Kenyan government, and routed much of its funding through local Kenyan organizations.

This all gets to my bigger question: How much is actually different in practice, once you sift past the rhetoric? I reached out to John Kuehnle, my old colleague who actually ran America’s health programs for USAID in Kenya from 2020 to 2024, to ask. (Today Kuehnle is the CEO of the American NGO Partners for World Health).

Kuehnle welcomes the effort to persuade Kenya to invest more of its own money, which he says mirrors what USAID and the Centers for Disease Control and Prevention had pushed for years. But he warns that “the challenge that we always had was that we knew that even if we got the Kenyan government to agree to increase spending over time, fiscally that would be very difficult for them to actually do. I don’t think that has changed,” he said. (It’s worth noting that the agreement is, uh, non-binding.)

“I think that the Kenyan government signed this agreement out of desperation to guarantee funding for the next five years, and buy time in the hopes that their financial situation improves, or that there is a regime change in the U.S. that is open to renegotiating [the agreement] when it ends,” Kuehnle said.

As the agreement rolls out, Kuehnle points to a few key signals to watch.

For one, “the U.S. government currently does not have enough staff in Kenya to manage an [agreement] like this. Keep an eye on ... the amount of funding that actually moves.” And perhaps most importantly, Kuehnle raised the specter of the c-word that had constrained many of USAID’s earlier attempts to route money more directly through governments like Kenya’s: corruption. “I think many Kenyans outside of the Kenyan government do not believe that their government can be trusted to manage funds directly,” he said.

Preventable childhood deaths are increasing

For the first time in 25 years, childhood deaths from preventable diseases are rising globally, TIME magazine reports. (This is according to University of Washington researchers in the Gates Foundation’s annual report on global health.) All told, an additional 200,000 children under 5 are expected to die in 2025, bringing the total to about 4.8 million. (Disclosure: The Gates Foundation is a funder of Healthbeat).

To be clear, these are deaths that could have been entirely avoided “with vaccines or other [existing] treatments.” In the report (which can be downloaded here) Bill Gates himself puts this compound tragedy fairly succinctly: “There’s something especially devastating about a child dying of a disease we know how to prevent.”

Regular readers of the Global Health Checkup probably won’t be surprised by what is being fingered as the primary driver of this reversal: “significant cuts to spending in global health from the world’s largest donors.”

What’s the takeaway?

For one, it’s worth noting that the report largely presents this year’s rise in deaths as a short-term bump rather than a lasting reversal. Even without reversing the global cuts, the projections show child deaths falling again in most future scenarios, even as soon as next year. At the same time, the report warns that child survival is now more fragile than before, and that progress against preventable diseases can be increasingly pushed off course by shocks like conflict, climate disruption… or a further drop in funding.

Malaria is on an ominous path

The World Health Organization just published its yearly report on the global state of malaria, Euronews reports. (One note up front: Like the tuberculosis data we covered three weeks ago, WHO’s reporting speed is glacial, so the “2025” report only describes 2024.)

How was last year? Ominous.

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.

Even before this year’s aid cuts, malaria cases ticked up in 2024 over 3%, reaching an estimated 282 million total cases. Deaths also rose upward to 610,000 in 2024, with the majority being young children in “11 African countries.”

Malaria is one of the rare tropical diseases with a well-funded advocacy community and decades of scientific focus, so it’s worth asking, why we were losing ground last year?

There are really two answers, according to the WHO. One is rising resistance to malaria drugs and insecticides, and the other is a familiar foe, climate change, which is giving various mosquito species more places to survive and more months each year to spread the parasite.

My takeaway: Looking “forward” to this past year, malaria is the disease I’m most worried about on the continent I call home. That’s because malaria moves fast (the incubation period is tiny), and once you let off the brakes, or conditions shift, cases can explode. As we covered in early October, in places like Cameroon, aid agencies are already saying the clock has rolled back 20 years due to the aid pullback. If we were already losing ground, the worst may still be ahead.

Exit ebola, enter cholera

It’s been a week of whiplash in the Democratic Republic of the Congo. As we reported last week, the country announced the end of the Ebola outbreak on Dec. 1. But UNICEF, the U.N. Children’s agency, just confirmed that DRC is now contending with its worst cholera outbreak in 25 years, Reuters reports.

Just by the numbers, there’s been more than 64,000 cases and roughly 1,888 deaths since the start of the year. But one, smaller line hit me particularly hard: “In one case, a quarter of the children in a Kinshasa orphanage … died days after the disease swept through.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. 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 conditions driving this disaster are painfully familiar: “Only 43% of people in Congo have access to at least basic water services [like basic plumbing or just treated water], the lowest rate in Africa, and just 15% use basic sanitation,” like toilets or sanitized latrines. Combine that with ongoing conflict, displacement, overcrowding, and crumbling infrastructure, and cholera is spreading through many communities with ease. Unsurprisingly, UNICEF is calling for “more funding” to help contain the crisis, which is unlikely to come unless it is diverted from elsewhere.

The takeaway: It is encouraging to see what the world can do when it focuses on a threat like Ebola. But if that focus is built on rerouting and draining support from other crises, and if the plan for this cholera outbreak also just moves money from one emergency to the next … it’s hard to celebrate a system that’s only moving the danger around.

Expert advice from Scandinavians on winter darkness

Admittedly some tough news in today’s report, so let’s end with something light. With the solstice around the corner, the Associated Press published a story that sums up advice from Nordic health professionals on coping with winter darkness.

As far as I could tell, the advice seemed sound: You should get morning light, keep your routines, stay social, and lean into winter. That said, there’s a famous adage in journalism on the importance of verifying whatever anyone tells you, even from trusted sources: It’s “if your mother says she loves you, check it out.”

So I passed on the article to three close Scandinavian friends of mine for, uh, let’s call it fact checking. I asked them to be unvarnished, and boy were they!

Generally, my Nords concurred with the AP. Ragnar, a Norwegian-Swede, stressed just how central the cultural value of coziness (“hygge”) really is for managing the enduring dark, along with a steady drumbeat of holiday festivals and “small cozy moments and traditions,” he said. Although … he noted that a certain triumvirate of important and traditional Scandinavian winter staples was entirely missing in the AP story. That’s alcohol, caffeine, and salty Christmas food. But “I’m not sure if these are the best tips to put into a global health newsletter,” he acknowledged.

Miriam, a Swede, challenged the central premise of the article. “I’m not sure we, as a population, know how to deal with the winter darkness,” she said. “Yeah, we do a lot of things, but also a lot of people just go depressed.”

But my favorite takeaways came from Théo (also Swedish) who wrote to me from Kuala Lumpur, Malaysia. “My best remedy for managing Nordic winters is not living there,” he said.

He also took umbrage with one particular line in the AP story. “The saying ‘there’s no such thing as bad weather — only bad clothing’ is a scam invented to force preschool kids to play outside even in the rain and freezing cold,” he said, channeling what sounded like a long-held grievance. “Ice on the sidewalk and horizontal rain mixed with snow 100 % qualifies as bad weather.”

I’ll see you next week!

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

This HIV expert quit the CDC: ‘Erasing people from the story harms actual people’

2025-12-10T12:00:00+00:00

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

John Weiser, a doctor and researcher, has treated people with HIV since the beginning of the AIDS epidemic in the 1980s. He joined the CDC’s HIV prevention team in 2011 to help lead its Medical Monitoring Project, the only in-depth survey of HIV across the United States. The project has shaped the country’s response to the epidemic over two decades, but the Trump administration censored last year’s findings and stopped funding it.

Weiser spoke with KFF Health News on the evening before World AIDS Day, which the U.S. government didn’t acknowledge for the first time since 1988. That was only the latest blow to efforts to combat HIV. The Trump administration has cut funds to provide lifesaving HIV care abroad, withheld money to prevent and treat HIV in the United States, and fired HIV experts at the Centers for Disease Control and Prevention.

Weiser was fired from the CDC during mass layoffs in April, rehired in June, and then resigned. He continues to treat patients at Grady Memorial Hospital in Atlanta. In November, he published an article that warns against complying with presidential orders to censor data about transgender people.

The following conversation has been condensed and edited for clarity.

In the first weeks of his presidency, Donald Trump issued several executive orders with implications for HIV programs. One directed federal employees to exclude gender identities that didn’t correspond to a person’s biological sex assigned at birth.

On how this played out at the CDC:

We were told to scrub any mention of gender or transgender people from dozens of research papers and surveillance reports that had already been published or were going to be published, and to stop collecting information from participants about their gender identity. For example, we had to recalculate our numbers on HIV among men who have sex with men, or MSM, a category that the CDC changed to “males who have sex with males.”

The CDC had no director at the time. The order came from on high. And there was no discussion about whether we wanted to comply with the directive.

On how this directive has affected his research:

Using data from the Medical Monitoring Project, we found that people with HIV who misused opioids were more likely to engage in behaviors that could pass on HIV to another person — through unprotected sex or shared injection. And we found that very few people who misused opioids were receiving treatments for substance misuse. This information could have been useful to change clinical practice and boost funding to treat people with HIV who misuse opioids.

We were getting ready to publish this study, but when I put the paper through CDC’s clearance process, I was told to remove data about the prevalence of opioid misuse among transgender people.

I thought carefully about that, and I decided not to do that because it’s bad science to suppress data for ideologic reasons, and because erasing people from the story harms actual people. I thought about my transgender patients and how I would face them, and what I would say to them while I’m sitting with them in the exam room, knowing that I had erased their existence from CDC.

I withdrew the paper. It remains unpublished.

On how removing data harms people:

Purging data about transgender people has the effect of erasing them from the real world, pretending that they don’t exist. This group of people is heavily affected by HIV, and this type of information informs improvements in treatment. My transgender patients struggle with poverty, with unstable housing, with food insecurity, with mental health disorders, with substance misuse, and face a huge amount of stigma and discrimination in their daily lives.

My transgender patients are trying to get by, day by day. They’re trying to survive. I think it’s important to realize that somebody who is transgender needs to feel comfortable in their own body to be healthy — and denying them recognition compounds their challenges.

After the executive order came down, one of my patients said she felt even more afraid of being in public and not passing, and so she was considering having additional surgical treatment to feel safer. Her concern was not about politics. It was about survival.

On why the CDC went along with orders to remove transgender data:

I think the hope was that by complying with the directive, other work at the CDC would be spared. And unfortunately, that hasn’t proved to be the case. Funding for the Medical Monitoring Project was terminated after 20 years, and the concern within CDC is that the president will eliminate all HIV prevention and surveillance funding.

One of my concerns while there was that if it’s OK to comply with a directive to remove information about gender, what if the next demand is that we don’t report about people who emigrated from other countries, or on people who are experiencing homelessness? What if there’s a directive to suppress data about a particular racial or ethnic group that’s unpopular? How far would we go?

Some HIV clinics and organizations have considered curtailing their work with transgender people and undocumented immigrants, or on equity initiatives, because they fear the loss of federal funds.

His advice on these decisions:

People making these decisions are in a really tough spot. They want to do what’s best for their programs. They want to do what’s best for their employees. They want to do what’s best for the people they’re charged with taking care of. Those are careful decisions that need to be made weighing all of the considerations. What I want these leaders to do is also consider how a decision to essentially throw one group of people under the bus undermines scientific integrity, and harms everyone.

And I think that it’s also necessary for the rise of autocracy to go along, to compromise, to acquiesce. While all of this was going on, I heard an interview with Masha Gessen, who is a Russian American journalist who writes about the rise of autocracy. Gessen explained that decisions to go along are not made because people are unethical or heartless. They’re rational choices. They’re made in order to protect something that’s important — institutions, families, jobs — even if it means sacrificing principles. Gessen’s point is that this gradual process of compromising ultimately is what solidifies an autocrat’s power.

On why he resigned from the CDC:

As a physician working at the CDC, numbers have always described individual people, people whose suffering I witness. When you know somebody, they’re no longer just a concept that you make a judgment about.

I realized that I could do more good by spending more time with my patients than I could working for the CDC under this administration.

Amy Maxmen is a Healthbeat national reporter through a partnership with KFF Health News.

Vaccine panel drops recommendation that all newborns get hepatitis B shot

2025-12-05T20:33:43+00:00

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

A longstanding recommendation that all babies be vaccinated at birth against hepatitis B was abandoned in a divided vote Friday by a federal advisory panel at the Centers for Disease Control and Prevention.

Members of the committee who voted in favor of the change hailed it as supporting informed vaccine choice by parents, who they say have been abandoned and marginalized by pediatricians when refusing or delaying immunizations.

“True choice has not been existing in practice,” said committee member Hillary Blackburn, a doctor of pharmacy. “No child should lose their medical home because their parents are engaging in the very individually based decision making we’re encouraging.”

Those who voted against the change said parents always have the final say in what vaccines their children receive, and that the new recommendations lacked scientific evidence and will result in children suffering needless infections and serious liver damage.

“We know that three doses given according to the existing schedule are safe and effective in preventing hepatitis B,” said Dr. Cody Meissner, a professor of pediatrics at Dartmouth’s Geisel School of Medicine. “We are doing harm by changing this wording, and I vote no.”

All of the committee’s members were chosen by Health and Human Services Secretary Robert F. Kennedy Jr., who has long been critical of vaccine safety. Kennedy dismissed the panel’s previous members during the summer, then fired Trump administration CDC Director Susan Monarez for what she told Congress was her refusal to rubber stamp future recommendations of the committee.

The CDC Advisory Committee for Immunization Practices voted 8-3 that women who test negative for the hepatitis B virus should consult with health care providers to “decide when or if“ their child should be vaccinated against the virus, with any initial dose “suggested” to be administered “no earlier than 2 months of age.”

The committee did not change the current recommendation that a birth-dose of the vaccine be given to infants born to women who test positive for the hepatitis B virus.

U.S. Sen. Bill Cassidy, the Republican chairman of the Senate Health Education, Labor, and Pensions Committee urged acting CDC Director Jim O’Neill to not sign the recommendations and maintain the current standards.

“As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake,” Cassidy, whose vote was instrumental in Kennedy’s confirmation as HHS secretary, said on the social media platform X.

“The hepatitis B vaccine is safe and effective. The birth dose is a recommendation, NOT a mandate,” Cassidy said, noting that before the birth dose was recommended, 20,000 newborns a year were infected with hepatitis B. “Now, it’s fewer than 20. Ending the recommendation for newborns makes it more likely the number of cases will begin to increase again. This makes America sicker.”

The committee makes recommendations to the CDC director, who can accept or reject them. O’Neill is a deputy secretary at HHS in addition to serving as acting CDC director. CDC and HHS did not immediately respond to questions from Healthbeat about O’Neill’s timeframe for making a decision on the recommendations.

Major medical and public health associations – including the American Academy of Pediatrics, the American Medical Association, the Infectious Diseases Society of America and the National Association of City and County Health Officials – had urged the committee not to change the recommendation that all babies receive the birth dose.

The American Academy of Pediatrics has said it is not going to change its recommendation to pediatricians that all babies should receive a first dose of hepatitis B vaccine shortly after they are born.

The associations noted that babies born to mothers who test negative for hepatitis B virus remain at risk of infection early in life from families, caregivers, and other close contacts who may be infected but often do not know it.

The hepatitis B virus is highly contagious and spreads through contact with blood and body fluids. It can cause severe liver damage and cancer. The virus can spread from person to person through sharing of personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and use of unsterile needles.

Universal infant and childhood vaccination against hepatitis B, recommended since 1991, has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults.

“Recommendations are not mandates,” Dr. Flor Muñoz, representing the Infectious Disease Society of America at Friday’s meeting, told the committee as it prepared to vote. “The issue of consent is not being solved with these changes … 30 years of information regarding the safety and efficacy of these vaccines are very strong to continue to support the existing recommendation.”

Committee members Meissner and Dr. Joseph Hibbeln, a psychiatrist and neuroscientist, objected throughout the meeting to what they said was a lack of evidence supporting the new recommendations. No data were presented to the committee to support recommending a two-month delay before babies born to hepatitis B negative moms get their first vaccine, they said.

“We have no basis for saying that. That’s been kind of pulled out of the air,” Meissner said.

“I am hopeful that pediatricians will continue to administer the birth dose within the first 24 hours of delivery and before discharge from the hospital. I think to follow any other course is not in the interest of the infant,” Meissner said.

Added Hibbeln: “This specific point is the reason why we tabled this issue for three months to more fully discuss it. However, we have still not had any information or science presented or discussed with regards to this issue of [giving the first dose of hepatitis B vaccine ] before or after 2 months of age. This is unconscionable.”

The committee also voted to recommend parents consider antibody testing to evaluate the hepatitis B vaccine’s effectiveness before getting subsequent doses. The vote passed with six members in favor, four opposed, and one abstaining.

This blood testing, the recommendation says, should be used to determine whether adequate protection against hepatitis B has been achieved. The recommendation says the cost of the testing should be covered by insurance.

Hibbeln objected to this testing recommendation being added to what had been a changing series of proposed recommendations shared with the committee with little time for advance consideration. “This fourth iteration of votes in 96 hours is still incredibly problematic,” he said.

“There is an absolutely novel concept being put forth here to vote, that a serology test should be offered” after the first dose, he said. “There has been no data presented that this plan would actually work.”

Dr. Raymond Pollak, a transplant immunobiologist, expressed similar concerns. “We have no data whether monitoring serology actually implies immunity,” he said.

Dr. Kirk Milhoan, a pediatric cardiologist who recently was appointed the committee’s chairman, said the tests could help parents decide how many vaccines their child needs.

“I would be very happy if we were to vote to simply recommend that this needs to be studied. That would also serve the purpose,” said Milhoan, noting “there is a paucity of data.”

But none of the committee’s members made a motion to do this.

This story has been updated with more details from Friday’s meeting.

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 York state to require insurers to cover inhalers. NYC life expectancy rises.

2025-12-05T20:00:00+00:00

There’s a lot to cover and celebrate this week in New York public health. From improving New York City’s life expectancy to a new state law ensuring inhaler coverage, public health and policy are quietly working behind the scenes. But there’s still plenty of work ahead. Let’s jump in.

Insurance has to pay for inhalers in NY

No one should struggle to breathe because they can’t afford it, but that’s been the reality for many New Yorkers with asthma. The cost of inhalers varies widely, from $35 with insurance to over $500 if uninsured, and depending on the type (e.g., daily preventative vs. emergency relief inhaler). Starting in 2027, though, that reality will shift for many. Last week, Gov. Kathy Hochul signed into law a bill that will require state-regulated health plans — including those on the Affordable Care Act marketplace — to cover the cost of asthma inhalers fully.

Why this matters

Nearly 2 million New Yorkers (about 10% of the state) live with asthma. In New York City, the problem is even greater, especially in neighborhoods with higher pollution levels due to heavy traffic and industrial zoning. In the Bronx, for example, the neighborhood of Mott Haven has become known as “Asthma Alley” because of its concerningly high rates of childhood asthma.

Mott Haven has nearly double the rate of asthma-related emergency room visits for kids 5-17 years old (266.2 per 10,000) compared to city averages (143.7 per 10,000). And these are some of the highest asthma-related emergency room visit rates in the country. (For comparison, the national average asthma-related emergency room visit rate is 36.6 per 10,000 for kids aged 0-18.)

New York City asthma emergency department visits (ages 5-17) in 2023 by community district.

Access to free inhalers is more than a convenience — it’s a lifeline. This is especially true for low-income families living in neighborhoods with high air pollution, who are least likely to afford consistent care. Mott Haven is one of these neighborhoods: a community with many families earning low incomes, surrounded by three major highways and industrial warehouses, resulting in higher air pollution.

While this new law is a major step forward for health equity, it’s still a band-aid: It doesn’t address why asthma rates are so high in the first place. Until we tackle the upstream causes, like air pollution, housing quality, and environmental justice, New Yorkers will continue to need more inhalers.

The state has taken similar steps to make treatments accessible for other chronic conditions, such as capping insulin costs under state-regulated plans. Though this piecemeal approach raises a bigger question: Is the best solution to pass drug-by-drug legislation? Do we need individual bills for every lifesaving medication New Yorkers depend on, and that many families struggle to pay for? This approach is reactive, and many experts argue that broader reforms may be more effective at addressing the underlying root drivers of high drug pricing.

New York City just beat its own health goal, 5 years early

In 2023, the city launched HealthyNYC following a dramatic drop in life-expectancy — from 82.6 years in 2019 to 78 years in 2020, mainly due to the Covid-19 pandemic. The initiative aims to raise life expectancy to 83 years by 2030. But according to new data released last week, we’ve already passed that goal: Life expectancy in New York City is now 83.2 years — the highest in our city’s history since we began tracking.

What drove this change?

Covid-19 deaths dropped by over 90% from 2021 to last year. This alone added years back to New Yorkers’ lives. Other leading causes of death, like heart disease, diabetes, suicide, and homicide, also declined.

But not every number went in the right direction. Deaths from screenable cancers (think breast, colorectal, cervical) rose slightly — up 0.7%. These are cancers we can often catch early or prevent through routine screening, yet outcomes worsened last year in the city.

Additionally, major health inequities persist:

Screenable cancer deaths are still highest among non-Hispanic Black New Yorkers, and especially men.
Heart and diabetes-related deaths are most common in non-Hispanic Black communities.
Homicide and overdose rates disproportionately affect Black and Hispanic communities.

What’s working?

Some of the programs helping to improve life expectancy include:

The Public Health Corps, connecting high-risk communities to care.
Citywide media campaigns and vaccine outreach.
Distribution of 300,000+ naloxone kits and harm reduction services.
New investments in opioid treatment programs like Relay.
Doula and nurse home visiting programs for 20,000+ families.
Action centers focusing on neighborhoods with the highest premature death rates.

With the HealthyNYC initiative codified into law, these efforts won’t disappear with a new mayor or budget cycle — the city will keep working on improving these metrics. But these successes aren’t the finish line. There’s still a big question: How do we not just live longer, but live better? Some city leaders say the next chapter should focus on healthspan — the years of life spent in good health — not just lifespan. It’s also crucial that we continue to double down on closing health inequities across neighborhoods and populations.

Infectious disease ‘weather report’

Flu: Flu continues to increase quickly. The most recent data show that cases and hospitalizations in the state have increased by 117% and 99%, respectively. In New York City, emergency department visits for the flu rose by 142%.

Hospitalizations of respiratory viruses in New York.

RSV: Also increasing across the state and in New York City, mostly in kids under 4. Statewide, hospitalizations increased by 21%, while emergency department visits in New York City went up by 71%.

Covid-19: Cases and hospitalizations are holding steady at low levels in both the city and across the state.

The New York state wastewater program recently launched a helpful update to its dashboard. They now color-code sites by whether they are increasing, decreasing, or stable for Covid-19.

Right now, most sites across the state have either stable or decreasing Covid-19 wastewater values. Sixteen sites, though, are reporting increases, with the largest spikes seen in Seneca and Tioga.

HIV diagnoses have gone up in NYC

A new report shows that last year, 1,791 people were diagnosed with HIV in New York City, up 5.4% compared with 2023. And huge inequities remain: 86% of people newly diagnosed with HIV were Black or Latino/a, and 91% of newly diagnosed women were Black or Latina. Among people newly diagnosed with known transmission category, 65% were men who have sex with men, 82% of whom were Black or Latino.

Upstate updates

If you are looking forward to ice fishing this winter, make sure to check the conditions of the ice before you go out. A minimum of three to four inches of solid ice is the general rule for safety. For more information and to learn about specific fish species in ice fishing, check out the New York Department of Environmental Conservation page.
A raccoon tested positive for rabies in Deansboro. This is a reminder to avoid touching wildlife. If you see any acting strangely (acting mad, shy, getting unusually close, or drooling or foaming at the mouth), stay away, and call your local animal control officer for help. (Find contact information on your city’s website).
Monroe County launched MonroeAlert, an emergency notifications system for residents to get alerts about critical situations in their community. Residents can sign up to receive alerts via text message, email, phone call, or mobile app about emerging issues like severe weather, public safety incidents, travel restrictions, and shelter information.

Bottom line

New York is making real progress, from adding years to our lives to making breathing a little easier for those with asthma. But equity and prevention must stay front and center. Our communities should strive to live better, in addition to living longer.

Love,

Your NY Epi

While scientists race to study spread of measles in U.S., Kennedy unravels hard-won gains

2025-12-05T15:09:32+00:00

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

The United States is poised to lose its measles-free status next year. If that happens, the country will enter an era in which outbreaks are common again.

More children would be hospitalized because of this preventable disease. Some would lose their hearing. Some would die. Measles is also expensive. A new study — not yet published in a scientific journal — estimates that the public health response to outbreaks with only a couple of cases costs about $244,000. When a patient requires hospital care, costs average $58,600 per case. The study’s estimates suggest that an outbreak the size of the one in West Texas earlier this year, with 762 cases and 99 hospitalizations, costs about $12.6 million.

America’s status hinges on whether the country’s main outbreaks this year stemmed from the big one in West Texas that officially began Jan. 20. If these outbreaks are linked, and go on through Jan. 20 of next year, the United States will no longer be among nations that have banished the disease.

“A lot of people worked very hard for a very long time to achieve elimination — years of figuring out how to make vaccines available, get good vaccine coverage, and have a rapid response to outbreaks to limit their spread,” said Paul Rota, a microbiologist who recently retired from a nearly 40-year career at the Centers for Disease Control and Prevention.

Instead of acting fast to prevent a measles comeback, Robert F. Kennedy Jr., a lawyer who founded an anti-vaccine organization before taking the helm at the Department of Health and Human Services, has undermined the ability of public health officials to prevent and contain outbreaks by eroding trust in vaccines. The measles vaccine is safe and effective: Only 4% of nearly 1,800 confirmed U.S. cases of measles this year have been in people who had received two doses.

Kennedy has fired experts on the vaccine advisory committee to the CDC and has said, without evidence, that vaccines may cause autism, brain swelling, and death. On Nov. 19, scientific information on a CDC webpage about vaccines and autism was replaced with false claims. Kennedy told The New York Times that he ordered the change.

“Do we want to go back into a pre-vaccine era where 500 kids die of measles each year?” asked Demetre Daskalakis, a former director of the CDC’s national immunization center, who resigned in protest of Kennedy’s actions in August. He and other scientists said the Trump administration appears to be occupied more with downplaying the resurgence of measles than with curbing the disease.

HHS spokesperson Andrew Nixon said in a statement that vaccination remains the most effective tool for preventing measles and that the “CDC and state and local health agencies continue to work together to assess transmission patterns and ensure an effective public health response.”

Scientists look for links between outbreaks

CDC scientists are indeed tracking measles, alongside researchers at health departments and universities. To learn whether outbreaks are linked, they’re looking at the genomes of measles viruses, which contain all their genetic information. Genomic analyses could help reveal the origin of outbreaks and their true size, and alert officials to undetected spread.

Scientists have conducted genomic analyses of HIV, the flu, and Covid for years, but it’s new for measles because the virus hasn’t been much of a problem in the United States for decades, said Samuel Scarpino, a public health specialist at Northeastern University in Boston. “It’s important to get a surveillance network into place so that we could scale up rapidly if and when we need it,” he said.

Fulton health team logs 200 extra hours tracing measles exposures tied to GSU student

“We are working with the CDC and other states to determine whether what we’re seeing is one large outbreak with continued spread from state to state,” said Kelly Oakeson, a genomics researcher at the Utah Department of Health and Human Services.

At first glance, the ongoing outbreak in Utah and Arizona, with 258 cases as of Monday, seems linked to the one in Texas because they’re caused by the same strain of measles, D8-9171. But this strain is also spreading throughout Canada and Mexico, which means the outbreaks could have been sparked separately from people infected abroad. If that happened, this technicality could spare the United States from losing its status, Rota said. Being measles-free means the virus isn’t circulating in a country continuously year-round.

Canada lost its measles-elimination status in November because authorities couldn’t prove that various outbreaks from the D8-9171 strain were unrelated, said Daniel Salas, executive manager of the comprehensive immunization program at the Pan American Health Organization. The group, which works with the World Health Organization, includes health officials from countries in North, South, and Central America, and the Caribbean. It makes a call on measles elimination based on reports from scientists in the countries it represents.

Early next year, PAHO will hear from U.S. scientists. If their analyses suggest that measles has spread continuously for a year within the United States, the organization’s director may revoke the country’s status as measles-free.

“We expect countries to be transparent about the information they have,” Salas said. “We will ask questions, like, ‘How did you determine your findings, and did you consider other angles?’”

In anticipation of PAHO’s assessment, Oakeson and other researchers are studying how closely the D8-9171 strains in Utah match others. Instead of looking at only a short snippet of genes that mark the strain, they’re analyzing the entire genome of the measles virus, about 16,000 genetic letters long. Genetic mutations occur naturally over time, and the accumulation of small changes can act like a clock, revealing how much time has ticked by between outbreaks. “This tells us the evolutionary history of samples,” Oakeson said.

For example, if one child directly infects another, the kids will have matching measles viruses. But measles viruses infecting people at the start of a large outbreak would be slightly different than those infecting people months later.

Although the Texas and Utah outbreaks are caused by the same strain, Oakeson said, “more fine-grained details are leading us to believe they aren’t super closely related.” To learn just how different they are from each other, scientists are comparing them with measles virus genomes from other states and countries.

Ideally scientists could pair genetic studies with shoe-leather investigations into how each outbreak started. However, many investigations have come up dry because the first people infected haven’t sought care or contacted health departments. As in West Texas, the outbreak in Utah and Arizona is concentrated in close-knit, undervaccinated communities that are leery of government authorities and mainstream medicine.

Researchers are also trying to learn how many measles cases have gone undetected. “Confirmed cases require testing, and in some communities, there’s a cost to going to the hospital to get tested: a tank of gas, finding a babysitter, missing work,” Andrew Pavia, an infectious disease doctor at the University of Utah, said. “If your kid has a measles rash but isn’t very sick, why would you bother?”

Subtle Surveillance: Researchers analyzing genomes

Pavia is part of a nationwide outbreak surveillance network led by the CDC. A straightforward way to figure out how large an outbreak is would be through surveys, but that’s complicated when communities don’t trust public health workers.

“In a collaborative setting, we could administer questionnaires asking if anyone in a household had a rash and other measles symptoms,” Pavia said, “but the same issues that make it difficult to get people to quarantine and vaccinate make this hard.”

Instead, Pavia and other researchers are analyzing genomes. A lot of variation suggests an outbreak spread for weeks or months before it was detected, infecting many more people than known.

As measles exploded, officials in Texas looked to CDC scientists. Under Trump, no one answered.

A less intrusive mode of surveillance is through wastewater. This year, the CDC and state health departments have launched efforts to test sewage from households and buildings for measles viruses that infected people shed. A study in Texas found that this could function as an early warning system, alerting public health authorities to an outbreak before people show up in hospitals.

The quiet research of CDC scientists stands in stark contrast to its dearth of public-facing actions. The CDC hasn’t held a single press briefing on measles since President Donald Trump took office, and its last publication on measles in the agency’s Morbidity and Mortality Weekly Report was in April.

Rather than act fast to limit the size of the Texas outbreak, the Trump administration impeded the CDC’s ability to communicate quickly with Texas officials and slowed the release of federal emergency funds, according to investigations by KFF Health News. Meanwhile Kennedy broadcast mixed messages on vaccines and touted unproven treatments.

Daskalakis said that as the outbreak in Texas worsened, his CDC team was met by silence when they asked to brief Kennedy and other HHS officials.

“Objectively they weren’t helping with the Texas outbreak, so if we lose elimination, maybe they’ll say, ‘Who cares,’” Daskalakis said.

Nixon, the HHS spokesperson, said Kennedy responded strongly to the Texas outbreak by directing the CDC to help provide measles vaccines and medications to communities, expediting measles testing, and advising doctors and health officials. The U.S. retains its elimination status because there’s no evidence of continuous transmission for 12 months, he added.

“Preliminary genomic analysis suggests the Utah and Arizona cases are not directly linked to Texas,” the CDC’s acting director, Deputy HHS Secretary Jim O’Neill, wrote on the social platform X.

Given Kennedy’s distortions of data on vitamin A, Tylenol, and autism, Daskalakis said the Trump administration may insist that outbreaks aren’t linked or that PAHO is wrong.

“It will be quite a stain on the Kennedy regime if he is the health secretary in the year we lose elimination status,” he said. “I think they will do everything they can to cast doubt on the scientific findings, even if it means throwing scientists under the bus.”

Amy Maxmen is a national reporter for Healthbeat through a partnership with KFF Health News.

Vaccine panel delays votes on hepatitis B shot for newborns

2025-12-05T01:20:58+00:00

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

A federal vaccine advisory committee delayed votes Thursday on changes to hepatitis B immunization recommendations for infants as a top Republican senator called the group “totally discredited.”

U.S. Sen. Bill Cassidy, chairman of the Senate Health, Education, Labor, and Pensions Committee, expressed outrage over a scheduled briefing to the Advisory Committee on Immunization Practices on Friday by lawyer and vaccine critic Aaron Siri.

“Aaron Siri is a trial attorney who makes his living suing vaccine manufacturers. He is presenting as if an expert on childhood vaccines. The ACIP is totally discredited. They are not protecting children,” Cassidy, a Louisiana Republican and a physician, said on the social media platform X.

It’s unclear whether Cassidy plans to take any further action. His spokespeople did not immediately respond to questions from Healthbeat.

The committee, based at the Centers for Disease Control and Prevention, has become a flashpoint for controversy since this summer when Health and Human Services Secretary Robert F. Kennedy Jr. dismissed all its members and appointed replacements.

At Thursday’s ACIP meeting, CDC vaccine subject matter experts were largely sequestered in a “SME room” away or remote offices, away from where the committee members meet and providing expert input through video connections only when asked.

Siri, a Kennedy ally, is scheduled to brief the committee Friday morning on the childhood and adolescent immunization schedule, the evolution of the schedule, and a comparison of the U.S. schedule to those in other countries. The meeting’s agenda, as of Thursday, did not disclose any details about his presentation.

Siri, who compared himself to consumer advocates like Ralph Nader, fired back at Cassidy on X, saying vaccine manufacturers regularly speak before the committee. “Yet, I have never heard you take issue with those presenters,” he wrote.

On Thursday, the committee’s focus was on a push by some of its members to reduce the number of infants who are vaccinated at birth against hepatitis B, a serious infection that can cause chronic liver disease and cancer. The committee’s work group was led by ACIP committee member Vicky Pebsworth, research director of the National Vaccine Information Center, a group that warns against vaccine risks.

“It’s been 35 years since the universal birth dose policy was implemented,” she said. The work group was asked to assess whether the universal birth dose should continue to be given to children of mothers who test negative for the virus.

Since the universal birth dose started being given in 1991, there has been a 99% decline in cases of hepatitis B among children, adolescents and young adults.

Pebsworth said the review was prompted to address parent and stakeholder concerns about administering the hepatitis B vaccine at birth.

The committee voted 6-3 to postpone until Friday votes on any changes to the current recommendation that all infants be vaccinated against hepatitis soon after birth.

The decision to delay came after some committee members objected that they had no way to know what they were voting on. While the proposals were verbally read to the committee by vice chairman Robert Malone, they weren’t provided copies of the proposals’ text so they could assess and discuss the language.

The proposals, among other things, would recommend a birth dose of hepatitis B vaccine for babies born to women who test positive for the virus – a significant change from the current recommendation that all babies receive the vaccine. The proposals also contain language that would recommend delaying an initial dose of the vaccine until a child is 2 months old.

Text of the three proposals briefly read during Thursday’s meeting was not posted on the committee’s website.

Edward Tate, a spokesperson for the Hepatitis B Foundation, said Thursday’s meeting was concerning for many reasons.

“The meeting lacked transparency, with many of the presentations showing one-sided data, and several points made by committee members clearly showed that they have a very specific agenda,” he said.

“The committee members dismissed the extensive body of scientific data and real-life experience that prove the necessity, safety and value of the universal birth dose vaccination for hepatitis B,” Tate said.

The committee will resume its meeting at 8 a.m. Eastern on Friday. The meeting will be livestreamed at this link.

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

What to watch for at this week’s CDC vaccine advisory committee meeting

2025-12-04T14:57:58+00:00

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

The front line in the escalating political, cultural and scientific war over vaccination in the United States will return to a meeting room at the Centers for Disease Control and Prevention in Atlanta on Thursday and Friday.

That’s where an important CDC vaccine advisory committee – whose members were replaced with appointees of Health and Human Services Secretary Robert F. Kennedy Jr. – is scheduled to take another series of votes that could reshape longstanding recommendations to protect babies against the cancer-causing hepatitis B virus.

The two-day meeting of the CDC Advisory Committee on Immunization Practices is happening in the wake of Kennedy personally ordering changes to language on the CDC’s website that diminishes the agency’s longstanding statement that “vaccines do not cause autism” as not being an evidence-based claim – despite decades of research that has not found a link between vaccines and autism.

And it comes less than a week after a top U.S. Food and Drug Administration vaccine official asserted in a memo to agency staff – without providing data – that at least 10 children’s deaths are related to Covid-19 vaccination. The FDA has not released any information about the cases or how any links were made to vaccines.

With the advisory committee scheduled to start meeting at 8 a.m. Eastern Thursday, the CDC had not posted a final meeting agenda by Wednesday evening. The posted draft agenda – listed only broad topics of discussion, without details about the specific issues of concern, the data that will be presented, or the names of individuals who will be making presentations. Sometime overnight, a final agenda was posted that added a few lines of additional information but still few details.

Here’s what public health practitioners say they are watching for at this week’s ACIP meeting, which will be livestreamed on Thursday and Friday.

Votes that may delay or limit babies’ protection against hepatitis B

At issue: The meeting’s agenda shows that Thursday’s session will be focused on discussions and votes related to this vaccine. Overnight the committee posted draft language for two proposed recommendations.

The first vote is on language that would change current recommendations for universal vaccination of babies soon after birth. The proposed new ACIP recommendation would be for “individual-based decision-making, in consultation with a health care provider” on whether to give the hepatitis B vaccine to infants born to women who test negative for the virus or whose status is unknown.

This proposed recommendation also would leave it up to parents, in consultation with their health providers, to “decide when or if their child will begin the HBV series.”

The second vote involves draft language that would recommend that parents consult with health care providers about giving their children blood tests to check levels of immunity before receiving follow-up hepatitis B shots. The cost of these tests should be covered by insurance, the draft language says.

At the committee’s last meeting in September, the group postponed a vote on recommending a delay for when babies receive a first dose of hepatitis B vaccine.

Currently all babies are recommended to be vaccinated against this virus soon after birth. This is done to help prevent infection during the birth process if the mom’s infection hasn’t been detected during prenatal screenings, and also to protect them from exposure to caregivers and other contacts who may not know they are infected.

ACIP members have previously discussed the need for better hepatitis B screening of mothers during pregnancy. Other concerns have been raised about whether only babies deemed to be at high risk of virus infection should receive the shots.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

Why it matters: Universal infant and childhood vaccination against hepatitis B has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults. The vaccine plays a significant role in preventing liver cancer caused by the virus.

“We have tried all of these methods that we’re now talking about potentially going back to and they did not work. So that is why universal vaccination is so important,” Michaela Jackson, the Hepatitis B Foundation’s program director for prevention policy, told Healthbeat before the final agenda was released.

“Prior to universal vaccination, only 50% of children who were being infected before the age of 10 were getting that from mother-to-child transmission,” she said. “The other 50% were getting it from places like day cares, from contact sports, from caregivers who didn’t know that they had hepatitis B. We’re talking about innocent interactions that you don’t really think about every day.”

The virus is highly infectious. It is transmitted through contact with blood and bodily fluids of infected people, who often have no symptoms or awareness they are living with the virus. While the virus can be spread through childbirth, sexual contact, and sharing contaminated needles, it also can be spread through contact with sharp items commonly shared in families: nail clippers, a toothbrush, even some kinds of jewelry.

Interest in changing the childhood and adolescent immunization schedule

At issue: It’s unclear what aspects of the schedule will be discussed. The posted draft agenda, which listed this as a discussion topic for Friday, didn’t say. The final agenda shows the presentation to the committee on this topic will be made by Aaron Siri, a lawyer and close adviser to Kennedy.

Critics of the current recommendations for when vaccines are given, including Kennedy, have questioned the number, timing, and spacing of shots.

The final agenda lists two sub-topics for Siri’s presentation: the evolution of the vaccination schedule and a comparison of the U.S. schedule to those in other countries.

Why it matters: “The childhood immunization schedule is an important framework that we use to protect children from harmful and potentially deadly childhood diseases,” Dr. Sean O’Leary, chair of the American Academy of Pediatrics committee on infectious diseases, said before the final agenda was posted.

“Every vaccine on that schedule and the recommended timing of it exists for a reason,” he said. “The timing of each dose of a vaccine for a child is critical, and it’s based on the age at which a child’s immune system can provide optimal protection after vaccination, and the earliest possible time for protection … There is no reason to delay or space out vaccines. Doing so just puts children at risk.”

Discussion of ‘adjuvants and contaminants’ in vaccines

At issue: The meeting’s draft agenda said there will be a discussion of adjuvants and contaminants on Friday afternoon. The final agenda describes the presentation as involving aluminum exposure from vaccines before the age of 24 months and persistent asthma at age 24 to 59 months.

Why it matters: “Just like the childhood vaccine schedule itself, every vaccine ingredient plays an important role in making sure the vaccine is safe and effective,” O’Leary said.

“I won’t be surprised if some on this committee refer to these ingredients as contaminants. This is simply false,” he said. “As with any medicine, the ingredients in vaccines are there for a reason. Aluminum, for example, they’ll talk a lot about aluminum. It’s one of the ingredients that vaccine skeptics like to go after.”

Aluminum salts, which are used in some vaccines – including diphtheria, tetanus and acellular pertussis, hepatitis A, and hepatitis B vaccines – boost the body’s immune response to the vaccine, O’Leary said.

“They’ve been safely used in vaccines for about 100 years and have been received by billions of people,” said Dr. Jesse Goodman, professor of medicine and infectious diseases at Georgetown University. “They strengthen our immune response and keep the antigens of the vaccine from disappearing too quickly.”

Wildcard issues, including alleged children’s deaths from Covid-19 shots

At issue: It’s been difficult for the public and public health stakeholders to provide focused input to the committee because information has not been shared in advance about the substance of the issues that will be discussed.

Why it matters: “There’s like zero transparency in this draft agenda,” said Rekha Lakshmanan, executive director of The Immunization Partnership, a Houston-based advocacy group. “We don’t know who’s going to be speaking. You know, it’s sort of like this rough outline that you put together in high school.”

With the ACIP meeting coming soon after last week’s internal FDA memo alleging 10 children’s deaths have been linked to Covid-19 vaccination, Lakshmanan, O’Leary and others said it’s possible the committee will raise the issue.

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

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

2025-12-02T18:17:08+00:00

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

Working out of a tribal-owned hospital in Anchorage, Alaska, liver specialist Brian McMahon has spent decades treating the long shadow of hepatitis B. Before a vaccine became available in the 1980s, he saw the virus claim young lives in western Alaskan communities with stunning speed.

One of his patients was 17 years old when he first examined her for stomach pain. McMahon discovered she had developed liver cancer caused by hepatitis B, just weeks before she was set to graduate from high school as valedictorian. She died before the ceremony.

McMahon thinks often of an 8-year-old boy who showed no signs of illness until he complained of pain from what turned out to be a rapidly growing tumor on his liver.

McMahon can still hear his voice.

“He was moaning in pain, saying, ‘I know I am going to die soon,’” he recalled. “We were all crying.” The boy died at home a week later.

The hepatitis B virus is transmitted through blood and bodily fluids, even in microscopic amounts, and the virus can survive on surfaces for a week. Like many of his patients, McMahon said, both children contracted hepatitis B at birth or in early childhood.

That outcome is now preventable. A birth dose of the vaccine, recommended for newborns since 1991, is up to 90% effective in preventing infection from the mother if given in the first 24 hours of life. If babies receive all three doses, 98% of them have immunity from the incurable virus, with the protection lasting at least 30 years.

FDA delays left recalled baby formula on store shelves, food safety expert says

In the communities of western Alaska, years of targeted testing and widespread vaccination efforts led to the number of cases plummeting.

“Liver cancer has disappeared in children,” McMahon said. “We haven’t seen a case since 1995. Nor do we have any children under 30 that have gotten infected that we know of.”

He worries those hard-won gains could soon be rolled back.

Vaccine panel may limit children’s access

A Centers for Disease Control and Prevention vaccine advisory panel appointed by Health and Human Services Secretary Robert F. Kennedy Jr. is scheduled to discuss and vote on the hepatitis B birth dose recommendation during its two-day meeting starting Thursday, potentially limiting children’s access.

On Tucker Carlson’s podcast in June, Kennedy falsely claimed that the hepatitis B birth dose is a “likely culprit” of autism.

He also said the hepatitis B virus is not “casually contagious.” But decades of research shows the virus can be transmitted through indirect contact, when traces of infected fluids like blood enter the body when people share personal items like razors or toothbrushes.

The committee’s recommendations carry weight. Most private insurers must cover the vaccines the Advisory Committee on Immunization Practices endorses, and many state vaccination policies are directly linked to its guidelines.

Neither ACIP nor the CDC is regulatory. They cannot mandate immunizations. It’s up to states to do that. But keeping the recommendation for a hepatitis B vaccine at birth preserves the widest range of options for families. They can choose to vaccinate at birth, wait until later in childhood, or not vaccinate at all, and insurance will continue to cover the cost of the shot as long as it remains approved by the Food and Drug Administration.

Health alert shows growing concerns about type of mpox spreading in Europe and California

Two senior FDA officials — Commissioner Marty Makary and top vaccine regulator Vinay Prasad — suggested at the end of November that changes to the vaccine approval process may be coming. Vaccines must be approved by the FDA to be administered in the United States.

In internal agency emails obtained by PBS NewsHour and The Washington Post, Prasad questioned the routine practice of “giving multiple vaccines at the same time.” It’s not clear whether he was referring to combination vaccines that offer immunity against multiple diseases with a single shot. Three of the nine hepatitis B vaccines currently approved by the FDA are combination vaccines. The birth dose of the hepatitis B vaccine is given only as a stand-alone vaccine.

Meeting designed around ‘sowing distrust’

If private insurers opt to still cover the shot, misinformation from the meeting still could lead families to falsely believe the vaccine could harm their babies, said Sean O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and an assistant professor of pediatrics at the University of Colorado School of Medicine.

“Whatever comes out of this disaster of a meeting in December is going to be mainly designed around sowing distrust and spreading fear,” he said.

President Donald Trump, Kennedy, and some newly appointed ACIP members have mischaracterized how the liver disease spreads, ignoring or downplaying the risk of transmission through indirect contact. The hepatitis B virus is far more infectious than HIV. Unvaccinated people, including children, can get infected from microscopic amounts of blood on a tabletop or toy, even when the infected person is asymptomatic.

McMahon has cared for children who tested negative at birth and later became infected through indirect contact. In a study in the 1970s, nearly a third of such children went on to develop chronic hepatitis B without ever showing symptoms, he said.

“It’s a very infectious virus,” McMahon said. “That’s why giving everybody the birth dose is the best way to prevent it.”

The CDC recommends that all pregnant people be screened for hepatitis B, but it estimates that up to 16% are not tested and fall through the cracks. O’Leary and other experts say testing mothers for the virus shortly before or after delivery is unfeasible, because most hospitals lack the staff and resources.

The three-dose vaccine has a long track record of safety. Numerous studies show it is not associated with an increased risk of infant death, fever or sepsis, multiple sclerosis, or autoimmune conditions, and severe reactions are rare.

“We have an incredible safety profile,” O’Leary said. “No one expects to get in a car wreck, right? And yet we all put our seat belts on. This is similar.”

The CDC estimates that 2.4 million people in the United States have hepatitis B and that half do not know they are infected. The disease can range from an acute infection to a chronic one, often with few to no symptoms. If the disease is left untreated, it can lead to serious conditions such as cirrhosis, liver failure, and liver cancer. There is no cure.

Expert’s advice to parents: Talk to a doctor

William Schaffner, a professor of preventative medicine at the Vanderbilt University School of Medicine and a former voting member of ACIP, said some parents struggle to understand why a healthy newborn needs a vaccine so soon after birth, especially for a virus they feel certain they don’t have and often wrongly associate only with risky behaviors. Those perceptions, he said, mix with declining trust in public health and rising skepticism about vaccines.

His advice to expectant parents who are on the fence is to talk to their doctor about the shots. Even if the pregnant woman has tested negative, he said, it’s still important to give the baby the birth dose, because false negatives are possible and because the virus can spread so easily from surface contact. Babies who receive the full vaccine series starting from birth have their chance of liver cancer reduced by 84%.

“If you wait a month and if the mom happens to be positive, or the baby picks it up from a caregiver, by that time the infection is established in that baby’s liver,” Schaffner said. “It’s too late to prevent that infection.”

He said that if fewer people get vaccinated, hepatitis B will circulate at higher rates in American communities and the risk of contracting the virus will rise for everyone who doesn’t get the shots.

And more hepatitis B cases could mean higher costs for patients and the broader health care system. The CDC estimates treating someone with a less severe form of the disease costs $25,000 to $94,000 per year. For patients who require a liver transplant, annual medical expenses can climb above $320,000, depending on their treatment.

Over the past 30 years, the main adverse events parents have reported from their babies receiving the birth dose have been fussiness and crying, both of which pass quickly. Schaffner said that’s a very strong safety profile — for a newborn vaccine with a track record of protecting babies from an incurable disease.

“The data are so clear about this,” Schaffner said. “A whole array now of other countries have initiated this program. They’ve modeled it on us.”

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