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

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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

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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.

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

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

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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

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

2026-04-27T23:55:10+00:00

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The South Carolina measles outbreak is one of the largest in the United States in decades.

It started with just five known cases in October, but by January exploded to 847 – becoming larger than last year’s deadly outbreak in Texas. By mid March, the outbreak had further grown to 997 known cases.

Along the way, hundreds of additional people in South Carolina – many of them children at schools with low vaccination rates – have had to stay in home quarantine for up to 21 days because they aren’t immunized and have been exposed to contagious people.

South Carolina’s state epidemiologist, Dr. Linda Bell, has said there also were likely many more people who weren’t in quarantine, but should have been. They were unaware they had been exposed during the normal course of their lives: Going to work, school, and church, shopping for groceries, dining in restaurants, and visiting museums.

Measles spreads through the air and can linger in a room for two hours after an infectious person has left. The people who are spreading the disease often don’t know they have it: They are contagious for four days before they develop the virus’ hallmark rash.

A Healthbeat review of the outbreak’s history provides a detailed timeline of how the South Carolina Department of Public Health worked to trace and contain new infections. For a while, the outbreak smoldered with few new cases. Then the holiday season supercharged the spread in January.

The South Carolina outbreak was declared over on April 27.

Here is how it happened.

October 2, 2025 - South Carolina announces measles outbreak

Total outbreak cases: 5.

The South Carolina Department of Public Health announces it has confirmed a measles outbreak in the Upstate region, the northwest part of the state that includes Spartanburg County. During 2025, the state had only identified three earlier measles cases: two in July and one in early September – and those were linked to exposures during international travel, plus one close contact of a traveler who became infected. “We now have identified five cases in a little more than a week,” Bell said. “This sharp uptick in cases and the unknown source of two of the recent cases indicates unrecognized community spread.”

October 7, 2025 - Two schools have early outbreak cases

Total outbreak cases: 7. New cases: 2.

Two additional cases of measles are identified in Spartanburg County, raising to seven outbreak cases that had been reported since Sept. 25. None have an identified source, state health officials said, “suggesting that measles is circulating in the community.” Two schools – Global Academy of South Carolina, a public charter school where state data show only 21% of students had all their school vaccinations, and Fairforest Elementary, a public school where 82% of students were up-to-date on their school shots – are locations with confirmed measles cases. Health officials identified 153 unvaccinated students at the two schools who were exposed and at risk of measles infection, resulting in their required exclusion from classes until the 21-day period of potential disease transmission was over. The school exclusion periods were over on Oct. 21 for the Global Academy students, and on Oct. 22 for the Fairforest students.

Vaccination coverage of 95% is needed in local communities to stop the spread of measles. Across Spartanburg County, the state health department estimates that just 90% of school-age children are fully vaccinated. Rates at some schools are even lower, state data show.

Global Academy of South Carolina, a public charter school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

October 9, 2025 - A child in Greenville County has measles

Total outbreak cases: 8*. New cases: 1.

State health officials announce another case of measles, a child in Greenville County, which borders the west side of Spartanburg County. While it was not immediately clear whether the child’s illness was related to the Spartanburg County outbreak, health officials eventually included the case in the outbreak count. “What this case tells us is that there is active, unrecognized community transmission of measles occurring in the Upstate, which makes it vital to ensure that the public have received their measles vaccinations,” the state health department said. The department would later identify the Crunch Fitness gym at 1332 S. Pleasantburg Dr. in Greenville as the source of the child’s exposure on Sept. 30.

(*) Total case count includes this Greenville County child, whose measles case was later determined to be an outbreak case on Oct. 21.

October 13, 2025 – Quarantines appear to be working

Outbreak investigators from the state health department are optimistic about their efforts to control the spread of measles at Global Academy of South Carolina and Fairforest Elementary, according to internal health department records obtained by Healthbeat. “The quarantine of students from Global Academy and Fairforest Elementary appears to be working. The recent confirmed cases in those exposure groups did not lead to additional case investigations because they were already in quarantine,” according to an Oct. 13 email obtained by Healthbeat that the state health department sent to staff in the governor’s office.

October 14, 2025 - School exposures result in more cases

Total outbreak cases: 13*. New cases: 5.

Five new measles infections are confirmed among unvaccinated students who were already in quarantine at home because of previously reported school exposures. The department previously identified exposures at Global Academy of South Carolina and Fairforest Elementary. “Because they were quarantining before they became infectious, no additional exposures occurred with these new cases,” state health officials said. The state health department announces the next day that it will be sending its mobile measles vaccination unit to hold five events at four locations in Spartanburg County – including churches, a community center, and a library.

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 17, 2025 - Three cases among contacts in quarantine

Total outbreak cases: 16*. New cases: 3.

Three new cases are identified among close contacts of people with measles who were already in quarantine at home. State health officials said the new cases show how early quarantine after an identified exposure “is highly effective in preventing community spread.”

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 21, 2025 - Four new cases in Spartanburg County

Total outbreak cases: 20. New cases 4.

Two new cases are confirmed among close contacts of people already in home quarantine. And two additional measles cases are identified in association with a business in Spartanburg that had “no public exposures,” health officials said. They also announce that the Greenville County child exposed at a gym whose case was announced on Oct. 9 is now being considered an outbreak case “due to ongoing unrecognized community transmission.”

October 24, 2025 - Two more sickened with measles

Total outbreak cases: 22. New cases 2.

Two new measles cases are confirmed in Spartanburg County; both are linked to close contacts of people with measles who had been in quarantine at home, state health officials announced.

October 28, 2025 - Mobile clinics give 24 shots as more fall ill

Total outbreak cases: 30. New cases: 8.

As state health officials announce eight new measles cases in Spartanburg County among close contacts of people already in home quarantine, they continue to send their mobile vaccination clinic to offer free measles shots at more locations. Multiple vaccination events have been offered in the community since Oct. 16, but only 24 vaccines have been administered: 19 to adults and five to children, state health officials said.

October 31, 2025 - State emphasizes isolation, quarantine

Total outbreak cases: 34. New cases: 4.

Four new measles infections were confirmed in Spartanburg County. All were linked to close contacts of previously known cases. “No public exposures have been identified from these cases,” state health officials said. “We continue to rely on isolation and quarantine measures for those who have been exposed and are unvaccinated to prevent the spread of measles in the community to contain this outbreak.” The state health department added that its “additional response” to the outbreak “is to encourage protection with the measles-mumps-rubella (MMR) vaccine for those who are not immune.” With free mobile vaccination clinics ongoing, just 28 doses of MMR vaccine – 23 to adults and five to children – have been administered since the outreach events began on Oct. 16.

November 4, 2025 – No new cases as holiday season looms

Total outbreak cases: 34. New cases: 0.

No new measles cases were identified by health officials since the previous Friday. Yet they cautioned that 34 people were still in quarantine because they were unvaccinated and had been exposed to someone who was contagious. The latest end date for those in quarantine to no longer be at risk of developing measles is Nov. 24. “We are reminding people that travel for the upcoming holidays increases the risk of exposures greatly for those traveling and for those accepting visitors,” the state health department said. “Consider getting vaccinated now to prevent measles from disrupting your holiday plans.”

November 7, 2025 – Another case confirmed, more expected

Total outbreak cases: 35. New cases: 1.

State health officials announce they have identified one new measles case and are still investigating how many people may have been exposed to the virus by this person. “We also expect more cases to come in the days ahead from exposed family members of known previous cases,” the state health department said, noting that there are 31 people in quarantine.

November 10, 2025 – Restaurant mistakenly flagged for exposure

While investigating the ongoing outbreak, state health officials put out a press release saying a person who was infectious with measles was at the Kanpai of Tokyo restaurant at 2300 Winchester Pl. in Spartanburg on Nov. 2 from 3 to 6 p.m.; they urged anyone who believes they were exposed – particularly those without immunity – to contact their health care providers. But a mistake was made, and the health department said it had been given the wrong date: The person actually dined at the restaurant in late October – at a time when they weren’t infectious.

“Our business went down for a good two months. We lost sales, we lost wages,” general manager Nick Nakincheng told Healthbeat. “People thought we closed, and then people were just scared to even come at all.” Business is finally returning, he said in January. But the state health department, while acknowledging the error to the Post and Courier in December, still had not corrected its press release as of Jan. 26. The department declined to answer Healthbeat’s questions about the error or explain why the press release remained posted on its website without correction – even though it had corrected at least one other outbreak press release. After Healthbeat published this timeline, the department added a correction to its Kanpai of Tokyo press release.

The general manager of Kanpai of Tokyo said the Spartanburg restaurant lost business after the state health department publicly warned in November 2025 that an infectious person had dined there. It later turned out that outbreak investigators were given a wrong date – and the person wasn’t contagious when they were at the restaurant.

November 12, 2025 – Eight new measles cases identified

Total outbreak cases: 43. New cases: 8.

Of the eight new measles cases announced by state officials, six were household members of known cases who were in quarantine. But the source of the infection for the other two cases, who were people from the same household, is unclear. “The unidentified source of the two new cases reinforces our concern about potential ongoing community transmission,” the state health department said.

November 14, 2025 – One new measles case

Total outbreak cases: 44. New cases 1.

Just one new measles case has been identified since the state’s last update and the extent of others exposed to the person is still under investigation, state health officials said; 18 people are currently in quarantine because of outbreak exposures.

November 18, 2025 – More cases, more public exposures

Total outbreak cases: 49. New cases: 5.

While two of the five new cases are household members of known measles cases in quarantine, the source of the infection of the other three people is unknown, state health officials said. “The initial investigation of contacts of the new cases has determined potential exposures in public settings. Additional information will be provided once more details are obtained,” the department said, noting that 84 people are in quarantine and that direct contacts and facilities that have been impacted are being notified about the potential exposures.

November 21, 2025 – School, church, airport exposures

Total outbreak cases: 52. New cases: 3.

State health officials announce the confirmation of three new measles cases – and that as a result of contact tracing by health workers, there are now 137 people in quarantine because they are unvaccinated and have been exposed, plus one person in isolation because of infection. Many of these people are from schools in Spartanburg County: 57 are from Lyman Elementary School (where 89% of students were up-to-date on school vaccines); 55 are from Boiling Springs Middle School; and one attends D.R. Hill Middle School (where 88% of students were up-to-date on vaccines). Health officials also warned that an employee at the Greenville-Spartanburg International Airport who was infected with measles may have exposed airport visitors between 9 a.m. and 7 p.m. on Nov. 10 and 11. They also said an infectious person attended the Way of Truth Church in Inman, S.C., which is in Spartanburg County, from 7 to 11 p.m. on Nov. 7 and from 10 a.m. to 2 p.m. on Nov. 9.

State health officials linked multiple outbreak cases to exposures that occurred at the Way of Truth Church in Inman, S.C., which is in Spartanburg County.

November 25, 2025 – Public exposure at county treasurer’s office

Total outbreak cases 55. New cases: 3.

On the Tuesday before Thanksgiving, the state health department announces they have identified three additional measles cases. Two of the people are household members of known cases. The source of the third person’s infection is still being investigated. Meanwhile, the department warns of another public exposure location: An infectious person was at the Spartanburg County Treasurer’s Office on Nov. 17 and 18 during the hours the office was open.

November 28, 2025 – Public exposure event at Costco

Total outbreak cases: 62. New cases: 7.

Of the seven new measles cases announced, six were household members of known cases who were in quarantine, and one was a person exposed in a school setting who also was in quarantine. Total people currently in quarantine: 144; six in isolation. State health officials also warn there was a potential measles exposure event at a Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18 between 9:30 a.m. and 1 p.m.

As the outbreak grew, state health officials warned of infectious people potentially exposing others while shopping at a range of retail stores. One incident occurred at the Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18, 2025.

December 2, 2025 - More school exposures, 14 new cases

Total outbreak cases: 76. New cases: 14.

Eight of the 14 new measles cases announced by state health officials were the result of the previously reported exposure at the Way of Truth Church in Inman. Three of the new cases were exposed in a school setting, and the other three are still under investigation. Based on public health investigations of the new cases, the public was alerted that four Spartanburg County schools were the sites of additional measles exposures, requiring dozens of unvaccinated students to be excluded from school and quarantined. The schools involved: Hendrix Elementary School, where state data show 87% of students are up-to-date on school vaccines (40 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (13 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (5 students in quarantine); and Tyger River Elementary School, where 89% of students are up-to-date on vaccines (17 students in quarantine).

December 5, 2025 – Measles quarantines hit more schools

Total outbreak cases: 84. New cases: 8.

Eight new measles cases are announced by state health officials, but the number of people in quarantine and at risk of developing measles has jumped to 281. Based on public health investigations of the new cases, the public was alerted to new measles exposures at four additional Spartanburg County schools: Fairforest Elementary School, where 82% of students were up-to-date on their school vaccines (44 students in quarantine); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (61 students in quarantine); Fairforest Middle School, where 90% of students are up-to-date on vaccines (fewer than 5 students in quarantine); Dorman Freshman Campus, where 93% of students are up-to-date on vaccines (15 students in quarantine). This is the second round of quarantines at Fairforest Elementary, which was one of the earliest sites of known measles cases in early October.

December 9, 2025 – Earlier church exposure fuels new infections

Total outbreak cases: 111. New cases: 27.

Of the 27 new measles cases announced, 16 resulted from previously reported exposure incidents in November at Way of Truth Church in Inman. Eight of the new infections were among household members of known cases. One infection was from a school exposure, one had an unknown source, and one was from an exposure in a health care setting. State health officials said the new cases have resulted in additional public exposures at Inman Intermediate School, where state data show 83% of students were up-to-date on vaccines (43 students in quarantine). Officials continue to encourage those who may have been exposed to measles to alert their health care provider in advance of going to their office, so that measures can be taken to protect against additional exposures.

December 12, 2025 – More than 300 in quarantine, 15 new cases

Total outbreak cases: 126. New cases: 15.

As state health officials investigate the contacts of 15 new measles cases, they identified two more Spartanburg County schools where public exposures have occurred: Campobello Gramling School, where state data show 80% of students are up-to-date on school vaccines (67 students in quarantine), and Boiling Springs Elementary School, where 80% of students are up-to-date on vaccines (16 students in quarantine). Overall, 303 people are in quarantine, many of them students at 11 schools. The large number in quarantine is a potential warning sign of the magnitude of future measles cases because there is a lag time between when people are exposed and when they start feeling sick – typically seven to 10 days, but sometimes as long as 21 days.

Of the 15 new cases, 13 involved exposures within households with known measles cases; one infection involved a neighborhood contact; and the source of one is unknown and under investigation.

Boiling Springs Elementary, a public school operated by Spartanburg County School District Two, is among several schools in South Carolina’s Upstate region that have had multiple rounds of quarantines.

December 16, 2025 - Nine new cases, another school exposure

Total outbreak cases: 135. New cases: 9.

Of the nine new measles cases announced, five were the result of a previously reported exposure at Way of Truth Church in Inman. Three cases involved known household exposures and one involved a neighborhood contact. Investigations of the new cases identified an additional Spartanburg County school with public exposures: Berry Shoals Elementary School, where 93% of students are up-to-date on school vaccines (44 students in quarantine).

December 19, 2025 – Another school with measles exposures

Total outbreak cases: 144. New cases: 9.

State health officials announce nine new measles cases: Four were infections of household members of known cases; one was from a previously identified school exposure; one was from a previously identified exposure at Way of Truth Church in Inman; and the source of three infections is unknown. Contact investigations for the new cases identified an additional school where measles exposures have occurred: New Prospect Elementary School in Inman, where 82% of students are up-to-date on school vaccines (56 students in quarantine).

December 23, 2025 – Nine new measles cases identified

Total outbreak cases: 153. New cases: 9.

Of the nine new cases announced, five resulted from household exposures to known cases; two involved a previously known school exposure; the source of one is unknown; and another is still being investigated.

December 26, 2025 – Three new measles cases identified

Total outbreak cases: 156. New cases: 3.

Amid the holiday season, three new measles cases were reported between Tuesday and Friday. All were the result of a previously reported school exposure, state officials said. There are 252 people in quarantine and three in isolation. The latest end date for those in quarantine is Jan. 15.

December 29, 2025 – School contact tracing delayed by holidays, resistance

Although it was not made public at the time, internal health department records later obtained by Healthbeat under South Carolina’s public records law show how efforts to quickly quarantine schoolchildren exposed to measles before winter break were hampered by school closures, as well as resistance from one school. With students continuing to fall ill with measles in late December, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff and others who had been exposed before the two-week break. The schools where state records show contact-tracing delays occurred included: Global Academy of South Carolina, Sugar Ridge Elementary, Boiling Springs Elementary, and Jesse S. Bobo Elementary. The result: During this critical period in the outbreak, as cases were rising and more people were socializing and traveling, public health officials were not able to warn potentially infected people they needed to quarantine at home.

“Our inability to get contact information for potentially exposed students and notify those families resulted in some people being out and about in the community without knowing that they were infectious,” Bell would later tell Healthbeat. “The consequences being new cases due to additional exposures from people who would have otherwise been in quarantine had we been able to make contact.” At one school that health officials were able to reach by email on Dec. 29 – Westgate Christian School in Spartanburg – the principal refused to provide required information about students who had been exposed to measles. “We will not provide personal details and immunization status information for the students in our school,” the principal replied the next day. After state health officials sent Westgate a “final notice” letter in early January that threatened enforcement actions and potential fines, the school provided the information.

December 30, 2025 – As cases rise, 3 hospitalized from measles

Total outbreak cases: 176. New cases: 20.

Since Friday, state health officials identified 20 new measles cases and learned of three people – including adults and children – who required hospitalization because of complications from the disease. Citing patient privacy, health officials would not provide additional details about the hospitalized cases. The measles virus can cause serious complications such as pneumonia, brain inflammation, risks of premature births for pregnant mothers and it also can weaken a person’s immune system. Of the new cases, seven involved household exposures, five involved a previously known school exposure, two involved a church exposure, and one resulted from an exposure at either school or church, the state health department said.

January 2, 2026 – Nine more measles cases identified

Total outbreak cases: 185. New cases: 9.

Of the nine new cases detected, four were household exposures of known measles cases; one involved a previously reported school exposure; one case is still being investigated; and the source of three cases is unknown. The number of people in quarantine because they lack immunity and have been exposed: 223; three are in isolation for infections.

January 3, 2026 – Exposures at Best Buy, restaurant, library

The state health department announces that a person who did not know they were infectious with measles visited multiple public locations during the previous week. On Dec. 24, they visited the Nose Dive Restaurant, a gastropub at 116 S. Main St. in Greenville, then went to a Best Buy store at 1125 Woodruff Rd. in Greenville. A few days later, on Dec. 27, they attended an afternoon planetarium show about solar superstorms at the Spartanburg County Public Libraries headquarters library in downtown Spartanburg, which in October opened a new planetarium learning center with a 135-seat domed theater. Todd Stephens, the county’s librarian, said a public health official called him the day before the state’s press release went out and let him know someone with measles had been in the library’s theater a week earlier. “We have a response plan on Covid. We don’t have a document like that for this,” Stephens told Healthbeat. “But I can say we applied some of those principles that we’ve learned.” He said he’s not received any calls or concerns from library patrons about the potential exposure and he is not aware of anyone becoming infected.

A person who didn’t know they were infectious with measles attended an afternoon show in the Spartanburg County Libraries 135-seat domed planetarium theater on Dec. 27, 2025 in downtown Spartanburg, according to state health officials.

January 5, 2026 – S.C. outbreak exposes other states

People infected in South Carolina’s outbreak have exposed others while traveling, including at sites in Kentucky, North Carolina, Texas, Georgia, and New Mexico, according to a Jan. 5 memo the South Carolina Department of Public Health sent to staff at the South Carolina governor’s office. “The three latter sites are all associated with one case,” said the memo, which Healthbeat obtained with a public records request. “We sent an exposure notifications [sic] to all U.S. jurisdictions regarding the potential for exposure at the out-of-state-sites.”

January 6, 2026 – Public exposures at more schools, churches

Total outbreak cases: 211. New cases: 26.

Among the 26 new cases identified by state health officials, 19 involved exposures in households with known cases and at schools with previously announced exposures. Four of the new infections resulted from an exposure at church. One case has an unknown source, and two are still being investigated. Another 144 people without immunity are in quarantine because of exposures. Investigations of recent cases identified multiple locations of public exposures. Nine students are in quarantine at two Spartanburg County schools where these exposures occurred: Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines. It was the second time during the outbreak that students at Boiling Springs Elementary had to be quarantined; the previous quarantines were in December. Churches where public exposures occurred, health officials said, included: Tabernacle of Salvation Church, Slavic Pentecostal Church of Spartanburg, Ark of Salvation Church, and the Unitarian Universalist Church of Spartanburg.

January 7, 2026 - Health alert sent to providers, facilities

The state department of public health sent out a statewide alert to all health care providers and facilities about the importance of having “heightened awareness” for measles and providing advice on the recommended measures for the use of masks and rapid isolation of people suspected of having measles infections to protect others in health care settings from being exposed.

January 9, 2026 – Measles cases spike with 99 new infections

Total outbreak cases: 310. New cases: 99.

Between Tuesday and Friday this week, state health officials identified 99 new cases of measles. They said another 200 people were in quarantine because of exposures. Dr. Linda Bell, the state epidemiologist, warned it was becoming increasingly difficult to identify likely sources of infection because of the increasing number of public exposure sites. “The number of those in quarantine does not reflect the number actually exposed,” Bell said. “An increasing number of public exposure sites are being identified with likely hundreds more people exposed who are not aware they should be in quarantine if they are not immune to measles.” The department flags one new public exposure site: Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Jesse S. Bobo Elementary School, a public school in Spartanburg County School District Six, had a measles exposure incident that state health officials announced on Jan. 9, 2026.

January 12, 2026 – Measles exposures at BMW, Michelin plants

Although not publicly known at the time, internal South Carolina Department of Public Health records obtained by Healthbeat show that large manufacturing plants for BMW and Michelin in Spartanburg were the sites of measles exposure incidents in January. While the health department alerted staff at the South Carolina governor’s office about the plant exposures in a Jan. 12 email, these exposures at large, prominent manufacturing plants weren’t publicly announced. When Healthbeat later revealed the exposures, BMW said it kept its workforce informed about measles cases at the plant and that the company was providing on-site access to vaccinations. Michelin declined to answer questions about what actions it took.

January 13, 2026 - Surge continues with 124 new measles cases

Total outbreak cases: 434. New cases: 124.

Health officials announce another surge in cases, with 124 new infections identified in recent days. They said another 409 people are in isolation because they were exposed and lacked vaccination or immunity from previous infection; 17 were in isolation. Investigators have learned of more than 30 public locations where infectious people have potentially exposed others to measles in recent days, Bell said. Besides schools, these locations have included churches, restaurants, and many health care settings, she said. But the department is only naming locations where details about exposure dates and times are available to allow the public to take informed actions, she said.

Adding to concerns: Health officials learned that a person who didn’t know they were infectious had visited the South Carolina State Museum in Columbia – the state’s capital city, which is about 95 miles southeast of the outbreak area in Spartanburg County. No measles cases have been identified outside the Upstate region, officials said. “Circulation of the measles virus is increasing in numerous community settings in the Upstate, and the risk of infection to those who are not immune to measles by vaccination or previous disease is increasing,” Bell said. “This includes people who may be traveling to the upstate region. So [the Department of Public Health] strongly encourages those who are not protected to consider getting vaccinated now to protect against unexpected exposures, against illness, and possible complications.”

January 15, 2026 – S.C. residents spark Washington, N.C. cases

The Snohomish County Health Department in Washington state announces that an infectious family from South Carolina who was visiting the area two weeks ago is now connected to three new measles cases among local children. The three cases are considered an outbreak and a sign the virus is spreading in the community, the department said. The South Carolina family members, one adult and two children, were infectious while visiting multiple locations in Everett, Marysville, and Mukilteo – including schools – from Dec. 27, 2025 through Jan. 1, 2026. They also flew through Seattle-Tacoma International Airport. “We are hoping to contain it, but unfortunately there have been a number of exposure sites already and there are likely more cases in the community that we do not know about yet,” said Dr. James Lewis, the Snohomish County health officer.

In North Carolina, state health officials announce that the South Carolina outbreak is connected to two cases of measles in unvaccinated siblings Buncombe County, N.C.

January 16, 2026 – Schools hit with repeated quarantines

Total outbreak cases: 558. New cases: 124.

Another 124 new measles cases are announced by state health officials; 531 people are in quarantine; and 85 are in isolation. The outbreak continues to be centered around Spartanburg County, they said.

Based on investigations of the newest cases, health officials said public exposures have occurred at nine schools: Holly Springs-Motlow Elementary, where state data show 80% of students are up-to-date on school vaccines (53 students in quarantine); Campobello Gramling School, where 80% of students are up-to-date on vaccines (46 students in quarantine – and the school’s second round of quarantines); Crestview Elementary, where 90% of students are up-to-date on vaccines (22 students in quarantine); Libertas Academy, where 74% of students are up-to-date on their vaccines (15 students in quarantine); Fairforest Elementary, where 82% of students were up-to-date on their school vaccines (14 students in quarantine – and the third round of quarantines at this school); Berry Shoals Elementary, where 93% of students are up-to-date on school vaccines (14 students in quarantine – and the school’s second round of quarantines); Oakland Elementary, where 83% of students are up-to-date on vaccines (6 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (6 students in quarantine – and the school’s second round of quarantines); and Landrum High School, where 94% of students are up-to-date on vaccines (5 students in quarantine).

Additional public exposures occurred during certain hours at: Walmart at 203 Cedar Springs Rd. in Spartanburg on Jan. 3; Wash Depot at 2177 S. Pine St. in Spartanburg on Jan. 3 and 4; and at Bintime Spartanburg at 445 S. Blackstock Rd. in Spartanburg on Jan. 7.

Fairforest Elementary, a public school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

January 20, 2026 – Exposures at schools, Clemson University

Total outbreak cases: 646. New cases: 88.

“As we continue to watch this daily surge in cases, DPH strongly encourages those who are not protected to take advantage of the opportunity to get protected,” Dr. Linda Bell, the state epidemiologist, says at a press briefing about the outbreak numbers released on Jan. 20.

In recent days, state health officials identified 88 new measles cases. They said 538 people are in quarantine and 33 in isolation. Bell said that since the outbreak began,10 people, including adults and children, have required hospitalization for measles complications.

Through investigations of the latest cases, health officials have identified six additional schools where public exposures have recently occurred: Starr Elementary, where 96% of students are up-to-date on school vaccines (17 students in quarantine); Global Academy of South Carolina, where 21% of students are up-to-date on vaccines (13 students in quarantine – and this school’s second round of quarantines); Boiling Springs High School, where 92% of students are up-to-date on vaccines (11 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (fewer than 5 students in quarantine – this is the school’s second round of quarantines); Boiling Springs Elementary (students in quarantine to be determined – this is the school’s third round of quarantines); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (quarantine numbers still being determined – this is the school’s second round of quarantines).

Public exposures have also been identified at Clemson University (where 34 students were in quarantine) and Anderson University (where 50 students were in quarantine). While both universities are in South Carolina’s Upstate region, they are in counties west and southwest of the Spartanburg County area where the outbreak has been centered.

Additional public measles exposures were announced as occurring during certain hours at two grocery stores: a Publix at 2153 E. Main St. in Duncan on Jan. 16; and a Food Lion at 11153 Asheville Hwy. in Inman on Jan. 11 and 12.

January 23, 2026 – Cases reach 700, plus 485 in quarantine

Total outbreak cases: 700. New cases: 54.

The number of known cases in South Carolina’s measles outbreak is approaching the total cases in the huge Texas outbreak last year. When the Texas outbreak was declared over in August 2025, the state health department had confirmed 762 measles cases since late January 2025. Two school-age children died and 99 people required hospitalization. The South Carolina Department of Public Health announces it has identified 54 new measles cases in the Upstate region – raising the total outbreak cases to 700. There are an additional 485 people in quarantine and 10 people are in isolation, the department said. Since the outbreak began, 12 people have required hospitalization.

Case investigations have identified additional public exposures at multiple schools: Cooley Springs-Fingerville Elementary, where 77% of students are up-to-date on their school vaccines (22 students in quarantine); Cannons Elementary, where 95% of students are up-to-date on vaccines (8 students in quarantine); Abner Creek Middle School, where 89% of students are up-to-date on vaccines (the number of students being quarantined is still being determined); Mayo Elementary, where 89% of students are up-to-date on vaccines (student quarantines still being determined); and Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines (student quarantines still being determined, this is the second round of quarantines at this school).

Additional public exposure locations occurred during certain hours at: Anytime Fitness at 3621 Boiling Springs Rd. in Boiling Springs on Jan. 13; the U.S. Post Office at 504 Pennsylvania Ave. in Greer on Jan. 13; Goodwill at 1333 W. Wade Hampton Blvd. in Greer on Jan. 13; and Aldi at 1560 W. Floyd Baker Blvd. in Gaffney on Jan. 17.

January 27, 2026 – S.C. outbreak exceeds Texas outbreak

Total outbreak cases: 789. New cases: 89.

State health officials announce they have confirmed 89 new measles cases, and that there are 557 people in quarantine and 20 in isolation. Outbreak investigators also have identified more public measles exposures that have occurred at several schools: Dorman High, where 96% of students are up-to-date on school vaccines; Inman Intermediate, where students have previously been quarantined and 83% of students are up-to-date on vaccines; and New Prospect Elementary in Inman, where students have previously been quarantined and where 82% of students are up-to-date. The state health department said the number of students that need to quarantine at each of these schools is still being determined. The newly identified cases raise the South Carolina outbreak’s total to 789 – surpassing the number sickened in the deadly Texas outbreak last year. In Texas, 762 cases of measles were confirmed in an outbreak that began in late January 2025 and was declared over in August 2025.

January 30, 2026 – Surge puts 443 in quarantine

Total outbreak cases: 847. New cases: 58.

Numbers released by the state health department show 58 new measles cases have been identified. There are 443 people in quarantine who have been exposed, who lack immunity, and who are at risk of developing the disease in the coming days and weeks. Twenty people are in isolation because of illness. Public health investigators have identified a school and a fast food restaurant with recent public exposures because of the presence of an infectious person. Health officials are still determining how many students need to be quarantined and excluded from class at the school, Lyman Elementary, where state records show 89% of students are up-to-date on school vaccines. The school was involved in a previous exposure situation announced on Nov. 21. The other public exposure event involves a Burger King restaurant at 6196 US-221 in Roebuck, S.C., that occurred on Jan. 28 between 11:30 a.m. and 2:30 p.m.

February 3, 2026 – Fewer infections – but one in Sumter County

Total outbreak cases: 876. New cases: 29.

The state health department announces 29 new cases of measles in the ongoing outbreak in South Carolina’s Upstate region, in and near Spartanburg County. They also said a measles case has been confirmed in a resident of Sumter County – which is located in South Carolina’s Pee Dee Region, southeast from where the outbreak has been occurring. “At this point in the investigation, it is not yet clear whether this new case is linked to the Upstate outbreak centered around Spartanburg County or if the case may have been exposed where measles is occurring in other locations,” the department said. The department said public exposures to measles have occurred during certain specific hours at three locations in Sumter, S.C.: Mariachis Mexican Restaurant at 1072 Broad St. on Jan. 23; Food Lion at 5700 Broad Street Ext. on Jan. 24; and the Walmart Neighborhood Market at 343 Pinewood Rd. on Jan. 25. The health department said there are currently 354 people in quarantine who have been exposed to measles and lack vaccination or immunity; 22 people are ill and in isolation.

February 6, 2026 – Vaccination is up significantly

Total outbreak cases: 920. New cases: 44

State health officials announce 44 new measles cases, plus another 277 people who are in quarantine because they were exposed and are unvaccinated or lack immunity from prior infection; eight people are in isolation because of illness. They also announce new locations of public exposure incidents during certain specific time periods at a Social Security Administration office at 145 N. Church St. in Spartanburg on Jan. 29; Boost Mobile at 1515 Asheville Hwy. in Spartanburg on Jan. 29; Rick Erwin’s Level 10 Restaurant at 225 W. Main St. in Spartanburg on Jan. 29; and the Target store at 6025 Wade Hampton Blvd. in Taylors on Jan. 30.

During a media call earlier in the week, Bell said state health officials are encouraged by increases in measles vaccination during January. In Spartanburg County, the number of measles vaccines given last month was up 162% over January 2025, an increase of more than 1,000 doses, she said. Statewide, measles vaccination was up 72%, with about 7,000 more doses given across South Carolina last month than were administered in January 2025. “So far, this is the best month for measles vaccination during this outbreak,” Bell said.

While complications from measles aren’t reportable to state health officials, Bell said the department has learned of some serious complications among 19 people – children and adults – who have been hospitalized since the outbreak began in October. “Some of these complications include measles encephalitis, or inflammation of the brain in children, and pneumonia.”

In addition, Bell said, several pregnant women were exposed to measles and required administration of immune globulin to protect against the high risk of complications measles poses to pregnant women and their newborns. Bell declined to provide additional details about the exposures of the pregnant women. Earlier in the week, Healthbeat revealed a measles exposure incident had occurred on a labor and delivery unit at Prisma Health Greer Memorial Hospital.

February 10, 2026 – Fewer new cases, but one in Lancaster County

Total outbreak cases: 933. New cases: 13

Just 13 new measles cases are announced in the state health department’s update; 235 people are in quarantine because of exposures, and six are in isolation because of illness. The department noted that a measles infection has been confirmed in a resident of Lancaster County; the source of the person’s exposure is still under investigation. The outbreak has not previously had any cases in Lancaster County, which is in north-central South Carolina. Two schools in Spartanburg County have been the sites of recent public exposures: Libertas Academy, where 74% of students are up-to-date on their school vaccines (nine individuals in quarantine); and Inman Intermediate, 83% of students are up-to-date on vaccines (fewer than five individuals in quarantine). People also remain in quarantine from an earlier public exposure at Lyman Elementary School, where 89% of students are up-to-date on vaccines (23 individuals remain in quarantine).

February 13, 2026 – Concerns linger about undetected cases

Total outbreak cases: 950. New cases: 17

The number of new measles cases announced today continues to be well below the numbers during the January surge. The state health department said 17 new cases of measles have been identified and there are another 186 people in quarantine because of exposures; nine people are in isolation because of illness. The recent identification of measles cases in Lancaster and Sumter counties – with no identified source of exposure – indicate that unrecognized transmission of measles is occurring in the community, Bell told reporters this week. “That can result in more and more transmission if we don’t stay on top of those cases, find out where that transmission is occurring, and implement our disease control measures,” Bell said. The outbreak continues to be centered in Spartanburg County, she said, and about 95% of those who have been infected are unvaccinated. The department announced three locations where public exposures have occurred recently during defined time periods: Children’s Medical Center, 841 S. Buncombe Rd. in Greer, all day on Feb. 4 and 6; Itto Ramen Bar, 1807 Poinsett Hwy. in Greenville, on Feb. 5 from 12:30 p.m. to 3:30 p.m.; and HomeGoods, 1125 Woodruff Rd. in Greenville, on Feb. 5 from 10 a.m. to 12:45 p.m.

February 17, 2026 – Most new infections involve known cases

Total outbreak cases: 962. New cases: 12.

State health officials announce 12 new cases and said there are an additional 127 people in quarantine because of exposures; eight people are in isolation because of symptoms. “The majority of cases are close contacts of known cases,” the state health department said. “However, the number of public exposure sites indicates that measles is circulating in the community, increasing the risk of exposure and the risk of infection for those who are not immune due to vaccination or natural infection.” The department said it is aware of 20 hospitalizations, involving children and adults, since the start of the outbreak. Libertas Academy has been the site of a recent public exposure event (17 individuals in quarantine). This school, where 74% of students are up-to-date on their school vaccines, has had previous exposure events, state records show. The department also announced a public exposure event occurred at Walmart – Powdersville, 11410 Anderson Rd. in Greenville on Feb. 8 from 4 to 8 p.m.

February 20, 2026 – Church, school, community college exposures

Total outbreak cases: 973. New cases: 11.

Health officials announce the identification of 11 new measles cases, and say there are 105 people in quarantine because of exposure and seven in isolation because of illness. “We are seeing a slowing, but it is too soon for us to say when this will end,” Bell said this week. “The concern is that we can see ongoing, smoldering transmission that can be introduced into other communities. The measles virus can find susceptible people wherever.”

While the number of new cases announced continues to be low, state health officials warn that public exposures have occurred recently at multiple locations in Spartanburg County. The exposure locations include Mabry Middle School in Inman, where 81% of students are up-to-date on vaccines and exposures have occurred previously. Other sites: Tabernacle of Salvation Slavic Church, 150 Outlet Rd. in Spartanburg, on Feb. 15 from 10 a.m. to 1 p.m.; Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 11 from 6:30 to 10 p.m .; Spartanburg Community College - Giles Campus, 107 Community College Dr. in Spartanburg, on Feb. 17 from 9:30 a.m. to 7:30 p.m.; Costco, 211 W. Blackstock Rd., Spartanburg, on Feb. 17 from 12 to 3 p.m.

February 24, 2026 – Just 6 new cases

Total outbreak cases: 979. New cases: 6.

Just six new cases of measles are announced by state health officials, plus 91 others who are in quarantine for exposures; one person is in isolation because of illness. The latest end date for those in quarantine is March 15. The newest cases have resulted in outbreak investigators identifying public exposures at Willow Creek Gathers Homeschool Co-op, where 17 individuals are in quarantine, the state health department said. Although South Carolina requires immediate reporting of cases of measles or suspected measles to the health department, the state doesn’t specifically require reporting about whether these cases were hospitalized or had complications. Over the course of the outbreak, the health department says it has learned about 21 people, children and adults, who have been hospitalized.

Since the outbreak began, the South Carolina Department of Public Health has used its mobile clinic to offer free measles-mumps-rubella vaccines in the Spartanburg County area.

February 27, 2026 – Hopes for earlier end to outbreak

Total outbreak cases: 985. New cases: 6.

Since Tuesday, state health officials say they have identified six new measles cases. There are 61 people in quarantine because of exposures; two people are in isolation for illness. The latest end date for people currently in quarantine and who may develop the disease is March 20. “We’re encouraged with the downward trend, particularly in the last two weeks,” Bell, the state epidemiologist, said this week. It’s possible that the outbreak may even end earlier than projected, she said. But the risk of another surge remains because of low vaccination coverage. The department said that based on the recent cases, investigators have identified public exposures that have recently occurred at Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines. Fewer than five individuals from the school are in quarantine, officials said. This is the third round of quarantines for the school, health department records show. Another public exposure incident occurred at Costco - Spartanburg at 211 W. Blackstock Rd. on Feb. 22 from 2 to 6 p.m. It’s the third known measles exposure incident at the store, with the others occurring on Feb. 17 and Nov. 18, according to health department reports. State health officials said their mobile health unit will hold another measles vaccination clinic next week.

March 3, 2026 - Increased vaccination is helping slow outbreak, state says

Total outbreak cases: 990. New cases: 5.

The number of new cases reported to the state health department remains low: Just five new cases since Friday, health officials announced. There are 52 people in quarantine because of exposures and four in isolation because of illness. The latest end date for those in quarantine is March 27. The state health department also said there was a public measles exposure incident at Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 22 from 10:45 a.m. to 4 p.m. This church also had a measles exposure incident on Feb. 11. “We saw another strong increase in measles vaccination uptake during the month of February, which is encouraging,” Bell said at a media briefing this week. “Compared to February of 2025, there was a 133% increase in measles vaccination in Spartanburg County, with around 900 additional doses given,” she said. Statewide, there was a 70% increase in measles vaccination, with an additional 7,000 doses given. “This increase in vaccination is one of the reasons why this outbreak is slowing,” Bell said. “But given the surge in cases we saw following the Christmas holidays, we remain concerned that another surge could occur following spring break, when many people can be traveling and participating in more social activities.”

March 6, 2026 – Just one new case as outbreak cost reaches $1.6 million

Total outbreak cases: 991. New cases: 1.

Just one new measles case is announced by state health officials in their Friday update. There are 52 people in quarantine because of exposures and three in isolation because of illness. The latest end date for those in quarantine is March 27. Meanwhile, state health officials told Healthbeat this week that the public health response to the outbreak has cost taxpayers $1.6 million so far. Most of that has been personnel costs, including for contact tracing and other activities to combat the outbreak, the department said.

Of the 991 outbreak cases, most have been children and teens: 260 are younger than 5; 637 are ages 5-17; 86 are age 18 or older; and the age is unknown for eight cases. Almost all who have been infected have been unvaccinated or only partially vaccinated: 925 were unvaccinated; 19 had only one one dose of the recommended two-dose MMR vaccine; 26 were fully vaccinated with two doses of MMR; and the vaccination status was unknown for 21 cases.

March 10, 2026 – Slow trickle of cases continues

Total outbreak cases: 993. New cases: 2.

State health officials announce just two new measles cases have been identified since Friday; 42 people are in quarantine because of exposures; 2 are in isolation because of illness. The latest end date for those keeping watch for signs of illness while in quarantine is April 2. “We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said this week. The department doesn’t want to have measles cases surge during the upcoming spring break period. Bell said the department has asked all schools in the Upstate region to identify a point of contact who will be available when schools are closed over spring break to provide student contact information if it’s needed for measles exposure investigations. Healthbeat previously revealed how outbreak investigations were hampered and quarantines were delayed during school winter break because health officials couldn’t quickly get contact information from several schools.

March 13, 2026 – Three new cases

Total outbreak cases: 996. New cases: 3.

State officials announce three new measles cases, and that the number of people in quarantine because of exposures is down to 30. Four people are in isolation because of illness. The latest quarantine end date is April 2. Of the outbreak’s 996 cases, 993 have been in Spartanburg County and 36 have been in neighboring Greenville County. A handful of additional cases have been in three other nearby counties in South Carolina’s Upstate region: eight in Anderson County, six in Pickens County, and fewer than five in Cherokee County. Two additional counties in other parts of the state also have a small number of cases: Lancaster County, in the state’s Midlands region, and Sumter County in the Pee Dee region each have fewer than five cases, according to state data.

March 17, 2026 – ‘We are not letting our guard down’

Total outbreak cases: 997. New cases: 1.

State officials announce one new measles case and say there are only eight people in quarantine for exposures and none in isolation because of illness. The latest end date for those in quarantine is April 2. “We are not letting our guard down. It is too early to say that we will not see any more cases,” Bell said this week. She said it’s important that health care providers remain vigilant and continue to suspect measles when they see illnesses with a fever and rash. “That gives us the opportunity to immediately place people in isolation, to place their contacts in quarantine, if necessary,” she said. “If we let our guard down too early, then we just put ourselves in the position of allowing more disease to spread if we are not paying careful attention.” Before South Carolina can declare the outbreak over, there must be two incubation cycles – or 42 days – with no new cases, Bell said. In the meantime, spring break for many schools in the Spartanburg area is scheduled for early April, and state officials remain concerned that travel and socializing during the school break period could result in more measles cases.

March 20, 2026 – No new measles cases since Tuesday

Total outbreak cases: 997. New cases: 0.

State health officials, in their Friday update, announced no new measles cases had been identified since Tuesday. The last time there were zero new cases in one of their twice-weekly outbreak updates was more than four months ago on Nov. 4. There are two people in quarantine because of exposures. Their last date in quarantine is March 28.

March 24, 2026 – Again, no new measles cases

Total outbreak cases: 997. New cases: 0.

For the second update in a row, state health officials in their Tuesday update said no new measles cases had been identified. Two people remain in quarantine because of exposures, with a latest quarantine end date of March 28. Nobody is in isolation because of illness. It will take 42 consecutive days with no new cases – two incubation cycles of the virus – to determine that the outbreak’s transmission chain has been broken, the health department said. If the no cases trend continues, the last day of the outbreak will be April 26.

March 27, 2026 – No new cases, only one person in quarantine

Total outbreak cases: 997. New cases: 0.

South Carolina health officials announce they continue to detect no new measles cases. Just one person remains in quarantine because they lack immunity and were exposed – and that person is almost out of danger. Their quarantine ends March 28. One question lingers: Are there still some measles cases that aren’t being detected and reported? A report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, said it was likely measles cases in the outbreak were going unreported, Healthbeat reported.

While Bell told Healthbeat she remains concerned about unrecognized cases, if they exist, the department doesn’t think there are a lot of them. “Our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” she said. Before the outbreak can be declared over, a period of 42 days – two incubation cycles for the virus – must pass without any more measles cases. If that happens, the last day of the outbreak would be April 26.

March 31, 2026 – No new cases and nobody in quarantine

Total outbreak cases: 997. New cases: 0.

With no new cases reported again and also nobody in quarantine, the countdown to the end of the outbreak continues. The outbreak can’t be declared over until two incubation cycles of 21 days each have passed without any new cases. If that happens, the last day of the outbreak would be April 26, state health officials have said.

April 3, 2026 – Still no new cases

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak remains underway as state health officials again announce no new cases.

April 7, 2026 – Still no new cases as DPH scales back public updates

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak continues as state health officials again announce no new cases. Unless a new measles case is identified, the South Carolina Department of Public Health said it will reduce the frequency of its Wednesday media briefings to every other week. While Tuesday outbreak data updates will continue, Friday updates will be discontinued, the department said. “If a new case is reported, DPH will immediately notify the media and resume briefings and updates as appropriate,” the department said.

April 27, 2026 – DPH declares the outbreak over, risks remain

Total outbreak cases: 997.

After 42 days passed without any new outbreak cases, the South Carolina Department of Public Health declared the outbreak to be over.

“Though we reached nearly 1,000 cases, we are grateful that, by and large, it remained confined to one county and did not spread statewide, as was always our concern and fear,” Dr. Brannon Traxler, the department’s deputy director and chief medical officer, said at a news conference.

Traxler said there are three main reasons state health officials think the outbreak has ended: the large number of people infected, widespread community cooperation with quarantine and isolation, and increased vaccination against measles in recent months.

While this record-breaking outbreak is over, Traxler said conditions remain for another measles outbreak in the future, brought into the state through travel.

“If we don’t continue to see increases in vaccination, I’m worried that we could see another large – maybe not this large, but hopefully not – but another large outbreak in a community where it gets introduced from someone who had traveled.”

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

South Carolina’s measles outbreak is over: 7 things to know about largest U.S. outbreak in decades

2026-04-27T23:49:47+00:00

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Officials at the South Carolina Department of Public Health declared their record-breaking measles outbreak to be over on Monday after no new cases emerged during the past 42 days.

Here are seven things to know about the largest U.S. measles outbreak in more than 35 years:

Most people who got infected weren’t vaccinated

Of the 997 measles cases documented in the outbreak, 932 patients were unvaccinated, 19 had an unknown vaccination status, and 20 were only partially vaccinated with only one dose of the two-dose MMR (measles-mumps-rubella) vaccine, according to the department’s data.

Just 26 people were fully vaccinated with two doses of MMR vaccine. Two doses of the vaccine is about 97% effective in providing protection against measles infections; one dose is about 93% effective, according to the Centers for Disease Control and Prevention.

Infections, increased vaccination credited in stopping outbreak

The 997 people sickened with measles developed immunity to the disease, Traxler said. “Though that carried with it, of course, the risk of severe illness, a weakened immune system and the potential for devastating complications even years from now,” she said.

Another important factor in stopping the spread of the virus, she said, was that the “vast majority” of people who were infected or exposed followed public health instructions to stay home and avoid infecting others.

Lastly, thousands of people got vaccinated. In Spartanburg County, she said, an additional 3,788 doses of MMR vaccine were administered during the six months of the outbreak compared with the previous year.

“In particular, January and February were record months for MMR vaccination in the state,” she said.

Risks for future measles outbreaks continue in South Carolina

This outbreak may be over, but outbreak risks remain in Spartanburg County and across the state. Traxler noted that pockets of people who are not protected against measles remain in many communities.

“We’re going to continue to see sporadic cases that are going to be travel-associated most likely,” Traxler said, noting the goal is to keep one of these travel cases from sparking a larger outbreak.

State’s $2.1 million cost is only part of the outbreak’s bill

The department estimates that the outbreak response cost the state of South Carolina $2.1 million. But that was just the costs the department could calculate for staff time, vaccination costs, and other direct expenses.

It doesn’t include all of the costs to the health care system, schools, businesses, and beyond, she said. “What were the economic impacts to the state of parents who had to miss work?” she asked. It’s not part of that number.

Outbreak began with 5 cases, centered in Spartanburg County

The outbreak was first identified in early October, with just five cases. For weeks the virus seemed to spread slowly – then the holiday season began.

On the Tuesday before Thanksgiving, the state had logged 55 measles cases. By Dec. 12, there were 126 cases – and more than 300 people in quarantine, Healthbeat’s timeline of the outbreak shows.

By mid January – after the December holidays and multiple public exposures at schools and churches – the outbreak surged, with more than 100 new measles cases being identified every few days. By Jan. 20, the department had documented 646 cases. Cases slowed during February and March.

The last time the state announced a new case in the outbreak was on March 17, the day the case total reached 997.

Before the measles outbreak could be declared over, there needed to be two incubation cycles – or 42 days – without any new cases.

Winter break school closures delayed investigations, quarantines

During the critical December holiday period – before the outbreak surged – South Carolina health officials were hampered in their efforts to control measles exposures because of winter break school closures, Healthbeat reported earlier this year.

Internal department records, obtained by Healthbeat, revealed how outbreak investigators were delayed in their efforts to quickly quarantine schoolchildren exposed to measles right before the two-week winter break period began. Because schools were closed, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff, and others who had been exposed to infected people.

To prevent similar communications gaps during the recent spring break period, the department contacted schools across the state’s 11-county Upstate region to identify a person who would be available to provide attendance and contact information during the spring break closures of schools and administrative offices.

Department’s response, lessons learned to be evaluated

“The outbreak is over, but our work to understand and prevent measles and future outbreaks is not,” Traxler said. “A thorough after-action review and analysis is being started. We believe our outbreak response team did a tremendous job under really unprecedented conditions. But there are always things that we can learn from and improve on in our future with future responses, and we are committed to doing so.”

One of the things the department did well, she said, was urging members of the health care community to be pro-active in immediately reporting any suspected measles case – even before any test results come back. That early heads-up, she said, allowed the department to immediately start educating the patient about the need to isolate and begin earlier contact tracing.

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

Michigan measles outbreak shows high cost of stopping even a small number of infections from spreading

2026-04-03T22:40:20+00:00

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The small measles outbreak that health officials are combating in Michigan began last month with an unvaccinated young woman returning home from visiting Florida, a state where there have been more than 140 cases this year.

Her first symptoms around March 7 seemed like a cold. By the time the telltale measles rash appeared a few days later, she had exposed her family and scores of other people in public settings, according to health officials in Washtenaw County, near Detroit.

The Michigan outbreak is one of 17 new outbreaks nationwide reported to the Centers for Disease Control and Prevention since January. There have been 1,671 confirmed cases of measles reported this year across 32 states, according to CDC data.

Most of this year’s cases – 94% – have involved outbreaks. Some – like those in Texas and Florida – involve more than 100 infections. In a few, cases have surged into the hundreds, as is the case in the outbreak in Utah, which is still growing, and the outbreak in South Carolina, which appears to be ending.

Many of the outbreaks are small – just a few cases. But as public health officials in Washtenaw County, Michigan, are learning, the resources required to keep them that way can be enormous.

Staffing costs for managing a handful of measles cases: $45,000

“We’re still at seven cases,” Beth Ann Hamilton, communications coordinator for the Washtenaw County Health Department, told Healthbeat this week. “We’re definitely not out of the woods yet.”

Meanwhile, another measles case announced Thursday in neighboring Monroe County has state health officials concerned that measles may be silently spreading in the community. No definitive link has been established to the cases in Washtenaw County, but the timing and location of the new case are concerning, officials at the state health department said.

Because of this risk, the Michigan Department of Health and Human Services is recommending young children receive their first measles shot early – at 6 months to 11 months of age.

Yet even with just a handful of known measles cases, the containment workload is already taking its toll.

Spring break travel risks spread of measles across U.S.

At the Washtenaw County Health Department, measles control is taking priority over many other health department services as staff have been needed to help track down and counsel hundreds of exposed people, test them for immunity to measles when they don’t have vaccination records, and monitor those in quarantine.

“Seven cases may not seem like a lot, but it is, and it’s hundreds and hundreds of contacts that our staff have to follow up on and monitor,” Jimena Loveluck, the department’s health officer, told the Washtenaw County Board of Health on March 27.

“We’re not able to get other work done,” she said. “We just don’t have the capacity to respond and then continue all our regular level of services. The expense also is tremendous.”

Exposures have occurred at a popular mall in Ann Arbor, a community college, hospital, urgent care clinics, several stores, and a restaurant.

Investigating and managing the exposures of just the initial three or four cases cost $45,000 in staff time, Ruth Kraut, the department’s deputy health officer, told the board. Other health department staff noted that $100,000 in funding from the state to help with the outbreak had been largely spent.

@healthbeatnews
Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
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“It’s been a huge effort,” Dr. Juan Luis Marquez, the department’s medical director, told the board. “We get lists of students or patients or whatnot. We don’t have much information to go by other than their name and date of birth. So that basically means our team of nurses and other folks calling everybody to verify their immunization status.”

Because two doses of measles-mumps-rubella vaccine is 97% effective at preventing the disease, public health officials are mostly trying to identify those who aren’t protected so they can be advised to quarantine at home and not spread the disease to others.

But people often don’t remember whether they’ve been vaccinated or don’t have access to their immunization records, Marquez said. So then they need to come to the health department clinic to have a blood test to check to see if they have measles immunity from past vaccination or infection.

The result is that the health department’s clinic is largely focused on measles and vaccine response, he said, and communicable disease efforts are being limited to measles and other high-risk cases.

Like forest fires, measles outbreaks are ‘sending out sparks’

A significant challenge for public health officials is that it’s difficult to know which small measles outbreaks can be quickly and easily contained, and which ones will spread to hundreds of people.

Dr. William Moss, a professor at the Johns Hopkins Bloomberg School of Public Health and director of the school’s International Vaccine Access Center, compared the measles landscape across the United States to a map of forest fires.

“You’ve got these bigger outbreaks, they’re kind of sending out sparks,” Moss said. “If that spark lands in a county or a community with high vaccine coverage, you don’t get much spread. And so you see one of these small outbreaks. But if it does land in a community with a large number of individuals who are under vaccinated or unvaccinated, then you get these larger outbreaks.”

It would be helpful to overlay measles cases onto maps with detailed vaccination coverage data, he said. But sources of vaccination data are limited and fragmented, and while school vaccination data can be helpful, it doesn’t include information about adults in the community.

“We and many other groups have been trying to develop ways to predict or forecast, as best we can, where the hotspots are. It’s just very difficult with measles,” Moss said.

Moss said that to know how easily measles will spread requires having detailed information about the coverage levels of vaccination and immunity within very localized communities where people socialize. But such data isn’t readily available, he said.

The places Moss and his team are watching closely are those where cases have been increasing the most in the past few weeks. That includes Hudspeth County, Texas, where the Johns Hopkins U.S. Measles Tracker has tallied 31 cases in recent weeks, and several counties in Utah, which is in the midst of a surge in its outbreak. Many of the cases in Hudspeth County, Texas involve a federal detention facility.

Since it began last year, Utah’s measles outbreak has sickened 559 people, 362 since January. South Carolina’s measles outbreak, the largest in the United States in decades, has had 997 known cases since October – more than 660 of them since January.

The good news: South Carolina health officials haven’t had a measles case reported to them in more than two weeks. If that trend continues for 42 consecutive days – which is two incubation cycles for the measles virus – that outbreak will be declared over after April 26.

As of early March, the South Carolina Department of Public Health told Healthbeat it had spent $1.6 million on its response to the outbreak.

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

Georgia lawmakers pass health workforce bills, but leave gaps on community health workers

2026-04-03T20:20:27+00:00

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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.

Leadership disruptions at the CDC endanger American health

2026-04-01T11:00:00+00:00

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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

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.

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

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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

The vexing challenge with antibiotics: We’re taking too many. And we need to make more.

2026-03-25T11:00:00+00:00

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

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

Antibiotics are one of the most important inventions of the 20th century. They made it safer for humans to do virtually every normal activity: breath air, drink water, eat food, and have sex. In fact, we now depend on antibiotics so much that we now face a vexing situation: We need to start taking fewer antibiotics, and we need to start making more of them.

In this week’s report, I review a new research finding that even a single course of antibiotics may disturb our body, the over-prescribing of antibiotics by dentists, and new Food and Drug Administration action to address a shortage of one of our oldest antibiotics: penicillin.

Do antibiotics harm your body?

A large new study published in Nature Medicine this month offers some of the most compelling evidence that antibiotics could cause lasting harm to our gut microbiome. The gut microbiome is the dense, diverse community of bacteria that live in our intestines and help with digestion, nutrition, and immunity.

Researchers in Sweden linked prescription records from 14,979 adults to data about each adult’s microbiome (specifically fecal metagenomics data) to study the question: Does antibiotic use in the past eight years show up in the gut microbiome today? The answer was “yes.”

First, associations between antibiotic use and lower gut microbiome diversity were detectable for antibiotics whether they were taken within the past year, one to four years earlier, or four to eight years earlier. Second, the effects varied sharply by drug class: Clindamycin was the most damaging, with each course taken in the past year associated with an average of 47 fewer gut species detected. Each course of fluoroquinolones was associated with 20 to 21 fewer species. Standard penicillins, by contrast, showed minimal or no association. (More on penicillin below). The gut, it seems, has a long memory for antibiotics.

I routinely have to convince patients (as well as friends and relatives) why they do not need antibiotics for their runny nose, benign skin rash, or upset stomach. Often they become frustrated, believing that I am somehow gate-keeping a precious and harmless resource that will relieve their symptoms. One way that I try to assuage them is to explain all the ways that antibiotics could actually hurt, not help, them.

Antibiotics can wipe out protective bacteria in the gut, increasing the risk of Clostridioides difficile (C. diff), which kills nearly 30,000 people in the United States annually, as well as Salmonella and other foodborne bacteria. Repeated antibiotic use has also been linked to an increased risk of obesity, type 2 diabetes, cardiovascular disease, and colorectal cancer — all potentially through microbiome disruption. The effects are also not limited to the gut microbiome. Another study just published in Nature highlighted potential risks to the respiratory tract microbiome when doctors inappropriately prescribe a “Z-pack” to patients with Covid.

Whenever we prescribe a drug, we are balancing harms and benefits. The benefit of antibiotics outweighs the harms for many infections – both to cure infections that you currently have and for infections you might get after a high-risk exposure. Whenever a doctor tells a patient that a conventional therapy could harm them, we run a risk that we will frighten them away from taking a medication that could save their lives. (Look at this bizarre and inappropriate statement recently from FDA Commissioner Marty Makary that he would only give his young child antibiotics if he was “on his deathbed or suffering.”) The value of studies like the one in Nature Medicine is to help all of us — patients and providers alike — ensure we use antibiotics only when they are truly needed.

Is your dentist prescribing too many antibiotics?

I recently experienced a version of this problem myself. In February, I had to get urgent dental work done, and the dentist prescribed me a week of amoxicillin after the procedure. I went straight to the medical literature to review the evidence for whether antibiotics are proven to prevent infection and promote healing after the specific procedure I had done. The answer was: There is no evidence of benefit, but it is standard practice by many dentists

Journalist Liz Szabo has just written an illuminating three-part series about dentists over-prescribing antibiotics. She describes how dentists wrote 27.3 million antibiotic prescriptions in 2025 and that 80% of preventive dental antibiotics are inappropriate, meaning they are prescribed to patients before or after procedures where there is no evidence of benefit.

The second most commonly prescribed antibiotic by dentists is clindamycin, the antibiotic found in the Nature Medicine study to have the most severe impact on the microbiome and a drug that carries a black-box warning — the FDA’s strongest caution — for its risk of causing life-threatening C. diff infections.

In addition to the risks to individual patients, every unnecessary antibiotic prescription accelerates the evolution of bacteria that can evade our drugs. Drug-resistant infections already cause an estimated 5 million deaths worldwide each year, a number that is growing as pathogens evolve new ways to survive in the presence of antibiotics.

Changing the behavior of health care providers — whether they are dentists, physicians, or others — is hard. What we learn in our training, even if it’s incorrect, often becomes our default practice for life. With opioids, it took a national crisis, widespread legislation, and mandatory continuing education before dental opioid prescribing meaningfully declined.

The rise of the anti-vaccine movement may also further increase antibiotic use. One of the best ways we have to prevent antibiotic use is to prevent infections in the first place by taking recommended vaccines.

And, in case you’re wondering, I did not take the antibiotics my dentist prescribed, and, so far, my teeth are OK.

We have a dangerous shortage of penicillin

Of course, infectious diseases are still a major public health problem, and antibiotics are often life-saving. What we try to teach clinicians is to prescribe the right drug for the right bug at the right dosage for the right time. That is, make sure you know what bacterial infection the patient has, then prescribe an antibiotic that is specifically targeted to kill that bacteria using the correct dosage for the least amount of time necessary.

What happens, however, when the right drug is not available? And that drug happens to be one of the oldest and most useful antibiotics we have?

One of the most common sexually transmitted infections in the United States is syphilis, and, unlike many other bacteria, it remains uniquely susceptible to plain old penicillin, specifically a long-acting injectable form called Bicillin L-A (benzathine penicillin G).

Syphilis rates in the United States have been rising sharply, particularly in pregnant women in whom untreated syphilis can lead to stillbirth, organ damage, and death of the fetus. No other antibiotic can reliably substitute for Bicillin L-A.

Unfortunately, only a handful of manufacturers worldwide are willing to produce an old drug that is not very profitable. As syphilis cases increase, the United States has been experiencing recurrent supply shortages of Bicillin L-A.

The shortage has gotten so acute that the FDA has authorized the temporary importation of a version of benzathine penicillin called Lentocilin, made by a Portuguese company not normally licensed to sell in the United States. (Interestingly, the only U.S. company willing to import Portuguese penicillin was the Mark Cuban Cost Plus Drug Co., a venture by the billionaire entrepreneur aimed at lowering consumer drug prices).

On March 10, the Centers for Disease Control and Prevention issued guidance to health departments across the country explaining how to use Lentocilin and urging them to conserve the remaining domestic supply of Bicillin L-A.

It’s a difficult paradox that I have to warn both about the danger of excess antibiotic use and the loss of access to antibiotics. Antibiotics are fundamentally a public good, and, as with other public goods, their supply is limited. When we act as if supply is unlimited — prescribing them too much and for the wrong reasons — we degrade a resource we all need.

Until next week,

Jay

From operating room to the Gold Dome: How Georgia’s medical lawmakers shape policy

2026-03-23T11:00:00+00:00

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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.

Georgia lawmakers advance bills aimed at easing nurse and doctor shortages

2026-03-19T20:03:20+00:00

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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.

Lawmakers seek meeting with RFK Jr. over staff shortages, delays at World Trade Center Health Program

2026-03-13T21:43:52+00:00

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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.

Brooklyn nurses lose health care for weeks despite $15M from state

2026-03-13T14:36:02+00:00

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More than 400 nurses at the Brooklyn Hospital Center, where officials warned of a dire financial hole, have been cut off from health insurance coverage for six weeks, according to their union.

Gov. Kathy Hochul provided $15 million in emergency state aid recently to the financially strapped 181-year-old community hospital that borders Fort Greene Park, multiple sources told THE CITY. Hospital officials requested $160 million last fall, and the $15 million is not enough to restore health benefits for the nurses, according to the New York State Nurses Association.

Officials with the nurses union told THE CITY that workers feel targeted by hospital administrators’ decision not to pay into their health care fund. Nurses are the only hospital employees without coverage; doctors, administrative staff and other workers have been unaffected.

“You chose the nurses, the one group of people that actually show up — rain, sun, sleet, snow,” said Rehana Lowtan, a nurse educator who began her career at the hospital 20 years ago. “We have nurses here that have serious medical conditions. They have families that are on their plans that don’t have access to any kind of care right now.”

The nurses who spoke to THE CITY said they do not know when, or if, coverage will be reinstated.

The Brooklyn Hospital Center sits at the intersection of Fort Greene and Downtown Brooklyn.

“There’s no communication,” said Yvette Byer-Henry, a certified nurse midwife who has worked at the hospital for 25 years. “It just reeks.”

A spokesperson for the hospital, Zachary Fink, said the facility is “working closely with NYSNA and the Hochul administration on a solution.”

“The Brooklyn Hospital Center values our NYSNA represented nurses and recognizes that medical benefits are an essential part of supporting our colleagues and their families. The immediate issue is securing the funds necessary to continue covering those medical benefits,” he said in a statement.

The hospital has requested additional money from the state on top of the $74 million it received in 2025. The plea for help comes as the facility considers bankruptcy, the hospital’s chief executive Gary G. Terranoni, told Spectrum News in November.

Bill Hammond, a senior fellow for health policy at the Albany-based think tank the Empire Center, called the hospital’s failure to pay nurses’ benefits “a move of desperation” that could show the governor it needs the requested aid.

“That would communicate to the state we are in deep trouble, and it would turn the nurses into your allies for pushing the state for money,” he said. “If that is their strategy that would be using them as a bargaining chip.”

Assemblymember Phara Souffrant Forrest, a Brooklyn Democrat, said the reality of safety net hospitals necessitates state aid, explaining that Medicaid reimburses the hospital below the cost of its care.

“The reimbursement rates are not on par with the care that is being given,” she said.

“Ultimately, the responsibility rests with the state that hospitals like Brooklyn Hospital Center should be made whole,” added Souffrant Forrest, who has worked as a nurse. “Unfortunately, the governor is trickling in funding. She did make the choice not to include increases in safety net funding overall in last year’s budget.”

Hochul’s office did not respond to a request for comment.

Brooklyn Hospital Center’s nurses averted a strike in January by coming to a tentative agreement on a labor contract with management. The terms included the hospital fully providing the nurses’ health care and pension benefits.

The nurses, who said they were unaware that the hospital had not paid the benefits fund since November, accepted the contract. They are now legally prohibited from striking due to the contract agreement.

“If they are in a financial crisis, [hospital officials] should not be making promises they can’t keep,” Hammond said.

Byer-Henry told THE CITY the hospital has failed to make monthly payments to the benefit fund in the past, but this is the first time nurses have lost health care.

“When you made the decision to not pay one portion of your employees’ benefit, what was your thinking going forward?” Byer-Henry said. “Because you can’t run a hospital without nurses — nurses are the backbone of the hospital.”

Yvette Byer-Henry has worked as a nurse at the Brooklyn Hospital Center for 25 years.

Brooklyn Hospital Center is a safety net hospital and is not affiliated with large providers such as Mount Sinai Health System or Northwell Health.

Instead, its primary source of income is from its patients. About 80% are covered by Medicaid and Medicare, where the hospital receives its reimbursement and funding, according to a recent report from the Healthcare Association of New York State.

President Donald Trump’s recent cuts to Medicaid have hurt safety net institutions like Brooklyn Hospital.

According to Hammond, the request for state aid also points to a broader issue of hospitals relying on the state for emergency bailouts, rather than having long-term plans to solve their fiscal problems.

“That makes it more likely that hospitals will get in financial trouble in the future because they have a reasonable expectation they can squeeze money out of the state,” he said.

The nurses at Brooklyn Hospital Center currently face what Hammond called, “a very painful irony” — confronting the health care system every day while not having coverage for medical care themselves.

Byer-Henry said she continues to show up at the hospital to work, despite the changes in her insurance. She previously thought her husband’s insurance would cover her, but found out on Wednesday it would not.

“I do it because I love my patients,” she said. “A lot of my patients don’t want to see anyone else.”

Lilly Sabella is a spring 2026 editorial intern for THE CITY. She is a graduate of SUNY New Paltz and a Queens native. Her work has appeared in the Nashville Banner, the Legislative Gazette and The Oracle.

Trump surgeon general pick Casey Means: How her medical experience compares to previous doctors in role

2026-03-04T17:28:51+00:00

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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

A health care executive is running for Ga. governor. His company has had about $1B in state contracts.

2026-02-27T20:01:25+00:00

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The latest candidate to enter the Georgia Republican primary for governor is a health care executive whose company supplied hospital and nursing home workers during the Covid emergency under a state contract.

Billionaire Rick Jackson’s companies have been paid nearly a billion dollars by state agencies since fiscal 2020, according to a Healthbeat analysis of government records.

That includes about $710 million, starting in 2020, from the Department of Community Health, for health care staffing services. Much of that work ended by 2023, but Jackson Healthcare subsidiaries remain state contractors for other services.

The candidate’s campaign materials describe a rags-to-riches story of growing up in foster care and going on to build a health care empire. Jackson Healthcare, founded in 2000, has grown to include 21 subsidiaries, most of them providing health care staffing. Jackson Healthcare also owns USAntibiotics, which says it is the country’s sole manufacturer of two widely used antibiotics. The company operates in all 50 states, according to his campaign website.

Jackson, 71, who entered the governor’s race in early February, has quickly gained steam against previous front-runner Lt. Gov. Burt Jones in the primary, with two recent polls showing Jackson leading among voters who have made a decision. Jackson plans to spend at least $50 million of his fortune to fuel his campaign, according to news reports.

Jackson’s companies have active contracts with the Department of Behavioral Health and Developmental Disabilities but the agency did not respond to multiple queries about the value of those contracts.

A Department of Public Health representative also refused to answer questions about that agency’s contracts with Jackson Healthcare subsidiaries.

If Jackson becomes governor, he may need to take steps to separate his business interests to avoid ethical or legal challenges over conflicts of interest, legal and ethics experts said.

His campaign wouldn’t make Jackson available for an interview with Healthbeat but said the company “has always and will always follow the law” with respect to its state contracts.

Georgia law generally prohibits elected officials from holding contracts with the state government, said Matt Maguire, a longtime Atlanta attorney who specializes in government contracts. But there are several exceptions – including for contracts that existed prior to an official being elected.

And Georgia law isn’t clear on whether Jackson Healthcare or its subsidiaries could bid for new contracts, Maguire said, pointing to a possible exception for professional employment services. There are also exceptions in the case of an emergency, or if there is only one company that could provide the needed services.

Edward Queen, an attorney and professor at the Emory University Center for Ethics, said that if Jackson is elected, he should disengage from decision-making related to his businesses, and assets related to those businesses should be put in a blind trust.

Queen said he would expect Jackson to resign from Jackson Healthcare and its subsidiaries, and the company should refrain from bidding future contracts with the state while he is in office.

“If you want to do the state’s business as an elected official, then focus on the state, not whatever your ongoing organization or corporate interests are,” Queen said.

It’s important to create such firewalls to bolster the public’s trust in the government and ensure that officials act in the public interest, experts said.

“If there are any questions as to whether the government contracts with this governor are changed, enhanced or in some way further benefit the governor, there will always be a cloud of suspicion as to whether he’s violating that fundamental ethics principle,” said Kedric Payne, an attorney who leads the ethics program at the Campaign Legal Center, a nonpartisan national organization focused on democracy.

Queen and Payne said the public should be informed about elected officials’ business interests well ahead of Election Day. Georgia’s party primaries for governor are scheduled for May 19, with the general election set for Nov. 3.

“Information about the government contracts of the candidate should be made public,” Payne said.

Jackson Healthcare supplied doctors and nurses during Covid

Jackson points to his health care experience as evidence of his commitment to the state’s well-being.

“When Covid hit Georgia, Gov. [Brian] Kemp asked Jackson for more doctors and nurses,” a campaign ad states. “And Jackson delivered again, refusing to send help to New York until Georgia got the emergency care it needed.”

Georgia’s largest health agency, DCH, paid a Jackson Healthcare subsidiary $709 million in federal American Rescue Plan Act funds starting in 2020 for the staffing services. The agency also paid the Alpharetta-based company an additional $511,353 in state funds, said spokesperson Lauren Williams.

The funds paid for doctors, nurses, therapists, laboratory technicians, housekeeping, and food service workers during the pandemic.

DCH worked with DPH to “triage” requests from Georgia facilities that faced staffing challenges, Williams said.

Jackson Healthcare subsidiary Healthcare Workforce Logistics then created contracts with the selected facilities. The costs were subsequently paid by DCH after approval of documentation, Williams said. She did not answer a question about whether those contracts are still active.

The DCH agreement was described as a sole-source contract by Georgia Health News in 2021, and the bidding opportunity is not listed in the Georgia Procurement Registry, the online database that details state contracting opportunities.

Healthbeat requested a copy of the contract from the state via an open records request on Feb. 10 but had not received it by Friday.

Jackson will work to increase health care access and lower costs for Georgians, campaign spokesperson Brian Robinson said, adding, “Other politicians talk about it, Rick will get it done.”

Subsidiaries have had contracts for mental health services

Jackson Healthcare subsidiaries held contracts with other state agencies as well.

DBHDD has held contracts with subsidiaries since at least 2015 for mental health care professionals to work at state psychiatric and other facilities, state records show. Those contracts appear to have been awarded through a competitive bidding process, with other companies also winning contracts.

Department spokesperson Camille Taylor did not respond to a question about how much the company had been paid for its services, but state records indicate the agency has paid Jackson Healthcare subsidiaries about $239 million since fiscal 2020.

Jackson Healthcare subsidiaries also worked for the Department of Human Services, which includes the Division of Family and Child Services that oversees the state’s foster care program. DHS used the existing DCH contract with subsidiary Healthcare Workforce Logistics in 2022 and 2023 due to a staffing crisis, agency spokesperson Ellen Brown said.

DHS paid a total of $7.4 million to the company for workers to help with “complex youth in foster care, including youth who require hospitalization at psychiatric residential treatment facilities, youth with intense behavioral and mental health needs, youth with moderate developmental delays, and youth with autism,” Brown said.

That contract is no longer in effect, she said.

Jackson has been a longtime donor to GOP politicians, including to some of his current opponents for governor: Republican Secretary of State Brad Raffensperger; Attorney General Chris Carr; and former Lt. Gov. Geoff Duncan, who was then a Republican but is now running in the Democratic primary.

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

4 calls to action from public health leaders who served in Republican and Democratic administrations

2026-02-27T00:24:54+00:00

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Public health is inherently political because it often involves policy decisions, but it shouldn’t be partisan.

That was among the key messages during the 2026 State of the Public Health Union webinar Thursday with three former directors of the Centers for Disease Control and Prevention and a former U.S. surgeon general who served under Republican and Democratic administrations. The 90-minute event, which can be watched on YouTube, is organized annually by the American Journal of Public Health.

Here is one takeaway from each of the four speakers.

Dr. Tom Frieden, former CDC director (2009-17)

Frieden served as CDC director under President Barack Obama. He is now president and CEO of Resolve to Save Lives, a global health organization.

“I don’t agree with the statement that we have to get the politics out of public health. I think we need to get the partisanship out of public health. There are decisions about public health that communities should make. At what [blood alcohol] level should we tell people that they shouldn’t drive? … Should we take over land to make safe water for our community? Does a community decide to be smoke-free in their restaurants or bars or parks? These are community decisions. They’re policy decisions. What has infected public health over the past few years is a partisanship. I think this is something that all of us – right, left, Democratic, Republican, progressive, conservative – should try to address. Sen. [Daniel Patrick] Moynihan used to say that you’re entitled to your own opinion, but not to your own facts. And unfortunately, today, it seems like people feel they’re entitled to their own facts.”

Dr. Jerome Adams, former U.S. surgeon general (2017-21)

Adams served as surgeon general during President Donald Trump’s first term. He is now executive director of the Center for Community Health Enhancement and Learning at Purdue University.

“We’ve got to reclaim public health as consistent with conservative principles, not against conservative principles. It’s about personal responsibility, strong families, a ready workforce, military preparedness, and reducing wasteful downstream spending. Those are all conservative principles. Prevention aligns with fiscal responsibility. Clear, accurate information aligns with individual liberty, because you can’t make an informed choice without trustworthy facts. Second, we need trusted messengers. And in many conservative communities, people are going to be far more likely to trust their pastor, their local physician or pharmacist or nurse practitioner, their sheriff, or their governor than they are any federal agency. So that means empowering state and local leaders and respected voices within conservative circles to speak clearly and consistently about evidence-based health information. And then third, we’ve got to be willing to call out misinformation even when it’s politically inconvenient to the point I raised earlier. If we stay silent, when bad information spreads because it benefits our side, we lose credibility.”

Dr. Robert Redfield, former CDC director (2018-21)

Redfield served as CDC director during Trump’s first term. He is now a senior visiting fellow for biosecurity and public health policy at the Heritage Foundation, a conservative think tank.

“We need to learn how to share our differences of opinion on public health issues, but to do it respectfully ... I’ve said many times that vaccination, I think it’s one of the most important gifts of science to modern medicine. And it’s very disconcerting to see people being encouraged to leave it on the shelf rather than to embrace it. But I think if we could just have a little more honest debate among ourselves about different opinions on what policy directions we think we should go, but to do it in a respectful way, knowing that, you know, each of us really cares deeply about the public health of our nation, and we may see things slightly differently … When we see things that are obviously true, we need to speak out and clearly say that they’re true. For example, we’re dealing as you know now with measles in South Carolina, in Florida, in Texas, in Arizona. And we all know that the best way to stop the measles pandemic is to get the American public vaccinated against measles. Period. There doesn’t need to be any qualifiers around that.”

Dr. Mandy Cohen, former CDC director (2023-25)

Cohen served as CDC director under President Joe Biden. She is now a national adviser at Manatt Health, a health care consultancy.

“In order for us to fulfill our mission of protecting health and improving lives, we need the federal government – and state and local governments – all working well and working together. But there are things that you do not want to create, state by state by state. Some of that is certainly a data architecture, right? … [Public health cannot do its job] if you don’t have that visibility of what’s going on, both around you and, frankly, internationally as well. So CDC certainly has to maintain those connectivities and the data systems. But then it’s also expertise. We have wonderful experts at the state level, but they can’t be an expert in every rare pathogen. And so having both the laboratory expertise, the pathogen-specific expertise at the federal level is really important … I am very concerned about us pulling back in our global footprint. And that is something that needs to be done in a coordinated way at the country level, at a federal level, so that we are making sure to protect us here at home. So those are the things the feds need to do.”

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

‘You aren’t trapped’: Hundreds of U.S. nurses choose Canada over Trump’s America

2026-02-26T13:57:44+00:00

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Last month, Justin and Amy Miller packed their vehicles with three kids, two dogs, a pet bearded dragon, and whatever belongings they could fit, then drove 2,000 miles from Wisconsin to British Columbia to leave President Donald Trump’s America.

The Millers resettled on Vancouver Island, their scenic refuge accessible only by ferry or plane. Justin went to work in the emergency room at Nanaimo Regional General Hospital, where he became one of at least 20 U.S.-trained nurses hired since April.

Fear of Trump, some of the nurses said, was why they left.

“There are so many like-minded people out there,” said Justin, who now works elbow to elbow with Americans in Canada. “You aren’t trapped. You don’t have to stay. Health care workers are welcomed with open arms around the world.”

The Millers are part of a new surge of American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April. As the Trump administration enacts increasingly authoritarian policies and decimates funding for public health, insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system.

Additionally, some nurses were incensed last year when the Trump administration said it would reclassify nursing as a nonprofessional degree, which would impose strict federal limits on the loans nursing students could receive.

Canada is poised to capitalize. Two of its most populous provinces, Ontario and British Columbia, have streamlined the licensing process for American nurses since Trump returned to the White House. British Columbia also launched a $5 million advertising campaign last year to recruit nurses from California, Oregon, and Washington state.

“With the chaos and uncertainty happening in the U.S., we are seizing the opportunity to attract the talent we need,” Josie Osborne, the province’s health minister, said in a statement announcing the campaign.

Fears realized: Nurse killed by ICE

Amy Miller, a nurse practitioner, said she and her husband were determined to move their children out of the country because they felt Trump’s second term would inevitably spiral into violence.

First, the Millers got nursing licenses in New Zealand, but when the job search took too long, they pivoted to Canada.

Justin was offered a job within weeks.

Amy found one within three months.

So they moved. And just a few days later, the Millers watched with horror from afar as their fears came true.

As federal immigration forces clashed with protesters in Minneapolis on Jan. 24, federal agents fatally shot an ICU nurse, Alex Pretti, as he filmed a confrontation and appeared to be trying to shield a woman who was knocked down. Video of the killing showed border agents pinning Pretti to the ground before seizing his concealed, licensed handgun and opening fire on him.

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

The Trump administration quickly called Pretti a “domestic terrorist” who intended to kill federal agents. That allegation was disputed by eyewitness videos that circulated on social media and spurred widespread outrage, including from nurses and nursing organizations, some of whom invoked the profession’s duty to care for the vulnerable.

“I don’t want to say it was expected, but that’s why we are here,” Amy Miller said. “Even our oldest kid, she was like: ‘It’s OK, Mom, because we are not there anymore. We are safe here.’ So she recognizes that, and she’s not even in middle school yet.”

The United States and Canada have a severe need for nurses. The United States is projected to be short about 270,000 registered nurses, plus at least 120,000 licensed practical nurses, by 2028, according to recent estimates from the Health Resources and Services Administration. In Canada, nursing job vacancies tripled from 2018 to 2023, when they reached nearly 42,000, according to a recent report from the Montreal Economic Institute, a Canadian think tank.

When asked to comment, the White House noted that industry data shows the number of nurses licensed in the United States increased in 2025. It dismissed accounts of nurses moving to Canada as “anecdotes of individuals with severe cases of Trump derangement syndrome.”

“The American health care workforce is the finest in the world, and it continues to expand under President Trump,” White House spokesperson Kush Desai said. “Employment opportunities in the American health care system remain robust, with career advancement and pay that far exceed that of other developed nations.”

Nurses cite White House fears in move

It is unknown precisely how many American nurses have moved north since Trump returned to office, because some Canadian provinces do not track or release such statistics.

British Columbia, which has done the most to recruit Americans, approved the licensing applications of 1,028 U.S.-trained nurses from when the province’s streamlined application process took effect in April 2025 through January, according to the British Columbia College of Nurses and Midwives. In all of 2023, only 112 applicants from the United States were approved, the agency said. In 2024, it was 127.

Increased interest from American nurses was also confirmed by nursing associations in Ontario and Alberta, as well as by the nationwide Canadian Nurses Association.

Angela Wignall, CEO of Nurses and Nurse Practitioners of British Columbia, said American nurses used to move north because they had fallen in love with Canada (or a Canadian). But more recently, she said, she had met nurses who feared the White House would spur violence and vigilantism, particularly against families that included same-sex couples.

“Some of them were living in fear of the administration, and they shared a sense of relief when crossing the border,” Wignall said. “As a Canadian, it’s heartbreaking. And also a joy to welcome them.”

Vancouver Island, which has a population of about 860,000, has gained 64 U.S.-trained nurses since April, including those at Nanaimo Regional, said Andrew Leyne, a spokesperson for the island’s health agency.

One of the nurses was Susan Fleishman, a Canadian who moved to the United States as a child, then worked for 23 years in American emergency rooms before leaving the country in November.

Fleishman said hateful rhetoric from Trump has fueled an angry division that has permeated and soured American life.

“It wasn’t an easy move — that’s for sure. But I think it’s definitely worth it,” she said, happily back in Canada. “I find there is a lot more kindness here. And I think that will keep me here.”

What I’ve learned as a nurse about the power of human connection in public health

Brandy Frye, who also worked for decades in American ERs, said she moved to Vancouver Island last year after waiting to see whether Mark Carney would become Canada’s prime minister. Carney’s rise was widely viewed as a rejection of Trumpism.

Meanwhile, Frye said, the California hospital where she worked had been stripping words associated with diversity and equity out of its paperwork to appease the Trump administration. She couldn’t stand it.

“It felt like a step against everything I believe in,” Frye said. “And I didn’t feel like I belonged there anymore.”

Like many of the American nurses who have moved to Vancouver Island, Frye was first wooed to the area by a viral video that was meant to attract tourist dollars but ended up doing much more.

About a year ago, Tod Maffin, a social media content creator and former CBC Radio host, invited Americans to the port city of Nanaimo for a weekend event designed to offset the impact of Trump’s tariffs on the local economy.

Maffin said about 350 people attended the April event.

“A lot of them were health care workers looking for an escape route,” Maffin said. “They were there to help support our economy but also to look into Canada.”

Maffin saw an opportunity. He repurposed the event website into a recruiting tool and launched a Discord chatroom to help Americans relocate.

Maffin said he believes the campaign helped about 35 health care workers move to Vancouver Island. Volunteers in more than 30 other Canadian communities have since duplicated his website in an effort to attract their own American nurses and doctors.

“There are communities across Canada where the emergency room closes at night because one nurse is out. That’s how thin staffing is,” Maffin said.

“One new nurse in a small town, or in a midsized city like Nanaimo,” he said, “makes a difference.”

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

Join Healthbeat for a community conversation on public health in Queens

2026-02-25T13:35:11+00:00

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

These are turbulent times in community health.

Federal funding that supports local health programs and food assistance is under threat. Climate change is bringing new health risks to neighborhoods. Vaccine confusion persists. And for many families, finding reliable health information — and affordable care — is only getting harder.

How is all of this affecting you?

Healthbeat is hosting a free community breakfast and conversation in Queens to hear directly from the people living and working through these challenges every day. We want to know:

How are you coping with uncertainty in health policy and funding?
What barriers are you facing when seeking care or trustworthy information for your or the clients you serve?
What solutions are emerging in your community?
What stories aren’t being told?

Join Healthbeat’s New York City reporter Trenton Daniel and me, Editor in Chief Charlene Pacenti, for a discussion about how health policy is playing out on the ground — in real neighborhoods, with real effects.

Whether you’re a concerned resident, health worker, epidemiologist, researcher, social worker, advocate, or someone serving your community another way, we want to hear your perspective. This conversation will help shape our reporting and ensure we’re covering the issues that truly impact Queens.

Admission and breakfast are free, but advance registration is required.

🗓 March 24, 9–10:30 a.m., King Manor Museum, 150-03 Jamaica Ave., Jamaica, Queens.

Come share your experiences. Help us tell the stories that need to be told. Register now to reserve your spot.

Charlene Pacenti is Editor in Chief of Healthbeat. Contact her at cpacenti@healthbeat.org.

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

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

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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.

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

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

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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.

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

2026-02-19T16:02:47+00:00

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As Dr. Michelle Morse leaves her role as acting commissioner to refocus on her role as chief medical officer at the New York City Department of Health and Mental Hygiene, she plans to stay engaged in her work in health equity and pledges to help the city’s new commissioner navigate the challenges ahead.

In an interview this week after nearly 16 months as acting commissioner, Morse reflected on this moment in public health as Dr. Alister Martin, an emergency room physician in Boston, prepares to take the helm of the department.

“He’s coming in of course at a very, very challenging time,” Morse told Healthbeat in a video interview from her office in Lower Manhattan. “Our whole agency is really committed to making sure that he has what he needs to succeed.”

The new Trump administration has brought upheaval in the federal public health system, which cities and states rely on for funding and support. Looming cuts to Medicaid and food assistance programs are also bringing uncertainty for local officials.

“You just really can’t predict what your era of leadership is going to look like. It is very much shaped by things outside of your control,” she said.

Morse, 44, said she will use her CMO position to develop relationships with her counterparts at the many community health organizations across the city. She also said she plans to return to projects in the works, such as a data-driven tool that compares the number of Medicaid and uninsured patients that a hospital treats to the hospital’s share of beds in the city. And she is eager to support Martin.

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The two have had a “few conversations” since Mayor Zohran Mamdani announced Jan. 31 that Martin would run the department, one of the biggest public health agencies in the world with more than 7,000 employees across the five boroughs and an annual budget of $1.6 billion.

Many expected the new mayor to keep Morse in the role; she has been serving as acting commissioner since October 2024. Martin’s resume as a CEO at a health care nonprofit, a Harvard professor, and a White House fellow during the Biden administration shows more experience in health care than in public health. At 37, his leadership experience is limited to small startups.

Morse is a longtime health equity advocate who worked with Boston-based Partners in Health at hospitals in hard-to-reach places like the Haitian countryside. In 2021, she was brought on at the New York City Health Department as its inaugural CMO to bridge the divide between health care and public health.

Dr. Dave Chokshi, a former city health commissioner who recruited Morse as the department’s first-ever CMO, said that “since serving as acting health commissioner, she’s shown really steady leadership for a number of crises that we have faced, including Legionella and a host of other issues. … She has had deep global health experience, even before her tenure in New York City.”

What advice might she have for her new boss?

“That’s the trillion-dollar question,” she said with a smile.

On a more serious note, Morse said she hopes Martin comes to the department with a “learning mindset.” The two will also need to sort out his stimulant beverage of choice, because “it’s a very high-intensity job,” she joked.

Morse said she and Martin can connect on their mutual experiences as Harvard graduate students and later professors at Harvard Medical School and as doctors at Harvard teaching hospitals in Boston: She at Brigham and Women’s Hospital, he at Massachusetts General.

Martin begins his new job on Monday and will report to Deputy Mayor Helen Arteaga Landaverde, who had served as CEO at NYC Health + Hospitals/Elmhurst in Queens and now oversees Health and Human Services for the city.

When Morse looks back on her time as acting commissioner, she points to accomplishments including contributing to a lawsuit filed last year by a coalition of more than 20 attorneys general that sought to block the federal government’s withholding of public health funding of more than $11 billion that had already been allocated for infectious disease prevention. Some $100 million of that in grants had been earmarked for New York City.

“That was at a time when the federal government was really ramping up its attacks against public health,” Morse said. “Those were life-saving funds.”

NYC’s new deputy mayor for health went from Covid patient to hospital CEO

A federal judge issued a temporary halt on the efforts to block the funding.

Morse cites how the city saw a decline in 2024, for the first time since 2018, in opioid overdose deaths among Black and Latino New Yorkers as another accomplishment, along with “really [doubling] down on using health equity strategies to improve the quality of our work.”

When Morse wore her full-time CMO hat the first time, the New York City Board of Health on Oct. 18, 2021 passed a resolution directing the Health Department to work toward a “racially just recovery” from the pandemic, which had taken a disproportionate toll on communities of color. This, she hopes, will offer guidance for Martin.

“I hope for the future of the agency that we continue to stay true to our deep commitment to health equity,” Morse said. “That is most explicitly and powerfully expressed in that Board of Health resolution declaring racism a public health crisis. That’s on the books forever.”

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.

Why NewYork-Presbyterian hospital nurses are still on strike

2026-02-13T19:42:09+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.

When a mediator presented a proposal to striking NewYork-Presbyterian nurses and hospital management on Sunday, the elected rank-and-file representatives at the bargaining table didn’t like what they saw.

Securing improved nurse-to-patient ratios in the new contract has been a major priority for the New York State Nurses Association, and staff at NewYork-Presbyterian have been pushing the hospital to agree to enforcement language that matches what their colleagues at Mount Sinai and Montefiore have already won.

Among other issues, the mediator’s proposal, which the union’s representatives rejected, offered only about half as many new hires as the union was asking for, said neonatal nurse Beth Loudin, who sits on the NewYork-Presbyterian executive committee.

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The nurses ultimately turned down the contract by a resounding margin on Wednesday, following a tense skirmish with union leadership, who forced a vote over the objections of rank-and-file nurses holding out for a better deal. (Mount Sinai and Montefiore nurses approved their tentative agreements by wide margins, and will return to work by Saturday.)

NewYork-Presbyterian stands as the only hospital still on strike as nurses enter their second month on the picket line. As of Friday afternoon, the two sides and their mediator had not agreed on dates for further negotiations.

Patrick Kline, a cath lab nurse and strike captain at NewYork-Presbyterian Milstein, said he believes the vote results delivered a mandate and granted nurses significant leverage as they head back to the bargaining table.

“I think that’s what people have learned through this process — that we, the rank and file, are the union, and that if we’re not happy, we hold elections,” Kline said. “We want our nurses and jobs protected, and we want more nurses to safely care for our patients. That’s what it’s coming down to.”

The tentative agreement included the same 12% salary increases that the union secured in its earlier deals with Mount Sinai and Montefiore and preserved the health care and pension benefits the union and NewYork-Presbyterian locked in weeks ago.

But staffing remains the heart of the nurses’ demands.

NewYork-Presbyterian laid off 2% of its workforce last year, or about 1,000 staff, nurses and other health care workers among them. “We just need stronger language in our contract to protect our jobs. NYP just continued to delete that line that we needed,” said Loudin. “There’s no countering, there’s no conversation.”

Jacqueline Brown, a recovery nurse at NewYork-Presbyterian/Columbia, agreed. “No nurse should have to take on 20 patients in the emergency room by themselves,” she said.

On Wednesday, a NewYork-Presbyterian spokesperson said the hospital was “disappointed that our nurses did not ratify the mediator’s proposal, which we accepted on Feb. 8 and NYSNA leadership endorsed.” The spokesperson, Angela Karafazli, said the hospital is willing to honor the proposal the nurses rejected for reconsideration.

How long the strike continues depends on several factors, said Rebecca Givan, an associate professor of labor and employment relations at Rutgers University, who specializes in the health care sector. Management can weigh their readiness for a long strike, and they have a greater pool of travel nurses to hire once Montefiore and Mount Sinai staff return to work.

On the other hand, nurses have delivered a strong mandate in rejecting the contract, Givan said.

“I think it weakens Presbyterian’s hand, and it creates greater pressure on the hospital,” she said. “And it shines a light on the fact that nurses and patients in the other hospitals have enforceable ratios that benefit patients, and Presbyterian has so far refused to have the same contract language.”

Since the Wednesday night vote, the hospital has sent out notices to nurses asking them to indicate whether they are interested in returning to work by 6 p.m. Saturday.

Meanwhile, also in the last several days, the union has stepped up its efforts to ensure that NewYork-Presbyterian nurses do not cross the picket line.

On social media, nurses have circulated infographics warning that the union will no longer protect anyone who breaks the strike. In conversations with colleagues, they are emphasizing the need for solidarity. Strike captains are routinely checking in with their hospital units to ensure members stay strong.

In the cath lab, Kline said, 100% of nurses pledged to continue holding the line.

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

NYC infectious disease experts prep for World Cup as ‘huge global migration event’ with 1.2M visitors

2026-02-13T18:39:37+00:00

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Health care professionals at the nation’s oldest hospital in New York City have been quietly preparing for an influx of soccer fans to come watch the 2026 FIFA World Cup this summer.

Such a large increase in visitors from around the world also raises the risk of imported infectious diseases – including “high-consequence” ones, or special pathogens that have high mortality rates, like Ebola or the Marburg virus.

That’s why doctors, nurses and others at NYC Health + Hospitals/Bellevue Hospital have been practicing elaborate drills that include actor patients and even chartered and commercial airplanes. As part of that broader preparation effort, some 500 health care professionals working at hospitals near the main World Cup venue in New Jersey have received training to ensure they’re ready to treat what comes.

“We’re training a lot,” said Dr. Vikramjit Mukherjee, an intensive care physician who is chief of critical care and the special pathogens program at Bellevue. “Through June, we’re going to the hospitals next to the MetLife stadium, where people will be more prone to present with symptoms, and making sure their front-end capabilities are ready.”

MetLife Stadium in East Rutherford, New Jersey, a venue that holds 82,500 spectators, will host eight World Cup matches starting June 13, including the championship on July 19. Greater New York is expected to see more than 1.2 million visitors this summer for the tournament, as the United States expects up to 10 million. Sixteen major cities, and a few smaller ones, across North America will host matches.

Big crowds will gather. A watch party in Central Park is expected to draw some 250,000 viewers. A separate party is scheduled for Liberty State Park in Jersey City.

Public health leaders see this year’s World Cup, billed as the largest tournament in world history, as the world’s largest temporary migration into the United States’ most densely populated urban corridor. They are planning accordingly.

“We’re looking at it as if it’s a huge global migration event,” Mukherjee said while giving Healthbeat a tour of Bellevue, including its biocontainment lab and tuberculosis ward. “The whole health care system in New York City will be a bit on alert for all of these events.”

Bellevue Hospital leads outbreak preparedness

The New York City health care system has experience with an influx of international visitors and potential pathogens. Greater New York has three international airports that are among the busiest in the world, and the city has been on the front line of recent disease outbreaks as they near or encroach upon the United States. The oldest hospital in the United States and one of the largest, Bellevue has had years to prepare.

In October 2014, the hospital received a bit of fame for treating New York City’s only confirmed Ebola patient. Dr. Craig Spencer had been treating Ebola patients in Guinea when he contracted the fatal disease and later entered Bellevue (his discharge is captured in a photo hanging on a hospital wall).

“Because of what we’ve seen in the last few years — Ebola, Covid, and mpox — we feel that we will be the ones who will be affected first for the next outbreak, and therefore have an additional responsibility of keeping prepared,” Mukherjee said.

Central to preparation has been simulated exercises that bring together different agencies working in different time zones and across international borders. Repeated drills help spot deficiencies.

Last summer, Bellevue health care professionals and others participated in a four-day exercise that required transporting by air a group of pretend patients with a high-consequence infectious disease from Toronto, a World Cup host city, to LaGuardia Airport in New York. The pretend patients were then taken to Bellevue for treatment. The exercise aimed to test workers’ ability to handle a portable biocontainment unit — a device used to isolate and transport patients with highly contagious diseases.

“That was the biggest drill we’ve done, because that involved local, state, federal, and international partners,” said Noel Alicea, a spokesman for Bellevue.

New York City Mayor Zohran Mamdani named a former campaign manager to the new post of “World Cup Czar,” but it is unclear whether the position has public health responsibilities.

“Maya Handa will use this innovative role to oversee the Mamdani administration’s inter-agency work to host the FIFA 2026 World Cup and ensure the historic event benefits the city’s residents and economy,” the city said in announcing the role.

Cities have stronger role in preparedness

The World Cup games are also certain to test local public health workers’ ability to coordinate with the federal government. Because the Trump administration has overhauled the U.S. Centers for Disease Control and Prevention and withdrawn from the World Health Organization, both of which have historically played a major role with disease surveillance, state and local governments have taken on additional responsibilities preparing for the World Cup. They are expected to do the same once the matches begin.

This week, the New York State Department of Health announced that it was joining a WHO global network of public health institutions, governments, academic agencies, and labs that aims to coordinate responses to public health threats. New York City, California, and Illinois have also joined.

For its part, the White House created a FIFA task force, led by Andrew Giuliani, the son of former New York City Mayor Rudy Giuliani. Reporting to the Department of Homeland Security, Andrew Giuliani is “spearheading the federal government’s extensive efforts to ensure that the largest World Cup in history will also be the safest,” according to the task force’s website.

Asked how Bellevue was preparing for the World Cup in light of the significant federal changes, Mukherjee said:

“We are trying to paint the picture that this is essential to U.S. biosecurity, which has great bipartisan support, and we recognize that at the end of the day our biggest asset are our health care workers, and if we cannot keep them safe, the entire health care system infrastructure falls through.

“So our priority — our laser focus — is toward making sure our health care workers are safe as they go into relatively dangerous zones of high-consequence, infectious diseases. And that’s what we advocate for in D.C. That’s what we teach and train every day at the front lines.”

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.

NewYork-Presbyterian nurses reject contract by overwhelming margin

2026-02-12T16:50:57+00:00

NewYork-Presbyterian nurses rejected a tentative agreement by an overwhelming margin Wednesday, voting to extend their strike — now 32 days running — against the hospital system.

Their union, the New York State Nurses Association, said the unfair labor practice strike and bargaining will continue. Out of about 4,200 NewYork-Presbyterian nurses who were eligible to cast ballots, 3,099 voted to reject the deal, and 867 voted to approve it.

At Mount Sinai, Mount Sinai Morningside and West, and Montefiore, nurses voted to approve their contracts Wednesday evening by margin of 87%, 96%, and 85% respectively and will return to work this weekend.

A NewYork-Presbyterian spokesperson said the hospital was “disappointed that our nurses did not ratify the mediator’s proposal, which we accepted on Feb. 8 and NYSNA leadership endorsed.” The spokesperson, Angela Karafazli, said the hospital is willing to honor the rejected proposal for reconsideration.

Nancy Hagans, the president of NYSNA, called on the hospital to “agree to a fair contract and bring all of our nurses back to work.”

Nurses at the three hospital systems have been on strike since Jan. 12 trying to secure stronger nurse-to-patient ratios, claiming that staffing shortages put their and their patients’ well-being at risk.

Nurses demand investigation

The dramatic development unfolded hours after more than 50 nurses delivered a petition to the NYSNA headquarters demanding a formal disciplinary investigation into top union leadership over members’ claims that leaders are forcing a vote on a tentative agreement with NewYork-Presbyterian that rank-and-file representatives rejected at the bargaining table.

Nurses’ union, Mount Sinai and Montefiore reach tentative agreement to end strike

It was not immediately clear what mechanism the union has to investigate the actions of its two top executives, said Hagans and Pat Kane, NYSNA executive director. Nurses also demanded that the findings of the probe be subject to a full hearing open to all of its members.

More than 1,500 nurses signed the petition in the hours after NYSNA and NewYork-Presbyterian announced the agreement that nurses ultimately voted to reject on Wednesday.

NYSNA’s decision to forge ahead with a vote at NewYork-Presbyterian had infuriated members who said they stood by their executive committee’s assertion that the deal did not meet their needs. NYSNA has executive committees at each of its hospitals; those committees are made up of union members who participate in contract negotiations.

Beth Loudin, a neonatal nurse and member of the executive committee at NewYork-Presbyterian, said top union leadership informed her it was moving ahead with a vote Tuesday afternoon — days after she and the committee originally rejected it.

“I can’t even call it a memorandum of agreement, because there’s no signature on it,” Loudin said. “This is a rush job to get a vote out, because it’s in alignment with the other hospitals. It was very jarring.”

The three-year agreement was pending ratification by the union’s rank-and-file members, who had until 5 p.m. Wednesday to approve or reject the deal. The tentative agreement included the same 12% salary increases that the union secured in earlier deals with Mount Sinai and Montefiore, but it did not guarantee nurse-to-patient ratio enforcement language available to nurses at those hospitals.

On Tuesday, Kane, the union’s executive director, addressed the controversy at NewYork-Presbyterian in a video to members that was included in an email with the ballot, first obtained by Gothamist: “The simple fact is that we’ve reached the end of negotiations.”

“They are overriding our voices,” said NewYork-Presbyterian nurse educator Cagatay Chelik.

Nurses marched from Macy’s on 34th Street to the union’s headquarters a block south on West 33rd to deliver the petition on Wednesday, chanting, “We are your nurses! Listen to your nurses!”

Asked for comment on the union members’ petition and protest, a NYSNA spokesperson referred THE CITY to an earlier statement by Hagans, the union’s president, where she urged her members not to rush to judgment.

“We believe all striking nurses deserve to see the details of their tentative agreements and get the opportunity to vote on whether to ratify a new contract,” Hagans said. “As a democratic, member-led union that responds to its members, we are moving forward with a vote on tentative contracts at all four hospitals with the goal of returning all nurses to work as soon as possible.”

Loudin and about a half-dozen other union colleagues became visibly emotional as they delivered the signed petition to NYSNA’s general counsel and contract specialists who were summoned to the lobby to meet with the protesting nurses. Hagans and Kane did not meet with the nurses.

“It’s been truly painful personally that my union decided to go against my leadership and my nurses,” Loudin told the union’s contract specialists. “We’ve been fighting for this for six months.”

‘Sold us out to management’

The strike is the longest and its kind in New York City history; at its peak, with 15,000 members across all four hospital systems on the picket line, it was also the largest. Nurses struggled to make ends meet over many weeks on the picket line without health care or their paychecks. The hospitals cancelled elective procedures, rerouted patients to hospitals unaffected by the work stoppage, and collectively paid about $100 million for travel nurses to staff their facilities during the strike.

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Mount Sinai CEO Dr. Brendan Carr on Wednesday cheered the nurses’ return to work, and acknowledged the rancor of the past month in a statement to staff.

“The past several weeks have been challenging, emotional, frustrating, and exhausting in different ways for all of us,” Carr wrote. “As I have said many times over the past several weeks, thank you again to everyone who played a role either big or small to help us navigate these challenges. We never lost sight of the fact that our patients always come first.”

NewYork-Presbyterian nurses who spoke with THE CITY earlier on Wednesday said they felt betrayed by their top leaders.

“Unfortunately now we’re at a point in which our union’s senior leadership, specifically our executive director and the president, have sold us out to management,” said Esteban Barrena, a nurse at NYP-Morgan Stanley Children’s Hospital.

The union had touted the tentative agreement at NewYork-Presbyterian as a victory for nurses, securing commitments to preserve the union’s health care and benefits and to hire more staff in order to improve nurse-to-patient ratios.

The union’s executive committee had rejected the deal because the staffing proposals that the mediator had recommended would not guarantee job security for existing nurses, Loudin said. It also does not include the same staffing ratio enforcement language that nurses at Mount Sinai and Montefiore have had in their contracts since 2023, which the union has touted as some of the most secure in the country.

“This is the reason we’ve been fighting for all of this,” Barrena added. “Why would union leadership compromise on that?”

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

Georgia lawmakers consider first steps to streamline public health system

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

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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.”

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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.

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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.

Nurses at NewYork-Presbyterian reach tentative agreement to end strike

2026-02-11T14:50:11+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.

The New York State Nurses Association and NewYork-Presbyterian reached a tentative agreement on raises, staffing and on-the-job safety to end its strike, the union announced late Tuesday. The tentative deal at NYP, the last of the three hospital systems where nurses have been on strike since Jan. 12, will likely put an end to the work stoppage that involved 15,000 people.

The three-year agreement is pending ratification by the union’s rank-and-file members, who have until 5 p.m. Wednesday to approve or reject the deal. The tentative agreement includes the same 12% salary increases that the union secured in earlier deals with Mount Sinai and Montefiore, as well as agreements on nurse-to-patient ratios and addressing workplace violence.

The earliest date that the about 5,000 striking nurses at NYP-Columbia, Allen Hospital, and the Morgan Stanley Children’s Hospital campuses will return to work is Saturday.

NYSNA is allowing its members to vote on the tentative pact even though the union’s own executive committee at NYP rejected the deal, infuriating rank-and-file members. NYSNA has executive committees at each of its hospitals; those committees are made up of union members who participate in contract negotiations.

The union began circulating ballots to its members on Tuesday via email and text message, urging them to approve the deal, bypassing a decision by the executive committee to reject the proposal, which was originally presented by a mediator on Sunday.

On Tuesday, NYSNA executive director Pat Kane addressed her members in a video that was included in an email with the ballot, first obtained by Gothamist: “The simple fact is that we’ve reached the end of negotiations.”

“NYSNA sold us out,” read a post from an Instagram account of rank-and-file NewYork-Presbyterian nurses to its more than 6,000 followers recommending that union members reject the deal. “The [executive committee] does not endorse this proposal. NYSNA went over our heads to force a ratification vote.”

Together with earlier tentative agreements at Mount Sinai and Montefiore, the pact at NewYork-Presbyterian, if ratified, will mark the end of the longest and largest strike of its kind in New York City history.

The union touted the tentative agreement at NewYork-Presbyterian as a victory for nurses, securing commitments to preserve the union’s health care and benefits and to hire more staff in order to improve nurse-to-patient ratios.

In a statement announcing the tentative agreement at NewYork-Presbyterian late Tuesday, NYSNA president Nancy Hagans encouraged members to look at the full details.

“We believe all striking nurses deserve to see the details of their tentative agreements and get the opportunity to vote on whether to ratify a new contract,” she said. “As a democratic, member-led union that responds to its members, we are moving forward with a vote on tentative contracts at all four hospitals with the goal of returning all nurses to work as soon as possible.”

The first signs that a deal was imminent arrived on Monday, about an hour after NYSNA announced the earlier pacts at Mount Sinai and Montefiore. A NewYork-Presbyterian spokesperson said the hospital was willing to accept the same wage increases agreed on by the other hospitals on the recommendation of a mediator. That was the same proposal that NYSNA’s executive committee at NewYork-Presbyterian rejected.

“We look forward to bringing our nurses back to care for our patients,” Angela Karafazli, the NewYork-Presbyterian spokesperson, said.

The protracted strike was fraught throughout. Negotiations between the hospitals and the union picked up and broke down repeatedly over the last month, a feature of a strike that was more bitter than any in recent memory.

The nurses’ union has lodged more than a dozen complaints against the three hospital systems accusing them of violating U.S. labor law, including by allegedly retaliating against nurses for organizing.

The strike came at a steep cost. Hospitals cancelled elective surgeries and rerouted patients to hospitals unaffected by the strike. Nurses scrambled to make ends meet, turning to unemployment insurance and GoFundMe to pay their bills.

Hospital administrators hired scores of temporary travel nurses to cover nurses’ shifts throughout the strike, some of whom were getting paid $9,000 per week. The three hospitals paid $100 million to staff their facilities during the strike, according to a leading trade group.

NewYork-Presbyterian is one of the most prominent hospital systems in the country and, according to the union, one of the wealthiest. Its CEO earned more than $26 million in total compensation in 2024. Last year, the U.S. Department of Justice launched an antitrust probe into NewYork-Presbyterian over allegations it colluded with insurance companies to keep prices high for New York City patients.

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

‘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

Nurses’ union, Mount Sinai and Montefiore reach tentative agreement to end strike

2026-02-09T22:22:38+00:00

The New York State Nurses Association reached a tentative agreement with Montefiore and Mount Sinai that preserves nurses’ health care and pension benefits and its existing enforcement language on nurse-to-patient ratios, the union announced Monday morning.

The agreement is pending a vote from NYSNA members scheduled to take place Monday afternoon through Wednesday. The strike continues until the agreement is ratified, though picketing was suspended through the weekend because of the dangerous cold. If the agreement is approved by union members, the nurses will return to work on Saturday.

The nurses’ union and NewYork-Presbyterian have not yet reached a deal, the union said.

“For four weeks, nearly 15,000 NYSNA members held the line in the cold and in the snow for safe patient care,” NYSNA President Nancy Hagans said in a statement. “Now, nurses at Montefiore and Mount Sinai systems are heading back to the bedside with our heads held high after winning fair tentative contracts that maintain enforceable safe staffing ratios, improve protections from workplace violence, and maintain health benefits with no additional out-of-pocket costs for frontline nurses.”

Spokespersons for Mount Sinai and Montefiore did not immediately return a request for comment.

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

The strike, which began on Jan. 12, is the longest and largest of its kind in New York City history. After 28 days on strike, nurses who spoke to THE CITY said they were inclined to vote to approve the deal and return to work, even if they didn’t get everything they wanted.

Notably, management at Mount Sinai Hospital did not agree to immediately rehire the three labor and delivery nurses it fired last month in what NYSNA says was retaliation for their union activity. Those three nurses instead will have to arbitrate their firings, according to a source who was briefed on the tentative agreement.

At Mount Sinai, the three-year tentative agreement includes raises of 4% next month, 4% in March 2027, and an additional 4% staggered in January and June of 2028, according to a union fact sheet distributed to the membership that was obtained by THE CITY.

At Montefiore, the base wage increases by $15,000 over the three-year length of the contract.

The hospital had agreed last month to preserve the union’s premium-free health plan, another major point of contention for the nurses.

“We honestly got most of what we wanted,” said Zara Roy, a recovery nurse at Mount Sinai Morningside. “I’m planning to vote yes.”

In a major victory for the union, the tentative agreement preserves the staffing enforcement ratios the union first secured in its last strike in 2023, which was smaller and only lasted three days. Under that agreement, the nurses can arbitrate and secure monetary compensation when they work shifts at understaffed units. To date, Mount Sinai has paid millions to nurses whose units were chronically understaffed.

Still, there was compromise. One Mount Sinai nurse said he was inclined to reject the deal because it did not secure the jobs of the three fired nurses. Both hospitals agreed to hire additional nurses, but it will not hire as many as the union wanted.

The agreement capped a dramatic bargaining session at the Jacob K. Javits Center over the weekend in which mediators presented their final recommendations to the nurses and all three hospital systems and allegedly threatened to quit, according to a source.

Negotiations between the hospitals and the union picked up and broke down repeatedly over the last month, a feature of a strike that was more bitter than any in recent memory.

The nurses’ union has lodged more than a dozen complaints against the three hospital systems accusing them of violating U.S. labor law, including by retaliating against nurses for organizing. At Mount Sinai, the union accused administrators of unlawfully disciplining — and in some cases firing — pro-union nurses. Mount Sinai, in turn, accused striking nurses of “bullying” travel nurses, a charge the union denies.

Montefiore, Mount Sinai, and NewYork-Presbyterian have jointly spent about $100 million to pay temporary nurses for the duration of the strike, the Greater New York Hospital Association, a trade group, has said. Meanwhile, striking nurses scrambled to make ends meet, with some collecting unemployment checks and applying for COBRA.

Last week, nurses staged several large demonstrations without the union’s endorsement at Grand Central Terminal and Times Square, marching to Gov. Kathy Hochul’s Manhattan offices on the east side, and outside the League of Voluntary Hospitals and Homes. Thirteen nurses were arrested at the latter picket on Thursday, in a show of civil disobedience.

A previous version of this story mischaracterized the tentative raise scale at Mount Sinai facilities.

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

Public Health Service workers are quitting over assignments to Guantánamo

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

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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.

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.

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

2026-02-02T22:40:39+00:00

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

The new health commissioner for New York City is a Harvard-educated emergency physician and former White House fellow who has spent the past several years in Boston combining medicine with advocacy work, burnishing a resume that leans more toward health care than public health.

At a news conference Saturday in the Bronx, New York City Mayor Zohran Mamdani named Alister Martin as the new head of the New York City Department of Health and Mental Hygiene following weeks of speculation about who he would pick to run the agency. At 37, Martin will oversee one of the largest health departments in the world, with more than 7,000 employees and an annual budget of $1.6 billion.

“While this is a new chapter for me in the city, it is not the beginning of my story. It’s a continuation of one that began just down there, the street in Queens,” Martin said from the lectern after Mamdani introduced him. “My mother raised me as a single parent in Jackson Heights, just a few blocks from Elmhurst Hospital.”

(Elsewhere, such as in his White House fellow bio and in a Harvard magazine, Martin has said he grew up in New Jersey.)

Martin’s appointment comes at pivotal time for New York City, and he will be tasked with protecting the health of millions of New Yorkers, some of whom stand to lose their health insurance or Medicaid under looming federal cuts, or see their premiums spike under the Affordable Care Act.

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

Martin will also assume a key role in coordinating efforts around the World Cup matches that are expected to bring more than a million visitors this summer to Greater New York — a responsibility that will take on even greater significance because of the deep cuts to the Centers for Disease Control and Prevention and the U.S. withdrawal from the World Health Organization.

Martin will report to Helen Arteaga Landaverde, the deputy mayor who was recently named to oversee Health and Human Services. She previously led NYC Health + Hospitals/Elmhurst as its CEO.

Health Department spokesman William Fowler said Martin was unavailable for an interview. Martin did not respond to an interview request sent to his email address.

Dr. Michelle Morse will remain chief medical officer

Martin’s appointment came as something of a surprise. There had been high hopes in certain New York City public health circles that Mamdani would keep Dr. Michelle Morse, a longtime health equity advocate who had served in an acting role since October 2024 and expressed her desire to run the department under Mamdani. On the reddit thread r/nycpublicservants, commenters expressed disappointment that Morse was passed over.

In a statement released Monday, Morse welcomed Mamdani’s pick.

“This work was always far larger than any one person: It did not begin with me, and it does not end with me. I look forward to working with Commissioner Martin as he prepares to lead the best health department in the world.”

NYC’s new deputy mayor for health went from Covid patient to hospital CEO

Fowler said Morse “continues to serve in her role as the agency’s chief medical officer.”

Generally, heads of public health departments are selected after having led smaller departments and moved up through the ranks, said Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health & Health Policy. Martin’s resume reveals little leadership experience.

“This is not a traditional pick,” Lee told Healthbeat.

Martin went from high school expulsion to Harvard graduate

The son of a mother who worked as a biology teacher and a United Nations human rights consultant with Haitian ancestry and a father who served as a diplomat from Belize, Martin grew up in Neptune, New Jersey, and played competitive tennis in high school. During his senior year, he was expelled because of an off-campus fight and earned a GED, he told Teen Vogue in a 2023 interview.

Instability at home was apparently the norm. His father had suddenly left the family, and he and his mother sometimes went without insurance or a primary care doctor, he told the magazine. The experience would later help him connect with patients in the emergency room.

Martin and his father didn’t meet until he was 20 and his father was dying of a late cancer diagnosis, according to a 2021 profile in the Harvard Kennedy Magazine.

“My going to be there for him in his final days was a reflection of my mother’s strength, of all the kindness, love, and compassion she had instilled in me. I came to understand my father, and by doing so, came to understand myself more clearly,” he told the magazine.

Martin went to college at Rutgers, where he continued to play tennis, and then went to Harvard Medical School and the Harvard Kennedy School, earning degrees from both in 2015, according to his LinkedIn profile. He holds a master of public policy degree from the Kennedy School of Government, instead of a master’s of public health degree that is more traditional for someone running a public health department.

Martin brought voter registration to emergency room

Two years after completing his residency, Martin built successful

national campaigns to enlist doctors in the battle against the opioid epidemic, according to the Harvard magazine story, and his advocacy work as a doctor would only deepen.

In 2019, during the presidential race between Donald Trump and Joe Biden, Martin co-founded a startup at Massachusetts General Hospital called Vot-ER, where he had been a chief resident and faculty member. And during the pandemic, he knocked on doors in Boston neighborhoods that saw high numbers of residents sick with Covid-19 and needed vaccinations.

Here’s a look at who’s advising Zohran Mamdani on health policy

After years of seeing patients struggle with the health consequences of poverty, drug addiction, homelessness, and other issues, he founded Vot-ER to register voters in emergency rooms.

“What if long emergency room wait times, an unfortunate fact of life, could also be a key to increasing voter participation among traditionally underrepresented groups in our electorate?” Martin wrote in a January 2020 opinion piece for The Boston Globe with Cass Sunstein, a prominent Harvard law professor. “The demographic overlap between those who most use the ER for their health care and those who don’t vote presents a potential opportunity.”

The effort provoked debates about the roles that physicians should or shouldn’t play in civic life. It also drew rebuke from conservative groups, including the Republican National Convention, which sent letters to the secretaries of state in six swing states urging officials to monitor Vot-ER ahead of the general election, according to a 2024 article in The Philadelphia Inquirer. Vot-ER was folded into A Healthier Democracy, a nonprofit that has made contributions ranging from $5,500 to $60,000 to community health centers in mostly swing states, according to 2024 tax records.

An executive director of Vot-ER said at the time that Vot-ER does not endorse political parties or candidates, complies with election laws, and has board members from both political parties.

From 2021 to 2022, Martin was a White House Fellow, working as an adviser to Vice President Kamala Harris on voting rights issues. Later, he was part of a U.S. Department of Health and Human Services advisory panel on outreach and education.

In recent years, Martin has focused on running A Healthier Democracy as its CEO and teaching as an assistant professor at Harvard Medical School.

In his remarks at Saturday’s news conference, Martin said he no longer wanted to see health care become such a financial burden to patients.

“We are going to make sure that when a family walks into a health center, they can walk out not just healthier, but more financially stable,” he said. “We’re going to prove that public health is not just about disease. It’s about dignity, about stability, about making sure that no one gets left behind.”

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 I’ve learned as a nurse about the power of human connection in public health

2026-01-27T15:18:32+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 18 at Powerhouse Arena bookstore in Brooklyn. Watch the full show here. Sign up to receive Healthbeat’s free New York newsletter here.

In the weeks since learning of this opportunity to share stories on community and public health, I discussed with a few close friends how I might attempt to do justice to themes that drive much of how I experience the world. One such friend gently reminded me I had already said most of it to her in our conversations. This is an attempt to share the essence of those exchanges.

The scope of public health can make it seem as though individuals have little effect. Then a moment will remind me what underpins all of it are the individuals themselves – their stories, and everything that led to whatever moment we are in, or decision we are trying to make.

Holding space for genuine connection between those of us working in these spaces and those we serve is essential, because outside these roles, we are all members of a shared idea of community. Through these moments of human connection, people become three-dimensional. Every time we remember and feel this truth, we push back against the false dichotomies of “you versus me” and “us versus them.”

My insights rarely come in a grand way. They present more as blips across time and place. A conversation in New York connects to moments in Michigan, and experiences in India will have a throughline back to another in New York.

One day while volunteering at a food bank in New York City this past summer, I found myself alongside an objectively put together individual. This artist by vocation seemed imbued with confidence and humor. Over hours of shared work and conversation, she revealed her grief over losing a parent when young, her struggles with self-image and eating disorders, and how generational cycles that shaped her family were entangled with larger societal messages about how one’s worth is evaluated. Beneath a surface of style and security was another human being looking for peace while navigating pain and hope.

A few years ago, as part of the team at a no-cost community health clinic in rural Michigan, I was witness week after week to the various needs and truths of those utilizing the clinic’s services. Many patients worked full-time yet could not consistently afford the cost of medications for chronic conditions like diabetes. Chatting with an established patient at the clinic, who never complained if there was a long wait and would stay after his appointment to continue conversing with office staff, I learned over time these moments were one of his main sources of social interaction. Shadowing a bilingual provider and seeing how her ability to communicate fluently, and in a way that developed rapport and trust, revealed additional and relevant layers of a patient’s complex health history, refining their care plan.

When last year I visited relatives in India after years away, I was reminded again of the universality of humans’ desire for self-determination, belonging, safety, and understanding. Sometimes it took different forms within tradition, religion, or social systems, but the essence was the same.

Soon after returning to New York from India, I was part of the care team for an adolescent patient hospitalized for complications related to anorexia. Through many 12-hour shifts together, I came to appreciate her pride in her family’s traditions and spirituality, her desire to honor them while also not being subsumed by them. When her parents came to visit, I witnessed her joy at seeing them, as well as her pain for how their love and despair often echoed the very messages she identified as part of the cycle she was trying to break.

Often, connection seems like a luxury our health care system cannot afford. On the surface, it appears not to fit with health care metrics related to efficiency. But again and again, as a nurse, a volunteer, and a member of this shared community, I have come to see that while science and knowledge give us tools, it is our interconnectedness with other beings that gives us purpose.

One form of that is in the stories we tell, and the space we hold for one another. When we lose sight of this, every protocol, policy, and system we design is similarly limited, as it misses core aspects of what it means to not only exist but have a chance to thrive.

Vidya Thirumoorthi has worked as a nurse in Detroit and, most recently, in New York City at Morgan Stanley Children’s Hospital. She holds degrees in nursing and psychology from the University of Michigan and Wayne State University. Her interests include global health and health equity, with a focus on adolescents and emerging adults.

What working in a clinic in rural India taught me about health care

2026-01-26T16:13:01+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 3 at Manuel’s Tavern in Atlanta. Watch the full show here. Sign up to receive Healthbeat’s free Atlanta newsletter here.

In 2016 and 2017, I worked at a hospital and community health program in rural eastern India. That revolutionized my view of what health care could be like.

Everything in the system was geared to serve the patient: Signs over offices and paperwork included pictograms for the mostly illiterate people we served. This proved so effective that many of our village health workers successfully completed their work without ever learning to read.

We economized on everything, using mosquito nets for hernia repairs and washing gloves with bleach so they could be reused.

We didn’t have much – and it was by no means perfect – but what we did have was care; respect; compassion – all built into a community health system that actually served its community.

When I came back to Atlanta, I worked in hospital emergency rooms. Here, we had state-of-the-art equipment, highly trained staff, air-conditioning, and gloves galore. But something felt different to me. Patients and doctors spoke English, but talked right past one another. Doctors were scolded for taking too long with patients. Psychiatric patients and others lingered for days because we could find no place to send them.

And worst of all, we were all rowing in different directions. The doctors answered to one authority; the nurses to another; social workers and chaplains appeared and then disappeared; and no one seemed to care about the environmental services team, who worked so hard to keep the hospital clean.

Spending time at clinics like this one in rural Chhattisgarh in eastern India helped me rethink how health care is delivered.

I was disheartened that my hometown, a public health capital, couldn’t provide the kind of compassionate care I saw being provided in rural India. Yes, our patients were sick, but so was our system. For more than a year, I took all this in and bottled up my emotions, mostly, my anger and sadness.

Finally, I had an aha moment: I put down those bitter emotions and picked up my pen, pledging to write about what I knew. That was more than five years ago, and while I can’t claim to have fixed our broken system, I am proud to to be here, still writing about health in my hometown, learning from all of you, and carrying with me the compassion and can-do spirit that I learned thousands of miles away in rural India.

Born and raised in Atlanta, Rebecca Grapevine is back home as a Healthbeat local reporter. She has a Ph.D. in history from the University of Michigan and in her travels learned to speak Hindi (nearly) fluently. Read her Healthbeat work here. Contact Rebecca at rgrapevine@healthbeat.org.

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.

‘I never thought I deserved something so valuable’: How health kits are empowering birth care in New York and abroad

2026-01-21T14:58:37+00:00

I’m going to share with you two “aha” moments – both revolving around the lifesaving toolkits that we at Saving Mothers distribute to pregnant women. It’s a story that highlights both the shared experiences of giving birth, no matter where on Earth you live, but also the wide discrepancies in available birth care.

I’ll start here at home in New York City, where Saving Mothers has been giving out “mPOWHER” kits.

These are maternal health kits that contain resources that women need to take charge of their maternal health care and understand their health risks in pregnancy. They also contain cards that are meant to help them talk to their doctors and nurses in the hospitals and clinics so they can make sure that they are seen and heard.

We know that racial disparity in maternal health is very high here in New York City. So these kits are specifically aimed toward addressing racism and disparity, making sure women can advocate for themselves, get their needs met, and frame their questions in a way that they can get quick answers and thorough answers.

The kits have these resources, including a blood-pressure cuff, a Fitbit, some venodyne stockings to address blood clots. They target the top causes of maternal death here in New York City, that’s where we focused the kit.

These kits cost about $125 because they include a lot of nice resources, like the Fitbit, the blood-pressure cuff, a beautiful diaper bag for the mother, and some other giveaways. They are nice kits that we put together, that we do by hand, that we have our teams pack.

The goal of the kit was to improve maternal health and improve their odds in pregnancy. We give it out to the women, and we asked for feedback. And one mom I remember, and this was an “aha” moment for me: She opened the kit, she looked at all the resources, and we asked her about her feedback, like, how did she think that the kit was helpful? And she said, “When I opened this kit, I just started crying, because no one has ever given me anything so beautiful and so valuable. And I never thought that I deserve something so valuable.”

That was her feedback. It was an “aha” moment for me as a doctor, as an OB-GYN, because I’m thinking she’s going to give me feedback about how she used the blood-pressure cuff, or how she used the resources. But she was so touched by the fact that someone packed this kit for her and that it had valuable contents – it had a Fitbit, it had things that she knew had some value – and she just loved it so much.

From Kenya to New York: How a global nonprofit is addressing local maternal health needs

She said, “I brought my mPOWHER kit everywhere. I brought it to every appointment. I did everything that was in it. I felt so lucky to have such a valuable kit.” I thought that was really, really interesting and really telling about how mothers, especially underserved mothers, those who live in shelters, or in areas of the city where they don’t have a lot of access, how much they truly do value this. She could see that we put a lot of thought and effort into it, too. We put little handwritten notes in it, like “You can do this.” We have a lot of inspirational messaging that we include.

Through the feedback that the mothers in New York have given us, we’ve also added a mental health component to the kit. Now the kit has a journal, and that journal has inspirational words and stories for mothers along the lines of “You are valuable. You are important. You are amazing. You can complete this pregnancy, have a baby.” We have inspirational words to get them through pregnancy and postpartum, as well.

That one helped us understand the mental health piece, which I think is something that needs more attention. Now our $125 kit includes that. It includes a mental health card and a wellness card and a journal, and it actually incorporates a lot of the feedback that we got from our mothers and the focus groups.

I’ve learned other things from those focus groups, too, like that blood-pressure cuff that we give women – the woman doesn’t just use it for herself in pregnancy. It’s actually become a family unifying thing. They do everyone’s blood pressure, the in-laws come over, the parents come over. Everyone’s getting their blood pressure checked now, and a lot of these families are larger. That’s also a really great downstream effect of habit, giving people resources and making sure they know how to use them.

These are low-cost, high-impact kits, the “mPOWHER” kits that we’ve used in New York. But we have another kit, probably our longest-standing kit that we created when we started Saving Mothers in 2009 – the clean, safe birth kit.

In Africa, women must bring own birthing supplies to hospital

What I have learned about birth in many of our countries that we’ve served in many parts of Africa, specifically many of the hospitals there, is that mothers, when they want to deliver, they cannot come into the hospital, even a major hospital in a big city, like in rural West Pokot, Kenya, without bringing their own birth supplies.

A laboring woman will come to the hospital, and she will be turned away for delivery because she doesn’t have her clean birth supplies, like cord clamps, scissors to cut the umbilical cord, gloves for the doctor or nurse, a clean surface, soap – some of these basic tools that women and their families in very poor, very underserved regions of the world, have to go and find and purchase and come back with.

I didn’t realize when we first created the clean birth kit that the hospitals also needed the resources, that women were actually being asked to bring their own clean birth kit. That was an “aha” moment.

The clean birth kit was meant for the over 80% of women that deliver babies at home in most regions of the world. In most of the world, there aren’t a lot of trained OB-GYNs. There are whole countries that have a handful of trained OB-GYNs. Back when we were working in Liberia years ago, 2009, 2010, there were like three. The vast majority of women around the world are being delivered by birth attendants or midwives with varying levels of training. Some places they have some training; other places, not as much.

They’re called anything from traditional birth attendants to midwives. But they lack training, and obviously they’re not surgically trained – any of them – to be able to deal with urgent, emergent and C-section type delivery. So these clean birth kits were meant to be a resource for women at home, so that we could promote sanitary birth, so we could lower the risk of infection to the newborn. So that the mother had a provider that was using gloves. So that there was a clean surface. So that the attendant washes their hands, at least with Purell, even if there was no running water.

Our safe birth kit cost $15, and we’ve sent tens of thousands of these kits around the world since we started. They go everywhere, from clinics, directly to community health workers and birth attendants, especially in the areas where we train them, like Guatemala and Kenya. Then we empower them with the kits, as well. It’s been really amazing to see how much these kits are needed everywhere.

The $15 includes shipping. We bundle that into the cost because we want them to be accessible and low cost. Our big goal is always to make all of our things low cost. It’s about creating things and streamlining programming so that the highest number of women have access, so the cost is always important.

People need our kits everywhere. They need them, based on the culture, the circumstance, the issues that bring the highest risk of maternal death. Those causes are different in different communities. But the need is the same: for all women, everywhere, to have a safe, clean birth.

Dr. Taraneh Shirazian is the founder and president of Saving Mothers, a 501(c)3 non-profit organization founded in 2009. Saving Mothers is dedicated to eradicating preventable maternal deaths and birth-related complications in the developing world. She is also a practicing gynecologic surgeon and associate professor at NYU Langone Medical Center and director of NYU Langone’s Center for Fibroid Care.

Her story was told at Healthbeat’s event by Re Perry, program coordinator for Saving Mothers who earned her MPH at NYU.

Nurses’ strike enters second week, with no end in sight

2026-01-20T22:52:28+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.

Negotiations between the New York State Nurses Association and three hospital systems broke down again over the weekend, dashing the hopes of a potential resolution to a strike involving 15,000 nurses now in its second week.

NYSNA, the nurses’ union, said it had submitted a revised set of proposals heading into weekend bargaining with Mount Sinai, Montefiore and NewYork-Presbyterian, but talks went nowhere. The union is demanding better staffing, improved on-the-job safety, and maintaining health benefits. But the hospitals are dug in on rejecting those demands as unreasonable. The hospitals have reportedly spent $100 million on temporary nurses, according to a leading trade group.

Only Montefiore submitted counterproposals addressing workplace violence during a marathon bargaining session Sunday evening, though no meaningful progress was made, according to union sources. Mount Sinai and NewYork-Presbyterian rejected the nurses’ revised proposals without countering, and no additional bargaining sessions had been scheduled as of Tuesday afternoon.

The breakdown was the latest development in a strike more bitter than any in recent memory. The nurses’ union has lodged more than a dozen complaints against the three hospital systems accusing them of violating U.S. labor law, including by retaliating against nurses for organizing.

Here’s a look at who’s advising Zohran Mamdani on health policy

At Mount Sinai, the union accused administrators of unlawfully disciplining — and in some cases firing — pro-union nurses. Mount Sinai, in turn, has accused striking nurses of “bullying” travel nurses, a charge the union denies.

Michelle Gonzalez, an oncology nurse who sits on the Montefiore bargaining committee, said that safety is the union’s top priority, and she described how the loss of beds has led to overworked nurses tending to patients in hallways.

“There’s a certain amount of moral duress that comes from dealing with these conditions for both the patient and for the provider,” said Gonzalez. “And that’s why we cannot accept from them this idea that there’s nothing that [the hospital] can do.”

Nurses on strike at Mount Sinai West hospital watch Mayor Zohran Mamdani speak on Tuesday.

The strike, which the union claims is the largest of its kind in New York City history, has already eclipsed the duration of a smaller strike in 2023 that resulted in improved nurse-to-patient staffing enforcement mechanisms the hospitals are now attempting to roll back.

Pickets continued at nine hospital facilities through the long weekend as real-feel temperatures plunged to the single digits. On Tuesday morning, nurses at Mount Sinai West were joined by Mayor Zohran Mamdani, in his second visit to the NYSNA picket line, and U.S. Sen. Bernie Sanders, I-Vt., both of whom urged hospital representatives to come back to the bargaining table.

“The people of New York City, the people of Vermont, the people of America, love and appreciate our nurses. And today we say to those hospitals: Sit down and negotiate a decent contract,” Sanders said, prompting chants of “Bernie! Bernie! Bernie!” from the scores of nurses and supporters in attendance.

Earlier Tuesday morning, NewYork-Presbyterian spokesperson Angela Karafazli said the hospital was “working through the mediator” to schedule the next bargaining session. Mount Sinai CEO Brendan Carr said in a notice to staff on Monday that the hospital “extended our plans to run the Health System without the support of the nurses NYSNA leadership has convinced to strike.”

Montefiore strategic communications executive Joe Solmonese said the union’s demands were “reckless and dangerous.”

“Until they can back away from their reckless and dangerous $3.6 billion demands, progress overall will not be possible,” he said. “In the meantime, we continue to provide the world-class care our communities deserve.”

Nurses who spoke with THE CITY said that hospital management has been emboldened by what they described as the Trump administration’s anti-worker agenda to reverse the union’s previous victories. The union, the nurses said, was more determined than ever to hold the line.

“It’s not just about nurses: This is to try and teach the working class that we are not in power, that who has power is the 1% — the CEOs and the rich,” Gonzalez, the Montefiore nurse, said. “We’ve had this erosion of our contract that they’re trying to do right now because they feel empowered and emboldened, in my opinion, by the Trump administration.”

“If they succeed in breaking our power and what we’re fighting for here in New York, taking away health care for nurses, they’re going to do this in every other unit, and in every other state,” said an OB-GYN nurse at Mount Sinai Hospital who declined to give her name. “So this fight is about more than just us.”

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

How Emory’s Vaccine Dinner Club helps scientists connect in tough times

2026-01-20T21:42:13+00:00

The downstream echo of my “aha” moment in public health is the reason I was late arriving for tonight’s program.

Here’s the background. In 1981, Dr. Jim Curran led the Centers for Disease Control and Prevention task force that investigated the very first cases of a new disease that we all later came to know as AIDS. I joined the field as an AIDS community and medical educator five years later, and 12 years after that, in 1998, I was recruited from the Emory School of Medicine to the Rollins School of Public Health by Curran, who was by then serving as the school’s dean, to help him start a National Institutes of Health-funded Center for AIDS Research at Emory.

At one of our first meetings with organizational shareholders from across campus, someone floated an idea that CFAR and the Emory Vaccine Center could collaborate on hosting an evening seminar series to raise our mutual profiles.

“That’s a great idea!,” I chirped up. “We could serve food too and call it the Vaccine Dinner Club!”

Instantly the room erupted with laughter, but as soon as Curran handed me the job of designing, organizing, and running the new initiative, that is exactly what I did.

Having been told that a seminar on HIV vaccines at Emory might draw as many as 30 or 40 scientists, I booked an appropriately sized room and sent out an email to a couple of colleagues asking for their help in advertising our first gathering. In that email, which I begged recipients to treat like a chain letter, I asked people to write me back directly if they wanted to attend the VDC’s first meeting, which would begin with networking over wine and cheese, followed by a science presentation given by Emory Vaccine Center Director Dr. Rafi Ahmed, and end with a casual buffet dinner.

Return emails began to trickle and then pour in. This shouldn’t have been all that surprising because this was during a period in history in which you weren’t allowed to even serve coffee at a federally funded meeting, and here I was offering free wine, cheese, and dinner. But I was still floored when, by the time the Vaccine Dinner Club met for the first time a month later, on Jan. 6, 1999, more than 300 people had registered to attend.

As you may know, the CDC is a separate nation-state located on the Emory campus and, to this day, I swear I felt the ground rumbling gently beneath my feet as wave after wave of CDC employees came thundering down Clifton Road on foot, apparently at a dead run, in the direction of food-and-drink-enabled science.

My gratification turned to panic, though, when it became clear to the milling crowd that somebody (OK, me) had forgotten that wine bottles must be opened before their contents can be consumed.

Fortunately, it turns out that the VDC membership has self-selected for resourcefulness from the very beginning and that a surprisingly large number of people carry corkscrews in their pockets and purses.

In almost no time at all, an impromptu bucket brigade of meeting attendees, led by biostatistics luminary Dr. Betz Halloran, formed to uncrate, open, pour, and distribute 300+ glasses of wine. The rest of the evening was fabulous as well, and I really think that that night set the stage for thinking of the VDC truly as a club, not a seminar series.

But, believe it or not, that wasn’t my “aha” moment.

And it still wasn’t my “aha” moment 21 years and almost 200 programs later when the pandemic happened and the VDC had to go online.

Taking dinner club to Zoom opened it to more people

I still vividly remember stepping up to the podium on March 4, 2020, to open what later turned out to be our last in-person meeting for four years. The talk was titled Covid-19: What We Know, What We Suspect, What We Fear and starred Dr. Jay Butler, deputy director for infectious diseases at the CDC.

In those days, the VDC’s average meeting attendance was around 200, but I have no idea how many people were there that night. Seriously, I don’t because to maintain plausible deniability with the fire marshal I stopped counting at 550. But let’s just say that we were in a two-level auditorium and it was standing room only.

When I stepped behind the podium and looked at that absolute sea of faces, I put down the meeting-opening cowbell I had been ringing and, without thinking, blurted out:

“Dr. Butler’s talk will include an analysis of Covid-19 super-spreader events. And speaking of super-spreader events ... would everyone in this extremely crowded, windowless room please behave responsibly and hold your breath for the next 60 minutes?”

Mike Luckovich, editorial cartoonist at The Atlanta Journal-Constitution, drew this sketch of Dr. Kimbi Hagen, the founding director of two international science-focused dinner clubs.

But my “aha, this is why I do it” moment didn’t even occur then. That came later, after the VDC had entered the Zoom era and my fear that the club would collapse in the absence of free wine proved to be unfounded. In fact, to my puzzlement, membership requests and registration attendance absolutely exploded in size during the pandemic to the point that I began opening each meeting with a slide showing the ever growing list of countries around the world from which any given month’s attendees were Zooming in.

And then one day it all made sense. I was reading registration form comments for the upcoming meeting and one said “thank you, Thank You, THANK YOU Kimbi for keeping the VDC going. My job is to increase Covid vaccine uptake in a part of the country that believes Covid is a hoax. I absolutely LIVE for these monthly opportunities to relax and spend time, even if only online, with my tribe, The People Who Get It. The VDC makes me feel less alone.”

That was my “aha” moment. That was when I realized that for some people, maybe many, attending VDC meetings was no longer simply about having access to cool science, it was now also, and perhaps more importantly, about having access to a safe space where — in a world that was increasingly making the trashing of public health and public health professionals into a full-time job — they could feel seen, heard, supported, and not so alone.

Now there are two: Vaccine Dinner Club IRL and online

I am a public health professional like most of you here, but it turns out that my public is you — the people who make public health happen. I do what I do, so that you can do what you do.

That insight was re-crystalized for me post-pandemic when, after pausing the VDC for the entirety of the 2024-25 season, I was absolutely inundated with hundreds of thank you messages when I restarted the club this past September.

As a result, when the VDC’s two major sponsors notified me that they want VDC meetings to scale back from monthly to quarterly and revert to in-person only, which would restrict meeting attendance to people in Atlanta, I became acutely aware of the sense of abandonment and exclusion that that might create among the membership.

My solution was to start a second club. With sponsorship from the Rollins School of Public Health, the new club only meets in the months that the Vaccine Dinner Club does not meet and addresses public health issues that are not vaccine specific.

Because I outsourced the naming of the club to the members and we are currently narrowing down possibilities for a final vote, the new org is currently officially known as the As-Yet-Unnamed Dinner Club, or UDC. Membership in the UDC, which didn’t even exist 2 months ago, is 6,711, which is almost 1,300 more members than the Vaccine Dinner Club took 27 years to accrue. That speaks very strongly about the continued need for an organization like this.

Our inaugural meeting of the As-Yet-Unnamed Dinner Club on Oct. 1 was titled Public Health Chaos: What It Means for America, and starred three long-time VDC members, Drs. Demetre Daskalakis, Deb Houry, and Dan Jernigan — aka “D3” — the three senior leaders who resigned from the CDC after Health and Human Services Secretary Robert F. Kennedy Jr. fired CDC Director Susan Monarez.

Almost 2,600 people attended that first meeting, including more than 100 who have retroactively registered after the meeting was over, just to receive a link to meeting recording.

The second meeting of the UDC, Science Under Siege: What You Can Do About It, took place this evening. It featured superstar author Dr. Peter Hotez and is why I was late getting here tonight. Because I couldn’t bear the thought of missing out on your stories, not to mention Healthbeat’s first birthday party, I hosted this month’s UDC meeting from my laptop here at Manuel’s Tavern. You can retroactively register for that meeting if you want to hear Hotez’s thoughts about how we can fight anti-science.

Why there’s hope for public health in America

Speaking of anti-science … before ending my story, I want to read a few sentences that I included in my email opening registration for this evening’s UDC meeting. They originally came from an email to one of the UDC members and spring from conversations I have been having with multiple VDC and UDC members who have reached out to talk about how distraught they are, as I am, as we all are, over the deliberate damage that is being done to public health in America right now. This is what I wrote:

“I keep reminding myself that perhaps the only advantage to being as old as I am is that I have lived a long time. Including growing up in the Jim Crow South. Which means that I have real-time memories of cross burnings, segregated schools, whites-only everything, and the Tuskegee study.

“Which also means that I know, from my own lived experience, that we as a country are fully capable of righting great wrongs that are inflicted on us by our government because we have done so before. There is precedent for it in my own lifetime.

“So I have to believe that we will get through this because we can get through this because we have gotten through even worse. And successfully come out on the other side.”

Thank you.

Dr. Kimbi Hagen is the founding director of two international science-focused dinner clubs. She has been a faculty member in the Department of Behavioral, Social, and Health Education Sciences at the Rollins School of Public Health at Emory since 1998.

Universal child care, NYC nurses’ strike, ACA subsidies, and the flu

2026-01-16T18:46:54+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 lot happening in New York health right now — from universal child care plans and the New York City nurses’ strike to rising health care premiums and continued flu. Let’s jump right in.

Hochul and Mamdani announce a plan for universal child care in New York

Last week, Mayor Zohran Mamdani and Gov. Kathy Hochul announced a joint plan to bring truly universal child care to New York City and extend it across the state.

Why this matters

Access to high-quality child care has been shown to benefit children’s and parents’ health and well-being:

High-quality early care and education programs are associated with positive developmental outcomes for children, including early learning, cognitive and language development, stronger school readiness, and emotional skills.
Child care has been associated with improved maternal mental health, including protection against symptoms of depression, by reducing stress and caregiving burden on parents.
Expanded access has also been shown to increase maternal employment and economic stability — important components of health equity. One assessment found that mothers’ labor force participation in New York City increased by 7.5% after universal pre-K for 4-year-olds was implemented.

It’s important to note that the quality of the care is what’s most important, not necessarily where the care takes place. High-quality care and education can take place at child care centers or inside the home, and with community-based caretakers or family members.

What’s the plan?

The joint plan to expand child care in New York City and the rest of the state is mostly driven by funding additional child care facilities and increasing staffing levels.

In New York City, the additional funding would help make 3k (child care for 3-year-olds) access truly universal. Right now, many families qualify for 3k but don’t have spots available in their neighborhoods, requiring them to commute unfeasible distances or find/pay for other child care. The funding would increase facilities and staffing in New York City.

The proposal would also launch a new “2-Care” program in the city, providing free child care for 2,000 2-year-olds in high-need areas beginning this year. The program would then be expanded citywide over four years, with the state fully funding it for the first two.

The state’s goals are to expand child care to all 4-year-olds (also called pre-k) statewide by fall 2028, and help counties build pilot programs to offer affordable child care. Hochul said the broader statewide plan would increase affordable child care to nearly 100,000 additional children through a mix of universal pre-K expansion, new community-based care programs, and broader eligibility for child care subsidies.

The plan also includes:

Increasing state funding for pre-k seats to at least $10,000 per child
Expanding child care subsidies, with most eligible families paying no more than $15 per week
Raising income eligibility to about $114,000 for a family of four

How will it be funded?

The governor has committed a $1.7 billion investment to expand child care across the state. If the legislature approves the budget, total child care and pre-k funding will be $4.5 billion for fiscal year 2027. The current proposal uses funds that already exist and would not currently require increased taxes. However, a plan for long-term funding of the expansion has not been proposed.

What happens next?

To accomplish the goals of universal child care in New York, there are a couple of big milestones ahead:

The state legislature still needs to approve Hochul’s funding requests, although the strategy of using existing state funds rather than raising taxes makes it more likely to go through.
The child care workforce will then need rapid growth, including hiring and training teachers, and improving the infrastructure of the current fragmented system of schools, day care centers, and private home caregivers.
The plan will also need long-term funding. If the program is successful, will taxpayers and lawmakers be willing to sustain its funding? Additionally, how will changes in federal funding affect New York programs? ($10 billion in federal funding for child care subsidies is currently frozen, including in New York, and being debated in the courts.)

Making child care truly universal in New York has great potential to improve the health of children and parents. I’ll be watching its progress closely and reporting back.

~140,000 New Yorkers now face higher health care costs

Remember the 43-day government shutdown in the fall? (Feels like years ago already, I know …) One of the issues at the center of the debate was whether to extend health insurance subsidies under the Affordable Care Act. While the government eventually reopened, Congress never reached an agreement, so the enhanced subsidies expired on Dec. 31.

Now, 140,000 New Yorkers, and millions of Americans across the country, are seeing their health insurance costs substantially increase.

I did a deep dive on ACA subsidies in November, but here’s a quick refresher:

Under the ACA, coverage in New York is tiered based on income, anchored to the Federal Poverty Level. Before 2021, anyone making just $1 over 400% of the FPL — roughly $60,000 for an individual or $124,000 for a family of four — got zero financial help through the ACA. This was called the “subsidy cliff.” It disproportionately affected those who don’t get insurance from an employer and don’t qualify for Medicaid or Medicare. This includes many self-employed or freelance workers, small business owners, farmers, and early retirees, among others.

In 2021, the pandemic relief package removed the subsidy cliff, allowing anyone to get financial help if their premiums were greater than 8.5% of their income. But when the ACA subsidies expired at the end of last year, the cliff came back.

Hochul’s office estimates the average health care cost for a New York couple who previously qualified for ACA subsidies is now up 38%, meaning an additional $238 per month. That’s nearly $3,000 more per year for couples. It also varies across New York; Mohawk Valley has seen the steepest increase at 49%.

(Data from Gov. Kathy Hochul’s office.)

Despite the increases, there are some signals that Congress may be moving toward getting these subsidies back up. Earlier this month, the House passed a bill to reinstate and extend the ACA subsidies another three years; this moved to the Senate for consideration, where negotiations are ongoing. (A similar bill was voted down just last month.)

If you have questions about your New York coverage options, premiums, or eligibility, call 1-855-355-5777 or visit nystateofhealth.ny.gov. The deadline to enroll in a Qualified Health Plan (i.e., if you aren’t eligible for Medicaid, Medicare, the Essential Plan, or Child Health Plus) is Jan. 31.

I’ll also keep watching this and share updates as they come.

NYC nurses strike: What’s happening and what it means for you

This week, nearly 15,000 nurses across some of New York City’s major hospitals — Montefiore Medical Center, Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, and NewYork-Presbyterian — went on strike. This is the largest health care strike in New York City’s history.

Why are they striking?

The union is calling for:

Legally enforceable nurse-to-patient staffing ratios, so that nurses aren’t overwhelmed with too many patients, increasing safe patient care.
Higher wages to keep pace with inflation and retain staff amid worsening nursing shortages.
Increased hospital security to reduce workplace violence, which has risen in New York City health care settings.

The hospitals have pushed back on the demands, stating they would cost billions of dollars over the next three years and that they can’t afford the increases in light of health care funding cuts from the One Big Beautiful Bill Act. They also say these funding issues will be exacerbated as more New Yorkers lose health insurance, resulting in more uncompensated medical care.

What this means for patients

The New York State Nurses Association is encouraging patients to continue seeking care at the hospitals. In preparation, hospitals have brought in travel nurses and temporary staff, and Hochul issued an executive order to temporarily suspend certain licensing and practice restrictions so that clinicians who are licensed and in good standing elsewhere can work in New York without penalties, allowing hospitals more flexibility to keep adequate staffing. Still, hospitals may resort to transferring patients to other hospitals if capacity is strained.

How long will it last?

The last major New York City nurse strike in 2022 lasted three days. This one is much larger with the potential to cause more disruption to hospital systems — the longer it continues, the more pressure hospitals may face to delay non-emergency procedures and divert incoming patients.

Why it matters

Staffing ratios are a public safety and health equity issue. Studies show that safe nurse staffing is linked to lower patient mortality, shorter hospital stays, and better health outcomes. A 2002 JAMA study showed that:

Hospitals that staff 1:8 nurse-to-patient ratios experience five additional deaths per 1,000 patients than a 1:4 nurse-to-patient ratio.
The odds of patient death increase by 7% for each additional patient the nurse must take on at one time.

Ensuring nurses have the time and bandwidth to adequately care for their patients is vital.

I’ll keep you updated if anything changes.

Infectious disease ‘weather report’

Flu: It looks like flu may have peaked in New York, but levels remain very high across the state and New York City. Even with recent declines over the past two weeks, we’re still at levels close to the peak of the 2023-24 season. In short: Flu is still widespread in New York.

Flu cases in New York City.

I wouldn’t be surprised if we saw flu pick up again — that happens in some seasons. Because flu will still circulate into February and March, it’s not too late to get your flu shot.

RSV: Remains high but may have plateaued. (I know I said that last week, but the data is holding.) The good news is that RSV this season is lower than in the past two years.

RSV cases in New York City.

Covid: In good news, Covid is still low across the state. State case data show that it may have peaked, and at a lower level than the late-summer surge we saw earlier this year.

Covid cases in New York this season and last season.

Bottom line

There’s a lot going on in the New York health policy world, with many evolving situations that I’ll keep a close eye on.

From an infectious disease standpoint, flu is still the biggest concern right now. Staying cautious, especially in crowded indoor settings, is still a smart move, particularly for those at higher risk (older adults, people who are immunocompromised, pregnant, etc.).

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.

Bargaining to resume as nurses’ strike enters fifth day

2026-01-16T15:39:32+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.

All three striking hospital systems have agreed to meet with the New York State Nurses Association and federal and state mediators, in the first sign of progress since 15,000 nurses walked off the job earlier this week, THE CITY has learned.

Representatives from Montefiore and Mount Sinai will return to the bargaining table on Friday, their first session with the nurses’ union since Sunday, the eve of the strike, according to union and hospital sources. Representatives from NewYork-Presbyterian agreed to return to the bargaining table Thursday evening and again on Friday.

A spokesperson for NewYork-Presbyterian confirmed the hospital system was set to resume bargaining with the union on Thursday night. Representatives from Mount Sinai and Montefiore did not immediately respond to THE CITY’s request for comment.

Despite this progress, the two sides are far apart on issues the union says are non-negotiable for its membership.

Mamdani backs hospital nurses as 15,000 strike over pay, safety

A major sticking point is health care: Mount Sinai and NewYork-Presbyterian allegedly want to roll back or cease their payments to the union’s health fund — a move that would reverberate far beyond the striking nurses. (Montefiore provides health benefits through a separate plan.)

Any reduction in the hospitals’ contributions to NYSNA’s health benefits fund would increase costs for the 44,000 people enrolled in the union’s health care plan, including members in the private sector across the state and their dependents. If the hospitals get their way, NYSNA President Nancy Hagans said in a phone interview, premiums and prescription drug costs under their plan could dramatically increase.

“For them to come in and destroy the medical benefits of our nurses is a shame, and it’s unacceptable,” she said. The union also wants administrators to agree to install metal detectors and panic buttons and to agree to preserve nurse-to-patient ratios it secured in 2023.

Hospital representatives have said that they cannot afford to meet the union’s demands amid looming federal cuts and rising health costs.

Montefiore, Mount Sinai and NewYork-Presbyterian have jointly spent about $100 million to pay temporary nurses for the duration of the strike, the Greater New York Hospital Association, a trade group, has said.

“Our goal continues to be an agreement that balances the amazing contributions of our nurses with the long-term financial realities,” Mount Sinai CEO Dr. Brendan Carr said in a strike update to staff on Thursday. “To support ongoing safe operations, we’ve now extended our nonrefundable contract [for temporary nurses] to ensure we have a workforce willing to provide care to our patients. This investment consumes limited resources that I would have preferred to direct to our nurses.”

The three hospital systems are among the city’s most costly for patients. As patient costs soared by as much as 213% in the last decade and a half, executive compensation also soared, according to an analysis by the union.

NewYork-Presbyterian is under investigation by the U.S. Department of Justice for allegedly colluding with insurance companies to keep prices high for New York City patients.

The nurses’ strike, now in its fifth full day, is the largest work stoppage of its kind in city history. It has already surpassed the length of a smaller, three-day strike in 2023 by nurses at many of the same facilities.

This strike has also been more acrimonious. Hospital administrators have disciplined and in some cases fired outspoken nurses leading up to the strike. NYSNA has filed more than a dozen charges to the U.S. labor board alleging unlawful retaliation and threats against workers related to the contract talks and strike. Earlier this week, Montefiore officials accused nurses of striking to protect staffers “compromised by drugs or alcohol while on the job.”

Claudia Irizarry Aponte is a senior reporter covering labor and work for THE CITY.

Consolidation may be the answer to more austere global health funding

2026-01-15T13:43:48+00:00

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

Hello from Nairobi.

It’s a new year and I’m happy to be back home, where the vanilla orchids in my garden are blooming. (They’re beautiful, but won’t form beans unless I get on a ladder and pollinate them by hand!) This week’s report ranges from a big proposal to remake global health institutions to a very concrete, “cynical” decision shaping health care in a humanitarian disaster.

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.

Big structural reforms (try not to get too excited!)

Looking ahead to 2026, there are zero signs that last year’s global health cuts will revert. If anything, deeper reductions this year look like the more likely scenario.

And that leads us to the central challenge facing global health right now: Unless the goal is to just do less with less, this winter of austerity is a moment for the largest organizations in global health to reform. Either by slimming/changing their structures, or tightening their mandates. (As we’ve reported, the Global Polio Eradication Initiative deserves credit for being among the first to grapple seriously with this in practice.)

With that in mind, our first story this week is an essay in Think Global Health by Muhammad Ali Pate, Nigeria’s minister of health; Donald Kaberuka, the African Union’s top financing official; and Peter Piot, the former director of UNAIDS. Together, they argue that global health’s largest institutions should make changes that would have seemed unthinkable just a year ago.

Their proposal is deliberately severe.

At the center is a serious overhaul of institutions with overlapping mandates. The authors argue that GAVI and The Global Fund (the two biggest international funding organizations in global health outside the World Health Organization) should be merged into a single entity, writing that “financing institutions should form a holding company with a single governance and secretariat.” Under this model, that body could also absorb various other smaller organizations, including the “Pandemic Fund, Unitaid, and the Global Drug Facility for TB.”

The consolidation would not stop there. Other “single-disease entities that were created at the start of the millennium — such as Roll Back Malaria and Stop TB” could be folded in as offices under the same structure, or potentially into WHO itself. Ultimately, it’s hard to argue with their logic that in a world of shrinking budgets, funding parallel institutions built for an era of expansion is increasingly hard to justify.

Cost cutting is explicitly part of their vision, and the authors note an initial target: “The expensive Geneva presence should be minimized.” (It’s worth noting that Geneva is one of the most expensive cities in the world to house and support international staff.)

To gauge how this idea is landing among policy insiders, I reached out to Pete Baker, deputy director of global health policy and policy fellow at the Center for Global Development, a leading think tank tackling these ideas. Baker welcomed the proposal. “This is an important contribution to the current global health reform debate,” he told me, adding that consolidation could do more than cut costs. In his view, “one institution with a broader mandate could improve efficiency and be better at building health systems.”

But Baker is also clear-eyed about the obstacles. “However, this kind of merger will be very time consuming,” and cautioned that because we are talking about massive staffing redundancy, “each organization’s board and secretariat may resist it.” (I am reading this as a massive understatement.)

He leaves us with a set of open questions that will hang over global health reform throughout the year: “This will also consume a huge amount of effort from global health leaders. Will it be worth it?” he asks. “Or will it be easier to close existing institutions, and set up a new financing mechanism? One that is aligned to the multilateral development banks, broadly supports health system development, funds on-budget and backcountry priorities — and crucially — also provides loans as well as grants as countries get wealthier?”

A ‘cynical’ ban of health aid groups in Gaza

Let’s turn to what, despite a ceasefire, is still one of the world’s worst man-made humanitarian disasters: Gaza.

Israel has moved to ban dozens of international aid organizations from Gaza, which the British Medical Journal reports will sharply reduce an already abysmal state of medical care.

Under new registration rules, NGOs must hand over personal information on Palestinian staff to Israeli authorities or lose their ability to operate. Groups including Doctors Without Borders, Oxfam, and the Norwegian Refugee Council say the requirements put workers at risk and violate humanitarian principles. Israel argues the measures are necessary to prevent armed groups from infiltrating aid operations, an accusation the organizations strongly deny.

The potential impact of the bans is severe. “Overall, around 60% of Gaza’s field hospitals are run or supported by such international non-governmental organizations,” and Doctors Without Borders alone backs about a fifth of hospital beds and a third of births.

This is in the context where “more than 500 humanitarian workers [and] at least 1,700 health workers have been killed” in Gaza since October 2023, making demands for staff lists especially fraught.

Doctors Without Borders calls the policy a “cynical and calculated” move that could leave Palestinians without lifesaving care, at a moment when winter conditions, flooding, and aid restrictions are already proving deadly. Taken together with Israel’s earlier ban on UNRWA (the U.N. agency for Palestinian refugees), the decision signals a further, deadly contraction of humanitarian space in Gaza.

I reached out to Elisabeth Mahase, who reported the story, to ask how she sees this move in the context of years of grim news for Gaza’s health system. She emphasized that “considering how inadequate the health care capacity already is compared to the need, any loss in this space will have a devastating impact on Gazans. Palestinians in Gaza desperately need more aid and more health care, not less,” Mahase said.

Burning plastic indoors is surprisingly common

A new study has put numbers on a historically under-reported health risk: burning plastic inside the home for heat or cooking. One in three people in poor urban communities have seen it, and one in six say they have done it, The Guardian reports.

As you probably know: Burning plastic releases a noxious mix of pollutants, including “dioxins, furans, and heavy metals.” These are all chemical classes linked to respiratory disease, heart problems, cancer, and developmental harm.

Researchers have also found these toxins in soil and food near burn sites, raising concerns about longer-term contamination of local food chains. No real surprise here, but the practice is most common where waste collection is weak, and cleaner fuels are unaffordable or unavailable.

What’s the takeaway? The authors argue this is a major blindspot in global health and environmental policy. (On a personal level, I agree. I’ve seen a lot of burning plastic in my decade on the African continent, but even I find this rather surprising. What I’ve seen is usually outside, and done as a way to dispose of trash.)

Household plastic burning rarely shows up in official pollution data, yet plastic waste is expected to nearly triple by 2060. Without investment in basic waste services, cleaner cooking options, and public awareness, this is a health threat that will keep growing.

More funding for Marburg?

The European Union has announced $1.4 million in new funding for the ongoing outbreak of Marburg virus in Jinka, southern Ethiopia (a city I last visited in 2022 for work.) The new funding will be split among the WHO and two of the biggest organizations working on the ground: the International Medical Corps and the Red Cross.

Disease breakdown: Marburg virus is a high-fatality fever that is similar to Ebola, and often leads to hemorrhaging and organ failure. Untreated, about 9 in 10 people who contract the disease will die. The disease exists endemically in bats, allowing it to spread and occasionally spill over into humans. While this ongoing epidemic is Ethiopia’s first record of the disease, the WHO says the strain matches those seen in past regional flare-ups. There is, unfortunately, no vaccine.

What makes this announcement notable, and a little odd, is the timing. Just last week, the Ethiopian Ministry of Health announced the country had gone 21 days without a new Marburg case, essentially putting the outbreak halfway to epidemic control. That’s the kind of milestone that is usually announced, or at least echoed, by the WHO. Yet an International Medical Corps briefing Friday painted a very different picture, describing a ramping up of the response effort in Jinka.

This matters because, like the Democratic Republic of the Congo’s Ebola outbreak last year, Marburg in Ethiopia is shaping up to be an early test of how well the world can control one of its deadliest viruses in an era of global health austerity. Right now, the funding announcements and official signals don’t fully line up. It’s unclear whether they reflect caution and bureaucratic lag, or if there’s genuine concern that the outbreak is not as contained as it appears. I’ll be following up with independent reporting next week to try to sort out which story is closer to the truth.

Parenthood only needed this 13% tax

Let’s end this week’s report with a story that I’m sharing because, well, it just gets stranger the longer you sit with it. As Reuters reports, China has scrapped “a three decade-old tax exemption on contraceptive drugs and devices … to spur a flagging birth rate.”

Condoms and contraceptive pills are now subject to a 13% tax. Of course, this is not China’s first attempt to centrally engineer fertility decisions, though it may be one of the more delicate nudges. (The country, after all, enforced the one-child policy from 1980 to 2015.)

Yes, this move is just one of several recent efforts aimed at pushing China’s birth rates upward. But … I just can’t fathom how a 13% tax is really meant to nudge would-be parents in the direction of a newborn! A 130% price hike? Maybe at the margins. A 1,300% increase? Sure, I could see that.

But as a parent whose child just entered pre-K this week, let me say: Kids are incomparably expensive to a one-time tax. They’re more of an uncancelable subscription service that has a very aggressive pricing model.

Condoms in China are already extremely cheap by global standards, costing just a few cents at the low end (yes, I looked up a Chinese condom industry report.) So… I’d like to meet the person staring at a half-cent price increase and thinking, “Well, that settles it. Let’s just have the baby.”

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

How one NYC rat warrior finds pride in restoring public spaces

2026-01-13T14:41:28+00:00

Prior to joining the NYC Department of Health and Mental Hygiene’s Pest Control Program in August 2023, I wore many hats in my journey. Over the years, I have worked at a supermarket, as an EMT, and at the post office. While all of these are different, they all share one commonality – community engagement.

That’s why when I joined the NYC Health Department, I knew I’d be part of something important. But I didn’t realize just how deeply it would resonate with me.

I work in the neighborhood rat reduction unit, and one of my favorite parts of the job is visiting parks like Jackie Robinson Park, St. Nicholas Park, and Riverside Park during my monthly checks. When I first started, these parks were riddled with rat activity. Burrows were easy to spot, and signs of infestation were everywhere.

But over time, I noticed something remarkable: The rats were disappearing.

Now I sometimes have to search just to find evidence. That shift didn’t happen overnight; it’s the result of a lot of hard work and longstanding partnerships with our sister agencies, such as Sanitation and Parks. From our rat contraceptive pilot study to our community engagement efforts, I get to play a small but meaningful role by collecting field data.

While this may seem like a simple task, the information that is gathered helps my team, and my co-workers and I brainstorm new strategies and refine our approaches to rat mitigation across the city.

This work is not only about reducing the rat sightings but helping New Yorkers reclaim public spaces. It’s incredibly rewarding to know that my contributions are helping to shape real solutions for our city.

One of the most fulfilling parts of this work has been getting to know the people who care for these parks every day, the gardeners and extermination teams. Each month, I’ve had the chance to build relationships with them, learn from their insights, and share updates on our progress. They’ve taught me how to spot subtle signs of rat activity, and I’ve been able to offer data that help guide their on-the-ground efforts. It’s a true partnership, and it’s made every visit feel like a shared mission.

One moment that really stuck with me happened during a check-in at Jackie Robinson Park. A longtime resident approached me and said, “I see you out here every month. Whatever you’re doing — it’s working. My grandkids are back on the swings.”

That was my “aha” moment. I realized that our work isn’t just about controlling rats — it’s about restoring public spaces, rebuilding trust, and protecting the health of New Yorkers.

I’m proud to be part of this team and this mission. Every data point, every park visit, every conversation with a gardener, exterminator, or community member reminds me that public health is about people — and even the smallest actions can lead to big change.

This has led me to pursue my degree in public health – which I hope to use in in order to make an even greater difference in the lives of New Yorkers.

Nadia Shepherd is a community associate at the NYC Department of Health and Mental Hygiene’s Neighborhood Rat Reduction Unit, where she focuses on rat mitigation, zoonotic disease surveillance, and public health outreach. She is also a student, pursuing a bachelor of science degree in public health and plans to continue with a master’s in health policy and management.

Mamdani backs hospital nurses as 15,000 strike over pay, safety

2026-01-12T21:55:50+00:00

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New York City Mayor Zohran Mamdani on Monday stood in support of thousands of nurses who began striking at some of the biggest private hospitals in the city after months of failed bargaining.

Nurses with the New York State Nurses Association began their strike Monday morning citing unsafe staffing levels, paltry health care benefits, and unmanageable workloads. Another major part of their grievances: their pay, compared to the multimillion-dollar salaries of hospital executives at Mount Sinai and New York-Presbyterian hospitals in hospitals in Manhattan, and Montefiore Medical Center in the Bronx.

“At every one of our city’s darkest periods, nurses showed up to work,” Mamdani said at a news conference called by the union, flanked by members and wearing a red union scarf in front of New York-Presbyterian, one of the largest and more well-regarded hospitals in the world. “Their value is not negotiable, and their worth is not up for debate.”

Organizers say the walkout of 15,000 nurses is the largest strike of its kind in the city’s history, coinciding with an early flu season that is sending more people to the hospital than years past.

All three hospitals released statements saying they have brought in nurses to cover those on strike and were prepared to care for patients.

New York-Presbyterian said in a statement that it would keep negotiating toward a contract that respects nurses’ “critical role,” while recognizing the challenges facing health care.

“While NYSNA has told nurses to walk away from the bedside, we remain focused on our patients and their care,” the statement said. “This strike is designed to create disruption, but we have taken the necessary steps so our patients continue to receive the care they trust us to provide. Our patients should visit nyp.org/nursingupdate for important updates and other additional information.”

NYC’s new deputy mayor for health went from Covid patient to hospital CEO

The strike was led by union President Nancy Hagans, who was a member of Mamdani’s transition team, an informal group of more than 400 supporters that was formed following his November victory and solicited policy recommendations. Hagans belonged to the health group, which included a mix of hospital executives, university scholars, and public health advocates. The team disbanded following Mamdani’s inauguration on Jan. 1.

The strike comes at a time of looming cuts that will see New Yorkers lose health insurance and squeeze hospital budgets as a result of President Donald Trump’s One Big Beautiful Bill Act signed in July. Health care workers from nurses and technicians to doctors are certain to feel the effects, and public safety-net hospitals that receive Medicaid patients could even face closure.

Joe Solmonese, a spokesperson for Montefiore Medical Center, said in a statement, “NYSNA’s leaders continue to double down on their $3.6 billion in reckless demands, including nearly 40% wage increases.”

A statement from Mount Sinai called the nurses’ demands “extreme.”

“Unfortunately, NYSNA decided to move forward with its strike while refusing to move on from its extreme economic demands, which we cannot agree to, but we are ready with 1,400 qualified and specialized nurses – and prepared to continue to provide safe patient care for as long as this strike lasts.”

Mamdani said the nurses deserve more, citing the $16 million salary last year for the president and CEO of Montefiore and the $26 million salary of New York-Presbyterian’s CEO.

“There is no shortage of wealth in the health care industry, especially so at the three privately operated hospital groups at which nurses are striking, the wealthiest in the entire city, the hospital executives who run these hospitals, the ones where these hardworking nurses are asking for what they deserve,” he said.

The striking nurses cite worries about violence in hospitals, which have been the site of shootings and other incidents in recent years. Just last week, a man who checked himself into New York-Presbyterian Brooklyn Methodist Hospital in the Park Slope neighborhood was fatally shot by police after he cut himself with a sharp object and threatened others.

Tanya Fisher Morales, a nurse at New York-Presbyterian, said at the news conference that workplace violence against nurses had become routine.

“Every week, nurses are injured in incidents of workplace violence at our hospital, especially in our emergency room,” she said, choking up. “We need protection from work-based violence — now. This is not up for debate anymore.”

The strike is part of a broader trend across the United States in which health care workers are feeling emboldened to air their grievances following the Covid-19 pandemic that led to so much burnout.

In 2023, nurses went on strike at Mount Sinai and Montefiore for three days. The protest led to a deal raising pay 19% over three years at those hospitals. The same year, trainee doctors at Elmhurst in Queens went on strike for three days as they protested a salary gap compared to their colleagues at Mount Sinai. It was the first physician strike at a New York City hospital in more than 30 years.

Here’s a look at who’s advising Zohran Mamdani on health policy

Nurses in Massachusetts and California have also gone on strike, the former group in 2022 for nearly 10 months, the longest nursing walkout in state history.

Nurses at several hospitals on Long Island signed tentative agreements on new contracts Friday that averted a possible strike. The three-year tentative contract agreements include improved staffing levels, an annual wage increase each year of around 5% and improved pensions.

Hospital executives had been preparing for a possible strike for weeks by bringing in travel nurses to cover the absences in an effort to minimize disruption. Over the weekend, the state Department of Health asked hospitals not affected by the strike to accept patients from hospitals that were.

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

HIV work in Kenya showed me the powerful impact of treating a whole population

2026-01-12T15:03:39+00:00

I embodied the cliché that drives many people to become doctors: I wanted a career that was both deeply impactful and also really interesting. And I made it. I graduated from the medical school at Temple University and then completed my residency in, um, “war-torn” Portland, Oregon.

Although as a teenager, I’d been aware of the Centers for Disease Control and Prevention’s investigative work during the 1976 Legionnaires’ disease outbreak in Philadelphia, it was during residency that I truly began to understand public health. The general concept was familiar — impacting health — but instead of working with one patient at a time, public health offered the chance to impact entire populations simultaneously.

After residency, I joined the CDC’s Epidemic Intelligence Service. I found myself in Pakistan, evaluating the validity of survey questions on immunization rates, and later on rooftops in Los Angeles, sampling water from cooling towers for the now-infamous Legionella bacteria. After EIS, I returned to clinical medicine to complete my infectious diseases specialty training and was immersed in the rapidly evolving world of HIV treatment.

A decade later, I landed my best job ever — working for the CDC to help establish HIV treatment clinics in Kenya. In Kisumu, in western Kenya, where I lived with my family, 1 in 4 adults had HIV infection. Almost all hospitalized adults were HIV positive. When we arrived in 2001, coffin makers were thriving. Our research programs had to hire 125% of needed field staff because so many people were dying on the job.

The world had finally begun to realize that HIV treatment needed to be offered in the hardest hit parts of the world. With initial seed funding from the CDC, followed by a major grant from Columbia University’s School of Public Health, then the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief – PEPFAR – my job was to visit clinic after clinic with my Ministry of Health colleagues, asking whether they wanted to establish HIV treatment services. When they voiced concerns about lacking resources or expertise, I could say, “I can offer both.”

As PEPFAR started, we had to secure the drugs. The contracting office put us in a bind — they’d finalize the contract to secure essential drugs and supplies from the mission — but only if we could secure signatures from six board members scattered all over Kenya over a weekend. My colleague, John, took eastern Kenya, I took the west. With a CDC driver, off I went. I had the easier job. All of the board members were bishops, but two of mine were Anglican, meaning they had wives — who were easier to find, and who led us to their husband board members.

Cellphone coverage was limited, and the roads were rough, but by the end of the weekend, John and I had both secured our share of the needed signatures. To the people who’d been asking “when are the drugs coming,” I could soon say “they are here.”

Before HIV treatment was made available in western Kenya, many furniture manufacturers turned to making coffins.

I had lived through the transformation of HIV in the United States — from a death sentence to a manageable chronic illness. Now, I had the privilege of witnessing that transformation again, on a massive scale. By the time my family returned to the United States in 2005, 65,000 people in Kenya were on treatment. That’s a small fraction of the number who have since initiated care.

But that early period was transformative. Coffin makers returned to building furniture. Ambulances stopped serving as full-time hearses. Weekends, once dominated by funerals, reclaimed their hold on dance parties and weddings.

Taxi drivers in Kenya are a great source of wisdom. During my frequent trips to Nairobi, I often asked for their perspectives. Every one of them had been touched by HIV — through a sibling, a spouse, or their own diagnosis. Many had faced initial reluctance to get tested or seek treatment. But in overcoming stigma and barriers, they found a return to normalcy — and a deep gratitude to the World Health Organization and the United States.

The effects of establishing HIV programs began to ripple outward, strengthening the health system. That trust meant we were often the first called when new threats emerged — whether aflotoxicosis from poorly stored corn, or a hemorrhagic fever.

So maybe not so much an “aha” moment, but a quiet recognition: Focused programs can build immense goodwill. And I had the great privilege of being one small part of that.

Dr. Barbara Marston is an infectious diseases physician who retired from the CDC in 2022 after a 28-year federal career primarily focused on international health. She had leadership roles in emergency responses (Ebola in West Africa and the international component of the Covid response). Since retiring, she’s traveling and supporting protection of endangered amphibians and native plants. She is the co-founder and the coordinator of a CDC advocacy group, CDC Alumni and Friends.

Georgia lawmakers return as federal health funding uncertainty looms

2026-01-09T17:34:31+00:00

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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.

NYC’s new deputy mayor for health went from Covid patient to hospital CEO

2026-01-09T13:47:07+00:00

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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.

‘Aha’ moment in public health: Building relationships before the next outbreak

2026-01-06T14:39:35+00:00

In July 2015, I stood in front of a packed auditorium in the South Bronx. People were wedged shoulder to shoulder on folding chairs. Another hundred or so crowded the hallway outside, many trying to squeeze in.

I came there to talk about facts. They came there to talk about injustice. That was the night I learned that relationships always come first, and facts come second.

The town hall was organized by the Bronx Borough president to discuss a large outbreak of Legionnaires’ Disease. Legionnaires’ disease is a severe pneumonia caused by bacteria that grow in water. One common source is cooling towers. They sit on rooftops and release a mist that can carry bacteria hundreds of yards through the air. This outbreak had already sickened dozens of people in the South Bronx, and the numbers were rising each day.

I sat in the front of the room. I felt prepared.

I was wearing my favorite suit. Charcoal gray, the J. Crew Ludlow type, similar to the ones our new mayor wears. Sure, it was not the most appropriate choice for a hot summer day. But it was appropriate for my goal that evening: to project credibility, authority, and trust.

I also carried the tools of the public health trade. Maps. Figures. And, most important, the confidence that the best epidemiologists, microbiologists, and environmental health experts in the city had gathered the data, crunched the numbers, and used this to contain the threat. I believed that if I explained the data clearly enough, people would leave reassured.

That is not what happened.

I started the way the Centers for Disease Control and Prevention had trained me. First, describe the disease, its cause, how it spreads, and how it gets treated. Next, describe the investigation. I showed a map of cases and explained that the pattern pointed to something that had been in the air. I told the room that we had identified several contaminated cooling towers, that one of them was the most likely source of the outbreak, and that we had ordered the contaminated towers cleaned.

The air was now safe to breathe.

When I stopped talking, I scanned the room. People’s heads shook from side to side in disagreement. They turned to their neighbors and scowled. Hands shot up. People shouted over one another.

I felt confused. Had I not explained the facts clearly enough? Maybe I should just repeat it with a little different phrasing?

A woman’s voice rose from the back. She spoke sharply and forcefully, and it stopped everyone else from talking, “Why is the outbreak only happening in the Bronx? Why is it always happening here. In our community.”

I felt the power rush out of my suit. It was now constricting me. My palms were sweating, and my black leather shoes were weighing me down.

I had not come prepared to answer that question.

When I get flustered, I don’t stop to think. Or to listen. I just start talking. And then talk some more.

I kept repeating that the air was safe, that the water was safe, that we had fixed the problem. Those were the facts. But the facts weren’t quelling anyone’s anger.

This is the moment that stays with me. That moment when I realized the facts are not enough.

By the time I got to that town hall, I was confident we had found and cleaned the most likely source of the outbreak: a cooling tower on top of a boutique hotel near where we were speaking that night. So, when I said the air was safe, I meant it.

When they heard me say that, they heard something very different.

They heard government saying, “Just calm down. No need to get all worked up.”

They heard a system that had failed to protect them in the past now asking them to trust that this time was different. They heard the long history of neglect that shaped their daily lives well before this outbreak started.

In this community, where chronic disease, environmental pollution, violence, and racism are fixtures of daily life, this outbreak felt like yet another insult. Yet another unfair injury.

Why does this always happen here?

Why is our neighborhood the one that always suffers?

Why should we believe you now?

I came to talk about pathogens and probabilities. They came to talk about fairness and dignity. They wanted to know whether their lives truly counted as much as everyone else’s.

I realized that I had walked into that room thinking my job was to lower fear by explaining risk. What I had not understood, until that night, was that my job was to feel their outrage and connect with them at an emotional level.

The anger in that room was not fundamentally about risks or the facts of the case. It was about the relationship between the city government and this community and their outrage at the way they had been treated in this relationship.

Outrage is shaped as much by history as it is by acute hazards. Communities react to threats based on the stress they already carry, the inequities they already endure, and the ways institutions have treated them long before the first person became sick in this outbreak.

What I learned that night is simple but often overlooked: If you want people to trust you in a crisis, get to know them before the crisis.

As public health officials, we cannot focus only technical excellence. We must focus equally on our relationships with people and communities.

If we wait until an outbreak to learn how people live, what they love, what they fear, and how government has failed them in the past, then we will be speaking past them at the exact moment we need to be speaking with them.

In public health, relationships come first, and facts come second.

Dr. Jay K. Varma is a special contributor to Healthbeat, sharing his expertise from a long career in public health. As a physician and epidemiologist, he is an expert in the prevention and control of infectious diseases who has served as a public health official in New York City.

How my own medical mystery led to a career in scientific research

2026-01-05T17:26:17+00:00

Days after my 18th birthday, I had a seizure in a lecture hall of 300 people. My introduction to Clemson University and collegiate life involved an ER trip and a big unanswered question: What caused the seizure?

Afterward, my health began to decline. My heart was constantly racing out of control, and I would get dizzy and start sweating profusely, occasionally passing out. I was severely fatigued, and my body ached all over.

I bounced between specialists, had every test you can think of, and left each appointment with more questions than answers.

Then one night while scrolling through Twitter (as one does when they’re desperate for distraction), I came across a lab at the Medical University of South Carolina researching the mechanisms of hypermobile Ehlers-Danlos syndrome, also known as hEDS, a genetic connective tissue disorder.

The collection of symptoms I was reading about sounded suspiciously like what I was living through. Not only was the team in Charleston conducting research, but they were looking for interns — interns who had hEDS.

Most primary care physicians are unfamiliar with hEDS. The average delay between symptom onset and diagnosis is over 10 years. On top of that, hEDS is the only subtype of Ehlers-Danlos syndrome that does not have testing available for known causal genes. That means it is both an “invisible disability” and an unsolved puzzle for the medical community.

I had no diagnosis at the time, but I reached out anyway. I asked if I could still apply, even though my condition had not been confirmed. After I interviewed, it took them just seven minutes to offer me the position.

That summer, I moved to Charleston. I spent my days doing research and learning about hEDS, and through the incredible mentors I met there, I finally got my diagnosis confirmed.

At the end of the summer, my mentor and the team sat me down for a meeting — not to discuss the data I was working with, but to persuade me to pursue a PhD. To consider research as a career.

After a whole year with no direction, no thoughts of anything past the day in front of me, I was suddenly imagining a future in science. I had previously intended to pursue genetic counseling, but the proximity of research to groundbreaking developments in the field drew me in.

Back at Clemson, I switched my focus to research. I joined a canine genetics lab comparing disease etiology in dogs to what was known in humans. I started my own independent project on Miniature American Shepherds, fell in love with Eloise, and she is now my greatest joy.

When I applied to graduate schools, I was advised against disclosing my disability until after I received offers. It might be seen as a hindrance toward my degree progress and ability to produce research for a university. I decided to write about it anyway in my admissions essays because I didn’t want to attend a program with a culture that would not support disabled students.

I leaned into my story. I talked about my diagnosis, my lived experience, and my passion for accessible research. I wasn’t trying to hide my disability — I was reframing it as a strength. And it worked. I received offers of both admissions and fellowships, and I got to share my experience as a patient-scientist.

I think the programs that accepted me recognized that, having experienced the patient side of genetics, I can provide a valuable perspective and enhanced motivation to clinical research and patient care. Patients are an often overlooked resource for important scientific questions, and patient outreach can lay the groundwork for developing treatments and interventions that target the most troubling issues.

MUSC’s hEDS research program and the internship I participated in have led to the first candidate gene discovery, with almost every initiative driven by a patient-scientist.

We need more disabled representation in both genetics and biomedicine to provide an empathetic lens to our research and connect our goals back to those we hope to serve. By including patients and disabled researchers in the research that benefits them, we ensure the impact of our work and learn from the perspectives of those it supports.

Diverse perspectives in research broaden our minds, enhance our critical thinking, and keep moving us forward. Because inclusive science means better science — for everyone.

Katherine Grace Singleton is a genetics and molecular biology PhD candidate at Emory University. She is from Sumter, South Carolina, and did her undergraduate degree and research at Clemson University. After completion of a PhD, Katherine hopes to complete an ACMG-accredited Laboratory Genetics and Genomics fellowship program to continue research in a clinical setting.

5 From the Field: Q&A with Harris County Public Health official Ericka Brown

2025-12-24T12:00:00+00:00

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Dr. Ericka Brown, the local health authority at Harris County Public Health in metro Houston, began her career as a physician providing clinical care.

But Brown was always focused on helping underserved communities, she said, initially working in Harris County’s safety net health system and now serving as the county health department’s division director for community health and wellness.

We recently spoke with Brown to get her insights on five questions about her public health work in Texas’ largest county by population. This 5 From the Field interview has been edited for clarity and length.

What drew you to a career in public health? Is it something you planned? Did you stumble into it?

It’s a little bit of both. I am a family medicine physician by training, and when I trained, there was not much education or exposure to public health. It was strictly clinical practice. I always practiced with underserved communities. As a provider, that’s just my love.

Now I get to affect the lives of patients and vulnerable populations, not just one patient at a time, but really thinking about it from a more global perspective, and driving the health of the community forward.

What are the one or two most pressing public health issues that your department is working on right now?

Immunizations. It’s really a huge issue since Covid and the politicization of immunizations. There is a lot of misinformation, which leads people to make misinformed decisions. So providing factual, scientific, evidence-based information about immunizations is one of the key issues we’re working on.

The other issue is equity, specifically equity for marginalized, vulnerable populations. Not just around their medical care, but around all the social support drivers that make a community healthy.

Access is one of the biggest issues. Providing education to the community and support about what is out there and what is everyone eligible for, what’s available. Then working with those partners to make sure that there is direct access and that the barriers to that social support service or medical service are removed, whether it be a language barrier, transportation barrier, or financial barrier.

How has declining public trust impacted the work your department is doing in the community?

It makes it more difficult.

The role of the community health workers and our outreach teams is very important to make sure we are reaching into communities from a culturally responsible perspective. I can say for Harris County Public Health, that is something that we do very well.

We are still a trusted member of the community, and I think that that is something that was built over time, and it is withstanding what is happening now.

We have a huge network of community health workers, both internal to our department and with external partnerships. These are people who are trusted advisers in the community, who are of the communities and part of that culture.

This goes a very long way to be able to speak to different communities in a culturally competent way, so that they can hear and receive the message that we are trying to give, hear and receive information about resources, about prevention. And they can trust that the information is factual.

What public health accomplishments are you particularly proud of?

My division holds all of the clinical and some of the social support services for the county public health department.

The team has done a phenomenal job at standing up a maternal-child health program, a Healthy Start program, and one of the leading WIC programs. Harris County, unfortunately, has one of the highest Black maternal mortality rates in the country.

It is our role to not only provide a strategy on how to move the needle in improving those outcomes, but to bring the community together and then to also provide programming around that.

Our clinical services for those who are vulnerable, in marginalized populations, who may be uninsured or under-insured, provides a range of health services, such as dental services, preventive services, STI [sexually transmitted infection] testing and treatment. Our substance use department is doing a phenomenal job at educating the community about the substance misuse problems that we have in our county, what to do about them, how to destigmatize those who are suffering from that condition.

Those are just some of the things that I’m just extremely proud of that we’ve been able to make a difference in improving the health of the community.

It’s the holiday travel season. Do you have any personal best practices for staying healthy when you travel?

When I’m sick, or when my children or someone in my family is sick, I stay home. You may not have the flu, you may not have Covid, but you have something. Nine times out of 10 that something is contagious. So, I try to stay home and keep my germs to myself.

If I’m traveling on a plane, I am one of those people that has my own sani-wipes, and I wipe my space down.

Certainly when we’re traveling, hand washing with soap and water is really key because all of those things we’re touching, other people are touching. It’s a naturally occurring thing that germs are around.

I am a huge proponent of vaccinations for myself, for my children, for my family. I do think they keep the public and myself and my family safer. So getting vaccinations at least two weeks prior to travel, because immunity has to have time to build up.

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

‘When tears tell a story’: A social worker in gender-affirming care learns the healing power of trust

2025-12-23T14:42:43+00:00

On the phone, my client was crying so hard from anxiety and the immense physical pain she was in that at first, I couldn’t understand her.

“Take a breath, slow down — I’m here for you,” I told her gently. As a social worker with the VNS Health Gender Affirmation Program, I and my fellow team clinicians are often the first people a client may speak to after they’ve been discharged from the hospital following gender affirmation surgery.

As my client started to calm down, it became clear she was experiencing the wave of emotions and feelings that are part of this life-changing moment. She was beyond happy after her first gender-affirming surgery – something she had dreamed of for so long. But she was also overwhelmed with everything that accompanied the journey, including having to recover alone in New York City, far from her home.

She knew this was the best place she could get care, but that didn’t ease the sense of isolation. She also felt deep fears and stress about her timing. We are living through a time when many people across the country are fighting to prevent the type of care she needed most.

Experiencing every feeling under the sun — from elation to fear — is not unusual in this situation. As a woman of transgender experience myself, I relate deeply. I know the highs and lows that come up during those first hours, days, and months. Finally getting to this amazing moment is something my clients have hoped and dreamed of for so long. The truth is, however, that healing and change can sometimes feel bittersweet.

When I came home after my first gender-affirming surgery, I was unbelievably happy, but I was also scared. I was recovering alone, and some days the physical pain was intense. People in my life I thought would help me were suddenly nowhere to be found. I was on my own: I had to rely only on meals I had prepped myself beforehand. If I needed to go to the bathroom, pick up a dropped pillow, take my medicine on time, it was all on me.

Looking back, I’m proud and grateful for my resilience during those days, because it was all worth it. That surgery saved my life. And that is something I hear often from clients in the GAP program: that without gender-affirming care, they might not be here.

But going it alone doesn’t have to be the norm, and I knew a better kind of care could exist. Transgender and nonbinary people deserve to feel safe, comfortable, and supported as they recover at home, receiving health care that respects their gender identity and makes them feel accepted. Now, years on into my career as a social worker for transgender and nonbinary individuals recovering at home after gender-affirming surgery, it makes me so happy that I can help make that care a reality.

The challenges for our clients include both physical needs — such as getting groceries, setting them up with transportation to appointments, even finding them a bed — as well as emotional needs, such as helping a client out of a domestic violence situation, getting them counseling, connecting them with resources right in their community, or simply providing a listening ear they can trust.

Once my client on the phone was feeling calmer, she shared a harrowing incident. The day before, she’d suffered serious post-surgery complications and, out of necessity, went to the closest ER. There, she encountered clinicians who weren’t knowledgeable about her needs. Whether intentional or not, they made her feel like an “other.”

Trying to connect her to a catheter, the nurses struggled, not understanding her unique needs related to her surgical procedure. The physical pain my client was dealing with was excruciating, but the emotional trauma hit even harder. It’s an experience that would wear down anyone, but for a transgender woman, it felt like yet another knock, another hurtful reminder that she was seen as “different.”

As my client shared her struggles, I listened. And I shared. I reminded her that it’s important to make space for the difficult times alongside the amazing ones. I told her to envision where she would be days, weeks, and years from now as she moved beyond the initial post-op stress. I told her to remember what brought her to this moment, and I told her how much hope I had for her future.

As our call started to wrap up, she told me that knowing I was there for her made her feel less alone. In many ways, the conversation I had with her that day was like many others, but this particular call felt special to me. It was a reminder that having compassionate peer support in health care truly makes a difference — especially for communities that are not just historically underserved, but have been mistreated by the health care community.

As a social worker, I sometimes feel a need to accomplish big “wins” for a client, always going above and beyond. But there is also so much to be gained from these seemingly small moments, when you realize that simply bringing care, understanding, and compassion to this work — and knowing your clients trust you — can heal us all.

Asha Lyons is a trans-woman of Latin and Caribbean descent who works as the Gender Affirmation Program licensed social worker at VNS Health. She holds an MSW from the Silberman School of Social Work at Hunter College. She has worked in the fields of social work, public health, research, anti-violence, and group work for almost 20 years.

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

2025-12-22T14:15:01+00:00

I’ve been working in addiction counseling for a long time. And every now and then, a story sticks with you. This one — this one stuck.

I had a client who was referred to us from another agency here in Atlanta. Homeless. Strong opioid addiction. He was getting Suboxone through a county program at 10 Park Place. That’s part of the Fulton County Health Department. He’d come in every couple of weeks to get his dose.

We kept his medication locked up — two locks, two keys. That’s how we do it. When clients are in treatment, they bring in a 30-day supply of whatever they’re on — blood pressure meds, HIV meds, mental health meds, you name it. We monitor it, make sure they take it right, and lock it back up.

This guy — he was from South Georgia. Used to climb trees for a living. Had a whole Facebook page full of pictures of him way up in the branches, cutting limbs like it was nothing. Strong guy. You could tell he’d worked hard his whole life.

But addiction doesn’t care how strong you are.

Word got back to me that he was selling his Suboxone – that’s a medication used to treat opioid use disorder. Or maybe overusing it. Either way, I had to let him go out to get it. That’s part of the process sometimes.

Then one day, he’s in my office. I’m sitting with a veteran client, and my guy is slumped over at the desk. I hear him snoring, but something’s off. I tell the vet, “Wake him up.” Still hadn’t hit me yet.

The vet nudges him — and he slides out of the chair.

I’m like, “Lord, he’s going into cardiac arrest.”

I jump into action. Start CPR. If you’ve never done CPR by yourself — it’s a workout. I’m on speakerphone with 911, rotating compressions with the vet, yelling down the hall for someone to bring me the defibrillator.

But there’s no one. No staff. No other clients. Just me and the vet.

Finally, the ambulance arrives. They revive him. He’s on the stretcher, heart monitors on his chest, and the first thing he says is: “Mr. Smith, you saved my life. I’m never doing dope again.”

I believed him. I wanted to believe him.

But maybe 10 days later, he’s back. High as a kite. Shirt off. Causing a commotion in the parking lot. It’s wintertime.

I go out to talk to him. I say, “What about what you told me? That I saved your life?”

He looks at me and says, “I don’t remember that.”

I said, “That’s okay. But I’m gonna have to ask you to leave the property. You can’t be out here half-naked, making a scene.”

That was the last time I saw him.

And here’s the thing — this isn’t rare. But addiction is a disease. It’s not a choice. It’s not a moral failure. It’s a cycle. And sometimes, even when you save someone’s life, they don’t remember. Or they’re not ready. Or they’re just too deep in it.

But we keep showing up. Because every person who walks through our doors deserves another chance.

Johnny Smith is a certified addiction counselor and substance abuse case manager at Mercy Care, where he helps guide others through the same journey he once walked. A former top-ranked basketball player in Georgia and professional athlete overseas, his life took a dramatic turn due to addiction. After years of struggle, he found recovery at the Salvation Army, where he now also serves as a part-time chaplain.

Here’s a look at who’s advising Zohran Mamdani on health policy

2025-12-17T17:06:40+00:00

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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

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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

Why flu season will likely be worse this year and how to prepare

2025-12-16T18:53:37+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 my clinic last week, I began to see the signs of what I have been fearing for months. Two patients came in on the same day with high fever, sore throat, and body aches. Both tested positive for influenza.

While there is nothing remarkable about people getting the flu in the winter, what worries me is the timing and spread. Across New York state, influenza activity is already far higher than it was at this point in recent years. During the week ending Dec. 6, there were more than 12,000 reported flu cases and nearly 1,400 hospitalizations. During the same week last year, there were fewer than 5,000 cases and about 300 hospitalizations. Two years ago, cases were similarly high, but hospitalizations were substantially lower.

This season, influenza is arriving earlier, spreading faster, and sending more people to the hospital. The United States is heading into a flu season that is likely to be worse than what we have experienced in recent winters.

Why this flu season is likely to be severe

Several factors are converging at the same time to increase the likelihood of a severe flu season.

The first factor is viral evolution. The dominant strain right now is influenza A H3N2, and it has accumulated mutations that allow it to partially evade prior immunity. This strain has already driven early and large flu surges in other parts of the northern hemisphere, including Japan, the United Kingdom, and parts of Europe. Some hospitals in those countries reported seeing January level flu activity as early as October.

The second factor is timing. Flu has arrived earlier than usual before health systems have fully prepared and before vaccination campaigns have reached their peak, so the pressure builds faster.

The third factor is behavioral. During the Covid pandemic, many people adopted habits that reduced flu transmission, including masking in crowded indoor spaces, staying home when sick, and improving indoor air quality and ventilation. Most of those practices have faded. At the same time, fewer Americans are getting their annual flu vaccine. Adult flu vaccination coverage has declined over the past several years, particularly among people under 65 who nonetheless have medical conditions that put them at higher risk of complications.

Finally, hospitals are entering this winter with little reserve. Emergency departments, inpatient wards, and intensive care units are operating close to capacity even before seasonal respiratory viruses peak. In that context, a severe flu season can make it much harder for people to get prompt and high-quality care in outpatient and inpatient facilities.

What we know about this year’s flu vaccine

Because of the way influenza viruses mutate and the waning of human immunity over time, the effectiveness of the seasonal flu vaccine varies each winter. Every spring, global experts analyze data and try to predict what influenza strains are likely to circulate in the coming winter. When circulating viruses mutate after those strains are selected, the match between vaccine and virus can be imperfect.

That is what has happened this year. Data from the United Kingdom show that the dominant H3N2 subclade circulating this winter is different from the strain used to produce the northern hemisphere vaccine. Laboratory studies confirm reduced reactivity between the vaccine strain and the circulating virus.

Early vaccine effectiveness data from the UK show that, despite this mismatch, vaccination does reduce severe illness, albeit not as much as we would like. The vaccine reduced emergency department visits and hospital admissions by 72%-75% among children and adolescents and 32%-39% among adults.

This aligns with how I have been counseling patients in my clinic. The flu vaccine does not guarantee that you will avoid infection. What it does is lower the odds that influenza turns into pneumonia, respiratory failure, or a hospital stay – turning a “wild” infection into a “mild” infection.

In a year when hospitals are stretched thin, that difference matters both for individuals and for the entire health system.

What public health agencies can do now

While the Centers for Disease Control and Prevention’s website still recommends annual seasonal flu vaccination for anyone ages 6 months or older, it is unlikely the CDC will be permitted to run advertising this year to promote that recommendation, as it has in years past. Last February, soon after taking office, the new Health and Human Services secretary cancelled the CDC’s 2024-25 flu vaccination campaign.

State and local health departments can fill that gap by promoting flu vaccine through all available channels and enlisting social media influencers to promote it as well. The priority is demographic groups and settings where flu spreads quickly and causes disproportionate harm. Nursing homes, assisted living facilities, long-term care facilities, shelters, jails, and prisons all require targeted vaccination efforts, rapid testing access, and clear infection control guidance.

Clinicians also need reminders about antiviral treatment. Medications like oseltamivir are only effective when started as soon as symptoms begin and primarily benefit populations at highest risk for severe complications, including young children, pregnant people, older adults, and those with chronic medical conditions. Too often, opportunities to reduce severity are missed because testing and treatment are delayed.

What health care facilities can do now

While flu season has begun, hospitals and clinics still have time to bolster their capacity to handle future surges. Bolstering capacity starts with ensuring their staff do not become severely ill from influenza.

Many patients arrive at a facility with one illness, but leave with influenza, because respiratory viruses spread easily inside health facilities. Facilities need to upgrade the completeness of screening patients for respiratory symptoms at initial intake, then isolating and testing patients for influenza and other respiratory viruses. Masking policies that include visitors, especially in patient care areas, remain a simple and effective tool during periods of high respiratory virus circulation. Assessing airflow, upgrading central air filtration, and using portable air purifiers in crowded spaces can reduce viral spread indoors. These improvements benefit patients and staff well beyond this flu season.

What employers can do now

Employers have more influence on flu spread in their offices and communities than they often realize. Providing paid time off for vaccination or offering on-site flu clinics removes a major barrier for many workers. Encouraging employees to stay home when sick and permitting remote work, rather than rewarding them for showing up despite illness, reduces outbreaks in the workplace.

Making high-quality masks available to employees that want to use them, improving ventilation, and offering home test kits are relatively low-cost interventions that can protect workforce health and continuity.

What individuals can do

This will be the first flu season since federal officials instituted severe cuts to infectious diseases and immunization programs across the country. For individuals, this means that it is more important than ever to take pro-active steps to protect your and your family’s health. Get vaccinated if you have not already. Keep high-quality masks and home test kits available in your home. If symptoms start, test early and contact a health care provider if you are at higher risk and may benefit from antiviral treatment.

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.

Where culture meets compassion: the story behind India Home senior care in New York

2025-12-16T14:37:38+00:00

My story begins far from Queens, in a small, quiet village in Andhra Pradesh, India, called Bangaramma Peta.

In that village lived a gentle, scholarly man named Vangapadu Lakshmi Naidu — my father.

A man who spent his days surrounded by books, ideas, and the calm joy of thinking deeply.

But one day, age brought a silent thief: vascular dementia. Slowly, the words he loved so dearly began slipping away … until even the names of the people he loved were out of reach.

At the time, I was a young psychiatrist in New York.

I understood dementia in theory. But when it hit home — my home — none of the textbooks could prepare me for that pain.

And what hurt most was this: There was nowhere for him to go. No community center in his village. No space to meet people his age, talk, laugh, belong.

He was isolated. And that loneliness broke him, long before the disease did.

I wanted to bring him to New York, but when I looked for culturally appropriate senior care, I kept hearing things like: “We don’t have any curry-serving facilities.”

If doctors can’t figure it out, what about elders who don’t speak English so well, whose routines were built over decades half a world away?

In my circles, I met families like Dr. Kiran Dave, whose late mother, Swarupa Kumari, faced Alzheimer’s disease with few culturally appropriate programs.

And Dr. Deepika Sood, whose father, Dr. Nagarajan, spent his final years yearning for conversation, community … connection.

Different families. Same pain.

My father made me a doctor at a time when girls were not always encouraged to study — especially in a village like ours.

And yet … when he needed care the most, I couldn’t give him what he truly needed — a space to belong, to be understood, to feel at home. That is the ache that never leaves.

But it is also the fire that built India Home.

Because while I couldn’t change his ending, I can change the story for someone else’s father, someone else’s mother.

And in doing so, I honor him every single day.

In 2007, I and my friends founded India Home, a nonprofit organization.

NYC’s India Home loses federal funding over its culturally sensitive senior care. It’s not giving in.

My goal? To build a space where our elders could age with dignity, connection, and cultural pride.

It started small. In 2008, India Home established the first senior center catering to South Asian values and culture at the Services Now for Adult Persons of Eastern Queens.

A few aunties. A few uncles. Some chai. Some samosas

And today?

Let me share what that India Home care looks like — not just in feeling, but in real numbers:

Reach:

Operates five senior centers in Queens.
Has served 5,000+ South Asian and Indo-Caribbean seniors since inception.

Nutrition:

Provided 60,000 congregate meals and 5,200 home-delivered meals last year.
Hosted 70 food pantries.
Provided 4,600 nutrition education units.

Health and wellness:

Provided 49,000 physical exercise sessions, plus yoga, meditation, and health education.
Hosted 20 mental health group sessions.

Creative aging:

Provided 4,400 arts and culture activities (painting, crafts, karaoke, jewelry making).
Provided 1,300+ technology sessions for digital literacy. (Yes, we teach WhatsApp. Because nothing says connection like 73 unread messages from your cousin in Delhi.)

Dementia care:

Offers “Desi Dementia Daycare” (3D Care) for mild to moderate dementia, with cognitive and physical activities and provide caregiver support.

Housing:

Operates innovative co-living homes in Queens for vulnerable seniors, providing shared living and case management.

Case management:

Assistance with SNAP, SSI, Section 8 housing vouchers, Access-A-Ride, and rental aid.
90% success rate in benefits applications.

Community education:

Provided 21,000 education units in English as a second language, citizenship coaching, elder abuse prevention, know your rights informational sessions, Arabic classes, and health workshops.

Special initiatives:

SACCHI Project: South Asian Colon Cancer Health Initiative reached 40,000+ people with culturally adapted education.

Future plans:

Renovating main center into South Asian Community Home with library, arts and crafts corner, and technology lab.
Providing 100% low-income affordable housing units to seniors.

At India Home, our elders don’t just receive care. They rediscover community.

And the best part? You walk in, and you feel it.

You hear Hindi, Gujarati, Bengali, Urdu, Punjabi, English, Telugu, Tamil, Malayalam, Kannada, Sinhala, Creole … You smell spices – cumin, cardamom, and tea.

You hear laughter — not from staff, but from elders rediscovering joy.

One aunty told us, “I don’t wait for weekends anymore. I wait for Mondays, so I can come back to India Home.”

When Mondays become popular, you know you’re doing something right.

And this — this space — it’s not just for our parents. It’s for us.

Because one day, we’ll be those elders. Hopefully doing yoga. Probably gossiping after it.

And when that day comes, we’ll want a space that gets us.

India Home is now a national model for culturally competent elder care. But to me, it’s something more personal.

Every smile I see there carries a piece of my father’s legacy. He taught me that words can heal.

India Home is my way of giving that healing back. One elder. One story. One day at a time.

What happens when compassion meets culture? You get India Home. A place where aging is not endured … but celebrated.

Dr. Vasundhara Kalasapudi, known as Dr. K., is a psychiatrist specializing in geriatrics. She is founder and executive director of India Home. Her story was read at Healthbeat’s event by India Home treasurer Neetu Jain.

India Home was a sponsor of the event.

A social work story: How the smallest human connection can shift the course of a life

2025-12-15T14:50:31+00:00

Early in my career, I was a social worker in Manhattan, helping older adults navigate life’s challenges. I had studied social service administrative practice at school and wanted to make big systems work better for people. But to do this I knew I first needed to “live” inside one to understand it.

The walk-in center where I worked was a converted storefront — a cramped space with nine desks and little room for privacy, but full of purpose and always teeming with people. My desk was just 10 feet from the door, with the waiting area tucked in between, and spitting distance from the receptionist, who would put calls on hold and then call out as if we were fields apart, “You’ve got a call on line 3!”

Many of the people I served shared similar struggles: loneliness, fading social connections, and confusion with the systems meant to help them. It was a humble, imperfect place, but it taught me something important, especially at the start of my career. We had scarce resources, there were no frills (the bathroom door hit the bookkeeper’s desk every time!), and we were met with constant challenges. But every day we showed up to help people figure things out.

One day in October, a little over a year in, something happened. I emerged from the stifling heat of the subway and felt the crisp fall air snap into my lungs. As I walked with the familiar waking rhythm of the city swirling around me, I thought of fall in New England, when green leaves always gave way to brilliant reds and golds that were swept away by a gust of wind only to gently fall and settle as a waiting pile that would elicit shrieks of joy from bounding children. That cycle was and is still a simple, natural, and predictable one; one where each action yields another, and every aspect of life is connected.

That October morning, my mind drifting with the leaves, I turned the corner to my workplace and stopped short. There, perched on the stoop in front of me was James — head tucked, body curled in on itself, rocking slightly, and oozing sadness.

James had been coming to the center for about six months. He had lost his partner of 20 years to complications from AIDS, and though he came in first for help with a heating issue, he regularly returned with small but compounding needs — each one seeming too big to handle, too confusing to navigate, too much to deal with. With each visit, James talked, and I listened to his stories of love, loss, and grief. I could see he had a growing sadness that was pulling him down like quicksand, slow and deliberate in its lasting grip. I saw it happening, but I struggled with what to do to “fix” it.

When I saw him that morning, wound tight with despair, I ushered him inside and sat with him. He cried; I listened. When his sobs finally slowed, he began to speak. The words he whispered that day have stayed with me ever since:

James told me he had woken that morning in the stillness of his life and thought of suicide. He dressed and walked to the stairwell leading to his building’s roof and stood there, staring upward. He put his foot on the first step and thought: I can go up to the roof and jump, or I can go talk to Aliki.

There were mornings after that day when I would arrive at work wondering, Will today be the day James chooses the roof? I think often of the simple power of that lesson for me. It was when my job became my purpose. When I realized I would carry an enormity and an intimacy in service to others. When I realized that the smallest human connection could shift the course of a life.

Now, years later, after many more years in public health service, I reflect on that time — on the tiny office, scarce resources, and endless challenges — I am reminded that the most powerful system of all is not born from policy, or organizational design, or quick fixes. It is in the simple, natural, predictable actions.

It lives in the smallest moments, the listening without fixing, the quiet power to make a difference, one person at a time. It is the shared joy of jumping in a pile of leaves and shrieking with glee.

Aliki Pappas Weakland has over 25 years experience in social services and public health. She currently serves as an associate director in the Centers for Disease Control and Prevention’s Office of Readiness and Response. Among her degrees is an MPH from Emory University’s Rollins School of Public Health.

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.

Holding the flashlight: How a nurse-teacher helps students find strength in storytelling

2025-12-09T18:18:36+00:00

I’m a bachelor-prepared registered nurse, but my work in the New York public school system focuses on guiding students to find, tell, and write their own first-person stories.

When anyone refers to me as “ex-nurse,” it’s so confusing. First, do they really think I don’t pick up a shift or two on weekends? Nurses (especially New York City nurses) are the original jugglers of multiple job types. I remember when we first heard people talk about “side hustles.” That seemed almost like a dare: “Hold my lanyard, here I go.”

Second, is it possible to stop being a nurse in everyday interactions? I can’t imagine not assessing my brother-in-law’s rapid pulse when we hold hands around the family dinner table on holidays. I’d have to be a different person.

But during the week, I swap my stethoscope for composition notebooks and writing prompts, and every day I’m reminded that nearly everything that matters to students is secretly (or not so secretly) health-related.

A kid forgets breakfast and can’t focus on an essay: blood sugar. Another keeps their head down; this isn’t defiance, it’s exhaustion from sleeping approximately 12 minutes the night before, thanks to a crowded apartment, the gentrifying bar next door that makes noise until very, very late, and the pull of watching just once more YouTube short. Someone shares about losing a cousin to gun violence: That’s trauma, grief, community health, and the broken places we’re all trying to live in.

Even grammar sometimes feels like triage: We can’t fix everything at once, but maybe if we get the comma in the right place, we can all feel better for a bit.

Early last semester, a student casually announced, “I think I caught the cortisol.”

“The cortisol?”

He nodded, very serious. “Yeah, I read about it online, I’m nervous all the time, and my stomach hurts.”

So we slowed way down. I started to explain that cortisol isn’t something you catch. And then I realized that’s not true. We talked about what might cause a release of stress hormones, and the student named that he absolutely could inherit a whole ecosystem of anxiety about rent spikes, sirens at 3 a.m., and metal detectors at school.

His shoulders dropped in relief. He wasn’t cured, but he did feel understood. And he understood himself. His reactions made perfect sense given his environment.

One student wrote about an uncle who refused to go to the doctor because “men don’t need checkups.” His last line was: “He didn’t die because he didn’t care. He died because he did what he was taught.” That sentence hit harder than any peer-reviewed article on what we as providers call “non-compliance.” Call it anecdotal evidence if you’d like, but it’s also data with a heartbeat.

And because I’m a nurse in my everyday interactions, the work doesn’t keep school hours. Like the night I got a 12:47 a.m. text from a trans young adult I know from queer kickball (yes, it’s a thing), asking “do I need to go to the emergency room for…”

As a provider, whenever I get a 12.47 a.m. text asking if someone (especially a queer or trans person) needs to go to the ER, they almost always know the answer is yes. They often just need some loving encouragement. Sometimes, firm loving encouragement.

My texting acquaintance hadn’t availed themselves of any health care since they came out as trans, and was worried they wouldn’t be able to advocate successfully, or be able to communicate what the problem was.

There was no way I could reach them to be their ER buddy; classic New York timing means crises always wait until the trains are running “every 28 to 47 minutes.” Or whenever they feel like coming.

“Tell me a story about a time you did stand up for yourself,” I texted.

There was a long pause. A pause long enough for me to consider the possibility that I’d accidentally invented the world’s worst crisis intervention technique. Then:

“Once I told my barber to stop giving me the ‘cute girl fade.’”

There it was. Strength. Humor. Agency. A tiny act of self-definition with a very uneven hairline attached.

“Great,” I texted back. “Use that energy. You don’t need medical jargon. You just need that same ‘nope, not today’ tone. Now go get the care you deserve.”

And they did. Not because I coached them through it, but because telling their own story reminded them that they already knew how to advocate for themselves.

My “aha” moment wasn’t a single beam of light. There wasn’t any celestial chorus singing the takeaway in breathtaking harmony, no brave student holding a metaphorical lantern. It was the slow, steady realization that every time someone tells their story — whether a teenager talking about their grandma’s diabetes medication or a scared queer young adult trying to get urgent care — they locate their own strength.

My job is just to hold the flashlight while they look.

Kelli Dunham is a nurse, a writer, an educator, and a comedian, sometimes all three at once. She is the author of the best-selling guide to puberty, “The Boy’s Body Book,” and host and executive producer of Good Get’s newest podcast, “Cared For.” Former New York City Mayor Bill DeBlasio once called her a showoff. To her face.

How adding doors to toilets became a lifeline for women’s health in the Balkans

2025-12-08T16:03:15+00:00

My story is about health care deserts in the heart of the Balkans. It involves periods, toilets, and a mobile clinic.

Health care desert number one: menstruation.

It was 2019, and I was serving as the British Ambassador to North Macedonia. The country’s Institute of Public Health had released a survey that showed over 90% of girls in rural areas in North Macedonia miss school during their period due to poor menstrual hygiene facilities at schools.

Girls were missing school not just because they couldn’t afford sanitary products, but also because the school toilets didn’t have doors. Doors! It was frankly eye opening to see that in a European country.

After this survey was released, we, the United Kingdom, partnered with a regional government to fix a small number of toilets and fund free menstrual products in school bathrooms. We talked to some journalists about the project, and that helped get information out about the problem and the impact on education.

It was a small campaign. It was not expensive to the UK. But the ripple effect was amazing. Here’s what happened next:

The World Bank supported a project to refurbish toilets across primary schools.
The central government offered free menstrual products for high school girls.
The government dropped the value-added tax from period products nationwide.

Rachel Galloway is the British Consul General to the Southeast United States.

Because of all of these steps, girls in rural areas were able to go to school when they had their periods. That moment — watching a policy shift born from a box of pads and a few well-placed headlines — it was stunning. And it made me think, what else can the UK do here?

Which brings me to health care desert number two: mammograms and pap smears.

The UK funded a mobile gynecology unit — an ambulance retrofitted to deliver exams in rural villages. It was a lifeline, especially during 2020 pandemic lockdowns, when women were trapped at home, often in unsafe situations.

The unit reached Roma communities and others who had never seen a doctor. It was a fantastic program. I was really proud of it. But something gnawed at me.

There were no records. No continuity. The nurses remembered faces, the doctors remembered stories, but the system remembered nothing. It was health care by memory, not by data. And in a pandemic, memory isn’t enough.

Local health care workers spoke about the challenge of serving a community without having background knowledge of who people were, what they needed, and even what they understood.

Both of these examples highlight the problem of health care deserts, which are a global problem. And as our mobile clinic demonstrates, it’s not just about providing direct access, but also about the need for better tools. Maybe this is where artificial intelligence could be useful.

An AI future does seem a little scary at times. But when it comes to health care, AI could change lives for the better. It is an area that the UK and the United States are collaborating on through our new technology partnership.

Imagine mobile units equipped not just with medical tools, but with smart systems that build records, track needs, and flag risks. Imagine AI helping us understand those farflung communities in rural locations. It could go a long way in predicting future outbreaks, tailoring care, and building trust.

It won’t replace the nurse who remembers every patient’s story. But it could mean that the next time we roll into a village, we’re not starting from scratch. We’re building on knowledge, not just goodwill.

And maybe we’ll remember that sometimes diplomacy starts with a door on a toilet — and ends with a country changing its laws.

Rachel Galloway is the British Consul General to the Southeast United States. She arrived in July 2022 having previously served as the UK’s Ambassador to the Republic of North Macedonia where she played a pivotal role in strengthening diplomatic relations in the region, including the country’s accession to NATO. Her career spans various positions, from working in Brussels at the EU, to leading a team working on Darfur policy, to a posting in Helmand Province in Afghanistan to a stint at the British Embassy in Washington.

A lesson from ‘Mr. Happy’ in how life after hospital affects recovery

2025-12-03T17:11:09+00:00

What matters most in health care goes beyond medical treatment. It is understanding what truly matters to each person and shaping care around their lives, not just their diagnoses. I learned this lesson firsthand in 2020, when I had just graduated from medical school, moved to the United States, and began my journey caring for some of New York City’s most vulnerable older adults through my work at JASA, one of the city’s largest providers of aging services.

In medical school, I was trained to treat disease and preserve health, yet I quickly realized how little I knew about what happens once patients leave the hospital. Social determinants, daily challenges, and loneliness can profoundly affect recovery and quality of life.

In 2021, I met a patient I will call Mr. Happy. He had recently been discharged after a prolonged hospitalization for congestive heart failure exacerbation and ascites secondary to colon cancer. Reaching him was difficult since he was often unavailable, and the referring social worker warned me that he was hard to engage. When I finally did, he became both my teacher and my patient.

My first “aha” moment came when Mr. Happy taught me the power of patience and persistence. After several attempts, he finally agreed to a visit. When I arrived, I immediately understood his hesitation. His apartment was nearly empty. During his hospitalization, his few possessions had been discarded. He had no chair, no linens, no clothes. He was angry and embarrassed. Through JASA’s support, I was able to provide clothing, shoes, linens, and a recliner so he could sit comfortably.

As we reviewed his medications, I discovered that he had stopped taking his heart failure medicine because it was unaffordable without insurance. I contacted the manufacturer, obtained a coupon, and coordinated with his pharmacy. Within hours, he had his medication in hand. We reviewed each prescription together using the teach-back method and created a simple list he could follow. From that point forward, he took his medications consistently. That was my second “aha” moment: realizing that patients often labeled as “non-compliant” are, in fact, navigating real and significant barriers to care.

My final “aha” moment came when JASA implemented the Age-Friendly Health System framework, which centers on asking every patient a single, transformative question: “What matters most to you?”

That question changed my entire approach to care. For Mr. Happy, what mattered most was regaining his health so he could spend time with his son and siblings and once again play chess in the park. Together, we worked to make that possible by arranging transportation, medication delivery, and home aide support, and by helping him secure insurance for ongoing care.

Through this experience, I learned that true healing begins when we listen deeply to what matters most. Mr. Happy became more than a patient; he became a mentor. On my final visit, we played chess together, honoring one of the things that mattered most to him. He reminded me that compassionate, person-centered care, grounded in empathy and partnership, is at the heart of medicine.

Dr. Jose R. Martinez-Escudero is the associate director of transitional care for JASA at Maimonides Hospital, where he helps underserved older adults navigate the complexities of the health care system in New York City. Dr. Martinez-Escudero completed his medical training at the National Polytechnic Institute in Mexico City, followed by a Master of Science degree focused on research in Parkinson’s disease and the basal nuclei.

How an ‘aha’ moment at age 10 led to a career in science and public health

2025-12-02T15:11:53+00:00

I was a career scientist at the Centers for Disease Control and Prevention for nine years, and a public health professional for over 20 years. I’ve had many “aha” moments over the years.

My first “aha” moment was when I was 10 years old. I was sitting on the couch with my grandmother watching a movie, as we did every time I visited. I saw helicopters, people in uniform, and lots of action. The thing that stood out for me was being curious about what a “BSL” was. I saw BSL 1, BSL 2, BSL 3, and so on. This was the opening of the movie “Outbreak.”

If you don’t know, BSL stands for Biosafety Level, with 1 being the lowest.

I was a curious kid, always questioning things and discovering answers to the world. You can imagine how much my parents loved hearing from me constantly!

Some may have watched that movie and thought they wanted to be Dustin Hoffman, the virologist investigating the outbreak. I always wanted to be Rene Russo. Why? Because she was the one who practiced public health and science in the movie the most.

My “aha” was learning that I didn’t want to be the person who knew how government or knowledge was controlled and dispensed, but rather the person who was on the ground with the people it affected. Rene Russo embodied the sacrifices and the leadership that changed the entire outcome of the film. At 10 years old, I wrote an “essay” … if you can even call it that … about how I wanted to be a scientist, and it propelled me on a linear track to achieving that goal.

My second “aha” was becoming a scientist. I realized I didn’t really know much about how to do this job. I was thankful for career scientists and mentors who guided me through the process. If you would have told me it would take a decade to understand the science, and then another decade to understand how I fit into the science, I don’t know if I would have continued on my path. So I had another “aha”: that we don’t have to know it all. Part of public health is constantly learning, and I appreciated that so much when that came to be for me.

My third “aha” was learning that as a civil servant, and one who dedicated their life to saving others, that I would never give up or halt in my efforts. The job is neverending. And so to relate back to my favorite movie “Outbreak,” my second was “The NeverEnding Story.”

Many of us can likely relate to this … who didn’t want a Falcor in their life? But the impact of that movie in the scene with the horse, Artax, is in the Swamp of Sadness. We remember that scene because it was the sensation of leaving your most beloved thing behind. That, in many ways, is what it feels like to be dismissed from duty at the CDC in public health professions.

With all that said, I continue to question, to be curious, to investigate, analyze, and report on my life, assisting others who need information, and to support the wider communities who rely on our strongest efforts. Because who am I without everyone else, and with the sadness of our professions being attacked … we persevere.

Thank you, and with solidarity,

I’m Brandon Kenemer.

Brandon Kenemer is an associate director for informatics focused on data science, surveillance, communications, and bioinformatics at the Centers for Disease Control and Prevention. Previously, he worked in psychology, behavioral health, and nursing care.

Meeting ‘Ms. Mary’: The call that changed my shift – and my life

2025-11-24T12:00:00+00:00

“Grady Unit 695, respond to Metropolitan Parkway …”

When it comes to emergency medicine, unpredictability is part of the job. You never know if the next call will be a heart attack, a car crash, or a cry for help that no one else knows how to answer.

That morning, the radio crackled with a call that seemed routine enough: “52-year-old female off her medication, flashing drivers, walking in and out of traffic.”

It was my third hour into a 13-hour shift at Grady, one of the largest public hospitals in the South. My partner and I had a system: He drove, I handled behavioral emergencies. That division wasn’t random — it was personal.

My mother had lived with schizophrenia until her death at 42. In the 1980s, no one spoke openly about depression or psychosis. People just said my mother was “crazy.” I still remember her walking down Albany Avenue in Hartford wearing a pink tutu and white leotard, smiling at strangers who didn’t understand. I was too young to see that she wasn’t dangerous — she was sick, and society didn’t know what to do with her.

On the way to Metropolitan Parkway, all I could think was: Please, don’t let this woman be wearing a tutu.

Meeting Ms. Mary

When we arrived, Ms. Mary stood near a weathered Cutlass Supreme, her yellow sundress dancing in the breeze. She was poised, articulate, and surprisingly self-aware. “My daughter’s getting on my nerves,” she told us. “I need to go to Georgia Regional for 30 days.” Her honesty made me smile.

I invited her into the back of the ambulance, where it was cooler. As I checked her pulse, she explained that she had schizophrenia, high blood pressure, and borderline diabetes. She’d stopped taking her medication because it made her feel off-balance — something I’d heard before, and something I understood.

Then, with the blunt curiosity that often comes with familiarity, she looked me up and down and asked a question about my sexuality — one that could have stung in another setting. But her tone wasn’t cruel; it was matter-of-fact. Before I could respond, she added, “My grandson’s gay, too. And I love him. When we walk down the street, he holds my hand. Don’t let these folks bother you, baby. You just be yourself.”

The tension in that ambulance dissolved into something like grace.

A mirror in the back of the ambulance

Ms. Mary didn’t know she was speaking to someone who had spent a lifetime wrestling with identity. I’d always been aware of my otherness — the way I walked, talked, and carried myself. At 6 years old, a cousin once asked, “Why do you walk like that? You walk like a girl.” Later, my grandmother, whom I loved deeply, told me I had “a spirit” inside me — one I should pray for God to take away. I didn’t understand then what that spirit was, only that it seemed to make people uneasy.

Her words filled me with confusion. How could I pray away something that felt natural? Something that was, in fact, me? Years later, in the back of that ambulance, Ms. Mary unknowingly answered my grandmother’s question. She told me, without apology or hesitation, to live in my truth. Her message — “You just be yourself” — felt like the permission I’d been waiting my whole life to receive.

Beyond the emergency

After that call, I couldn’t stop thinking about the deeper patterns I saw every day. So many people like Ms. Mary were cycling in and out of emergency rooms, never getting the long-term care they needed. So many families, like mine, were left to cope alone. Too many conversations about health stopped at the body and ignored the mind — and the structural issues that shape both.

Being an EMT taught me to treat the crisis in front of me. But I began to realize that the bigger work lay in preventing the crisis before it started. That’s when I found my way to public health. Public health asked the questions that had been haunting me all along: Why do people like Ms. Mary fall through the cracks? Why don’t families like mine get the help they deserve? Why do stigma and silence still have such power over who gets well — and who doesn’t? I wanted to do more than respond to emergencies. I wanted to change the conditions that caused them.

‘You’ve got work to do’

Months later, I saw Ms. Mary again. I was sitting at a red light in Atlanta’s West End when I spotted her — black mini-skirt, red sandals, same confident stride. I rolled down my window, waved, and called out to her. She turned, met my eyes, and said with a knowing smile: “Don’t be late, baby. You’ve got work to do.”

Then she kept walking. Her words have stayed with me. Because she was right — I do have work to do. Work that honors my mother. Work that lifts people like Ms. Mary. Work that challenges the systems that silence the vulnerable and stigmatize the misunderstood.

That single 911 call didn’t just change a shift — it changed my purpose. That’s why I chose public health: not for the prestige, but for the people. For those who walk through the world labeled as problems when, really, they are prophets — reminding us all what care should look like.

Anaré V. Holmes is a firefighter with the Atlanta Fire Rescue Department and an award-winning journalist. He has been honored by the state of Georgia for excellence in trauma care.

Idaho’s Medical Freedom Act disarms public health

2025-11-21T20:08:33+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.

While most national attention has focused on the dismantling of public health infrastructure at the federal level, a new law in Idaho may be one of the most consequential.

On the surface, the Idaho Medical Freedom Act affirms an individual’s right to bodily autonomy. In practice, its broad language threatens the state’s ability to prevent illness and death from infectious diseases, and, if replicated elsewhere, it could unravel decades of progress in public health.

U.S. Constitution delegates public health to state ‘police powers’

Under the Constitution’s Tenth Amendment, states are primarily responsible for public health through their “police powers.” The federal government is only permitted to intervene in public health when an issue involves interstate commerce or international borders.

The power of states to protect health is vast, including the ability to restrict an individual’s freedom and mandate they receive a medical intervention. In 1905, the Supreme Court’s Jacobson v. Massachusetts decision confirmed that states may compel people to get vaccinated to protect the community from a dangerous infectious disease (in this case, smallpox). The court ruled that individual liberty does not include the right to expose others to harm. Or, as is often said in public health discussion, the right to swing your fist ends where the other person’s nose begins.

The Jacobsen decision supports many accepted public health practices that limit one person’s individual freedom in order to protect another person’s safety: requiring vaccination for school attendance, isolating ill people with tuberculosis, quarantining exposed persons during measles or Ebola outbreaks, and mandating masks or other protective equipment for health care workers.

What the Idaho Medical Freedom Act does

The Idaho Medical Freedom Act prohibits any government or private entity from requiring a “medical intervention,” defined broadly as any procedure, drug, device, or action used to diagnose, prevent, or treat disease. While drafted in response to Covid-era rules, its reach extends far beyond Covid vaccines.

The statute bars health departments, employers, and schools from requiring medical interventions unless explicitly mandated by federal law. This includes treatments, testing, vaccination, and any preventive practices that alter “biological function.” In doing so, the law removes public health authority at the state and local level to enforce measures that have long been essential for disease control and occupational safety.

A narrow exemption in the law does permit employers to require personal protective equipment if consistent with “traditional and accepted industry standards.” Yet the law excludes vaccines, masks, or any “medical interventions introduced during the Covid-19 pandemic.” This language leaves unclear whether respiratory protection like N95 respirators counts as traditional PPE or as prohibited “Covid-era” requirements.

The statute also forbids excluding any “healthy” person during a disease outbreak because of vaccination status. This provision directly contradicts standard outbreak management practices, which rely on temporarily excluding people who have been exposed to a disease if they are not immune to that disease.

Public health and legal risks of the Idaho Medical Freedom Act

Tuberculosis control. Isolation and treatment orders for active tuberculosis could be contested as compelled medical interventions. Preventive therapy for exposed contacts might be viewed as coercive. Hospitals could hesitate to require N95 masks for infectious patients and health care providers, as well as restrict patients to negative-pressure isolation rooms, potentially causing TB outbreaks in health care facilities.

Health care infection control. Facilities may face lawsuits for requiring flu vaccines, N95 masks, or testing among staff. The “traditional PPE” clause is vague, leaving health care administrators uncertain whether basic protective standards remain enforceable. Federal Occupational Health and Safety Administration rules might override the law, but only after litigation.

Outbreak management. Health departments could lose authority to exclude unvaccinated or exposed individuals during outbreaks of vaccine-preventable infections, such as measles and meningococcal disease. As a result, people who are incubating an infectious disease will be permitted to develop and potentially spread that disease.

Occupational safety. Laboratories and emergency services may be unable to require hepatitis B vaccination, gloves, or N95 masks unless explicitly mandated by federal law. This creates conflicts with federal occupational health standards and uncertainty for employers seeking to protect workers.

Conflicts between federal and state authority to protect health

The Idaho law could result in legal challenges on multiple fronts. Prohibiting isolation or exclusion of contagious individuals could violate others’ rights to health and safety under substantive due process. The Tenth Amendment allows states to regulate health but not to obstruct federal laws for infectious disease control. Federal supremacy gives OSHA, the Centers for Medicaid and Medicare Services, and the Centers for Disease Control and Prevention authority to enforce workplace and health care safety rules that pre-empt conflicting state statutes. At the same time, it’s unclear if the current federal administration would pursue these cases, given its negative views of public health interventions.

Until courts resolve these conflicts, Idaho’s hospitals, clinics, schools, and employers will operate in legal uncertainty. Some will comply with federal rules and risk violating state law, while others will comply with state law and risk outbreaks.

Idaho is choosing to disarm its police powers for health

By stripping itself of the authority to require basic infection control, Idaho has weakened both its own government and its private institutions. The Medical Freedom Act’s sweeping ban on medical interventions, ambiguous exemptions for PPE, and prohibition on excluding unvaccinated individuals during outbreaks dismantle standard infectious disease control practices.

Public health law balances liberty with the collective right to safety, i.e., the freedom to do something versus the freedom from something. What Idaho calls freedom leaves its citizens less free from infection and less protected from harm. The state has used its police power not to defend public health but to take that power away.

‘Terrified’ to seek help: Georgia nurses can lose license if they admit addiction. Advocates want to change that.

2025-11-20T23:29:09+00:00

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

It can be tough for anyone to decide to get help for substance abuse, but nurses in Georgia face a special set of barriers: They have to report seeking treatment to the state’s Board of Nursing, which can jeopardize their license or put long-term restrictions on their practice and job prospects.

Addiction recovery and nursing advocates are urging the state to adopt an “alternative to discipline” for nurses who want to get help for substance use issues. The aim is to keep nurses in the workforce and ward off serious crises for them and their patients. At least 41 states have implemented such programs, according to the National Council of State Boards of Nursing. Georgia has not, though all five neighboring states have.

A bill to set up such a system came close to passing in the state legislature earlier this year. Sponsored by Rep. Ron Stephens, a Savannah Republican, the bill passed the House unanimously but failed to get a Senate floor vote.

Advocates plan to renew the push during the next session, which begins Jan. 12. The Board of Nursing will also consider the idea at its December meeting, a spokesperson for the board’s parent agency, the Secretary of State’s office, said.

It’s much needed, said Greg Gardner, a peer recovery coach for the Georgia Council for Recovery. He said that of 25 nurses struggling with alcohol use disorder he has seen in emergency rooms as part of a peer support program, only one was willing to proceed with getting help.

“They feel they will lose their license, they will lose their job, even without an incident at work. Moms with kids, they can’t afford to lose their job. They are terrified of what’s going to happen if they ask for help,” Gardner said during a Thursday meeting of the Georgia General Assembly’s Working Group on Addiction and Recovery.

In 2024, the board took 238 disciplinary actions for all reasons, according to data from the Secretary of State’s office. The board wouldn’t say how many were related to addiction, citing confidentiality. The Georgia Nursing Association sees 200 to 250 nurses in its Peer Assistance Program for those struggling with addiction, executive director Felicia Chatman told Healthbeat.

Seeking treatment triggers disciplinary process

As part of their license renewal process, nurses must check a box stating they have not sought treatment for substance use within the past five years, even if they’ve had no incidents at work, Gardner said. Colleagues or supervisors can also report nurses, and nurses can choose to self-report as well.

Such reports, whether through the license renewal process or another way, trigger a disciplinary process with the state Board of Nursing – and can deter nurses from seeking help.

The reports typically result in a “consent order” that establishes steps nurses must take to maintain their license and continue to practice. That includes regular drug tests and participation in recovery support programs.

The details are public, and nurses may face difficulty finding employment even many years after completing all the steps and remaining sober because of the disciplinary record, several nurses told Healthbeat.

The initial process can take up to a year or 18 months to play out, during which time a nurse might move to another job or face worsening addiction, said Helen Diana Ware, a registered nurse in recovery who spoke during the Thursday meeting.

“That’s not protecting the public,” Ware said.

The formal disciplinary process isn’t foolproof, Alison Trinkoff, a nursing professor of the University of Maryland-Baltimore who studies nurses’ well-being and substance use, said in an interview. She added that some employers may fire nurses without reporting them to nursing boards.

Advocates say alternative system could head off more serious problems

Ware and others said providing an alternative to discipline would encourage nurses to get help before their problems become more serious or endanger patient safety.

“When they enter our program, they really do run into barriers with re-entry and finding employment because they have a consent order,” Chatman said. “The irony … is that those are the nurses that employers can hire that are really the safest nurses out there, because they’re being monitored” with routine drug and alcohol testing.

Chatman and others at the Peer Assistance Program want to see the state adopt the alternative-to-discipline program.

“Those nurses that … know that they’re getting into trouble, they’re not healthy. They want to get treatment. They can reach out to us and say, ‘Help, help. Yes, my house is not on fire yet. I’m not arrested. I haven’t stole drugs, and I don’t want to go down that path of destruction,’” said Barbara Austin, a nurse who helps facilitate recovery meetings through the Peer Assistance Program.

“It would be a phenomenal boost, not only to the nursing shortage, but to the health of nurses in Georgia,” Austin said. About 153,544 nurses worked in Georgia in 2024, and the state is short an average of 772 RNs each year, according to the Georgia Center for Nursing Excellence.

“We need every nurse we can get,” said Mary Lou Wilson, an administrator at the Northeast Georgia Health System.

Alternative to discipline programs are generally effective, Trinkoff said.

“It gives you options as a nurse. ‘Hey, I can hang onto my license. I can get better,’” Trinkoff said. “‘This is good. I don’t have to worry I’m going to be a danger to myself and to others.’”

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

5 From the Field: Q&A with NACCHO CEO Lori Freeman

2025-11-11T12:00:00+00:00

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

As CEO of the National Association of County and City Health Officials, Lori Freeman spends much of her time on the road talking with the people on the front lines of public health.

It’s been a challenging year for local health departments.

The federal government in March announced it was pulling back $11.4 billion in funding allocated across the nation for pandemic response and infrastructure, an action that’s now being debated in the courts. More cuts are expected amid a dramatic reorganization of the Centers for Disease Control and Prevention, which has traditionally sent about 80% of its domestic budget to states, localities, tribal organizations, and other public health partners.

Meanwhile, swaths of the American public have grown increasingly distrustful of scientific and public health institutions.

We spoke with Freeman to get her insights on five questions about some of the current challenges facing local health departments. This 5 From the Field interview has been edited for clarity and length.

What public health concept do you wish the public better understood?

It’s this concept that from the youngest age possible, that public health is around them, keeping them safe.

They don’t see it, but they need to know that for all of their lives, that we will be there on the ground, in their community, helping to make sure that there’s safe water to drink, safe air to breathe, safe places to play and walk, safe restaurants to eat at, safe pools to swim in.

We need to make it real for them, because we just haven’t done that.

You recently co-authored a journal article titled, ‘Where Do We Go From Here? The Way Forward for State and Local Public Health.’ The article notes that the future of public health depends on rebuilding trust with the community. What are some ways to do that?

We talk about this a lot. There is a lot of distrust right now in our federal government, and we have to not automatically extend that distrust further down to the community, because that simply isn’t the case.

Broadly speaking, our local health departments still are very well trusted in their communities. Not as much as the No. 1 primary care physician, but close up there.

For me, this is about how we retain trust, not regain trust. We had some missteps during the pandemic, but they weren’t all of our fault at local public health. But we had to take the brunt of the punishment because we’re the closest to the ground.

We’re past that now. We want to talk about how we assure anybody coming into a local health department that they can have an honest conversation about their concerns and what they need.

If you have a young mom coming in nervous about getting a Covid vaccine, what we have to do is say: This is the information about the vaccine. And this is the information if you want to find further information about some of the side effects, or what can happen if you have certain conditions. This is what you need to know, and this is how you can research that, and how can I help you?

More open conversation about choices is where we’re headed here. It allows our health departments to stay in a neutral space, because we are completely bipartisan. We treat everybody the same.

Really focusing on honest conversation where we can. And it’s not always easy to do that. But we have to listen, and we have to understand where people aren’t meeting us in terms of understanding what public health needs are and how they can contribute.

If we don’t listen and understand that, we’re not going to address the misunderstanding that is still out there, and the mistrust.

This has been a year of significant change and disruption in public health. What are you most concerned about in the year ahead?

There’s a lot of things. One is our ability to actively respond to public health emergencies and threats. Not only are the resources changing and shrinking, but the administration that’s in place now clearly believes in a smaller federal government footprint, impact, and influence.

The partnership between federal, state, and local agencies is never more important than it is in a national public health emergency. Without an active federal component, or even a lessened federal component, the state and locals will be left to manage this more directly on their own. And I don’t know that they have the capacity to do that.

Imagine a year ago when the hurricane [Hurricane Helene] came up through multiple states, and we saw a tremendous impact in the South, in mountain areas, and across multiple jurisdictions. States and locals can’t provide that level of coordination themselves. It’s impossible.

How have the job losses at the CDC impacted local health departments?

It’s a lot of chaos right now with the workforce at the CDC. We had broad-scale layoffs. We had recissions. I can tell you right now, nobody I talk to anywhere at the CDC or elsewhere knows where we stand.

Local health departments, they function along until they need help. Those instances are usually when there is an outbreak, a novel disease shows up in the community, [or they need] advanced testing and diagnostics. We’re seeing some instances where the CDC has been unable to respond or provide assistance.

We recognize the CDC is a huge bureaucracy with a lot of people, and maybe not all of them are needed. But we can point to real expertise that has been lost that we miss.

The CDC represents some of the most world-renowned expertise in disease. We don’t have that capacity locally. We’re not set up that way.

The level of expertise we’re losing from the CDC is alarming. This CDC that we are seeing right now is a fully burned-down version of what we were experiencing a year ago.

Your recent journal article focused on ways public health departments can move forward in the current climate. What are some of the key suggestions?

Look at your core mission. Look at who you are serving, and make sure that you are really targeting what you need to do in the community.

If we continue down this road of federal back-out of supporting public health, health departments really have to look at what are the core things that we have to worry about to keep our community safe. Drinking water, environment, clean air, safe places to eat, keeping communities free of disease – and really honing in on those and letting the rest of the things fall away for now or get diminished. It’s going to be painful.

Some of those core services in local public health are supported by regulatory funding. They’re able to get funding for licensing and inspections. We can still do things at a basic level.

That’s one way to look forward. It’s not an ideal way.

We have to keep returning to our own visionary model of public health. We are the public health strategist for the community, convening and organizing our partners in a way that blends funding support resources across the community.

Some of our communities have already moved here. You have some states and locals who have disengaged and disentangled themselves from federal funding to the extent that they feel far less pain. A lot of these are conservative, red states. They have a story to tell and one that is important for us to learn from. How did they do it, and are they successful at it?

Our partners have to be different and expanded. We have never attempted, as far as I can tell, to try to tie ourselves more closely to the spectrum of health.

Public health is just the pre-health care part of it: Everything that we do [in public health] that you don’t always see that is keeping you from going to the doctor and that is keeping you from having to seek health care, and that is keeping our communities healthy as a whole.

Healthbeat’s “5 from the Field” series highlights insights from public health leaders and practitioners. To suggest someone for a future interview, email Alison Young, Healthbeat’s senior national reporter, at ayoung@healthbeat.org. You can also reach her through the messaging app Signal at alisonyoungreports.48

‘Ikigai to Ubuntu’: How a chance encounter in Haiti gave me a new ‘reason for being’

2025-11-10T18:15:33+00:00

In the tapestry of life, there are moments that stand out like vibrant threads, weaving together experiences that shape our understanding of purpose and community.

One such moment for me was the day I discovered the profound connection between the Japanese concept of ikigai — a reason for being — and the African philosophy of Ubuntu, which emphasizes our shared humanity.

This realization came to me in a small, unassuming community health center, where a simple act of kindness resulted in a chance encounter that transformed my perspective on the impact of my work.

It was a warm muggy afternoon in the outskirts of Port au Prince, Haiti. I was at a local community health center, a place that served as a refuge of hope for many in the surrounding neighborhood. As I entered the compound, I was greeted by the warm smiles of children playing and the gentle hum of conversations among countless adults.

I had been involved in various community service projects around the world, but that day felt different. It had been a few years after the 7.0 magnitude earthquake that left tens of thousands dead and millions homeless. I was there to help organize a health fair, but little did I know that I was about to experience a pivotal moment in my life.

As I sorted through boxes of medical supplies that we had acquired from MedShare International in Georgia, I noticed an elderly woman sitting alone at a table, her hands trembling slightly as she sorted through a box of food items. Her name was Mama Guerline, a widow who had lived in the community for decades. I approached her, offering a smile and a helping hand. We began to chat, and she shared stories of her late husband, and her late children, all lost in the 2010 earthquake.

She talked about the challenges she faced living on rations on a day-to-day basis. Despite having extraordinarily little left to her name, she was determined to do her part to help rebuild her torn nation. She believed her life had been spared during the earthquake so she could be a messenger of hope and change. She did not have any sources of funding, but she had a heart of gold and the determination of steel.

As she spoke, I felt a deep sense of empathy wash over me.

Here was a woman whose life was filled with love and loss, yet she radiated resilience and hope. I asked her what we could do differently for her, and she stated: Do not worry about me. Instead, focus on the youth, as they represent tomorrow. She stated that the children represent the heartbeat of the broken community. If the heart failed, the community would cease to flourish.

In that moment, I realized that my work was not just about organizing health fairs, or collecting and distributing medical donations and countless resources. It was about connecting with people, understanding their stories, and recognizing the impact of our collective efforts in the bid to transform the community.

Ubuntu: ‘I am because we are’

Mama Guerline’s gratitude for the small act of kindness we offered was palpable. She expressed how the community health center had become a lifeline for her and many others, a place where she felt valued and cared for. It struck me that this was the essence of ikigai — finding purpose in serving others and contributing to the greater good. As our conversation deepened, Mama Guerline introduced me to what I then realized was the concept of Ubuntu. She explained that in her culture, the phrase “I am because we are” encapsulates the idea that our identities are intertwined with those of others.

This philosophy resonated with me, illuminating a path forward that I had not previously considered. I began to see how my work could extend beyond individual acts of service to fostering a sense of community and belonging. That day, I left the community health center with a renewed sense of purpose. What we were doing was simply not enough. The children in the community needed to go to school in order to champion the cause for tomorrow. To do that, they needed to have food and nourishment, and they also needed to have a safe environment to live and play in.

Our group of students and volunteers adopted a Creole term on that day: “Nou kapab,” simply meaning “We can.”

I understood that my role was not merely to aid but to cultivate relationships and create an environment where everyone felt seen, heard, and respected. The ripple effect of a small act of care and simply listening could transform lives, just as it had for Mama Guerline. I realized that when we invest in one another, we build a stronger, more resilient community.

How deep listening can be a catalyst for change

In the weeks, months and years that followed, I took this newfound understanding to heart. I began to engage more deeply with the people we served, listening to their stories and learning about their needs. We organized a student movement that not only provided outreach and resources but also fostered connections among community members by engaging the community and performing extensive community needs assessments.

I witnessed firsthand how these small initiatives created a sense of belonging and empowerment. People began to share their knowledge, skills, and talents, forming a network of support that transcended individual struggles. The breakthrough I experienced that day was not just a personal revelation; it was a call to action. I understood that my work could be a catalyst for change, a means to uplift others and create a healthier and more compassionate society.

The principles of ikigai and Ubuntu became guiding lights in my journey, reminding me that true fulfillment comes from serving others and recognizing our shared humanity.

Reflecting on that pivotal moment, I am grateful for the opportunity to connect with Mama Guerline and the many others who have enriched my life. Their stories have taught me that every small act of kindness has the potential to create ripples of change and transformation. I have come to appreciate the beauty of community, where we can support one another and thrive collectively.

In conclusion, my journey from ikigai to Ubuntu has been transformative. It has illuminated a path forward, one that emphasizes the importance of connection, empathy, and shared purpose. As I continue to navigate my work and life, I carry with me the lessons learned from that day – a reminder that we are all interconnected, and that our actions, no matter how small, can have a lasting impact on the world around us.

Dr. Alawode Oladele is the supervising physician and laboratory director for infectious diseases and refugee health at DeKalb Public Health, following decades in global public health. He has degrees from the Morehouse School of Medicine and the Rollins School of Public Health at Emory University.

White House calls this 9/11-era fund ‘wasteful.’ Red and blue states rely on it.

2025-11-06T14:43:21+00:00

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SACRAMENTO, Calif. — President Donald Trump’s push to eliminate a federal disaster preparedness program threatens a fund used by state health systems from Republican-led Texas to the Democratic stronghold of California.

The Hospital Preparedness Program was created more than two decades ago in response to the Sept. 11, 2001, terrorist attacks on New York City’s World Trade Center and the Pentagon, and the deadly anthrax attacks that began days later. The fund has provided nearly $2.2 billion to states, territories, major cities, and other entities over the past 17 years to ready health care systems for the next pandemic, cyberattack, or mass-casualty event.

Recently, that money has been used to combat the bird flu that has sickened at least 70 people in the United States, killed at least one, and remains a threat. The funds also have been used to respond to crises such as hurricanes, tornadoes, mass shootings, floods, and heat waves.

But the budget request sent to Congress by Trump’s budget director, Russell Vought, proposes eliminating the program, saying the effort “has been wasteful and unfocused” and that cutting it would allow states and cities to “properly” fund their own preparedness plans. Any action is stalled by the government shutdown, which stems from a partisan dispute over expiring health care subsidies that affect many of the 24 million Americans who buy coverage from Affordable Care Act marketplaces.

Red and blue states say the hospital preparedness funds are essential and could not be readily replaced with local funds. It’s an example of how the White House’s efforts to reduce its role in responding to public health and natural disasters have imperiled state and municipal reliance on federal resources to meet community needs.

The program “is the main source of government funding for disaster preparedness among hospitals, EMS providers, and other parts of the health care system,” Texas Department of State Health Services spokesperson Chris Van Deusen said.

Texas received more than $20 million from the Hospital Preparedness Program this year, and Van Deusen said it’s unlikely the state could backfill any federal funding gap in the short term since the budget has been finalized through August 2027.

The funds help Texas’ health providers create disaster plans and test hospitals’ ability to boost their capacity in an emergency, he said, while enabling the distribution of medical resources and patient loads so hospitals aren’t overwhelmed during disasters. The program, along with state funding, supports the state’s Emergency Medical Task Force, which responded to deadly floods this year and the Uvalde school shooting in 2022, among many other emergencies.

Georgia, which received $13.5 million this year, “continues to monitor and plan for potential changes to future federal funding while ensuring health care preparedness efforts across Georgia remain strong and sustainable,” said public health spokesperson Eric Jens.

A California health official called the money vital to ensuring local health care systems can respond to emergencies beyond their usual capacity. The program is the only federal funding devoted to health care system preparedness for such catastrophes, said Department of Public Health spokesperson Robert Barsanti.

“Without this funding, California risks losing critical infrastructure for emergency response, weakening its ability to protect lives, maintain continuity of care, and meet federal preparedness benchmarks,” Barsanti said.

As the most populous state, California receives the most money — nearly $29 million this year — as it struggles with a massive budget deficit and fights a running rhetorical battle with Trump administration officials. The funds go to the state’s public health department; the California Emergency Medical Services Authority, which coordinates the state’s emergency medical system; health care associations; and about 60 local entities. Los Angeles County, with more than a quarter of the state’s population, received an additional $11 million, and the University of California system got $1.2 million.

Neither the White House, the Administration for Strategic Preparedness and Response, which administers the program under the U.S. Department of Health and Human Services, nor the Office of Management and Budget responded to repeated requests for comment about the May proposal to cut the Hospital Preparedness Program.

The Administration for Strategic Preparedness and Response has seen an 81% reduction in employees over the past year, The New York Times reported. It’s by far the largest workforce reduction at HHS and part of the wider culling of federal workers under Trump.

Already, HHS has delayed the distribution of this year’s Hospital Preparedness Program funds by nearly three months. The funds were supposed to be available to states for use starting in July, but the bulk of the money was not released until late September. Health officials in the waning days of the Biden administration had wanted to quickly distribute the funds for the nation’s response to the H5N1 bird flu.

The months-long delay “is yet another example of how changes and uncertainty at the federal level threaten critical public health programs in New York state,” said Department of Health spokesperson Cadence Acquaviva. Despite health officials’ best efforts, “delays or elimination of funding places New Yorkers at significant risk in the event of a disaster or emergency,” Acquaviva said.

New York state received nearly $14 million, and New York City more than $9 million.

Illinois Department of Public Health spokesperson Jim Leach said the medical system needs the federal funds to prepare for natural and human-caused disasters of every sort, “regardless of the ebb and flow of any single disease.”

Illinois and Chicago received a combined $15 million from the preparedness program.

During emergencies, the state’s federally funded crisis response program “turns hundreds of Illinois hospitals, EMS, and other health care facilities into a single, coordinated system,” Leach said, adding it saves both lives and taxpayer dollars. “If there is a natural disaster or an infectious disease outbreak, a state would not be able to react quickly enough without the HPP funds.”

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

A public health horror story: If the zombies arrive on Halloween, will the CDC be there to respond?

2025-10-27T17:01:48+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 2011, the Centers for Disease Control and Prevention decided it wasn’t enough to keep humans alive. It was also going to make sure the dead stayed that way.

The CDC’s Office of Public Health Preparedness and Response published a graphic novel called “Preparedness 101: Zombie Pandemic.” In this story, a fictional couple watch news reports of a mysterious pathogen spreading across the United States. The pathogen turns out to be a virus that turns people into zombies, and the CDC leads an effective national response. The story was meant to teach Americans about the importance of being prepared for health emergencies and the role of CDC in responding.

Unfortunately, as we approach Halloween 2025, I am more fearful of what’s happening to CDC than I am of ghosts and vampires. If the zombie outbreak from “Preparedness 101” happened this Halloween, the outcome would be far worse.

Patients rush to emergency departments with first signs of zombie illness

In CDC’s graphic novel, a couple, Julie and Todd, see news reports about a strange illness emerging in the Southeast. People are stumbling into emergency departments, confused and feverish, then suddenly becoming violent. The first nurse is bitten before anyone realizes an outbreak has started.

In this scenario, astute clinicians would have called state health departments, and they would have immediately called the CDC – a seamless network for early detection of new health threats. Syndromic surveillance systems supported by the CDC would immediately detect a surge in emergency department visits for an unusual combination of symptoms.

Today, in a change from previous administrations, CDC staff are prohibited during the government shutdown from even speaking with state health officials. Even if the federal government were open, I suspect there would be insufficient staffing to assess the situation adequately. In the early stages of a zombie attack, CDC requires epidemiologists from across the agency to collaborate on assessing an event.

As with any unexplained cluster of illness, the CDC must consider the possibility that the zombie illness could be caused by a non-infectious agent, such as radiation, industrial chemicals, or naturally occurring toxins, but CDC’s environmental health and toxic substances programs have been gutted.

State and CDC laboratories work to identify the cause of zombie illness

CDC’s graphic novel shows scientists in lab coats analyzing specimens, sequencing the virus, mapping its spread, and tracing its origins – just as happened with SARS, influenza H1N1, and Covid-19 over the past 25 years.

Today, state laboratories that would previously have been responsible for collecting specimens to send to the CDC are struggling with staffing after their CDC grants have been cut. Many CDC labs have been closed, and microbiologists fired, including from CDC’s premier laboratory training program, the Laboratory Leadership Service. Epidemic Intelligence Service officers — the “disease detectives” who deploy during outbreaks — have been fired then rehired twice in the past year, and at least two state requests for their assistance (“Epi-Aids”) have been declined by the CDC. All of this would add up to delays in identifying a zombie virus and understanding how to prevent its spread.

CDC coordinates a national response to zombie illness

In the CDC’s graphic novel, as the infection spreads, the CDC Emergency Operations Center hums with activity. Federal, state, and local agencies coordinate messaging and logistics. Scientists brief elected officials and the media calmly. The CDC recommends that people lock themselves down at home until we know more about how the virus is spreading.

Today, it’s unclear how the chain of command would operate at the CDC during a national emergency. After his appointment, Health and Human Services Secretary Robert F. Kennedy Jr. eliminated the CDC staff who work on intergovernmental coordination and communication, arguing that all health-related communications, operations, and policy should reside within HHS headquarters, not the expert agencies within HHS.

In 2025, we’ve seen what this means for outbreak response: Amid an ongoing nationwide outbreak of measles that threatens the country’s measles elimination status, there have been zero CDC press conferences and only one health alert issued to medical providers. During the current shutdown, the CDC’s most authoritative outlet for written communication, the Morbidity and Mortality Weekly Report, has stopped publication, and multiple editors and staff have been fired.

Even if the CDC were permitted to speak during a zombie outbreak, it’s highly unlikely the CDC would instruct people to stay at home or even advise exposed persons to quarantine. One of the most strident critiques of the CDC by the current HHS secretary, National Institutes of Health director, Food and Drug Administration director, and the current acting CDC director are that the CDC should not have told people to stay at home during the peak of the Covid pandemic and that public health agencies should not restrict people’s freedom of movement. Would they do the same in a zombie outbreak?

CDC develops a vaccine and supports mass vaccination sites

In the graphic novel, CDC scientists rapidly identify the cause of zombie illness: Z5N1, a mutated flu virus. They quickly design, validate, and produce a vaccine. Staff from HHS and the CDC’s Strategic National Stockpile work in tandem. Trucks roll, planes fly, and CDC staff work with states to establish mass vaccination sites within “safe zones.”

Today, that image of coordinated national response to a health emergency seems as fictional as zombies themselves. The president and HHS secretary have repeatedly questioned the safety of vaccines, funding has been cut for vaccine research at the NIH (including the mRNA platform that would most likely be used if a new virus emerges), CDC vaccine experts have quit because of political interference, and, during the most recent October layoffs, multiple personnel responsible for health emergency response were fired. Several states have established a new public health alliance, arguing that they can no longer rely on the CDC.

Surviving an epidemic of zombie virus or other viruses

In the CDC’s graphic novel, Julie and Todd survive. They make it to a shelter, receive the vaccine, and wake up to find it was all a dream. The message of their dream was simple: If you prepare for all hazards, you can survive a hurricane, flood, pandemic, and even a zombie apocalypse.

The systems that made the CDC the hero of the zombie apocalypse graphic novel, as well as movies and TV shows, are being dismantled. For many public health experts, the horror of this Halloween is realizing that, in a fight against a zombie virus, the virus might win.

Disease sleuths piece together clues in unusual malaria case in Washington state

2025-10-27T11:00:00+00:00

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When public health investigators received a report this summer about a woman hospitalized with malaria who lived east of Tacoma, Wash., the case didn’t seem unusual.

Even though malaria was officially eliminated from the United States decades ago, every year about 2,000 people travel to places where the disease is common and bring it back with them.

All it takes is a bite from an infected mosquito to inject the malaria parasites into the skin.

So when the Tacoma-Pierce County Health Department received an official notifiable disease report on Aug. 4 about the woman’s malaria diagnosis, it triggered a routine investigation.

In the beginning it was just another of the 20-70 malaria cases reported in Washington state each year, and among the thousands of reports for a wide array of other diseases and conditions that health departments across the state track and investigate.

“The vast majority of people who are diagnosed with malaria in the United States have traveled to a malaria endemic setting,” Dr. James Miller, the department’s health officer, told Healthbeat. “By the time they’re diagnosed, they’re back in the U.S.”

It usually takes seven to 30 days from the time the person is infected until they start getting sick with fever, chills, sweating and other flu-like symptoms. Without quick treatment, the infection can become life-threatening.

Dr. James Miller, health officer for the Tacoma-Pierce County Health department, says he was initially skeptical a local mosquito bite could have caused a woman's malaria infection.

Each person whose malaria case is reported to the department gets interviewed by public health staff.

The department’s health investigators expected to learn that the woman had traveled to one of more than 80 countries where malaria infections routinely occur. Worldwide, there were about 263 million new malaria cases in 2013, according to the World Health Organization, and about two-thirds of them occurred in about a dozen African countries.

Yet the woman in Washington state hadn’t traveled anywhere she could have become infected.

“That’s what made this case unusual,” Miller said.

Reports of locally acquired malaria are rare in the U.S.

It raised the question: Could the Pierce County woman have somehow become infected with malaria in the local community?

That seemed implausible. There had never been a case of locally acquired malaria documented in Washington state, he said.

While rare, there had been sporadic reports of local infections in other parts of the United States over the years.

In 2023, health departments in Florida, Maryland, Texas, and Arkansas identified 10 people whose malaria infections were attributed to mosquito bites in those four states. Before this unusual series of small malaria outbreaks, it had been 20 years since a locally acquired malaria case had been identified in the United States.

So Miller was skeptical that a local mosquito bite was how the woman in Pierce County, Wash., had been infected.

“Initially I thought we’ll probably find some other explanation here,” he said.

New research raises concerns about local malaria infections in U.S.

Before joining the local health department, Miller had been a regional medical officer for the state’s health department, and he had also served as an epidemic intelligence officer – a disease detective – for the Centers for Disease Control and Prevention.

Often in public health investigations, he said, additional interviews and other probing will result in an explanation that makes sense. “So I think that was my first thought, that we would find another explanation,” he said.

After consulting with zoonotic disease specialists at the Washington State Department of Health and additional experts in the CDC’s malaria branch, Miller and his team started digging deeper.

“The first step was to do a more detailed Interview with the patient and their family,” he said. “Not just recent international travel, but exploring their lifetime international travel history, also looking at recent domestic travel, looking at things like outdoor activities, as well as any other potential sources of infection.”

There can be rare scenarios where people can become infected with malaria without a mosquito being involved, Miller said.

Could the woman have been infected with malaria through a transfusion, despite precautions blood banks take to prevent that from happening? Or could she have been exposed to malaria-contaminated blood through unsterilized medical equipment or perhaps by getting a tattoo in unsterile conditions?

“Again, very rare, but obviously local transmission of malaria is also rare. So we explore all the possibilities,” Miller said.

“There are rare cases where someone can have traveled to a malaria-endemic setting years prior and then not develop malaria until later,” he said. “But in this case, we didn’t identify any relevant travel for the patient, even in the more distant past.”

Investigators also didn’t identify any medical procedures or other potential blood exposures that could explain her infection.

Miller said his skepticism about a local mosquito causing the infection faded after the team’s in-depth interview with the patient and her family.

“Even though it seems very unlikely, we have to really be thinking that this could be transmission within Washington,” Miller said.

Investigators went from skeptical to warning the public

On Aug. 6, the department put out a press release alerting the public that they were investigating a possible locally acquired case of malaria.

The most likely cause of the woman’s infection, the release said, was a local mosquito biting someone who was infected with a travel-associated case of malaria, then spreading the infection to the Pierce County woman.

Malaria is caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people.

The department emphasized that the risk to the public was “very low,” that malaria does not spread directly from person to person, and that the best way to protect against malaria was to prevent mosquito bites and to talk with a health care provider about taking anti-malaria medications if traveling to countries where the disease is more common.

An alert also was sent to the area’s health care providers to be on the lookout for malaria infections, even in people who had not traveled abroad. “Without a relevant travel history, people wouldn’t be suspecting malaria in a place like Washington,” Miller said.

Meanwhile, the Tacoma-Pierce County public health team worked with the state health department and CDC to examine recent emergency department data. The records were analyzed looking for people with possible malaria symptoms who may not have been diagnosed with the disease in the recent past and going forward. No additional malaria cases were identified, Miller said.

Mosquitoes were trapped at the patient’s house and at other nearby locations.

Investigators wanted to determine whether the specific type of mosquito that’s capable of spreading malaria – the Anopheles mosquito – was present in the area. Some Anopheles mosquitoes were captured, but testing showed none of these individual mosquitoes was infected with the malaria parasite, Miller said.

The local health investigators went back and reviewed the cases of other people in the county who had been diagnosed recently with travel-related malaria infections, just to see if there was anything that was overlooked in those earlier investigations, Miller said.

They also went back to the Pierce County woman’s family and took a closer look at their travel and illness histories, in case one of them had been an initial malaria case.

But neither of these efforts produced additional clues, Miller said.

In labs at the CDC, scientists did molecular testing on samples of the malaria parasites that infected the Pierce County woman, then compared the findings with the genetic makeup of the parasites involved in the county’s other recent travel-related malaria cases.

These lab results indicated parasites in the county’s recent malaria cases weren’t similar enough to suggest any connection, Miller said.

“So where that leaves us is that in the absence of any other explanation, we think the most likely scenario is that this person did acquire a mosquito bite either here in Pierce County or potentially in a neighboring county,” Miller said.

The investigation’s findings suggest that this Pierce County woman is the state’s first known locally acquired malaria infection.

But there is no way to know exactly how her infection occurred.

One possibility, Miller said, is that a mosquito with malaria could have somehow been brought into the United States, perhaps on a plane.

The CDC’s testing of the malaria parasites that infected the woman indicate that they are most likely from sub-Saharan Africa, Miller said.

Another possibility, he said, is that there may have been a person in the area who had malaria, but their infection didn’t receive medical attention, and therefore wasn’t reported to public health officials. Miller noted that people who have lived in areas where malaria infections are common can have some level of immunity and may have a less severe case of the disease.

“And then a mosquito would have had to bite that person and then bite the person with locally acquired malaria,” Miller said.

But there is no way to know for sure. “We don’t have any confirmation or ability to say for sure about any of those scenarios,” he said.

Miller said the rapid investigation of this malaria case highlights the way the nation’s public health system should work, with local, state and federal agencies, sharing resources and expertise.

“In this situation, fortunately, the patient recovered. We didn’t identify any other cases. But of course, you don’t know that at the beginning of an investigation,” Miller said. “So it’s important to have a public health system that’s ready to ramp up quickly and to work together effectively to do an investigation.”

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 Khartoum to Clarkston: How a Sudanese nurse is filling a gap in health care

2025-10-22T20:25:02+00:00

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Maha Mousnad doesn’t let much keep her down. Not a long journey to the United States or the arduous process of becoming a registered nurse here. Not the fact that her family is living in the midst of a civil war in Sudan, nor the start of a global pandemic a month after she landed on U.S. soil.

Rather, Mousnad’s sunny disposition and faith in a better future have driven her from the streets of Khartoum to Clarkston, Georgia. And it’s been a banner year for the 38-year-old. In 2025, she managed to become a U.S. citizen and pass a licensing exam so she can practice as a registered nurse at her beloved Mosaic Health Center.

Mousnad had a successful career back in Khartoum, even teaching nursing. Married with three children, she lived near her parents and brothers. But she wanted something more.

“For me and the people I know, America is one of the big dreams,” Mousnad said. “When we come in USA, we’re looking for home.”

Last year, nearly 60,000 foreign-trained nurses took the National Council Licensure Examination to qualify as registered nurses in the United States. There’s a shortage of RNs across the country, with Georgia needing to train 772 more RNs annually to keep up with projected demand, according to the Georgia Center for Nursing Excellence. Mousnad’s journey from Khartoum to Clarkston shows how foreign-trained nurses can help plug that gap.

Her infectious smiles, can-do attitude, and personal experiences navigating the path to the “American dream” have sparked a loyal following among patients at Mosaic, where she speaks to Arab immigrants in their native language, breaks down scary medical information into simple terms, and provides those most essential elements of good medical care: time and understanding.

Praying for a visa, then knocking on doors

Back in Khartoum, her daily 4 p.m. bus ride was her time to pray: “Yah Allah lottery” – let her family land a visa to the United States. The diversity immigrant visa program awards about 50,000 visas each year to randomly selected applicants from countries with low rates of immigration to the United States. Mousnad was so committed that even her friends were praying for her, she said.

Finally, her family won a visa through the lottery. Soon after they arrived in eastern Maryland in 2020, the country shut down for the Covid pandemic.

Maha Mousnad works as a registered nurse at the Mosaic Clinic in Clarkston, Georgia.

That didn’t stop Mousnad: She knocked on the door of a local hospital, where only a window opened due to the pandemic. Mousnad said she’d been a nurse in Sudan and was offered a new job as a medical assistant. She devoted herself to learning English and soon became a certified nursing assistant.

While working in the hospital, other international nurses told her there were steps she could take to become an RN in the United States. Many elements of her degree transferred, but she needed to take the NCLEX to get her license.

In the meantime, her husband got a job in Atlanta, where Mousnad visited the public library in Clarkston daily, looking for jobs. An internet search revealed that Mosaic Health Clinic – then called the Clarkston Clinic – was just two minutes away.

Again, Mousnad knocked on a door. Shortly thereafter, she was hired at Mosaic.

“You have to move, find the way, and if this door [does] not open for you, of course, the other door can open for you,” Mousnad said.

Mousnad’s relationship with the clinic grew strong. She tried to pass the NCLEX once but failed, like more than half of this year’s first-time test takers who were educated abroad. So Mosaic’s executive director Jeremy Cole lined up nursing professors to help her prepare to take the exam again. It was a no-brainer, he said, because Mousnad and other team members embody “what is best about our nation in all of its diversity.”

Beth Ann Swan, a professor at Emory University School of Nursing, stepped in. She wanted to help Mousnad for professional and personal reasons. The Mosaic Clinic has a close relationship with Emory, and Mousnad helps guide Emory students as they learn to be nurses.

Personally, Swan had been mentored by two foreign-born nurses early in her career (Mrs. Cho and Mrs. Cherian), so when asked to help Mousnad, “the only response was yes, absolutely!” With the help of Swan and another instructor, Sharon Mingo, Mousnad passed the NCLEX in April, three months after she became a U.S. citizen.

Mousnad, in turn, has found many ways to pay it forward. She founded three What’s App groups – along with fellow nurses – to help foreign nurses who face the same challenges she did. One sends practice questions out to help Arabic speakers prepare. Others help demystify the process of becoming a nurse and finding a job.

Mousnad bridges a gap for Arabic-speaking patients

Meanwhile, at the Mosaic Health Center, which provides health care to uninsured people in Clarkston, one of the most diverse neighborhoods in the United States, Mousnad has built a following among her patients, whom she calls “my people.”

The clinic is on track to provide 500 to 600 more visits this year than last, Cole said. Mousnad said many Sudanese people have started coming, learning about it through word of mouth, and she has many Arabic-speaking patients from Syria and Iraq as well.

Mousnad helps them bridge cultural differences in health care. She said many patients lack information, especially about chronic conditions like hypertension, heart disease, and diabetes. That and a desire to turn to traditional remedies is a commonalty between her patients at Mosaic and her patients back in Sudan, she said.

When Mousnad encounters patients at Mosaic who are skeptical of allopathic medicine, she spends a lot of time counseling them in simple language. She said it’s important that she can speak to them in Arabic.

“When you see someone like you, it’s really more comfort for them,” Mousnad said. “They believe on me.” Patients come and ask for her by name. “‘Where is Maha?’” one asked, she said, insisting only Mousnad would do: “‘I will wait.’”

Mosaic’s staff members often make follow-up calls to patients to check on them and ensure they are taking their medications, Mousnad said, reflecting what Cole said is a belief at Mosaic that health care is “transformational not transactional.”

Mousnad said what many of her patients need right now is mental health support because they are facing anxieties over their immigration status, as well as economic strains.

“Our patients now, they need more psychological support and anxiety, stress relief and depression, because normally per day, we have one or two patients, they stay here four or five hours just for crying,” Mousnad said.

As an immigrant herself, she understands just how much stock many have put in the American dream.

“They live in the country a long time, they come here with big dreams,” Mousnad said. “It’s really hard and painful for them” to fear losing that, whether for reasons related to immigration status or job loss.

Cole agreed, saying “there is a significant amount of fear and uncertainty in this community.”

Mousnad said in that context, Mosaic’s commitment to caring for its patients as whole people is what keeps them coming back.

“We are not like any other facility. We give the patient time,” Mousnad said. “They want someone [to] listen to them, hear them, advise them, love them like we are.”

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

Calling NYC’s community health voices: Share your ‘Aha’ moments

2025-10-21T16:47:58+00:00

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

Hello, New York.

As Healthbeat moves into its second year, we want to shine a light on the people who carry the quiet weight of protecting our communities – those working on public health issues on the ground.

This November, we’re inviting New York’s public health community to step into the light and share the stories that reveal why this work matters, in their own words. Because behind every data point, every policy, every initiative, there are human moments — moments of clarity, heartbreak, hope, and resolve.

We want to hear your “Aha” moments. That instant when you understood your work’s true impact. The day you saw how a small act of care could ripple through a community. The conversation that changed your perspective. The breakthrough that illuminated a path forward.

If you work in community health — whether as an epidemiologist, nurse, researcher, social worker, volunteer, or myriad other related profession, here or abroad — we invite you to share a true story from your own experience. Set the scene. Let us feel what you felt. Tell us what you learned, and why it matters. Humor is also welcome!

Send your story (500-800 words) to community@healthbeat.org by Nov. 3.

We’ll publish the most powerful stories on Healthbeat and invite a select few of the authors to join us for a live evening of storytelling at 7 p.m. Nov. 18 at the Powerhouse Arena bookstore in Dumbo, Brooklyn. (Admission is free, but space is limited — reserve your ticket now.)

Storytellers chosen for the stage will receive coaching beforehand, so your voice and message shine.

This is more than an event — it’s a chance to help the community see the dedication behind public health, and to connect with neighbors who are working tirelessly for the greater good.

We can’t wait to hear your story.

If you’d like to get involved as a partner or sponsor, reach out to community@healthbeat.org. (We’re doing this in Atlanta, too. Learn more about that event here.)

Charlene Pacenti

Editor in Chief

This story was updated to extend the deadline for story submissions to Nov. 3. Keep them coming!

CDC reversal restores funding for Atlanta-based HIV home testing program

2025-10-10T15:17:02+00:00

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

Funding for an Atlanta-based program that has provided nearly 1 million free HIV home testing kits nationwide has been restored, allowing it to continue for another year.

Together Take Me Home, based at Emory University, delivers the tests through an easy-to-use website and integration with dating apps. The program is funded by the Centers for Disease Control and Prevention and earlier this year received notice that its funding would not be renewed amid cuts to the CDC.

That decision has been reversed, said Dr. Travis Sanchez, the project’s executive director and a professor at Emory University’s Rollins School of Public Health. The project will get $10 million for its fourth year, which runs through October 2026 – $2 million more than the prior year. The grant was for around $55 million over five years, starting in 2022.

Together Take Me Home is funded through Ending the HIV Epidemic, an initiative launched by President Donald Trump during his first term, with a goal of cutting new infections 90% by 2030. The initiative has steered resources to the areas with the highest rates of HIV, including DeKalb, Cobb, Gwinnett, and Fulton counties in Georgia, which has the highest rate of new cases among states.

Nationwide, there has been a 12% reduction in new infections from 2018 to 2022, according to the CDC, and the number of new diagnoses each year has also decreased in Georgia, from 2,491 in 2018 to 2,350 in 2023.

Deal to lower price for new HIV prevention shot is ‘huge moment of hope’ in global health

The April letter canceling the funding for the home testing program said the CDC would no longer have the staff to oversee it. About 150 staffers who work on HIV prevention were laid off that month as the Trump administration moved to restructure the nation’s federal health agencies.

Since then, many have been recalled to work.

Together Take Me Home is the biggest self-testing program ever, Sanchez said, resulting in about 7,000 people learning that they have HIV. He estimates the tests have saved about $200 million in health care costs by connecting people to care early and preventing additional infections.

The kits use a simple online interface (offered in English and Spanish) and can also be ordered directly from apps like Grindr. Oral swabs provide results within 20 minutes and provide guidance about next steps if the result is positive.

The free, discreetly packaged tests help surmount financial and transportation barriers, as well as stigma. Similar home test kits cost about $40 or more at commercial pharmacies.

The program has been effective in rural areas, and more than half of those who have ordered the tests are under age 35, Sanchez said.

Home testing “is more confidential than walking into a local health department or even a local organization where you may be stigmatized,” said Daniel Driffin, a project manager at the HIV Vaccine Trials Network.

That many of the people who used the home service were first-time testers “creates a new opportunity to start testing habits that one can maintain over longer periods,” he said.

The CDC recommends that all Americans be tested for HIV at least once in their lifetime, but only about 40% of adults have been tested, according to 2024 data from KFF, a nonprofit health policy organization.

Each Together Take Me Home kit comes with two tests, so people can test themselves more than once or share.

Other participating partners in the project include the National Alliance of State and Territorial AIDS Directors and Building Healthy Online Communities, which helped build relationships with dating apps.

Sanchez said the project’s leaders thought it would end this fall, when funding was due to run out. But renewal came in the nick of time, and services were never disrupted. He wasn’t sure why it was restored.

The program is tied to a pre-existing campaign from the CDC called “Let’s Stop HIV Together” – hence the Together Take Me Home moniker.

Sanchez said he’s glad the program’s funding has been restored, but he’s still worried about support beyond the next year, as well as funding for HIV prevention in general. President Donald Trump’s proposed budget includes deep cuts to the CDC and a plan to move HIV prevention work to a new agency, the Administration for a Healthy America.

“We’re paying very close attention to that,” Sanchez said.

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

California’s nursing shortage is getting worse. Front-line workers blame management.

2025-10-08T13:15:23+00:00

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

TURLOCK, Calif. — California, like much of the nation, is not producing enough nurses working at bedsides to meet the needs of an aging and diverse population, fueling a workforce crunch that risks endangering quality patient care. Nearly 60% of California counties, stretching between the borders with Mexico and Oregon, face a nursing shortage, according to state data.

Democratic Gov. Gavin Newsom and state lawmakers have tried to bolster the state’s health care workforce, in part by implementing recommendations from the California Future Health Workforce Commission, a 24-member panel of state, labor, academic, and industry representatives. The state in recent years has expanded the scope of practice for nurse practitioners, allowing them to practice medicine — ordering tests and prescribing medication, for instance — without traditional doctor supervision, and has worked to expand academic nursing slots and training programs.

Still, California’s shortage of registered nurses is expected to grow from 3.7% in 2024 to 16.7% by 2033, or more than 61,000 nurses, due to inadequate recruitment, training, and retention, according to Kathryn Phillips, associate director of the Improving Access team at the California Health Care Foundation, a nonprofit philanthropic organization specializing in health care research and education.

Regional shortages, particularly in the Central Valley and rural North, are expected to swell. “There are major deficits and those could get even worse,” Phillips said.

Researchers say the gap between nursing supply and demand is exacerbated by inadequate career pathways and high turnover in a labor-intensive industry, but nurses and their unions argue the problem is driven primarily by a management-induced staffing crisis and poor working conditions. Nurses say nursing remains a noble calling, but many report feeling pressured to turn over beds and take on more patients, stress that can dissuade young people from entering the field and drive experienced nurses to leave or retire early.

A $51 million investment in New York’s nursing workforce aims to bolster staff well-being, patient care

Industry representatives cast those concerns as union talking points to drive up labor costs, but nurses say they are losing benefits while being overworked, hobbling morale and hampering their ability to provide even basic health care in hospitals, clinics, and nursing homes around the state.

Lorena Burkett, a registered nurse at Emanuel Medical Center in Turlock, an agricultural city in the heart of the Central Valley, recounted being so overloaded last year that she didn’t promptly log a medical chart after administering a psychiatric patient’s medication, a critical step for ensuring proper drug doses.

“I was being told get him out, and I forgot to scan his opioid medication; I missed it,” said Burkett, a 12-year veteran, who later updated the patient’s record. “After that I said no more. We have to prioritize patient care, but we are under a lot of pressure to get patients out and turn profits.”

Tenet Healthcare, the Dallas-based for-profit hospital system that owns Emanuel, declined to respond to Burkett’s claim, as well as questions about staffing levels. In a statement, Tenet spokesperson Rob Dyer said that the hospital provides “quality and compassionate care” and broadly disputed nurses’ concerns.

“We are currently in contract negotiations with the union which represents our nurses,” he said, “and suspect that this is what is behind these false claims.”

Lawmakers try to improve conditions for nurses

Two years ago, state lawmakers approved $300 million to help financially struggling hospitals maintain operations, which can include retaining nurses. Lawmakers are also trying to improve nurses’ work conditions in hospitals and to protect patient care by strengthening minimum nurse staffing at health care facilities. Some also call for investing in a more robust nursing workforce.

“Nurses are working in hospitals and other places that are severely understaffed,” said Michelle Mahon, director of nursing practice for National Nurses United, a union that represents 225,000 nurses.

Phillips said the reasons vary. In the San Francisco Bay Area, nurses must contend with a high cost of living, a lack of affordable housing, and expensive child care. In the Central Valley, there’s insufficient education, training, and mentoring. And the rural North has a hard time attracting enough nurses to replace those who are retiring and to meet the needs of an aging population.

University of California-San Francisco researchers who have studied the nursing workforce say although people are still seeking jobs in nursing, student enrollments and graduations have declined.

The California Board of Registered Nursing shows nearly 552,000 active licensed registered nurses in California as of Oct. 1. Yet the California Nurses Association says significantly fewer were practicing, pointing to 2024 data indicating only 350,850 were working in the field. The same problem persists nationally, according to National Nurses United, which reported that, as of May 2024, more than 1.1 million licensed nurses were not working in the field.

California Hospital Association spokesperson Jan Emerson-Shea said hospitals around the state are facing “skyrocketing costs” for labor, pharmaceuticals, medical equipment, and compliance with government mandates. Patient care costs have soared 30% in the past five years and continue to rise, she said. Meanwhile, 53% of hospitals in the state “lose money every day caring for patients,” she said.

Nursing aides plagued by PTSD after ‘nightmare’ Covid conditions, with little help

And it could get worse.

Under the GOP tax-and-spending bill that President Donald Trump called the “One Big Beautiful Bill,” the state estimates roughly 3.4 million Californians could lose health coverage due in part to major Medicaid cuts and new rules like work requirements that narrow eligibility for low-income and disabled residents. California is at risk of losing $30 billion in annual funding, and hospitals will be hit particularly hard because they rely on federal reimbursements and need enough insured patients to remain solvent.

Emerson-Shea said California hospitals stand to lose up to $128 billion over 10 years due to the law.

“This projection does not include the likely increases in uncompensated care due to Medicaid work requirements, coverage losses due to the elimination of the Affordable Care Act subsidies, more frequent Medi-Cal redeterminations, and coverage losses for those with unsatisfactory immigration status,” Emerson-Shea said.

While some California hospitals lose money on patient care, financial data show the industry is making money, earning about $11.5 billion in net income, or profit, in 2024, said Kristof Stremikis, director of Market Analysis and Insight at the California Health Care Foundation, pointing to preliminary state data comparing 365 hospitals. “The industry as a whole has returned to pre-Covid profitability levels,” Stremikis said.

He acknowledged, though, that Medicaid cuts will reduce revenue for all facilities.

Hospitals will be burdened as uninsured patients, who often arrive with prolonged illness or injuries that can make treatment more expensive, increase in number. That will exacerbate health care challenges in high-poverty communities with large Medi-Cal populations, since the safety net program generally pays hospitals and providers less than private insurance or Medicare.

Already, some hospitals are closing due to financial struggles, before the impacts of the federal health care cuts are felt, and others are limiting access to care, including by shuttering maternity wards and emergency rooms. Officials at Glenn Medical Center, about 85 miles north of Sacramento, reported that it would be shutting down its ER at the end of September due to staffing shortages.

Pandemic-era burnout persists

Front-line nurses said the well-documented burnout of health workers from the Covid-19 pandemic, mixed with growing hospital demands, is still being felt today as many part ways with the industry. That is prompting some hospitals to hire more traveling nurses from out of state.

At Hazel Hawkins Memorial Hospital, a financially strained public facility in San Benito County near the Central Coast, the California Nurses Association said the hospital is employing 22 traveling nurses, although the hospital put the number at 16. Local nurses said temporary workers can ease workloads, but they worry hospitals are using traveling nurses to avoid labor contracts that require higher pay and benefits. They say hospitals should invest in well-trained, local staff familiar with the community.

ER nurse Ariahnna Sanchez said workers at Hazel Hawkins, a 25-bed critical access facility, are pressured to discharge patients quickly so more patients can be seen. As union contracts come up for renegotiation, union officials say, hospitals have slashed benefits and haven’t offered adequate raises to keep up with the cost of living. Salaries vary by region but the average annual wage for California registered nurses was $148,330 in 2024, according to the U.S. Bureau of Labor Statistics.

“The morale is so bad right now,” Sanchez said. “We’re trying to fight the good fight but we’re constantly holding people in the emergency room who should be admitted due to the hospital being at max capacity.”

State data show San Benito County has an extreme shortage of nurses and needs about 180 more to accommodate the local population. But Hazel Hawkins disputes it has a shortage. The California Nurses Association said 40 nurses have left since last year, whereas the hospital said it has replaced 15 of 21 departing nurses.

Hazel Hawkins spokesperson Marcus Young said nurses are conflating staffing levels with protocols for handling ER patients when there aren’t enough beds. “There is no material shortage of nurses, and hospital operations are not being impacted today,” Young said. “We are in full compliance with state-mandated nurse-to-patient ratios at all times.”

California law dictates staffing minimums at hospitals, ranging from one nurse for every three patients to one nurse for every five patients, depending on the level of care the patients require. Research has shown that clinical errors can increase in hospitals and other health care workplaces when nurses are stressed and overwhelmed. Studies indicate that burnout related to work overload, career satisfaction, and patient satisfaction is a major concern and can lead to mistakes.

The state has issued 32 citations to California hospitals since 2020 for violating these minimum nurse staffing levels, financial penalties totaling $840,000, according to the state Department of Public Health. Neither Hazel Hawkins nor the Turlock hospital Emanuel had any citations. Spokesperson Mark Smith said the agency could not provide information on any “potential, pending or ongoing investigations” into health care facilities alleged to be in violation of state nursing ratios.

Burkett, the nurse in Turlock, said though she can see up to five patients at a time, she exceeded her ratio twice in the past year. In its latest quarterly financial filing, Tenet reported $288 million in net income, up from $259 million over the same period last year.

“I’ve taken that assignment against my will,” Burkett said, noting that the union distributes forms protecting nurses from repercussions if mistakes happen on their watch when they take on more patients than the state allows. “It says I’m taking these patients against my better judgment, and I’m protected because I am not agreeing to this, but the hospital is making me do it,” she added. “It’s tough. I mean, you just have to juggle and do what you can and hope you’re not going to miss something important. It’s not safe.”

State Sen. Caroline Menjivar, a Democrat representing part of the Los Angeles region, has legislation on Newsom’s desk to strengthen the state’s nurse-to-patient ratio law by requiring hospitals to work harder to identify available nurses to meet staffing mandates.

“Hospitals for years have been getting a pass on minimum nurse staffing,” said Menjivar, a former emergency medical technician. “If we do not provide more support to our nurses, then we do not get the quality care that is needed.”

Menjivar’s niece Megan Noguera-DeLeon is excited about becoming a nurse, despite workplace challenges. A nursing student who expects to graduate next year from West Coast University in Southern California, she said relatives who work as nurses have warned her how tough the job can be. She’s worried about burning out but remains committed to the mission.

“I think taking care of people is a beautiful thing,” Noguera-DeLeon said. “I know this job can be really hard, and a lot of nurses are experiencing burnout, but honestly I’ve seen firsthand how much nurses can help people even on the darkest of days, and I want to help people.”

This article was produced by Healthbeat’s national reporting partner KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Stories worth sharing: Public health workers, scientists, tell us your ‘Aha’ moments

2025-09-24T15:10:03+00:00

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

Hello, Atlanta.

As Healthbeat moves into its second year, we want to shine a light on the people who carry the quiet weight of protecting our communities – those working on public health issues on the ground.

This November, we’re inviting Atlanta’s public health community to step into the light and share the stories that reveal why this work matters, in their own words. Because behind every data point, every policy, every initiative, there are human moments — moments of clarity, heartbreak, hope, and resolve.

If you work in community health — whether as an epidemiologist, nurse, researcher, social worker, volunteer, or myriad other related profession at home or overseas — we invite you to share a true story from your own experience. Set the scene. Let us feel what you felt. Tell us what you learned, and why it matters. Humor is also welcome!

Send your story (500-800 words) to community@healthbeat.org by Oct. 15.

We’ll publish the most powerful stories on Healthbeat and invite a select few of the authors to join us for a live evening of storytelling at 7 p.m. Nov. 3 at Manuel’s Tavern. (Admission is free, but space is limited — reserve your ticket now.)

Storytellers chosen for the stage will receive coaching beforehand, so your voice and message shine.

This is more than an event — it’s a chance to help the community see the dedication behind public health, and to connect with neighbors who are working tirelessly for the greater good.

We can’t wait to hear your story.

Thank you to the Georgia Health Initiative for its sponsorship of the event. There is still room for more partners and sponsors. Email us at community@healthbeat.org if you want to get involved.

Charlene Pacenti

Editor in Chief

Fired CDC chief says RFK Jr. demanded she roll back vaccine policies without evidence

2025-09-18T13:43:02+00:00

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

Susan Monarez, the former director of the Centers for Disease Control and Prevention, testified before the Senate Health, Education, Labor and Pensions Committee on Wednesday in her first public remarks since she was fired. Some Republicans on the committee accused her of lying and said she hadn’t been on board with the administration’s agenda.

As in earlier hearings concerning Robert F. Kennedy’s performance as secretary of the Department of Health and Human Services, the focus was on Sen. Bill Cassidy, the Louisiana Republican who cast the deciding vote as HELP Committee chair to confirm Kennedy early this year. Since that vote, Cassidy has repeatedly expressed skepticism about Kennedy’s leadership.

Cassidy noted that when Kennedy swore in Monarez on July 31, he extolled her “unimpeachable scientific credentials.” Less than a month later, she was fired. “What happened?” Cassidy said. “Turmoil at the top of the nation’s top public health agency is not good for the health of the American people.”

Access to Covid shot and 2 childhood vaccines may change this week. Here’s what to know.

Monarez said she came into the job aligned with Kennedy’s goals of improving America’s health and was open to changing the policies and structures at the CDC. She wasn’t ready to compromise her scientific judgment, however.

“I could have kept the office, the title, but I would have lost the one thing that cannot be replaced: my integrity,” she said.

Monarez said that at an Aug. 25 meeting, Kennedy demanded she fire senior scientists and agree to approve all changes in vaccine policy put forward by the new members of the Advisory Committee on Immunization Practices. In June, Kennedy fired its members and replaced them with a smaller group that includes leading opponents of the U.S. vaccination program.

When Monarez refused both requests, she said, Kennedy told her to resign. She refused, and the White House fired her, she said.

Kennedy, in testimony this month, denied he’d made the ultimatums and said Monarez had lied. Republican senators repeated that claim at Wednesday’s hearing. Markwayne Mullin of Oklahoma said a recording of the Aug. 25 meeting contradicted Monarez’s account. But later in the hearing, Cassidy said that Mullin had retracted his statement, saying there was no such recording.

The hearing appeared to confirm reports that Kennedy intends to change the childhood vaccine schedule, moving initially against recommending a hepatitis B vaccination shortly after birth, a practice the CDC has supported for more than three decades.

The CDC recommends that children be vaccinated against 16 pathogens with about 25 shots, sprays, or oral vaccinations in their first two years of life. The vaccines protect kids against such diseases as influenza, measles, whooping cough, meningitis, diarrhea, chickenpox, cancer, and pneumonia. It’s up to states to decide which vaccinations are required for schoolchildren.

RFK Jr.’s vaccine panel expected to recommend delaying hepatitis B shot for children

Sen. Lisa Blunt Rochester, a Delaware Democrat, noted that for decades universal vaccination of newborns for hepatitis B has reduced case rates of the disease among young people by 99%, as reported by KFF Health News. Sens. Ashley Moody, a Florida Republican, Ed Markey, a Massachusetts Democrat, and Cassidy asked about plans, first reported by KFF Health News, for ACIP to vote to recommend pushing the first dose of the hepatitis B vaccine from the hours after birth to age 4.

Cassidy, in closing the hearing, spoke gravely of the dangers of ending the hepatitis B dose for newborns. He noted that before 1991 as many as 20,000 babies would become infected with hepatitis B, often leading to liver disease and sometimes death. Today, fewer than 20 babies a year contract the virus from their mothers, he said.

“That is an accomplishment to make America healthy again, and we should stand up and salute the people that made that decision,” he said.

Asked by reporters after the hearing whether the American public should have confidence in the advisory committee if it votes to delay the hepatitis B dose for newborns, he replied, “No.”

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

Federal public health is changing. Local leaders can’t wait to act.

2025-09-17T13:52:47+00:00

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

Health organizations across the country face shrinking budgets. Federal agencies responsible for emergency preparedness are being restructured and consolidated. It’s hard enough just to keep track of the fusillade of changes, let alone respond to them. But paralysis is not an option for local leaders; the health of millions of Americans depends on how cities and counties prepare for and respond to the next health crisis.

The challenge is steep. Between 2017 and 2021, nearly half of all employees in local and state health departments left their positions. This workforce crisis predates the recent political turbulence — and leaves communities more vulnerable at a time when robust health infrastructure is needed most.

Yet within this challenge is an opportunity to plant a new vision — one that embraces an “always on” approach to emergency preparedness, by making readiness part of our everyday work. This vision rests on three essential pillars: hyperlocal community engagement; partnerships as an antidote to scarcity; and actionable data to drive strategy.

It’s about trust: Why hyperlocal approaches work

At its best, public health pairs breakthroughs with follow-through. The world eradicated smallpox not when the first immunization emerged in the 1790s, but two centuries later when it finally paired vaccines with highly coordinated monitoring and containment strategies. The Covid-19 pandemic reinforced that the most effective health interventions happen at the community level, delivered by trusted voices who understand local context and needs.

“Hyperlocal” approaches, going neighborhood by neighborhood, are effective because they recognize the heart of our struggle with communication: The real battle is not over facts, but over trust. Behind a nugget of information that takes hold is a web of individuals connected by mutual trust — and sometimes the promise of an alternative to the institutions or experts that have lost their confidence.

Community health workers increased Covid-19 vaccination in NYC, a new study finds. Here’s why their efforts worked.

Community Health Workers, who come from the neighborhoods they serve, embody this idea. They are trusted not because of a title, not even just because they know a community — but because they are known to it. And they help deliver results. Last year, for example, Chicago rapidly contained a measles outbreak, administering 30,000 vaccinations in less than 3 months, by incorporating CHWs and partnering with local doctors.

In North Carolina, Operation Gateway mobilized CHWs after Hurricane Helene, providing immediate relief that complemented federal responses but did not await their starting whistle. And in Louisiana, community-based organizations opened church-based cooling centers and conducted neighborhood needs assessments during extreme heat events, demonstrating how community leaders provide essential infrastructure for emergency response.

Hyperlocal approaches are effective because they empower people with trusted relationships — but they face funding constraints and limits in addressing health challenges at scale. That’s where broader partnerships are needed.

Partnerships can help counter scarcity

We are already seeing diminished public budgets for health. As Your Local Epidemiologist uncovered, these cuts have human consequences, borne particularly tragically by low-income Americans, and erode preparedness for the next public health crisis.

Yet even as resources may become scarce, partnerships can help counter a scarcity mindset.

Partnerships add value because health threats don’t respect county lines or sectoral silos. Hospitals, health departments, clinicians, insurers, nonprofits, and community groups each hold a piece of the solution. And the more these pieces come together in quieter times, the less we have to scramble to assemble them when a crisis strikes.

For example, in Washington state, the Northwest Healthcare Response Network coordinates diverse players in emergency preparedness and response, ensuring hospital capacity is seen as a resource across jurisdictional lines. In Ohio, The Health Collaborative showed the benefit of regional, cross-sector partnership during the 2024 IV solution shortage. By pooling resources and coordinating distribution across multiple health systems, they prevented what could have become a crisis from compromising patient care.

New York City aims to increase life expectancy by targeting chronic diseases

Cross-sectoral coalitions unlock opportunities to address social factors like housing, food access, and social connection. New York City’s recent chronic disease plan provides a roadmap for engaging government agencies, health care systems, and nonprofits across a range of sectors — health, social services, and businesses — to tackle upstream drivers of chronic diseases. And the plan expands the city’s CHW footprint, known as the Public Health Corps, recognizing that the real work still happens block by block, neighbor to neighbor.

When resources are the barrier to forming partnerships, philanthropists can step up to fill specific funding gaps, and cities and counties should try innovative financing strategies, like public health bonds, to partially offset federal shortfalls. Funders will find that there are opportunities for dramatic return on investment when partnerships enable pooled resources, or open doors to interventions that address root causes rather than merely scratch the surface.

Of course, not every shortfall will be covered by philanthropy, and innovative financing won’t reach all communities. But where these tools are implemented, they can make the difference between fragile response and more durable readiness.

New models for sharing data can help find gaps early

Local leaders should assess what data streams they already have and establish agreements to share and analyze them now, before an emergency reveals the gaps. Many surveillance systems for detecting everything from novel pathogens to climate threats are now understaffed or offline due to budget cuts, leaving dangerous blind spots.

However, new models for data sharing are emerging. The Yale School of Public Health recently launched the popHIVE platform that integrates data from a wide range of sources, from national surveillance systems to clinical platforms like Epic Cosmos to Google Trends. Health leaders across the country can now access deeper insights from better-linked, near real-time data and maps. For example, popHIVE helps clinical leaders visualize how surges in RSV-related emergency room visits vary by age, helping optimize staffing and resource decisions.

In Minnesota, the Electronic Health Record Consortium shows how data sharing across the health system can create comprehensive pictures of community health. This type of integrated data sharing enables more targeted interventions, for instance to address an increase in opioid-related hospital visits in certain subpopulations.

An “always on” approach must strengthen both systems and relationships. That means conducting regular preparedness exercises, maintaining open communication channels, and establishing formal agreements well before they’re needed. These practices help with “turnover proofing” — systematizing ways of working that endure even when staff change roles.

Local health leaders can’t ‘wait on Washington’ to act

In every city and county across the nation, the health of Americans depends on how we navigate the uncertainty before us. During my time as New York City’s health commissioner, “we have to wait on Washington” was not an acceptable response to New Yorkers’ urgent needs; nor is it an acceptable answer to the patients in my exam room today.

Innovative partnership models can do more than bridge the gaps in federal leadership, they can help fix the fractures that have long been present and growing over time. The Japanese art of kintsugi can offer a valuable perspective. Practitioners of kintsugi don’t shy away from highlighting imperfections; they shine a light on the cracks and mend broken pottery with gold, making it even stronger than it was before. The bright spot in this moment of uncertainty is that we have an opportunity to strengthen systems that have shown their cracks.

Pioneering local leaders are already starting to set the fractures. Their work is both blueprint and warning: Without sustained support, even the best leaders will falter. With it, we have a chance to build systems that are responsive to local needs, always in ready posture, held together by partnership, and reinforced by trust.

Dr. Dave A. Chokshi is a physician at Bellevue Hospital, professor at the City College of New York, and chair of the Common Health Coalition. Previously, he served as health commissioner of New York City.

CDC decapitated: What comes next for public health in the United States?

2025-09-03T11:00:00+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.

The resignations and public statements of multiple senior leaders from the Centers for Disease Control and Prevention last week signaled what I feared was inevitable under the new presidential administration: The nation’s premier public health agency is now guided by ideology, rather than science.

The recently confirmed director and three top officials are leaving, saying the Trump administration directed them to approve vaccine policy changes that defy scientific evidence and threaten the health of all Americans. Forced to choose between professional integrity and political obedience, they walked away.

These dramatic events raise two questions: Why do we need a CDC? What happens if we do not have one we can trust?

Why national public health agencies matter

Since the 1950s, governments around the world have learned that strong national (and multi-national) public health agencies are critical to population health. They serve five roles that no local system can perform on its own:

Monitor health conditions and potential threats to health that involve more than one state.
Provide a repository of expertise about these conditions, including highly specialized reference laboratory services.
Synthesize the best available evidence about these conditions and threats, then translate them into norms and standards for improving the health of communities.
Coordinate responses to all hazards, both acute and chronic, providing staff, supplies, and funding from the federal government to promote health and prevent disease.
Train the next generation of public health professionals, including epidemiologists, microbiologists, disease intervention specialists, and informaticians.

Over the past several decades, governments and multi-national organizations around the world have looked to the CDC as the premier model of a public health agency, choosing to create agencies that mirror the CDC for their populations. I had the privilege of helping in these efforts in Asia and Africa.

‘I hope this is a tipping point’: 3 CDC leaders walk out over RFK Jr. policies

Amid the 2002-03 SARS epidemic, the Chinese government identified critical weaknesses in its ability to detect and respond to outbreaks. In response, it combined formerly disparate programs into a new public health agency called “China CDC,” named its subsidiary units after the U.S. CDC’s, and asked the U.S. CDC to help strengthen its programs. In 2008, I was invited to help China CDC improve detection and response to emerging infectious diseases. The Chinese government wanted to establish disease surveillance, laboratory systems, and applied epidemiology training programs similar to the United States. One of the programs I helped them build — surveillance for “severe acute respiratory infections” — led to the detection of Covid in late 2019.

I had a similar experience in Africa. The West Africa Ebola epidemic from 2014 to 2016 revealed that no single country in Africa could respond effectively to cross-border threats. In the midst of that outbreak, U.S. President Barack Obama negotiated an agreement with the African Union, the inter-governmental organization that oversees the 55 countries on the African continent, to establish a continent-wide public health agency.

As part of that agreement, I was seconded from the CDC to the African Union to help establish the Africa CDC. Africa CDC’s mission was to “safeguard Africa’s health” by providing technical expertise, cross-jurisdictional coordination, and human resources training. Soon after its establishment, Africa CDC built systems that detected and stopped outbreaks in fragile states, such as Ebola in the Democratic Republic of Congo. During Covid, Africa CDC developed a continent-wide response plan that was endorsed by 55 member states Feb. 22, 2020 – before the United States declared a national emergency on March 13. (The United States had declared a “public health emergency” on Jan. 31, 2020.)

My experiences working in Africa and Asia taught me how important these centralized public health agencies are. Without them, local and state health officials are often left to improvise, resulting in policies that conflict and substantial gaps in data, expertise, and resources.

How the U.S. CDC became compromised

According to public statements of departing officials, the crisis at CDC today arises from a deliberate campaign to subvert these functions. The agency is being directed to endorse policies that have already been decided for political reasons. It is expected to find data that support fringe beliefs, reject input from established professional societies and experts, and enlist advisers who have financial conflicts and limited expertise. Its leaders are constrained in what they can say publicly and what actions they can endorse.

The new acting director for CDC has no training in science, medicine, or public health. He is an expert in politics, and, instead of relying on CDC experts to develop guidance based on scientific consensus, he’s being appointed with a clear directive to implement policies based on ideology. The disclosures by the departing CDC director suggest the CDC is now expected to create policy-based evidence, rather than evidence-based policy.

Run. Hide. Fight. What the CDC shooting means for public health

For much of my career, I have focused on detecting and responding to new external threats, such as pathogens arising from nature, laboratory accidents, or deliberate release. The assumption was that institutions like the CDC would always retain the capacity to respond, even under strain. That assumption no longer holds. The greater danger now is vulnerability created by weakened institutions. Instead of stopping the bullets that are flying through the air, we’re now taking off our bulletproof vests.

Can public health survive without a strong CDC?

If the U.S. CDC is compromised, can public health improve without a national public health agency? I do not know of any models in which an economically advanced country with a well-established public health system suddenly dismantled it. The nearest example might be the newly independent states after the collapse of the U.S.S.R. Those states dealt with highly lethal outbreaks of infectious diseases for more than a decade before they were able to rebuild their systems.

One colleague of mine put it bluntly: “No one is coming to save us.” In his view, throughout recorded history, communities have organized their own systems of care when the government could not meet their needs. The future of public health may need to look like the past with community-owned and operated systems, such as worker-run clinics, community health councils, and locally controlled infrastructure. While these systems would look modest compared to the professionalized infrastructure that we are used to, they could be more resilient. They are rooted in communities and cannot be dismantled by the results of a single election or the preferences of specialized interests.

When I was based in Thailand, I saw how programs initiated by concerned citizens and run by community leaders were uniquely effective at saving lives and reducing suffering during the 2004 tsunami. In the United States, Covid offered a glimpse of this possibility. Mutual aid networks arose across the country, delivering food, masks, and reliable information when official channels faltered.

Building the future of public health in the U.S.

While the lesson of the CDC for over 75 years is that strong central public health agencies matter profoundly, the lesson for the future may be that systems must be built and strengthened at the local level first.

In the United States, public health will succeed only if communities, professionals, and civic leaders across all 50 states organize now to preserve evidence, protect science, and create systems that endure beyond political cycles. The challenge now is whether they can be made durable, with the essential physical infrastructure, legal frameworks, and financing needed to endure.

‘I hope this is a tipping point’: 3 CDC leaders walk out over RFK Jr. policies

2025-08-28T23:45:35+00:00

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

Three senior leaders walked out of the Centers for Disease Control and Prevention on Thursday in Atlanta after resigning over their opposition to the Trump administration’s political interference in the agency’s science-backed work.

Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases; Dr. Deb Houry, chief medical officer and deputy director for program and science; and Dr. Dan Jernigan, director of the National Center for Emerging Zoonotic and Infectious Diseases, emerged from the CDC campus greeted by a crowd of supporters and employees.

“I hope this is a tipping point to where we get our public health back, that we get the trust of the nation back, we get the trust of our leaders back, and that public health does the work they’re meant to do on the ground, saving lives,” Houry said.

The three resignations – along with that of Dr. Jennifer Layden, director of the Office of Public Health Data, Surveillance and Technology — announced late Wednesday, came after news that CDC Director Susan Monarez was being ousted after only three weeks on the job.

CDC Director Susan Monarez vows to restore trust in agency after shooting, latest layoffs

A week ago, Monarez stood amid shattered glass on the floor of a CDC building where a gunman had fired into the windows and said she wanted to restore trust in the agency and support its workers, whom she called family.

This week’s developments are the latest in a series of blows to the beleaguered agency since the start of President Donald Trump’s second term and the appointment of Robert F. Kennedy Jr. as health secretary. The CDC has faced several rounds of mass layoffs, funding cuts, and the Aug. 8 shooting that resulted in the death of a police officer and the gunman.

Monarez’s attorney, Mark Zaid, said in a post on X that Monarez had “refused to rubber stamp unscientific, reckless directives and fire public health experts” and said Kennedy had weaponized “public health for political gain.” She is fighting her dismissal.

Dr. Demetre Daskalakis, who resigned as director of the National Center for Immunization and Respiratory Diseases at the CDC, speaks to supporters and media on Thursday.

In a resignation letter posted on X, Daskalakis said political interference in the Advisory Committee on Immunization Practices, a part of the CDC, drove his decision to leave.

In June, Kennedy removed all 17 members of the committee and replaced them with his own appointees. That move, as well as the new committee’s decisions about vaccine policies have drawn criticism from scientists and many professional medical organizations.

The committee is expected to rule soon on policies for the latest Covid vaccine, raising fears that many Americans would lose insurance coverage for the shots or be unable to access them altogether. Advocates also worry that the committee will change recommendations for long-established childhood vaccines.

More than 100 CDC supporters and current employees turned out in support of Daskalakis, Houry, and Jernigan. Many workers crossed the street from the agency’s headquarters near Emory, while others drove from other locations in Atlanta to show their support. Several said they and their fellow employees had taken leave so they would not get in trouble for attending the event during the workday.

With many top roles vacant, the CDC is facing a leadership vacuum. The Department of Health and Human Services did not respond to an inquiry about who is the current acting director, or who has taken over the positions of the four other leaders who resigned. The Washington Post reported late Thursday that Deputy HHS Secretary Jim O’Neill would act as interim director.

Houry, Daskalakis, and Jernigan adopted a defiant tone, vowing to fight for remaining CDC employees and scientific integrity.

“America needs to see that you are the people that protect America,” Daskalakis said. “We are going to be your loudest advocates.”

Dr. Dan Jernigan, who resigned as director of the National Center for Emerging Zoonotic and Infectious Diseases at the CDC, speaks to supporters and media on Thursday.

All three criticized political interference in science and public health.

“What makes us great at CDC is following the science, so let’s get the politics out of public health … because that’s how we get to the best decisions for public health,” Jernigan said.

Houry said the three had agreed to act in concert after “talking about it for months.”

“We need to get our people back. We’ve terminated, RIFed, valuable people. We need to support our labs. We need to get our budget for appropriate programs. We can’t lose our chronic disease center,” Houry said, referring to multiple “reductions in force” at the agency over the past few months.

The leaders said the work CDC employees do is important in protecting American health, with Daskalakis pointing to the work the agency has done to “stop Ebola at its source” and Houry pointing to this year’s measles outbreak.

“We have unvaccinated populations and a secretary that promoted vitamins over vaccines,” Houry said.

Inside a crisis at the CDC: Shooting adds to trauma as workers describe projects, careers in limbo

HHS did not immediately respond to a request for comment.

The instability has disrupted work at the agency, said Dr. Elizabeth Soda, a current CDC employee.

“RFK has created so much chaos,” she said. “I’m not sure what he expected in terms of getting work done.”

CDC retirees who worked at the agency for decades said they are concerned about the impact on Atlanta’s economy and reputation.

“This has been one of the crown jewels of Atlanta. … It’s a point of pride,” said retiree Marta Gwinn.

She doesn’t think the local job market can absorb all of the laid off workers, and Atlanta will lose brain power as professionals and students drawn to the city’s public health institutions, from the CDC to universities like Emory and Georgia State, look elsewhere.

She and fellow retirees Joanne Mei and Laura Fehrs said they also want to hear from state political leaders.

“It’s been pretty much silence, and I don’t understand that,” Mei said. “Where’s our governor who wants to attract all this new science and all these tech companies?”

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

Q&A: How a vaccine advocate turns down the temperature in discussions around hesitancy

2025-08-27T18:32:44+00:00

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

Karen Ernst is the director of Voices for Vaccines, a national organization focused on increasing vaccination rates by providing accurate information to families. The organization is part of the Task Force for Global Health in Atlanta.

Ernst, who lives in Minnesota but often travels to Atlanta, is a former English teacher who became a public health leader focused on “bringing people to this place of calm and good information, and helping to protect as many families and communities as possible.” Ernst was featured in the documentary Shot in the Arm, which aired on PBS and was executive produced by Neil deGrasse Tyson.

In Georgia, and nationally, childhood vaccination rates are decreasing, according to data recently released by the Centers for Disease Control and Prevention. Georgia has reported six measles cases in unvaccinated people this year. Some vaccine hesitancy is driven by misinformation on social media, research shows. Vaccines are safe and help save lives, scientists and doctors emphasize.

Turning down the temperature on heated conversations on vaccines is part of Ernst’s approach, and her own questions and anxieties around vaccines when she was a new parent inform her empathetic approach to those conversations.

Here are some of her thoughts about improving communication around vaccines.

How has the dialogue around vaccines changed since you started with Voices for Vaccines in 2012?

What we’re seeing right now is people really feeling less engaged in their communities in general. This is systemic beyond vaccines. I call it the age of disengagement, people really disengaged themselves from each other. They’re not as involved in their communities, they don’t know their neighbors, they don’t trust their public servants, they don’t trust scientists who seem very far away. And all of this disengagement has made it a lot more difficult to empower people with information and to get people to trust that vaccines are going to do something good for their family.

I’ve seen people cornering themselves into their own sphere and have trouble feeling trust. And trust is really engagement, that they are involved in their communities, that they’re involved with their neighbors, that they have a stake in people’s lives, that they have a stake in, and a say in, what the government is doing, and what their local public health officials are doing, and what science is happening. That’s the biggest change I’ve seen. And as I said, it makes it more difficult to engage people, even to even start those conversations. It’s gotten trickier.

What is the role of social media in the conversation around vaccines?

When I started in 2012, I was already alarmed about social media, and I used to describe those days as the wild west, because you could literally say anything on social media. There were no guardrails. We’ve taken the guardrails away again. Certainly, social media does two things: It amplifies rumors, it amplifies scary stories that are hard to verify, but it also has what I call a pufferfish effect. It makes vaccine hesitancy seem a lot more common than it is. It makes ideas about vaccines seem more prevalent than they are, because it’s easier to find someone who will think the same thing as you.

If we had some guardrails, if we had better engagement in the physical world of our communities, social media wouldn’t be as much of a factor in driving false information about vaccines.

It’s easy to blame social media, but the problem is us. We’re the problem because we’re not engaged with each other.

What are some of the top concerns people have about vaccines?

The top one is still concerns that vaccines cause autism. People hear that so much, even with the context of we’ve debunked this, they still hear it. And when they hear it, they think, if there’s smoke, maybe there’s fire here. But they don’t realize that it’s just like a smoke machine. We try to center autistic voices, but also make sure that people understand that we know a lot more about autism than we used to. We can pinpoint that autism happens before a baby is born.

Another is this idea of why do we have all of these vaccines, or how did they even make this schedule? It feels mysterious to people how the schedule is made.

It is scary to bring your baby in to get a vaccine, and they’re like, ‘Hey, look at this. We’ve got four needles. Isn’t this fun?’

I remember the first time my baby got a vaccine in 2003. I legitimately cried because I was like, this is hurting him. This is hard. It’s hard to vaccinate your baby. I don’t know what these diseases are. Why are there so many? Does my baby really need all these vaccines now? It still has not been well explained to parents. There could be a lot more education around these diseases and what exactly a vaccine does.

The last one is what’s in a vaccine? What is a vaccine made of? How do they make vaccines? It’s like hearing ingredients’ names, and they sound scary. When you hear chemical names associated with something that you’re going to be putting in your new baby, it’s very scary.

These are all answerable questions. These are all answers that we can provide parents and we should.

How can public health professionals help people understand the value of vaccines?

If you’re a person in public health, you are incredibly powerful in the community that you form around yourself. You should engage people, you should help them understand who you are, what motivates you, why this is important to the work that you’re doing, and invite them to ask questions, listen to their concerns with empathy, and trust them to understand the science if you explain it in plain English.

That might sound too simple, like, ‘Oh, you just want me to talk to people I know,’ but that’s really where we start. The other part of that is when we talk to people we know, we give them the full power of information, then they can talk to the people that they know. That’s really the best way to do it. This is where social media can be good for us.

It’s really easy not only to be judgmental, but to be really annoyed with people. Like, ‘Are you kidding? I just spent eight hours today doing this intense, incredibly difficult work. I’m trying to preserve people’s health, and you’re coming at me with this, what?’

One of the things we really need to do is take our internal temperature on it. ‘Okay, I’m annoyed right now.’ That’s okay, just put that little annoyance in your pocket, and come out with your best self. I always say turn annoyance into curiosity: ‘Hey, tell me more about what this concern is, or why you’re asking me this question? Where are you hearing this from?’ Turn it into a conversation instead of a lecture.

Is access also a challenge, in getting vaccines to people?

There are definitely access problems. I was just in Arkansas, and there are a few counties in Arkansas where the only place you can get your free Vaccines for Children vaccines is at the local health department. You can imagine being like, ‘Well, gotta take two hours out of my life to get my kid vaccinated, or I’m going to sign this form’ [for a religious exemption].

If the vaccine was just right there, you would probably just get vaccinated. Even with people who report it as vaccine hesitancy, if you talk to them a little bit, and you have the vaccine available right there, the chances that they’re going to get vaccinated are better. Sometimes it’s a timing issue, taking time off of work, not being able to take time off of work during the scheduled hours, thinking I don’t have time to have a cranky baby for a day. All of these things are part of the tapestry of it, and we always have to be concerned about access.

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

Healthbeat’s 1st year: Explaining public health in chaotic times

2025-08-26T11:00:00+00:00

Public health, explained: Sign up for Healthbeat’s newsletters here.

Happy 1st Birthday to Healthbeat!

We launched on Aug. 26, 2024, as the only newsroom committed exclusively to covering public health in America.

It was already an urgent need as Civic News Company – creator of Chalkbeat and Votebeat – laid the groundwork for this nonprofit project in the wake of the Covid-19 pandemic. Fast-forward to 2025, and the events of the past few months under the new Trump administration have only made our reporting more vital.

As health and science research is disrupted or canceled, longstanding policies on vaccines and other disease prevention are upended, global aid is cut off, and federal health funding cuts trickle down to local communities, Healthbeat is here to explain what it all means – in a nonpartisan voice, centering scientists and other experts you can trust.

Our inaugural bureaus in New York City and Atlanta have reported impactful stories that have been republished and shared locally and nationally. We’ve been privileged to meet so many people who are doing the vital work of public health – at home and abroad.

We’re working on some live events so you can meet them, too, and hear some of their stories firsthand. Stay tuned for details.

We’re expecting a momentous second year, adding new staff to meet this critical moment – and to bring Healthbeat to other cities. Should yours be one of them? Email us: expansion@civicnews.org.

In the meantime, catch up and learn from some highlights of Healthbeat’s first year of reporting. (And sign up for our newsletters so you won’t miss a thing).

Public health is local

When Rebecca Grapevine arrived at Healthbeat Atlanta, she discovered right away that the Georgia Board of Public Health had gone several months without a public meeting, even as the state was facing numerous crises: the aftermath of Hurricane Helene, a chemical fire at the BioLab chemical plant that was spewing pollution into the air, a summer Covid surge. Since our reporting on why open government is important, the board has met more regularly.

This year, we’ve been working to understand how the Trump administration’s cuts to federal health funding affect communities. New York City reporter Eliza Fawcett was among the first to detail the impact it would have there – billions of dollars in losses and disruptions to programs like Head Start.

Grapevine has exposed how HIV workers were laid off, then reinstated, in Fulton County; how Atlanta startups that depend on federal contracts are being disrupted; and layoffs at Emory University, among many other impacts.

Our rare glimpse inside the Centers for Disease Control and Prevention in Atlanta showed how scientists, researchers and other workers are coping with disruptions to important health projects, and then the aftermath of a shooting.

Public health is prevention

Our science-based guides explain how to protect against infectious diseases and environmental health threats, including:

Ticks: Tick populations are surging in the Northeast – and so are related infections.
Extreme heat: How to stay safe in scorching temperatures; and how Atlanta lacks enough weather stations to provide neighborhood data.
Tuberculosis: The world’s most deadly disease is on the rise again. Here’s what to know about it in New York City and Atlanta.
Measles: How doctors and clinics can prepare for a measles comeback decades after it was eradicated; how an Atlanta pediatrician advises parents; how Georgia officials contained an outbreak, and how to reduce your family’s risk.
Vaccines: Why immunization is important for community health, no matter where in the world you live.
HIV: Georgia tops states in new HIV cases. Here are 10 easy ways to get tested in Atlanta.

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Public health is community

Some of the best sources for what’s going on in public health are those serving the community at the ground level. We think of them as “civic catalysts” because they are the helpers connecting their neighbors with resources to stay healthy, a bridge between people and policy, getting things done. Focusing on their work helps readers learn about challenges and solutions.

Here’s a sampling of those stories:

People helping each other: ‘A place of empathy’: Queer mutual aid group helps New Yorkers with disabilities
Lifeline for older adults: How a NYC center for older adults tripled membership in a year and aims to be national model
Teen wellness: Nutrition expert vows to continue wellness club for NYC teens after USDA cut it
Health and the arts: Atlanta theater that used arts to combat vaccine misinformation loses HHS funding
Young caregivers: Metro Atlanta program looks to support high-schoolers responsible for caregiving at home
Community health workers: East Point’s ‘Miss Morehouse’ works to build trust as community health worker
Scientific research: Morehouse School of Medicine researcher aims to improve prostate cancer screening for Black men

Public health is national – and global

As epidemiologists often say, infections don’t recognize borders. In that way, and many others, local public health is tied to national and global public health. Look at how the West Texas measles outbreak spread to four other states and Mexico.

Helping other nations prevent disease keeps those infections from traveling. There are also economic and diplomatic reasons for the United States to provide global health aid, as we’ve reported, for example, on the PEPFAR program that supports AIDS relief overseas.

The Trump administration this year has gutted U.S. global health aid, dissolving the U.S. Agency for International Development. Besides endangering lives abroad, the funding cuts have resonated in places like Atlanta, which is home to nonprofits like CARE International that administer the aid, the Task Force for Global Health, and global health workers at the CDC.

Here are some other ways that global public health hits home:

TB in Georgia: ‘Global work on a local level’: DeKalb gets new tuberculosis clinic
Immigrant hunger: New York City food pantries work to give immigrants a taste of home. Trump’s aid cuts are making it harder.
Maternal health: From Kenya to New York: How a global nonprofit is addressing local maternal health needs
Foreign-trained doctors: Georgia has a doctor shortage. Barriers to training keep foreign-credentialed physicians from filling the gap.
Dengue in California: Cases prompt swift response from public health officials
Mpox: NYC Health Dept. urges mpox vaccination amid global emergency

What else should we be covering? Email us at community@healthbeat.org. And we’d be grateful for your feedback in the survey below. If you don’t see the form, head to this link to open it in a new window.

Thank you for reading.

Charlene Pacenti, Editor in Chief

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CDC Director Susan Monarez vows to restore trust in agency after shooting, latest layoffs

2025-08-21T20:11:35+00:00

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

Newly appointed director Susan Monarez voiced support for Centers for Disease Control and Prevention workers in a media event on Thursday, nearly two weeks after a shooting at the agency’s Atlanta headquarters.

Monarez said restoring Americans’ trust in the CDC and educating people about the work the scientists, researchers, and others do for public health is a top priority.

“If the American people could really understand how good and sincere and hardworking the CDC employees are, we would really be able to effectively communicate that they are trying everything every day to make the lives of American people better and stronger,” she said. “It’s the fabric and the tapestry of how we make Americans well.”

A window at the Centers for Disease Control and Prevention in Atlanta, shown Thursday, was damaged when a man fired a gun into several CDC buildings on Aug. 8.

Local reporters were invited to tour an area where windows with bullet holes had not yet been repaired and offices where glass shards remained on the floor. (Repairs to some buildings have been made).

Monarez was completing her first week as director on Aug. 8 when a gunman fired about 180 rounds into six buildings. DeKalb County Police Officer David Rose was killed responding to the scene.

Reports have suggested that the gunman, identified by authorities as Patrick Joseph White, was mentally ill and blamed the Covid vaccine for his health problems.

Elevating stories showing the value of the CDC’s work is one way to fight the misinformation that erodes trust, Monarez said.

Mona Patel, who has worked in health communications at the CDC for about 15 years, told reporters Thursday that the shooting has mobilized workers “to get our science out there, and get trust from the public.”

The shooting deepened a loss in morale and direction after months of layoffs, with some workers rehired only to face more uncertainty. The CDC will lay off more than 600 additional workers who have been on administrative leave since earlier this year, Benjamin Haynes, media relations director, confirmed Thursday.

Many CDC employees say they feel unsupported – even attacked – by the Trump administration. Monarez said the administration is supporting the agency in the shooting aftermath.

Mona Patel, a health communications specialist at the Centers for Disease Control and Prevention in Atlanta, speaks to the media on Thursday.

“We are getting all the resources that we need. We have had such a level of support from the administration. They want to make sure that not only are we getting what we need for the physical repairs, but also the emotional and mental health repairs,” she said.

About 4,000 employees have used the employee assistance program, Monarez said, and she is meeting daily with small groups to hear their ideas and concerns. She acknowledged this year’s layoffs are tough for the remaining employees.

Monarez holds a PhD in microbiology and immunology from the University of Wisconsin–Madison and has been serving as acting director at the CDC since January. She formerly was the deputy director for the Advanced Research Projects Agency for Health, a Health and Human Services research funding agency focused on innovation.

“There are larger plans for reorganization across HHS toward really making sure that there is capacity and capability building for the future, but the CDC staff are my family,” Monarez said. “Certainly, when you see individuals that you’ve been working with for 10, 20, 30 years ... it’s still going to have some level of impact, and we have to come together, and we have to figure out how to move forward.”

Bullet holes are shown Thursday in a window at Centers for Disease Control and Prevention offices in Atlanta, resulting from an Aug. 8 shooting.

Many employees have been critical of the federal health leadership, including the CDC’s parent agency.

“Health and Human Services Secretary Robert F. Kennedy Jr., is complicit in dismantling America’s public health infrastructure and endangering the nation’s health by repeatedly spreading inaccurate health information,” said a letter sent this week to Kennedy and Congress signed by hundreds of HHS employees.

American Federation of Government Employees Local 2883, a union that represents about 2,000 CDC employees, called the decision to lay off the 600 workers who were on leave “cruel.”

“The cruel decision to move forward with these unlawful separations immediately after a violent attack on campus contradicts their stated commitments to promote the recovery of CDC staff and undermines the stability of our agency,” the union said in a statement.

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

Funding cuts sting, but Southern HIV prevention leaders say community joy and resilience will keep them going

2025-08-19T19:46:37+00:00

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

Frontline HIV prevention advocates from across the South gathered in Atlanta over the weekend to collaborate and compare notes about how to respond to challenges created by funding cuts and new Trump administration policies.

At the Saving Ourselves Symposium, an annual conference for leaders of color working on HIV prevention in the South, attendees were particularly alarmed about federal attempts to block projects that focus on gender identity and the health needs of the communities they serve.

Participants raised concerns about their ability to continue work on testing, education, and disease prevention – and about their own mental health as they navigate the challenges.

Trump’s proposed budget for next fiscal year would dramatically reduce funding for HIV prevention, and funding clawbacks have impacted organizations working on vaccine equity with vulnerable groups and people of color.

Here are four takeaways from the conference, which was themed “Black to the Future.”

HIV advocates worried about impact of funding and policy changes

The threat of funding cuts and the changed political environment were at the top of the agenda for many at the conference. Even groups that have not yet lost funding are rethinking their strategies as they anticipate cuts.

‘We need to keep fighting’: HIV activists organize to save lives as Trump guts funding

“It’s much harder now, as an organization. We did not immediately lose any funding, but what we did do was immediately began to forecast, and we know that it’s happening now,” said Kevin Anderson, CEO of the Houston-based The T.R.U.T.H. Project. “It just doesn’t look the same.”

Many leaders from different states said cuts that impact their work could come from a variety of directions.

For example, FreeState Justice, a Maryland LGBTQ+ advocacy group, lost state funding for a project involving victim services for people impacted by crimes, including hate crimes, Executive Director Phillip Westry said.

The latest funding problems are compounded by the longstanding structure of how HIV services are funded in the United States. Community groups are typically asked, as a condition of funding, to test or link to care for a certain number of people. That can lead to competition among groups to provide services to the same small group of clients in a certain region.

In response to those concerns, Daniel Driffin urged leaders to find ways to work together and to focus on their broader impact rather than just the raw numbers. Driffin is a project manager at the HIV Vaccine Trials Network and longtime HIV prevention advocate in Atlanta.

The conference drew a smaller number of people this year, about 156, compared to last year, said Mardrequs Harris, deputy director of the Southern AIDS Coalition, which organized the event.

Transgender people – especially those of color – face particular challenges

An in-depth, community-led study of Black trans women in Houston found that many feel a loss of autonomy over their bodies and judgment due to longstanding discrimination and the Trump administration’s attempts to restrict trans people’s rights.

That can manifest in challenges in accessing health care, with Black trans women being asked unnecessary questions by medical providers and feeling judged by staff. They also face long wait times for medical appointments and prescriptions. The need to seek separate care for issues ranging from gender transitions to HIV to routine matters can compound the complications, the study found.

Fulton County Board of Health to restore HIV prevention jobs after May layoffs

Black trans women want doctors to “treat my cough and not my gender,” said Joelle Espeut, the advocacy director at The Normal Anomaly Initiative who helped lead the study.

Organization leaders said they are feeling pressure to remove references to trans and gender non-conforming people from their official materials as they seek to protect their funding, creating a feeling of erasure.

Black trans women want to be included in the leadership of a variety of organizations, not just those focused on trans people, and be seen as regular members of society beyond just their gender identity.

“We work, we pay bills …. we are still taxpayers, we are still a part of this community,” said Christen “Coco” Valentine. “We’re human. So cut the stigma out.”

HIV workers focus on resilience

Many conference attendees said the recent funding cuts have taken an emotional toll on them.

“We’re holding the insecurities, the disappointments, the frustrations, the erasure,” said Simone Phillips, director of training and technical assistance at the St. Louis HIV/STI Prevention Training Center. Her comments drew “amens” from the audience.

“All of these headlines are just flooding us with nos and nos. So it does make you pause. It does make you feel overwhelmed, but it’s also like almost powerless to the sense of, ‘where do I start when there are so many fires?’” said Brady Maiden, the community science program manager for the Southern AIDS Coalition.

The desire to tell a different kind of story, one focused on resilience, was the impetus for Anderson’s short documentary “And We Rest on Giants,” which focuses on the stories of long-term HIV survivors and attempts to highlight the “joy and resilience as individuals that were living and thriving with HIV.”

The goal of the film is to encourage people to have conversations about HIV with their families and communities, reduce the secrecy and silence, and show that people living with HIV have rich and fulfilling lives and are not defined by the disease.

Resilience includes envisioning new ways to connect and support others in their community – like a proposed “auntie circle” in Houston, where women can lean on each other and learn from older trans women, said Bec Sokha Keo, a researcher at the University of Houston who helped coordinate the study.

Community support can be a vital resource

Research on HIV in the South can overcome federal funding cuts, Maiden said, by turning to community support, which can also help build trust and improve outcomes.

Research doesn’t always have to be sponsored by a large institution, Maiden said: “We are the subject matter of experts, and we’re allowed to ask questions.”

It’s important to ensure that projects center local voices because different parts of the South have different histories and challenges, she said. And it’s important to disseminate results of research to the communities who participated or are affected by the findings. Even decisions as basic as choosing a location should be guided by community needs and equity, she said.

“Community science is working with community, activating with community, being intentional, and making sure that we’re also using community to be the experts, but giving them that information back so they can also use it for what they need to advance,” Maiden said.

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

International doctors keep this Brooklyn hospital running. Visa whiplash has jeopardized that.

2025-08-15T13:43:18+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.

When Russia invaded Ukraine in 2022, Anastasiia Tsyunchyk was just finishing medical school. After her studies, she held off from starting a residency in favor of sorting medications and acting as a translator — work, she said, that was more valuable at the time, because as a resident in Ukraine she would not have been able to work directly with patients.

Then, she met Conrad Fischer, a physician at Brookdale Hospital and the residency program director there. Fischer was in Ukraine at the time on a medical mission.

Tsyunchyk applied to the medical residency program at Brookdale, part of the One Brooklyn Health hospital network, and moved here in 2024. At first, she had to make some cultural adjustments. Ukraine, she said, has less of a culture around small talk. But American patients, she found, “want more of an interaction with you.”

“They want to know a little bit more about you, which is a nice thing,” she said.

In Ukraine, patients can much more easily afford essential medicines, Tsyunchyk said. But here, “I’ve had so many people who needed some sort of medications for their heart condition or their kidney condition and it’s going to provide [a] mortality benefit, but they simply cannot afford it.”

At Brookdale, many of her coworkers come from other countries. “A lot [of doctors] are coming from war zones, too, which helped me feel that I belong here,” she said. “Here, I open new horizons for myself.”

But now, her ability to stay and work in the United States may be under threat.

States facing doctor shortages ease licensing rules for foreign-trained physicians

For months, the international medical residents who make up a significant number of the Brookdale physician staff, have been caught up in a whirlwind of restrictions and regulations regarding their visa and travel status.

In May, the Trump administration paused interviews for J-1 and J-2 student visas, which many international medical residents work under in the United States. Less than a month later, they resumed. On top of that, travel bans affecting at least 19 countries mean the many international residents of Brookdale find themselves in a kind of limbo.

“We are feeling that we are not valued,” said Tsyunchyk. “We are feeling partially in fear, too, for ourselves.”

“They’re terrified,” Fischer said. “All those people on visas are daily scared that there could be a change in legality.”

NYC hospitals depend on international doctors

The doctors-in-training rely on the hospital for their legal status to be here, and the hospital very much depends on those health workers to operate.

Fischer’s internal medicine department employs 135 international medical graduates, or IMGs, who account for almost all of his doctors. About half of the IMGs are in the United States on visas.

“If we didn’t have international graduates, we would close,” Fischer said. “We could not stay open — because what do you do if you miss 80 to 90% of your doctors? You’re done. We couldn’t go a year.”

Dr. Conrad Fischer has helped staff the Brookdale Hospital trauma center in New York with physicians from all over the world.

According to the National Resident Matching Program, 6,653 positions across the country for first-year residents were “matched” to non-U.S. IMGs this year, out of a total of 37,667 matches. Almost 20% of them — 1,259 — landed in New York state.

New York City’s hospitals have especially high rates of international residents, and most are here on J-1 visas. Those hospitals depend heavily on international residents to staff their departments: surgical wards, emergency rooms, internal medicine, and more.

At Brookdale, the rate of visa-holding residents is even higher, in part because the hospital has challenges attracting American medical graduates.

“Brookdale is a very troubled hospital,” said Bill Hammond, senior fellow for health policy at the Albany-based think tank the Empire Center. The hospital network, and Brookdale in particular, has faced significant concerns around patient safety and finances. Incorporating it into the larger One Brooklyn Health network was “kind of a pet project” of former Gov. Andrew Cuomo, Hammond said.

“He was going to turn it around. They were going to become efficient, and it just hasn’t worked out that way,” he said.

Brookdale’s residency program has grown as New York City’s hospitals have been hit by a series of consolidations and closures over the years, and other residency programs have shrunk or closed as a result.

Fischer says he receives 6,000 total applicants for 55 internships, the first year of a three-year residency. Most of those applicants are IMGs, he said.

For Sebastian Arruarana, a residency in the United States offered opportunities to improve healthcare in his native Argentina and globally that he would not have been able to find at home. Arruarana, a third-year internal medicine resident at Brookdale and founder of a network for IMGs, emphasized that international IMGs often fill lower-paying residency positions at hospitals that American doctors are not interested in.

Argentinian Dr. Sebastian Arruarana has been working as a resident at the Brookdale Hospital trauma center in New York.

“Not many people wanna work in these underserved communities,” he said. “Sometimes, you end up doing the work of the phlebotomist, the transporter, you’re dealing with a shortage of different things. But it’s part of our practice and training.”

Even local medical students in the city don’t often want to stay in the neighborhoods or boroughs where they study, Fischer said. Medical graduates of the only medical school across Brooklyn, Queens, and Staten Island, he said, often prefer to work in Manhattan, or other more highly-ranked hospitals around the country.

“Most of those students don’t want to stay in Brooklyn, so you can’t force them to stay in Brooklyn,” Fischer said.

Patients, too, choose to cross boroughs for care, which compounds financial issues for places like Brookdale. Hammond attributed some of its problems to patients electing to go to better-regarded hospitals in Manhattan when they have the choice.

“You go to your local hospital when it’s an emergency, but if it’s not an emergency, and you’re having a baby, or you’re having a hip replacement, or something like that, you go to the hospital with the best reputation, even if that means traveling,” he said. “Brooklyn hospitals in general, and One Brooklyn in particular, is suffering from living in the shadow of all these well-regarded hospitals in Manhattan.”

Visa limbo, travel fears impact doctors and hospitals

When J-1 visa interviews were paused by the Trump administration earlier this year, two incoming residents, from Greece and Pakistan, to Fischer’s internal medicine department were unable to enter the country — one for a few days, the other for a couple of weeks. While they are now settled in Brooklyn, Fischer emphasized that their slots might not have been saved for them at other hospitals.

“They made it, but I want to be clear that other programs, they wouldn’t have waited,” Fisher said. “Most of the program directors would not wait that long, and they would have lost their spots.”

Georgia has a doctor shortage. Barriers to training keep immigrant physicians from filling the gap.

For the international doctors who have made it to the United States, Fischer said many have missed crucial family events — postponing weddings and family visits — for fear of not being able to re-enter the country.

“The J-1 visa program isn’t just so we could do a bunch of nice things for international doctors,” said Fischer. “We drive an 80-hour work week for not even $90,000 for a doctor. And they should not be subject to this treatment where they cannot see their families. Ultimately, that’s not good for patients.”

Arruarana said interviews have resumed for doctors from countries that currently fall under the travel ban. Argentina is not on the list; countries like Haiti, Sudan, and Afghanistan are. To Arruarana’s knowledge, no doctors in banned countries have received visas, despite having waivers that should, in theory, allow them.

“They’re completely left behind, these guys,” said Arruarana. “Those are the ones that are very stressed, the ones that are coming from banned countries — desperate, trying to email congressmen and senators and everyone.”

The impacts of visa and travel restrictions on under-resourced, short-staffed hospitals is just one secondary impact of the Trump administration’s sweeping immigration policies.

“It’s an example of the Trump administration not thinking through all of the ins and outs, not thinking through all the ripple effects of what they’re doing on immigration,” said Hammond. “It doesn’t just affect people who find work in Home Depot parking lots, it doesn’t just affect daycare and home care. It also affects people going to the emergency room at their local hospital.”

Anna Oakes is a summer 2025 reporting fellow with THE CITY and recent graduate of Columbia Journalism School.

Fulton County Board of Health to restore HIV prevention jobs after May layoffs

2025-07-23T20:59:17+00:00

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The Fulton County Board of Health will restore at least 14 jobs in HIV prevention and sexual health after laying off workers in May citing a lack of federal funding, officials told Healthbeat on Wednesday.

The layoffs of 17 workers came amid delays in funding for HIV initiatives to state and local health departments from the Centers for Disease Control and Prevention. Those funds have since arrived, said Chris Rustin, interim district health director for Fulton County.

The Georgia Department of Public Health received $25.9 million for the second year of a CDC grant aimed at improving HIV surveillance and prevention. Of that, $5.9 million is allocated to Fulton, which covers the positions, DPH spokesperson Nancy Nydam Shirek said.

Fulton has also received other federal funds, including for the Ryan White program, which focuses on treating and supporting people living with HIV, and the CDC’s teen pregnancy prevention program, Rustin said.

The jobs will be reposted, and the former workers can reapply, though they will not automatically be rehired, he said.

Rustin said the county health agency is still working out the details of the budget with the state DPH, but that getting the job opportunities posted soon is “a priority,” and he hopes that will happen in the next couple of weeks.

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

Fulton health officials said in May that the layoffs would have no impact on services. At a town hall organized in response to the firings, Atlanta HIV advocates said they were concerned about how services would be affected.

“If there were any services eliminated that are critical for the community, we’re going to work to bring them back,” Rustin said.

The firings created an unnecessary disruption, said Leisha McKinley-Beach, a longtime HIV prevention advocate and CEO of the Black Public Health Academy, a training institute. She attended Wednesday’s meeting.

“It is an action that should have never happened,” she said. “Many of the staff that were released are necessary for implementation of the HIV prevention program.”

HIV testing services are vital in metro Atlanta. Fulton, DeKalb, and Clayton were among the 15 counties in the United States with the highest rates of new HIV diagnoses in 2022, according to the latest available data from AidsVu.

Fulton health leaders return from administrative leave

Two Fulton health leaders – district health director Dr. Lynn Paxton and human resources director Carol Lawrence – were put on administrative leave after the layoffs, which “were done without the prior knowledge or approval of the Georgia Department of Public Health,” Nydam Shirek said. Both are state employees assigned to county work.

Paxton has since been reassigned to DeKalb County, where she is serving as the interim district health director, replacing Dr. Sandra Valenciano, who left to accept the position of health officer for public health in Seattle & King County, Washington.

Rustin, who formerly served as a deputy commissioner at the state DPH, has stepped away from those duties to serve as the interim district health director for Fulton.

On Wednesday, Lawrence was back at work in Fulton, attending the board meeting.

DPH determined she was not involved in the layoff decisions and was reinstated on May 24, Nydam Shirek said.

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

How AI can help strengthen emergency response to public health threats

2025-07-21T11:00:00+00:00

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

In addition to controlling routine health threats, public health agencies are responsible for emergency response to outbreaks, bioterrorism events, extreme weather events, and other urgent threats.

During these events, health agencies activate incident management systems to organize their personnel and resources. In these systems, staff are reassigned from their usual duties into a new structure with defined leadership, planning, logistics, operations, and communications roles. If the event is sufficiently large, the health agency’s incident management may be one part of a larger state or federal response known as Emergency Support Function 8.

Having served as incident manager for health emergency responses domestically and globally, I’ve seen how quickly public health agencies can get overwhelmed by the sheer volume of information, decisions, and coordination required.

Artificial intelligence systems can improve the speed and accuracy of disease surveillance. In an emergency response, AI, if developed and deployed responsibly, can improve planning and documentation, countermeasures deployment, and communication.

AI can help with crush of information updates

When an incident management system is activated, the volume of information multiplies exponentially. Updates arrive by email, text, meeting notes, spreadsheets, shared folders, and, more often than not, conversations in the hallway. During large-scale emergencies, incident management meetings may occur as often as every eight hours, every day of the week, requiring rapid synthesis of new information and clear documentation of action steps to ensure coordination between staff who are leaving duty and those on duty. This documentation often becomes the official record of response activities and is essential for day-to-day operations and legal accountability, including periodic evaluation.

How AI can make infectious disease surveillance smarter, faster, and more useful

AI tools can improve this process in several ways.

“Ambient AI” can serve as a real-time recorder, taking notes during meetings and automatically extracting action items, decisions, and unresolved issues, similar to how it is being used as a scribe in doctors’ offices. Rather than relying on overworked staff to compile electronic files, emails, and verbal reports, AI agents can gather this information from shared systems and draft situation reports and other required documents for leadership, elected officials, and partner agencies.

Another overlooked but critical aspect of incident management is evaluation, such as “after action reports” and improvement plans. Evaluating an emergency response requires observing meetings, conducting structured interviews, and reviewing records, a process that often happens months after an event has ended. AI systems that are integrated into the response from the beginning can monitor decisions, measure timelines, and assess whether key benchmarks are being met. They can also collect feedback from frontline workers through surveys or chat-based tools, accelerating and enhancing the evaluation process without requiring more staffing.

AI can also help with workforce and resource planning. In routine times, public health always has more needs than people or supplies available; this gap becomes even worse during emergencies. AI tools can ingest rosters of personnel, track their hours, assignments, and availability, and match them to the operational needs of the emergency. It can flag gaps and resource bottlenecks for leadership to use when advocating for more resources. AI is uniquely good at calculating quantitative metrics and visualizations that are highly persuasive to budget officials but often difficult for staff to produce quickly during an emergency.

AI can help deploy countermeasures in health emergency

In public health, “countermeasures” are the tools used to control or reduce harm during a health emergency. These include diagnostic tests, personal protective equipment, antibiotics, vaccines, and vector control products like insecticides or bed nets. During an emergency, these tools must be procured, distributed, and tracked in real time.

Managing this process is a complex logistical challenge. Emergency operations centers must identify where supplies are located, how much is available, how quickly they can be deployed, and whether they are being used appropriately. AI systems can help monitor inventory levels in real time, integrate data across warehouses or distribution points, and model future supply needs based on case projections.

Here’s how artificial intelligence could improve public health

For countermeasures that involve patient care, such as diagnostic testing and dispensing antibiotics or vaccines, AI can also improve quality and safety. These operations often involve pre-existing large-scale clinics or “pop-up” facilities — both of which require protocols that must be followed precisely, including record keeping that adheres to routine health care standards.

AI-powered tools can assist with registration, eligibility screening, dosage calculation, scheduling follow-up appointments and reminders, and tracking post-appointment symptoms. They can flag deviations from protocol or identify unusual trends that might signal an adverse event or error in procedures, such as missing data, an unusually low number of positive diagnostic tests, or high number of patients reporting a fever after their appointment.

AI can help improve communication in a health emergency

Probably the greatest challenge I faced as an incident manager was making sure the right information got to the right people with the right style and content as soon as it was needed. This could be information going internally within the agency, such as to the health commissioner or other leaders, or externally to other government or non-governmental groups. Because this was a public health emergency, it was critical for these messages to reflect the different perceptions of risk, level of technical knowledge, and desire for detail for each of these audiences.

Generative AI systems are uniquely skilled at summarizing complex technical information in formats that are easy to read and act on. Notes can be input in a messy and incomplete format, and the output will often be organized coherently. When trained on previous correspondence or given sufficient direction about the audience, these systems can also ensure the format, tone, and detail align with the audience. For example, the same content can be revised by the AI system for elected officials, partner agencies, and journalists with different levels of data and tailored talking points for each.

Because generative AI may get things wrong — sometimes horribly wrong when they “hallucinate” information — a skilled human must always carefully review and revise the text before distribution. In an emergency, where time is short, however, editing a document is far more efficient than writing one.

Reaching the public, especially those with the least resources, requires cultural and linguistic competence. AI tools are increasingly capable of real-time translation and sentiment analysis. A chatbot deployed during an emergency can deliver guidance in multiple languages, detect confusion or mistrust in responses, and escalate conversations that need human follow-up. AI systems can also monitor social media, online forums, and community channels to detect rumors, misinformation, or new concerns, helping agencies adjust their messaging and response strategies. All of these systems, however, must have intensive human oversight, given the health, legal, and political risks of error.

AI can help free up time for workers to focus on protecting lives

During every emergency I’ve worked on — whether it was Ebola in Sierra Leone or Covid-19 in New York City — my email inbox was routinely filled with spreadsheets, phone trees, and requests for action that I could barely keep up with. I and many of my colleagues fear our health emergency response systems are too labor-intensive, reactive, and vulnerable to error.

As threats rise and public health systems weaken, AI systems may help sustain or even improve our ability to respond by reducing the burden of repetitive cognitive tasks and giving public health practitioners more time to focus on protecting lives.

How an Atlanta pediatrician deals with climate anxiety – and finds joy in action

2025-07-11T14:12:31+00:00

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

Dr. Preeti Jaggi remembers clearly the moment she became concerned about the environment. Robin Williams was there – on the television.

Jaggi was a teenager in Ohio in 1990 when Williams and other celebrities landed in her living room to talk about pollution and other environmental problems as part of “The Earth Day Special.”

“I remember they talked about climate and how we depend on a stable Earth to thrive. … I remember being concerned about it,” she said.

Jaggi, 52, went on to become a pediatrician specializing in infectious diseases. She works at Children’s Healthcare of Atlanta and as a professor at Emory University, blending her workplace focus on protecting patients with a role as an environmental advocate.

She chairs the advocacy group Georgia Clinicians for Climate Action, where she argues for more renewable energy before the state’s Public Service Commission, collaborates to electrify Georgia’s school buses so kids have cleaner air, and finds ways for the health care industry to be more environmentally sustainable.

Her “everything, everywhere, all at once” presence is driven by her belief that pediatricians have a duty to protect the Earth’s future for their young patients.

Summer heat is felt unevenly across metro Atlanta. Experts say more data is needed to address the public health threat.

“It’s becoming more and more obvious that the environment is affecting health … We just had this huge deluge flood in Texas, and all these kids in a camp were either displaced or died from that,” said Jaggi, who lives in Decatur.

Closer to home, she often talks about the death of 1-year-old twins and their mother in Thomson, Georgia, last year after a tree fell on their home during Hurricane Helene.

Rising temperatures also drive more hot days, which lead to more emergency room visits, Jaggi said.

Excess heat days increase the risk of heatstroke, and longer warm periods mean ticks, mosquitoes, and other vectors of disease are moving to new areas, bringing infections like Lyme disease, malaria, and dengue fever.

Air pollution also has a range of impacts, Jaggi said, including driving up rates of premature births, cancer, autism, and especially asthma.

Jaggi said that during the 1996 Atlanta Olympics, when there was significantly less driving, air pollutants fell, and so did the number of children going to the hospital for asthma – by 40%.

“We need to have strong air pollution standards because we know that it makes us sick,” Jaggi said.

“Our new reality” can make it tough for kids to play outdoors and connect with nature, Jaggi said, something that’s always been a key source of pleasure for her.

“There are going to be days where kids cannot go outside as much as they would otherwise do, which is really sad for them, right? We want them to be outside and be playing in that unstructured time,” she said.

While her medical training did not include much of a focus on climate change, she has enrolled in programs like the Climate Health Organizing fellowship through the Cambridge Health Alliance.

Children are tapped into the impact of climate change, and they’re worried about it, Jaggi said.

“I’ve heard a kid say, ‘I feel that adults take no initiatives into protecting the climate, and they put all the burden on future generations. .. And I don’t know if we can do that without you’,” Jaggi said.

“In Georgia, about 23% of 16- to 25-year-olds are extremely worried about climate, and 75% are worried,” Jaggi said, referring to a study published in The Lancet last year. She can relate to the concerns, since she felt them many years ago as a high school student.

Jaggi also spends a lot of time thinking about vaccines in the face of increasing hesitancy among parents. She sees a parallel with her climate work: “We want to prevent a problem. … This is why, as a mom, you would tell your child, ‘Don’t stay close to that hot stove. Don’t put your hand on that hot stove.’ …. We do things to prevent a problem.”

Jaggi said she has had patients who suffered from vaccine-preventable illnesses. For example, one child was not vaccinated for chickenpox, and suffered a bacterial infection.

“It really ate away at their muscle, and they had to be in hospital for three weeks with six or seven surgeries. The parents said to me, ‘If we would have known, we would have gotten this vaccination’,” Jaggi said. “I just listened to them, and I empathized with their suffering also, because they, I believe, had some regret.

“Giving good information to people about the safety of vaccinations is our responsibility,” Jaggi said.

Vaccination and protecting the environment are driven by a community ethos: “Your community protects you, and you protect your community. It’s similar – we want to protect our environment so that our kids can thrive.”

“The best thing that I can say to people to convince them that I love my children more than anything in this world, and I vaccinated them because I want them to be healthy,” said Jaggi, the mother of two college students.

Even as she reels off a host of climate concerns, Jaggi has found that her advocacy brings her “joy,” inspired by the marine biologist and climate activist Ayana Elizabeth Johnson.

“There are so many things that I view with confusion and bewilderment, but I can still do something, and … even small actions are important,” Jaggi said. “I find a lot of joy in at least just remembering that I can do something.”

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

When public health is undervalued, health care pays the price

2025-07-10T16:08:31+00:00

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

As clinicians and public health leaders, we’ve spent our careers in both the exam room and the outbreak command center. And we’ve seen firsthand how clinical care and public health reinforce one another in preventing illness, delivering care, and protecting communities.

Now, we’re watching as these interwoven threads are snipped, one by one. Whether it’s a health outreach team in a neighborhood, a clinic-based prevention program, or critical systems like Medicaid, each cut carries consequences for patients, communities, and the health care system itself.

Whether they know it or not, clinicians across the country rely on public health every day. They refer patients to public health programs outside clinic walls that are essential to what happens inside them — services like home inspections for lead, tobacco quitlines, and maternal health programs. And importantly, they count on public health to spot trouble early, to guard against invisible threats, and to step in before a crisis hits.

Take the example of lead poisoning. A child with elevated blood lead levels may not present to their pediatrician with obvious signs right away. But even small amounts of lead exposure can permanently harm a child’s developing brain, affecting their language or behavior. Public health agencies act quickly to identify where the lead exposure is coming from and then work to remove it from the child’s environment. Scrap those services, and more children will suffer brain damage before anyone intervenes — harm that is entirely preventable.

Funding cuts to public health also mean missed opportunities to test, treat, and contain a disease outbreak. Right now, Maine is experiencing the largest HIV outbreak in the state’s history, already straining local health care systems. The Centers for Disease Control and Prevention team that would typically be deployed to assist? They’ve been held back by workforce reductions.

Meanwhile, a surge in measles cases across the United States reminds us of what’s at stake if immunization efforts falter. The next season of flu, Covid, and other respiratory illnesses is just around the corner — a time when clinics and hospitals are perennially overflowing. That strain will worsen if budget cuts leave fewer people vaccinated and protected.

As public health services are hollowed out and Medicaid cuts loom, the cumulative impact will be most deeply felt by those already struggling to access care, especially in rural and underserved communities. Medicaid covers individual health care, but it also plays a less visible role in funding prevention and community health services across the country. The compounding effects of this disinvestment will fall most heavily on people already facing barriers to care.

Importantly, public health and Medicaid cuts don’t make costs disappear — they just shift them downstream to the health care system. Hospitals are already seeing the fallout: longer wait times, overburdened staff, and sicker patients requiring more intensive — and expensive — care.

Modernization is undoubtedly needed across public health and health care. And some leaders argue that these cuts are necessary for fiscal responsibility. Yet the scale of the proposed cuts risks eliminating vital programs outright, adding costs down the road, rather than making our systems more effective. Consider that the proposed cuts to HIV prevention programs would lead to thousands more people with HIV, costing the health system an estimated $52.4 billion over patients’ lifetimes.

A different path is possible, one that knits together the threads of health care and public health. Renewed partnerships for data exchange, strategy setting, and sharing of staff point the immediate way forward; tapping into new sources of investment would help further protect lives and livelihoods.

Health systems already have choices to weigh: Do they consider taking on traditional public health roles to recapture the benefits that prevention services once provided? Will hospitals be expected to send nurses into homes to ensure tuberculosis treatment is completed? Or dispatch staff to remove lead from children’s homes? Without this much-needed support from public health, we’re asking clinicians to do more with less — essentially tying one hand behind our backs.

Health care alone cannot fill these gaps, and we don’t have to wait for Washington to act. States, health systems, and communities can lead now by forging stronger partnerships with public health, pooling data and dollars. Ignoring the gaps left by public health disinvestment won’t meet patients’ needs — but facing them together, with urgency and intention, just might.

Dave A. Chokshi, M.D., MSc., former New York City health commissioner and chair of the Common Health Coalition; Chelsea Cipriano, MPH, managing director of the Common Health Coalition; and Charlene Wong, M.D., MSHP, former senior adviser for health strategy to the CDC director, are the authors of More Illness, Greater Cost: The consequences of public health cuts for the health care system, a special report from the Common Health Coalition.

The coalition brings together leading health organizations in pursuit of a reimagined health system in which health care and public health systems work hand in hand. Its founding members are the Alliance of Community Health Plans, AHIP, American Hospital Association, American Medical Association, and Kaiser Permanente.

Q&A: Georgia nursing leader on how to educate patients amid information overload

2025-07-09T19:25:20+00:00

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Over the course of her 40-year career as a nurse, people have gained greater access to information, and that’s both a good and bad thing, said Patricia Horton, the CEO of the Georgia Center for Nursing Excellence.

Patients are more empowered, but many also suffer from information overload, receiving confusing messages about vaccines and other health issues, Horton said.

As trusted messengers with close links to their communities, nurses are tasked with helping people understand health information, Horton said. It takes perseverance.

Patricia Horton is the CEO and founder of the Georgia Center for Nursing Excellence, a nonprofit focused on better understanding the state’s nursing workforce.

“There’s a light at the end of the tunnel, and we just have to keep on trying and trying different ways of getting that information out there,” Horton said. Emphasizing positive stories and listening to people’s personal concerns are effective ways to share good information.

Horton founded the Georgia Center for Nursing Excellence in 2021 to gather data and insights about the state’s nursing workforce. The nonprofit’s data dashboard tracks supply and demand, wages, job postings, and other aspects of the workforce, for RNs (registered nurses), LPNs (licensed practical nurses), and CNAs (certified nursing assistants).

The organization also sponsors a summit where nursing leaders can interact with professionals from other industries and a mentorship program to help new nurses adjust to their jobs, with the hopes that they won’t leave the profession. The dashboard shows that about 153,544 nurses worked in Georgia in 2024, and the state is short by an average of 772 RNs each year, with LPNs and CNAs also facing shortages.

Healthbeat recently spoke with Horton about nursing in Georgia. This interview has been edited for length and clarity.

What role do nurses play as trusted messengers in their communities?

Nurses have been, for upward of 20 years, the most trusted profession, and so we really see that as an opportunity to work in our communities. Many times they’re the ones giving the vaccines, [they] go out and talk to their community, whether it’s in a church setting, school setting, because they have that trust, and [are] trying to share the things in a way that people understand it.

How do nurses deal with anti-vaccine messages?

It is very difficult. We’ve had lots of discussions about that, because it can be very frustrating, especially the science and the reasons behind things. But we keep on trying to put a positive spin on it. Many people have to hear the message and see things and hear stories. One of the things that we’re really trying to get better at in nursing is sharing the stories. What are the benefits? How can we help you? And how can we help you understand? It may take one in that family to believe it and do something, whereas the rest of the people in that family might come along. It’s a constant effort.

We don’t believe in giving up hope. There’s a light at the end of the tunnel, and we just have to keep on trying and trying different ways of getting that information out there … What are the other ways we can get information [to] people and have them see a different perspective and get beyond the political side? We’re more alike than we are [different], and if we can look beyond that, and see what the benefits are, then you’re more likely to reach them.

Is that something that’s changed over the course of your career?

It has changed over my career, because over time, the whole technology of looking on the internet, all of the information that’s shared now, and the way things are shared … The good part of it is, hopefully it has increased the information that patients and families have access to, but on the other hand, many times the information that they’re seeing is not always accurate. So it has made things more challenging.

People will continue to be informed in different ways, and it’ll be our responsibility in the medical field to make sure that we share the correct information and the science behind things.

What contributes to nursing turnover and people leaving the profession?

A … study that was surveying nurses and what impacts them and their intent to leave [found causes to be] stress and burnout, which has to do with workload, under-staffing, inadequate salary, and workplace violence. … Workplace violence has significantly risen to the top, more so during Covid, and has continued to remain a concern, in even nursing homes, as well as hospitals. It’s being addressed with policies and standards being put in place.

Obviously, we always focus on recruitment, because you’re constantly having a need to fill positions. But truly our focus needs to be on retention, because in order to have recruitment, you really have to have strong retention of the individuals that you bring on board.

There’s been a lot of focus and effort on residency programs to really work with our new graduate nurses that are coming along. The intent to leave is much higher early on, and that’s why many [hospital systems] have focused on residency programs and really leaning in with mentors. Turnover costs a significant amount and has an impact on the quality of care you deliver.

What other challenges face the profession in Georgia?

We saw for a period of time, especially during Covid, and a little bit after that, a decline in the number of nurses applying for the nursing programs … Now we’ve seen an increase. The challenge with that is there are many that are not able to be accepted because we also have a faculty shortage.

And the other challenge is clinical placement. Mostly their training is done in hospitals, and hospitals can only take on so many students at a time.

Are you a nurse? Healthbeat wants to hear from you. Please take our new survey about the health needs in the communities you serve. Your input helps inform our public health newsroom — and only takes 5 minutes. As a thank you, five participants will be randomly selected to receive a $50 Amazon gift card. And please pass it along to nurses in your network.

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

Pandemic aid revived rural health care clinics. Losing it imperils access.

2025-06-13T11:00:00+00:00

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In Clay County, Kentucky — one of the nation’s poorest counties — a single mobile van and a stack of gas station gift cards had long been a lifeline for rural patients.

The federal pandemic relief funding approved in 2021 enabled AdventHealth Manchester, a local rural health clinic, to continue operating a van service that transported rural patients to specialty appointments hours away, helping them access care they otherwise couldn’t.

For millions of Americans living in remote areas, simply getting to a doctor or nurse practitioner can be a daunting challenge; access to health care requires more than a Medicaid card.

“Transportation access is a huge problem for many who don’t have a car and can’t get themselves to the doctor,” said Tawnya Brock, who conducts national assessments of rural health clinics and works locally at AdventHealth Manchester. “The ability to buy and offer Covid testing was instrumental, but keeping our van operational helped continue bringing patients in for nearby services, like MRIs or CT scans, while our rural health clinic providers were newly overloaded with Covid demand.”

At UNC Chapel-Hill’s Rural Health Clinic, Covid-era funding allowed staff to purchase a van and begin this same crucial transportation service for patients in Durham’s nearby rural areas.

As part of the Trump administration’s widespread health spending reductions, any remaining grant funds to rural health clinics were rescinded on March 25. Health and Human Services communications director Andrew Nixon defended the cuts, stating the government would “no longer waste billions of taxpayer dollars” on a pandemic that “Americans have moved on from years ago.”

Keeping these van services operational was one of many small but transformative ways pandemic-era grants helped rural health clinics serve patients.

As the Covid-19 pandemic surged across America in 2020, causing 375,000 U.S. deaths that year, health care systems across the country buckled under the strain. In response, the federal government allocated over $4 billion in relief funding to state and local health agencies, expanding their capacity to track infections, conduct testing, and provide vaccinations.

With few dentists and fluoride under siege, rural America risks new surge of tooth decay

A small share of that funding went to the 5,600 rural health clinics across America, from southern Florida to northern California. These federally designated clinics serve areas with limited access to hospitals or other health care infrastructure — and are often the only point of care for 62% of rural Americans, roughly 39 million people, many of whom are uninsured. The pandemic marked the first time in their history that these rural clinics received direct federal support.

Although the federal money was targeted for Covid-specific needs, its impact extended further, helping clinics hire staff, expand services, and reach patients who might have otherwise gone untreated. Clinics were able to offer telehealth appointments for substance abuse and mental health issues, offer pediatric screenings in public schools, and even provide dental care.

Rural health clinics are underappreciated and undervalued, said Sarah Hohman of the National Association of Rural Health Clinics.

“Rural health clinics bear so much responsibility with so little [funding],” Hohman said. “So many policy makers in Washington don’t realize how critical [these clinics] are.”

Rural clinics handle more chronic disease, get less funding

Created in 1977 as part of a federal program to support underserved populations with limited access to health care, rural clinics vary widely in their size and capacity. Some operate out of a single trailer with one nurse practitioner; others are connected to larger hospital systems with more robust staffing. But even the better-resourced clinics struggle to keep up with overwhelming patient demand.

Federally designated rural health care clinics like AdventHealth's facility in Clay County, Kentucky, serve areas with limited access to hospitals or other health care infrastructure — and are often the only point of care for 62% of rural Americans, roughly 39 million people, many of whom are uninsured.

Unlike federally qualified health centers, which receive annual federal grants and can apply for supplemental funding, rural health centers are financed by bare-bones per-visit reimbursements from Medicare and Medicaid. Lacking federal funding and patients with private insurance, or those who are capable of paying out of pocket, these rural clinics operate on a shoestring. Because Medicare and Medicaid rates are fixed, longer appointments or more complex services result in a financial loss for providers. In rural areas, juggling multiple chronic conditions in a single patient visit is the norm.

Rural communities have a higher prevalence of chronic disease, addiction, and mental health issues, cancer, and obesity. They are also more likely than their urban counterparts to die a preventable death, according to the Centers for Disease Control and Prevention. In Clay County, Kentucky, where there is one doctor for every 2,800 residents, these disparities are especially pronounced — poverty, obesity, and life expectancy rates are significantly worse than the national average. In comparison, New York City’s Health + Hospitals system alone has one doctor for every 187 residents.

Brock said that, especially in poor regions like Clay County, there aren’t enough primary care providers to meet patient demand. One nurse at AdventHealth Manchester’s clinic sees over 20 patients a day — managing everything from walk-ins to substance abuse counseling.

In remote communities, reaching a clinic can require hours of travel.

“A few times a month, I’ll have patients who suddenly lose their hearing, and not be able to get to the clinic in time to get it treated. If it’s not treated in 48 hours, these patients permanently lose their hearing,” said Emily Waller, an audiologist in rural Illinois who worked at a public health care system during the pandemic.

Millions in U.S. live in places where doctors don’t practice and telehealth doesn’t reach

Even when clinics have openings for preventative and non-emergency care, people in these areas often don’t make the time to come. “[We have] a lot of opioid addiction and financial challenges. It’s hard to get these patients for a mammogram or a colonoscopy when they’re worrying about whether they’re going to have food on the table that night, or have to go to rehab and lose their children the next,” Brock said.

In 2023, Leonard Carpenter, a Native American veteran in Butte County, California, missed what would have been his first chemotherapy appointment. With clinics overwhelmed and appointments scarce during the early pandemic, he had to wait five months for the next available slot. By then, his cancer had progressed beyond treatment. He died three months later in his apartment, surrounded by volunteers from the Chico-based emergency shelter nonprofit SafeSpace.

“When he died, 30 or 40 of us packed into his home and put him in a cardboard coffin box. We all wrote signs on it,” said Ashley-Michelle Arnold, a SafeSpace volunteer.

Covid funding gave rural clinics a brief reprieve

The $632 million in Covid relief funding provided an average of $138,000 to each rural clinic. The money supported staffing, overtime pay, retention bonuses, and makeshift expansions like parking-lot tents and mobile testing units.

“It was life-changing, allowing them to fill the funding gaps that other public health systems, like FQHCs, have always had,” Hohman said.

In addition to her administrative role at AdventHealth Manchester, Brock travels the country conducting surveys of rural health clinics for QuadA, one of four organizations authorized to accredit rural health clinics under Medicare guidelines. Brock said many clinics want to expand services but can’t afford to hire the needed staff.

Hohman said clinics are eager to expand into areas like mental health and specialty care because the need is clear, but the upfront cost of hiring makes it difficult. Since they only get reimbursed once providers start seeing patients, it can be financially risky to bring on new staff.

The pandemic grants showed how funding makes a difference. But because they were tied to a public health emergency, Hohman said they’re a difficult precedent for long-term support.

Rural health centers don’t have the staff or money to systematically collect data for policymakers. That makes it hard to prove the need for more support — or to track how many clinics are at risk of closure.

“So much of my job is explaining to decision-makers in Washington what rural health clinics are, how they are paid, and how that payment looks different than that of federally qualified health centers or other public health care centers. And the data just isn’t there,” Hohman says.

The NARHC has lobbied lawmakers to introduce bills that would provide workforce grants to rural clinics to help pay salaries of new workers before they start generating reimbursement. These could be a critical lifeline for the clinics, Hohman said.

“The reality is we need more of these clinics, not less. Workforce grants for RHCs would allow patients greater access to care — covering hiring costs and the initial salaries of providers before they start to generate reimbursement,” she said.

“These clinics have the patient volume, the demand, the desire to offer more care. But right now, they just can’t.”

Even as the NARHC pushes for long-term solutions through workforce grants and policy support, recent events like the devastating tornado in southeastern Kentucky have laid bare the unpredictable challenges rural clinics continue to face.

On May 16, the storm swept through Laurel and Pulaksi counties, nearby areas served by the AdventHealth Manchester clinic. Twenty-nine people died, and 1,532 homes were destroyed, said Gail Timperio, readiness response coordinator for the Southeast Kentucky Healthcare Coalition.

Brock said the AdventHealth Manchester clinic’s manager lost her home and everything she owned.

Volunteers flooded the area in the days following the storm, offering cleanup services, gas cards, and even vehicles to those who lost theirs in the destruction.

Though the link is not fully understood, climate change may be creating favorable conditions for increasingly frequent and violent storms, including tornadoes. These localized, violent natural disasters could add pressure on rural health clinics that are stretched for resources to provide care for their population.

For half a century, staff at rural health clinics have dedicated their lives to providing for medically underserved patients across the country. From the pandemic emergency to the widespread devastation caused by the recent tornado, Brock said these practitioners have carried the weight of entire communities.

“I see pride in our nurses, doctors, and all rural health care providers. I see their grit, digging in day after day to do what had to be done. I see the deep bond with their towns, and the trust their communities placed in them. It is much more than medicine, it is love, sacrifice, and an unwavering commitment to care.”

This story was produced in partnership with the Health & Science Reporting Program at the Craig Newmark Graduate School of Journalism at CUNY.

Community health workers increased Covid-19 vaccination in NYC, a new study finds. Here’s why their efforts worked.

2025-06-06T15:06:37+00:00

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In the depths of the Covid-19 pandemic, community health workers played a significant role in increasing vaccine uptake in hard-to-reach New York City communities, a new study has found.

Community health workers are public health workers with close connections to the communities they serve, and often act as intermediaries between local residents and health systems or social services. Across the country, many regions invested in community health worker initiatives as part of pandemic response efforts. But the workforce is particularly vulnerable to public health’s boom and bust funding cycle.

Quantifying the impact of community health workers who don’t work in clinical settings has long been challenging, said Dr. Maureen Miller, an epidemiologist and contractor with the New York City Department of Health and Mental Hygiene. But the data that emerged from the pandemic — and the Health Department’s significant investment in community health workers — offered an unusual opportunity to show their value, she said.

At MoMA, celebrating the ‘invisible workforce’ of community health workers

In the study, recently published in the American Journal of Public Health, Miller and other researchers affiliated with the Health Department found that community health workers, in partnership with the agency and community-based organizations, helped drive sharp increases in vaccination levels among local residents.

In 75 ZIP codes targeted for public health interventions, residents were primarily Black and Latino — demographics that had experienced disproportionately high mortality rates in the early weeks of the pandemic. At the beginning of the initiative in July 2021, 44% of all residents had completed their primary series Covid-19 vaccination. By June 2022, vaccine uptake rose to 76%. The majority of those communities received high levels of engagement from community health workers, defined as interactions during at least 11 months of the year.

Dr. Maureen Miller, an epidemiologist, studied the impact of community health workers on Covid-19 vaccination in New York City along with other researchers affiliated with the New York City Department of Health and Mental Hygiene.

Over the course of that year, community health workers also provided vaccination information to local residents more than 18 million times and participated in more than 22,000 outreach events, according to the study. They made 800,000 linkages to Covid-19 vaccination appointments, created more than 200,000 referrals to testing sites, distributed 17 million face masks and handed out 73,000 at-home antigen tests. They also helped residents tackle other issues, from food insecurity to housing instability.

In an interview this week with Healthbeat, Miller discusses the study, the role of community health workers, and why their approach to community engagement proved so effective. This interview has been edited for length and clarity.

Take us back to where New York City was in the pandemic when this project began. What motivated this research?

I was hired just as [the Covid-19 variant] Omicron was taking off, as were all of my colleagues. It was a very crazy period in the pandemic. Although vaccines were increasingly available, they were kind of challenging to get in New York City. You had to make appointments through computers and online. Not everyone knows how to operate that, not everybody has access to that, and we were also in the communities that had been left behind already by vaccines, by treatments. People had already died.

The statistics are astounding: Almost half of the people who died in the pandemic in New York City died in the first month or two. That’s staggering, and I think we’ve swept that loss under the rug because it’s enormous. It has affected all of us.

Against that background, people were mistrustful. They said, ‘You want us to take this vaccine now, we don’t understand it. We hear bad things about it.’ There was already a great deal of misinformation and skepticism on the part of community members that we were working with. So the idea was not, as the city Department of Health, to go in and say, ‘Get vaccinated.’ It was to partner with community-based organizations who hire people who are centered in the community. We provided funding for the community-based organizations to hire community health workers who we would help train and keep updated on all the new variants, the new vaccines, the boosters.

The community health workers and the community-based organizations developed a lot of their own methods of interacting with the community. We would provide the information, but they would make up songs and get them on the local radio, they’d have flyers. They would do videos and put them on social media. We had biweekly meetings with community members and with community-based organizations. We had a series of trainings for community health workers. It was probably the largest effort that the New York City Department of Health has ever made to integrate community with government in the city.

How did you set up this study?

One of the reasons that community-based community health workers get no respect is because it’s been extremely difficult to find a database that shows the impact of population-level change. We wanted to change entire communities, not just one person at a time. We didn’t interact with every single person in the community, yet our impact was felt, as evidenced by the huge increase in vaccine uptake over time.

We had an outcome: how many people had received the full series of vaccinations. We had that data, and it was collected on a weekly basis for everyone who became vaccinated. I can’t even tell you how unusual that is in the world of public health — but so is a pandemic. This provided a unique opportunity to look at the outcomes and then to see how our work with the community was impacting our objective, which was vaccine uptake.

We didn’t interact with every single person in the community, yet our impact was felt, as evidenced by the huge increase in vaccine uptake over time.
Dr. Maureen Miller

The contracts were based on X number of outreach engagements, X number of handing out materials and documentation. You had to satisfy a minimum set of criteria in terms of engagement that you would then get paid for. That’s unique in my experience, but it was extremely effective, because the community-based organizations wanted to help the community in any way they could. So most of the time they exceeded [the goals].

What were the main findings of your research?

I was shocked — I hadn’t looked at the data until things started to settle down with the pandemic. I wondered: Well, how big of an impact did we have? And we had an enormous impact. I don’t know of vaccine uptake that has happened so quickly for any other disease.

Community health workers distributed face masks and Covid-19 tests, helped residents make Covid-19 vaccination appointments, and also provided connections to food and housing social services.

Within one year, from the initiation of the project in July 2021 through June 2022, we had a 30% increase in vaccine uptake in a community that is under-resourced, marginalized, distrustful, and disinvested. People went out and got vaccinated.

One of the projects that we did was a storytelling project. We wanted to know, ‘Why did you get vaccinated? Why are you encouraging others to get vaccinated?’ And it was all about family. It was about, ‘I’m going to protect my family.’ It was about community. In an individualistic society such as ours, it was really heartening to hear that that was a fundamental reason why people were choosing to get vaccinated and to convince others to get vaccinated. Not only were our community health workers acting as advocates for vaccination, eventually so were community members.

How do community health workers’ efforts to help residents with other issues, like food insecurity or housing instability, connect to the broader goal of increasing vaccine uptake?

The Health Department wanted people to get vaccinated right away. And the community came back and said, ‘Listen, my kid doesn’t have diapers. I’m not getting a vaccine before I can get diapers.’ There was such a great deal of need — and there continues to be need — for food, for housing, for money for child care, for elder care. There is just so much need in these communities that they can’t afford to think about the Health Department’s priority of getting people vaccinated and not spreading Covid.

People really wanted help, and they didn’t necessarily want the help that we came in with — to provide vaccines. They wanted help with daily living needs that were not being met, and in fact, were exacerbated by the pandemic. So we started providing referrals. We pulled together a list of organizations where people could go to get food. We partnered with the Department of Homeless Services to provide vaccine information and opportunities to make reservations to get vaccinated, and also to find housing for people. Community-based organizations also corralled their networks of food pantries and other resources so that we could amplify their ability to refer others to these services.

That’s how we build trust. We need to pay attention to what it is you need and want; it’s not only about getting vaccinated. It’s dealing with community priorities to ensure that when we would like to do an important health intervention, we’ve already built up the trust.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Atlanta HIV prevention advocates plan town hall on Fulton County public health firings

2025-05-27T19:41:57+00:00

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Atlanta HIV prevention advocates plan to hold a town hall Wednesday to discuss the layoff of 17 workers from the Fulton County Board of Health.

The town hall is scheduled for 11 a.m. to 1 p.m. at Mayfaire Medical, Suite 410, in the Summit South Building at 777 Cleveland Ave. in Atlanta. It is open to the public.

The event is being organized by Daniel Driffin, an independent public health consultant, and William Francis, pastor of The 166 Church. Both have spent years working on HIV prevention.

They are concerned about access to services like testing and access to drugs that can prevent infection in the wake of last week’s layoffs of Fulton health department staff who worked on HIV and sexual health.

“The safety net is literally being yanked out from under people,” Francis said.

Fulton, DeKalb, and Clayton counties were among the 15 counties in the nation with the highest rates of new HIV diagnoses in 2022, according to the latest available data from AidsVu.

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

“We as a community are going to have to figure out what can be done so people don’t fall through the cracks of public health,” Francis said.

After the surprise layoffs, the state Department of Public Health placed two senior Fulton health department leaders on unpaid administrative leave: District Health Director Dr. Lynn Paxton and Carol Lawrence, human resources director. The DPH said the Fulton layoffs were unauthorized.

Neither state nor Fulton health department officials would elaborate on the layoffs, or the source of the funding for the terminated staff.

“My greater concern is that this will ripple across the state,” said Jeff Graham, executive director of Georgia Equality, a nonprofit LGBTQ advocacy organization.

“There needs to be some transparency from the state health department and Fulton County immediately,” Graham said, adding that groups that provide services to people with HIV are worried about their own funding and also want to ensure that people have the services they need to prevent HIV.

Some of the affected Fulton workers and other advocates told Healthbeat that innovative services like a syringe exchange and initiatives with community groups to promote HIV testing could be disrupted.

Tyson Randolph, who was among those laid off last week, said the terminations will have “major implications for the community’s health going forward.”

“I was in the developmental process of building the bridge with the kids at this community center … but my efforts are all out the window.”

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

Fulton County, Georgia health department leaders put on leave after HIV workers laid off

2025-05-21T19:18:28+00:00

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The Fulton County Board of Health this week laid off 17 workers, including those focused on HIV and sexual health services, apparently without the approval of the state Department of Public Health.

The unexpected layoffs prompted the state to place “two executive leaders” of the county agency on unpaid administrative leave.

Jack Hardin, chairman of the Fulton health department’s board, confirmed Wednesday that District Health Director Dr. Lynn Paxton and Human Resources Director Carol Lawrence were placed on leave. Chief of Staff Brian Easom is leading the department.

The Monday layoffs “were done without the prior knowledge or approval of the Georgia Department of Public Health,” spokesperson Nancy Nydam said Wednesday in an email, and “DPH is reviewing the actions.”

Neither Paxton nor Lawrence could immediately be reached for comment.

Hardin said the layoffs were part of a restructuring and would not affect delivery of services.

“FCBOH emphasizes there is no disruption in HIV, STI, and TB clinical services because of these actions,” Nydam said.

County health departments like Fulton’s provide a range of HIV testing and other sexual health services.

Tyson Randolph, who told Healthbeat he was laid off on Monday, said his team was working on innovative ways to bring services to those who aren’t typically reached.

He worked on public health education with youth groups and college students in Atlanta’s West End, where he lives.

The layoffs will have “major implications for the community’s health going forward,” Randolph said. “I was in the developmental process of building the bridge with the kids at this community center … but my efforts are all out the window.”

HIV testing services are vital in metro Atlanta. Fulton, DeKalb, and Clayton counties were among the 15 counties with the highest rates of new HIV diagnoses in 2022, according to the latest available data from AidsVu.

The U.S. Centers for Disease Control also recently laid off much of its HIV prevention staff, including the team working on preventing mother-child transmission of the disease. A CDC-funded program headquartered at Emory University that delivered nearly 750,000 free home HIV testing kits also will be canceled.

Community groups across the South have cut back on HIV services due to funding delays and cuts.

The Fulton County workers laid off this week will be paid through the end of May, with additional severance payments in June, according to a letter to one employee viewed by Healthbeat.

The staffing cuts come after the state health department lost an estimated $334.2 million in funds due to “clawbacks” of Covid-era funding from the CDC announced in March. Those cuts resulted in layoffs of temporary contact tracers and other workers at the state agency.

Georgia community groups including those focused on vaccine outreach and equity also lost grants due to the cuts.

This story has been updated to correct a quote from state health department spokesperson Nancy Nydam to include that the Fulton County Board of Health emphasized that HIV, STI, and TB clinical services would not be disrupted.

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

‘All public health is local’: Experts sound alarm on consequences of HHS shuttering NYC regional office

2025-05-16T09:00:00+00:00

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On a recent visit to Federal Plaza in Lower Manhattan, some floors in the mammoth office building bustled with people seeking services or facing legal proceedings at federal agencies such as the Social Security Administration and Immigration and Customs Enforcement. In the lobby, dozens of people took photos to celebrate becoming U.S. citizens. At the Department of Homeland Security, a man was led off the elevator in handcuffs.

But the area housing the regional office of the Department of Health and Human Services was eerily quiet.

In March, HHS announced it would close five of its 10 regional offices as part of a broad restructuring to consolidate the department’s work and reduce the number of staff by 20,000, to 62,000. The HHS Region 2 office in New York City, which has served New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands, was among those getting the ax.

Public health experts and advocates say that HHS regional offices, like the one in New York City, form the connective tissue between the federal government and many locally based services. Whether ensuring local social service programs like Head Start get their federal grants, investigating Medicare claims complaints, or facilitating hospital and health system provider enrollment in Medicare and Medicaid programs, regional offices provide a key federal access point for people and organizations. Consolidating regional offices could have serious consequences for the nation’s public health system, they warn.

“All public health is local,” said Georges Benjamin, executive director of the American Public Health Association. “When you have relative proximity to the folks you’re liaising to, they have a sense of the needs of those communities, and they have a sense of the political issues that are going on in these communities.”

The other offices slated to close are in Boston, Chicago, San Francisco, and Seattle. Together, the five serve 22 states and a handful of U.S. territories. Services for the shuttered regional offices will be divvied up among the remaining regional offices in Atlanta, Dallas, Denver, Kansas City, and Philadelphia.

Head Start program affected by cuts

The elimination of regional HHS offices has already had an outsize impact on Head Start, a long-standing federal program that provides free child care and supportive services to children from many of the nation’s poorest families. It is among the examples cited in the lawsuit against the federal government challenging the HHS restructuring brought by New York, 18 other states, and the District of Columbia, which notes that, as a result, “many programs are at imminent risk of being forced to pause or cease operations.”

The HHS site included a regional Head Start office that was closed and laid off staff last month. The Trump administration had sought to wipe out funding for Head Start, according to a draft budget document that outlines dramatic cuts at HHS, which Congress would need to approve. Recent news reports indicate the administration may be stepping back from this plan; however, other childhood and early development programs could still be on the chopping block.

Bonnie Eggenburg, president of the New Jersey Head Start Association, said her organization has long relied on the HHS regional office to be “our boots on the ground for the federal government.” During challenging times, such as the Covid-19 pandemic or Hurricanes Sandy and Maria, the regional office helped Head Start programs design services to meet the needs of children and families. “They work with us to make sure we have all the support we can get,” she said.

In recent weeks, payroll and other operational payments have been delayed, and employees have been asked to justify why they need the money as part of a new “Defend the Spend” initiative instituted by the Elon Musk-led Department of Government Efficiency, created by President Donald Trump through an executive order.

Facing federal turmoil, this New York City Council member wants to ‘Trump proof’ public health

“Right now, most programs don’t have anyone to talk to and are unsure as to whether or not that notice of award is coming through as expected,” Eggenburg said.

HHS regional office employees who worked on Head Start helped providers fix technical issues, address budget questions, and discuss local issues, like the city’s growing population of migrant children, said Susan Stamler, executive director of United Neighborhood Houses. Based in New York City, the organization represents dozens of neighborhood settlement houses — community groups that provide services to local families such as language classes, housing assistance, and early childhood support, including some Head Start programs.

“Today, the real problem is people weren’t given a human contact,” she said of the regional office closure. “They were given a website.”

To Stamler, closing the regional Head Start hub without a clear transition plan “demonstrates a lack of respect for the people who are running these programs and services,” while leaving families uncertain about their child care and other services.

“It’s astonishing to think that the federal government might be re-examining this investment that pays off so deeply with families and in their communities,” she said.

Regional HHS offices acted as ambassadors

Without regional offices, HHS will be less informed about which health initiatives are needed locally, said Zach Hennessey, chief strategy officer of Public Health Solutions, a nonprofit provider of health services in New York City.

“Where it really matters is within HHS itself,” he said. “Those are the folks that are now blind — but their decisions will ultimately affect us.”

Dara Kass, an emergency physician who was the HHS Region 2 director under the Biden administration, described the job as being an ambassador.

“The office is really about ensuring that the community members and constituents had access to everything that was available to them from HHS,” Kass said.

At HHS Region 2, division offices for the Administration for Community Living, the FDA’s Office of Inspections and Investigations, and the Substance Abuse and Mental Health Services Administration have already closed or are slated to close, along with several other division offices.

HHS did not provide an on-the-record response to a request for comment but has maintained that shuttering regional offices will not hurt services.

Under the reorganization, many HHS agencies are either being eliminated or folded into other agencies, including the recently created Administration for a Healthy America, under HHS Secretary Robert F. Kennedy Jr.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said in a press release announcing the reorganization.

CDC cancels grant that funded free home test kits for HIV

Regional office staffers were laid off at the beginning of April. Now there appears to be a skeleton crew shutting down the offices. On a recent day, an Administration for Children and Families worker who answered a visitor’s buzz at the entrance estimated that only about 15 people remained. When asked what’s next, the employee shrugged.

The Trump administration’s downsizing effort will also eliminate six of 10 regional outposts of the HHS Office of the General Counsel, a squad of lawyers supporting the Centers for Medicare & Medicaid Services and other agencies in beneficiary coverage disputes and issues related to provider enrollment and participation in federal programs.

Unlike private health insurance companies, Medicare is a federal health program governed by statutes and regulations, said Andrew Tsui, a partner at Arnall Golden Gregory who has co-written about the regional office closings.

“When you have the largest federal health insurance program on the planet, to the extent there could be ambiguity or appeals or grievances,” Tsui said, “resolving them necessarily requires the expertise of federal lawyers, trained in federal law.”

Overall, the loss of the regional HHS offices is just one more blow to public health efforts at the state and local levels.

State health officials are confronting the “total disorganization of the federal transition” and cuts to key federal partners like the Centers for Disease Control and Prevention, CMS, and the FDA, said James McDonald, the New York state health commissioner.

“What I’m seeing is, right now, it’s not clear who our people ought to contact, what information we’re supposed to get,” he said. “We’re just not seeing the same partnership that we so relied on in the past.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org. Michelle Andrews is a reporter for KFF Health News, Healthbeat’s national reporting partner.

A $51 million investment in New York’s nursing workforce aims to bolster staff well-being, patient care

2025-05-14T21:47:01+00:00

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As New York faces a persistent nursing shortage, more than a dozen hospitals across the state, including three in the Bronx, are poised to receive a significant boost for their recruitment and retention efforts.

A $51 million grant program from the Mother Cabrini Health Foundation, a private nonprofit, announced on Wednesday, will fund efforts to strengthen the state’s nursing workforce as New York braces for an estimated shortage of nearly 40,000 nurses by 2030. The funding will help hospitals apply for nursing accreditation programs, which hospital leaders say will improve nurses’ well-being, as well as patient care.

At a press conference in Midtown, Monsignor Greg Mustaciuolo, the foundation’s CEO, described the nursing shortage in New York as a “staggering problem” without an easy fix — but one worth tackling.

“This is all about affirming our nurses and supporting the work that they do, and doing as much as we can do to help them,” he said.

The foundation launched the grant program following the publication of a 2024 report from the Center for Health Workforce Studies at the University of Albany’s School of Public Health that identified pervasive statewide shortages in registered nurses and licensed practical nurses, driven by the Covid-19 pandemic, a wave of retirements, a diminished pipeline of qualified workers, and the draw of better-paid opportunities outside healthcare.

Through the program, hospitals from Hudson to Auburn will receive grants of $1 million to $5 million over the next five years to pursue accreditations from the American Nurses Credentialing Center, which sets standards for nursing excellence. The funding will also help hospitals establish or expand nurse residency programs, and bolster virtual nursing, a health care delivery approach where off-site nurses assist with tasks to reduce administrative burden.

Martine Edwards, the vice president of nursing operations and quality nursing at St. Barnabas Hospital in the Bronx, said the grant would be “transformative” for the hospital, helping to strengthen the “continuing education of our staff, which will eventually decrease health care workforce shortages and promote career progression.”

At the Moses campus of the Montefiore Einstein Hospital, also in the Bronx, their grant will enhance professional development, leadership, and mentorship opportunities, expand nurse residency programs, and support wellness initiatives, said Maureen Scanlan, senior vice president and chief nursing executive.

The accreditation process is resource-intensive and can be particularly difficult for safety-net hospitals to achieve. Nurses and hospital leadership work together to identify gaps in care and strategize solutions, often over the course of years, said Rebecca Graystone, ANCC’s senior vice president of accreditation and organization credentialing.

Michael J. Fosina, the president of Calvary Hospital, a Bronx hospital that specializes in palliative care for adult patients with advanced cancer and other illnesses, said their grant would help strengthen nurse recruitment and retention.

“We don’t have enough nurses in this country. We don’t have enough physicians in this country. While we’re trying to change that as an industry, getting on the Magnet journey helps other nurses know that the institution is investing in nursing,” he said, referring to one of the accreditation programs.

Catherine Nicpon is a perinatal float nurse — working in the neonatal intensive care, labor and delivery, and mother-baby units — at Mercy Hospital in Rockville Centre, part of the Catholic Health System of Long Island.

While many hospitals feel the pressure of the workforce shortage, Nicpon said she hopes the grant will help nurses like herself offer more advanced care — and increase staff confidence.

“Happier nurses make for happier patients,” she said.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Atlanta VA nurses and hospital workers plan rally to protest proposed layoffs

2025-04-25T15:32:31+00:00

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Nurses at the Veterans Affairs Medical Center in Decatur plan to protest Saturday against proposed federal layoffs that they say will impact patient care at the facility that serves more than 70,000 veterans last year.

Two VA employee unions are organizing the protest outside the medical center at 1670 Clairmont Rd. National Nurses United represents 1,000 registered nurses at the facility. The American Federation of Government Employees Local 518 represents over 1,100 crisis hotline workers and member services employees.

The protest, scheduled for 11 a.m. to 1 p.m., will put a spotlight on former U.S. Rep. Doug Collins, a Georgia native, who was appointed VA secretary by President Donald Trump and confirmed by the U.S. Senate in February.

Collins has outlined plans to cut the VA workforce by nearly 15% following an executive order from Trump in February calling for agency heads to prepare for “large-scale reductions in force.”

“Our goal is to reduce VA employment levels to 2019 numbers of roughly 398,000 employees from our current level of approximately 470,000 employees — a nearly 15% decrease. We will accomplish this without making cuts to health care or benefits to veterans and VA beneficiaries,” Collins wrote in an opinion piece in The Hill last month.

“VA will always fulfill its duty to provide veterans, families, caregivers, and survivors the health care and benefits they have earned. That is a promise,” Collins wrote.

Teshara Felder, a steward for National Nurses United who works as a registered nurse at the Decatur VA hospital, told Healthbeat that while nurse staffing can’t be cut because it is determined by patient need, the loss of other VA employees and services will impact veterans’ care.

Felder gave the example of the prosthetics department, which is down to one employee who plans to retire within the year. Felder said nurses end up doing work to help fill the gaps in services.

“We are being asked to do more with less, and that’s always a problem. … And we can see this trickling down to the patient care,” Felder said. “Even if we the nurses remain, we still don’t have enough people to do all those other services.”

The Decatur hospital lists long wait times for patients to get appointments. For example, new patients face waits of 109 days for gastroenterology and 67 days for neurology appointments.

Existing patients face waits of 191 days for women’s services and 64 days for pain medicine, data from the Atlanta VA facility shows.

VA press secretary Peter Kasperowicz told Healthbeat the agency is “working hard to fix these and other issues.”

“Unfortunately, many in the media, government, union bosses and some in Congress are fighting to keep in place the broken status quo,” he said. “Our message to veterans is simple: Despite major opposition from those who don’t want to change a thing at VA, we will reform the department to make it work better for veterans, families, caregivers and survivors.”

Felder said the government could be more efficient, but solutions should be implemented with a “fine-tuned” method that will take “time and care.”

“It is a violation of trust … that people who gave so much are getting taken away from them,” Felder said. “Stop the cuts. Stop doing this to the people who matter, who have done so much.”

“We’re not talking about reducing medical staff or claims processors, we’re talking about reducing bureaucracy and inefficiencies that are getting in the way of customer convenience and service to veterans,” Kasperowicz said.

Social worker Erika Alexander, president of AFGE Local 518, said she is worried about veterans’ mental health if employees are laid off. Some of those she represents work as responders for the Veterans Crisis Line.

“If you’re working with a veteran that is suicidal and needs to get connected to mental health resources, and they have to wait three months before they can talk to a psychiatrist to be prescribed medication, or a therapist, or a social worker, or psychologist to process what they witnessed during war, that’s one [more] day that they’re at risk of ending their lives,” Alexander said.

“Having to wait for that appointment so that you can address the chronic pain, or that you can address the nausea that you’re dealing with every day because you’re having anxiety, or the irritability that’s impacting their daily lives,” Alexander said. “It’s impacting their family members, the people that they live with, the people that they love.”

The proposed job cuts come amid other changes at the VA under Collins’ leadership. The agency will create a task force to examine whether “anti-Christian bias” exists at the agency, Military.Com reported Wednesday.

The VA cut about 585 contracts worth about $1.8 billion, the agency said on March 3, and fired about 1,400 “non-mission-critical employees” and about 1,000 probationary employees in February, according to press releases.

This story has been updated to reflect a more recent number of patients served and to add comment from VA press secretary Peter Kasperowicz.

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

Mass layoffs at CDC hit public health, economy in Atlanta

2025-04-01T22:16:26+00:00

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Thousands were laid off Tuesday from the Atlanta-based CDC, dealing a blow to the city’s public health workforce, local, national and global research on illness prevention, and likely the city’s economy.

The CDC’s parent agency, the U.S. Department of Health and Human Services, last week announced a sweeping reorganization that would result in about 2,400 “reductions in force” at the CDC.

Kevin Caron, a health scientist in the CDC’s Office of Smoking and Health, received notice via email early Tuesday that he had been terminated. He spoke to Healthbeat as he drove to the agency’s Chamblee campus to retrieve his belongings, including awards for his work.

Caron was instructed not to come in, but then received notice about 10:30 a.m. that his access to the office could be cut off by noon. He is on administrative leave until June 2 and was told to hold onto his work laptop for now.

Caron said the majority of the staff at the Office of Smoking and Health – over 90 people – was laid off. He was worried about the work they will leave undone. The office is “essentially not functional anymore,” Caron said.

The team’s research saved lives, he said, recalling their discovery in 2019 that a chemical was causing serious lung injuries and deaths in teenagers who vaped.

“Smoking is the number one, the leading cause, of preventable death in the U.S.”, and Caron’s entire office was working on it.

“Children will be vulnerable because they’re the ones who are most frequently targeted by the industry and most susceptible to becoming addicted to the use of tobacco products,” Caron said.

Kevin Caron, a health scientist in the Centers for Disease Control and Prevention's Office of Smoking and Health, was laid off from the agency on Tuesday. He and his wife, Priyanka Bhatt, a human rights attorney, are expecting a baby this month.

On the home front, Caron and his wife are expecting their first child on April 12, and his wife’s maternity leave has started.

“I’m very worried about what kind of world she’s going to come into, and worried about my own … financial security,” Caron said of the impending birth. “But I’m also worried about the bigger picture.”

Specimens put into deep freeze as cuts disrupt labs

Kevin Pettus also lost his job Tuesday after more than three decades at the CDC. Pettus worked as a clinical microbiologist and in syphilis serology as a unit lead at the Laboratory Reference and Research Branch of the Division of Sexually Transmitted Disease Prevention.

He was able to retrieve his belongings from the agency’s campus on Clifton Road but said he’s worried about the future of the lab — and the work that it did.

“We were just told to place whatever specimens that we are working on into our long-term freezer …. with the hopes that somehow this will all be recanted, and they will ask us to come back and continue our research,” Pettus said.

Lab instruments would become unusable without daily maintenance, he said.

Kevin Pettus, a clinical microbiologist who worked in syphilis serology at the Laboratory Reference and Research Branch of the Division of Sexually Transmitted Disease Prevention at the Centers for Disease Control and Prevention, poses for a photo with his wife and four daughters.

“I don’t see how this is saving the taxpayers money. [It] is going to cost them so much more in either repairing or even discarding some of these materials and supplies,” Pettus said.

The CDC lab provided important testing services to state and local health departments, Pettus said.

The changes will “dramatically impact healthcare and the testing process in the very near future,” Pettus said. “I’m not sure what these institutions and public health labs … are going to do moving forward.”

CDC job losses could impact Atlanta economy

HHS Secretary Robert F. Kennedy Jr. has said the CDC layoffs were in line with President Donald Trump’s executive order calling for “large-scale” terminations.

The reorganization will involve moving two CDC centers – the Agency for Toxic Substance and Disease Research and the National Institute for Occupational Safety and Health – to a newly created branch of HHS, the Administration for a Healthy America. Meanwhile, 1,000 employees at the Administration for Strategic Preparedness and Response will move to the CDC.

Supporters of workers at the Centers for Disease Control and Prevention rally outside the agency's Atlanta headquarters on Friday.

Lists circulating among CDC employees and retirees on Monday suggested that many parts of the agency had been impacted by the layoffs, including the divisions of violence and injury prevention, the Office of Health Equity, the asthma and air quality branch, the global division of HIV and tuberculosis, the division of reproductive health in the National Center for Chronic Disease Prevention and Health Promotion.

“There’s a growing sense of uncertainty and not feeling whole in this nation,” said Atlanta Mayor Andre Dickens on Friday of the impending reductions. “Cuts at the CDC impact health, national security, community wellness, jobs in Atlanta, and faith in our day to day.”

The CDC employed about 13,000 people, with 10,000 in Georgia, spokesperson Jason McDonald said in November.

“It has a specifically devastating impact on jobs in this area, and these are thousands of jobs,” said Barb Marston, who leads an informal group of CDC retirees who have been organizing and rallying each week to support the agency’s workers.

“Ordinarily, if somebody had something that was going to create thousands of jobs, they’d celebrate that as good for Georgia’s economy. Here we have a situation where we’re losing thousands of jobs. That’s obviously going to be bad for the economy,” Marston said.

The impact of the job losses will include the loss of employees’ spending on items like health care, housing, going out to eat and entertainment, said Peter Bluestone, of the Center for State and Local Finance at Georgia State University.

“Firms will be reluctant to make investments with an unpredictable future going forward, and job seekers may be reluctant to apply to the CDC again, with its future potentially uncertain,” Bluestone said.

Councilmember Jason Dozier last month sponsored an Atlanta City Council resolution calling on local and state governments to hire employees laid off by the CDC and other federal agencies. The resolution was adopted unanimously.

He said Tuesday he’s especially worried about the HIV epidemic in Atlanta.

“Atlanta is especially vulnerable to these cuts as our city has been and will continue to be on the frontline of combating the spread of HIV. But we need the CDC’s help in that fight. Black and LGBTQ+ communities in Atlanta are disproportionately affected by HIV and the CDC funds programs specifically designed to address these disparities,” Dozier said.

Georgia health dept. to lose $334.4M in federal funds

HHS last week cancelled billions in grants to state and local health departments, including funding initially provided for Covid relief and funds for mental health services.

The Georgia Department of Public Health said late Tuesday the cuts would result in a loss of at least $334.4 million in federal funds.

“There will be minimal impacts to essential core public health services,” DPH spokesperson Nancy Nydam said. The canceled grants were set to expire between May 2025 and July 2027.

Covid services will be reduced or continued, including testing kiosks, mobile vaccine deployments, community-based vaccine services, and vaccine and testing registration systems, Nydam said.

DPH also laid off about 170 Covid contract tracers on Thursday, Nydam said, as well as 10 other staffers.

“The impact on district-level staff is still being analyzed, with each district conducting its own review to determine local effects,” Nydam said.

The cuts could result in a $467,000 cut to the Cobb and Douglas county public health budget, leaders said last week.

This story has been updated to include a second interview with a CDC staffer and figures from the Georgia Department of Public Health on federal funding reductions released late Tuesday.

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

Public health workers look to address childhood iron deficiencies in Atlanta-area refugee community

2025-04-01T11:00:00+00:00

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Memory Kapapa frequently thinks about the nutritional health of metro Atlanta’s refugee community. As a community health worker for Refugee Women’s Network, a DeKalb County nonprofit focused on supporting immigrant women in the region, Kapapa helps manage programs that teach newcomers to the United States how the food they eat impacts their well-being.

The Congolese asylum seeker knows access to nutritious foods can be difficult for immigrants in Georgia. With the high cost of groceries and the precarious financial situation many refugees face when they come to the country, Kapapa said many people she serves struggle to afford foods that help prevent chronic conditions like diabetes and heart disease.

“If I go to buy sweet potato leaves just for myself, I think a pound costs already $12,” she said. “If it already costs me that much, talking about somebody who has a big family, how much money are they going to spend to have vegetables?”

Lately, she’s been focused on iron intake among the young children of the women her organization serves. The nutrient — highly concentrated in foods like animal products, lentils, and leafy greens — is important for babies’ and infants’ development.

Deficiencies can hinder how oxygen circulates in the body, resulting in a condition called iron-deficiency anemia. When that happens, a young child can have trouble breathing and exerting energy, among other health issues.

Researchers have found the children of refugees to be at high risk of iron-deficiency anemia across the United States. And for DeKalb’s refugee community, Kapapa and other health professionals believe this problem might be especially urgent.

Ethnē Health clinic in Clarkston, a Central DeKalb city with one of the highest concentrations of refugee residents in the United States, recently examined how many of its young patients screened positive for anemia at their 12-month and 24-month checkups. The providers there found that about a quarter of them had low oxygen levels, much higher than the estimated 1% to 5% of U.S. young children who have the condition.

The rates of childhood anemia were even higher among some communities served at the Clarkston-based clinic. Among Congolese and Afghan pediatric patients, Ethnē found that about 28% of patients screened positive for anemia.

While not all anemia is caused by iron deficiencies, Dr. Laurie Boden, a co-founder of Ethnē Health and a pediatrician who worked on this analysis, said the mineral is most often responsible for this condition in 12- and 24-month-olds.

Kapapa said Ethnē’s data are reflected by some of the children she sees in the community.

“They don’t look good,” she said. “Some of them do look weak and pale.”

Georgia has a doctor shortage. Barriers to training keep immigrant physicians from filling the gap.

From 2010 to 2020, Dr. Susan Reines worked with the DeKalb Public Health department to treat refugee children who had recently resettled in the metro Atlanta area. Although she saw plenty of anemia among those kids, she said she wouldn’t have expected numbers to be that high among the children of people who have lived in the country for over a year.

Reines, who was not involved with the Ethnē analysis, said new refugees are supposed to go through nutritional education classes within their first few months of being resettled. The classes, part of a federal program designed to help new parents from low-income backgrounds, are intended to prevent nutrition-related health problems like iron-deficiency anemia from reappearing.

“That’s a little bit concerning if these families have truly been here for a long time,” she said.

Boden said she and the clinic’s staff don’t fully understand why this disparity is persisting. But she thinks there are a variety of factors that could help explain it.

Some of it, she said, comes from nutritional classes not being tailored for refugees living in a new country. While newcomers might be given jarred baby food that’s rich in iron, it may not be introduced to them in a culturally appropriate format.

“It’s just not familiar to the refugee population,” she said.

To Kapapa, the novelty of the nutrition plans paired with the financial and acclimation challenges of being a refugee, like language barriers, makes it so many iron-rich resources are out of reach for the mothers she serves.

“It takes a little more than just doing outreach to help somebody who doesn’t have the language,” she said.

The Refugee Women’s Network, a DeKalb County nonprofit, is focused on supporting immigrant women in the region.

She and Refugee Women’s Network are working on some attempts to address these problems. Through a partnership with some Emory University public health researchers, Kapapa helped conduct focus groups with Congolese mothers to better understand community food challenges and share nutrition education. She said there’s plans for her organization to host similar discussions with Afghan mothers later this year.

Thai Vang, one of the researchers and a master of public health graduate student at the university, said the team is also looking to develop a culturally competent cookbook chalked full of iron-rich recipes that Congolese mothers could make. Dr. Amy Rule, an Emory pediatrician who oversaw Vang’s work on this project, said they’re hoping to have consistent community input as they go about designing the book.

“The idea is that we’re working alongside our community partners, including hopefully some parents, to really be able to actually create something that is really useful,” Rule said.

Kapapa is excited about the cookbook project. She thinks it would pair well with cooking classes that Refugee Women’s Network wants to begin hosting, where mothers could practice making these iron-rich recipes.

But she worries all these efforts could be compromised by efforts by the federal government to roll back some social services. In addition to drastically scaling back refugee-specific resources, President Donald Trump’s administration has moved to cut funding for safety net nutrition services like community food banks —- programs that Kapapa said the mothers she serves often rely on for nutritious foods.

Kapapa wishes that the people making these decisions would consider how refugees use existing federal resources to become self-sufficient, something she said has benefits to everyone in the country.

“Because when people are independent, they’ll learn how to manage themselves.”

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

With few dentists and fluoride under siege, rural America risks new surge of tooth decay

2025-03-27T09:00:00+00:00

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In the wooded highlands of northern Arkansas, where small towns have few dentists, water officials who serve more than 20,000 people have for more than a decade openly defied state law by refusing to add fluoride to the drinking water.

For its refusal, the Ozark Mountain Regional Public Water Authority has received hundreds of state fines amounting to about $130,000, which are stuffed in a cardboard box and left unpaid, said Andy Anderson, who is opposed to fluoridation and has led the water system for nearly two decades.

This Ozark region is among hundreds of rural American communities that face a one-two punch to oral health: a dire shortage of dentists and a lack of fluoridated drinking water, which is widely viewed among dentists as one of the most effective tools to prevent tooth decay. But as the anti-fluoride movement builds unprecedented momentum, it may turn out that the Ozarks were not behind the times after all.

“We will eventually win,” Anderson said. “We will be vindicated.”

Fluoride, a naturally occurring mineral, keeps teeth strong when added to drinking water, according to the Centers for Disease Control and Prevention and the American Dental Association. But the anti-fluoride movement has been energized since a government report last summer found a possible link between lower IQ in children and consuming amounts of fluoride that are higher than what is recommended in American drinking water. Dozens of communities have decided to stop fluoridating in recent months, and state officials in Florida and Texas have urged their water systems to do the same. Utah is poised to become the first state to ban it in tap water.

Health and Human Services Secretary Robert F. Kennedy Jr., who has long espoused fringe health theories, has called fluoride an “industrial waste” and “dangerous neurotoxin” and said the Trump administration will recommend it be removed from all public drinking water.

Separately, Republican efforts to extend tax cuts and shrink federal spending may squeeze Medicaid, which could deepen existing shortages of dentists in rural areas where many residents depend on the federal insurance program for whatever dental care they can find.

Dental experts warn that the simultaneous erosion of Medicaid and fluoridation could exacerbate a crisis of rural oral health and reverse decades of progress against tooth decay, particularly for children and those who rarely see a dentist.

“If you have folks with little access to professional care and no access to water fluoridation,” said Steven Levy, a dentist and leading fluoride researcher at the University of Iowa, “then they are missing two of the big pillars of how to keep healthy for a lifetime.”

Many already are.

‘Dental deserts’ and fluoride-free zones overlap

Nearly 25 million Americans live in areas without enough dentists — more than twice as many as prior estimates by the federal government — according to a recent study from Harvard University that measured U.S. “dental deserts” with more depth and precision than before.

Hawazin Elani, a Harvard dentist and epidemiologist who co-authored the study, found that many shortage areas are rural and poor, and depend heavily on Medicaid. But many dentists do not accept Medicaid because payments can be low, Elani said.

The ADA has estimated that only a third of dentists treat patients on Medicaid.

“I suspect this situation is much worse for Medicaid beneficiaries,” Elani said. “If you have Medicaid and your nearest dentists do not accept it, then you will likely have to go to the third, or fourth, or the fifth.”

The Harvard study identified over 780 counties where more than half of the residents live in a shortage area. Of those counties, at least 230 also have mostly or completely unfluoridated public drinking water, according to a KFF Health News analysis of fluoride data published by the CDC. That means people in these areas who can’t find a dentist also do not get protection for their teeth from their tap water.

The KFF Health News analysis does not cover the entire nation because it does not include private wells, and 13 states do not submit fluoride data to the CDC. But among those that do, most counties with a shortage of dentists and unfluoridated water are in the south-central U.S., in a cluster that stretches from Texas to the Florida Panhandle and up into Kansas, Missouri, and Oklahoma.

In the center of that cluster is the Ozark Mountain Regional Public Water Authority, which serves the Arkansas counties of Boone, Marion, Newton, and Searcy. It has refused to add fluoride ever since Arkansas enacted a statewide mandate in 2011. After weekly fines began in 2016, the water system unsuccessfully challenged the fluoride mandate in state court, then lost again on appeal.

Anderson, who has chaired the water system’s board since 2007, said he would like to challenge the fluoride mandate in court again and would argue the case himself if necessary. In a phone interview, Anderson said he believes that fluoride can hamper the brain and body to the point of making people “get fat and lazy.”

“So if you go out in the streets these days, walk down the streets, you’ll see lots of fat people wearing their pajamas out in public,” he said.

James Flanagin, the only dentist in the tiny Arkansas town of Leslie, which also has unfluoridated drinking water, treats patients in the back of an antique store on Main Street.

Nearby in the tiny, no-stoplight community of Leslie, Arkansas, which gets water from the Ozark system, the only dentist in town operates out of a one-man clinic tucked in the back of an antique store. Hand-painted lettering on the store window advertises a “pretty good dentist.”

James Flanagin, a third-generation dentist who opened this clinic three years ago, said he was drawn to Leslie by the quaint charms and friendly smiles of small-town life. But those same smiles also reveal the unmistakable consequences of refusing to fluoridate, he said.

“There is no doubt that there is more dental decay here than there would otherwise be,” he said. “You are going to have more decay if your water is not fluoridated. That’s just a fact.”

Fluoride seen as a great public health achievement

Fluoride was first added to public water in an American city in 1945 and spread to half of the U.S. population by 1980, according to the CDC. Because of “the dramatic decline” in cavities that followed, in 1999 the CDC dubbed fluoridation as one of 10 great public health achievements of the 20th century.

Currently more than 70% of the U.S. population on public water systems get fluoridated water, with a recommended concentration of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, according to the CDC.

Fluoride is also present in modern toothpaste, mouthwash, dental varnish, and some food and drinks — like raisins, potatoes, oatmeal, coffee, and black tea. But several dental experts said these products do not reliably reach as many low-income families as drinking water, which has an additional benefit over toothpaste of strengthening children’s teeth from within as they grow.

Fact-checking RFK Jr.'s fluoride claims

Two recent polls have found that the largest share of Americans support fluoridation, but a sizable minority does not. Polls from Axios/Ipsos and AP-NORC found that 48% and 40% of respondents wanted to keep fluoride in public water supplies, while 29% and 26% supported its removal.

Chelsea Fosse, an expert on oral health policy at the American Academy of Pediatric Dentistry, said she worried that misguided fears of fluoride would cause many people to stop using fluoridated toothpaste and varnish just as Medicaid cuts made it harder to see a dentist.

The combination, she said, could be “devastating.”

“It will be visibly apparent what this does to the prevalence of tooth decay,” Fosse said. “If we get rid of water fluoridation, if we make Medicaid cuts, and if we don’t support providers in locating and serving the highest-need populations, I truly don’t know what we will do.”

James Flanagin (right), the only dentist in Leslie, Arkansas, speaks with patient David Potts after a dental appointment. Leslie is one of hundreds of American communities, mostly rural, that have both a shortage of dentists and unfluoridated drinking water.

Multiple peer-reviewed studies have shown what ending water fluoridation could look like. In the past few years, studies of cities in Alaska and Canada have shown that communities that stopped fluoridation saw significant increases in children’s cavities when compared with similar cities that did not. A 2024 study from Israel reported a “two-fold increase” in dental treatments for kids within five years after the country stopped fluoridating in 2014.

Despite the benefits of fluoridation, it has been fiercely opposed by some since its inception, said Catherine Hayes, a Harvard dental expert who advises the American Dental Association on fluoride and has studied its use for three decades.

Fluoridation was initially smeared as a communist plot against America, Hayes said, and then later fears arose of possible links to cancer, which were refuted through extensive scientific research. In the ‘80s, hysteria fueled fears of fluoride causing AIDS, which was “ludicrous,” Hayes said.

More recently, the anti-fluoride movement seized on international research that suggests high levels of fluoride can hinder children’s brain development and has been boosted by high-profile legal and political victories.

Last August, a hotly debated report from the National Institutes of Health’s National Toxicology Program found “with moderate confidence” that exposure to levels of fluoride that are higher than what is present in American drinking water is associated with lower IQ in children. The report was based on an analysis of 74 studies conducted in other countries, most of which were considered “low quality” and involved exposure of at least 1.5 milligrams of fluoride per liter of water — or more than twice the U.S. recommendation — according to the program.

The following month, in a long-simmering lawsuit filed by fluoride opponents, a federal judge in California said the possible link between fluoride and lowered IQ was too risky to ignore, then ordered the federal Environmental Protection Agency to take nonspecified steps to lower that risk. The EPA started to appeal this ruling in the final days of the Biden administration, but the Trump administration could reverse course.

The EPA and Department of Justice declined to comment. The White House and Department of Health and Human Services did not respond to questions about fluoride.

Despite the National Toxicology Program’s report, Hayes said, no association has been shown to date between lowered IQ and the amount of fluoride actually present in most Americans’ water. The court ruling may prompt additional research conducted in the United States, Hayes said, which she hoped would finally put the campaign against fluoride to rest.

“It’s one of the great mysteries of my career, what sustains it,” Hayes said. “What concerns me is that there’s some belief amongst some members of the public — and some of our policymakers — that there is some truth to this.”

Not all experts were so dismissive of the toxicology program’s report. Bruce Lanphear, a children’s health researcher at Simon Fraser University in British Columbia, published an editorial in January that said the findings should prompt health organizations “to reassess the risks and benefits of fluoride, particularly for pregnant women and infants.”

“The people who are proposing fluoridation need to now prove it’s safe,” Lanphear told NPR in January. “What the study does, or should do, is shift the burden of proof.”

Cities and states rethink fluoride

At least 14 states so far this year have considered or are considering bills that would lift fluoride mandates or prohibit fluoride in drinking water altogether. In February, Utah lawmakers passed the nation’s first ban, which Republican Gov. Spencer Cox told ABC4 Utah he intends to sign. And both Florida Surgeon General Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have called for their respective states to end fluoridation.

“I don’t want Big Brother telling me what to do,” Miller told The Dallas Morning News in February. “Government has forced this on us for too long.”

Additionally, dozens of cities and counties have decided to stop fluoridation in the past six months — including at least 16 communities in Florida with a combined population of more than 1.6 million — according to news reports and the Fluoride Action Network, an anti-fluoride group.

Stuart Cooper, executive director of that group, said the movement’s unprecedented momentum would be further supercharged if Kennedy and the Trump administration follow through on a recommendation against fluoride.

Cooper predicted that most U.S. communities will have stopped fluoridating within years.

“I think what you are seeing in Florida, where every community is falling like dominoes, is going to now happen in the United States,” he said. “I think we’re seeing the absolute end of it.”

If Cooper’s prediction is right, Hayes said, widespread decay would be visible within years. Kids’ teeth will rot in their mouths, she said, even though “we know how to completely prevent it.”

“It’s unnecessary pain and suffering,” Hayes said. “If you go into any children’s hospital across this country, you’ll see a waiting list of kids to get into the operating room to get their teeth fixed because they have severe decay because they haven’t had access to either fluoridated water or other types of fluoride. Unfortunately, that’s just going to get worse.”

KFF Health News data editor Holly K. Hacker contributed to this article.

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

Current, former CDC staff warn against slashing support to local public health departments

2025-03-24T14:59:15+00:00

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On a sunny weekday in Atlanta, a small crowd of people gathered for a rally outside a labor union headquarters building.

The event, put together by Atlanta-area Democratic U.S. Rep. Nikema Williams, was attended mostly by union members and recently fired federal workers, including Ryan Sloane.

“I was fired by an anonymous email at 9 p.m. in the middle of a holiday weekend,” he said.

Sloane is still seeking reinstatement, but he feels he no longer has much to lose by speaking out.

“I’m only here today because they cannot fire me twice,” Sloane said.

When he received his termination notice, he was a few months into a job as a public affairs specialist at the Centers for Disease Control and Prevention.

Looming cuts to NIH funding have Atlanta startup founders on edge

At the CDC, his days were spent updating farflung local TV, radio, and newspaper journalists about threats such as seasonal flu, measles, and food safety in their communities.

A judge has ordered the reinstatement of some fired federal employees, at least temporarily. But their jobs are still on the line.

Sloane said his former colleagues at the CDC whose jobs aren’t yet in limbo are scared.

“They are terrified that their life’s work is going to be deleted from servers and not backed up because it does not comport with the ideologies of the new administration,” he said. “No one is benefiting from this.”

From the end of January to mid-February, the Trump administration took offline some CDC webpages and froze external communications, including its widely read Morbidity and Mortality Weekly Report epidemiological digest.

The webpages that were removed included CDC public health reports, datasets, and guidance on infectious diseases and sexual health. After a court order, some agency information was restored, at least for now.

But even temporary disruptions to CDC communications could have big ripple effects.

It is information that state and local health departments, hospitals, university researchers, and others rely on to help them respond to outbreaks.

“CDC is there to provide technical information, provide funding, provide support, but it’s a collaborative work, working together to keep Americans safe,” said former CDC Director Tom Frieden, who headed the agency from 2009 to 2017. He is now president and CEO of the nonprofit organization Resolve to Save Lives. “In this country, we have a patchwork or network of public health. It’s really up to the local, city, and state health departments to get the job done.”

City and state health agencies also need the collaboration of CDC experts to help investigate local disease outbreaks and other threats to public health.

A clinician who has worked at the agency for more than two decades pointed to the CDC’s singular ability to send medical supplies and deploy highly specialized teams of scientists to help local communities identify and contain outbreaks. KFF Health News agreed not to use the clinician’s name because she fears she will be fired for airing these views publicly.

“A lot of them are assigned to state and local health departments, so really even beyond individual positions, any funding cuts that the agency takes are also passed on to state and local health departments,” the clinician said. “A lot of their budget comes from federal money as well.”

The Trump administration has attempted to terminate hundreds of employees from the CDC alone, along with hundreds more workers at the National Institutes of Health and other federal agencies with a U.S. health and safety role.

Emory University plans to curb spending, staffing as fed research cuts loom

Many public health and science researchers are concerned about the cuts’ impacts on the nation’s ability to respond to threats — and about whether state and local public health departments will be able to keep communities healthy without the CDC’s partnership.

Billionaire Elon Musk has said his Department of Government Efficiency intends to keep cutting federal agencies’ budgets and staff, targeting what it calls “fraud.”

“Anytime someone gets fired, it’s always difficult. But with $36 trillion in debt, we have to reduce the size of the federal government,” Republican U.S. Rep. Marjorie Taylor Greene told WABE during a March visit to the Georgia State Capitol.

Her district includes parts of suburban Atlanta about 30 miles from CDC headquarters.

Greene chairs a House subcommittee also called “DOGE,” for “Delivering on Government Efficiency.”

“Fortunately, with all the investments that are being brought back into the country under President Trump, I really hope that those federal workers are able to find new jobs,” she said.

She did not comment on whether local public health departments around the country would be able to work efficiently without the support of CDC experts who have been terminated.

But many U.S. public health experts are expressing concern.

The CDC has long been a key training ground for the next generation of U.S. public health researchers.

Emory University epidemiology professor Patrick Sullivan was one of them earlier in his career. The HIV expert previously worked at the CDC for about 15 years.

“When I started working in HIV prevention at CDC in the early 1990s, we didn’t have the treatments that essentially allowed people living with HIV to have a full, healthy, normal lifespan,” he said. “We didn’t have the treatments that essentially allowed people living with HIV to have a test that people could take home to test themselves.”

Sullivan said the progress he has seen over the last several decades gave him optimism, and that advances in HIV treatment and prevention are a great example of the importance of federal support for public health work.

“Discovery science and pharmacy science really have given us the tools that we need to end the HIV epidemic in the United States,” he said.

But, to have those scientific tools without adequate public health staff or funding to use them, he said, will cost American lives.

This article is from a partnership that includes WABE, NPR, and KFF Health News, Healthbeat’s national reporting partner.